JPINFV

Correct me if I'm wrong, but you're saying that you train to standardize your reports, thus attempting to remove any individuality from the reports. You even imply that you attempt to remove letting personal experience and expertise impact the verbal report. What I'm trying to figure out is why letting experience and expertise affect the verbal report would be a bad thing.

Why is being different a bad thing? Why shouldn't education and experience change how care and transfer of care is performed?

IR?

If the unions can make EMS act like professionals, then I'm all for it. However I don't see the unions pressing for more education and making sure that the average provider is willing and able to use personal judgement, think past the cookbook-ocol (I think I invented a new term), or make a hard decision without punting to medical control. Now, how much is a group of people in a technical trade that is overloaded with applicants and where the average provider cries out for someone else to make their tough decisions for them worth?

Without qualifying that statement with something along the lines of "personal use," your instructors are idiots. Systems that lack appropriate and enforced policies for on-scene photography and providers who lack self control. To drive home this point, here's a case from two idiots over at the California Highway Patrol. http://en.wikipedia.org/wiki/Nikki_Catsouras_photographs_controversy

...and how often do unions protect bad employees who legitimately should be fired?

I will say, though, that the use of stock options as an alternative or supplement to salary reimbursement should be taxed as regular income, and not just as capital gains.

OWS claims to be representing the 99%. The problem is that by it's very structure, there are no specific demands besides 'eliminate corporate greed,' hence why there's three or four crack pot lists of "demands" floating around. However, by the very nature of the fact that they are claiming to represent the 99%, anyone who disagrees is defacto a member of the 1%.

No more a false dichotomy than the "either you support the occupy movement, or you're a member of the 1%." The Occupy movement doesn't speak for me, and I'm not a member of the 1%. That doesn't stop the Occupy movement from claiming to speak for the 1%. It's not just the rich that take deductions... err.. "loopholes." Oh, wait, it's only a loophole when the other guy does it!

Of course if anyone wants to know about ambulance service fraud in Texas, all they have to do is talk to the Dallas Fire Department.

I'm not sure if your response is meant seriously, because if it was then you took my post seriously, which was not the intent of my post. My post was meant more of a poke than a serous alternative. Serious note: Keep what you kill works for some emergency medicine physician practice groups because physicians can treat more than 1 patient at a time, unlike EMS. As such, it's easier to get a mix of the higher paying, more complex patients, as well as the higher volume quicker patients. Similarly, issues with one patient and billing isn't nearly as bad if the other 5 patients you're seeing at that time pay.

How about being paid based on a percent of money brought in by the calls? The so called "keep what you kill" method. Longer distance, more mileage charge, more pay. The drunk 20 something without insurance that doesn't end up paying his bill? Too bad, so sad, no pay for that run. Now it's paid based on run, severity, and length of the call. Oh, and if those rural guys have it so great, why don't you move out there? Alternatively, is this something along the lines of the grass always being greener on the other side?

Why would it be a HIPAA violation any more than the patients currently waiting in the waiting room? On a side note, a hospital I used to volunteer at would use the code room for "triage plus" where patients would go in, get a physical exam done by a physician, get labs drawn, and then sent back out to the waiting room while waiting for the labs.

The licensure vs certification debate is a distraction. No one important cares what the card issued by the state that allows you to practice is called. Heck, in California, the term "certificate" and "license" is deemed synonymous when it comes to physicians. So if the people who write the laws can't get it straight in regards to a profession that no one questions is licensed, why do you think it matters for a trade trying to become a profession? Every paramedic who calls medical control because they're too afraid or incompetent to make a decision, thus making them want to put the liability on medical control does more in that medical control call to destroy paramedicine as a profession than if all 50 states were to call their card a certificate.

I'd rather have Romney over Cain, Paul really surprised me with how well he did during the last debate.

How could you get into trouble writing too detailed of a report?

