HERBIE1

We had this patient last week who presented with dizziness and loss of balance when standing. He also began complaining of pain in his upper and lower extremities and all 4 Qs of his abdomen. En route he also began experiencing CP. He had no history of MIs or CPs prior, his EKG and VS were all normal. But he did have lung cancer and was undergoing hemotherapy which he had just finished the previous week. Could that be the cause of all his symptomps?

Could be a million reasons. The cancer has metastasized to and compromised other organs. Many chemos are very toxic and could indeed by the source of his problems. Dehydrated because a loss of appetite from chemo, and/or N/V/D, which could result in his vertigo. Sounds like the person needs a complete work up.

Coming from someone who has been on the street myself I can assure you MOST of the people on the street are there by their own choice and actions. The normal people who have a bit of bad luck and are put out on the street seek help and their situation is usually temporary, the bums and drug addicts out on the street have no desire whatsoever to change.

When I was younger my dad volunteered at a homeless shelter in Lee County Florida which I was with him there quite often. So needless to say I have plenty of experience with these types of people.

Its just like that old saying "You can lead a horse to water but you cant make him drink"

True, sub. The dirty little secret here is that many of the shelter beds are not used- except for a couple days with severe cold or heat. In most areas, there ARE plenty of options and resources for people to change their situation IF THEY SO CHOOSE. I'm certainly not diminishing the tragic situations that happen to people, but those are NOT the chronic abusers of the system- the original subject of this marathon thread.

could give a long winded answer, but the short answer is "thats the price you (whites) pay for breaking the window". I know it wasnt you personally, or anyone in this room, but a price must be paid for what you did to the american indian and blacks. I am sorry your forefathers kept passing the buck, it should have been settled in the last century.

And there you have it. This is all about payback. Couch all this in racist accusations, and the inevitable invocation of slavery, but in the end, this is about settling a score. That tactic is working out well so far, isn't it?

I would just love to know when that score will be even- if ever. I'm sick of being expected to apologize for something I never did, and having to pay for something none of my ancestors were even responsible for since they were too busy being indentured servants at the time.

Have you even bothered to read any of the posts by myself or docharris? If you did you would have seen how and where EMS providers fit in.

You believe that the EMS provider can do nothing more than provide a ride to the hospital but fail to see where you could make even a slight difference without even getting anymore of that awful education stuff.

Save the "education" speech- I'm a lifelong learner. I've been taking and teaching classes my entire adult life.

Since you also brought al of this up, let me give you more examples and you may even be who I am talking about.

Even though it is mandatory in all states to report elder and child abuse, many in EMS believe they just need to drop the patient off at the ED and say, "I think this person is living in an abusive enviroment" and then leave. The EMS providers believe the RNs will notify Case Managers and the State agency as well as filling out the report. The problem is they may not have witnessed what those in EMS saw. Yet, those in EMS believe "it's not my job", "I just bring them to the hospital", "I don't want to get involved", "It means more paper work".

It's not about paper work or not wanting to get involved, it's about time management, and proper utilization of resources. In a busy urban system, crews may essentially run back to back calls their entire 24 hour shift. Tell me how much time should we take ensuring the proper social service agencies are notified, a case manager is assigned, a therapist is notified, etc? Every time I have initiated these contacts- mainly for issues of elderly abuse and/or neglect, after countless phone calls, and a couple hours, in the end, the person and/or their family are still the ones who need to follow up and seek this help. They need to make and keep the appointment, and unless you suggest we also drive someone to their AA meetings or housing assistance agencies, how far should we take this?

I don't know about your area, but our system cannot afford to have units and personnel tied up for that length of time. We have very strict turn around time limits because there is usually another call waiting. We need to justify any delay in returning the unit to service.

I'm sorry, but this is like triage. We can spend hours on personally obtaining social services for one person or we can notify the MANY TRAINED people who do this for a living all day, every day, and have all the necessary contact information at their fingertips. I have a hard time justifying playing social worker for 2 hours when we could be helping a couple people who need the skills we have been trained to use. If a department wants to assign a social service liaison whose only job is to track the homeless and frequent flyers, that's fine. I suggest it is an inappropriate use of your street assets to have them playing social worker, and most organizations would have a hard time selling that idea to their bean counters. If a unit is tied up, another one must cover their area, which delays the response, the snowball effect ensues, and it may take hours before the system recover.

