cosgrojo

First off... Mateo. Thanks for replying. For obvious reasons we will allow that section to lay dormant until the end of time, but I appreciate the reasoning behind catching back up. Now on to the discussion...

Just for some initial background information, I am a Basic. I have worked in a variety of systems throughout Maine, New Hampshire, and Massachusetts over the last 11 years. Have worked closely and for long periods of time with providers of all the levels available in my area (Basics, Intermediates, Paramedics (regular and CCT)). The person most responsible for my stance on EMS and my passion for education and excellence is a Paramedic, and was my first full-time partner. My EMS mentor always believed that Basics are incredibly important to the success of any EMS system, and is still to this day making sure that the next generation of Basics are as well prepared as they can be (through the advent of his very own EMT school). He believes... and I believe that there is a lot more that can be done in that 120 hours that is traditionally not done to raise the bar for future EMS'ers (obviously we would like to have more than 120 hours, but the DOT will only let him do so much). The better Basic makes a better Intermediate, makes a better Medic. (And if said mentor happens to read this... I think that it might threaten his hat collection).

Dwayne, when you say "ignorance and (hopefully) intelligence," I will assume that you mean in regards of level of education and not the actual literal definitions of those terms. After arguing with you a bit so far, I really do not believe that you equate level of licensure with intelligence. So let me try and explain my stance by drawing upon some real world examples. And for the sake of this discussion about EMS systems, let's agree that all providers are proficient at their jobs, and that there are only quality Basics and Medics available to work for us (no lazy Medics, and no drooling basics).

In a hospital ER you have a myriad of different levels working together to try and provide the best care possible. From ED techs (LNA's, CNA's, sometimes EMT's), to RN, to PA, to MD and to on-call physician specialists. If your train of logic is correct and EMS should only comprise of the highest level of care (paramedics), then is your stance the same for ER's? Should they only have MD's staffing the ER? Of course not. Each level has their particular skill set that is used to ensure efficiency and positive patient outcomes. Obviously a MD has the skill and ability to stock shelves, change foley's, clean up rooms, and wipe granny's bottom after an accident... but it is not an appropriate thing for them to be doing. The same should hold true in EMS (in my opinion). There is an opportunity cost (I did learn something in Economics class... thank you Professor White) to everything that we do. On a seriously sick patient that will require multiple interventions in the field, I do not want my medic to waste even a second worrying about planning egress, moving patients, coordinating Fire/PD, moving bags and equipment, and securing loose items prior to transport. I don't want them to have to talk to the family/bystanders to get hx of present illness, when they should be attending to the patients needs and relying on their partner to gather the background information. I recognize that Medics are eminently capable of those skills, but it is rare to find those that can do ALL of those skills, while providing patient care to the best of their ability without at some point compromising some aspect of care.

So does an EMS system of Medic only have the ability to work, and often does...? absolutely. I believe however that it can work better with the proper support staff in place that can focus on their specialties all while working together moving toward definitive care.

In all the systems that I have worked in, I have seen the most success with Paramedic/Basic trucks. I believe that these two levels complement each other better than any other combination. When a competent Medic is paired with a competent Basic, things run more smoothly in my experience. The company I work for (AMR) creates reports on just about everything under the sun. A few years ago they started tracking response times... out of chute, on scene, turnaround times, etc... For a while they were posting the results on the common area cork boards. They showed pretty clearly that the 911 trucks in New Hampshire (P/I or P/B) had shorter on scene times than those of Mass (P/P) 911 trucks. By no means am I submitting this as rock solid statistical data, but since I have no access to any other data, I will at best recognize it as a trend in the Northeastern AMR devision. My evaluation of this data has always pointed to this efficiency variance as a product of the Dual Medic system in Mass. What I think is going on is that Medics can't help being Medics and want to do Medic skills and evaluations (can't blame them for that... if I spent that much money and time invested in school, I would want to utilize those skills as well). By the time they have conferred... compared their differential diagnoses... and done whatever interventions they are going to do... then they start planning egress and patient movement and so on. While it probably got done, it could be far more efficient if the proper support staff was in place.

Another under-discussed aspect of EMS is burnout and apathy. While I won't go too far into this because I don't want derail our debate, I believe there are aspects of it that are germane to the topic. I hear a lot of complaints by medics at my service about having to do all these "bull-caca" BLS calls. I have heard it in all States that I have worked in and from medics from many different services. A lot of these medics get so burnt out on these types of calls that they freely admit that it takes away from their joy of their job, and sometimes takes away from the way that they treat their patients. I believe that P/B staffed 911 trucks could also help reduce this burnout/apathy. BLS can handle all the calls that do not require a Medic's specialty, and keep the medics fresh and content with only having to tech the calls that demand their skills. This also gives BLS valuable experience and the opportunity to see how medics evaluate and triage patients according to their presentation and complaints.

