strippel

No easy button. Damn. I guess then you can't thank them for playing, and send them all home with a years supply of Turtle Wax, and remind them to spay/neuter. Are there helipads at either community hospital? When you tell your dispatcher to send you "everyone", you could have the further away services report to which ever hospital does not have a helipad, or to the landing strip. Have the dispatcher notify the community hospitals to consider extra help in the ER. Have them call the landing strip, and leave the light on for you. If they decide to close, and you have resources going there.... Besides that, you are screwed no matter what. If you are a paid service MICU, you have 2 providers. If you had a third, you would be livin' large. I like the idea of putting the walking wounded guy in a KED, and in the front seat. Take your LBBs (hopefully you have more than 1, and the off going crew did @$%^ you) and scoop/reeves, and take the 3 remaining "accessible", and currently living patients, immobilize them, and throw them into your warm truck. After that, you are damned if you do, damned if you don't. I'd start driving, probably toward either the hospital (with a helipad), or to the landing strip. I would have to know there was someone there, and helicopters on the way.

About 2 years ago, we tested the Zoll, Phillips, and LP12. The staff and management voted for Phillips, but we got LP12. All of our hospitals have Medtronics, transfer of care is easier. Medtronic threw in 2 of the fax receiver stations for hospital 12 lead transmission. Very competitive pricing on LP12, full bells and whistles (10+). Hugely decreased cost of consumables. Lots of free education. All other services in the county either have old LP12, or are buying new. Service is good, and support is great. We got LP12, and have been happy.

Got dispatched today to our local mall for an injured person. Our additional was to respond to the department store entrance for an 82 year old female who fell, and has a head injury. We respond to said store, and are then directed to the parking lot. The patient and her friend (also elderly) are in a legal parking space, some distance from the mall. A mall employee arrives, and directs us to the vehicle. The patient is sitting in the front passenger seat, showing us a bump on the back of her head. She was on the escalator with her friend, when she turned just prior to reaching her floor. Her moving feet caught the stationary floor, and she fell. Luckily, her friend caught her by the arm, preventing a nasty spill. But her head still hit something. (She shopped until she dropped...sorry, I couldn't resist). After the fall, she stood up, she and her friend walked to the car. They started driving, and exited the mall looking for lunch. Her headache increased, so as they left the mall for the highway. They called her FMD so she could make an appointment. The office was closed ( for Aardvark day*), so they left a message. As they were driving toward the FMD's office, someone from the office returned her phone call. The told her to return to the scene of the fall, and call 911.?!?!?!?!? She walked out of the scene, and sat in the car. She was being driving toward her FMD, and multiple hospitals. Since the patient was alert and oriented, why didn't they tell her to drive to a local hospital??? She could have been at a related FMD's office or a hospital, and being seen, by the time we arrived. ??? *(Aardvark day. Any holiday, usually celebrated by school teachers. It is not a federal, state, or local holiday. It is only a day that a selected group of (union) people get a paid holiday off, for no apparent reason., and you need to find day care for your children.)

My friend David (the paramedic) was called an "ambulance driver" yesterday by a long retired physician. She had been improperly care for, and forgotten in the personal care area of a local ECF. I thought his head would explode.

If you are willing to go a little further east (South-Central Harrisburg/Lancaster), there are openings, and offers are very lucrative. As far as command, meet with the boss, then our MCP, pretty mellow and laid back. For protocols, [web:cf27ef19e6]http://www.ehsf.org[/web:cf27ef19e6]

I was actually able to talk with the charge nurse today in our ER. She used to be an EMT with our service, and still has understanding of EMS. Even though the staff gets rapidly overwhelmed, and pissy, she did realize that at least at our service, we try offer up hospital choices to the patient. Others do not. As of 0700, there were 21 holds, waiting for beds upstairs. There was only one regular female bed available in the hospital (400+ beds). They were not on divert. She told me that a certain ALS service was actually transporting cardiac patients to her hospital (on divert), bypassing two closer hospitals, including the one affiliated with that service. At least two of these patients wanted to go to the closer hospital, and were convinced not to. (Both those hospitals have full service ERs and ICUs, and limited cath labs. They do not offer OHS). Then there was another service who transported a patient to the only hospital that was on divert. She wanted to go to the other hospital, and requested that hospital. That was where her physician and all of her records were. She was fully alert and oriented, and very angry. EMS took her to the hospital they wanted to go to. The hospitals are only 6 blocks apart.

