mikeymedic1984

My point would be that the Constitution is a living/breathing document; as brilliant as our founding fathers were, there is no way that they could forsee today's issues from the view of the 1700s, which is why we have amendments to "upgrade" as times change. I agree that everyone should have the right to bear arms, but there is no reason for an ordinary citizen to own an assault rifle. You have the right to free speech, but you can't yell "fire" in a crowded theatre (not sure why that would cause a panic these days). So I am a Republican (really prefer conservative) who is for common-sense when it comes to gun ownership and rights.

So here is a scenario (a real one): You pick up a mentally ill ETOH patient at the local pay-by-the-week motel. He would be homeless, but he draws a disability check that keeps him in motels and booze. Patient is depressed, and has been in and out of psych facilities several times per year. His psych facility has granted him admission, and he is seeking transport to the psych facility. All of his worldly belongings are in his hotel room, which he demands to take. Upon arrival at the facility (which could just as easily be the ER for those who dont do transports to a psych facility), they notify him that they are going to search his belongings, to which he replies "my gun is in that green knap-sack, its in a black zip-up case". Staff takes the weapon, puts it in the safe, and acknowledges that they have accepted it and all other valuables on a sheet of paper that the patient and staff sign. After the patient is taken back to the triage area, you inquire as to what will happen with the gun. The staff advises that as long as he is not suicidal or homicidal, they have to give it back to him upon being disharged (it will remain in the safe until then). Question 1: Does EMS have the right to search a patient's belongings in this situation? Question 2: Mentally ill persons are not supposed to be able to own firearms, but what constitutes mentally ill ? Depressed, Bi-polar, Schyzophrenia, Manic ??? OR IS IT JUST SUICIDAL AND HOMICIDAL IN YOUR STATE ?? QUESTION 3: Would you report this patient to the police ? Would they do anything about it if you did ? There is already a thread on here about what EMS personnel should do regarding the transport of a weapon in the ambulance (if known about), so there is no reason to rehash that arguement. Just wondering how this is handled in various areas ?

Base your decisions, plans, and goals on what is best for the patient from the EMS perspective, let hospitals worry about their profit or lack thereof. When was the last time your local hospital ever did anything internally that helped the external EMS community ?? They run their company based on what is best for their organization and patients, you should do the same.

Sorry, didnt have time to read the whole thread, so much of this may be duplication. 1. Your state laws need to change, a Physician should be able to commit these patients without going through the judge, and I am shocked that your hospitals are discharging them without proper psychiatric consultation, that is a big liability. 2. In most states, law enforcement provides the transport to the psych facility, although ambulances are allowed to do so in many states -- you have to check your state law. 3. Most in-patient psych facilities will not accept a patient from the field, they have to go to an ER first for "medical clearance", then there is the whole insurance issue. So your idea of bypassing the ER is probably not feasible even if the distances have changed. 4. The best solution I can think of for you, which probably requires more work than you are willing to do, is to bring all the players together (Psych facility, ERs, Law Enforcement, EMS) and hold a summit on the entire issue. Possible solutions would include "out-patient crisis clinics" in your area that these patients could be referred to, which could be a profit center for the psychiatric hospitals that they have not thought of. In medicine, we tend to only change things when our payors (insurance) demands a change, otherwise we stay with the status-quo no matter how dumb or painful that is. You might have to involve a congressman to bring this kind of group together.

Back in the 80s: Two man stretcher, you had to lift from ground. Lifepak 1, weighed about as much as a console TV, no 12 lead, CAP, BP, or end tital No Pulse Ox No Glucometer No spider straps or headblocks, made from rolled towels No cell phone, pagers came later Backboards were made of wood, we made them ourselves If you had "911", AA medics, or females, you were in the big city All codes started with 2 amps of Bicarb and Epi Main O2 tanks were M cylinders and were stored under the squad bench (lift that) In the yellow pages, you were the bomb if your ad said "Radio dispatched, Oxygen Equipped" PS: Roy and Gage were GOD

http://bostonherald.com/business/healthcare/view/20220924ambulance_operatorchasing_payments_amr_claims_blue_cross_members_owe_3m Although this is an article from Massachussets, this is happening country-wide; your billing department may not have caught on to the problem yet. Blue Cross Blue Shield has pretty much taken the position of sending ambulance reimbursement checks to the patient instead of the ambulance provider, at a very discounted rate, if you are not a "preferred provider"(which means you have to sue most of them to get your money, as they spend it right away). To become a preferred provider you must agree to drop your rates to Medicare rates, which is usually means a loss for your company. I imagine other insurance companies will follow suit if BCBS remains successful at this practice. If you are a 911 provider that is tax-payor supported, you probably do not care, but if you work for any type of corporate or private service this is a very scary tactic that could cripple our industry (if Obamacare does not do it first). Ask your billing department if they have noticed the drop in BCBS claims being reimbursed ? But on the flip side, is it fair for BCBS to have to pay more for the same service than Medicare pays ?