That should be enough for now... I have more ideas and theories (completely devoid of facts, figures, or statistical corroboration), but I do not want this to turn into a completely unreadable manifesto...

Until next time...

Yeah, I get some of that, and having reread your posts I guess I can see where you're coming from, don't completely agree, but I think I get it.

So, if no one objects, in the spirit of restarting the thread, how about if we start again here?:

If this has been argued, or requires a new thread then that's ok too.

I don't understand your balance. I don't know your cert level, but I can't imagine that you're a medic. Not because I don't think you're smart, but because if you were and had worked with other medics I think you'd find very few medics that have similar strengths.

At my last job I worked regularly with a rotating crew of 6 medics. We all felt like strong medics, but none of us excelled at the same things. One had near xray vision where bone and muscle injuries were concerned, another loved derm issues, I tended to be strongest at following multi system physiological disease stuff, and on and on. We went to each other daily for 'second opinions' and learned from each other constantly.

Also, I would never allow them to 'best' me if I could help it, and they felt the same. I grew stronger there in a few months than I expect to do here in a few years.

So I guess my initial argument, without having spent a lot of time thinking on it so far, would be, how is combining ignorance and (hopefully) intelligence considered balance? I lift every pt, often making what I consider significant improvements over my Basics ideas for doing so. How is his lack of education an advantage to our team? And I'm not clear how a more advanced education is somehow a detriment to proper lifting? I'm just not seeing it so far. Perhaps you and I can do better with these issues...

And in reference to our previous conversation. I can't really get what you're saying, and I see the same from you. But I do believe that one of the things that are lacking here are examples of good arguments. Arguments and debate are valuable skills, and I believe EMS would be much stronger if people could do it without anger. I don't see out previous dialog as wasted time, would be my convoluted point.

I look forward to your thoughts.

Dwayne

Excellent!!! I appreciate the turn of the page... water under the bridge and all that. I do not have time today to answer your questions you have posed (funny, as I've been formulating them for years). I am about 20 minutes away from leaving for my friends wedding, and will not be able to post again until tomorrow. I look forward to sharing with you my answers. I do not believe that I will sway you to my side... but that is kind of the fun of it.

Win, lose, or draw... I am happy to engage in the upcoming discussion.

Some of that got a bit heated... and as that is normally not my style, I fully and completely regret whatever back and forth we did that crossed over that sometimes blurry line. I hope that others too cautious to tread into the white-hot cauldron of debate we had before, will step into this new and improved conversation. BTW I'm going to NC in a couple of weeks... maybe Mateo can show me how fun he is at dinner parties...

I am off to see my friend into his last step of perpetual doom! Until tomorrow.

-You believe everything you said? Please explain the statement, "It is no accident that I was not able to draw out Dust or any of the other City veterans... cuz they knew what I was doing. I think it is enough for them to chuckle at my ridiculousness." I guess I don't get that comment following a statement you claim to stand behind.

Of all the quotes you mentioned, I believe that a reasonable reader of this thread will have a hard time coming to the same conclusions you do... if they do... oh well. And of all the quotes... the one above is the only one that I would even need to explain. A while back, I posed a thread about what people thought would be the "perfect system." This was probably 2 years ago... if you want to look it up... be my guest. I was trying then to figure out what peoples thoughts were about a system that they themselves would design. I was unable to draw anyone out then about ALS and BLS working together, as I am unable to draw them out now. The point of that was that sooooo many threads on this site have been centered around ALS and BLS hate and discontent, and I have been trying to make people think a bit more critically about the systems they are in, to think about the possible benefits of working together. I have failed more often than not to get people to understand my belief in provider balance... so much so that I usually can not get anyone to debate it with me. When I say that they knew what I was doing, it is because Dust and others have VERY long memories and do not forget my previous attempts even if they are a couple years in the past.

You say you cannot find those references in my posts... well then you must not be reading them then. Because in EVERY post, my original post, and those that were a response to either you or Meteo, I have mentioned it.... nay, dedicated entire paragraphs to. Every one Dwayne. I have been consistent throughout.

You have provided no thoughts, you have provided no references, you have provided no substantive material at all... heck... you have not even provided an opinion of your own (except to call me names i.e. childish, assumptive, arrogant, and cast a pox on me). I would have loved to debate the dual medic system that I continually referenced in all of my posts trying to get people back on track... but you would have none of it. Is this just to satisfy your need to "yell into the void?" If so, then I will allow you to continue to yell into that void as much as you like... but I do not think it will make you feel any better.

I'll try in good faith to break this down for you, on each of your points, but have no faith that you'll get it. Here goes...

How kind of you, but you do not use each of my points, and continue to misrepresent them so that you can try and play the scolding older brother role, it's actually quite pathetic.

