spenac

We actually get people that report us at times but Border Patrol still has not stopped us. Border patrol will sometimes tell us that they received tip that we were hauling an illegal but they did not want to interfere with patient care. Again if patient is in custody they are responsible for medical care of the prisioner, thats my guess to why they do not check us.

I have been surprised by comments that we should transport any person that calls for any reason. If we transport anything and anyone maybe we do deserve the title of taxi um... ambulance driver rather than health care professional. I do understand that we are not educated to the level of doctors but come on does it not annoy you that you can not think for yourself at all, that you are treated as if you are not smart enough to tell a person that gives no medical reason that they can not ride your ambulance. No wonder no one looks at us as professionals when you show up at the ER with a person that stubbed their toe, that sneezed once last week, that just wants a ride for a new prescription. If I were the Doctor, the nurse, and for that matter the patient I would not feel that you were a professional, I'd look at you as an expensive taxi driver that wasn't even smart enough to get paid upfront. Theres been so much talk about increasing the education level to become professional, but whats the point of more education if all you are going to be is a taxi um... ambulance driver. The extra education would be great if we were allowed as a group to start using our brains, to, do I dare say it, think a little on our own. Before I entered EMS and received medical education I was smart enough to know when I should call an ambulance but now with education some how we are no longer able to judge when a person needs an ambulance. I do think that certain events should be transported regardless of what we think just in case, but thats another discussion, this rant is about not being able to use any thinking on our own. If I wanted to be a professional taxi driver I would have bought a yellow car with a meter, probably would be making better money to and not have been out all the money and time for education. OK I'm done ranting for the moment but maybe more later.

Thank you. It was great to see someone catch that the illegal part plays no part in the decision making. The decision is made based on the medical complaint or lack of. Our medical director looks at us as professionals that have enough brains to think for ourselves. With what many say from other areas our job would be unbearable if we had medical director that would not allow the use of our brain and education. Like most we still transport the majority of patients but we do have more treat and release protocols available than other systems I've seen. People know that we are not stopped. I have asked them to stop us a few times to get word out that we can get stopped but they won't, at least so far. I've even asked that the drug dogs be used to help discourage attempted drug smuggling by patients.

Congrats on the passing. Now your education actually begins if your going to be good at this profession.

Or I knew a guy that burned to death because he could not get out of the seatbelt so I don't wear one. To fireguard not sure as to your system but it would seem more appropriate to set up triage center at the ambulance. If your not in bunker gear and scba you should not be that close to the fire and smoke otherwise you could become like the blue canarys(law enforcement that rush in no training no gear for those that don't know) and be of little help to anyone. Most fire services I've seen and heard of require enough additional fire members in gear on the outside to go get any firefighter that goes down then they carry them out to you in order to make sure everyone goes home. Another reason ambulance is further away is so you can head to the hospital with your injured or sick fire brothers.

Our not transporting is because there is no medical reason to transport even per the mothers statements. Patient has already been treated and is able to safely be transported by POV. Per our protocol patient is to be denied transport in this case, not having a car, or not having a passport is no reason to justify taking a person to the hospital. Man I am glad we have a medical director that allows use of our brain and not one that says transport everyone that calls as that would bite. As already stated if there is an emergency we will treat and transport regardless of legal status. Having seen the conditions many people live in in Mexico, I don't blame them for wanting to try a new place. We do not ask if a person is legal, remember in this scenario she tells you she has no concern about the child that would require the ambulance it is just that she can not pass the checkpoint.

The border patrol checkpoints are about 50 miles north of the border in our area. At the checkpoint they stop all vehichles going north and ask for proof of citizenship. The border zone runs from the border to the checkpoint. Many people can get day passes at the point of entry to enter up to 25 miles of the border into the USA to shop and visit family and some decide to stay illegally. Some illegally walk accross the border no fence and the rio grande is not that grande anymore. Many people live in this area illegally for years not able to re-enter Mexico (w/o having to sneak back into USA) and not able to go further north. Many raise their familys here. There is a large number of Border Patrol agents in the area but they are mainly here to try and stop illegal crossings of the border but it's a large border. So her being in the USA does not give her full access to the USA. Once past the checkpoint she will be able to go any where in the USA she wants. This is the biggest abuse of the ambulance in our area, using us to get past the checkpoints. We have asked the Border Patrol checkpoint to start stopping and checking us but there orders are to let us pass without delay and the illegals know this and use it.

