Taxi um... ambulance driver or Professional

[spenac]

I have been surprised by comments that we should transport any person that calls for any reason. If we transport anything and anyone maybe we do deserve the title of taxi um... ambulance driver rather than health care professional. I do understand that we are not educated to the level of doctors but come on does it not annoy you that you can not think for yourself at all, that you are treated as if you are not smart enough to tell a person that gives no medical reason that they can not ride your ambulance. No wonder no one looks at us as professionals when you show up at the ER with a person that stubbed their toe, that sneezed once last week, that just wants a ride for a new prescription. If I were the Doctor, the nurse, and for that matter the patient I would not feel that you were a professional, I'd look at you as an expensive taxi driver that wasn't even smart enough to get paid upfront. Theres been so much talk about increasing the education level to become professional, but whats the point of more education if all you are going to be is a taxi um... ambulance driver. The extra education would be great if we were allowed as a group to start using our brains, to, do I dare say it, think a little on our own. Before I entered EMS and received medical education I was smart enough to know when I should call an ambulance but now with education some how we are no longer able to judge when a person needs an ambulance. I do think that certain events should be transported regardless of what we think just in case, but thats another discussion, this rant is about not being able to use any thinking on our own. If I wanted to be a professional taxi driver I would have bought a yellow car with a meter, probably would be making better money to and not have been out all the money and time for education.

OK I'm done ranting for the moment but maybe more later.

[Just Plain Ruff]

The problem I see is this

We are functioning under the control of a doctor or medical control. Since we do not have a doctor on board the ambulance who is the final authority as to whether there is a emergency medical condition occurring then we cannot in our right minds expect that we will be granted carte blanche to say "No transport for you"

Couple that with the image that EMS is not a profession but a job that most people in America have and we are already behind the eight ball.

Since we don't have the title MD Or DO or NP we cannot justifiably in our own defense tell a patient that they do not have a condition that requires ambulance transport. If we had the initials behind our names then that would be a different story, but plain and simple we do not.

We can bitch and moan on this forum all we want about Sally the ambulance abuser and Marty the trauma junkie, but we need to begin to think outside the box and ask the question "Why does America expect us to transport everyone?" The simple answer is that since we are NOT doctors, we cannot with any certainty tell someone that they are not suffering from a Emergency and tell them we are not going to transport them.

Unfortunately hindsight is 20/20 and if we knew then what is painfully obvious today, that the state of EMS is in trouble and part of that trouble is the mentality that we transport anyone and everyone no questions asked, we could have been better prepared as well as been able to better prepare the public that EMS is for emergencies and not a quick trip to the hospital.

If more and more people were educated via a media campaign and flyers sent to their houses what constitutes a emergency then I believe that our number of transports would decrease.

This then brings me to another point - payments to the ambulance services. If every service pursued collections of people who use their services instead of writing their bills off then maybe the public would stop and think, do I really need to call a ambulance to take me to the hospital. I'm gonna get a 450 dollar bill from the ambulance service that they are going to want to be paid. Maybe I don't need to go by ambulance when Virgil next door is perfectly able to drive me to the hospital.

If insurance companies would pay more than a piddly little amount and if Medicare paid more for our services then maybe we would be able to put more ambulances on the streets to combat the epidemic of running out of ambulances in a city. I can count on everyones hands here the number of times when the places I've worked have been out of ambulances and calls were backed up.

Finally, if we as americans didn't expect that their medical care be free or nearly free with insurance and if American's didn't expect to be seen in an ER within 30 minutes (those er's know who they are and they are bad for Emergency care In my opinion) then we would not be in the crisis we are in right now.

WE have to re-set expectations of the general public in a way that fosters caring and firmness. To do nothing is tantamount to not being able to bitch about this subject.

[spenac]

Medical directors should set protocol as to when not to transport. If medical director does not trust their medics to think maybe they should refuse to allow the medics to work under them or just maybe the medical director is not one that is right for EMS. A medical director needs to be able to let go of some of the power if EMS is going to turn around and have it's people looked at as Professionals. If you are a medical director that tells your medics how many sheets of paper they should use to wipe their butts you are part of this problem. You need as a medical director be able to set some guidelines that allow the EMS members to think, to do, and to become Professionals that can be respected by the public and other healthcare providers.

