VentMedic

Go away? Yeah the television appearances say that.... I gave him some benefit of the doubt until I saw what he was all about on his guest appearance on TV. "Pro bono"? Hardly. Rid was posting earlier about donations to his legal fees. Sorry, I don't believe in donating to help one person get rich and is self serving. By him being able to buy a new car and a big house will not help out EMS. The attorney will also take a share of the winnings so you can bet they are asking large.

I am confused if they want the patient back in this country or if someone just wants a settlement which the patient may never see. His legal guardian and attorney may control whatever monetary settlement gained. It would also be very difficult for him to re-enter the country as I believe his mother was not allowed to travel to visit him when he was injured. By the way, do you have the equivalent of the AARP in Canada? The one good thing about 50 is joining that association for the benefits and the magazine with cool travel specials.

Actually I have worked in a Maximum Security prison before I got hired by the FD. Whatever...I didn't specify the type of cell. What happened to "professionals" and departments working out their differences? Believe it or not many departments do work out their issues with each other without talk shows and lawyers. What makes this Paramedic so different that he is entitled to money and fame? How many times have the LEOs looked the other way when ambulances or known EMT(P)s do stupid stuff with the ambulance or POV? How many times have whackers in their POVs demanded professional courtesy from LEOs and have sometimes been granted it. There I have a problem and that LEO should be seriously disciplined.

From the new article: Some paraplegics do not always need medication. Decubitus ulcers would be his biggest problem and that would take preventitive measures and not medicine. A paraplegic who is not capable of caring for himself doesn't not have a long life expectancy. Granted Christopher Reeve was a quad but he died of sepsis stemming from decubitus ulcers after 8 years. He also had some well known specialists caring for him but they may have forgotten the little things. Elderly? The guy is 35. Yes if she had him when she was 45 that would put her around 80. It would depend on your definition of elderly. Some use that term for someone of 60. We have RNs working FT in their 70s.

For positive, I hope you are not saying that with a "we showed them cops a thing or two attitude". Again, both of these two characters had a history of prior events and this would have been destined to have happened with someone by each of them again. It is just unfortunate that it has been taken this far as to make the Paramedic a rich guy and possibly cause the LEO to lose his job. Lawsuits should not be intended for reasons such as this. The Paramedic has no other motive for this lawsuit other than to get what is "owed" to him. Personally I think both should be locked in a cell and let the one who is still alive at the end of the day be the winner or they could come out with a handshake which would be the better outcome. We also have other headlines making the news with stupid and unprofessional acts by EMTs. The EMT Capt. in NJ was found guilty for disobeying a LEO. In that case the EMT's haste to reach the patient did injure the LEO, do property damage and could have caused another accident which would have led to more injuries. Do we really want to engage in an us against them war? Don't we have enough of that within our own professio?

Can we merge the two threads? Apparently his cousin by marriage was his legal guardian. She had to have been aware of the issues with his placement as he was already placed once in a NH and then returned to the hospital. I would hope the hospital informed her of the difficulty placing him again. Surely there had to have been alternatives discussed which might have included training his family in the U.S. for home care. As his legal guardian she also had some responsibility to stay informed about his care and to also help with finding alternatives. Now if the legal guardian and family only visited for appearance or rarely, there may be other issues involved to which they also failed to assume some responsibilty just like American families are often asked to do. I am also wondering what input his mother in Guatamala had since she is a nurse. She may not have been allowed to come to this country for visits by restrictions from her own country. Since it has been almost 10 years since his accident I wouldn't doubt his condition is deteriorating. But, that has been almost 6 years in his home country and I would say his mother is taking good care of him. It took an American nursing home less than a year to almost kill him off with decubitus ulcers. That is a sad statement on our own health care situations. Being this is in Florida, I can only speculate on what the nurse/patient ratio is. This country does provide long term medical to thousands of illegals. However, we are running out of options to warehouse these patients. Thre are long waiting lists and many of these patients take up ICU beds because they are on ventilators. It there is no longer a facility that can care for this patient available the family may have to help with options. The hospital may also have found placement a couple hundred miles away but the family may have refused it. Of course, there would have been a legal battle there also if the hospital got a court order placement. This family now has strong backing from every human rights group as the legal battles have been going on for over 6 years. This will be messy because we also have one of Obama's campaign promises to stop deportation of illegal Haitains. I linked this article with more detail in the other thread. Stuart hospital's deportation of illegal immigrant sparks legal battle http://www.miamiherald.com/569/story/1107995.html

