JPINFV

The county medical director where I live is the individiual the runs the system as a whole, including the requirments for EMT and paramedic licensure, service licensure, and hospital licensure in regards to the EMS system ("paramedic receiving centers" and "paramedic trauma receiving centers"). He also sets the protocol for all of the services and is involved if anything gets reported to the county. While I can't find the link right now, the county medical director's reimbursment is a matter of public record and runs around $100k.

The answer is to wait until you start working. Some places will require some of the small things like a pen light and shears. Everything, especially any consumables, should be supplied by the company you work for. So now the question is, "What do you want to buy to make your life easier?" Often a good stethoscope is one thing. A good clipboard case if the one your company supplies sucks. Personally, I used my own BP cuff because I prefer the trigger griped hand aneroid style cuff (the ones where the gague is attached to the bulb) more than the cheaper ones. If the company is willing to supply you with consumables (tape, bandages, BVMs, etc), I can definitely see an argument in building your own jump bag. You shouldn't be buying equipment to play rescue randy or because your company is too cheap. You should be buying equipment because it makes your life easier.

Warbargarble

Can I presume that you have some sort of evidence supporting the practice? Scientific evidence? Heck, even from a mechanical point of view spinal immobilization with a long back board doesn't pan out. After all, assuming an unstable spinal injury is present, what sense does it make to strap down a naturally curved structure to a flat board?

Sure... women should be allowed to join Augusta once men can join Ms. Fitness or Curves.

Good thing mine is as clean as a whistle.

Thank you very much for the heads up

Same here. Never had a conviction, never been in an accident.

I find it hilarious that we're still discussing whether an agency violated a privacy rule that they don't have to follow.

Let me spell this out again.

Non-billing = not a covered entity = HIPAA doesn't apply = impossible to violate something that doesn't apply.

I have a "hypothetical" scenario and would love your experienced input. Thank you in advance for your time.

An in Town, non transporting, non billing Ems

Stopped reading here. Not a covered entity, so HIPAA does not apply. State and local laws may vary.

That's what started the whole subject. We were told that PHTLS would be required by the company ahead of state mandates that might go into place in the next few years. Once I questioned the pay, they backed off and said that the training was suggested.

Are they requiring any PHTLS course, or are they requiring that you take their PHTLS course?

What shocks me the most is that the article is not coming from a local newspaper but a EMS news site.

Umm...

By Melody Gordon

The Commercial Appeal

Emphasis added.

Quoted from the article:

"Over the intercom, a flight attendant asked if there was a doctor on board.

"They were all standing over her, and at that time I identified myself as a Memphis firefighter."

I'm having a real problem unstanding how this guy could rationlize being firefighter is synonymous with being a doctor.

A very scary mind-set in my opinion.

I think it's fair to interpret "Is there a doctor on board" as "Is there anyone with medical training on board."

The notification system went down yesterday.

http://www.emtcity.com/topic/21404-notification-emails-down/

If your base jumping has the ability to put the patients in my waiting room at risk, then sure. Somehow I don't see that happening with BASE jumping.

Is it just me? Is anyone else not getting completely over this bullshit "I'm a hero!!!" nonsense? Why do we not burn these shitheads down in public when this happens?

Too many of them, and there's other places I'd rather burn political capital than on the "ZOMG, I'm a hero.HERO DON'T YOU SEE!" Heck, I'm sure I burned a few dollars when I pointed out in a Facebook group that, while Gov. Christie's order to fly the national flag at half staff for Whitney Houston is illegal per flag code, it's just as illegal when the fire, police, or EMS department does it when one of their members die.

Sort of, but can't we say the same about Gramps in the waiting room who is hacking up flu droplets because he did not take the antibiotics for his lower lobar pneumonia?

1. The flu is a virus, while there are antivirals out there, they are only effective if given relatively soon, antibiotics does nothing for it.

2. The vaccine for influenza isn't nearly as effective, both at preventing and herd immunity as, say, polio.

3. The medical consequences of the flu, and say, polio are no where near the same. Heck, the medical consequences of pneumococcal infection and, say, polio aren't even comparible.

I provided the wrong link for which I apologise; the correct source is Cole's Medical Practice in New Zeal which does on page 40 state that a physician may terminate a relationship with their patient only when they are incompetent to care for the patient ; see here http://www.mcnz.org....0-%20george.pdf

NB termination of a relationship and discharge are not the same thing as I wondered about that but it seems they're separate

Physicians should not be subject to any law, rule or standard less natural or fair than any other member of the community and should not be "held hostage" but we must carefully balance the right of the patient to have their beliefs and choices respected and whatever right is applicable to the physician that would apply in this circumstance.

