Taxi um... ambulance driver or Professional

[spenac]

Recently got called to the local clinic for anaphylactic shock. Got there found person breathing no difficulty with minor edema at bee sting site. Asked patient when they were stung, was more than 24 hours earlier. Patient never complained of anything but some discomfort at bee sting site. Doc wanted them taken the 90 miles to the hospital, I was bored so went ahead and loaded them. Went back in to get paperwork on patient, they didn't want to release it to me. They refused to provide the medical necessity form required by medicaid. I finally lost it, told the doctor that he was wasting our time and just cost his patient $1500 for no reason, as patient could safely travel private car. Told him I could have actually denied the patient per protocol. Told him we would not leave until we at least received his treatment sheet. Finally got that from him and left with him cussing me all the way to the door. Enroute to hospital patient had no problems, did not start IV or do EKG as nothing gave indication for it. I started reading treatment sheet and they had administered several meds and had not told us, so if they would have actually had problems we would not have known and could have harmed them. But long story short I should have denied this patient transport and told the doc to go jump in the river. rant done for now.

[WelshMedic]

Hi all,

I can fully understand how frustrating it would be to have to transport someone you knew did not require urgent medical treatment. I can remember a ride-along in the Philadelphia area (not PFD, by the way..) where we picked up a young woman. Chief complaint: she had got a bit cold waiting for the SEPTA bus to turn up. Referring party: the local police department! I was appalled at the misuse of the service by colleagues, but I was speechless when we then transported to the ED as well.

I'm not going to launch into a sermon here about how much better we have it here in the Netherlands, you can't compare apples to pears. Yes, I can refuse but I would be the one standing before the coroner as an independent practitioner.

No, there is, in my opinion, a number of basic flaws in american EMS:

1) The litigous culture has made every healthcare professional afraid to take risks, perceived or otherwise. I would think twice as well if I had a multi-million claim hanging above my head for leaving poor Mildred at home with her broken fingernail that, by chance, 6 weeks later got infected and gave her a mild case of septicaemia.

2) Whilst most of the EMS people I have met are wonderful people doing a great job, their scope of practice tends to be a bit limited. I guess I'm with Dust, AK and Ruffems on this one, education is the way forward. There lies a great future for EMS if you are willing to take the reins and throw the shackles of medical direction off. Become a profession in your own right!

3) Last but not least, if you decide not to transport then it's important to offer the patient another care pathway. This is not an option for a lot of people as they have practically no access to primary healthcare. This is why urban ER's are snowed under with a lot of people that shouldn't be there in the first place.

The above is just my take on things. There a lots of things that american EMS does right, and we have all learned from them. Take for example PHTLS, this is franchised worldwide. But they have nothing to do with this topic. I know I'm just a presumptious foreigner. I also realise my experience is limited. Don't take offence at any of my remarks, it's not my intention. Just argue with me why I'm wrong.

WM

[spenac]

Thanks WM. Good post. Today I was promoted to bus driver. With only 1 ambulance for 3000 square miles we received 3 calls within minutes of each other. We loaded first one I started treatment while partner drove and we got the other 2. We loaded and a cop drove us north, met our mutual aid about 30 minutes later and shuffled patients. Of the 3, two were flown out from the small town hospital we drive 90 miles to.

Hey wonder if I get a pay raise as a bus driver compared to taxi driver.

[riskynremtp]

spenac, I am overly impressed with your commentary. It is the reasons you have stated along with many others, that EMS is not more regarded as a "professional" occupation. I have worked the cities, and I am now working rural. Fortunately, we have a director, whom had the insight to recruit a "competent medical director" with street medic experience. This should be a Federal requirement for any physician, whom desires the title of "med-control".

Ours, in many instances responds to the scene with us, and has also put the trust in his medics to educate an abuser of the system, by reviewing with them the reasons for untilizing an "emergency" ambulance. In many instances, we will contact local law enforcement whom assist us in dealing with a habitual abuser, or if we find no reason for "emergency" use of our unit, we will contact one of the local convo agencies in the area, and have them respond to the scene (if a request for transport is still requested). So in summary, I am 100% behind you on this topic, and I hope the day will come that there is a mandated protocol for physicians whom desire to be med control. No doctor should attempt to direct a medic unless he or she has previously served as a paramedic. Minimum of one year would be a start. Take care.

[Ridryder 911]

I totally disagree... just because some yahoo.. rode in the back of EMS unit while he attended medical school does not make them any better. There is NO correlation of medical control and being a former medic. In fact, I have seen some sharp paramedics become medical control and become sh*tty at it. Restricitng medications and procedures, that they as medics would had fought for. The reason, now the risks is on their license.

There is a medical control/EMS medical physician course that all those that have interest should be required to attend (even those that had been medics). As well, as EMS Physician residency programs. There is much more than just authorizing protocols and procedures. Unfortunately, most EMS Medical Control is not aware of that or care more than that. Until, we have support from the top, we will never improve our profession.

R/r 911

[Freaknuggetz_chick]

this is an oldie but goodie topic. everyone hates getting BS calls, especially in the middle of the night when we should be sleeping. however, working in rural ems, i often see times when personally i wouldnt call an ambulance, but the patient has no other options. i was involved in a call in which phoning 9-1-1 for a mild flu was the only way a woman could get out of a severly abusive and controlling relationship on a reserve. sometimes the BS calls can surprise us.

that being said, for the arsehole who calls for a stubbed toe, with taxi service, we should be able to call MC to deny transport.

[riskynremtp]

Ridryder, I was not aware that there were classes offered for med control. I thank you for the information, and hope that I can pass it on. However, you will never convince me that a "course" can take the place of experience. If this were simply the case, then why not do away with clinical time altogether, and for that matter, take the road test out of the exam for 16 year olds getting their driver's license. Education must be accompanied with experience, and vise versa. One could never survive or enhance itself without the other.

[Ridryder 911]

I agree experience is great, but then we will have to split hairs on what type, level, etc.. What if they only ran one call a month or worked at a very non-progressive service..? One can see the dilemma.

I believe NAEMSP has the medical control course. They as well have very good information out there.

R/r 911

[Dustdevil]

I would agree with Rid. Good medicine is good medicine, regardless of where it is rendered. I don't think a physician needs to have spent time working in EMS to understand our capabilities and limitations. As Rid points out, even that experience would provide him with only a very limited view, considering the vast differences in regional sophistication. Would you want to work for a physician who had been a medic with DCFD? What are the chances that he would understand and respect the advanced education and capabilities you may have in your suburban or rural system? You see, his "experience" could just as easily be a negative as a positive.

If we were talking about the man writing your operational policies and procedures, then yes, I would agree that he needs to have significant experience in the field. But not for the guy developing my medical protocols.

[Richard B the EMT]

On the topic of refusing transport, I was sent this link to a "MyFoxCleveland" investigative report, on misuse of 9-1-1. It holds almost as true in my New York City, as well as possibly, and probably, in your localities, around the world.

I hope everyone finds it as interesting as I did.

Link:

http://www.myfoxcleveland.com/myfox/pages/....1.1&sflg=1