GAmedic1506

I am with you on that one. At the busiest service that I worked at, we knew that we could either transport 8-10 or not transport 14-20, you had to do the same amount of paperwork whether you took them or not. If the AMR model is right and you only kill 1 out of every 100 that refuse (1%), that number can sound reasonable. But if you are running 50,000 calls a year, that equates to 500 patient deaths. So if you are ever looking for a good CQI project for your service, I would point you in this direction, and ask: How do you know that your employees educated the patient properly, and did all that they could to get an AMA patient to go to the hospital ? Is what the patient is being told consistent, by all crews, and at all times of the day or night ? What is your refusal percentage after midnight (yes the call acuity is generally lower after midnight, but the medics can also be tired and sleepy) ?

Thank you, and I appreciate all that weighed in. I hate to be the bearer of bad news, but the legal opinion is that these activities must go. Hopefully the PC generation will die soon, but until then, there are many routine actiivites that must go: Including horseplay, friendly versions of WWE wrestling, hazing of rookies, and watching soft/hard porn. Frequently the problem is that employees say they are OK with all of these type of activities, and may even participate willingly, but when they are terminated or are written-up they are suddenly offended by something that has been ongoing for years. Yes it helps when they can not produce any proof that they complained to upper management (although most will claim the workplace was so hostile and management was so uncaring that they just had to get out of there), but it also hurts if the activity is so agriegous that anyone would be offended (ie watching hard-core porn, painting genitalia with hydrant paint). Also remember some of the comments AND GESTURES that you have witnessed in your station while these shows are on (how many have never seen one male employee dry hump another male employee --cutting up -- pretending to be gay; how many times has a male employee exposed himself in the station for whatever reason). The last lawyer I talked to actually stated that they have seen an increase in the number of cases where the female employees are being accused of this type of harassment secondary to inappropriate conversations or dress. All the rest of the grey-area activities that were mentioned here would be in the jury's hands, so you have to ask if you are willing to take that risk -- sometimes the answer is yes, most of the time it will be no. Harassment is one of the few areas, where the victim gets to decide what harassment is, and it does vary from individual to individual, which is why it is hard to allow questionable activities without restriction. I think having two tvs, so that there is an option is a good one. I think forcing someone to leave the room that is offended, creates a hostile workplace that you can not defend. But dont take my word for it, I imagine most of your employers have an attorney on retainer, so feel free to have them take a look at some of the scenarios that were mentioned here, and get the most up-to-date opinion from a lawyer who is practicing in your region. At the end of the day, you have to ask yourself, do I really want to have to sit in a courtroom and defend this activity, and how would it hurt the organization if it became known in the community that we serve ?

your welcome --so does anyone else's organizations do anything different in this area ?

My three posts drew over 1600 views in just a few days. Hate me all you like, as long as the debate makes people think/question where they stand (even if they are right), my work is done.

No, its not like that -- it is symptom based. For instance for Chest Pain it goes over the symptoms for AMI again, clarifying that they understand that they are possibly having an MI. For minor lacs, it explains that they need sutures within 6-hours. For N&V, it goes over the bland diet, for hypoglycemia it discusses that they should eat, should recheck their glucose often, and gives them their pre &post EMS treatment readings, so they can inform their physician, and how to care for their IV site/wound. All of them educate the patient to what their symptoms could indicate. It doesnt tell them what their diagnosis is. If I remember right we have one for Chest Pain, Fever, Head Injury, SPrain/Strain, Domestic Abuse, Dyspnea, MVC, Woudcare, Diabetes, Seizure, Address Hard To Find, I cant remember the rest. JEMS gave us a thumbs up on the back page of either the 12/2000 or 12/2001 issue (the cover story is Aussie Motorcycle Medics), and listed a complete copy of the instructions on their webpage (not sure if they are still on there)