Again, if you want to be a social worker, change careers. We should do what we can- within reason.

Sorry, I'm being honest.

The parent company of AMR used to be Laidlaw, which among other things, is a waste disposal firm. I'm not sure what that means, but...

They are also Canadian, if I am not mistaken, but I won't hold that against them...

(Just kidding, Canucks)

With my educational 'prowess', I wouldn't even be allowed onto the campuses of any Ivy League school, let alone be allowed to attend classes! Does this mean I can sit back and cry how the whole world now owes me?

LOL

Good luck with that, Lone Star. Let me know how it works out for you.

As for people in any neighborhood, the unfortunate thing is, no matter how nice, or hardworking the locals are, let one negative thing happen in the neighborhood, and everyone residing there gets "labeled" as being as bad as whatever that negative incident happened to be.

Very true. I've encountered many people in public housing who were actively trying to change their situation and make something better for their kids. I recall one family who's tiny apartment was immaculate, and nearly every wall had bookshelves loaded with all types of literature, text books, SAT/ACT prep manuals- (the kids were in jr high). Unfortunately, these folks were the exception rather than the rule.

So because a few people know how to play the game we stereotype everyone that resembles them. Have some in EMS become so jaded that they take one story and say, "yep that sums it all up and none of them deserve the benefit of the doubt?"

Explain that statement.

Our job is to evaluate their immediate needs and transport them to the hospital.

At least John Q Citizen still cares enough to make a call. He/she could easily look the other way. But then they may be under the impression that they are calling people who might care and not cop an attitude that it is just another mucked up homeless junkie wanting something. After all, for some in EMS it is not about what we can do for the patient.

When John Q Citizen sees a homeless person lying on the street, they call for a multitude of reasons depending on where they are. Yes, usually they think the person is sick, but often they want him off their property, he's an eyesore they want out of their area, etc. When we arrive, we take care of their immediate medical needs and provide transport for them to the hospital for DEFINITIVE CARE.

Problem is, I find that the 5 -7 minute transport time is generally not enough to solve their chemical dependency issues, provide shelter for them, provide therapy for their emotional and psychological issues, offer financial advice, provide job training skills. and obtain gainful employment for them. Those are just some of the reasons someone lives on the streets. For all these years, I mistakenly thought that people like therapists, social workers, crisis workers, interventionists, financial planners, detox centers, housing advocates, and counselors were TRAINED to handle those things. Clearly, I have failed in my duties as an EMS provider, but thankfully we have people like you to pick up the slack. I bow to your prehospital care prowess.

I am sorry lonestar, i saw alot of your opinions, but not sure what question you want me to answer. And your thinking that minorities make up more of the prison population because they are guilty is incorrect. Ever heard the term "driving while black" ? Its kind of like having a supervisor who gets off on writing his employees up, he will look until he finds something to write you up for, and yes just about everyone in this forum could be written up on a daily basis if your supervisor wanted to do it, does that make you a bad paramedic or EMT. Anyone in here that claims they have never broken the law is a bald-faced liar, all of us have sped in traffic, maybe drove under the influence (not drunk), claimed a deduction on our taxes that was maybe embellished, ran a stop sign on accident, vandalized something as a teen, maybe even stole something somewhere along the way. Blacks do not break the law anymore than their white counterparts, it is just that the police focus on us more. All you have to do is look at the imprisonment statistics for powdered cocaine posession (white man's coke) versus crack posession (black man's coke).

http://www.ussc.gov/crack/CHAP7.HTM

You are talking about differences in sentencing based on the flavor of drug. THAT is wrong, but here's a little tip: If you don't sell or use drugs, you won't be "victimized" by the disparity in sentencing. Problem solved.

As for your claim that whites and blacks commit crimes at the same rate, before you make a blanket statement like that, you need to back that up with some numbers or at least set some parameters. What areas are you talking about? Is this a local or national issue? What are the demograhpics of the areas you are referring to? Intuitively, if there is no difference between rates of crimes, then you would think there would be far more(as a percentage of their group) whites in jail than blacks- since the racial make up of the country is minority black. CLaims of profiling cannot explain those differences by themselves.

