hatelilpeepees

Guess I should have explained that better. Grady is the trauma center/ indigent downtown hospital, that also operates clinics, and has ambulance service for 911. Non-emergent calls are routed to Grady Dispatch, and patients are triaged to see if they can go to clinic instead of ER. If questionable, ambulance is sent to assess patient and decides to take to ER or clinic. If patient is truly non-emergent (roach in ER, minor LAC, the flu) they are scheduled a clinic visit in the next 2-3 days. The call volume is huge, and the typical wait in the ER could be 16-24 hours with patients stacked in the hallways.

Actually it is a little worse than that, Grady/City of Atlanta only control the city limits of Atlanta which is in Fulton County. One of the evil mega ambulance corporations control the North and South Fulton County areas for EMS. The Northern cities inside Fulton County broke away from Fulton County and created several Fire Departments within the County. I did not design the system.

The unions are not dumb enough to broadcast that they are delaying responses............DUUUUUUHHHH. Actually the Grady thing is smart. They do not send alpha level calls there first, they send the BS calls there, the flu, general sickness -- so that they do not waste valuable resources and clog the ER with people that should be in a Dr's Office. Unfortunately, the taxi cab ride 911 calls far outweigh "real calls" dwontown.

Its been done the same for years, times only increased when the union got stuck with furlough days. Calls are routed to grady first because they have a triage system that allows them to schedule the patient for a clinic visit for minor ailments instead of going to ER.

If you do not share the mistake, you cannot stop it. How many times has a medic given Atrovent instead of Proventil because of similar packaging that is hard to read ? I agree that errors need to go to a committee, and strategies should be implemented to make sure it does not happen again. I think he meant report to the family of the dead patient Doc

9 of them work my company part-time.

http://www.ajc.com/news/atlanta/audit-atlanta-fire-medical-1209970.html They will spin this as "understaffed", but the truth is the union verbally ordered the firefighters to "slow down" as a result of cutbacks to prove their point. I don't think the 911 Center is unionized, but they got the same message.

I agree with you on a certain level KIWI, generally more education = better employee. But I have seen many "smart" EMT/Medics (have college degree in other field) struggle in EMS, because a good bit of the time the emt/medic who has more common sense versus education is the better provider. Kind of like the Harvard trained Cardiologist who has no bedside manner (people skills), but can tell you everything you want and don't want to know about the heart.

Yes, it was intentional, you guys found it quicker than i thought anyone would. Was going to mispell "spelling" but that would have been to obvious. How many errors do you see in above sentences ? juxtaglomerular apparatus (never heard that one, thanks for teaching me something)

I know thats the reason our service doesnt report the errors, and if you read all 11 pages of the thread, you will see the predominant theme is "lawsuits, my license, my job", you were the first (I think) to state your line of thinking, out of all these people. But no, I do not have any statistical proof that it is THE reason.

kiwi, thats not the way it works here in the US. A couple of insites and suggestions tcripp: 1. It sounds like they are not very proactive, so you will have an uphill fight, but what I would suggest is to pick the most "wrong thing" that you can find, find a solution to it, then present the solution as a project you want to work on or just fix it and show what you did. For instance, you talked about typos. I assume that your policy & procedure manual is filled with typos too, so take a copy home and retype it, throw in some graphics, make it snazzy. Then present them with the new manual that they can copy. I am not saying this about you, but generically speaking, medics are real good at pointing out what is wrong, but they rarely volunteer to be part of the solution. When you bring the solution, or are willing to work on it by yourself or with a group of employees, managers are typically more willing to listen. 2. Visit a neighboring service to see how they do it. I have seen the most common things done so many different ways, like truck inventory for instance. I know systems that use sealed tubs in the cabinets, I know systems that use sealed cabinets, I know systems where everything is just out in the open in the cabinets. Some systems pay a person to restock and wash trucks (private, all at one station), as it is cheaper to pay one person $10.00/hour to do it, versus two people on overtime. There is always a better way. Visit the largest 911 provider near you, and the smallest nasty service too you, you will learn something from both. 3. Do you have a QI/QA or CQI committee to join ? If not, create one with likeminded medics, and start solving problems. 4. Create the "Board Meeting". Invest in a large dry-erase board, during the day/week, write down the problems that occured. Then once per day/week get all managers to meet at the "BOARD" and assign each problem to a manager/employee, and assign a deadline time for fixing it. At the next BOARD Meeting, review if the problem has been fixed, and if not, why not. Your owner will love this idea, managers will hate it, until they see the productivity and ACCOUNTABILITY it creates.