Bullshit half statement. You state that basics are not better than medics, just systems with more basics and less medics. It seems to me that this statement speaks for itself, I'm not sure which part of it you're not getting? More basics and less medics means that, at least in some way, having more basics is superior to having all medics. Right?

Wrong again... clearly my stance has been that I think Basics and Medics work better TOGETHER... yet every time I write that, you ignore it and somehow come up with "I hate medics." Why are you trying so hard to contort my statements?

Perhaps it's possible that you mean that there is simply something pathologic about medics being in constant contact. I can't speak to that, though I have worked in such a system and found the opposite to be true, but will truly think about it, perhaps you're right, if that was your point. But we have no idea what part was your point and what part your 'clever trap,' so, how to tell?

The "trap" was simply the post itself, getting people fired up about an issue, and discussing it. I actually believe what I have posted, and have not wavered from it, but yet you keep telling me that I am and that I don't even believe in it...who's the arrogant one now Dwayne? Apparently you know what other people truly believe and what they don't.

Yes, it certainly is. But this is where I believed I began to see your arrogance. Why not simply man up and give YOUR opinion, an opinion that you would have to stand behind and be responsible for? Why simply give 'an' opinion, one that you can run from later by saying, "Ha! I didn't really believe that! I was simply trying to educate the children!" I have no respect for your education when you haven't shown to be brave enough to have an opinion. But that's just me. Or perhaps not.

IT IS MY OPINION AND I NEVER SAID IT WASN"T. I never claimed that it was not my belief, so I am at a loss to figure out why you think I am saying that it is not.

I haven't given you enough thought to take your ideas personally. What does offend me is people putting forth half efforts and half formed ideas and then running from them when called out. It teaches others here, and those that are new, to be cowardly and ignorant. There was a time when there was a whole cadre of the City that guarded against the "this is what I think" and then "But I didn't mean it! I was trying to teach!" crap...I still feel the need to shout into the void now and then even though those days appear long gone. I simply found your bullshit this time. Nothing personal.

Now you indulge yourself in a little nostalgia hoping that the inference of being an "ol' timer" will somehow make your argument make any sense. I still haven't retracted any statements, and I believe everything that I have posted, so your ridiculous attack of cowardly and ignorant, simply do not hold water. I never backed down from my statements, and I never did the"I'm trying to teach!" routine. Somewhere along the way you have made a personal value judgment about me... and that is your right to do... but I don't mind telling you that you are wrong. The fact remains that neither YOU Dwayne, nor Mateo have actually posted anything of quality on this issue and have decided to attack someone you "feel" has attacked the patch on your sleeve. When you finally do find that bullshit you are looking for, you will find it not to far away from your own bathroom.

Nah man, I can't imagine where anyone would get the idea that your attitude makes you appear to feel superior. This self serving assumptive nonsense should embarrass even you. I think you don't know my posts if you can write such silliness, but those that do might assure you that I didn't need to spend any time in a dictionary or thesaurus to struggle through your brilliant verbiage. It seems that there was a time that you had intelligent, productive posts at the City. What happened that you devolved to where you seem to believe that if a sentence or paragraph sounds pretty then it must also be logical? Surly you can see the error in that?

You've made your judgment.. c'est la vie... I can no more apologize for my language, as you can for your Paramedicine knowledge. I've never gone onto an ALS thread and called you arrogant for using correct medical terminology and appropriate treatment modalities. But I suppose I am not arrogant enough to do that. You, on the other hand, appear to be.

This thread doesn't have to be dead. Just bring your game brother. I'm not looking for ways to make you fail or appear impotent, I'm simply waiting for you to put on your big boy pants and step up to the grown ups table with your ideas. I ideas you believe in. Surly you have something that you believe that I can learn from?

I look forward to your thoughts.

So let me get this straight... I post my opinion, that uses the articles that this thread is based on as evidence... You tell me it is not my opinion, and go to great lengths to tell me that I am assumptive and arrogant... all the while you never actually posted anything of value germane to the subject. You are so caught up in trying to play the wizened elder states-man, you have totally forgotten the thread. So actually the thread was over the second you decided to get involved with your personal observations about my fundamental quality. If putting on "big boy" pants means grossly misinterpreting someones posts, adding no value what so ever to the conversation, playing the role of the chastising know-it-all (who doesn't have to make any sense, because he's a know-it-all), then I am quite happy to stay dressed in my onesies from the infant and toddler section.

As an aside... Thank you JPINV for the quote thing... I finally did it right.

Yeah, bullshit. I've been here a few days, read most of your posts, so let me see if I can come closer to the truth that you seem to proud of.

You made a bullshit argument without anything to support it, took Matty's good faith attempts to debate with you and wussed out on debating and tried to pretend that you were leading him around by the nose for fun without interest in education, and are now attempting to offer this as evidence of your superior logic and intelligence?