As for "profiling", PC or not, I am ALL FOR IT. I've worked in ghettos my whole career where the only other white face I would see would be my partner and a couple firefighters. If we saw a nonminority in the neighborhood, they stood out, and chances are they were only in the area for one reason- purchasing drugs or other illicit activities. They simply had no other reason for being there. I think the police should have every right to stop them and check them out- SOLELY because of their race- "Driving while white". I'm no legal expert, but to me, that should qualify as probably cause to check them and their story out. I've seen it happen dozens of times, but strangely enough, I've never seen ONE of those cases featured on the news as someone having their rights trampled on. They are out of place, they don't belong, and if the police prevent a crime by this "profiling", it's a good thing. Maybe they stop an OD, maybe they prevent a robbery, maybe they prevent a drive by shooting. How is this a bad thing?

If I'm driving through ANY area known for drugs, gangs, or prostitution, I should expect that my intentions should be questioned and my story should be verified.

Switch the players around and suddenly this "Driving while black" thing is a horrible injustice.

The race card cannot explain away everything.

So are Cortez and the other Spaniards considered whitey? I hope not because it would be nice to have another group to share the blame with. Now we can blame whites and hispanics. Spen, you guys have the casinos. Isn't that enough? What more do you people want? I'm also very conflicted. I am part white and part native American. Am I supposed to feel guilty or am I supposed to feel oppressed?

LOL

You are supposed to feel guilty about feeling oppressed.

Congrats!

Happens every day around here. The trauma center even satirically (and unofficially) named the ETOH/drug/psych unit of their new ER after one of the most prolific abusers, "Ron Salvatore."

There's no solution for people like Ron. They've been homeless for years, decades in some cases, and substance abusers for longer than that. Despite Vent's good intentions (and mysterious pot of gold to pay for her social solutions), Herbie is ultimately right- most of them will never change. They'll keep bouncing in and out of the ERs, until one day something goes wrong, and they die- just like Ron did, bleeding from the head on the sidewalk after falling down drunk for the 90984357347587345738475th time.

And then someone else takes their place, and the cycle begins again.

I have an extremely liberal friend who used to live in Seattle. The first time I visited, I commented on the number of homeless in a city with a reputation such as Seattle's. She growled and said, "There are SO MANY social programs here it's crazy. If you're homeless on the streets of Seattle it's because you want to be." Simplistic, perhaps, but even she knew that there's a limit to what good intentions and social spending can do.

\\Points to nose

Thank you CB- someone gets it.

Vent is not holier-than-thou... she just is able to empathize with this particular population despite how irksome they may be in the short term to us as medical providers. She's also trying to show that no "population" of people is perfect-- we are all human, and we all have flaws. Without exception. I'm too blunt, for example... and it's not always a good thing. I can also box myself into being a little bit arrogant because I'm smart. It's something I work on.

Herbie, don't be such an @$hole! I'm serious, man. I'm sure you're an excellent medic. You're probably very intelligent. But you're sounding like one of those people who doesn't understand a holistic approach to medical care, and since you don't understand it, you scoff at it and go off on those who are trying to (at the very least) broaden your mental horizons a little bit. It also sounds like you've developed a prejudice against the homeless because you know they drain your system... but have you tried to think PAST your prejudices and get inside the problem? Or are you just reacting to it?

Medicine is not just about being right. It's about communicating with your patient and determining what your patient *really* needs. Have you ever noticed that people who are upset respond better to treatments once they calm down? Sometimes patients need more than what we have written in our protocol books. Sometimes, a patient needs you to just *really listen* instead of hunt-and-peck for the pertinent parts. Many of the homeless are mentally ill, developmentally disabled, or otherwise combating something they may NEVER let you in on... and without addressing some of those underlying factors, handing them the information on a shelter is going to do nil point zippity...

Just saying. Don't fall into the trap of arrogance- that you must be right since you're a good medical provider. Some of these frequent fliers may have been something you can't even imagine before they descended to where they are now. Show some humility!

