fireflymedic

Can I have one?

In my general area rate of return averages around 60 percent - some better some worse. Granted the vast majority of people in this area that require 911 transport are not insured making things quite difficult. Those that are, it's medicare/medicaid which though most of us don't like it, is what pays our paychecks. There are two services I know with excellent return rates one last year had 82 percent, the other 78 percent - but are in technically rural areas by definition, but good sized towns with a high tax base and multiple employment opportunities that are steady with benefits compared to the majority of true rural areas like immediately surrounding me which have extremely poor residents, many on welfare, no health insurance, no job opportunities and things not getting better - only getting much worse by the day. I think that is largely dependent upon what your success rate in return payment is. Obviously the smaller your department, the higher your rate of return needs to be to keep going - the smaller the more than one unpaid bill is going to hurt. Collections sometimes increases return, but as many have said and is so true, you can't get blood from a turnip. Best benefit is to work with them on a payment plan or reduced pay for full payment. I know where I work operates within this so perhaps this may help you? Best of luck to you.

CONGRATS !!!!!!! SO happy to hear it ! Wonderful news. May your baby be easy and your sleepless nights few !

Congrats Ruff - you'll make a great daddy, and I'm sure she'll have you wrapped around her little finger. Wonderful news though I'm very happy for you.

Fl Medic - great resource and explanation !

Crotchity - I do recall the discussion of the alcohol and no, I am not that type of medic, far from it. The reason I was curious of this was I had seen it mentioned within a text and wondered how widespread the use was. I have used it previously and yes I do find it to be somewhat reliable (however as I said there are exceptions to everything). As far as the arm drop, that is falling quite out of favor very quickly. Harm can be done, however with the eye lash test no harm is ever done to the patient which makes it superior in my book. I think the context of the question was missed.

A previous topic discussed the issue of a pseudoseizure patient that appeared to be unconscious, but really wasn't. I've in the past used the eyelash reflex (rubbing finger over eyelashes seeing if the flicker or they blink) to assist in determining consciousness (have also been told it's a pretty verifiable means of finding out whether they can protect their own airway or not ). Obviously there are exceptions to every rule - but how prevalent is this practice. And also - has anyone ever used corneal reflexes? Just curious.

He wrote they carried him down the stairs out of force of habit? Riiiiiight. I suspect it was the other way around and they thought no one would object or make a comment otherwise. It's amazing how many lazy ones out there walk the patients to the truck just because they don't want to put forth a little effort. Sad - maybe the outcome would have been the same, maybe not, but at least he would have had a better chance otherwise. Also - doesn't say, but I would imagine they didn't put oxygen on him and then walk him down three flights of stairs - not sure, but just going hmmm As far as the state board - I think immediate temporary order of suspension would serve them well - that's what falsification of records gets you here and a revocation of license usually follows shortly thereafter. I wouldn't want anyone who does things on "force of habit" treating me. Sorry - you boys are in for a rough road ahead I hope. Maybe it will make more stop and think before walking that next patient.

Prayers for his family and friends- so sorry to hear that.

Man, he deserves an award for that performance. Everyone I have ever placed an IO on has given some reaction to pain even with premed with lido - you said his was short lived - WOW - talk about a serious pain tolerance. I've not heard of premedication with versed for IO's - that's a new one on me, but I think any service which does not permit some form of pain management for a quite painful procedure is behind the times and needs to have a discussion with the med director. I've seen a few that were fairly "out" still give a reaction to pain. The pain not from insertion of it, but the continued infusion. Bone pain is incredibly painful and I pity anyone, faking or not that receives an IO. As far as the issue of increased risk for infection, heck yeah there is one. You just put a hole in the bone ! Here it usually warrants an overnight stay in the ER or CDU for short term observation and prophylatic dose of antibiotics. I understand that isn't standard everywhere, but how the docs roll here. For the fact he's a pseudoseizure patient - there's really two classifications of these guys. One of which isn't faking - the seizures are actually happening to them, they are just a conversion disorder and NOT under the patient's conscious control. They can really be unconscious to the point they can't protect their own airway, even have what is similar to a post ictal period. These are the concerning patients - they aren't seeking drugs, they are scared about what's happening to them and should be handled with gentleness and respect, and are usually followed jointly by a neuro and a psych (as many times after these patients have received a video EEG they are found to have frontal lobe seizures which are more difficult to detect and require special electrode placement, etc and difficult to find on routine EEG's). The second group is the flat out fakers aka factitious disorder or malingers. They have something to gain from the faking either the sick role (factitious disorder) or financial like workman's comp, disability, etc (malingers). They are the ones that may also be seeking drugs and are worrisome from the point they may attempt to sue for malpractice saying you didn't treat them appropriately by giving medications. They can be all out trouble if one is not careful. For both variations of patients, if in question, treat as you would a normal seizure patient (you did fine Ruff), but we tend to get the med director involved and if possible the neuro as many a time we have received orders not to further medicate if meds have been given (we have one patient we've transferred multiple times for this very issue and that's the general rule). Another option you have is to give a saline flush - no harm done there to patient and see if they stop seizing. If so, don't follow up with meds. If they don't, you can give meds. There is no harm done as you are still treating the symptoms if unresolved, and if so, it would have terminated by time meds were given, so no real time is lost and avoids giving meds unneccesarily. At any rate, always protect them from themselves and watch those sats. There are some patients, especially with shorter seizures that will maintain reasonable sats, so don't stress out and most improve quickly shortly after the seizure ends. Also - keep on the watch for seizures other than generalized ones - they don't present the same way, but are seizures and can cause problems nonetheless. Stay safe out there and treat those patients well !

