hatelilpeepees

Actually, JCAHO is very negative about using restraints, so they are on my side lol, I must admit you get an "A" for your avatars, they are always entertaining.

Oh Dwayne, about the cursing, I am not offended by that as much as I am when getting farted on at the station, but I left my laptop up, and my son was wanting to know why you were saying mommy was full of s**t. It is my fault for leaving this page up on my screen, but I dont think cursing elevates anyone's arguement, and I know several others on here have small children. Thinking more basic DOC. Lets say JCAHO is in your facility right now. You have an altered elderly patient on a bed, with one of the side rails down. Do you think JCAHO is going to give you a "pass" because you are the ER and patients move in and out of your beds more frequently in the ER ? And if you have been involved with a survey, you know that they want to see your policies and training to address things that are infrequent, dangerous, and/or problem prone (thoughout the institution, across all departments). A department can not say, we do not have to know the infant abduction plan just because they do not work in the nursery every day. And I am not insenuating that you do not know how JCAHO works, but often times the ER Docs are not really held to the same standard or asked to participate depending on which shift you work, or your standing in your groups practice.

Paramagic I completely understand risk versus benefit, it is you who does not. Lets try this: there is a loaded gun in your home, do you ever point it at your family, even when you are cleaning it and are 100% sure it is completely unloaded. There is no risk, since there are no bullets and your finger is not pulling the trigger, but you do not take the risk, EVER. Everyone in here is saying that putting a 1000 lb patient on an ambulance floor is extremely dangerous (although no on can produce any proof that a patient has been injured or killed during one of these transports,, and it happens on a frequent basis. So if the risk to the patient is death (per you guys), and there is a way to avoid it (pay to play as one of you suggest, and require every service to at least purchase one bariatric ambulance that is centrally located in your service area), why would you continue to take the risk ? Because there is no greater risk with this patient than any other. Now in the scenario above with the gun, we can point to accidental gun death statistics to prove that pointing a gun at someone is dangerous and risky. So two questions you still refuse to answer: If you have no proof that a patient has been injured or killed while riding the ambulance floor, how can you say it is a "RISK" at all ? Using that logic, I could demand that all of you can never use a cell phone again because I believe it poses a risk to you. If the "risky behavior" can result in death, why would you ever choose to do it, and what other deadly situations do you allow to occur ? There was a whole thread where you guys argued against putting your life at risk for most calls, why would you not treat your patients the same way ? And finally, I have to call BS on this whole possible risk/benefit arguement. I have seen most of you blast people who come in here with a statement that is not backed up with statistical proof or research studies. Show me any SCIENTIFIC PROOF that you have that proves this is a dangerous activity, and again please explain how something that is too dangerous for an IFT service is totally blessed for the Paragods of a 911 service ? I will argue that there is less risk for this patient, because the driver will be more careful than normal, knowing the patient is not strapped in. And lets take this to a different industry. I would like to see how an ER Nurse could convince JCAHO that it is OK for her not to follow the hospitals safety policies because she is in the ER ---" those rules are only for the floor nurses who are in a less acute environment". Oh wait, I think that is why JCAHO was created, to protect patients from healthcare providers, who did not follow policies and create safety solutions for their patients. P.S. Dwayne, I posted before I read your comments. I am just trying to point out the hypocrisy of stating a medic has the right to refuse to treat a patient in the name of safety because this patient is nonemergent, then turning around and saying the exact same action is suddenly safe because someone called 911. You know as well as i that less than 5% of our calls are truly life-threatening at the time of the 911 call. My service is in north atlanta, the other services that have them are 20-30 miles away, and is either not manned (crew goes back to get truck at station) or it is only manned as an IFT transport vehicle M-F during hospital discharge time. Remember that most of my patients have been at their residence and had refused to call 911. We have tried to use those bariatric services before, but typically we find that they are already on a call, not available, have an ETA that is too long, or will not respond due to lack of the patient having good insurance. We have people who have pushed for us to purchase one, but in this economy, we do not have extra money laying around to purchase something we will use a few times per year. If we had $150k laying around to purchase the vehicle and stretcher, I would opt to use it for something we would use daily like new cardiac monitors.