If that's all you've got to bring to the table then taking the rest of the year off is a great idea.

Unfortunately there are many here that will not demand that you make more than your silly 3rd grade level argument to back up your claims of superiority so you'll enjoy a few more pages of textual masturbation before it's over.

Good for you.

Dwayne

NOTE: Mateo is a kick in the ass at parties... Just sayin'...

Congratulations on being here for more than a few days.

My bullshit argument was the ONLY argument being made that had ANYTHING in the way of evidence to back it up. The two articles that were the crux of the whole thread. Your party-pal Mateo didn't come to the ready with any facts, figures, or information to prove his statements (more of the same ALS vs. BLS malarkey that I even put a disclaimer on my original post to say I was bashing the SYSTEM, and not PARAMEDICS), and I don't here you calling him out.

Yes, I was trying to draw people out into debate and confrontation... isn't that the point? Post things that people may not agree with so that different views and ideas can be shared... isn't that a form of education?

I am truly sorry if you and Mateo took these postings personally... it is regrettable, I only wish to have a little fun, and learn a few new perspectives at the same time. If you don't get the humour, or my humour is not humourous... well so be it. That being said, I have re-read these posts a few times, and am still at a loss to figure out how any of my posts could be misconstrued to say that Medics are more useless than basics... in fact I have stated exactly the opposite.

I was not "leading him around by the nose," nor was I claiming to. But I did post something that I knew would get some people fired up, hoping to have a debate. It did, and I complied with said debate. I don't know how continually trading posts with Mateo is "wussing out"... he still hasn't replied to my last one. If anything, after my first post it was Mateo who was leading me around. I was frantically trying to figure out why he so egregiously misunderstood my posts, and was attempting to rectify the misunderstanding.

I do not recall intimating at any point that I am superior to anyone. If you read into that because of my usage of the English language and some of the finer vocabulary terms that it has to offer... than I don't know what to say. I can not un-learn the language that I use. if you would like me to use simpler words and possibly write everything in lower case or maybe start writing a lot of grammatically incorrect run-on sentences that are devoid of punctuation so that you can feel better about yourself and don't have to be reminded that there are people that may know a few words more than you know so that i can now be judged solely on whether i know how to do cpr and i took 120 hr class and like to play with lights and sirens and man am i angry that those bastard medics dont talk to me... Nope can't do it. Sorry Dwayne. Intelligence is not judged by vocabulary, and by using it correctly I am not trying to make people think I am smarter than I am. I've routinely taken more shots at myself than I do at others... but I guess that in your mind it is just another way for me to prove my superiority.

Mateo didn't need you to stand up for him Dwayne, he was doing fine on his own. Maybe we would have even come to some common ground eventually. The debate that was going on was derailed by the "hurt feelings" involved when people take things personally. Honestly, there are no personal hard feeling at all from me to you guys, if you feel any toward me than there isn't a whole heck of a lot I can do about it.

Oh don't under estimate Peace loving, rights crazy Canukistanians .... Stupidity in Government is not exclusive to the US but when Canadians actually decide to fight it gets real ugly real fast !

cheers

Clearly, I did under estimate to vociferousness of the resident Canadians. I think that more attention should be paid to the union leaders, and the people in charge of running this strike movement. They do not appear to be as organized as they should, and a few of their work actions have been ill-conceived and easily countered by the services and the Government.

Trying to drum up support for extra pay during a world-wide economic crises is not always an easy road to hoe. The CBA at my place of employment just came up for negotiation. Having a near strike averted the last time it came up over insufficient pay increase, we advised the union to not muddy the waters by asking for pay this time, because there is no way that anyone would support us this time. Instead we suggested they go after a bunch of stuff that we were always having to give up because we compromised for pay increases. We are not completely happy with the outcome... but no one lost their jobs, and with a mortgage on the line... it's enough for me right now.

Yes, a basic can take PHTLS/BTLS a lot of services require it. As for more advanced course, such as ACLS, and PALS, you can take them for the knowledge, but probably won't get certified for be allowed to do any of the advanced skills. It would be mainly a course for you to get a better understanding of the procedures so you can be more familiar with the operations when/if you ever are put in the situation at work/volunteer.

Also make sure that your state allows you to take those classes and count them toward con-ed. I work in two states... one allows just about any class you take to be counted as con-ed... the other does not allow anything that is above your current level. For example, if you are a basic and take an ACLS class because you are interested, the state would not allow you to count it toward con-ed because it is not apllicable to your current license. Stupid... but true.

do you transport right after the rapid assessment or after the rapid assessment

Ummmmmmm.... I choose........ darn this is a hard one.... so... many... choices...

spenac- I believe it is time for a change... out with the old and in with the new. Your chosen handle has so many comedy options that I think that we of the City should endeavor to explore. My recommendation (based on a fortuitous typo), is "splenac." Pronounced splee-nack. Definition- The guttural noise emitted while in the act of hacking up your spleen.

