JaxSage

You both received one as well. Please let me know that you got them. Also, I ask that you correspond with me privately concerning that matter. Thanks a lot

Zz, I have PM you a copy of my protocol regarding cancelling patients. Please let me know if you got it. Thanks a lot.

Zz, I'll send you a copy of my protocol shortly via PM. If anybody else is interested, let me know.

Your overly cocky attitude has warranted most of my comments. That included your reply to my concern about the use of ammonia inhalants on an incarcerated patient.

I didn't mean to come across as cocky or arrogant. If I did, I apologize. It wasn't my intention.

That article did make news. That county is the only other county besides mine in NC where EMS is allowed to refuse transport. I probably have as many questions as you concerning that call. Since he was 17, he should have been taken to the hospital regardless unless he was emancipated. Like I said, there are drawbacks to allowing medics to refuse transport and as I said a few times already, people have misused that authority. But remember, we don't know the whole story, and I don't even know the whole story. So, rather than make any sort of judgment, I think it'll be fair to look out for any updates concerning this call so that we could get both sides of the story. Who knows, perhaps the medics were careless and lazy in that case.

Vent, I'm really trying to keep the peace here. I'm sorry if I caused any problems. So, I'm offering to those who truly want to know where I'm coming from to PM me. Was I expecting concerns and constructive criticism? Yes. Was I expecting a name-calling spree? Not really.

Careful, buddy, I have already been stoned for bringing up a similar subject. But I agree with you 100%

I welcome anybody who has any concerns or questions concerning our protocol to private message me.

How long did you take your truck out of service to win this peeing match with a child?

Actually, since he was a minor, we would have transported him anyway. However, since it wasn't an emergency, we decided to call his mother and asked what she wanted us to do. She wanted us to wait until she got there. We don't just throw children on the back of our ambulance in non-emergent situations without first contacting a parent or guardian.

3 ammonia inhalants? You were determined to make a point. What if the guy had a TBI or CVA?

It's a good thing that he didn't. Whew!

You may also have foiled a child's cry for help for other reasons but you were to blinded by a few scrapes to see a bigger picture.

A child's cry for help? If it meant catching those who jumped him, then that's a police and a school administration concern, both of which were there. They would be better able to meet his need than we in EMS would have.

In your jail example, you did not indicate any medical assessment. You again was just intent on proving a point totally based on the fact the patient was a prisoner.

In fact, we did do a medical assessment, believe it or not. What we did had nothing to do with whether or not he was a prisoner. I have transported a prisoner before because he was definitely in medical distress and he was given morphine to help his pain. Regardless of how we feel about prisoners or anybody's status in society, we still do our job.

So far, you have demonstrated excellent examples where there is truly a need for an improvement in Paramedic education.

No, I have shown examples that I hadn't explained thoroughly enough.

Obviously, this is just not an issue that everybody would agree with. I'm absolutely fine with that. I thought that you guys would have been thrilled with the possibility of not having to transport everybody. But I was wrong. No one feels comfortable with it and it seems that almost everybody who responded seem to justify transporting everybody. There are both pros and cons to it.

Believe it or not, we actually do a thorough assessment before denying anybody, but according to many of you, no one could do a thorough enough assessment to deny anybody, even if a patient called because he bit his tongue eating fried chicken. Who knows, maybe that tongue would get infected and fall off...and ultimately the patient would have a huge MI and fall over dead. Then the family would sue us because we didn't take the patient to the hospital for biting his tongue eating KFC...and the family would win millions of dollars...something that we don't have in this agency. So instead, the family would go to the news, then would go to Washington, they would have a petition signed by thousands of people who would seek to shut this place down...and everybody would lose their certifications, retirement, and no other EMS agency would want to hire us, and we'll be blacklisted, and our homes would be taken away, and we'll turn to drinking and drugs, get arrested and sentenced, and we'll be faking seizures just to get out of jail...but that won't happen because you have nuts shoving up inhalants in our noses just to prove that we're faking.

I have a lot of respect for EMS to be treated like a cab service. Soon enough, we'll be extending our services to deliver people's groceries, servicing their cars, washing their clothes, mowing their lawns, and taking their dogs for a walk. Our motto should be, "You call, we haul...and everything else in between." And the way the economy is, we might as well extend our services so that we could raise funds to keep us in business, because knowing the respect we get, the government is going to cut off funding for us if push came to shove. So let me set up the EMS lemonade stand.

