VentMedic

If they get to that point it is probably too late. The idea is NOT tolet it get to that point. In some people it doesn't take much for out of whack electrolytes to stop the heart. If a person just gives you a wave each day but you don't know or care to know if that person is eating or taking their meds, how much good are you for their welfare. Essentially you are just a vulture circling while waiting for them to drop over and then you can take them to the hospital. Again, the things you are writing are only what a Paramedic has been taught which is not wrong but not entirely complete for a "home visit" assessment. You are thinking from an EMS provider point of view and not in a preventitive plan of care.

Yes, every state has reporting laws for child abuse as well as many other forms of domestic violence. However very few states mandate additional training for it. Some may require only 1 CEU for 4 years. That is NOT enough unless it is in your face obvious. EMS is most familiar with what they have learned about BLATANT abuse discovered during a 911 call. I'm sure you probably have known co-workers who abused their spouses but have kept quiet about it. Or, they may have a drug and alcohol problem that you don't say anything about because "they can handle it". However, in the homes it might be as rosy as things appear to you on the outside. Entering someone's home on a nonemergent bases is a very different ballgame. Also, you may not be the one who will always see the person and witness their behavior to establish a pattern. Malnourishment is not always that obvious. Many patients with chronic illnesses like COPD have albumin levels at 1. Often they are admitted to the hospital with a close watch on getting their nutritional status up as well as whatever inflammation they need to shake. Why do you think people on the street have wounds that won't heal?

EMS is a small community. In most areas, everybody knows somebody. It is hard to keep secrets. Those that have posted on a public forum probably will brag about it in other places and to other people as well. The bed you sleep in may have had many sexual partners on it. Not all are going to be neat freaks and clean up after themselves. The same for the ambulance. The public might not be too wild to learn the stretcher was just used by the two EMS providers for sex. Some may view others at the same station as also being participants in sexual relations as quilt by association or view them as unprofessionals for allowing it to occur. It may not show well for your future advancement with a company if the management learns of your activity even if it was just one time. Management is not always stupid and they will find out. Even if they don't counsel you, they may still quietly make note of it and will probably not put you in a position of responsibility where you can abuse their trust. Those of us who have been around for awhile do know this happens and also know that it rarely has a favorable outcome. When the relationship fails, one of the partners may have to be transferred or will quit. If the management finds out first, it may be an automatic dismissal for both. If the public finds out it may even make headlines similar to the one last year in Washington DC even it is not the same situation. It might be up to the parties involved to prove otherwise. In the meantime their reputation and that of their company is tarnished. I can not believe we are still feeding a 10th grade mentality.

That would all depend on what the welfare check consists of. If they want you to do a few vitals or any of the things I mentioned previously, you may have to do extensive documentation to cover yourself. If the persons dies a couple hours after you check on them or if the hospital questions abuse or a severely malnourished state, you may have to provide good documentation as to why you thought the patient was fine earlier. It also depends if your company is actually working through a formal contract with a governmental agency and what they are requiring and if there is some sort of fee your company is receiving from that agency for your service. To some in EMS, a welfare check might be a wave from the door. Again, it will depend on what your company and an overseeing agency have decided on. Of course, they shouldn't expect you to be a case manager since you have little education or training in this area but hopefully that is made very clear as to what your limitations are and what can be expected from Paramedics. That is another thing, don't overstate what you think you can do versus what you and your co-workers have a thorough knowledge of. Another area of concern would be how much medical and personal information you will have about each person you are visiting. Where will that information be stored? How much of that information, if you now have knowledge of, are you going to responsible for (meds, nutrition, living conditions, financial etc)? If there is not another agency involved, it may still not relieve you from thorough documentation since others may be watching how a program like this turns out. And, if something goes very wrong with the person you are checking in on, you may still have to answer who, what, when and why or how. I think we've all seen cases where the person was supposed to be monitored by some agency only to find they didn't have all the proper training amongst the workers and the paperwork was not adequate to show how much was actually done or poorly reflected the actual situation.