CONTENT REMOVED - ADMIN

The media always tells me that the Canadians are our kinder, gentler, neighbors to the North. They are not supposed to be snarling, rabid, attack dogs who are ready to mis-interpret everything you say. It is clear that this strike is not going well, and is not being handled well by the union. Get mad at your own leadership for sucking... not us gluttonous Americans for pointing it out. Nobody gets their panties in a bunch when the US system gets attacked... because we know it works like shyte.

I was disappointed that so many fell for your trap.

I know right? I need to figure out how to set them better I suppose... It was too obvious. I am gonna have to start being sneakier about it... Or take the rest of the year off, like I usually do.

Damn. Have I become that predictable?

Either that... or I am incredibly perceptive...

I hope to someday figure out this whole quoting thing so that I do not make things so hard to read. I am sorry for my cro-magnon like attempts at technology. I am still trying to learn how to use this darn thing. Cut me some slack... I've only been a member since '05.

ADMIN!!! I need a tutorial!

What you did say was.....

Which leads me to believe that you are implying paramedics cannot make a proper decision. In this case, the basics know what they are doing, the paramedics not so much.

RESPONSE: That, my friend, is an exceptionally long stretch. One that is a product of your own prejudices... not mine. That is a statement that I would not make... because I do not believe it.

The alternative is that basics do not know what they are doing and just carry the patient because that is what they were trained to do. Paramedics on the other hand know what they are doing, but are just too lazy. This insults basics, so I doubt you would support it.

RESPONSE: That is exactly what I am saying about Basics... a monkey does what a monkey is trained. I insult basics regularly, it is one of my favorite past-times... you are still transferring arguments that you think I am having because of arguments you have had with other BLS providers in the past. Paramedics do not all know what they are doing, there are many bad medics out there, and a lot of bad schools. I will repeat that I do not think that all medics are lazy, but in my opinion (and in my limited experience), I find that the two medic system in Massachusetts can lead to laziness and stagnant thinking.

As quoted exactly by your previous post....

So, I surmise by your statements that BLS care includes Carrying People. To provide proper care to someone, I would think a combination of skill, ability, and education are in order. So yes, I think you are silly enough to equate lifting with EMS skill and ability. Obviously, paramedics are not as able to lift patients like the basics are.

RESPONSE: You surmise incorrectly. Mountain.... meet molehill.

My observation, whatever it is worth, has been that a large number of EMSers (medics and basics included) cannot recognize sick patients that should not be walking.

RESPONSE: Agreed whole-heartedly.

I only wrote two sentences worth. You sure did come up with a lot of BS from two sentences. Seems to be your trend with the last two posts. I'll go get the boots on, its getting deep in here.

RESPONSE: I did come up with a lot, I was hoping that a bit of abject buffoonery would convince you that I am not taking any of this seriously, and you would be smart enough to recognize it. If you have ever been involved in any threads that I have posted in you would probably have understood that my tongue is usually planted firmly in cheek. It is no accident that I was not able to draw out Dust or any of the other City veterans... cuz they knew what I was doing. I think it is enough for them to chuckle at my ridiculousness. When you are finished putting on your boots... I will lend you my shovel... for that was the point.

Maybe you are the one who is afraid of their place in the EMS paradigm. Is this another justfication for basics? You trying to tell us you are valuable because you lift better than paramedics?

RESPONSE: Again, point missed. Not about you... not about me... comments were about the two-medic system in Mass where the story posted took place. I am not trying to justify Basics.... you are the one making this an ALS vs. BLS argument, not me.

You already showed us by posting you are a doozie. I did not feel much more needed to be said.

RESPONSE: You must be a ton of fun at dinner parties... sheesh

And we are supposed to take your personal experiences as factual evidence. Provide something we can use besides the ALS BLS blah blah cry cry about we lift better than you do. When you can provide us with something based with facts, then we can have some intelligent discussion.

RESPONSE: I never quoted my experiences as fact. I did use the factual article that was posted, as support for my claim about 2 medic systems. No one is crying here my man. I think you are falling into the same old routine of ALS vs. BLS, when I am trying to say that I think that we are all better when we work together. I am arguing ALS and BLS should be paired... How is that a "vs." situation? It is not... but that is what YOU are trying to make of it. You are proving that you can read anything you want out of a post if you ty hard enough... and you had to try pretty hard to do it on this one pal. To quote everybody's favorite Big Toe, "Lighten up Francis."

Mateo -

I never said basics knew what they were doing and medics did not. I certainly implied that basics are more accustomed to, and do a better job lifting and carrying people down stairs. If you would like to think that I am silly enough to equate lifting with EMS skill and ability... then that is your prerogative. It doesn't make it true, but whatever tickles your chain young man.