Wendy

CO EMT-B

Obviously you have the wrong opinion of me, but I won't lose any sleep over it. If I had an ego or humility problem, I would have quit this business a long time ago. I remember fighting with nurses who thought we had no right to intubate patients or operate on our own without a doctor standing over us.

Sorry for being honest. Read my reply to vent- no need for me to repeat myself.

My point was, in our limited time with patients, other than offering them help, and advising them of some of their options, what else do you think we should do? Of course many homeless people have tons of underlying issues, and contributing factors that resulted in their situation. I know I am not capable of handling those issues- I leave it for the experts.

Like I said, I knew many intimate details of the lives of these frequent fliers. Do you think they need to be told that they aren't dealing with their issues in a healthy manner? Do you think they need to be told that the reason they may be a chronic alcoholic is because their parents abandoned them at an early age, or that they were sexually abused as a child? People spend years in therapy to sort out issues such as these. Most of the time, they know EXACTLY what brought them to this point in their lives, but they simply aren't ready to do anything about it yet. If and when they are, and ask for assistance, I'll be more than happy to help in any way I can. I'm more than willing to listen to their stories and offer suggestions, but that's the limit of my expertise.

It doesn't sound like you have much respect for anyone unless they fit your "type" of patient.

You seem to be stereotyping homelessness and addicts. Have you looked at the homeless population lately? You may even find a few EMT(P)s in the crowd. Many of these people call because they don't know what else to do. When you have lost everything including your dignity, there isn't much left.

Get your head out of your arse and take a good look at the world around you without such jaded opinions on humans who are less fortunate then you and enough with the "not my job" crap. The other posters have given good examples and I gave one example but I can come up with a lot more. We are in the health care profession and not just in it to thump our own egos by picking and chosing who we decide to save today.

I guess you missed this part:

My "type" takes excellent care of people who request my help- regardless of what their problems are.

I'm not stereotyping ANYONE. If someone asks for help, I am first in line to offer whatever help I can. If a person has a psych history and is noncompliant with their medications, how does your dime store psych assessment help them with their problems? What about an alcoholic? You would probably need a detailed personal and family history to even scratch the surface as to why they decided to start drinking to excess. Point them in the right direction, make them aware of their options, notify the ER, and let the people who are properly trained take care of it from there.

I'm not qualified to do social service or psychiatric needs assessments, nor do I have the resources to accommodate their needs. I'll leave that to the experts like you. Our job is to evaluate their immediate needs, provide whatever care we are capable of, transport them to the hospital, and point people in the right direction if possible, and when pertinent.

I would never presume to understand the complexities of managing a CHF patient's long term care for example, so what makes you think I am qualified to make assumptions and/or recommendations for treatment about a person who may have life long substance abuse problems and/or chronic and complex psychiatric and social issues? I think YOU are the one with the inflated ego here. I happen to know my limitations. I am very capable in my chosen field, and put my skills up against anyone's, but I'm not arrogant enough to think I know more than I do.

What exactly do you think we can do for someone with our limited contact with them- especially when their problems most certainly transcend a "simple" issue of homelessness? We don't provide definitive care for medical issues, and we certainly don't have the training to provide for and address the many issues someone who is homeless may have. Even ER's only point someone in the right direction- they make a cursory evaluation, make referrals, and may even provide for the next step if the person is willing to agree to further long term treatment. If you want to be a social worker, a therapist, or a minister then get the requisite training and change careers, but don't forget what your role is as a prehospital provider.

Do you also free lance as a cardio-thoracic surgeon in your spare time?

That says it all about you. It is a shame your type even deals with patients.

My "type" takes excellent care of people who request my help- regardless of what their problems are. Look at the original article again-tell me what type of "help" are those patients requesting?

A significant part of our jobs is education and social work and I am more than happy to do that. I can refer them to any of a dozen shelters or agencies if that is what they want. THEY DON'T. Like a smoker, a drug addict, an overeater, or an alcoholic- you can offer someone all the help in the world, but until THEY are ready to accept it, they will not change their behavior-even if you are a well intentioned social worker wanna-be.

If I wanted to be a social worker, I would have followed that path as a career.

Again- save the bleeding heart, holier than thou lecture.

