VentMedic

Did you also not get the meaning of a team effort? Some just want to bitch about the repeat calls while others want to see what can be done to prevent. Again, why do some in EMS criticize those who want to make an attempt to fix a problem? We could also use education and EMS as an example. There are reasons why EMS has the problems throughout the country when it comes to education, standards and certifications. Many of those problems lie with the lack of motivation amongst some of the providers. Some just believe if they keeping defending the way things are even though it could be better or ignor what isn't, everything will be just fine. Some are just afraid to extend themselves alittle or get involved with issues that aren't directly in their protocol book.

Depression is also recognized as a mental disability. There are some in EMS who have this diagnosis on their record but may be under treatment and can still function well enough on the job. However, if they are unable to work it is recognized for disability benefits by the Social Security Administration. If you live in one of the states that has a specific law for placing someone under involuntary psych hold, your documentation will lhave to be very descriptive without prejudice. Although in most states only LEOs and mental health professionals are allowed to place someone under a psych hold.

It also depends on whether you are describing a pre-existing condition or an acute situation. Are they already taking meds for a known mental disorder? Is their mental status altered from their norm? I find it easier to describe the altered mental status and seek out the many causes of it before writing the patient off as just having a mental disability. As well, those with existing mental disorders can also have an acute medical condition which exacerbates an alteration in their mental status. For these reasons, many psych hold faciities want medical clearance before acceptance.

?????

Again and again and again.... Do you not understand the concept of team or how a healthcare system works? How many times do I have to explain it to you? Have you not even been part of a trauma system and know what goes into it. I take it you are asking for a recipe. Sorry, but we go by guidelines and use the form most appropriate for the situation and the patient. If it is elder or child abuse, we have our pathway for that with the necessary reporting forms. I would hope your state and agency have at the very least told you about what the mandates are. We take special care to document homelessness when it involves children and the elderly. Each area will usually have special programs for people that fall into this category especially if they are homeless for one of the reasons outlines within state laws. For repeat offenders, we track with the hospital systems by documenting "homeless" or "Social Service request" and filling out a separate brief information form. Honestly it is not that big of a deal to go out of your way to help someone or to start a paper trail to get someone who pisses you off by repeat calls locked up. You don't need to get any special book learnin' to do it or one of them college degrees. Don't play dumb (unless your really are and then you have my apologies) when this is a relatively simple concept but it seems there are those in EMS like yourself that choose not to get involved. Do you really have to be spoon fed everything or are you really just uninformed by choice?

You have done a total of 8 posts on this forum with most consisting of one sentence about Taco Bell or Wal-mart. When I thought you had some promise of making decent discussion, you want to run away. Try EMTlife.com if this discussion about differences in views on patient care offends you. I will not change my attitude about providing patient care to all regardless of where they live, their ability to pay or their lifestyle issues.

Blanket statements? Did you even notice the word "some" in almost all of my posts? Did you also notice that I specifically directed my remarks to herbie and CB? Did you even understand the remark I made about fat overweight Paramedics sucking up workmen's comp? Let me repost it: As far as the disgusting part, I feel the same way about obese, chain smoking EMT(P)s who suck up sick days, increase out of pocket insurance rates for everyone and then expect the government to support their fat, short of breath arses when they go out on disability from a line of duty injury they received while reaching for that last powdered sugar donut. Did that remark hit a nerve and are you one of those fat, chain smoking EMTs who are on workmen's comp? If not then how does that pertain to you or anyone who doesn't fit that description and is on Workmen's Comp? That also should be an issue others should be concerned about since it directly affects insurance rates and overhead for your company. If I am working in the Cardiopulmonary Stress lab I must test these EMT(P)s. So I do have first hand knowledge of their excuses. I have also worked in EMS for 30 years and have seen many types come and go in the profession. If you have even worked in EMS don't tell me you haven't seen these fine examples of an unhealthy lifestyle and then use their jobs as an excuse. Do you know how many workmen's comp claims are made and many of them could probably have been avoidable it the EMS provider had taken an interest in their own health? How about deaths on the job usually related to cardiopulmonary problems? Is this honestly any different than what a couple of you have been saying about the homeless who don't want to take care of themselves? Why is it also that when someone points out something that EMS could improve you must also use the "they do it too excuse"? This forum is about EMS. If you read some of the forums for law enforcement you will notice they are more aware of their fitness situation as are the FFs and have been trying to improve within their systems. But, no some in EMS must continue to make excuses for their profession which criticizing patients and other professions. Xanax? So are drugs your answer to ignor situations or to enforce the "don't care" attitude. No thanks you can keep your drugs. I prefer to be clear headed when I am providing patient care. If drugs are the answer to your own problems then I suggest you examine your own life and stop criticizing others. I seriously hope you don't give that advice out freely to your co-workers. Drugs are NOT the answer especially if you have the responsibility of patient care. It is too easy for an abusive habit to form and you may find your ownself on the streets.