I have no animosity toward paramedics... in fact have a tremendous amount of respect for the good ones. I do, however, have animosity towards laziness, and my comments were to point out my observations about the 2 medic system... not medics in general. There are just as many lazy basics out there... but their laziness tends to be toward assessments and patient care, and less toward lifting and moving patients.

It appears, dear sweet Meat-ee-o, that you are perhaps a little sensitive about your role as a paramedic. You obviously have some deep-rooted fear and hesitance toward your place in the EMS paradigm (probably suffer from a bit of Napoleon complex as well). I can not help you over come your emotional and psychological burdens... but I hope that your reading comprehension is not a skill that makes your para-medicine skills appear wanting.

BTW minus 5 for not being funny. I set myself up for any number of doozies with my last line... and that's all you come with? Goodness me Mateo.

Letmesleep - All credibility on your post was unserruptitiously negated with the use of the term "irregardless." You were making some good points... but they can no longer be taken seriously. Banish that term from your repertoire, and then we will be able to move forward amicably.

But to answer your question, I believe any good EMS system requires balance. If you have two evenly trained individuals working together all the time, who are focusing on the same things and working the same treatment modalities in their heads, things get overlooked and complacency sets in. I believe however that when you have two people who have different specialties working toward the same goal, less gets overlooked, and both sides get a chance to keep divergent skills fresh and in practice, or learn new skills that one didn't know at the outset. Having only basics in a system would be even more disastrous than having 2 medics... I recognize that. All I have been trying to point out is that a good system should have a balance of licensure and skills. Only working with people in your own level can cause serious gaps in knowledge and skills, and keep you further away from mastering your craft. And these gaps can and do lead to poor patient outcomes.

I award you no points, and my god have mercy on your soul.

+5 for getting the reference.

We are all dumber for having read this thread.......................................

The drama continues:

http://www.telegram.com/article/20090719/NEWS/907190373

July 19, 2009

EMT censures spur state action

By Thomas Caywood

The Sunday Telegram

WORCESTER, Mass. — In late April, Richard J. Markiewicz read a front-page Telegram & Gazette article about the death of Charles F. Rondeau, a 48-year-old city man who died of a heart attack in the hospital shortly after being walked down three flights of stairs by UMass Memorial EMS paramedics.

Mr. Markiewicz, who maintains that he, too, was made to walk down a flight of stairs by UMass Memorial paramedics while complaining of severe chest pains, in September 2007, said he was astonished to read a hospital official's characterization of Mr. Rondeau's case as an "isolated incident."

"I saw the article, and I was just completely flabbergasted," Mr. Markiewicz said in an interview. "I felt guilty that I hadn't called the state before. I thought, 'Oh God, am I responsible?' That's when I made the decision: 'I'm calling now.'"

Mr. Markiewicz's complaint to the state Department of Public Health was one of two lodged against UMass Memorial EMS in the days following publication of the April 26 article about Mr. Rondeau's death and the resulting state investigation.

Both complaints alleged that UMass Memorial EMS paramedics, as in Mr. Rondeau's case, had required gravely ill patients to exert themselves by walking down stairs — a violation of the state treatment protocols. Ambulances are equipped with a special device called a stair chair to carry patients when necessary.

The other complaint was lodged in early May by a city woman who, a state investigator determined, in May 2008 was made to walk down a flight of 10 stairs to an ambulance while suffering from what turned out to be a heart attack.

"It did appear that there was a pattern," said Abdullah Rehayem, director of DPH's Office of Emergency Medical Services, which regulates ambulance services in Massachusetts.

After the four-month state investigation into Mr. Rondeau's death, which determined the two paramedics involved attempted to cover up their actions, the DPH issued a stinging Notice of Serious Deficiency to UMass Memorial EMS. The action criticized the unit for serious, widespread and persistent problems that extended well beyond what happened in that particular case.

Then came the additional complaints, raising concerns that cardiac patients were being forced to exert themselves in at least several instances.

Hospital officials stress that such complaints represent a minute fraction of the roughly 30,000 calls the ambulance service's 75 paramedics and EMTs field during a year on average.

Even so, the hospital has moved aggressively and spent freely over the last three months to address the problems raised by the state investigations, Mr. Rehayem said.

More training, technology

"UMass has administered training programs to EMTs, and they have invested a lot of money into electronic collection of EMS data through a laptop technology. That will allow them to do more monitoring," Mr. Rehayem said.

In an effort to improve supervision of paramedics, the ambulance service also has created six field supervisor positions, a new level of management immediately over paramedics. UMass Memorial also has ordered five new ambulances, among other steps, officials said.

Dr. Walter Ettinger, president of UMass Memorial Medical Center, declined to discuss what, if any, disciplinary steps had been taken to address the problems cited in the state reports.