To everyone, I apologize for my previous comments, as that was very immature. As far as the need to talk about other agencies behind their back, that is just something I will not do. If they wish to divulge or discuss their numbers, they will when they read this post. It is not my place to fix any service but my own, nor is it my place to "dog" a service that is struggeling. If there is anyone out there that does not believe there are 911 services with no transport rates near 50%, then my naming of them will not convince you. But I can assure you that there are services in GA and Florida with rates that high. I will answer anything about my own service, though. My service is a 911 provider near but not in Atlanta. We average a 28-32% refusal rate, depending upon the month of the year. To reduce the liability in said refusals, we created pre-printed home-care instructions (illness/injury specific) that we leave with the patient. The purpose of my question was to learn what others are doing, not to call-out or punish those who do not meet my or your standard. If my failure to talk about others behind their back loses me points with you, then so be it. Either way, it is time for this to get back on the professional level.

Yes, i saw those numbers and thanked the person who sent them, but as you stated those are canada numbers, i was hoping for some recent US numbers.

Firefighter appeals firing over porn A lieutenant who ran afoul of St. Pete Beach's zero tolerance policy on pornography decides to fight to get his job back. By AMY WIMMER © St. Petersburg Times, published October 31, 2001 -------------------------------------------------------------------------------- ST. PETE BEACH -- The memo was posted in September 2000, instructing firefighters that sexually explicit material had no place in the firehouse. Not in magazines, not in videos, not in books. And not on the Internet. "As you have been advised in the past, the possession/use of inappropriate materials in the Fire Department SHALL NOT BE PERMITTED," Fire Chief Fred Golliner wrote, explaining his department would follow a zero tolerance policy on pornography in the workplace. One year later, the chief has recommended firing the first firefighter accused of violating the policy. Lt. Crist Fellman, a 20-year veteran of the department, will appeal the decision through a grievance procedure. The investigative report details how an internal affairs investigation, with the help of Florida Department of Law Enforcement computer analysts, linked Fellman to the pornography found on department computers. The report also showed that, possibly because of the atypical nature of a firehouse workplace, sexually explicit materials were more common around the St. Pete Beach Fire Department than in other workplace environments. "Unlike other public officials, it is entirely appropriate for firemen on 24-hour shifts, upon the completion of their duties, to watch cable television and/or to use the Internet," Fellman's former lawyer, Morris Weinberg, wrote in a letter to the city requesting Fellman be reinstated. Fellman's appeal of the city's decision might rely on evidence produced in the city's internal investigation of him. The report, produced by police Capt. Todd Kirchgraber, describes in interviews with employees that two other firefighters might have accessed pornography on the Internet after Golliner's zero tolerance memo was posted a year ago. "I certainly didn't see any focus being placed on them," said Fellman's lawyer, Robert McKee. The investigation also discusses how, historically, pornography was accessible in the all-male, 24-hour-a-day environment of the Fire Department, though Golliner is quick to say that it can't be found anymore and hasn't been as prevalent for years. "I think we're as clean of a department as you can find now," Golliner said. Still, the past could play a role in Fellman's appeal. "There's a history in the department in terms of a tolerance for adult-related material," McKee said. Kirchgraber says the investigation stopped with Fellman because he is the only firefighter who can specifically be placed at a Fire Department computer at a time when adult material was accessed. "This was the first piece of real concrete evidence that came into our hands," Kirchgraber said. Added Golliner: "We can't get any more thorough with the computer systems. There's no way of placing anyone behind the computer." That's because Fellman was working a shift with Paramedic Lori Kordecki and Firefighter Ron Nifong when Kordecki went online this summer to work on her St. Petersburg Junior College courses. Kordecki turned over the use of the computer to Fellman and later returned to the terminal to find pornography Web sites listed in the computer's history file. Kordecki had previous experiences with adult material at the firehouse. She had discovered pornographic Web sites in the history file before, and had also turned into the chief a pornographic magazine found under a mattress in the firefighter's bunks. "I was totally disgusted and offended," Kordecki told Kirchgraber in her interview. "I said, 'That's it. I've had it.' " Kordecki and Nifong saved items from the history file onto the computer's hard drive. That file, which the paramedics named "Stealth," linked Fellman to the adult material. And while other sexually explicit images were found on firehouse computers -- 308 in all -- none of the others could be directly tied to any individual employee, Kirchgraber said. The report discusses past experiences with adult material at the firehouse: how firefighters sometimes exchanged adult videos at work and kept pornographic magazines at the department. On at least one occasion mentioned in the report, firefighters viewed an adult movie at work. Most of these incidents happened before the September 2000 memo. In interviews with Kirchgraber, one firefighter said he recalled a discussion with Fellman shortly after the memo was posted. "Well, they got most of the books out of here, but I still got mine," Firefighter Greg Fletcher recalled Fellman saying as he lifted up the mattress of the lieutenants' bunk to reveal porn magazines hidden there. "Times have changed," Kirchgraber said. "Nothing condoned, but understand that what might have been happening, as times changed, as people's standards changed, so does that behavior, and clearly the fire chief was trying to set a standard where those types of things weren't accepted." Fellman earned more than $49,200 a year from the city. He was promoted to lieutenant in 1995, and his personnel file includes letters from residents complimenting his service. The file also includes past disciplinary actions. In 1996, after he transferred some emergency medical technician supplies from the main firehouse in north St. Pete Beach to Station No. 22 in the Pass-a-Grille neighborhood, his supervisor reversed his decision and returned some of the supplies to the north station. Fellman responded in a terse memo and was reprimanded for writing it. The subject Fellman wrote on his memo was "I should have known!!!!" "Just once, I would like to see some support around here," he wrote. He also received "letters of instruction and caution," a low-level form of discipline, for hitting a pole while exiting City Hall with a fire engine and talking disrespectfully to another lieutenant. The monthslong investigation took a toll on Fellman and his family, his former attorney, Morris Weinberg, wrote in a letter to the fire chief in mid September. In the letter, Weinberg says Fellman "has had his life turned upside down." Weinberg complained of television newscasts about the investigation that "irreparably damaged" the firefighter's reputation and says his 12-year-old and 8-year-old children were pulled out of classes at school to be interrogated by detectives and the Department of Children and Family Services. The investigation was ongoing at the time of the Sept. 11 terrorist attacks and Tropical Storm Gabrielle, which followed days later. According to Weinberg, Fellman's requests to help with both events while on administrative leave were denied. "A veteran firefighter with such an outstanding record does not deserve the treatment that he and his family have undergone in the past month," Weinberg wrote.