I am curious as to what talks transpired during the 3 years he was receiving medical care. The hospital's doctors and case managers had to have talked to someone and what options were offered and what did his family or cousin by marriage legal guardian have to offer. That person was probably notified previously that the patient was being placed in a NH and then back to the hospital. That person also was probably aware the hospital was having trouble placing him again. The guardian must also have been made aware that the hospital would not warehouse him forever. So no, I do not believe this was totally out of the blue. However, I do believe they did do it to where there would not be time for a court or special interest group to organize. I also believe the legal guardian should have explored more options with the hospital to prevent this from happening. If the legal guardian was not able to understand the medical legal issues, she should have asked for help from a court appoint representative. I would also be interested in how many times the family visited him at the hospital or nursing home. Homecare might have also have been an option but were any of his family in the U.S. who it suing willing to assume that responsibility? Florida hospitals are not in the business of deporting illegals. However, I will say for Haitains it is a little different but that is once they are released and that is a whole other issue. A little more detailed report: Stuart hospital's deportation of illegal immigrant sparks legal battle An illegal immigrant left incapacitated when he was hit by a stolen van is at the center of a legal battle after the Stuart hospital that spent $1 million on his healthcare deported him. BY DAPHNE DURET Palm Beach Post STUART -- On his ride back to Indiantown from a landscaping job one afternoon almost a decade ago, Luis Alberto Jimenez's destiny collided with the front end of a stolen van. The impact killed two passengers in the car he was in and landed the van's drunk driver, Donald Flewellen, in prison for almost 10 years on a DUI-manslaughter charge. The crash also left Jimenez, an illegal Guatemalan immigrant, with debilitating injuries and the cognitive ability of a fourth-grader. Flewellen is on probation now. And Jimenez has become the center of a legal battle between the hospital that flew him back to Guatemala after spending more than $1 million on his care and Jimenez's family members who say the hospital falsely imprisoned him and deported him so it would no longer have to pay to treat him. CASE FOR REFORM Jimenez's case, which will be the focus of a civil trial expected to begin Tuesday in Martin County, is at the forefront of national debates on healthcare and immigration. ''If there's ever a case that highlights the need for reform concerning both issues, this is it,'' Miami immigration attorney Greg Wald said. Wald, who splits his time between South Florida and San Francisco, said the practice of hospitals privately deporting undocumented immigrants has happened across the country. But Jimenez's case is among the first, if not the first, in which such a deportation has been challenged. After the February 2000 crash, rescue workers took Jimenez to Martin Memorial Medical Center in Stuart with severe head injuries and broken bones. Because he was in the United States illegally, he was ineligible for Medicaid aside from a nominal amount allotted for emergency cases. The hospital treated Jimenez at its own expense. In June 2000 he was transferred to a nursing home. By January 2001, he was back at the hospital's emergency room with severe bedsores. The hospital again rehabilitated him. This time, according to court records, no nursing home would take him. Because Jimenez's injuries left him incapacitated, Martin County Circuit Judge John Fennelly allowed Montejo Gaspar Montejo, Jimenez's cousin by marriage, to serve as his guardian. A legal battle surfaced after Martin Memorial sought a court order to have Jimenez sent back to Guatemala. Hospital officials presented the judge with a letter from a high-ranking Guatemalan health official to bolster their argument that Jimenez would receive proper care in his home country. Against objections from Montejo and his attorney, the judge sided with Martin Memorial. Montejo filed an appeal, but less than a day later hospital officials flew Jimenez to Guatemala on a chartered jet. A nurse went along to make sure he was settled in the new hospital. But three weeks later he was kicked out of that hospital and then out of another. BACK IN GUATEMALA Jimenez, now 35, lives in a small village in Guatemala, where his elderly mother is his nurse. He has no medication. Family members say his condition is deteriorating. An appeals court in 2004 overturned Judge Fennelly's decision, saying he had no jurisdiction to authorize the return. Montejo then sued the hospital. The suit was initially dismissed, but the case was reopened two years later after another appellate ruling cleared the way. Martin Memorial officials declined last week to comment on the specifics of the case. They said their situation reflects those of hospitals across the country. ''Unfortunately, the cost of providing that care is rising, and the burden of paying the healthcare bill for many undocumented immigrants is falling on hospitals and health systems that simply cannot afford to pay it,'' hospital spokeswoman Ronda Wilburn said in an e-mail. If jurors rule in favor of Montejo and order the hospital to pay for Jimenez's care, then Wald said hospitals will think twice about sending patients back to their home countries. ''The hospitals are in an untenable position,'' Wald said. ``At the same time, I have a problem with any private entity deporting someone.''