Ah senorita mas fina no not in this case and not part of deciding to transport or not. Her child is USA citizen, she is not and she is here illegally. She is basically trapped in the border zone and sees this as a way out to the interior of the USA. She has not given any medical reason to transport her child but has clearly stated she is illegal and cannot pass the checkpoint. Had they called when the break occured we would have transported without hesitation, but this patient has already had the injury fixed. Odds are based on what is seen and stated nothing further needed until time to remove the cast. As mentioned per protocol this patient is not eligible for transport and would be denied transport. Now a twist if the mother is smart a couple of hours later they will call 911 again and this time she will focus on how severe the pain her child is getting. Pain will also be in neck and back radiating to the legs. Child will have been coached to say everything hurts 10 out of 10. Now what do you do, transport? Do you deny because you suspect the fake? I'll let ya'll chew on that a while as it happens often as well.

I get you now Dust. It is sad that laziness gets in the way of professionalism so often. If a patient is sitting there waiting why not protect the patient from injury and really yourself from lawsuits by using the gear you have.

If we tranport the child the mother goes. No need for the ambulance even based on what the mother has said. The ER would just tell her to follow up with her local doctor and then local doctor would help schedule a specialist if needed. The reason we are there is the mother sees an easy way past the checkpoint. In our area people see it as a free and easy way past the border patrol, but most do not out and out tell us they are illegal. After about 60 miles north a person will probably never be checked for legal status unless they get stopped for traffic violation and they know this and use the ambulance to bypass all reg and suprise checkpoints.

Since it's getting late heres more info for our area. First our Medical Director allows us to deny transport under a few instances. On this particular case in the scenario if we showed up at the hospital with a patient that already had been treated and only reason we were requested was the mothers legal status we would be talked to and questioned if we could not follow protocol. There is no medical need for ambulance, the mothers legal status can play no part in whether to transport or not. Patient can safely be transported by POV which is also determining factor as to getting paid by medicaid. As far as the law in this case we could be guilty of transporting illegals a felony and could face jail time. Had the little girl needed medical attention could have changed law interpetation according to BP and other local LE. Our instructions from all law enforcement agencys is to take care of our patients. In fact if they show up on scene with us none of the agencys check patients legal status. I am not a lawyer and have not studied all the laws rules regulations on this matter so what I say is not set in stone. Off the record we have heard rumors that none of the agencies want to know the status because they would then have to take the patient into custody and would thus foot the cost of all additional care both in the ambulance and the hospital. Rumor even has it they sometimes take people into custody as they leave the hospital even when they knew in advance the person was illegal just to avoid the bill and the posible bad publicity. Now normally while we may think people are illegal most do not tell us. Most also will act very sick or injured, thus we have to transport just to see a miricle occur just after the checkpoint 50 miles north and by the time we reach the hospital they're completly cured and leave hospital w/o seeing the doc. Many contract nurses and docs think we're darn good at treating patients until the reg staff explain to them just what happened. As a side note it is also interesing to watch the blood pressure drop shortly after we pass the checkpoint. Wish mine would lower just by passing it. May need a grant to study why it cures some people but not others. Please keep in mind this is a scenario that combines things that do occur in our area w/o dealing with a specific patient. Keep discussing I'm enjoying seeing how others think. We have always been instructed that we cannot report any information as to legal status as it could be breach of patients right to privacy and in the scenarios case the mother by default would be protected by it as well. What do ya'll think?

Basically da.... if you do, da.... if you don't by what your saying. Glad your not lawyer definitly had me worried for a little. Just kidding all you lawyers on here.

Well the big difference between you and myself is ... I was never taught to read X-rays .. so I couldnt use that as a diagnostic, (outta my scope,) and again would take them on the basis of not knowing if proper care was rendered(spelling?) and as far as wether or not a pt is legal/illegal and getting stopped etc... the pt the young girl is us citizen isnt she(i think this was stated) Why would you know the mothers legal status ? the mother is not your patient and is irrelevant to the pt's care. on a side note it was once explained to me that anyone over 65(legal i presume) gets medicare, and anyone who cant afford insurance or medical care(cant remember which, pretty sure its cant afford much of anything.) gets medicaid. If this is right how did the young girl get medicare ? (if im wrong can someone explain it better?) I still don't know and am sticking with TXP the pt .. lol

Lets say the patient is illegal and needs immediate care. A. Can you treat them or do you leave them? B. Can you report them without violating patient confidentiality? C. Do any laws supersede the other laws? D. Is it abandonment to not transport so you are not guilty of transporting illegals? E. Are you a lawyer that specializes in this so I can trust your responses? Thanks for your involvement it's fun to see how others respond to things I see often.

Hey Dust, This was taught to me when I was a NEWBIE EMR, by an EMT I had as my first partner. I didn't know better as I said in my first post this was only done 7 times in 9 years. I don't KED all pt. in a wheelchair, but it worked so we used it when we worked together.