I never said we did not have any, I am in Atlanta, and I am aware of 4 companies that have a bariatric truck that are spread around the area. I am not aware of any other service in GA that has them, but I have not taken a scientific poll to find out how many do. The point you are missing is that in this scenario this was a non-emergent transport, in my situations it was usually an emergency call at home, because they refuse to call 911. If it is incredibly unsafe during a nonemergency, then it must be more dangerous in an emergent situation. I do not understand the logic that because the call is a psuedo-emergency with a 911 response, that you are suddenly allowed to do what I am being chastised for. Why do your safety concerns fly out the window the minute 911 is called ? Dwayne, can you please argue a point without dropping the S and F bomb, you dont know who is reading this, and gentlemen do not curse at ladies. I have not cursed at you. But thank you for the compliment at the end of your post. Just because someone has a different opinion does not mean they right or wrong. This is a gray area, but I am guessing more patients in this country are transported on the floor versus a bariatric stretcher.

The point is that I am following your logic. If I agree with you that these patients should never be transported on the floor, I wonder why most 911 services transport them that way. I am sure in the larger cities there is "1" bariatric truck in every surrounding county, but I do not think that is the case in the rural areas and poorer states. So to ensure patient safety, every ambulance should be mandated to be bariatric, as it would not make sense to make a critical obese patient to wait on the bariatric truck to come from the next county over. Right ?

NY, you cant be the only service in your state, what percentage of others have it ?

I am betting none of the 911 services have made that investment, but at best one in 4 services in your immediate area have made the investment, right ?

Thank you medic girl, and how many "services" are in that same area, 911 and private ?

If you have a stretcher rated for 500 instead of 750, then that was dumb of your ownership, the price difference is negligible. To both of you, neither answered my question, how many bariatric stretchers/vehicles does your service have ? And I am not trying to insult you, as stated earlier, I am only aware of two, maybe three companies in the whole state of GA who have this equipment, if your state is different I would like to know

The stretcher is secured by 2 2inch bolts through a piece of 3/4 inch plywood in every ambulance made. Your studies are not accurate as there is no one that requires that ambulance services record stretcher failures, nor is there a governing body to report such incidents too. I am not 24, I made up a date when I created my profile, I am 40, and have 22 years of experience. I have personally seen 4 ambulances that have been involved in major crashes, and the stretcher and plexi glass gave way in all 4. Sure if you have a fender bender it will hold, but anything above 40 miles an hour, it will come loose. It is not that I am unwilling to listen to you, it is just that my life experience is opposite of what you people with no experience in these type of transports are preaching. No we do not do this all of the time, I would say that we probably do it 4-6 times per year. I am in the State of GA, there are no laws/rules regarding the transport of obese patients (all rules are on the state web site, feel free to check). OP, if you have a stryker or ferno stretcher made in the last 10 years it should be rated for 750lbs. You might want to check your equipment. And to those who think my motives are profit driven, most of these patients have Medicaid or are uninsured, we typically have to tie up 2-3 ambulances for this one patient, we are on scene and at destination way longer than a normal call, and then the ambulance is out of service until it can go back and get its stretcher. I can assure you that we are losing money on all of these calls. To those who claim my service is negligent or irresponsible, please tell me how many bariatric units each of your services have. If your service has not invested in this equipment, how are you superior to my service. I am guessing that 90% of you do not have this equipment, but I will wait to see how you respond. So to everyone who has commented in this thread, please respond back and tell us how many bariatric stretchers that your service has ? I am betting only 2-3 of you will have the guts to be honest and reply. P.S. and for the record, we do not employ any EMTBs. If I failed to answer your question, let me know.

You can't put a 1,000 lb patient on a stretcher rated for 750lbs, even if you had enough straps to wrap up all that is hanging over the mattress with the rails down.

I saw it completely opposite, the patient was still injured even though he was restrained properly to the stretcher. If the ambulance wrecks, I promise a lawsuit is coming no matter what.