So what is your agency doing about it? Establishing communications with your local Social Services? Leaving a paper trail for easier followup? Or, are you just dumping the problem into the ED and bitching about it? Maybe you're not even bothering to fill out the PCR appropriately for tracking? Do you just expect the ED and Case Managers to do everything? The Case Managers have their hands full trying to prevent others from becoming homeless.

As far as the disgusting part, I feel the same way about obese, chain smoking EMT(P)s who suck up sick days, increase out of pocket insurance rates for everyone and then expect the government to support their fat, short of breath arses when they go out on disability from a line of duty injury they received while reaching for that last powdered sugar donut.

Save the bleeding heart speech- not interested.

Every single one of these "at risk" patients are given information on homeless shelters, AA programs, rehab centers, detox options, etc. EVERY SINGLE ONE OF THEM, every time they are seen at an ER they are given a list of these options along with their discharge instructions. We see stacks of these forms among their worldly possessions. Every single one sees a social worker before they are discharged. EVERY SINGLE ONE. With a single phone call, the Department of Human Services even picks them up FROM the ER to start their recovery/detox/rehab/shelter assistance process if they want. They don't even need to be seen as a patient- simply show up at the waiting room and request services. All they have to to is take advantage of the help offered to them.

Many local charities and advocacy groups operate outreach services that go to the areas the homeless frequent and provide mobile health care, contraception, food, basic necessities, counseling, and more contact info.

If someone asks to go to detox(extremely rare), we contact the police for the transport since we cannot provide this service. 99% of the time, they are NOT interested in anything but a place to sleep it off and a "free" meal.

They CHOOSE not to take advantage of the help offered to them. If someone is not ready to change their lifestyle, you cannot force them.

Not my problem.

Come work in America and see if that holds true for EMS...

"Get to do something positive and rewarding that doesn't involve screwing people over working for some evil corporation"

Unless you are running the show and it's your name on the company door, the previous statement is true for ANY job you have.

So, to wrap it up, apparently crochity thinks it's perfectly acceptable to throw out a legitimate and fair promotional exam that was written as race neutral, simply because the results are not PC. There is no possibility that those(that means ANYONE) who did not pass the exam simply did not prepare well enough. It HAS to be racism.

Your opinions of anyone who dares to question something that is less than flattering to a minority is almost McCarthy-esque. Everyone is a racist if they do not agree with your ideas. That's damn scary.

A few things...

Physically demanding at times. The hours are rough, your sleep patterns are irregular, your eating habits aren't the best. Not only can you see things that most people shudder at, you need to make sense of them and then react appropriately.

Pay varies greatly by job title, location, and employer. EMTB's would be on the lower end, obviously paramedics get paid better. Pay also depends on where you work- hospital based, private provider, 3rd service as a 911 responder, as a cross trained Firefigher/EMT or paramedic.

I think you need to do some ride time on a fire based unit, a private provider, and/or in an Emergency room to get a feel for the job. Do multiple attempts, because no 2 days are alike. You may get what is called the "curse of the rider" where it's the slowest, most boring day in the history of that unit.

Bottom line- like was said above- it can't be about the pay, because in most cases, the pay is not the attraction. If this is indeed the business for you, once you do it, it will become like a drug-you can't get enough. It will also be the toughest job you'll ever love.

It takes a different breed- people in this business are crazy, but they will be the most loyal, true, and protective friends you will ever have. It's a family- with all the requisite drama that goes with any family.

Good luck.

I've got to agree with asys. I haven't been around in a while and nothing has changed. You control your destiny. Don't like where you are at, shut up and do something about it.

Much easier said than done, doc. Clearly some people will always have a major chip on their shoulder that NOBODY will be able to knock off.

In an old ER I worked at, one of our favorite gags was the "pity pot". We would present a bed pan to someone who did nothing but whine about how they have been wronged by everything and everyone, and nothing was ever their fault.

As a Native American I have no say. The Africans, Mexicans, Spaniards, British, etc have slaughtered us and locked us up on small reservations and we live in poverty. So you all owe me. You may send your guilt money to, HOW STUPID CAN I BE @ idiot dot com.

Spenac, as a Native American, you and your people DO have the right to complain the loudest. What the "white man" and everyone else who visited here- did to your people is horrendous.