"<< city boy ... i dont have any protocol that says make a medical decision/refuse treatment/txp cuz the next available unit is too far away. " Not refusing because mutual aid to far away. "Why not run an intercept with that unit 60 miles away ? split the ride half way ?" Mutual aid is only available for emergencys, this is not emergency. So now 2 ambulances and 2 areas uncovered for 1 none emergency and that assumes that the mutual aid is available. Also now you have to consider costs that we've been ignoring is it fair to ask them to lose money to. They are a different agency not part of ours. They only have one ambulance as well. "Further, theres no new medical complaint except the broken arm ? ... here's a question how well does the parent/child speak english ? are you certain she said what you think she said ? " Actually family is not requesting us for broken arm, they want us to go to the hospital because the patients mother cannot pass checkpoint. Child good english. Second medic is native of Mexico if that helps scenario so he can speak with patients mother. We will also in scenario allow you to speak fair spanish, so it is definite that the mother is just asking for a way past check point. "I don;t know the "text book answer" but i would take the pt. cuz i have no idea, whats going on under that cast, dont know if it was done right, or what. again I'd probably go for an intercept but im a city boy what do i know lol

"When are MASTS indicated in your protocols? The only reason we still carry them is the state requires it. We are NOT supposed to use them. They are not even in the area curriculum anymore." PASG are basically out of use most areas that I deal in. Numerous studies have shown little benefit in relation to the time involved in putting them on. Several studies have actually showed them to break the number one healthcare rule of cause no harm. The few instances that can be beneficial there are other devices and methods that are just as effective.

If you render medical aid to or transport an illegal with medical necessity are you breaking the law? Are you required to notify law enforcement? In the scenario are you breaking the law if you transport? Points to ponder.

Patient has given no medical complaint, if there is a complaint legal staus is never a question. The patient is not illegal as is indicated by her having medicaid. The patients mother is illegal and her being illegal is again the only reason being given for wanting to use ambulance. The patient obviously has legal family as they took her accross the border and back and thus could take her to hospital in USA. Again only concern given for ambulance is mother is illegal and can't pass the checkpoint. As additional info if mother were to cross back into Mexico then come to port of entry with her child she would probably be issued a temporary medical pass to take her child who is USA citizen to the hospital unless she is wanted for some crime. Not paid commision but thats an idea, just kidding again not about the money just a point to ponder on medicaid.

Again mother said "no concern" that required ambulance other than her illegal status. Do you need medical complaint to transport or are you just transporting illegals? As far as need more ambulances and staff I agree but thats another gripe for another day. But even if we had one ambulance for every house in our 2000 square mile plus primary coverage area is there any way to justify this transport. And please note I have not brought money into picture, we assume we will not be paid. But as another point to ponder do you feel medicaid would pay for this? But again we are not concerned with payment at this time, just more to ponder.

I'll get more into our Medical Directors protocols after see more thoughts and ideas. Like the way you're thinking.

You would take a person with no medical complaint leaving your community uncovered? Nearest mutual aid is at least 60 miles out. What if your mother collapses while your out on this call and could have been saved had ambulance been there? Points to ponder. Remember patients mother states there is no medical concern.

Since all info came while involved in medical, could you even report her if you wanted to? Point to ponder in this discussion. Also what is your reason for transport, helping her or helping the child since child has no new medical complaint? Another point to ponder.

I will only reply to your questions or comments? I will not bias this by telling what we do as we get things like this several times a week. Keep in mind the big old hipo that all actually helps keep us from being able to be in the publics eye the way firefighters are but thats another gripe.

This is not an actual call, but is something that happens here often. You are a medic in a border town 100 miles to nearest hospital with no other ambulances closer than 60 miles away. You have no communications with medical control, you work strictly written protocol. Law enforcement and fire do not respond with you. It is just you and another medic. You are dispatched "child with broken arm". On arrival you find a 10 year old girl already in a cast. Mother explains that the child had fallen and broken it earlier in the day in the USA. She had family members take child take the child to hospital in Mexico. She hands you a x-ray film that shows fracture at or about center of the radius. Everything is lined up and there are no fragments. Patients cast immobilizes arm above elbow and below wrist. All vitals in normal. Cap refill less than 2. Good motor function of fingers without pain on movement. Pain is dull pain at most a 1 out of 10 per child. Patient has pain pills prescribed in Mexico but hasn't taken one because it "does not really hurt" since was casted. You examine child for any signs of possible abuse none seen on back, legs, abd, etc. You ask mother since child is already casted why she called ambulance, she says that Doctor in Mexico told the family (keep in mind mother did not go with child) that the girl might need surgery and since the child has medicaid they decided to bring her back to USA to see Doctor. You then ask them is there some other concern for the childs well being that has caused them to want to have child taken by ambulance. The reply is "no concern" but that the mother cannot pass the Border Patrol checkpoint because the mother is illegally in the USA. So what do you do?