Found this interesting: http://www.setexasrecord.com/news/238677-patient-sues-after-ambulance-cot-detaches-during-rollover

I would have to agree that you can not blame fast food companies, as no one is forced to eat fast food, and almost all of the fast food companies do have healthy meals (at least a salad) that you can order. But your arguement may be correct if you pointed it at the school cafeterias. Most schools have a healthier menu than they did years ago, but most usually offer several choices now, and one is almost always a bad meal (pizza and fried chicken nuggets comes to mind). And somewhere along the way "ranch dressing" became the new ketchup or at least in my state it has. Allowing kids to choose an unhealthy meal 5 days out of the week, is probably not a good thing.But in reality, you have to blame the parents. I ate horribly as a kid, and we ate alot of good southern food every night at home. I was skinny as can be until I was about 18, but it was because as a child, I got exercise at school (PE)and when I came home we played outside until it got dark. Kids today are far too sedentary with TV and video games.

I see alot of "students" in this forum, so I am wondering how you would rate your ambulance third rides ? Did you learn anything, were you allowed to do anything ? Did the service try to put you with medics who enjoy students or did they just put you with whichever crew was closest ? What could we do as an industry to make your clinical time more rewarding ?

Agree with all of the above, the Nurses behavior should not happen but it does all the time, it is a coping mechanism. I would not complain about them though, as it would be a sure way to make sure students are not invited back in the future, and it is getting harder and harder to find clinical sites. As you do your clinicals you will probably see alot of things that you would never do, or atleast believe now that you will never do. Their actions were unprofessional, but of no harm to the patient.

No syst that was not directed at you. To the group, I do apologize for being rude, I was on the rag last week, and had some other stressors going on, I should not have been so rude with people who disagree.And yes I do understand the concept of risk versus reward and benefit analysis, but I just don't think the "risk" of performing a non-emergent transport a few miles is as great as many of you do, but everyone is welcome to disagree.About our policy, it was actually formed out of concern for our patients and our industry. We had a local busy 911 provider who created a policy where they would not transport any DNR patient for any reason; their logic was that using a 911 ambulance for a DNR patient was a waste of resources. This created a black eye for EMS for all bedridden patients who live at home and not in a nursing home. We had another 911 provider that refused to run nursing home calls, regardless of acuity of the call. And of course, as a private provider we frequently ran into the medic/nurse who would refuse to run a late call, long distance call, or a call because it was below their education (MICU Nurse doing a discharge to nursing home). We also terminate for any founded customer complaint (after investigation). All potential employees are made aware of all of our terminateable offenses before they are hired, so they know where the line is drawn. No one is forced to work for us. And for the record, I am probably a little too sensitive because I am obese, but it is also because we transport alot of these patients because they have been so mistreated by 911 services, that they refuese to call 911 anymore. We do have a wider bariatric stretcher to use, but we have encountered patients that are too large for it's weight rating. I am only aware of two services that have true bariatric ambulances, with wench and ramp. Most services use the tarp. We treat them like we would any other patient, and do not judge/abuse them, or make them feel bad for calling us. Yes, their predicament is of their own making, but most disease processes are of the person's making. Do you lecture people for smoking or having diabetes ?I googled "obese patient killed in ambulance wreck", in a variety of versions, and I did not see one news story regarding this risk. Which is not to say it has never happened, but it is obviously a rare occurence. I would argue that any call involving an MVC in a roadway or down a steep embankment is far more dangerous than this call.

all i can say is WOW

We turn ourselves into these type medics by working too many hours. I always tell my folks that if you had a job where you made love to the sexiest people in the world for 100 hours each week, sooner or later you would get tired of even that job. I always tried to do a differnt type of job entirely as my part-time job, so I would not get burned out.And yes our company does issue uniforms, but in this economy, they do not do it until absolutely necessary, because of the expense.

Our state is GA, and there are no laws regarding seat belt use in the back of an ambulance, there are laws regarding the front seat passengers. Regardless, if you have even been in a wrecked ambulance, you know that the seatbelts in the box are usually useless, unless your company invests in having lap/shoulder belts, instead of just lap belts. The entire stretcher, with patient, will dislodge from the floor and crush anyone who is in the "Captain's seat". It is obvious that I am not going to convince you that putting a patient on the floor, unrestrained, is no less dangerous than using a stretcher if involved in an MVC, as I guess you guys are refusing to believe video evidence. So lets quit beating this dead horse and move to another one. How many of you who are on the OP's side in this, have ever put a second back-boarded patient on the squad bench ? Do you really believe that the patient will remain on that squad bench in an accident ? Where are your "safety concerns" there ? Are you going to suggest to me that every time you have done so, that there was not another ambulance (private or 911) that could have responded and transported the second patient "SAFELY" (by your definition) ?