Besides the death part, insurers such as Medicare will not reimburse hospitals for any acquired infections and aspiration PNA falls into that category. The healthcare industry has gone to great expense to prevent aspiration which includes improved airway management methods. Good site with some statistics: http://www.zapvap.com/facts.aspx Since the cuff on an ETT or trach doesn't not prevent aspiration but rather just slows down the inevitable. We now use an ETT that has a suction port just above the cuff that is hooked up to continuous low suction. http://www.zapvap.com/_pdfs/inservice_poster.pdf We may also use silver coated ETTs in the hospital. http://www.bardmedical.com/products/loadPr...aspx?prodID=391 Aspiration becomes an issue with Stroke, TBI and Spinal Cord Injury patients even though they appear to be managing their airway. This is why it is imperative they get into a Speech Therapy program to identify the severity and start with rehab. As well, patients that have had prolonged intubation will have difficulty swallowing which can also be compounded by careless intubation technique and vocal cord or pharyngeal damage. If the aspiration issues are not dealt with, pneumonia will follow and it is possible that will be the cause of death and not the initial disease or injury. And this could happen also. Since I am now considering doing some travel assignments, I could be coming soon to a city near you.

My mistake. I guess somebody has to write you a recipe first. EMS just needs to stay providing first aid and let the other medical professionals try to alleviate the healthcare problems even though those in EMS do have a street view. You are correct that EMS providers are not trained/educated to provide the level of care needed by the homeless and do have little choice but to transport. RNs, NPs and PAs would be the more logical choice to provide care at that level. But, that doesn't mean those in EMS can't bring someting to patient care also instead of "just drive them to the hospital because our protocols say we have to" mentality. It doesn't mean you can't seek out alternatives and see how they will fit into your system. You aren't even reading the other posts to know what else has been done. Again and again and again, I NEVER said you had to be a social worker. Yes, you only have the training of an EMT but that doesn't mean you can not read, ask questions and see where you CAN make a difference. Again and again and again, did you not read the posts that state a working effort with other professionals? Back in the 70s? Some ended up homeless? Where are you that you are so out of touch? Do you not watch the news on TV or a computer? Read a newspaper? You do realize this country has serious health care issues and the mental health programs were the first to feel serious cutbacks. Honestly, where have you been that you don't know any of this? This isn't just in one city but in many cities in many states throughout this country. It even affects Small Town, USA.

Duke, do you read the freakin' posts before you jump on someone who is trying to make a difference? WTF!! I get criticized because I do find ways to implement something into systems that can make a difference. What the hell is wrong with that??!! You seem to have tried within you system. Is this a systemwide program or is it just you? And no, I did not call all of you uncaring, lazy, cold hearted bastards. I do however have a gripe with Herbie and CB who just seem to have given up and call any suggestions as useless. Thus they are the ones painting the picture that all in EMS are just like them and want more to jump in to say giving a shit about the homeless is just a waste of time. To them the homeless are just losers who don't want help and anyone stupid enough to believe you could make a difference for even one person is on some do gooder high horse. I live in a city with many homeless but that doesn't mean I have to be heartless and just put my head up my arse so I don't have to get involved in my community which includes healthcare issues for everyone and not just a select few that some in EMS might feel are more worthy than others. I would like people who are in healthcare or who are seeking a career in the healthcare professions to believe they can make a difference if they are truly in it for patient care. It doesn't have to be just a job of following recipes and waiting for burn out to set in. You don't have to be jaded to work in EMS or any other profession. It is about patient care and caring about those around you even in situations that seem overwhelming.