EMTs 9.50-15 Medics 13.50-20 Central PA, the cost of living is less than Eastern PA.

I frequently tell my supervisor, "Go to HE(LL), Bob". As was already stated, it is in how you tell them. Luckily, I don't have trouble with my partners and their treatment selections. We have all worked together for many years, and easily get on the same wavelength. But, there are many times both of us do not get the full story from the patient. Since we are a 2 person crew in a busy system, one of us might not get the whole story. So we talk, and relay information frequently. There have been times where my partner didn't hear the "near" syncopal episode, or the period of chest pain with radiation, or the fact that the patient is diabetic. How I relay that information to my partner helps them determine treatment. With many patients, you have to ask questions a few times, different ways, to get good info. We often get "the hospital has it all, why do you need it?" If I happen to be on a BLS truck with another service, there are some medics I will tell what to do, and how to do it. Some are competent medics, with HORRIBLE inter-personal skills, who need a dose of humanization. Some are just not good medics, and you need to give them a clue.

Well, I can tell you that you will have trouble getting info from Chester County, PA. EMS is provided by multiple agencies. Some are still hospital based ALS, some are independent EMS (both ALS and/or BLS), but most are volunteer fire companies. You will frequently get multiple agencies on a call. Separate ALS (either chase or MICU), with a BLS transport, and maybe VFD Quick Response, or even a helicopter. It is a VERY fragmented system. Check here... [web:7a67ca2623]http://dsf.chesco.org/des/site/default.asp[/web:7a67ca2623] or here... [web:7a67ca2623]http://www.chescoems.org/[/web:7a67ca2623]

Staff at both our local ERs do not understand divert. For the longest time (despite our education efforts), they believed that if they were on divert, no ambulance patients could come in. As mediccjh knows, in PA, divert is a "courtesy" from ambulances to the hospitals. I had one staff member at a local hospital ask me why we brought a patient there. She thought that dispatchers divided calls equally between our 4 county ERs. Boy, was she sadly mistaken. Her co-workers (many new, not from the area) ganged up on my partner and I. They could not believe that (gasp!) the patient actually made the choice. My service, being "overseen" by three of the four county hospitals, we have to ask the patient their hospital choice. It that hospital is on divert, we must "educate them", make them a good health care consumer, and then offer them another choice. If the hospital they want is on divert, then so be it. We still get yelled at. Other services just take the patient to their hospital of choice, without offering up options. One hospital sees over 60% of ER patients in the county. Some would be willing to go elsewhere, if given an option. When those 60% of patients are in beds, the 5% who really need to be at this particular hospital have delayed care.

It has always been state law here, each vehicle (and crew) on scene has to write a PCR. Back in the old days, BLS was volunteer, and ALS was hospital based. Each wrote their own PCR. Obviously, the BLS providers did not write any ALS skills, only documented something like "ALS care provided by Medic 2", then wrote what they found, and their care provided.. There are sometimes we have an ALS unit, BLS unit, and a fire department (state licensed) "quick response unit". In that case, 3 different PCRs are generated, one for each service. There was one volunteer service that decided to start their own ALS. Due to still having volunteers, the medic was given an SUV, both responded to ALS dispatched calls. The volunteers did not like writing PCRs, so they decided not to, since THEIR medic had to write one anyway. So they didn't. First, the billing company got upset, and tried explaining that they needed to produce 2 PCRs. One for the ALS services provided (different vehicle, additional crew member), and one for the BLS transporting volunteer ambulance. The volunteers did not like this, so many boycotted writing PCRs. "That is why we have the paid medic", they argued. After a while, the billing service convinced the manager that 2 PCRs were needed. So the manager convinced the volunteers to write a PCR. BLS PCR consisted of times, patient name and demographics, and "see ALS chart". Billing company was still upset, but... Finally, the regional council saw "missing" PCRs, and way to many with "see ALS chart". A nasty letter was sent, and now a PCR is written for each. Bottom line, unless your ALS provider belongs to your ambulance association, fire department, or rescue squad, you need to create your own PCR. If you bill, or not. If your ALS provider is your own, check with the DOH.