I am the one being attacked here, as far as my management skills go, feel free to attack, but as a manager I have to enforce all policies fairly, and we have a policy that does not allow the medic to refuse a call. You can disagree with the company's stance, but that is our policy. And I disgree with most people's answer that a safety concern can be variable and open to interpretation. If you refuse to transport this patient due to MVC concerns, then I say you can not transport any patient, as no patient is safe in the back of an ambulance during an MVC, the stretcher will come loose from the floor, the plexiglass and all supplies will become airborn missles. You can't have it both ways.

So does that mean if a 1000 lb patient presents to your ER, you will refuse care because your stretcher is only regulated for 750lbs ?

Or to give another example. I think we can all agree that Dopamine would never be administered by a nurse in an ICU without it being on an IV pump, yet we do it all the time. It is not safe, the equipment is not that expensive, so you could argue that we should "pay to play" or never administer this drug, if you are all really advocating patient advocacy on all fronts, at all costs. I think we could also agree that an IFT company that does cardiac cath transports should have 12-Lead EKG capability, but we know that is not the case nation-wide. We could also argue that we should only buy ambulances that can withstand a rollover crash without any significant damage to the box (or roof if it is a van), but that is not our reality. We could also argue that all IFT ambulances should be stocked/equiped the same as 911 ambulances since many do 911 back-up, but that has not happened yet.

No dwayne, i am not hiding, just have to work for a living every few days. I still stand by my point, obviously opinions are like assholes, everyone has one. We do things all the time that are not by the rules or totally black and white. This is a special needs patient that most services are not equipped to handle, and you have to do what you have to do. In a perfect world every service would have a bariatric unit, but we do not live in that world. When we do, I will agree that the patient should be transported by that unit. If you remember the crash videos that were posted on here a few months ago, you saw that the stretcher did not stay in the harness, in just a 35mph crash. So to argue that the patient is safer because they are on a stretcher is absolutely not true (just watch the videos again, I am sure you can find them). This is all about 911 attitude in my opinion, in that the non-emergent patients are not as important, therefore the medic can choose to provide service or not. This was a patient in need of transport, and this provider is in the IFT business. If you are a CNA in a nursing home, guess what, sometimes you have to wipe butts, like it or not. In the IFT business sometimes we have to transport patients that we would rather not. No HOSPITAL can refuse to atleast provide minimal care to any patient that walks in the door, and there is a reason that law is in place (because hospitals used to refuse care). Once we start down that slippery slope, it is a means to our end. I admit I may be hypersensitive because I am obese and know what it feels like to get the look of shame from all the skinny people, but again, to me, being a patient advocate means we find a way to meet their needs versus refusing care. There is no place in an ambulance that is safe in a crash (maybe than other the drivers seat with air-bag), and crashes happen very rarely, so to hide behind the rare occurrence of a crash is stupid. If you are that concerned about patient safety, then you would never put a patient in an air-ambulance helicopter, as the rate of death in that vehicle far outweighs deaths in ambulance crashes.

Again, much like crotchity USA, you are refusing to answer my question: 1. If it is unsafe to transport this patient in a non-emergent setting, why does it suddenly become safe in an emergent situation, isnt the risk of accident greater in an emergent situation. 2. You keep saying "pay to play", and have admitted that you have run several of these calls, so how many bariatric ambulances has your company paid for ? And I seriously doubt that you put pediatric arrest patients in a pedimate before you head to the hospital.You cant have it both ways, either it is unsafe to transport this patient all the time, or is it just when you deem that it is unsafe to get you out of doing a transport. What other type of patients do you refuse to transport ? The poor, minorities, drunks ?Here is something you might want to read:http://www.uwhealth.org/emergency-room/obesity-bias-weighs-heavily-for-ems/20377