Let's pull out the entire quote shall we as just throwing out the term "incompetent" is disengerous.

"A doctor may decide to discontinue seeing a patient only when there is a breakdown in the patient doctor relationship such that the doctor is rendered incompetent to treat the patient"

Yes, a patient who refuses to follow orders to the point that it puts everyone else in the physician's practice at abject and unncessary risk would easily lead to such a breakdown as to render the physician incompetent to see the patient.

Let me put this another way, if I harp on you every single time you see or call me that you need to be vaccinated, how toxic of a patient-physician relationship do you think that is going to be?

Finally, if physicians cannot be subject to any law, rule, or standard less natural or fair, then how about the ability to refuse service to anyone. How many other professions or services lack the ability to refuse service?

I couldn't find that reason on the GMC documents, perhaps I am not looking in the right place or you are referencing another?

I'm sorry, it's paragraph 7. Read the astrick regarding what it means with the antidiscrimination clause. Being non-compliant in a way that's dangerous isn't the same as discriminating a patient because they are Jewish or Muslim, or anything else.

Paragraph 38 of Good Medical Practice states a relationship may only be ended in "rare circumstances" citing theft, assault or violence as specific examples; see here http://www.gmc-uk.or...lationships.asp

To the subject of the non complaint patient, if a patient is persistently non compliant with all treatment and is making it impossible for the Physician to treat the patient then I think it is reasonable that the Physician be allowed to find another Physician for that patient because they (the first Physician) is actually incapable of caring for the patient because they are so non compliant.

Not taking a vaccination is not the same thing.

"or has persistently acted inconsiderately or unreasonably."

There, I again added the part you like leaving off. Refusing vaccination is unreasonable. Heck, I'll soften it. If the patient can get a signed affidavit by a religious leader, then fine. If it's "ZOMG AUTISM" than it's unreasonable and inconsiderate to everyone else in the physician's practice.

Again, shall we play the "how toxic of a relationship can I easily make this be" game?

That's a bit snobbish is it not; if your professional association advises against something (whatever it may be) wouldn't is be a bit foolish to tell them to pound sand as you say?

Next minute .... tens of millions of dollars lawsuit; I need me a new private jet

Outside of the push against Obamacare, membership in the AMA and the American Osteopathic Association (AOA, the DO equiliviant) are dropping like rocks with physcians seeking membership of their specific specialty groups. The AMA/AOA are not the only games in town when it comes to professional association for physicians in the US. Furthermore, to say that physicians must bend their knee to the AMA/AOA would be like saying EMTs and paramedics in the USA must bend their knees to the NAEMT. Shall we solicit the board for views on the NAEMT?

Because it is the right of a patient or their parent in the case of a paediatric patient to refuse any treatment or care recommended, including lifesaving treatment?

Because the Physician has a duty of ethics in care towards that patient and must respect the wishes, opinions and beliefs of the patient (or their parents for a paediatric patient)?

Except no one is saying that the physicians should be able to tie down a patient and force administration of a vaccine.

However, why should I put my patients in danger by entertaining the possibility that one day one of my other patients could come in suffering from measles simple because they, or they're parents, drank the anti-vacc cool aid? Don't I have an ethical responsibility to protect my other patients waiting in the waiting room from someone with a communicable disease that could have easily been prevented with a vaccine?

The Medical Council of New Zealand, the Royal New Zealand College of General Practitioners, the Health and Disability Commissioner, the Health Practitioners Disciplinary Tribunal, the College of Kiwiologists and the Centre for the Advancement of Kiwiology in Medicine (1) have all agreed that a doctor-patient relationship may only be ended by the Physician if they are incompetent to treat the patient.

Except that's not what it says. Per your own link, the only requirment is to be able to justify it. There's nothing about the physician becoming incompetent. The only requirment regarding the patient is that the patinet must not need immediate care and has found another physician. That last part can also be wavied, given how the document is written, following a deadline and a breakdown of the patient-physician relationship. Patients cannot hold physicians hostage.

General Medical Council of the United Kingdom in Good Medical Practice (2,3) also states it is ethical only end a relationship with a patient when doctor-patient trust has been broken and only then in rare circumstances, specifically citing theft, assault or violence as specific appropriate examples; it goes to to specifically state that a patient must not be denied access to medical care or discriminated against based on their religion or beliefs.