Full setup for anything non residential. Residences based on dispatch, bag only, if that. The truck is my workshop, not the floor of the house.[quote]That is what I am talking about. "We have one medic who likes everything on the litter, and to take it along. Luckily, she does not do that with me." Don't want to be rude in saying this, but if the Paramedic wants to take everything in, there is probably a good reason for this. Correct me if I am wrong, but we DO work for the patient at a time of need. If there is any doubts about what is going on, I surely hope the medic will error on the side of the patient. It isn't hard work to take everything in. I am sure we have all been caught with our pants down once or twice in our careers. We learn from our own mistakes!

If we are going to a residence, the litter does not leave the truck, until the patient is ready, and willing to go. No use creating more work for yourself, partner, cop, hose monkey. The litter ONLY leaves the ambulance (was going to say BUS) with equipment on it, if we have been to the building before, and know the layout, and if there is room. High-rise apartments, ECFs, large office complexes, put the stuff on the litter, and drag it along. Same if it is a serious crash. All other times, it stays back in the truck until we are ready for it. It is usually just my partner and I, maybe a student, volunteer, or observer. If we are lucky, a cop might show up. We don't hose monkeys very often. Why create more work. We have one medic who likes everything on the litter, and to take it along. Luckily, she does not do that with me. I don't want to chase it down the block, because the the Kwality Ferno brakes failed.

We have protocols that state when we must get a BGL. But, it is company policy at my full and part time to get a BGL with any IV start. We take the blood off of the retracted angio. Any POSSIBLE diabetic gets a BGL all of the time, IV or not. (Meaning if they are alert enough to eat or suck glutose.)

"Don't delay transport". Back in the day, it used to take 20+ minutes to get to the scene. ALS was responding from....somewhere in the state, and had another 10+ minute ride. Then there was a 30-50 minute trip to the hospital. Paramedics used to scream that on the radio for almost every call. Sad part was there were many EMTs who didn't get it. Don't have that problem now, as most ambulances are ALS. Volunteer fire department "medical assists". One area where I work is very suburban, bordering on rural. If you need a little help (more than just our supervisor), you call the VFD. At least 3 stations are dispatched, 6 guys with 8 fire trucks show up. One FF helps, and the rest stand there and watch, and talk. They all have radios, and use them, a lot. Then they call fire police for traffic control, because another 20 guys showed up in their POV with blue lights. We leave the scene rapidly, there is apparatus and fire police on the scene for another half hour.

Here, it is well advertised that all county inmates (long or short term) are responsible for their medical costs. Sometimes, those who need maintenance meds (like seizure, htn, and ARC patients) go without. Diabetics are well cared for.

You stop your truck, get out, and tell them. Period. It used to happen frequently, but now, not so much. I stop my ambulance safely, then walk up to the driver, and nicely explain. I have had to tell people that they were stupid, and will die if they continue. Many years ago, had one who just wouldn't listen, after I stopped twice. With a critical patient, I slowed down, and called the Po. Luckily they were available, and detained him. With overly excited family, I am pro-active. They are usually related to the patient who can walk to the ER, and have a good tooth to brain cell ratio. We did have a family that "passed out" while following, and crashed into a tree. Luckily, the bus was driving normal speed with a "routine transport" to a specialty center, no RLS. Crew stopped, and called for help. Luckily, nothing serious.

