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First of all, you DO know that the 2 year old doesn't have to TELL you in order for you to assess for nuchal rigidity, right? Secondly, assuming those patients who were transferred without a spinal tap being done were coming from a doctor's office, I'm not surprised. I wouldn't think that they would do spinal taps all that often in the doctor's office. Indeed. And how many of them were left due to provider incompetence versus truly benign assessment findings? The question is not whether or not MIGHT die if we don't transport every last one of them, the question is, how many with truly benign assessment findings would die? The old overkill them with tests adage again, I see. You do know that physicians don't regularly do invasive tests for patients with minor complaints and benign or low acuity assessment findings, right? I can't tell you. But I bet you can't tell me why you won't acknowledge what I've already said multiple times now: that increased educational standards come first, then follows treat and release, and every other wonderful tool I feel we should implement. So, what you're saying is that if we COULD answer those questions (that is, if our educational standards were higher), you WOULD agree with treat and release? How about a little evidence to back up those numbers? Or are those numbers still brown from pulling them out of your ass? By that insane logic, nobody should ever be let out of the hospital after they've walked through the doorways. Because if even two die following discharge, that's too many. For the record, simply transporting everyone to the hospital "just cause" does not equal good patient care, it constitutes clinical incompetence.

Trust me, I made up for it for you.

No flames from me. We are in agreement here. Political correctness is not only out of control, but it has jeopardized the safety of the civilized world.

Not at all, tell me what clinical competence you use to decide to let a 2 year old with fever stay at home and go see the doctor the next day ? How do you determine it is simple teething, versus ear infection, versus viral infection, versus menengitis ? Please tell me that you do not use the lack of petechia rash to determine the child is safe to go by car, I hope you are not that dumb ? Or do you subscribe to what we stupid people do and aire on the side of caution and transport all children with fever ? Show me a Doctor who wont look in an ear, do a CBC, or a strep test prior to discharging this child to stay at home ! So please educate me to your clinical expertise. P.S. Not trying to insult you, but before you decide to lecture the rest of us, you might want to run at least 100 calls.

Do y'all honestly believe diagnostic services are that important? That the educated provider can't use physical exam and history to determine how emergent the condition is in 99% of cases? Or are you figuring because y'all are incapable of it no one is. The ED is FAR from definitive care in a lot of cases. In things like acute psychosis the ED environment will probably exacerbate the issue at hand. People like Beiber who understand there has to be some level of cost benefit analysis will rise to lead EMS in the future. The era of EMS being "at any cost hero/lifesavers" are over. Unless we are able to SHOW benefit to people uneducated in medicine (which we can't right now) EMS will be deskilled to taxi drivers. Want to stop this and have a say? Get involved in research, push for better education and work on changing our reimbursement scheme so it focuses on services performed and not the expensive as hell taxi service it is right now. Repeating idiotic crap about "saving lives" and trying to maintain the (not working) status quo is only hastening our demise.

So the appropriate treatment for everything is transport? People are discharged from the ED with referrals to the appropriate services daily. You fail at understanding if medicine as a whole...