HHHHHHMMMMMMMM tcripp, good point. I guess it is similar to the whole question about whether or not to tell a kid that they are adopted, when they dont know. But, I think we can all agree that is not the reason it is not being done, we are keeping the information private to protect ourselves from lawsuit, which is where I see it as a selfish act.

Your job is not the problem, it is your depression, everything else is a related symptom. You can change careers 10 times in the next 10 months, it will not change your habits. Go see a counselor immediately. Once you fix the depression, it might be a good time to add some spice to your career as doing anything for 11 years can get you in a rut. You can think about a new company or location, but it might be a good challenge to accept new challenges at your current place (management, committee work, become an instructor). And if you are doing EMS as a part-time job in addition to your full-time job, STOP IT.

I WOULD RATHER BE THE MAN WHO BOUGHT THE BROOKLYN BRIDGE THAN THE MAN WHO SOLD IT --- Mark Twain YOU KNOW YOU ARE AN ADULT WHEN YOU ALWAYS DO THE RIGHT THING WHEN NO ONE IS LOOKING --- unknown I get the whole lawsuit-phobia thing, but just on a human level, can someone explain why "not reporting errors to the patient/family" is the RIGHT thing to do (and I mean after investigation, not the medic telling the patient at the time of error) ?

This might not go anywhere, but I see that alot of members in this forum have trouble with grammer and spelling, so I thought it might be good to have a "word(s) of the day posted on here, as an educational tool. I am thinking we take turns, and add: 1 medical word that we would use in our work-life. 1 word that you have probably never heard of. So here goes day 1, someone else find something for tomorrow please, who knows, we might actually learn something: PANEGYRIC = Elaborate praise. DIARRHEA = Watery feces

I have remained silent on this one, because I took such a beat down on the obese patient thread, but I can not stay silent any longer. Flaming, I have to agree with you, and I am glad you started this topic. It is shameful that our industry puts lawyers before patient rights. If you injure or kill a patient, it should be disclosed. I agree with Ruff that it should only be done after an investigation through all of the proper channels, but to go through that investigation and find that you were negligent, and then not report it to the family or patient is at best shady. It simply does not pass the smell test. I was always told, if you wouldn't want your mom watching you do something or finding out that you did something, you should not do it. I could not look my family in the eye and say, "Yes I killed the patient, but we successfully covered it up so I could keep my license". That is just "WRONG" on every level, if you are a professional.

I hope you are not planning on using versed alone for RSI, are you stating that you will just use it for those who fight the tube, after intubation ?

NYPA, I did not mean that literally, that was a joke, but as far as survival; if you like, I will make a $100.00 bet with you, you follow the next several arrests over age 80 in your world, and I will in mine, until June 1st 2012. If the majority live (anything over 50%) you win, anything under 50%, I win. And by live, I mean discharged out of hospital to home, not to nursing home (that is just delayed death).

I am not argueing with Dwayne, or suggesting he leave anybody at scene, I would have done as he did, if it were two adults I would use squad bench. It is just that Dwayne got me thinking about how unsafe the bench is --- I admitted I do it all the time. As far as the bariatric deal, its a dead horse, I will not discuss it anymore after this final comment : The only reason everyone said you should not transport the patient on the floor is that it would be unsafe in an MVC. Putting a patient on the flimsey squad bench is just as unsafe IN AN MVC. Thats all I am saying --- horse is beaten, shot, and buried.