So if this insults anybody, I'm sorry. But EMS is more than babying everybody who calls for the stupidest things. But that's just my opinion. And I'll end it at that. This is my last post on this subject. So, if anybody else has any insults for me, send them to me privately if you don't mind.

Are you the partner that people love to work with...or are you the one that people dread? One of the major drawbacks in the field, in my opinion, is having a bad partner. And when I say bad, I mean a partner who is, well, a jerk. For me, in this field we are family and stick with each other. Not everybody has that mentality. I've been told some horror stories of partners who would make their partners feel just awful. And I had my share of that experience as well. And although we could go on and on about how awful that is and those people should be fired...we have to also look at ourselves and see if we're not doing the same thing to our partners. We may think there is nothing wrong with us...until someone (perhaps a patient) points it out to you.

So, if people think you were a bad partner, what do you think would be their main reason for thinking that?

I think they should be taught more than to drive, CPR, and basic first aid.....

First off, they need to be taught to cook. Because between calls I need someone who can cook a good meal, I'm tired of eating out or this slapping crap together casserole.

Another thing, stretcher fetching. Very important. Might as well teach them how to work the cot too.

Keeping their mouth shut.

Massage therapy (females with nice boobies only).

And finally, making my bed and cleaning the station.

That's a damn good basic right there.

Sounds like you just described the ideal marriage life for the 1950s.

I agree. You FAIL. Good thing you're not still teaching.

Dang, Dusty, that was mean. What did I ever say to you? I guess we don't do too well with disagreeing with each other here, huh?

You know, sometimes it could do you guys some good to just simply listen to what the other guy has to say without making him seem like a do-do.

Forgive as I'm grass green new, but that's not what I believe this job is about at all. We're not cops looking at someone trying to figure out if they're lying or not so in most medical cases I don't see where street smarts comes into it as far as treatment goes. There are times for it sure, but not in field diagnosis. As for common sense? What assessment relies on that. Should we not be basing our practice on sound clinical judgement? And from that should the "smarts" we develop not be about familiarity with medicine that allows us to come quicker and more confidently to our clinical judgment? Maybe I'm missing something you're trying to say.

Let me give you an example, Harris. One time, my parnter and I were called for an animal bite at one of the high schools. This 15-year-old kid said that he was attacked by a dog. The only signs of a dog attack were a small abrasion on his face and on his hands. Nothing else. He strongly claimed that he was attacked by a dog. Even his sister said that he would never make up a lie like that. We doubted he was attacked by a dog, but he stuck with his story...until later when an officer and the principal talked with him. He finally admitted that he was jumped. We know that when dogs attack, they bite and scratch. He had no scratches, no bites, nothing that would suggest a dog attack.

Another time, a partner and I went to the jailhouse for a seizure. One of the inmates were lying out on a bed all twisted up and everything and we were almost convinced...but we still had our doubts. So, I put an ammonia inhalant to him and he started shaking then he would stop. I popped another one to him and he started shaking again. I did it a third time...you get the picture. On top of that, we were told that he has faked these seizures before. You be the judge.

If you don't have common sense on the job, then there is no way you could function well in this field, no matter how book-smart you are. Yes, we do use our clinical skills to evaluate the patient...but even that has to be supplemented with common sense. It doesn't take much to rule out who's full of crap and who isn't.

I'm laughing so hard that I'm crying. :roll:

Just when I thought we had a winner here.

Y'all just go ahead and laugh. You guys think that textbooks and clinicals are going to prepare you for the field? I learned more stuff in the field than I had in the classroom. In the field, I'm always reading ECGs, doing patient assessment, giving medication, working codes, dealing with trauma, starting IVs, etc., etc., more than you would ever do in a few hundred hours of clinical and class time. As a former teacher, I'll tell you that hands-on is always the best way to go than to sit through lecture and go through a bunch of silly scenarios that people pull from their nasty behinds.

Obviously, this isn't an issue that everybody is going to agree with. That is completely fine. I'll agree that ultimately it's safer to transport everybody than to deny one person...as far as covering your behind goes.

