john_boston

The SNF did not call us for altered mental status based on a lab result, it called because a nurse noticed a patient's disorientation and did not know the patient's PMH included dementia(!). This is the same facility that called us for "altered mental status" at 4pm and we arrived to find a 70something y/o f pt. hx of TIA/CVA, nonverbal/aphasic, pale, RN reported "She's been having trouble moving her left arm and left leg." Me: "Oh? When did you notice that?" Her: "Since maybe...oh...9 this morning?" Verdict: R MCA CVA. Right. It's too bad that in none of the cases I wrote my original post to vent about did an MD or DO order the pt. to be seen at the ED. Please stop assuming the particulars.

And would somebody please please please point out where exactly I stated that I thought "all nursing home calls are BS" or that "nursing home patients don't deserve our care and compassion". I think you'll realize I never said it, in fact I said the opposite.

Jesus, VentMedic, chill out! It's clear this is a really important matter to you and you aren't interested in having a discussion about the very real problem of SNFs dumping patients to EMS, then to the ED. If you've never had this experience, or don't routinely have this experience, I wish I had your job. And for what it's worth, condescension doesn't win an argument. I'm currently finishing medic school, returning to complete a biology degree next fall, then sitting for the MCAT. In my free time, I obsessively read biology, biochemistry, and pathology books and have for years. ...so yeah, I guess I'm just a total moron Ricky Rescue who likes lights, sirens, and batman belts full of EMS accessories, not a young person with ambition who is disappointed to discover that the old adage about carnivores seeing how meat is made applies without modification to the corporate health care industry in the US.

Note I said nothing about lab results, nor my (nonexistent) qualifications to interpret them. I specifically complained about BS reasons for calling an ambulance, not about the very idea of doing interfacility transfers. Also please note that I wrote "and, worst of all, the patients have to suffer the agony of being loaded and unloaded repeatedly, coming in and out of all types of weather, and wondering what the hell is going on the whole time." My point was that it's the patients that suffer most when corporate SNFs dump patients to the ED without a valid complaint. How so much I didn't say could be magically inferred from what I actually did say...I do not know.

<begin rant> An increasing and increasingly irritating phenomenon I've noticed among the "skilled" nursing facilities (and one in particular that inspired this post) is dumping patients at the ER for the slightest problem. Of course this is nothing new, just something that seems to be happening more and more frequently for utterly indefensible reasons. A few days ago we transported a discharge to aforementioned SNF and the MD forgot to note in the paperwork that the patient's IV haldol was discontinued. Instead of calling to clarify the order and saving the extremely infirm pt. an unnecessary trip back to the ER, then back to the same SNF, they called for an ambulance giving a meaningless c/c from the pt.'s PMH. We arrive with x lbs. of gear on our backs only to be told that the patient was to go to the ER because the MD didn't note that the order was discontinued. "So what, exactly, would you like me to tell the triage nurse is wrong with this patient?" "Well, the IV hal--" "I understand that, ma'am. But what is the complaint? I cannot bring someone into the ER who has no complaint." "Well, you ARE bringing her, you don't have a choice..." etc. Sure enough, we transport her back and she gets left on a hallway stretcher for who knows how many hours. Today, the very same facility pulls the same stunt. This time it's because they claim the pt. we brought to their facility less than an hour before has an NG tube. The pt. had the NG tube in place when we brought her in, nobody had a problem with it until about an hour after we left. When we brought that pt. back to the ER the very same nurse I saw two days before was shaking her head. "I know, it's ridiculous." I said. "No, no," she replied. "They did this yesterday too. Three times this week so far." I am so disgusted by these facilities calling EMS for "altered mental status" when the reality is the patient would like their diaper changed or to make a telephone call to their family. When they're ignored for hours or days and become quite distressed and nasty the nurses go "Hooray!" and call us for "non-cooperation w/ meds, going in for psych eval." Or if there's a one page of the nursing referral missing, rather than calling and requesting that it be faxed over, why not just dump the pt. first to EMS, then to the ED. The lazy, burnt-out nurses win because now they have less work to do and the EMS service's owners win because they bill (often the taxpayers) $800+ for each of these five-minute rides back and forth between the hospital and rehab/SNF. But the EMS people become demoralized, ambulances are taken off the road, the ERs are overloaded with pts that do not need to be there, and, worst of all, the patients have to suffer the agony of being loaded and unloaded repeatedly, coming in and out of all types of weather, and wondering what the hell is going on the whole time. It's a scam and a disgusting one at that. And people wonder why our health care system is broken... </end rant>

Dust - Agree with your thoughtful anaylsis. When you're not tearing into others on here, you're a pleasure to read.