That is the purpose of Social Services. They get a government agency through the VA, Medicare, Medicaid, Medi-cal or whatever to provide scheduled services with the appropriate level of care. Some may only require a PCA or CNA. Other may need an LVN or RN. The visits may be once a day or once a week. EMS should not be responsible for the person's body hygiene care, perscriptions, home equipment, shopping, meals, nutritional status or appointments which is what most of these patient need. Most EMS workers are also not trained to recognize all the signs of abuse or neglect that is also a responsibility for those making visits. If you visit and leave the patient without food, medication or in a dangerous environment that you may not have been trained to recognize or had the time to recognize, you open yourself for liability. Social Workers usually have a Masters degree specializing in seeing the correct services are provided. That is why their involvement is of importance. Case Managers may be RNs with graduate work in Social Services or some extensive specialization. Tough jobs with mega responsibility. Welfare checks on people are a great community service. But, get a detailed list of what is expected and only expected of you. Vague and general are too broad.

Social Services. Develop an official professional relationship with the Social Services ofc of your hospital or community. They can assist with home followups, VNA, psych evaluations and placement if needed. Lee County EMS (Florida) has had some good success with their program. Other "out reach" programs have not been as successful nor has the public health models that have been attempted in some EMS agencies. Part of their failure has been due to poor medical oversight, bad management and lack of interest on the Paramedics part.

Article from Missouri Emergency Medical Association: Sleep Deprivation Study Details Effects of Shiftwork in EMS By W. Ann Maggiore EMS and the Law http://www.memsa.org/content/view/69/50/ Article referred to in that article: http://www.jems.com/news_and_articles/arti...42E76708F8EFFED Results of National Study on Responder Sleep Deprivation Released IAFC & USFA release report on effects in EMS JEMS.com Staff 2007 Sept 25 Links to more articles are in that article.

Sounds like you work at a pretty unprofessional place. At the hospitals I am familar with, resident doctors and staff physicians would be severely reprimanded if unprofessional conduct is even rumored to where it adds as a distraction to the patient care environment. Most are made aware of this policy on the first day of their residency and few things are worth getting kick out from a good hospital with a less then professional recommendation. Nurses also know they can be fired if there is any evidence of having sex while on the clock. If it does happen with nurses and doctors, you are not going to read about it on their forums to where their peers will know that their professionalism in a patient care environment is questionable. I suppose I could refer to your thread "Why are you guys so scared?" and wonder how amused some of the lurkers must be will reading this thread. You may have started this thread to get your jollies and you are probably masturbating while reading the posts. Geez! When is EMS going to get beyond the 10th grade level?

This is a public forum and can come up on almost any search engine. Anybody can look through the posts and not register. Some may browse just for amusement or curiosity. Some may prefer not to register and risk getting their email address sold. Since I and a few others view this site occasionally on a computer in the ED lounge, this site is in the list of freguented addresses. Nurses, MDs and whoever else may browse through. Some again just for amusement and prefer not to comment because "it is just too damn funny the way some EMT(s) perceive medicine and other medical professionals". Why waste time correcting/arguing something you already know to exist? And, others have their own forums to post on. Quite often the attitudes on the EMS forums are just amusing (or embarrassing) and not always in a good way which also discourages new posters.

I believe NJ and MA have wording in their Good Sam laws for paid EMS providers. Good Article: http://www.emsresponder.com/publication/ar...d=1&id=6186 And one more articles http://www.emsresponder.com/features/artic...p;siteSection=3

Many in EMS only prefer the 24 or 48 hour shifts and EMS may not be that attractive to some if the shifts were 8 or 12 hours. Although, many of those are very young and/or work in slow stations. The companies that are busier may still try to accomondate those preferences to keep attracting people even though the turnover might be higher. The companies are essentially caught in the middle and will get whiners either way. Even those that complain of how tired they are may be reluctant to go to 12 hour shifts if given the option tomorrow.