As far as somebody complaining of chest discomfort that presents as heart burn...you'll just have to use your own common sense and street smarts, which is what most of this job consist of. I don't know why the medics didn't transport that guy, because he would have been someone I would have transported. As I said before, people have misused their ability to deny people transport, I won't keep that a secret. However, when it comes to this job, it's about using your common sense. If you're going to second-guess every ridiculous problem and make the most nonsensical complaint into a Dr. House project, then let's not complain anymore whenever people call for the most off-the-wall problems. Because afterall, you just never know.

If you don't feel confident in your skills, education, and judgment to deny someone transport, then don't deny anyone. Plain and simple. Not everybody should be trusted with this authority and not everybody who has been trusted with it should use it. Honestly, I think it's ashame that EMS personnel are judged to be too stupid to be trusted with this ability. I think we have some of the greatest medics in my agency who are sharp, knowledgeable, and on-point. If you can't say the same about your agency, then that's a problem. Denying transport is not a norm and many agencies would feel uncomfortable implementing it. Ultimately, it comes down to the best interest of the city/county to better serve them, and in my opinion, better serving the citizens should not involve playing cab driver.

Sounds to me that there needs to be some changes in the way your county manages EMS!

I work a county with a population of over 500k. We run between 15-19 trucks. We do not deny transport to anyone and still manage to cover the county just fine.

Good for your guys, then. It's not the case with us. Perhaps your county doesn't get ten EMS calls within two minutes like it is in my county. Literally, the busiest times of the day are at lunch time and during the 5:00 rush. It's very common for five or more calls to go out within two minutes. It's very common for almost all of our trucks to be depleted in no time. In five minutes, communications let the supervisor know that Medic such and such is the only unit available in the city. So, it's not so much of how the county manages EMS, it's the freaking call volume and the frequency of those calls.

Since we are able to deny transport, that actually helps us to respond to more calls. For example, one time my partner and I had eleven calls within a 12-hour shift. You know that one call could take about an hour if you include responding to the scene, staying on the scene, transporting to the hospital, and waiting at the hospital, and getting your stretcher ready. There is NO WAY we could have ran eleven calls and transported all those folks to the hospital within a 12-hour shift. As you probably guessed, most of those calls did not end up in transportation. Another time, my partner and I ran about four calls within ONE HOUR. No, we didn't transport anybody, but that should give you an idea of how quickly calls come in. Literally, this county would be in BAD SHAPE if we took everybody to the hospital. And this county has less people than yours.

RUFF, I know you ain't trying to start something, buddy Like I said, not everybody would feel comfortable with how we run things. Personally, I LOVE it. I hate 911 abuse and I hate people treating us like a taxi ride. I'm actually glad that someone stepped up and said that we're going to use EMS the way it should be used. Not everybody agrees, but you can't always make everybody happy. And by the way, what I've learned is that not everybody who calls us necessarily want a hospital. They just want answers and think we're there to answer them. I agree that not everybody knows any better, so that is why we do educate them and explain to them why they don't need an ambulance and what would be the best thing for them. Sometimes, we would tell a person that making an appointment with their own doctor would be a much better choice than waiting 12 hours at an ER. And since we don't have to take everybody to the hospital, we don't have to lie or try to talk someone out of going to the hospital. We try to steer them in the right direction that is not only good for their medical needs, but also good for their financial needs as an ambulance ride ain't cheap.

CRAZYEMT, our protocol isn't perfect. No one's is. If we deny someone transport, we have to be certain that their condition does not merit emergent ALS transportation and carefully document our reason. We don't advocate cancelling everybody and we believe that it is always better to transport than to deny. Yes, you will get in trouble if you make the wrong choice, but it's always about making a thorough assessment, careful documentation, and standing by your decision. On top of that, our protocol allowed us to make that decision, so ultimately the person who would get in trouble would be the medical director and the EMS director. But if no one feels comfortable in denying someone, they would just transport. That's all.

By the way, you're right, our paperwork would be the same whether or not we transport a person. It's just the principal of thing

I have no problems with any accelerated program. Ultimately, what makes you good at your job is the experience, not your schooling. In my opinion, there is too much classroom time in the U.S. education system and not enough hands-on experience. It should be the other way around. If it were up to me, most of your education would take place in the field...and classroom time would be simply follow-ups so that everything would make sense.

You find your male partner is unconscious, because he fell in love with this beautiful female patient, and had been swapping spit with her. Then he finished his secondary survey, and found out that she had a bigger penis than he did.