No, more of mis recalled something as stated. Probably a bit to do with discussing free water deficit, 0.45%NaCL, D5w, and enteral water replacement in a short amount of space.

Looking through my class notes a second time, it discusses D5W for IV for euvolemic hypernatremia and 0.45 saline for hypovolemic hypernatremia. I could have sworn, though, that I've heard sterile water being administered for hypernatremia, however it's definitely not something to be done without lab values.

Fluid replacement following severe dehydration when you don't want to increase the total body salt load. Hypernatremia is more often due to low fluid levels than excess sodium.

Well, to be fair, sterile water is used in certain situations, but lab values are required to decide to go that route. If you really want to blow your mind, look up how the body controls total body water and how the body controls osmolaity.

Probably a much better representation of what EMS does. Do you have a link to any sort of news article about this, or is it just rumor? I'm not questioning your integrity, but I'd like to write a blog post on the concept as I've been toying for about a month with the concept that maybe EMS is an antiquated name based on today's demands.

Here's the answer to half of the threads in that forum.

That's assuming that the misgivings of the provider are properly founded. Personally, I'll argue that this isn't necessarily a straight forward case. Similarly, I'm not impressed with the unsaid underlying tone of, "Well, sucks to be the hospital, you're now stuck with the over weight patient." To suggest that providers misgivings shouldn't be critically examined gives credence to every post by an EMT who refuses to transport a patient 4 minutes down the road to the ED because the patient is "critical" and that they should wait 8 minutes for the local paramedic service to arrive. After all, it shouldn't matter that other providers are more comfortable delivering a patient to the ED based on ETA, just that those providers aren't comfortable. Oh, and do you transport babies in their mothers arms or do you only transport babies in car seats unless a time sensitive emergency is present? If bariatric rigs are readily available, then how come they weren't apparently commonly used? If bariatric rigs are readily available everyplace, how come 911 services are being given a pass? Not every 911 bariatric transport is going to be a time sensitive emergency, but they're being given a pass simply because it's 911, and the assumptions being made about the severity of all 911 calls.

...because the only people who look at a PCR is the people at the hospital? What's the point if one set of times are going to be based off of one clock and another set of times off of another unless you synch your watch every shift? Want to read a novel, read the average physician H&P SOAP note. Additionally, two to three sentences isn't going to break the back of a narrative. My problem with that is the physical formatting. The concept that EMS narratives needs to be done with complete sentences and in a single paragraph needs to die. HPI: Allergies: Medications: Medical History: Surgical History: Social History (when pertinent, including sexual history): Family History (when pertinent): Review of Systems: General: HEENT: ...etc, but not in one continuous mind boggling paragraph. What's a "Cric pulse?" Allergies? Medications? History? Sensation to what (light touch, pain, vibration, etc) and where? Pain besides abdominal pain and chest pain? How about an evaluation of said pain (OPQRST). Examination of the back? Imobilized? How? KED? Backboard? Scoop? Vacuum mattress? Pulse oximetry? Did you administer oxygen (after all, the patient is suffering from dyspnea)? Again, pulse oximetry, recheck lung sounds? Did anything else change besides SOB decreasing and LOC increasing? LOC increased from what to what? The patient went from A/Ox3 (person, place, purpose) to A/O x ? was treated, and then went to A/Ox? For someone talking about making it organized and logical, why have intro, treatment, assessment, another treatment, disposition, followed by treatments mixed with what doesn't even amount to a full set of vital signs after the first set? You administered 2 liters of normal saline to a patient who isn't even hypotensive? I'm confused. Where did I ever advocate a block of text approach? However, I'd take a block of text approach over half documenting a case any day of the week. I also noted that you didn't add any of it either. Alternatively, are you trying to say someone else's blog is now my blog?

That's assuming that another company is present that has the appropriate resources. According to the OP, the normal transfer company does the mattress on the floor routine. So what to do if the only difference between the regular service and your service is the name on the side of the ambulance, and not the tools inside it?