Many of the symptoms of cancer progression and chemotherapy can mimic Fibromyalgia once the CNS is involved. However, it would be difficult to dstinquish since if it is actually the cause of the pain. The treatment and pain management would still be focused on the cancer unless there was a need for an antiflammatory. Some survivors of cancer do develop Fibromyalgia after they are deemed cancer free. Some believe it is from the chemical changes the body may have experienced while fighting the cancer and the chemotherapy that bring about chemical changes in the CNS and the nerve transmitters. Thus, they may have a lifetime of pain even without the cancer.

Actually many of the people on the streets with substance abuse and mental illness are there because the programs helping them have closed when funding dried up. That can definitely skew their own impression of those who now do want to help. And then, when they run into people who are supposed to be healthcare professionals that are borderline abusive to them in the streets, and don't deny that doesn't happen, they lose their perspective of what and who is helping. Making sure they don't fall through the cracks by starting some type of paper trail or a working relationship with the resources available at the hospitals and in the community is a good start. It may not be much but if just one person does get the help needed to make a difference, it may be another life saved. I am familar with Lee County EMS since they have strived to make a difference in their communities which has been a benefit to them as well as the people they serve. Herbie quote I have the advantage of knowing many different resources and do not have the financial, subtance abuse or mental health issues of those that are on the street. Even for the many who are now on the street for financial reasons, it may take them awhile to start thinking clearly. Those who have lost everything due to job loss and foreclosure may be in an emotional turmoil. Does that mean we just step over them and stereotype them as some loser in the streets who doesn't want help? You mean I should quit caring and become a jaded, burnt out individual like yourself? No, I think I will continue to provide patient care and do whatever I can to make a difference. I do have the advantage of following my patients and I can see what happens when good prehospital providers and the ED can bring about an opportunity for someone to get off the streets. Sometimes it just takes a little time to make the appropriate documentation on the correct form to be handed to the right person.

So you are now stereotyping all homeless people and were you one that made the choice to be there? If you yourself was on the street, you should have a little understanding of the type of people living there. And, you should also take another look at who is out there. Of course, if your reason for being on the street is personal, you don't have to explain on an open forum. You may have been with a different crowd in a different environment and didn't have or at that time wasn't aware of the issues. And, if you did make the choice to live on the streets, it doesn't mean everyone has. Those with substance abuse and mental issues are not really able to make rational choices. I guess it is attitudes like this is why some overlooked an elderly person lying in a ditch for 10 days in California and just made assumptions that it was his choice. Funny you should mention Lee County. I hope you are not putting them into the same class of burnt out EMS providers as yourself and Herbie. Look at how they have hooked up with other services do make a difference.

I guess you haven't really looked at who is on the streets lately in this economy. Being blind to societies problems as humans and healthcare professionals is just a cop out. Any you still didn't read any posts or probably have never examined the protocols of other services. Thus, it is useless to carry on an intelligent conversation with such a jaded and burnt out individual such as yourself. While you continue to make excuses, examples have been given how even a little can help a lot and differences have been made by those in EMS. Yes let's keep EMS in the stone age and let the other medical professions worry about how to treat everyone, homeless included, while you just stick to being an ambulance driver. Ever wonder why other healthcare professions are successful? They come together for what is best for the patient and not what the patient is supposed to do for the provider.

Have you even bothered to read any of the posts by myself or docharris? If you did you would have seen how and where EMS providers fit in. You believe that the EMS provider can do nothing more than provide a ride to the hospital but fail to see where you could make even a slight difference without even getting anymore of that awful education stuff. Since you also brought al of this up, let me give you more examples and you may even be who I am talking about. Even though it is mandatory in all states to report elder and child abuse, many in EMS believe they just need to drop the patient off at the ED and say, "I think this person is living in an abusive enviroment" and then leave. The EMS providers believe the RNs will notify Case Managers and the State agency as well as filling out the report. The problem is they may not have witnessed what those in EMS saw. Yet, those in EMS believe "it's not my job", "I just bring them to the hospital", "I don't want to get involved", "It means more paper work". I