Paragraph 8 in the first link is simply a standard non-discrimination clause. Discriminating againt patients who drink anti-vacc cool aid is not similar as discriminating against a patient because he is black. There's a legitimate public health risk involved here, including an unncessary risk to the physician's other patients. Furthermore, you're ignoring the last example given as a reason to terminate care, "has persistently acted inconsiderately or unreasonably." It's unreasonable to think that, despite all the evidence to the contrary, that vaccines cause autism.

Doctors' and Patients' Rights and Responsibilities as published by the South African Medical Association (4) also takes the same view; that a doctor has the right to choose their patients but must not discriminate against or decline medical care to a patient because their beliefs differ from their own and that a patient has the right to refuse any treatment if competent.

The physician also has a right to, "To have his/her life protected which includes the right not to be placed in disproportional life-threatening situations."

The Code of Ethics of the American Medical Association (5,6) supports the view taken by the funny-talking, national regulators mentioned previously. Specifically it states a patient may refuse any recommended health-care or treatment but here is where it gets interesting! It states that a physician has a right to end a doctor-patient relationship and does not specify the same cautionary notes as others.

"There may be times, however, when you may no longer be able to provide care. It may be that the patient is noncompliant, unreasonably demanding, threatening to you and/or your staff, or otherwise contributing to a breakdown in the patient-physician relationship."

http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/patient-physician-relationship-topics/ending-patient-physician-relationship.page

Key word: noncompliant.

I am not arguing that a Physician should be able to end the relationship with a patient if it is truly necessary for reasons the UK GMC specifies and those like it i.e. assault, theft from the practice or clinic, if the patient is being threatening or if the doctor is retiring etc. Canada warns that such termination again must be "legitimate" and the natural test of such interpretation will come down to the disciplinary bodies or perhaps an additional civil suit in the US and a reasonable person, and indeed a reasonable Physician or at least all the ones I know, would say the reason "Little Molly's mommy didn't want her vaccinated" is not legitimate.

How many of these groups are legitimate disciplinary bodies? In the US, at least, the AMA does not license physicians. They can ask or demand what ever they want, but since my future license to practice medicine doesn't come from them, they can similarly go pound sand.

Personally I think the massive over-subscription of various services' within the US to atropine auto-injector for "biochemical terrorism" might be conducive to ingestion of the Kool Aid

This I do agree with. Heck, even the EMT ambulances around here have duodote autoinjectors for the crew. However, the atropine used for OP wasn't autoinjectors.

Atropine is stillused here, however there is talk that they will remove it, however we wont lose it as it is the only prehospital drug we carry for the dreaded funnel web spider bite.................

So, what do you use for organophophate poisoning if not atropine?

At my school we are testing on patient assessments using standardized patients and learn suturing on pigs feet.

Provided the information is true, how would there be cause for a tort for libel/slander? Bad information isn't illegal to write or say. Intentionally wrong information, however, is.

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I would never underestimate the females ability persevere and overcome.

What the heck is wrong with the HTML for posting on this site now? It's almost more hassle than it's worth to post a picture or link since it reformattes the entire post and screws it up.

Another thing is how many dispatch channels are able to be accessed via scanner? It's not like the paparazzi don't know where the famous people live.

There is no spacer...

That's only if you count Los Angeles and Orange County as "California."

So the crew has to be able to change their contaminated clothing. Does OSHA consider any clothing used during pt care to be contaiminated? I'm not trying to be an ass, just curious what is and is not considered contaminated. If they consider any clothing used during pt care, it sounds like they should not be eating in the ambulance. So, they can go into McDonalds and contaminate everyone else and the is okay.

I think the argument there goes that OSHA regulates the workplace. The ambulance is a workplace for EMS whereas the McDonalds isn't.

On the flip side of this, would you really WANT to eat in the patient compartment? We can't sanitize the patient compartment after every patient, although in a perfect world, we should.

Assuming you either just bought the food or it was stored in a sealed container, and you aren't wiping the food on the bench seat and gurney prior to eating it, does it really matter? Any additional bacteria on the food will be rather unimportant, and probably not much different than the amount of bacteria you would find extra on the food if you consumed it in McDonalds. Since the time from exposure to consumption is small, there probably wouldn't even be enough time for the bacteria to begin to divide, thus further limiting the bacterial level.

On the other hand, the bigger issue in my mind is the crumbs that might be left behind and there ability to recontaminate the environment than the actual exposure to the person eating.

Hopefully he'll spend a few years in prison regularly being "checked for responsiveness" by his fellow inmates.