Winnipeg firehall visit includes porn viewing Last Updated Wed, 22 Sep 2004 16:25:40 EDT CBC News WINNIPEG - Winnipeg's firefighters, already under the microscope for bad behaviour, admitted on Tuesday that a group of children on a firehouse visit were accidentally shown a pornographic video. Fire Chief Wes Shoemaker told a news conference on Tuesday that the video accident happened some time last year. A class of young schoolchildren showed up at the firehall for a tour to find the paramedics and firefighters away on a call. A fire department employee offered to show the kids a fire safety video while they waited for the firefighters to return. That's when the porn tape was accidentally played. RELATED: Coverage from CBC Manitoba Shoemaker said the people involved were disciplined. Firefighters at a different fire hall were suspended earlier this year after they were caught partying in the station, and giving drunk visitors a ride home in a fire truck. Three people remain suspended after that incident, which took place in July and came to light last weekend. Ten were initially suspended. The firefighters' union is upset about the way the incident was handled. The union is threatening defamation lawsuits against the media and management, filing grievances, and asking the mayor to launch an investigation. A computer that had been also been used to download pornography from the internet, has also been confiscated from a fire hall as part of the ongoing investigation into the July incident.

Like i said, i am still waiting on your facts, and if you read above, you will see who attaced who first.