"We've done a number of things to improve what was already a good quality of care and to ensure that we're best serving our community," Dr. Ettinger said.

He pointed to the new, roughly $500,000 electronic medical records system for paramedics as a key improvement. The system allows them to quickly enter information from their calls into an electronic database.

Dr. Ettinger said the electronic system should enhance the quality of care because it allows supervisory medical staff to quickly gather and review data on calls dealing with a certain type of medical complaint, such as chest pains, or calls fielded by a particular paramedic.

In addition to the new equipment and new supervisors, UMass Memorial EMS required all of its paramedics to be re-trained on procedures for ensuring that the highest quality of care is provided, Dr. Ettinger said.

The DPH's Mr. Rehayem said his office is satisfied with the corrective action taken by the ambulance service.

In the case of the city woman who suffered a heart attack in May 2008, William E. Humphrey of Worcester, the lead paramedic on the call, told the state investigator that he ruled out using the stair chair because the woman was too large and heavy. The woman is not identified by name in the state investigation report.

Mr. Humphrey said he determined that supporting the woman on both sides as she walked down the stairs was the best means of getting her to the ambulance safely. The woman had to be resuscitated in the ambulance and again shortly after arriving at the hospital.

The paramedic told an investigator that the woman later called him to thank him for saving her life — the first time in his career that had happened.

Cardiac patients exerted

The state investigation faulted Mr. Humphrey and fellow paramedic Deanne Feeney of Hubbardston, both of whom were issued letters of reprimand by the state in July 2005 after another call, for walking a cardiac patient and for failing to bring their cardiac monitor and defibrillator into the home to begin treatment immediately.

The two paramedics will be issued letters of clinical deficiency as a result of the latest investigation. The letters will be placed in their EMT certification files for six months.

For his part, Mr. Markiewicz, who was out of town last week, had said earlier in a telephone interview that he's relieved to learn UMass Memorial EMS has taken steps to improve the care it provides.

The paramedics who came to his house shortly before midnight in September 2007 - Mark F. Wilson of Leicester and Christopher P. Cavan of Oxford - told the state investigator that Mr. Markiewicz was highly agitated and initially refused to go to the hospital.

Mr. Cavan told the investigator that the patient never complained of chest pain, according to the investigation report. Mr. Wilson said the patient complained of "chest tightness," but not of chest pain, according to the report.

When the patient agreed to go to the hospital, he hopped up and strode down the stairs to the ambulance without warning, according to the account of the two paramedics. They said they just followed him down the stairs for fear of discouraging him from seeking treatment at a hospital.

"That's complete baloney. It's completely untrue," Mr. Markiewicz said.

He said he knew something was seriously wrong when he called 911 because of the severe pain in his chest, but that the EMTs tried to convince him otherwise.

"They told me I was hyperventilating and that's what was causing the problem, and that I should just sit down and calm down," Mr. Markiewicz said. He maintained that he thought he had no choice but to walk down the stairs because he just wanted to get to the hospital.

"I was in so much pain. I questioned why I had to do that. They said, 'You're OK.' They said, `There will be one of us in front of you and one of us behind you.' At that point, I just wanted to get to the hospital," Mr. Markiewicz said.

"They never did any tests or anything in the house," he added. "At one point, finally, this guy started doing some of the tests in the ambulance, and I could tell by looking at his face that there was something wrong."

Letter of deficiency

Efforts to contact Mr. Cavan and Mr. Wilson at home and through UMass Memorial were unsuccessful. A letter of clinical deficiency, essentially a written reprimand, will be placed in their files for one year, according to the state report.

The report indicates Mr. Wilson has a "previous compliance history with the Department." The report doesn't elaborate.

The state report concluded that the paramedics violated the state treatment protocol for acute coronary symptoms, but the investigator said she was unable to determine if there were any other violations because of conflicting information provided by the patient and the EMTs.

Mr. Markiewicz had suffered a heart attack the night he was stricken, according to the investigation report.

Mr. Markiewicz said he called Stephen Haynes, chief of the ambulance service, in December and left a voice mail saying that he wanted to discuss his concerns. He said his call was never returned.

The Rondeau family earlier had told state investigators that Mr. Haynes also didn't return their telephone calls or take their complaint seriously. Feeling that their concerns had been blown off, one of Mr. Rondeau's daughters complained to DPH, triggering the initial investigation.

Mr. Markiewicz said he had called Mr. Haynes a few more times, but eventually let the matter drop as he focused on recovering from his heart attack, and then getting back to work.

Dr. Ettinger said that while the medical center has a "robust process" for handling patient complaints, all staff and managers in the ambulance service have been re-trained in what's expected of them when presented with a patient complaint.

The ambulance service has logged 10 complaints over the last two years, he said, but that number only reflects the complaints that were taken seriously and properly entered into the system, as all patient complaints should have been.