Now that's messed up, man

If a city or a state could go broke, I think it should show that no one's job is immune from cuts, no matter how essential it is to the citizens.

So avoid the trouble: start your own business and make your own dang money and grow your own food

funny, I can do everything that you said you can do. I can put an iv in anywhere that there is a vein, I can decide whether or not to c-spine someone, I can decide whether or not to RSI some poor chap and many other things. I can also spike and hang blood without a nurses OK.

Can you with 100% certainty say that all your paramedics are smart enough to know the difference that the knee pain that has been going on for weeks or years is not this time a blood clot?

Can you for 100% certainty say that the menstrual bleeding is not a miscarriage? Or one of the other pregnancy complications that I can't for the life of me think of right now.

I'm still leary of letting every paramedic in any system have the ability to refuse transport.

Let's discuss children now, child has a fever that started yesterday? Are you sure that all your paramedics in your system can differentiate between pneumonia or bronchitis, or RSV?

Sorry to disagree but I'm going to have to continually be leary of letting every medic in any system do this. The ones who are competent and educated can do this but by the logic that begs to happen here, can you be 100% sure that all your medics are as educated as you say you are?

just disagreeing

Ruff, I never said that ALL of the medics on the job were competent or educated enough to make the decision to deny transport. Like I said in my last post, some medics have misused their judgments when denying someone transportation. I believe that most of us on the job do a good job when it comes to making that type of decision. However, Ruff, our protocol concerning this matter is more geared towards those who obviously don't need an ambulance (e.g. paper cuts, the sniffles, etc.). If we come across a patient with a questionable problem, then we transport. If there is any doubt in mind, we transport. If it's obvious that this person needs a clinic and not an ER, then we refuse.

To answer your question, I suppose none of us could be 100% certain that a person's paper cut won't lead to respiratory failure and that a person's knee pain that he has been having for twenty years isn't a possible blood clot. If we're going to second guess every ridiculous problem that is obviously ridiculous, then we might as well stop complaining whenever a patient, especially a frequent flyer, calls us for what seems to be a bogus concern...because you just never know.

It's fine to disagree. Not everybody would agree with this policy of ours. But with a lack of ambulances, a lack of resources, and a high call volune with the number of people in our county, we can't afford to just take everybody to the hospital. Ultimately, the citizens in the county will pay dearly for that. Whenever I would tell people that if you call 911 you may or may not get an ambulance, they think that's just scary. Read the news and see how many people died because they couldn't get an ambulance because one wasn't available. I think that this fact wouldn't really hit home until one of our loved ones needs an ambulance...and knowing that there's a possibility that one may not show up.

By the way, we don't have forms for patients to sign when we refuse them...for the obvious reason that patients won't sign them if they don't agree with our decision. We do have forms for patients to sign when THEY refuse EMS and when we think they ought to go to the hospital with us.

I've fallen in love with a patient's boobs, that's about it. :twisted:

That's everybody on my job One of my partners said that he and another guy did a 12 lead on a woman just so that they could see her busty glories. And according to him, they were quite beautiful. This isn't really the norm. That patient was sort of the exception to the rule. I guess it's kind of like wanting to do a 12 lead on Pamela Anderson...and she just called 911 just to get her finger looked at.

I would tell female students in my CPR classes that if they ever get in an ambulance and the medics wanted to do a 12 lead, they have the right to deny it

One of the best ways to bluff is to put the patient on a heart monitor, frown and seriously say, "Hmmm?" Then, put a nonrebreather on the patient and say, "Just breathe and don't talk." If the patient and family members were giving you a hard time, this just might keep them quiet and distracted

Just something to think about but it sounds like they are setting you up to take all the blame if something goes wrong. Without proper policies they can wash their hands of you.

Not really. Whether we call it "rules," "guidelines," or even "suggestions," it's still protocol despite how strict or how loose it is. If we did something in accordance to protocol and something goes wrong, hey, it all falls on the medical director's head and the EMS director's head. We just simply did what they said we could do...or not do.

When I say that the protocols are seen more like "guidelines," I mean to say that it's recognized that treating a patient isn't always black and white. Ultimately, your best judgment will determine the best treatment for your patient as long as you're working within your scope of practice. For example, should you give everybody morphine for pain? Morphine is simply a comfort drug (unless used for pulmonary edema and such), and it's definitely not a necessity for survival if it'll be used only for pain control. It'll be up to you whether or not you want to give it. Under strict protocol, you might be COMMANDED to give morphine for pain control period unless there are some medical contraindications. Under our protocol, we'll make our own judgment as to whether or not we'll give it.