I am sorry, I will not slam another service by name, especially behind their back, in a forum. That is just immature. If you are not aware of services who have a percentage this high, you must be new to the business, work for a private service, or work in the rural west. You are also obviously a democrat, in that you can not argue anything of substance, but rather find a way to slam others so that you can run from the issue. If you do not like my posts, then simply ignore them. Last time I checked, you are not mandated to respond to any post. And so far, neither of you "fact lovers" have introduced your own stats, which was what I originally asked for. As usual, when you have nothing to contribute, you attack the author like a juvenile. I discussed my stats, which is all i will discuss, and that is all i will ask you to discuss. Man, I cant believe you got me to sink to your level -- i guess i will have to learn how to type nah-nanny-boo-boo.

Managers dont terminate employees, employees terminate themselves -- managers just do the paperwork. It is never fun having to do it, but if you have done your job correctly, and given the employee a chance to improve, you should feel no guilt for the outcome. Employees make the choices or lack of choices that put themselves in that situation.

Well i dont want to name names and embarass folks, but it is not uncommon to approach that stat in the larger american cities. I agree, that is a high number, but urban areas of a higher level of ems abuse. None-the-less, maybe some other services will share their percentages ?

Our survey didnt get into whether or not the medic talked them out of going, or whether it was an actual refusal -- some systems have a "not-needed category" for things such as minor cuts. We only looked at whether or not they were transported, regardless of reason. If they didnt go, they were catagorized as not-transported/refusal (unless it was a false call or we were cancelled enroute). That was kind of the reason for the study, as we frequently had a patient complaint, where the patient stated "they told me i could go to the doctor in the morning", and a patient care report that indicated the medic begged and pleaded for them to go to the ER, but the patient absolutely refused AMA. Many 911 systems have non-transport rates >50% (usually urban). Thanks for the links, that should help a bunch.

We did an extensive CQI study of 911 patient refusals/no transports back in 2000, and found that when a medic consistently (several months in a row; everyone has a bad month) broke the 36% threshold, they were almost guaranteed a negative patient outcome, regardless of their experience level. I had also heard of a study that was supposedly done by AMR that showed that statistically, for every 100 EMS refusals: 7 patients would be admitted to the hospital, 2 to ICU/CCU, and 1 would die. Has anyone studied this more recently, and if so, what benchmarks do you use ?

Sorry you have misread my intentions. I havent been in a church since I was 14, so you can hardly call me religous. Thus, my intent has no basis in any of my own personal beliefs (although my professional beliefs should be glaring through by now). This is about what is professional in a business setting ? As to all those who are also including soap operas, tv shows, and R movies without nudity; you raise good points. But I think the answer is in the following question that I have asked several times: Would you feel comfortable watching any of these shows in the presence of a citizen, a local elected official, a school-group, or your department's Chaplain (not because they walked in for a moment -- lets say they are spending the day with you to learn more about your department) ? If the answer is no, I would turn it off, then I think you have answered the question about whether or not it is professional ? It kind of falls into the old axiom for teenagers, "If you wont do it in front of your parents, its probably wrong". If you have to change the behavior when someone enters the room, I think the behavior should be questioned ? The video games are a new twist that I havent thought of, which raises yet another good question, since many of them have graphic themes. Great debate, keep it up, prove me wrong.

Thank you pelotari for your honesty. In case no one has read the entire post, I really dont want this to be a solely female issue, this is more about professionalism than it is about what we can do when a woman is in the station. As stated previously, a male who is fairly religous could be just as offended by such shows. But so far, I have only had one person to agree with me. I wonder if any supervisors have weighed in ?

So that situation is not acceptable EMS behavior to you. Thanks, we will see what others say. And to further the question, make her your 18 or 21 year old daughter, does that change the situation ? Is it professional at any age ? Let me know.

Mr. spykes you hedged the daughter situation, with "if you were in the room". What if you daughter were 16 and in the EMS explorer program in the neighboring county (she wants to follow in daddy's foot steps). She is riding third on a Saturday, wheh she calls you because is very uncomfortable watching an episode of HBOs Real Sex Series, with 4 young adult males in the room. Does your opinion change any ?