It is overwhelming which is why I say if I can make a difference for one patient, I've accomplished something. Hospital Case Managers may have over 100 open cases at any given time and get 30 more each shift if they have ED call. However, if attitudes persist or become prevalent throughout a system like an ED or even EMS that what good is it to try or who care since they don't care, then the whole process starts to break down. Sometimes it just takes one person being persistent that there is a better way and they can make a difference. Here's a feel good story. http://www.kcbs.com/pages/194580.php? Paramedic's H.O.M.E. Team Reaches Out to Homeless (CBS 5) If you shop or work in downtown San Francisco, chances are good you've passed Larry in his wheelchair. But Niels Tangherlini doesn't pass by - he knows Larry's name, and all about his health problems and alcohol dependency. "I've a little bit worried about some of the stuff I've been hearing," he tells Larry. "We picked you up two or three times on Thursday with the ambulance." Niels is a San Francisco Paramedic Captain, and he's determined to get people like Larry to stop calling 9-1-1 and start getting their lives back on track. "I have people who have made literally 100s of 911 calls," Niels explains. "The calls are often related to chronic alcoholism, seizures, intoxication, falls." A paramedic for 15 years, Niels grew frustrated seeing the same faces again and again. So he envisioned a program where paramedics would partner with social service agencies, keeping the chronically homeless off the streets and getting them out of the emergency room. "I realized you can sit and complain about it or really do something about it!" says Niels. So in 2004, Niels founded HOME - the Homeless Outreach and Medical Emergency team. He recruited social workers to ride with paramedics and together, they began to coordinate different city services for the homeless. Two years later, there are only a third as many chronic callers to 9-1-1. "We've been able to get people into supportive housing, ongoing alcohol and substance abuse treatment," he says. "Just the act of getting someone a case manager.. can just really change their life." Social worker and nurse practitioner James Eskridge rides with Niels. "This program is different because we are doing actually outreach on the streets with is basically front-line work," says James. "This is where we make the most difference." They're not only making a difference to people on the street, but countless people who call 9-1-1 with a real emergency. San Francisco Fire Chief Joanne Hayes-White says, "We're able to keep our units in service to respond to those Code 3 life-threatening emergencies that we otherwise might not be able to in the event of responding to a homeless person." And she adds, Neil's' HOME Team is a win-win for the homeless and everyone else. "Niels now is sort of an ambassador for the fire department as he works closely with other agencies reaching out to the homeless population. And we're really proud of him and we're really proud of the effectiveness of the program." "I knew this would work," Niels says determinedly. "We really can make a huge difference in dealing with public health problems and that collaborative efforts like this are the best way to handle problems." So for making non-emergencies a priority so that everyone gets the help they need, this week's Jefferson Award in the Bay Area goes to Niels Tangherlini.

Apologies. These cross country flights are getting tiresome. Just remember "haste can make waste". I like to look at the cords for abnormal anatomical structures that can create potential problems which I can make note of to follow up later with the Intensivist. The cords on a manikin are in one position and really do not give the best representation of a real person. When doing cllinicals, one should examine with their preceptor the movement of the cords if the person is not on a paralytic. Even while on a paralytic, the positioning and structure of the cords and surrounding tissue can be examined more closely if time permits. Over anxious attempts can damage the cords to where it will affect the patient for the rest of his/her life. A good example was young 21 y/o college senior who partied a little too much. He actually probably just needed positioning to where he didn't inhale his vomit and a banana bag but he got intubated in the field to where he started vomiting from the repeated attempts (5). In haste to get the tube in "to prevent aspiration", they damaged his cords. He returned to college several months later with a trach and his cords were too damaged for speaking with any clarity. He also got a peg for feeding since his swallow was affected. I also had a patient with a provider who thought he was shoving a CombiTube down the throat of a manikin and that ended with a trach/peg set. Granted, the patient's actions by getting drunk or drugged may have led to the intubation but it is also the provider's responsibility to do no more harm and to realize when another alternative should be used. When I am precepting students, at least in a controlled environment, I may have them first just do an examination with the laryngoscope without worrying about placing the tube. It is unfortunate that some can not recognize the basic anatomy within the oral cavity and pharynx. Some instuctors over simplify intubation and students get caught up in playing with the "skill" such as seeing how many tubes they can sink on the manikin.