So does screwing black hookers count?? Would I ever date an African American? I wouldn't ... if being American isn't good enough for you, if you need to separate yourself from me even down to your ridiculous title, then I have no interest in you at all. Would I date a black woman? Well, yeah! In a second! Some of the most beautiful and sexy women I've ever met have been black....(I have a really goofy story about a black prostitute that I hired in Dubai once...and no, I didn't end up sleeping with her...(see, that's what makes it a funny story)...But it was a close thing. Remind me to tell you in private) So, if I would have cheated with the black woman, that I purchased...(Ironic, right?) then I am ok in Crotchity's eyes, but having chosen not to do so makes me a racist? C'mon Crotchity...surely even you don't believe this 4th grade bullshit. You are an anchor to your cause brother. Every time you present a point you make blacks appear weak, and ignorant, and pathetic. That has not been my experience in general..I'm sorry that you would be one of their champions. As to his being banned, I am vehemently opposed to it. There is not one single person in this thread that was forced to be here. You certainly have the ability to ignore his postings..To consider banning him when he's not following folks around tormenting them is despicable in my opinion. Has he threatened anyone? Followed anyone around trying to make their lives untenable? Has he done anything else, that perhaps I'm missing, other that try and turn every topic to express his liberal opinion of the great white oppressor and the heroic but oppressed black man? I've not seen it. Even derailing this thread! He expressed his opinion, but it was the general disrespect that we've all showed for Wendy's topic that allowed this to turn into a shit storm. This has been a great learning experience. We should have stayed focused on the topic but instead chose to take the feel good Bash Crotchity path. If he should be banned for being an idiot, then the rest of us should certainly be banned for following an idiot. At least he was in the lead. To suggest that a person should be banned because they present an opinion that you dislike is the very worst possible direction that we can go here, in my opinion. Dwayne

Wow, you've managed to take stupidity and refine it into a substance so pure and free of any semblance of intelligence that it would merit an award if they gave out awards for such. Congratulations, man! That's quite an accomplishment!

I am here, all you have to do is say my name three times like beetlejuice. Good point beiber, you are correct, it is sad that this is such a racist country. Now before you all get mad, let me check the dictionary; racist: The notion that ones own ethnic stock is superior. Most everyone in this room is racist, but can't admit it. Here is a little self-test that I have mentioned several times, but cant get anyone to fess up to. To see if you are racist, ask this question to yourself: If I am white, have i ever dated or made love to an african american ? If you are african american, have I ever dated or made love to a white person ? If the answer is no, you are a racist. Even if you are non-racist enough to have done the deed, you would never admit it in this forum for fear of how you will be judged ? Which may make you more racist than the person that never has. Furthermore, every guy in here at some point in his life has done the fattest, ugliest chick (of his own race) because he was hard up and drunk, but never seems drunk enough to cross the jungle-fever line (what does that say) ? Fortunately, the women are a little more decerning, as far as number of partners, but just as racist as thier male counterparts. And please spare me all the comments about how you are best friends with the one AA person at your workplace. You have never had dinner at his/her house, or invited them to yours (at least 98% of you have not).

Your logic does not work here, homosexuality is a mental disease, I am not mentally ill, so I would not sleep with a homosexual. I have no problem hanging out with homosexuals in a social or workplace setting, so I do not think I qualify as a homophobe. But back to the original point, I still hear the crickets chirping, where are all those non racist who date everyone ?

You are entitled to your opinion

Because I worked in a pediatric ER, and 62% of menengitis patients were originally seen by EMS and sent to hospital or doctor by car. Close to 40% were seen in a regular ER and either discharged or transferred to us without a spinal tap being done. Petechia rash is a late sign of menengitis, and it is hard for a 2 year old to tell you his neck is stiff. Just read through the EMS news section and read the countless stories of medics leaving people at home to die. There is too much we can not diagnose in the field with the limited resources that we have, and there are many disease processes you simply do not have the experience to understand. For instance, WITHOUT GOOGLING, tell me the proper treatment for an adult sarchiodosis patient in respiratory distress ? Most new medics can not tell the difference between early CHF versus COPD ? Tell me all that you know about the prehospital treatment of pulmonary hypertension. Tell me about how you treat a child with hypoplastic left heart and an O2 sat of 68%. I imagine you will have some of the answers by morning when you research the web for the next few hours, or you could be honest and say I do not have a clue. These are just a few examples of why we should not leave patients at home. Then do me this one last favor; take the number of patients your service sees, and then multiply that number by 1-2%, what number did you come up with ? That is the number you kill every year from refusals. Sounds good when you say hey we are right 98-99% of the time, not so good when you say, damn we killed "x" number of patients. Even if the number is "2" that is "2" too many. And for the record, an unexpected death due to EMS refusing to transport a patient to the hospital does not equal clinical excellance; it constitutes negligence.