A few states have extended their immunity clause to non governmental EMS agencies and a couple are written under their Good Sam laws. There have been a few changes in some EMS laws since 9/11. However, the immunity statutes that exist for FDs in just about every area are probably very attractive to some Paramedics and a good reason to go with Fire and not a private EMS. Some states also extend their workmen's comp to off duty FF/EMS if injured performing in a similar capacity as their job description. Some health professionals prefer not to or are discouraged from volunteering on ambulances on their off duty hours unless they have 8 hours between shifts either volunteer or paid. While the Good Sam law will cover them for healthcare in good faith at the volunteer job, it will not protect them and and be used against them at their paid healthcare profession. We are required to disclose any and all sources of other employment to the hospital. While they may not always restrict your employment elsewhere, they can restrict you from OT and monitor special requests or sick time more closely. The other thing to consider is liability after you finish your shift and cause an MVC on your way home from work. There are several case precedents concerning that situation. There were also at least two deaths last year caused by the EMS provider falling asleep while driving the ambulance. One was a volunteer. So, it really doesn't matter if you are a volunteer or paid when it comes to the legalities that can stem from your actions or the very real consequences. The only difference will be if the patient or bystander or other motor vehicle operators/passengers can receive monetary compensation from you or your company. Night shift workers at the hospitals have their own jokes about EMS providers that do 24 hours shifts. Often the expectation of quality is not there. "Not alive after 5 (AM)" usually refers to both the providers and the patient. It doesn't take a rocket scientist to figure out more IVs are missed or not even attempted after 16 hours on duty. The same goes for ETIs. It is often as sad as it is funny to see the shape some providers are in when they bring patients to the ED after 23 hours on or after crawling out of bed from a dead sleep. Not the example of professional providers one would want to portray in broad daylight either from crews that work too many hours.

When one of our doctors in residency makes a mistake, the first thing risk managers and hospital attorneys now ask is how long they have been on shift. The same goes for any of the other licensed staff. If an RT is involved in a sentinel event even if it is equipment failure, their timesheets are requested. That can also mean any timesheets from other employers. There are still many that view 12 hour shift as too long for licensed hospital staff and use that to fight for 8 hour shift. There is now even debate in Law Enforcement as to whether 12 hours shift are safe since the LEO in CA ran over 3 bicyclists, killing 2 of them. However, when the San Antonio Fire Medics got heat for making a mistake at scene, they used the excuse that it was their 23 hour of work and that was okay. No further mention has been made again about the number of hours. Other employers of medical professionals that are wage, and not salaried, are severely scrutinized if the number of hours an employee works is unsafe. And, that is not necessarily a union thing. Unions could care less about the number of hours worked as evidenced by FDs. SFFD got some scrutiny from the public when it became known some of the type FF wage earners were working many days straight but the union justified the hours as not being a public safety issue since they spent most of the time sleeping. As long as EMS is identified with Fire, there won't be any change in safety for the employee or the public. Many still rely on governmental immunity or protection from the Good Sam portion of the statutes for EMS workers to get them out of many serious blunders.

In your electrocardiology/electrocardiography books, see if there is an explanation for the MCL leads. Most Holter monitors cannot do a true 12 lead ECG but will do the limb leads and MCL1-5 or 6 depending on the chosen positions for specific diagnostic value. Typically in the ICUs we will monitor the limb leads and MCL1. There are also a couple of sternal leads and the Lewis lead that can be done for more specific views. You can use Google books for some online reading with interesting textbooks.

Medical professionals such as Echo, RRT or CV Technologists are NOT going to discuss much more than to give you the necessary information to get through the test or the required teaching for special procedures. Many will down play what they know just to avoid questioning from a patient about a cause. If the technologists know you are in the medical profession but are asking questions that indicate you know some but not a lot, they will be extremely cautious as to what they say to you. Too many will read too much into something. Those that work in the hospitals know that it may take many tests for a definitive diagnosis unlike EMS where an emergent situation arises and you may treat a "symptom" or one manifestation from a disease process but don't actually know the true diagnosis or cause for that symptom to appear. There may be speculation but that is about all. Various nondescript EKGs changes on a young person can be anything from a serious disorder to poorly positioned electrodes. If I am working in a cardiac or pulmonary lab I will say as little as possible and attempt not to make any expressions if I do pick up on something. People will want to know: Do I have lung cancer? How bad is my heart damage? What's wrong with me? The questions from the transplant candidate screenings are the toughest because they know if denied as the result of a test, they're probably going to be dead fairly soon. Since it is usually not an immediate emergency situation happening during the testing and knowing that some diagnostics are just one small part of the puzzle, I tell patients to wait until the doctor has had a chance to analyze ALL tests (and shut the h*&$ up so I can finish your test).