This is still the best thing to happen to the EMT. He will probably get a large chunk of change regardless of whether it goes to court or it is settled out of court. It may be better if he does go to court since that will give him opportunity to make TV appearances and maybe even sign a book deal. We may see this soon as a Movie of the Week so we can watch the drama of these two pathetic fools on our big screen TVs. Both have serious problems communicating and issues with their anger and egos.

We don't have alot of EMTs working in anything other than IFT transfer trucks where I 'm from so the Paramedics do know lifting is part of the job. It's not a choice. So, our Paramedics have been accustomed to carrying patients for many, many years. Granted there was a time when the FD did call for a BLS truck and let the EMTs do all the lifting but now if a private ambulance does run with the FD, they are also usually Paramedics. Whatever happened here, they should have documented appropriately and if they did have the patient walk down the stairs they should have tried to justify it by documentation.

That could be related. I would probably have CP daily if I was an elementary or high school teacher under some of the conditions I hear about. It's bad enough in a classroom of EMT or Paramedic students. If I was a high school teacher in a classroom today, Nitroglycerin would not be my drug of choice to ease the pain.

DIB is also a common ED/hospital abbreviation for Disability Insurance Beneficiary when we are not using it as Dead in Bed.

There was actually an article published in JEMS several years ago when a couple of EMS chiefs who took offense to SOB when their EMT(P)s always got the giggles when they used the term on the radio. They also called for a change to DIB which is why it is seen in EMS and seldon anywhere elso. To my knowledge there is not a billing code for that in the hospital and the RN/MD will often rewrite for SOB. In RT and other areas of the hospital, we get a little more descriptive with breathing and will use DOE which is Dyspnea on Exertion which indicates the patient is fine until he/she moves. That does have some weight when it comes to making a definitve diagnosis as well as the codes for billing.

Yes that has been a serious concern for hospitals throughout he country. As well, with the deadly outbreak of bacteria at a L.A. hospital a couple of years ago and the blame was placed on the laryngoscope blade, everyone using scopes in the hospital have been on alert and have enhanced their cleaning policies. That incident closed the hospsital's NICU and PICU after 33 children were affected and at least one died. The bacteria a fairly common one called pseudomonas aeruginosa. This is also a huge concern in the Anaesthesia department and if you surf up some articles you will find extensive information on handles, blades and their cleaning. Many of the GI bugs enter into the respiratory tract when one touches the patient or bed clothes and then touches the blade or tube. Escherichia coli (E. Coli) is what we will sometimes see for a respiratory infection. Whatever equipment you have at bedside such as your intubation bag can be contaminated and then carried to the next patient you see and that is usually how C. Diff is spread. As for the C. Diff, we do have to remind the ambulance crews that transport patients with it to use the bleach based wipes which we have everywhere for that purpose. Microbiology seriously needs to be a prerequisite for EMT-B since they transport the most patients to and from other facilities that have immunosuppressed and surgical patients. Read a few reviews for Anaesthesia and see which scope they believe are the easiest to clean and care for. There have also been numerous articles written about scopes in the Infection Control Journals since the L.A. incident. Although, in all fairness there were a few other hospitals with similar incidents but not quite with the same numbers but deadly just the same.

Hypothermia has been used for specific purposes especially in the pedicatric world for many years. It was also trialed in the 1980s in prehospital but cooling the patient was primative. Hospitals started using hypothermia in larger numbers and different populations over at least the past decade and it is now being used prehospital in a few areas. The stats on it are still questionable as some patients still die and occasionally you have someone who has no deficit post cardiac arrest. However, we have had patients with few or no deficits without the hypothermia. I believe the determining factors are still weighing more heavily on witnesses arrests and CPR initiated immediately. Quote from your AHA Circulation Journal article: There is a very strict criteria as to which patients will be selected for the studies and usually they are the ones who would also have the best chance for survival without neuro deficits also. Some patients may also not be counted in the stats if they were rewarmed early from complications during the hypothermia. Those that die during the protocol may not be counted. Some researchers are looking purely at the outcomes of a patient that survives through the entire course and their neurological deficits. But this is not unlike any other medical study which is why I tell people to pull up the original article to read the methology of the research rather than a fluff story in the newspaper or JEMS.