"We are doing everything in our power to make sure that happens. We are really taking that seriously," Dr. Ettinger said. "We have re-educated and gone back to all of our EMS staff and mangers and said, 'If you get any kind of a call with a complaint, we have a protocol for taking that down and following up on it.'"

Well... haven't pissed anyone off in a while... how about this...

Further evidence that a 2 paramedic system leaves patients with sub-standard BLS care (i.e. lazy paramedics that are not accustomed to carrying people).

*DISCLAIMER* I am not saying all paramedics are lazy... but having worked in the Mass system of 2 medics for 911 trucks... and having worked in NH and Maine where a medic can be a medic regardless of their partner... I find that the 2 medic system breeds laziness that far too often leads to poor patient outcomes. So all the Medics on the city can now clamor about how you have never shirked your responsibility as a medic, and would never do as these medics have done... but it does not negate the fact that it is happening, and at a high frequency in this 2 medic system. *END OF DISCLAIMER*

At least if two basics were there, they would not hesitate to carry the poor people down the stairs. This is why I prefer systems with BLS first response and ALS intercept trucks. ALS gets to do ALS, BLS gets to do BLS. As my father always said... stick to what your good at. He also used to tell me, "Son, there are no stupid questions... just stupid people." Don't know why he said that to me all the time...

I have never liked math. I find it tedious and it gives me a bigger headache than when I shot-gun Slurpee's. I can not even take any enjoyment in this attempt at Math humour (Canadian spelling). In fact... Math, and Humour, should never be involved with each other... they are mutually exclusive terms.

RichardB- you should be ashamed of yourself!

In RT and other areas of the hospital, we get a little more descriptive with breathing and will use DOE which is Dyspnea on Exertion which indicates the patient is fine until he/she moves.

I currently use DIB in my paperwork. I really like this DOE... thank you for mentioning it Vent... I will endeavor to use it the next time it is appropriate... then maybe the RN's will respect me... telling them about my BMW didn't work...

But Help me out here first splenac ..

I don't know why... but I've gotten quite a bit of a laugh out of this line... splenac... that's funny. I have nothing of value to add to this discussion... so please ignore me.

Okay, I really don't know if people are not bothering to read my entire post or being deliberately obtuse and antagonistic. I thought it was pretty clear. I don't give credence to anonymous complaints in that I will not accept them as true and discipline an employee based on them alone. I thought that was pretty clear in my second paragraph. I look into them, I'll review the applicable video if it exists. (my units have patient and dash cams) I ask about them, and if the employee fesses up, then I act on it. But I will not ever put a black mark on an employee`s record simply because some ex girlfriend is trying to start some trouble to make his life difficult.

Obtuse and antagonistic?..... Are you talking about me again?

I use the scoop all the time. I prefer it to the LSB. Also any suspected hip or pelvic fx is getting it over the long board.

Actually, the scoop is my favorite piece of equipment on the ambulance... my post was more a commentary on the lack of familiarity that most in EMS have with some of the equipment that could make their lives a lot easier if they knew how to use it.

I believe there was a thread a few years ago started on what the most undervalued piece of equipment was... and my answer was the scoop... but my memory is a bit foggy these days.

I use the word 'retarded' regularly, just not to identify people. Retarded: To cause to move or proceed slowly; delay or impede. (www.answers.com/topic/retard ). The same as I refuse to stop using the word 'queer' simply because some have chosen a new, inaccurate definition. Some things or processes are retarded, or delayed, and some things are queer, or unusual.

I disagree though when you state that retarded is a term you'll heard used in professional circles to define individuals. For instance, if my doctor said, "Dylan's social skills seem to be retarded." it wouldn't so much as cause me to blink. But if, on the other hand he said, "I can see Dylan is retarded because he has limitted social skills." I would immediately get a different doctor, as the use of retarded to label a person instead of a trait is very much out of favor with those that make their living with such people.

Do all of these professionals choose different language because they are slaves to political correctness? No, simply because it's terribly rare to find an entire person that's 'retarded.' Traits or behaviors? Happens all the time, I have many such (some might say most), traits. But people? I haven't talked to a professional that has been so ignorant as to believe that in at least a generation.

Dwayne

As far as I have been discussing this thread, it has been for documentation purposes only. The original question was for a PCR, and when I asked my wife... it was qualified with the use for documentation. Most professionals do not use the term Mentally Retarded in conversation for the stigma that has been associated with it... and shortening it to "retarded" only worsens that perception. I would hazard a guess that many of these people who would not say the term in polite company, or even when discussing it with family, do not hesitate to use it on the clinical evaluation sheets that they produce. It is used much more than you know or hear.

Well, I know it is not the KED or the Scoop stretcher... cuz no-one ever uses them!

My money is on the door catcher in the top-middle of the rear door that I smash my head or back on about one-third of the times I get in or out of the ambulance.