Your posts give us a good idea of about you and obviously I did strike a nerve. You will probably be burned out and no longer in EMS long before I give up on helping people. You don't make it to 30 years in health care without keeping your focus on why you went into this profession rather than accounting or computer programming.

Just remember "haste can make waste". I like to look at the cords and for abnormal potential problems which I can make not of for follow up. The cords on a manikin are in one position and they are not on a real person. Over anxious attempts can damage this structure to where it will affect the patient for the rest of their life. A good example was young 21 y/o college senior who partied a little too much. He actually probably just needed positioning to where he didn't inhale his vomit and a banana bag but he got intubated in the field to where he started vomiting from the repeated attempts (5). In haste to get the tube in "to prevent aspiration", they damaged his cords. He returned to college several months later with a trach and his cords were too damaged for speaking with any clarity. He also got a peg for feeding since his swallow was affected.

I've pulled plenty of shifts on the street in the last 30 years. It is actually a lot easier on the street when you can get by with the "I don't care attitude" or don't have to make eye contact by staying focused on you paperwork. You can also fudge on the numbers so you don't have to remove any other clothes or even touch the patient as you give them a taxi ride to the hospital. Who's going to notice or care? Just give them a ride to the ED and dump them with some half arsed assessment on a piece of paper. Seeing how some in EMS treat their patients is the unfortunate part about working in different EDs. It doesn't seem to matter where I travel in this country, the attitudes of some in EMS are pretty much the same. And it isn't always very professional. I get to see a lot more of that attitude now than I did even while working on ground EMS. Of course that was probably because I would not work with someone who treated patients as garbage instead of human beings. When was the last time you actually had a conversation with your patients? How many patients do you take care of at one time? Ever work in a busy city ED with many patients from various backgrounds? Ever work at an inner city clinic where the clientèle is primarily homeless? Ever be part of a project to get a database for tracking some of your patients and getting their names to the proper agencies? Ever be part of a community project to do something for those less fortunate than you? How many codes on children have you worked because they couldn't their asthma or other chronic illness meds due to lack of clinics and programs? If you have, did that inspire you to get involved in at least learning what is available? Or do you still just don't care because "it is so different on the street"? I gues this statement tells us that you have just given up. Well luckily there are those that do care and don't give up. What a sad, sad statement.

So because a few people know how to play the game we stereotype everyone that resembles them. Have some in EMS become so jaded that they take one story and say, "yep that sums it all up and none of them deserve the benefit of the doubt?" At least John Q Citizen still cares enough to make a call. He/she could easily look the other way. But then they may be under the impression that they are calling people who might care and not cop an attitude that it is just another mucked up homeless junkie wanting something. After all, for some in EMS it is not about what we can do for the patient.

spenac, I hope you at least were able to get your Paramedic education paid for through the grants and scholarships that are set up for Native Americans. I know students striving to be nurses and other healthcare professionals have qualified for a large part of their tuition to be paid for.

It's about time!

Then post some facts. What have you and your state done? You have not addressed any real world problems or provided must information except to point out the bad about cities like Seattle which is trying. Maybe they can't help everyone, that doesn't mean that city and their system is a failure. So what exactly have you brought constructive to this discussion? I just don't get people who must constantly criticize those who want to take healthcare, including EMS, to a now level with a higher awareness for issues that do affect even EMT(P)s in someway. If you view it as "not your problem" or "not your job" why bash those to do establish programs to track the repeaters and see if referrals can be obtained? If a provider sees a health issue more than just intoxication, why criticize someone for doing a thorough assessment? Seriously, what is with the attitude towards seeing what can be done instead of just saying no to every suggestion?

But then the article didn't go indepth to what has been tried. Maybe he was just caught in a system of whiners and not doers. Since Miami and SF are both very attractive places for the homeless, it is a struggle. Yet, we don't just give up and say the hell with them. We constantly try to find solutions and find the ones that can be helped. It is when you become so jaded as some appear to have, that is when you lose your ability to identify healthcare problems and separate them from the social issues. And I love Seattle because of how it has dealt with the homeless situation. Your friend seems to only see those on the street or what she may perceive as failures or losers. She doesn't mention how many thousands Seattle's programs have helped. Nor does she mention how many days those still in the street have NOT occupied a hospital ICU bed because even if they do live on the street they may still get care at some of the clinics.