So- why is it that we DON'T hear the same complaints from this community- even when they are entitled to it? I submit this is a matter of pride, self respect, and self reliance.

Anyone who works in a busy urban system probably has at least 6 regulars. I had a couple guys so often, I knew their life stories, DOB's and even SSN's by heart. That's disgusting, isn't it? Everyone knows there is nothing wrong with them- they are alcoholics, and like the guys in the story, only want a bed and breakfast.

In my experience, the number of full arrest victims- where capnography is useless- far outweighs the patients intubated for only respiratory problems. Prehospital wise, capnography is most useful for extended transports which are not what most first response, urban areas see.

You cite the exception, not the rule. For every success story you have, I have thousands who are/were in prison, became teen moms, were murdered, and/or joined a gang. But don't take my word for it, go spend the night in your local housing project, and tell me how good you slept.

Like someone in one of those articles said who DID make it out, your situation does not define who you are or what you can become. You can decide to stay where you are, in the same situation, and continue the cycle, or do something to help yourself.

So explain to me WHY those "exceptions" are even possible? By your reasoning, these "exceptions" should not even exist.

I'll give you a little hint- it's about CHOICE, and time after time, those "thousands" you cite made the wrong choices.

BTW- I've spent my whole career in and out of projects. As bad as they are, they aren't even the worst areas to live. Besides, those projects are rapidly becoming a thing of the past around here- Section 8 and housing vouchers have spread these folks all over the place. Nice places to visit, but I'll pass on taking up residence there. The obvious reasons- violence, drugs, and the fact that a white guy might stand out a bit unless he was buying dope.

The not so obvious reason-

I have nothing in common with most of the residents there. I would not be content with my situation there and do everything humanly possible to get myself out of it.

spoken like a true white person.

No, spoken like a person who worked hard for everything they have, with no handouts and no help simply because of their race or ethnicity.

You can not leave the projects if you have no credit, if white banks will not loan you money, you can not buy a car, a house, or a college education.

White banks??

LOL You need to pay attention to the news. Our current financial collapse is due in large part to those "white banks" being forced by activist and liberal groups like ACORN to lower standards so "everyone" can own a home- regardless of their ability to afford it.

You can't leave the projects if you drop out of school and then complain that you can't find a job, gang bang, father children that the government needs to support instead of you, and then blame the "white man", racism, and slavery for all your problems.

The statistics from the department of labor show that blacks (hispanics and women) make less than their white counterparts at the same job.

Do those statistics also show that the son, in-law, friend, or political supporter of the right people also make more money, have better jobs, and get better promotions than people with no such clout? Get over it- life isn't fair for lots of people. Does a kid deserve to be born into an abusive home, or to a situation where he/she is being raised by a single parent on welfare? Since when does your situation doom you to repeat the same mistakes your parent(s) made? Bad things happen to people, and a good parent wants something better for their children. They instill proper values and a strong work ethic, and push their kids to do better than they did, not making the same mistakes.

That is if we can get out of prison long enough to get a job. Blacks are 7 times more likely to be in prison than whites, even though we only make up 17% of the population, but there is no racism there.

Interesting that you note the racial makeup of this country. I believe your numbers are high- I understand it's more like 12-13% of the population is black, but whatever. Point is, with affirmative action and set aside policies that apply across the board, in every city and state, this means that a very small percentage of the country gets a huge advantage over EVERYONE else. It's still not enough, I guess.

Hmm- seems to me this is "cause and effect", NOT racism. Break the law, get convicted, go to jail- regardless of your color or ethnic origin. Seems like a pretty straightforward consequence of one's CHOICES.

So if a black man commits a crime, he goes to jail because of RACISM, not because he BROKE THE LAW by doing things like selling drugs, armed robbery, or committing murder? I think you need to brush up on the definition of racism.

You seem like a bright guy- tell me you don't really believe this nonsense you are spewing.

This persecution complex has gotten old for a lot of people. Simply crying racism at every turn doesn't have the same shock value it once did and certainly hasn't done peple in ghettos any favors, has it? We have a black President of the United States, for crissakes, Tell me again about all those barriers and how opportunities are not available for black America.