I don't believe there is a national standard for what to call an OR and its rooms/suites/pods/nodes or whatever. ORs can be designed differently for different purposes so one label doesn't fit all. Also, some of the hospital and EMS abbreviations differ and while this is an EMS community, we pretty much understand each other. However, if you say DIB to hospital staff they will probably take that to mean "Dead in Bed" and not Difficulty in Breathing. If that same hospital staff uses the abbreviation SOB to the EMS crew who uses DIB, they may take it to mean Son of a Bitch and will get offended. On this forum it is fairly easy to just ask if you don't understand.

I just don't see where the big problem is in this situation. The engine could have shut down for a safety issue to secure equipment. The engine didn't lag behind behind the ambulance and they also knew the ambulance had at least one Paramedic who would also be the one transporting the patient if required. Its not like the patient lacked in care on scene. Of course if the arrival time for both were out of the specified limits, then there could be an issue. Some agencies do require paper work with at least a name if not canceled prior to arrival. The OP didn't respond to what the arrangement is for cancelation of services. The communication between the ambulance and FD as presented here is a little sketchy. The burden of proof might lie with you if accusing the Engine Paramedics of failing to act where it endangered the patient. You would also have to be certain that engine didn't stop for a legitimate reason that you could not see from your perspective. You may have to also show it was their intent to avoid patient care that led to harm being done. But then if you were the first Paramedic on scene that may nat play well towards your own abilities unless your response time was acceptable for the transporting ambulance and the FR engine's was not. The OP also has not made any effort to leave a paper trail. But, as she puts it this is a rant. Rants in the media will only make it look like a personal issue if not effort has been made to go through the chain of command. We also have had issues with the private ambulance service that used to do the FD transports. Essentially they lagged behind even after arrival to let the fire guys handle it. We solved that problem by getting trucks capable of transporting our own patients and let the private ambulance just do "BLS" calls. We had the documentatiom to back up our complaints against them and when it did go to the media, the FD was ready. The same goes for hospitals and NHs that are unhappy with the service from the privates. They document and when contract negotiations come around, they are ready. In some areas this is very competitive business and few private ambulances can afford to lose the big contracts. Pick your battles wisely and don't just let your dislike for the FD or the us vs them thing cloud your judgement. If it concerns an issue that relates directly to a patient where their actions caused harm, a report should have been made and presented to your supervisors. An anonymous letter to a newspaper may not benefit anyone especially that patient.

The FD you respond with may not be the best or have great manners but that doesn't mean all FDs are the same. The PUM was developed to provide the highest level of care possible to the community and for the government to oversee that some quality is maintained to the community's expectations. There should be a Board as well as an advisory committee that might be interested in what you have to say. While there are good points and some bad points to a PUM, in most cases it brings ALS and Paramedics to the people. Be thankful for that. There are still too many in EMS that don't appreciate ALS and will continue to argue that BLS is good enough for their community just to justify being an EMT with not intentions of advancing. And, I do hate using the term BLS and ALS. You are a Paramedic also regardless of what paperwork the FD must also do with their response or how the agreement within your PUM is setup. Just see that the patient gets taken care of and don't get caught up in petty "us against them" crap. It will only distract from the issue of patient care and if you wear your emotions on your sleeve, you will look worst to the public than the FFs. You could also be up against an all volunteer service doing another job during the day instead of getting paid to do what I hope you enjoy doing.

I don't believe we are trying to out some mafia scandal here but rather address a professional issue which should be done as the P&P book states by the professionals involved and offering professional courtesy to the professional you have the complaint about to respond as a professional. If these are direct patient care issues they should have a legitimate paper trail to show that every effort had been made to establish a professional relationship between the professionals involved. Then if all else fails the media can be contacted. However, if and when they investigate and find no complaints and/or rebuttals or any other paper trail on file, guess which file they are going to put your letter in and how much credibility you will have?

Do you honestly think I haven't? I have also help set up shelters to protect the homeless during hurricanes and have seen the new homeless had shelt afterwards. Again, enough of your stereotyping of the homeless. Geez! How many of those that call 911 are going to refuse treatment or at least a ride to the hospital? Addicts are not the most easily treated but at least we can do enough patch work each time we do see them so that they don't need the ICU. Do you know how many medical problems the homeless addicts face and how many hospital days they do require if they problems are ignored. If you don't want to do anything then don't. I definitely wouldn't want someone with negative attitude on a team that is trying to make a difference. So please don't think you have to do any more than what your few protocols state. You and herbie have made it clear that not all patients are worth your attention. I am just glad I don't have the same jaded outlook as you after all these years. Yes I do want to make a difference and through my roots in EMS and advanced education, I have and I will continue to. If you have a problem with that then maybe you should re-evalutate why you are in a profession involving patient care.

