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We were dispatched to the waiting room for CP once. We were in the EMS workroom so it wasn't to far to go. Anyway, the folks around here know how to get a emergency response. It;s either CP or respiratory distress. However, we treat everyone the same. Turn out to be a STEMI and we wheeled the pt. right through triage and into the ED, stopped long enough for the Attending to confirm our findings and continued straight to the Cath lab. The pt. did have a positive outcome. So yeah, not all pt.'s who call from the ED waiting room are self centered and full of shit. Do your job and treat the pt. appropriately. That is what we are here for. One other time we explained to the pt. what the word "triage" meant. After doing our assessment we advised her that she would not be seen any sooner if we took her through the back door and would "loose her spot in line" if she left. However, we did not refuse to take her stating it was her choice to come with us or not, but also informed her that she was most likely going to be "triaged" back to the waiting room.

I SERIOUSLY doubt that any "covered entity" is 'transmitting health information in connection with transactions' on ANY form of 'electronic social media' (i.e. facebook, myspace, twitter, youtube, etc) There's no need to be 'intentionally obtuse'!

(Shakes his head sadly....) Only in America! Come on people, this is just abuse of the system. They are already in an EMERGENCY room, full of EMERGENCY nurses and physicians. If they want to get taken elsewhere because of the waiting times then they take a cab. They are not going in my truck. Not that I would even get to see them because dispatch would refuse and ring the ER. Is it no wonder that healthcare in the US is so broke? I don´t normally have such strong opinions but this just goes beyond the pail to me.... Carl.

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.

I attended paramedic school at age 49, after a successful 23 year career in systems consulting and I too graduated at the top of my class. Guess what? I could not get a job. It had to do with the fact that I was not plugged into the young boy's network. I was too opinionated and was a threat to a lot of the status quo. I did ride time at a very good hospital based system and was devastated when I was not offered a job. I asked the director what I had done wrong. He told me that I would be difficult to integrate into the service because a lot of the existing medics resented the fact that I had options. (he meant, F**k you money.) I was doing it for love of the field. I moved out of state and took a job where the grueling call volumes, gnarly calls, and crappy pay made them welcome anyone with a cert crazy enough to work there. I made it work. The company has made major changes. We have great equipment, the best pay in this part of the country (more than fire) and high standards. I run CCT now, love the job and am delighted with how things worked out. Be flexible, keep looking and have faith. Your obvious intelligence and passion for the field will get you where you need to be.

I didn't claim that it is 'so good.' I debated your claim that it is no better than anything else that is moist. And the CDC website is hardly Wikipedia, nor the first thing that came up. And for the record, the shit you cited did in fact pop up in the first Google search I did...so..down boy. We've seen your posts, no one thinks that you're talking from your own knowledge..despite the fact that you have again failed to cite the sources for your claims and pass Googled info off as your own knowledge. We're debating IV sites, not the best product pre hip replacement surgery. Again...reread man..I never claimed it was better than Betadyne, never claimed it was the cat's meow, I simply disputed your ridiculous claim that it is no better than water. And will I put the alcohol cleaned laryngoscope in my mouth? Absolutely, 'cause to the best of my knowledge few, if any, pathogens get us ill orally. Would I touch it to my eye, or put it in my nose? Nah... I never claimed it would be sterile, just disinfected. You know Crotchity, I keep hoping that at some point your arguments will improve. That maybe someday we'll hit upon something that you'll care enough to make an intelligent, passionate argument about. I've seen you do one or the other many times, but never both together. I truly keep hoping that these types of arguments are not as good as you get... Dwayne

That's an ignorant question. Do you really need to ask it? I don't tolerate intolerance from anyone, including you.

Good question, as I am sure you know, alcohol has no cleaning properties other than being wet, so betadine is preferred.

Dwayne, so quick to judge me. If alcohol is so good why don't we sterilize surgical instruments with it. Why don't we soak our laryngoscope blades or other soiled EMS equipment in it ? Put your money where your mouth is, the next time you work an arrest, I want you to clean that laryngoscope blade with an alcohol prep, let it dry, and then put it in your mouth --- betting that is not going to happen. Makes me wonder why surgeons use all that betadine in the OR, why not just hit that site with some alcohol preps ? Now if YOU had done more research rather than just accept the first article that popped up when you googled it, you will find that alcohol has a hard time killing lipophilic viruses (HIV, RSV, and Hepatitis- because of the virus'lipid shell, and alcohol also has a tough time with hydrophylic viruses (Poliovirus, Rhinovirus, and Hepatits A)because of it's protein shell. If you want to knock the dust bunnies and boogers off someone's hand, use alcohol. If you want to use an aseptic technique, use something else.

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.