Under our protocol, we are allowed to cancel first responders, to downgrade or upgrade our response status, to clear C-spine, basically stuff that typical EMS agencies wouldn't allow their personnel to do on the job. We could put an IV anywhere in the patient as long as there is a vein, we could drill them with an IO needle, use central access lines, and arrange for alternative transportation to the hospital. We could determine whether or not to attempt CPR, when to discontinue CPR (under medical control's approval), etc.

What I like about our protocol is that it recognizes the power of pure common sense. Someone with knee pain that he had for years doesn't need an ambulance to the hospital. Calls that are simply nonsense doesn't require a lot of thought to determine whether or not an ambulance is needed. I think everybody could agree with that Now obviously not everybody is suited to make decisions to deny transport. This authority is for those who are competent in their skills, education, and judgment to make that bold determination to flat out deny someone transport. Unfortunately, there are draw backs to this. I have seen patients denied whom I thought should have been taken. I have seen medics rule out cardiac-related chest pain prematurely and denied pt. transport. Some people could get a bit cocky and make the mistake of refusing the wrong patient. NEVERTHELESS, I believe my system as a whole makes great decisions as to whom to transport and whom to deny.

On a typical day, we run about 16 ambulances for an entire county of nearly 300,000. On most days, we nearly run out of ambulances, and on some occasions we run out completely. We can't afford to take everybody to the hospital just to "be on the safe side." While we're messing around with a woman having menstral cramps, there's a person who's having a MI and there is no unit available for him. I know everybody is afraid of getting sued, but the best interest in the city as a whole is more important than worrying if some numbnut would take us to court for not taking his toothache seriously enough.

So, I'd much rather have a protocol that would allow for necessary adjustments than to have one that is so regulated that there is no room to think for yourself. I'm sure many of you would disagree with our protocol...but man, it feels good to know that when someone calls, you ain't got to always haul

You've just pulled up to the hospital while your partner is in the back with the patient. You get out of the driver's seat and walked behind the ambulance to open the doors for your partner and the patient. However, when you opened the doors...

Be creative

Would you please post your protocol for denying patients that do not need transport? Thank you.

The interesting thing about our protocols is that they are more like "guidelines" rather than regulations, leaving us with the ability to make our own judgment. Our protocol for refusing patient transport is the same way. In a nutshell, we are allowed to refuse any person transportation as long as we consider important criteria such as mental status, chief complaint, age, vital signs, medical history, overall impression, etc., etc. When we refuse, we have to of course make sure that we clearly document why we refused a person transport. The only exceptions for refusing transport are minors who are not emancipated and infants under 6 months old. These we have to transport no matter what. If there is any doubt as to whether or not a person needs an ambulance, then we have to transport. Both partners must agree that transportation isn't necessary. Pretty much, it's about thinking for yourself and making the best judgment regarding refusing transport.

It's understood that not all emergencies are true emergencies. Some problems may need to be evaluated, but not all those problems require EMS transportation. For instance, someone with cancer doesn't need an ambulance. Someone who suffers from chronic pain doesn't need an ambulance. A person with a stroke DOES need one. Someone with a nasty foot fungus DOESN'T.

We also could arrange for alternative mode of transportation if a patient doesn't need a 911 EMS unit. Sometimes we call up a private service that is dedicated to non-emergent transportation. These are for patients who may need to see a doctor but aren't critical enough for an emergency ride.

And, please, dont even start with, "but I have kids and they need to be able to get in touch with me, in case of emergency". I have heard these cellphone calls for years, and i have yet to hear anyone get an emergency phone call while onduty. And if you do have an emergency, your family can call dispatch or your supervisor like we did in the old days.

While I'm on the job during a call and a family emergency happened, my wife knows to call me multiple times to let me know that something is wrong. If my phone rings or vibrants once, I'll immediately turn it off. If it rings again and again, I'll know that something is wrong. However, I'll finish out my call first and then attend to my business. Besides, my wife knows my supervisor's number and has called it before when I forgot to let her know that I made it on the job safely.

Oops

There's one guy in my agency who would ALWAYS be on that cell phone. Someone told me that he was texting while driving code three!