At the community colleges it is the same 2 year degree. The tests are just at different levels. The CRT is more "technician" but with the prerequisites, it is no longer a 1 year tech program. The advanced courses are tested in the RRT with is applying the theories and more hemodynamics. You can get an idea of this by the same (free) at the NBRC as well as an outline. Any school that tells you the RRT is in addition to the 2 year degree is at this time scamming you. In the near future however that might not be true but if the profession goes to BSRT, Concorde will undoubtedly be out of the RT business.

This is noteworthy also before getting sucked into a long drawn out education process with an RT mill that doesn't offer the RRT program. From the NBRC website: I personally think there should also be a time limit to being an EMT on an emergency certified ambulance without continuing on your education.

The National Board for Respiratory Care (credentialing agency) http://www.nbrc.org/ Under Educators it lists the accreditation for schools and gives a list of the schools. The American Associaton for Respiratory Care (national association) http://www.aarc.org/ Under education it also provides a list of schools and how they are accedited or why. The Government section also gives an ideas how RTs are attempting to solidify their reimbursement opportunities with Medicare. The state chapter of the AARC for TN which also lists the schools. http://www.tntsrc.org/

CRT? Certified? Keep going for the RRT or you'll be recognized just as the EMT of the RT world and won't get to play in the big kid games. Like the chain medic mills this school has managed to stay afloat by students who didn't make the grade for a college or was promised "easy to sign loan", "very little paper work to fill out or they fill it out for you" and "they'll work with you". The "they'll work with you part only lasts until the check is cashed. It also attracks students who want a more "tech school" atmosphere rather than a structured academic world. If you look at their other programs this school offers such Medical Assistant, Patient Care Assistant, Massage Therapy and Office Assistant, you will notice that these are all certificate programs and mostly "skills" oriented professions. Concorde is the medic mill of RT that added a degree program when they went to the mandatory 2 year degree for credentialing. The 4 year degree is also the future for RT and there is legislation in the works to gain the recognition now for certain areas. Concorde's credit will probably not transfer to any worthy university. Look in the RT magazines you will also find this school advertises for instructors frequently. The school does meet accreditation as required by the NBRC for the student to test as a CRT. This part from their website worries me: Graduates of this program will be eligible and prepared to take the National Board of Respiratory Care Certified Respiratory Therapist Written Exam (also called Entry Level Exam) Again, as a CRT, you will be the EMT of the RT world. RRT is the credential you want which is what a regular college degree program will provide. BTW it looks like Concorde does have an "Advanced RT" program for which I'm sure another $20k will get you. Do NOT waste your time and money on this school. Do NOT waste your time and money on a program that does not meet the requirements to allow you to test as an RRT. Get into a program that will allow you to grow since the RT profession is growing. Unfortunately not all departments are alike. That hospital may also have taken advantage of the new grad RTs from this "mill" and pay them the minimum wage in that profession just to do the minimal skills/tasks required to keep the department open and show a lean budget to management. Thus, their technology might be from 30 years ago and the most exciting thing they get to do is plug in a flowmeter while the nurse takes care of the rest. These departments are then a reminder of how far others who have good education and work in progressive departments have come.

EMS49393 This may only get one ignored more and written off as a disgruntled employee who is holding a grudge for getting suspended once your identity becomes known. Also, when it is anonymous, the media may just toss it as being unsubstantiated and may not publish a bash and trash letter. When you were suspended did you pursue all avenues to make your side known? What other situation(s) was also occurring when you wanted medical command that also brought a FD Captain to the scene? Leave a paper trail through your own chain of command first or ask for a sit down meeting with your superiors. Are there any others who also have similar complaints and are willing to join you? What is your policy for canceling the FD? Often if the FD has already anounced they are on scene the Paramedics may have to do their own report whereas if they are canceled in route they may not. A lot of people hate where they work and that is one thing someone can change even if you have to relocate. Even those that work for a hospital in a town with only one hospital realize a change in location might be necessary to get the specialty or job situation desired. Good luck with your next job and maybe it will turn into a career position.

Look at the quoted reference in my post from the one just above mine with the "?????". It looks like he brought a quote about cancer patients over from another thread. I just didn't see the relevance of cancer patients and mental disability unless it is from depression which I did post about later.