I'm with Dust on this one. I would not report it. That could turn into a legal nightmare for you, and your department. Not to mention, if they are trafficking... could lead to danger.... I might mention it to the police in passing. I have done that before. But, it has no legal basis in your chart. I would make reference to the patient using drugs, that is relevant to his care. Maybe even to paraphernalia. If you tell the police, they would need an official statement, and then they would have to get a search warrant. Would you want to be called into court to testify against them? Or, how would you feel about them sending in a SERT team with a warrant, then finding nothing because it was all cleaned up. I am all about watching each others backs, but.. That is why our police try to respond on medical calls. They help EMS, and can do some looking around.

We have a minimum of 40 hours (for tenured people familiar with EMS in our area) to 80 hours with an FTO. That is after a pre-hire test. There is then a post hire test after that; it is similar to the NR. If they do OK, but not pass, they may have another 40 hours. If they don't pass then, bu-bye.

Today I went to the driving range for two and half hours. :wink:

Rid, we give verbal report to the nurses and doctor. Neither we nor them need anything signed, unless narcotics are used by command, and not protocol. Our ER does over 80,000 visits. They do not want, or get anything written, until EMS has time to write the chart. We deliver ours by hand, all other services fax, if they send at all. If the patient is from an ECF, they get copies of all paperwork provided. Most charts usually do not make it to the patient record. (Yes, I worked IS [information Services] inside the hospital. Loose attachments, EMS charts and anything not produced by a hospital computer system, have a pretty slim chance of making it to medical records. We have never been told of a time frame by the hospitals. Most times when charts are delivered (either by the crew at that hospital, or supervisor), the ER staff doesn't want them. I have seen them get thrown away. If the patient is a trauma, the TS manager needs the chart by the beginning of her next work day. She will track you down.

No place where I have worked did they allow you to write from home. You must be paid for timed worked, and outside access of the computer system is a bad thing. Our charting program is internet based (2 different jobs, different counties, same program). I can only access the QA portion of the program when not at a station. That is on the software company's server. We do have many people who work more than 1 job. Email is a good way to type your narrative. Then you can cut and paste. Yes, it is nice to limit your covers and scratches. In our case, we are city EMS, and the hospitals are in the city. Other agencies get dispatched to cover, but are further away. Usually. If they are closer, they can have the call. With over 22,000 plus inter-facilities, we can miss a few. Back to the original thread. When we have downtime, like today, we clean and restock. We also watch TV and rest. We recently got new con-ed videos, and have been watching them. This morning, I finished my charts from yesterday, following the company and DOH 24 hour rule, and we are resting. So far in 8 hours, we have had a vehicle accident with no injuries. One other truck hasn't turned a wheel. Others have been busy. We currently have 3 on an MVC with entrapment, covering another service.

"You do charts hours after dropping off the patient?" Yes. You write charts when you can. You are available for calls after patient care is transferred and the truck is restocked. When you do 22000 , some days are pretty busy.

I work in a small city. We have stations. I was able to log onto the computer and check my mail, read the local news, and type one chart. My partner was down 4, and me 3 when we both left. Since she can type, she was actually able to finish a few. At one point, I did attempt to turn on the TV, but it didn't work. Luckily, Plant Engineering (this station is at a hospital) had the TV fixed, because it was on when we stopped by to restock. Didn't see what was on. Yesterday was bad. We have 9 trucks day shift, and they were all busy. Our primary hospital was on divert, holding 32 in the ER for admit. The other hospital was pretty full, and the staff busy, attitudinal, and angry. The hot nurse was nice, and actually apologized for being pissy.

I want to wish you luck. If your private non-profits are anything like ours, they will fight to the death. Or until the wallet starts running dry. That is why no out of the area, or for profit service has ever made it up here. Since I don't live far away, and probably even have family in your "district", keep me in mind.