I would go get a copy of your medical records before they have a chance to alter them and add "Physician Notes" like he really saw you; then I would follow up with whatever regulatory body your state has to oversee Doctor's offices and hospitals. If such a thing exists ?As far as the bill, there are ambulance services that charge just as much to transport someone less than 10 miles. That's the american health care system, jack the price up 4 times what it should cost so that the people with insurance pay for the ones without insurance.

We had it happen to one of our trucks too, but they were not on an emergency. There is a hospital in the hood, where the only decent/safe restaurants in the neighborhood are inside the professional building connected to the hospital, but like most urban hospitals you have to pay to park personal vehicles. People tend to park at the gas stations across the street and run in to get a quick meal. There is a guy that sits there all day, just waiting to boot your vehicle if you do not walk into the convenience stores or buy gas. It's like $80.00 a pop, so no telling how much he makes in a day.

He had been drinking, drinking for years, which lead to his liver disease. The high ammonia level usually results in altered LOC, but not arrest. The causes of arrest could be any of hundreds. The good news is that his heart/vessels were probably pretty clean due to alcohol abuse, so his heart responded quickly to treatment, versus a patient who has had years of heart disease that may not have responded (similar to a young patient who arrests due to asthma).

This does raise a good question. What most people do not understand is that your "RIGHTS" protect you from the government, not your employer. I can stand on a street corner as a citizen and say pretty much what I want, without fear of the federal government stopping me. But if I stand in the middle of a corporate office building where I work, and say the exact same things, I may very well be fired. So the question is, what happens when your employer is the "government"?

I am in no way supporting this policy, but let me explain the changes I have seen since cell phones were added to ambulances: When I started on a 24/48 there were no cellphones, some of us had pagers. Somehow we managed to go a whole 24 hours with only makeing 1-2 personal calls. That is no longer the case. Be honest, have you witnessed any of this: 1. Talking on phone (personal call) while driving an ambulance. 2. Texting on phone while driving ambulance. 3. Stupid, stupid, hour long conversations between your partner and whoever. 4. An actual yelling verbal fight over a cellphone that everyone can hear. 5. Texting while patient-loaded 6. An embarassing ring-tone goes off during a critical call. 7. Someone actually answering the phone while patient loaded 8. Inappropriate conversation between lovers (one-sided) 9. Obnoxiously loud people who think you must yell to be heard on a cellphone. 10. Non-stop, ringing, buzzing, and alerts from a partner's phone who gets a million calls/messages a day, none of which being worth the time and space it took to send.

Although 24's are still prevelant, many services offer other shifts (8, 10, 12 hours).

Back to your original question: 1. As suggested work with him and observe his behaviors and treatment before you judge. 2. Suck up to him, tell him you want to learn from him, realizing the book knowledge you have gained is about 1% of what you need to know. Sounds like a burn-out, who needs a different career. 3. When you see something questionable, wait until after the call and ask him about it face to face in a calm and private manner (You know, they told me in school that anyone with a glucose of less than"x" should get D50, but you gave oral orange juice, Why ?) 4. If he is a burnout worthless slug, explain to him that you will not tolerate any behavior that puts your job/license at risk; start making a private list of your concerns that you can take to a supervisor shift 1, didnt take B/P on refusal pt, shift 2, didnt immobilize someone I thought should have been, shift 3, told radio there was no patient at the scene and went 10-8, when there was a drunk homeless pt there). If he is worthless and cutting corners, he needs to be counseled and set back on the right path. It makes the supervisor's job easier when he has a documented list that is somewhat verifiable by witnesses, than just listening to you say he is "lazy" and you want a shift change.

Maybe a spinoff question, but I think it is related ? Do you accept discounts for food at restaurants ? Many in my area offer up to 50% off to all in public safety, it used to be more, but as usual every off-duty public safety person got in uniform and drove to the restaurant to get discounted food for their family. I would have no problem accepting something like what has been described by you guys from a bystander/family, I just would not ever accept cash (which I have been offerred). People often bring stuff to the station (usually food) as a thank you.

Sorry if I am echoeing something that someone else already posted, but this was probably more of a billing situation, than a territory situation. Once you enter a hospice program, hospice is responsible for most bills, Medicare will not cover ambulance transportation of a hospice patient (except for the original transport from hospital to hospice/home -- and they typically deny that claim at first because they see the admission to hospice date as the same date). So it is likely that the hospice representative called the service that they contract with to do the transport. The private service I work with part-time has several contracts with hospice agencies, and it is not uncommon for us to go into someone elses 911 zone and handle the transport.

Well I guess you educated me to a difference that I had not thought of -- If someone signs a contract and knows this info up front, then I guess shame on them for being stupid. But does AMR really make everyone sign a contract, or is it just a policy that you find out about in orientation, after being hired ? I see your point AK, but how would you feel if all the 911 providers around you had the same no compete clause, making it impossible for you to hire anyone close ?