Exactly the kind of reply I was looking for, thanks jsadin!

VentMedic - All I was addressing is the incredible amount of negativity that I've seen exhibited by some people around here (you know who they/you are) at the drop of a hat. After merely asking for opinions about where other medics in the area have had positive experiences, I get these responses about all the crappy medic programs and unprepared students there are out there, how I'd better not show up without having met with a program coordinator (duh...), how I am apparently entitled and want special treatment? I have nothing but respect and deference for the doctors and nurses at these hospitals -- indeed I hope one day to be in their position. Very strange, very strange. "I don't think you quite realize the responsibility someone has who is mentoring you on a live patient for "skills" especially if they do not know your background or anything about what was already expected of you in your program." What gave you any indication that I don't understand that responsibility? I was merely asking where medics in my area have had positive clinical experiences. How is this being misinterpreted? I was commenting on the larger issue of negativity on the boards, negativity in American EMS culture in general. It's pervasive and poisonous and totally accepted for some reason. It's also self-perpetuating and tiring to listen to over and over again. Anyway, that aside, thank you for the info. I'll be sure to word my question much more precisely and carefully next time.

Because if you take the comment at face value, the poster seems to be making the claim (with a straight face) that he or she is surprised when she finds out that other people besides Americans have to deal with social problems. As physicists are wont to say, that's so stupid it's not even wrong. Why does there have to be some "cryptic" underlying implication behind the comment? Must be because I'm an evil tax-and-spend liberal who wants to teach gay black babies how to perform abortions or some such nonsense. Right?

I will certainly talk more with my instructors re: preexisting relationships that they have with hospitals. I certainly don't want to go somewhere where there is an incomplete understanding of my capabilities and education or where a medic intern would be ill-suited. That said, however, I find it a bit bizarre that so many here are quick to dismiss and condemn a program they know absolutely nothing about. Yes, there are lots of crappy medic programs and even more crappy medics who are an embarrassment to us all. That said...maybe lay off a little with the negativity and griping? It's kind of too much to listen to after a while around here. For those that offered constructive, encouraging feedback...thanks!

She never said anything of the sort. Why would you read that assumption into her post?

I am a student at ERG (Educational Resource Group) a new group run by some of the guys at Attleboro Fire. Northeastern was out of the question (due to cost, travel to Burlington, worsening reputation of the program), Pro's class didn't start for another few months that I didn't want to wait, and ERG came at the recommendation of a few paramedics that I work with and respect. ERG say they have relationships with "many" hospitals, including BMC, which is the one I inquired about. The impression that they gave me was that if they do not have a relationship with a hospital that one of their students would like to do some time at, it is an easy thing to arrange. I have a couple of concerns about doing rotations. A medic that I respect who did his time there acknowledged that BMC was a fantastic place to see and learn a lot, but that the moment the resident or whoever you are talking with notices your paramedic intern nametag, they completely ignore you. Of course, much depends on one's attitude, but I would hate to think that one of the most exciting and engrossing early chapters in my medical education will be marred by condecension coming from those who view me as an ambulance driver and an interloper because I want to be there just as badly -- if not much more -- than most people. If I would be better off traveling to a smaller hospital where I would receive more direct tutelage and be trusted to know what I'm doing and act with some degree of autonomy, it would be worth it. However...can't be St. E's. I spend far too much time there at work as it is and can't really stand the place.

Is it surprising for you to realize that problems don't just happen to you and your fellow citizens? What a bizarre sentiment.