got one for you terri, however, do me a favor and PM me where to send again. I misplaced it sorry

sorry there Eric - that should have said one other level one woops - what you get for typing after too many hours up lol. For the record, yes, KY has two level one centers University of louisville and University of kentucky in lexington.

Okay - here is my thought - it is much more concerning to think about wrong drug dosages as opposed to oxygen - yet we ensure that we have regulators, but we can scrimp and save on meds which require much more precise delivery and we can't break down and figure out a way to get some refurbed pumps? Come on that is a joke. Yes I hear it now, regulators and cheaper and oxygen does require precise delivery (okay then please explain to me why the mills are still saying everything gets 15 L via NRB). I'm simply stating that for the stupidity of the arguement. I often sit back and wonder what really is the problem behind EMS. Is it truly that we can't get paid - there are some services that have great reimbursement rates and do fine, what is it that they are doing that the others aren't? Perhaps because EMS directors should have a mix of both EMS and business experience before being placed in a director's position. They should understand what is needed, but also what is required. We spend money on things that are nice, but not required, and by all means if you have the money, buy it, but if you don't prioritize and yes, pumps should be a priority. However, that would require some medics to alter their training. Have to learn to deal with problems and yes, troubleshoot if required. In addition, there is the requirement of still being able to count drips if necessary if your pump fails (remember doing those calculations during medic class you thought you would never need again and that micro drip set that's collecting dust?) I was suprised recently when a nearby service polled on what they thought was the most important purchase. EZ IO drills, an easy lift cot, or IV pumps - the winner was the easy lift cot. Sad. Needed yes, a luxury, yes, but not in the same class.

I know, just pickin on you. My suspicion is same as any sympathetic response (yes sympathetic, not parasympathetic) with the exception of a dorsal vagal complex which is an extreme parasympathetic response causing brochoconstriction among the other symptoms. However, I am seriously doubting you had parasympathetic deal - I know if I pass a cop going that fast (heck even if I'm just speeding a little) I have that fun little heart race increase, everything else with sympathetic response. You know that fight or flight deal? I'd be wantin to run !

I'm not sure of the entire situation but evidently 8 neurosurgeons were hired into another hospital system and has caused a standing rift between the university of louisville hospitals and norton healthcare possibly endangering the future of the neurosurgery resident program and also the status of a trauma center. Currently Kentucky has only one level one trauma center in the middle of the state (Lexington) and it is already overburdened. The other closest alternatives are Cincinatti or Nashville which are already stressed systems, and Lexington reaches full capacity on an almost daily basis. If this does happen, I have serious concerns about the ability of the surrounding areas to handle the additional stress. Let's hope this doesn't happen. http://www.courier-journal.com/article/200...WS01/904190421/

So did ya get a ticket? Did ya? Did ya? Mandantory court appearance baby - will we see you on speeders fight back? What will your response be?

Not horribly long ago, got pulled over late at night for our back lights not working (yes they worked when we left the hospital and went out sometime back on the two hour drive home). Anyhow, even though we were in county, cop pulled rank and forced us to call for a tow for the truck rather than driving in and exchanging out buggies. He laughed at the fact we were riding in the back of his car and people were staring at us thinking god only knows what. I wonder to this day if they thought our ambulance was repoed (a repo man was towing it lol) and we got arrested. *sigh* the adventures in EMS.

If those of you that replied with smart comments had read my post you would have realized a few things 1. I stated what the rules were in my state - as general information and comments as to the disciplinary process here as some others have. It was for information only. I didn't comment on michigan's rules because I refuse to comment on that which I do not know to prevent ignorant postings. 2. I said if what the original post stated was correct - I agreed with him. However, I strongly suspect there were multiple issues involved and this was not the only thing. I may be wrong. I will give the OP benefit of the doubt by wondering if he was posting here to find out if there was someone more educated on the rules in Michigan than himself and how to proceed so as not to make himself look like an idiot to the state's disciplinary board. Perhaps he did to where he previously worked, perhaps he didn't. Hard to judge without knowing all the surrounding circumstances. He made his decision, he has to live with it. Can we try to ease up and just provide the information the OP wanted to know and helpful advice rather than scaring them off?