I have to disagree somewhat, stating up front that it is hard to tell without actually seeing the patient. This is a respiratory arrest secondary to COPD. This is not a patient who is going to get a breathing treatment and go home, she probably got sedated in the ER, put on a vent, and was sent to the ICU to die. Securing her airway via intubation is essential to properly oxygenate her lungs, forcibly expand her lungs with ventilation, and protect her airway from vomitus. Yes she will probably die anyway, but letting vomit in her lungs will definitely seal the deal. Although it is great to ask questions in this forum, one of the best ways I have found to learn if my treatment is right or wrong, is to follow up on the patient with the hospital staff, and watch what the ER Doc does. So I would ask, what did the ER staff do for this patient ? Not using sedation before and after was wrong.

Good twist Dwayne, and I am glad you were able to transport both on the stretcher (I have done the same with peds, and I have transported many on the squad bench as well, SO I AM AS GUILTY AS EVERYONE ELSE), but what would you have done if they were both adults ? To those who say this situation is different from an emergency bariatric call, you are wrong ! Dwayne lacked the resources he needed in a timely manner, and did what he had to do. When you have a patient who can not fit on the stretcher safely, the floor is the next best option, if bariatric resources are not available in a timely manner. To those who say transporting a patient on the squad bench is perfectly safe, I can not agree, even if you say you use spider straps, and run the seat belts through the hand-holes on the backboard (which most do not do). 1. Strap your partner to the board today and the squad bench, get the truck up to about 30-40mph and slam on brakes hard, then imagine what would happen if you actually hit something. 2. Remember, most squad benches are made out of 1/2 - 3/4 inch plywood or some form of veneer. Your car seat belts are bolted through metal, the bolts holding squad bench belts are not (some trucks have the female end of belt secured to the aluminum frame in the wall, but the male end is still attached to the wood bench). Those belts will not hold anything in a serious crash (and I have seen crashes where the "two lids/seats of the bench came loose in a crash, because it is only held to the bench by a 1/2 inch x 6ft piece of piano hinge. Take a look inside your bench today, how is it secured to the floor and the wall (and the pieces of the actual bench to itself, are the corners glued together, is there any metal flange and screws holding it together). How are the belts secured (through wood or metal)? How are the seats secured to the base? P.S. If you think that flimsey net at the end of the bench will not break away in a serious crash, you are wrong there too.

I did answer about state law, u can see all state requirements on state ems page. I am sorry haziness. I am one person trying to keep up what arr your questions, as far as my age I guess I hit wrong button on phone during setup, will try to fix it didn't know it was wrong till you pointed it out, no lie intended

Happy to oblige you dwayne: http://defrance.org/artman/publish/article_967.shtml http://allnurses.com/general-nursing-discussion/sad-story-480-a-75623.html Thats two more examples than anyone has given me of obese patients killed in MVCs because they were not on a stretcher. Love You !

Yes, we actually adopted a nursing home that is less than 1 mile from our main station. We go by every other Sunday and bring our dogs (just to the common area, not in the rooms). They really love the pets, since they are not allowed to have one. I can promise you that they have inspired us way more than we have inspired them. You have to remember that many of these people have led very interesting lives (war stories, the depression, invention of many devices we take for granted).

Wow you have some dirty minds, my name does not mean what you think it means. Dwayne, I am not allowed to post any departmental policies or documents on the internet, but I can give you the short list of some of the offenses that are an automatic termination: Reporting to duty impaired, threatening someone or actual violent acts, committing criminal offenses while onduty, disclosing confidential patient information inappropriately, giving false information, theft of company equipment, etc..... probably no different from yours. Yes employees are required to use 5 point restraints, or pedi mates, but when the patient will not fit on the stretcher, they are allowed to transport on the floor. Much like Docs example of you cant put a 1000lb patient in a helicopter or on a CT scanner table.I am not trying to be argumentative, it is just that no one has answered my questions, whereas I have tried my best to answer all of yours. Again:What statistics or research do you have to prove that this is an unsafe act that has resulted in injuries or death ? If it is wrong and horribly dangerous to do this in a non-emergent setting, why is it suddenly OK to put patient's lives at risk when they call 911 ?And lets take it a step further, we have all seen those obese patients that end up growing into the fabric of their couch, and have seen fire departments cut a hole in the house, extricate patient with couch, and load them on a wrecker for transport. How is that safe ?