More rant later

[Ridryder 911]

I understand the point, but let's look at the whole picture instead of focusing in on just the symptom. Does physicians and other practitioners get to tell those that arrive "you don't need my services?"... Yes, they can discharge the patient of "not requiring treatment for non-life threatening conditions" after they perform a medical systems assessment and hoping and praying they don't immediately have an AMI or SAH moment they walk out the door. Thus very few times I have seen practitioners actually disregard without going ahead of assessing and treating.

Is there a need of protocols for non-transports? Yes, definitely for absurd calls but as everyone describes we are working as an extension of their license and practice. Sure, the medics should be competent enough for the medical director to trust, but; everyone makes mistakes. If I was a physician could I trust my livelihood and license/practice from every medic and every situation ? Something to think about. Even though I am very pro-medic as my license and livelihood increases, I examine those that I would say as competent medics, I don't know I would totally trust a 10 month trained individual of making such decisions ? Remember, medics are educated in very limited medical conditions. The one time or mistake will be the potentially the end of your career, again a mistake you did not actually make, except for trust.

I am not in favor for transports of the isolated items that does not warrant such transports that common sense obviously informs continuous medical care and stabilization is not needed. Maybe, consultation between medical control would be more informative and reduce potential litigation risks.

R/r 911

[spenac]

ridryder -50 for saying that dirty word or words -"common sense" can not have it either. We can not think. We all must just load up everyone that calls including the guy that just wants to go eat at the hospital because he called 911 saying his stomach hurts.

Ok I understand that we work under the medical directors license. Again there has to be a reasonable point of balance that would help stop this abuse. Again if not then all we really are taxi drivers. Law changes may be in order to make this happen but it is needed or we can never be considered Professionals by anyone but ourselves. Again if the medical director doesn't trust the person fire the person or require them to work under another medic you trust until they earn your trust. If schools are turning out people that can not think and should not be out there close the schools. But if the other changes don't happen whats the point we're just taxi- ambulance drivers.

more ranting later bear with me.

[spenac]

Since we cannot think and therefore we must transport everyone as we are taxi drivers, a question to ponder, will we feel anything if our loved one dies while we transport the person that coughed once and thinks they now have some deadly disease they saw on House?

[BEorP]

Since we cannot think and therefore we must transport everyone as we are taxi drivers, a question to ponder, will we feel anything if our loved one dies while we transport the person that coughed once and thinks they now have some deadly disease they saw on House?

This argument came up in another thread and I have the same response... if a truck goes out on a call then there should be another to cover their area. This way I can sleep well knowing my family will be alright.

[chbare]

"Defensive Medicine." The way of the future.

Take care,

chbare.

[spenac]

This argument came up in another thread and I have the same response... if a truck goes out on a call then there should be another to cover their area. This way I can sleep well knowing my family will be alright.

By your theory it would require staffing one taxi um I mean ambulance at every house. Not going to happen. What happens when all your taxis are out transporting where are more coming from. If you continue to allow people to abuse the system you are saying all we are are taxi drivers. No way we can ever be considered truly professional when we have no use of our brains, I will not lower myself to that standard. Thankfully I have one of the few good directors that realizes that we can be educated to realize not all callers need transport. Even if we had another ambulance to cover, which we don't, not a perfect world, I would still prefer to be available to assist them in saving a real patient rather than transporting a person that has no medical problem.

[spenac]

I know I'm in a completely different environment but come on city medics you are saying that you are not willing to make the effort required to become professionals. You are satisfied being taxi drivers. While I'm sure that you can do cpr does it not insult your intelligence that you can not deny a person with no medical complaint transport. Even with protocols that allows denial of some 911 callers being transported I start feeling like a taxi driver. Why not work with your medical directors to make changes. I personally don't want to hear anything about education to be professional unless it will allow EMS members to start using their brains. Why should I go to school for 4 years just to drive a taxi, the same thing we already do. My rant meter is running probably about to break my piggy bank.