Well, I've never worked in michigan, nor held a michigan license. However, here the law is very clear about what is permissable and what is not. They say if you do not have an active license by midnight day of certification expiration, you can not work. There are no extensions granted, no exceptions. There have been issues with some people trusting their training officers to turn in their certifications and maintain them and well, there has been more than once where certifications were dashed in on the last day the office was open in a depserate attempt to get them processed. I do recall one service having 13 employees which were off duty at midnight and continued that way until the 10th of January when their license expired the 31st of Dec (offices were closed from the 18th of Dec to the 6th of Jan for the holiday). They trusted their training officer to turn it in, and he didn't and they were without work until they got a new license (licenses required to be postmarked by 31st to be valid, but can't operate past that date if no cert in hand). Here you can be charged with practicing medicine without a license criminally in addition to the actions of the disciplinary board. If the situation truly is as the OP says I would agree with him - I wouldn't be working for that service. Anyone that is willing to risk patient safety and skirt the requirements of the state is questionable and that is exactly what is happening IF things are as he said they are. Though, there are two sides to every story. I would have walked away as well - there are plenty of other places to work that are decent - don't waste your career on a place that might you your cert taken. I'm not sure if michigan permits anonymous complaints (I know you can't here), but anyone can fill out a complaint form with the info from a citizen to a person on the service and send it to the disciplinary board. It then goes to an investigator who interviews all parties involved, gets the story and it's presented to a preliminary inquiry board who decide whether there is enough evidence that something detrimental was committed - if so, then a complaint is filed with the attorney general and the legal counsel and the person has two options. They may either accept a proposed agreement (with wrongdoing always admitted and publicly posted - may be anything from a private letter of reprimand to revocation of license) or go before the board and fight it (with the typical result if they lose of suspension or revocation of license). It may then be referred for criminal action if applicable and decided upon by the board. I would definitely send it in to be investigated and let the board handle it from there. It's their ball game and worst case scenario, he's investigated, found to be okay no harm done, but if there is wrongdoing, then tough stuff for him and you've protected future patients.

Had a few I've threatened to do that with, but unfortunately when you aren't the one driving and you don't have those privledges, it's tough luck, so I had to take them back. Had a student I left on scene once (well she ran away so technically I didn't leave her lol). I'm not gonna ask why you left the partner - I probably don't want to know if your tolerance is as low as mine is for some stupidity.

Haha, this brings back some horrible memories, but some funny ones. 1. A stretcher in the ER on thanksgiving several years ago- I thought my partner put it up, partner thought I put it up. Neither one did - woops. Fortunately just went back and got it. 2. A stretcher on the side of a highway - patient was too heavy for stretcher, so we laid them flat on the floor (center mounts) on a blanket. It worked but stretcher was left there for two hours until we could retrieve it lol. 3. Monitor left on scene of a DOA - by another crew and we were sent to retrieve. 4. An ambulance - yes, an ambulance - slid off the road when part of a driveway gave out, so we left it where it was for a tow truck to come get and we ran off in the extra truck with a critical patient. And never mind the stretcher that "exited" the ambulance on one occasion because of two faulty things - we were taking it to be repaired. Cot lock didn't work, and when it hit the back doors, we found out the back door latch was faulty as well and stretcher was found in the middle of a major highway *sigh* that was rather entertaining. I'm sure there have been other things, but that's all that comes to mind at the moment.

wow - I have lost brain cells...I thought hampton died a LONG time ago - guess he will live forever.

Most of the services I have worked have done male/female or male/male crews only for the pure simple reason that female/female crews led to too much fussing and fighting. I hated having female partners and would take a male over the majority of females I was placed with any day. I have also been in the situation of a rural station with a male only and I don't think it posed a problem. Much of it is in how you portray the situation. I make it obvious from day one that I am not interested in getting involved with a relationship (that manner) with anyone at work - I think dating someone you work with, especially in EMS can just lead to issues. Even husband/wife teams can be a bad idea sometimes as if they are fighting it can make the shift miserable for everyone ! Because of that I've had no problems with a trust issue with my fiance' nor has anyone else. It's common for family members to come to dinner and its pretty routine to have at least one spouse/significant other around. I've not seen anything questionable out of the services I've worked because it was understood by all that behavior was unacceptable and would lead to dismissal. Bottom line though, if it truly makes you and her uncomfortable even after discussion (heck include your work partner and let them know your wife's discomfort with the situation as well) then either attempting to change the situation by sleeping somewhere else or changing stations/shifts if you cant reach an amicable agreement between them both. Typically, I've found the more involved spouses (both male and female) tend to have less problems than the ones that their partners don't ever stop by - just my experience, others results may vary. I'll take my male partner and be happy, and let my significant other stop by whenever he likes.

Okay why? Will he multiply or can I cook him for dinner?

Versed/Fentanyl seems to be prevalent in this area - (conscious sedation) - can't speak for other areas