Yeah, as someone who personally witnessed the attacks and ran from the collapse of the towers and whose family has many active service members, I can't help but think, once again, great job Dust, you hit the nail on the head. Your astute historical, social, and political analysis is like drinking from an bottomless cup of wisdom. Thank you so much for graciously providing another example of your towering intellect to all of us feeble-minded morons. I'll go burn my library card and keep reminding myself that the world is as black-and-white as some random dude on a messageboard seems to think it is.

What's going on with the cop? He just lets the pt. run away from him out into the road? The whole scene just looks a little too casual and unprofessional. Sure, drunks are annoying, but that doesn't mean you don't have a job to do.

I'm currently a paramedic student thinking about which hospital to do my clinical rotations at. I live in Boston and have no transportation apart from the subway and bus so that limits my choices. I have been leaning toward doing my time at BMC but have heard mixed things about medic students working in city hospitals -- namely that it's difficult to get your 'points' because there are far too many medical students, interns, etc. and that most of the codes are run by the code team. Of course everybody's individual experiences will vary and much of one's success depends on how outgoing and helpful one is, but I would be interested in hearing from medics who have done their rotations at any of the Boston city hospitals and had either a great or terrible experience. Thanks in advance!

I think it's grossly inappropriate. There are many perfectly normal, moral, reasonable people in EMS who get along fine without any religion. You need to see a priest about a particular incident? Fine. Do it on your own time and do not bring your private matters into the workplace.

Sure I do. Check out my edits here and my userpage here. I've been working 70+ hour weeks for most of the past few months so there's really not a whole lot that I've done recently. Wikipedia would certainly benefit from having experienced medics and EMTs refining relevant articles.

Hilarious. I don't know how the OP could work with such a medic. It's amazing some of them can pass certification.

I'm going to have to disagree with most of you. While traditional Chinese medicine predates the advent of western medicine, I would say acupressure, acupuncture, and related practices have not yet met the criteria of modern science. Where research has shown demonstrable effects of such therapies, the evidence for their efficacy is interesting but inconclusive at best, mystical psuedo-science at the very worst. Hospitals that devote resources to these therapies -- if in fact they exist -- are likely doing so to appease a loud minority championing "alternative medicine" out of a desire to be politically correct (such as some British hospitals promoting the completely bogus charade that is homeopathy). That's not to say that these therapies are of no value -- they simply have not yet been proven beyond a shadow of doubt to incur any huge medicinal benefit. I imagine acupressure, Ayurveda, homeopathy, and other "alternative medicine" would be of about as much use to saving the life of a patient experiencing an intracerebral hemorrhage as reciting the Lord's Prayer to them. You might believe it to be deeply meaningful but that's not going to stop the bleeding. What benefits acupressure does, in fact, bestow must be backed up with a lot more research, experimentation, and evidence before it can be incorporated into the arsenal of modern medicine, especially in EMS where the emphasis is so often on practical and immediate solutions to life-threatening problems. Here's a link to an interesting article on acupuncture and it's possible scientific promise: "Acupuncture, Magic, and Make-Believe", Skeptical Inquirer, March 2003.

I know it's an EMS stereotype and of course I do not know you one bit (so don't take this too personally), but I can't help but cringe at an EMT or paramedic spelling the word respiratory "respitory".

An hour of pharmacology and two of anatomy and physiology is like taking an hour long guitar lesson when you've never played before and expecting to play like Hendrix.

I say: "Go to a doctor."

This was not taken from a Wikipedia entry (there currently is none for subcutaneous emphysema). But even if it was taken from Wikipedia and the information was wrong, why not just fix it? Wikipedia is open-source and what drives its quality up is qualified, educated people correcting and refining articles so that they improve. Don't just complain about it, take some initiative. Wikipedia's record with regard to basic scientific material is actually quite good. The above definition was copied from the NIH's MedlinePlus Medical Encyclopedia here. The Merriam-Webster online medical dictionary (here) broadly defines crepitus as "a grating or crackling sound or sensation (as that produced by the fractured ends of a bone moving against each other or as that in tissues affected with gas gangrene)" so the definition applies to both phenomena.

"I am fully aware that this is not representative of all NHs." Not all but definitely most.