Good solution, it is pretty much the same that we have employed, although rated x is never permitted, which I am sure is the same for your group. Can you discuss whether or not the move was due to something that had happened in your organization, or just out of fear of potential problems ?

Thank you patrick, and please lets stick to facts and not sling mud. I am just asking a question, there is no reason to assault me with verbal jabs. I said daughter because 92% of the workforce is male, and this is where the difference comes for men. They have no problem watching these type of shows, on-duty, but if their daughter/girl-friend/wife were in that situation, they have a much different opinion. I was just trying to take the situation out of the accepted norm, that we are used to, and put it in a different context to see if your opinion remains the same. If you change the behavior, based on who is in the room, then you have to wonder if the behavior is appropriate ? If it is OK, you shouldnt have to stop it when certain people enter the room, or ask people to leave the room.

Good posts and arguments folks, and you are right in that my initial question did sound soapboxish (thats because I know how the courts have sided). So lets amend the debate slightly, and just simply ask this question: In today's EMS station is it professional to show movies (on DVD or cable) that have nudity, regardless of who is in the audience ? We are just discussing what is appropriate "on the clock" behavior ?

Oh no, not at all. I still believe my premice to be correct, as no service that carries AC has stood up and said that they can guarantee that their service is administering this drug as they should. Most admitted that they had never used it, or only used it a handful of times in their career. But I am big enough to realize that one opinion does not fit all EMS services or all regions of the country. My purpose was to put out an idea, spark conversation and debate, and see where we all fall on the issue. Like it or not, agree or not, we have three good pages of debate on one subject in about a week's time, that no one had paid much attention to in the past. Debate and disagreement are good, regardless of the subject, as long as they are constructive. To me, forums such as this, should not be about who won or lost a debate; I think we should be happy that we have the forum for the debate (and for the record, many times throughout our history the most unpopular decision that was being put forth at any particular time, was often the right decison when viewed through historical reflection). I can remember medics who were threatening to quit in the 80s when our employer forced them to wear gloves (i cant start an IV with gloves on). We all know how dumb that sounds now. Again, thank you for a healthy debate of the issue. I will continue to ask the unpopular questions, even though that gets your reputation score killed in this forum. There are alot of pretty smart folks in this forum, I believe they can take the heat. And yes, I will often take the most assinine position on something just to make you think (but that wasnt the case this time).

I appreciate the great comments, but I think we are missing the point. The question isnt whether or not you personally are offended, the question is, is it professional ? I am not sure where we should draw the line, but i know where the attorney's and courts have drawn the line, and many of us are over it. This falls into the same category of, Is it right to steal food if you are hungry ? The answer is no, it is never right to steal, although we can find all kinds of justifications to make it right in our minds. If you walked into the HQ of Home Depot or Microsoft, would you be shocked to see a TV playing a movie with nudity of any sorts in their lobby --- what if it were an episode of Rescue Me or the Shield, with the F or P word thrown out every other minute.

Well one of the first elements of an harassment case is that you have to prove that the workplace was uncomfortable for an employee (male, female, religious, age, whatever). Now of course, you usually have to go a step further and show that the complainant made you aware of the issue, and the employer failed to fix the problem. You may not be aware, but if two women are telling a racy-sex joke, and a third female overhears the joke in the same room, and is offended, it can be harassment (which is why I bring the subject up, many are still under the impression that sexual harrassment is only about a man trying to get sex from a woman -- that is no longer the case). But this isnt about female employees. The real question is what is "profesional" in the workplace, regardless of who might be offended (what you do at home is your own business). What if a citizen walks-in your station at 10 pm for medical attention, B/P check, or directions, and there is soft-porn on the TV ? Could you defend that to your community ? There is no inbetween, either it is professional to watch these type of shows on-duty or it isnt. What is your opinion ?