I know you meant this to be funny. But, I have a patient who suffered a TBI that we just trached and weaned off the ventilator so he can easily be placed in a LTC facility. The family has some medical knowledge and the doctors have been very truthful about his chances for any resemblance of a normal life. Thus, the family has spent the last two weeks at his bedside praying for him to die. This has made his care particularly challenging especially when the family saw him breathing on his own when I removed the ventilator. It was a look of pure anguish and my heart does go out to them because breathing may be the only function he can do on his own for the next several years of his existence. The medical staff all knew he would breathe on his own but the family was still hoping for one last miracle that their son would die and not have to go through the next several years in that shape. This family is not unique. We have had many faimilies with the same feelings. Many, especially the fathers, will try to avoid seeing their family member in that shape and just refuse to visit. The mothers are often left alone crying at bedside. It is an ethical dilemma. Some patients that have what should be unsurvivable injuries pull through with few deficits. And, many patients go on to be warehoused in LTC facilities to become those hated BS calls for sepsis from apiration or a foley catheter at 0300. What you intended as a joke would be a great discussion about what people would prefer for their own family members or themselves if such a tragic event was to occur in their lives.

Yeah, working in the cardiac cath lab many years ago used to be a fun time.

In the U.S., Expungement is the more common method to deal with a conviction on one's record. It requires an attorney and a court appearance with a judge and is an easier route to take. A pardon in the U.S. is a whole different deal with either the President or governor of the state. Each state's EMS office will review your application and take it on a case by case bases. Acts of violence can be viewed in a different light than petty theft. Contact your EMS office for more details and/or call an attorney about an Expungement. If you are in a low income bracket, you may be able to get assistance from legal aid programs.

If you are referring to the arterial line, mercury manometers were used to calibrate the tranducers to ensure accuracy of the digital readout.

It matters if people know which sphygmomanometer you are using and that it is marked off at increments of 2 mmHg. They will think you don't understand this, thus are clueless when it comes to reading the equipment. It says alot about the person's attention to detail when it comes to using some equipment. I seriously would not want a Paramedic on CCT who thinks an indwelling arterial BP line is "zerod" if it is only "off by one" during the calibration process especially if he/she did not know enough to check if there is a simple reason for the transducer to not calibrate but let it go as only being "one off".

Even though I learned from some of the best NYC and Long Island shoppers, I did not step on or over anyone. I made sure they were knocked clear of the door as I entered. Seriously, this is humans acting at their worst.

You are very wrong there when it comes to FDs and EMS in California. Quite a few city FDs have seen the light and are in the process of giving up their EMS. Maybe for once California can be a leader in doing something right. It is unfortunate that California Paramedics have had to endure such limited scopes of practices since they were written initially for FFs in California. Now, maybe the Paramedics in that state can start to catch up with the other states like those on the East Coast. You and your little buddy are definitely making FF/Paramedics on both coasts cringe by your posts. Believe it or not there are professional FFs who do not want to associate with wannabes like the two of you. If either of you actually were FFs, you would have a lot more professionalism then either you or FF4193 have shown on this forum. Banagas, BTW, when did you become a FF? Are you even a Paramedic yet?

I hope he also realizes he has just insulted every FF/Paramedic who do try their best to maintain professionalism to their Paramedic patch as well as their FF cert. Not all FireMedics are uneducated but ff4l93 has made it a point to present them as such. There are several good FDs where his attitude would not be welcome either.

After reading cynical_as_hell's post on the thread; "Stupid 911 calls clog system, put safety at risk", even I who enjoys jumping in as a patient advocate, found this person's post "too over the edge" to be worthy of a response. It is quite possible to even read some things into this person's posts that are a disturbing glimpse into his/her psyche. Unfortunately or fortunately, on anonymous forums we may never know a person's reasons for posting the things they do or what is actually going through their minds. The human psyche is very complex. For this reason I am not a fan of CISD. No two people in that room will have the same past and present baggage or interpret/process situations the same way. No two suicide attempts or actual suicides will be the same except for maybe the method. This month (November) has also been the 30th anniversary of Jonestown. That is one event in history that hit close to home for many and one can't help but wonder what happens in the minds of those that can fall for something like this that had such a tragic ending.

There are also a few of us that had quality medical oversight and QA/QI in place to review the care we provided, time on calls and if the appropriate hospital was chosen. Of course there are others who may never be held accountable for crap work ethics or crappier assessment skills due to laxed medical oversight and the mentality of those who are in control of EMS.