I see both sides from field and management, equipment is very expensive and if you work in an urban environment it is not uncommon for your well-marked equipment to get pilfered by one of the flybynight services. On the other hand, patient care comes first, and often times the patients who would need this equipment may not be released from the equipment immediately. If they are asking you to wait on the equipment, I am guessing you are a rural service, as no busy urban system has the time to "wait". Either way, my suggestions: If rural, talk with your local air-ambulance provider, and see if they will retrieve it and take it back to their station; Air-methods did this for us, as a courtesy when they had competition they were fighting. I am guessing they just had a guy in a truck who went around once a week and rounded it up from all the trauma centers (usually the distant facilities, we would go to local ones frequently each shift, so no issue). Rural or Urban: Report equipment left to dispatch or your supervisor, and the supervisors should make a daily (nightly instead of sleeping), weekly, or biweekly drive to round it all up. Paint (or order) your equipment in an obnoxious color like neon pink so that no one wants it, and so that it is readily noticeable on other trucks. Lastly, you guys should report that you are waiting on equipment (stating ER said it will just be another 10 minutes, then another, then another) and then always or frequently report that it is contaminated and you will be delayed while you are attempting to clean. After about two weeks of long ETAs because you are stuck at the hospital due to this policy, I imagine a supervisor with sense will make the other supervisors get off their ass and do something besides write policy.

They are not going to cte that as the reason, because they would be sued, but I bet you are a victim of age discrimination. Thoughts that could be in the younger manager's head: you could be more likely to be a work comp problem, you could be more forgetfull, because you were trained so long ago, your skills may not be up to today's standard; or more likely: the younger manager fears you are smarter or more experienced than them ---- I bet discrimination is at play. Try for training/instructor jobs instead of EMS jobs. Sad but true.

Do you not have signed contracts for a period of years ? If one emt could wreck your contract, did you really ever have a good relationship with your facility ?

Also remember that even if the EMT course was 3 years long, there is no school that can teach you everything you need to know for the rest of your career; you have to get experience and continue to learn along the way. Even if they taught you everything, and you absorbed everything in 2012-2013, you will need to learn something in different in 2015. Just because the EMT class is a diploma mill does not mean that is the only education you are limited to.

http://articles.courant.com/2012-09-15/business/hc-amr-paramedics-suspended-20120915_1_ambulance-service-amr-paramedics-life-support-services I know this has been around as a topic since AMR's existence, but really ? Are we working with top secret nuclear codes here ? Is this fair ? Is it legal ? Is there anyone at the competitor who does not know which contracts AMR has in their area ? I wonder if they have any problems hiring medics who work for another 911 municipal service ? What secrets could the average EMT divulge that would hurt AMR ? Someone from AMR please help me understand ?

The machine already exists, and has for some time, as listed above. Your challenge will be to create a smaller version of the machine, that is idiot-proof, while remaining economical. Most public buildings are still not properly equipped with AEDs, which cost less than $2k. To get a business/government to buy both for their building, or choose your machine over an AED, is going to be a tall order. That is if you can afford to meet all of the federal requirements since it is a healthcare device. I think your time would be better spent creating something that would work in an ambulance/field, as you would have a better audience for such a machine there, if you can create something that is better than what is already on the market. Just my two cents: Cost is going to be your "10" item, it would have to be cheaper than an AED. "9" would be it would need a way to monitor the heart like an AED and give voice commands to a layperson with no medical experience. Imagine I have a seizure and I am unconscious, but have a heart beat, but Joe Blow slaps a machine on me that starts doing CPR. Lawsuit for you. "8" It has to function perfectly on all shapes and sizes of people. Get through those three, then worry about everything else. If you still have time to change your topic, design a better ambulance. For years we have been slapping hand built boxes on the back of pick-up truck bodies. Like UPS or the Icecream man, we need a vehicle that is designed for our line of work.

Talk to any fixed-wing flight medic who goes to pick these people up in foreign lands, ALWAYS buy the trip insurance and make sure it covers air-ambulance.

Since we left the "federal Q" days a long time ago, it seems most ambulances still use the same "siren" that makes the same 2-4 sounds. I wonder if it is time to change it up to something different ? If you did what would you change it to ?

I am not sure how the Deptartments of Transportation determine where to put these in every state, in mine, they tend to put them at major intersections that have long delays, where 3-4 cars will block an intersection (trying to turn left usually), and then turn after the light turns red, or remain in the middle of the intersection, blocking it for all others who just got the green. Other municipalities in the area, just flipped the sequence of the lights instead of red, green arrow left, green straight ahead and then yellow, to red -- they go red, green straight ahead, then yellow, then red, then left green arrow (accomplishes the same thing but does not produce revenue). I usually go to the far left in the opposite lane (remember its a major intersection, usually with high concrete dividers or islands, and everyone ahead of you is stopped with nowhere to go, so why try to force them into an intersection where they are running a red-light ?