Just Plain Ruff

That's the issue, you will have to really be specific as to where you are willing to go. Most areas are already covered. You will have to really do some research as to what locations are underutilized. Someone here might be able to tell you that they have been underserved but the areas I'm from all have good coverage. Best of luck to you though.

I'll bet that's one of the reasons why there is a redesign. You can bet that the increase in the calls to the poison centers is not the single catalyst to the redesign. There is ALWAYS a lawsuit. But you are right Herbie. If you as a parent are not responsible enough to keep the chemicals away from your children then I don't know what to say about your parenting skills or knowledge. Get a measuring cup out and go to a store and buy some freaking common sense. And let's remember, this redesign is brought to you by the company that gave you "it's not my responsibility, it's the big nanny state who's responsible for my messing up" I mean if I can't find someone to blame some bottom sucking lawyer will find someone for me.

Yeah, I'm going with the first one. But hard to decide which one fits.

so 20 minutes ago was onset? is the nursing home sure about that. I mean 2300 is shift change right? I think we need to dig a little deeper with the nursing home staff on onset. I'll bet if we dig deeper we will find that the nurse who is giving you the info is really not his nurse but a nurse from another wing. So do we have an actual onset time?

They say they responded to a cardiac arrest but later in the article they say that no call required a defibrillator. HUH???? strange.

What, can you expand on what you are asking. What you asked in your post was so cryptic I'm having a hard time understanding what your asking. Can you please clarify.

Often are overutilized by crews Often are used as crutches for conditions that might not warrant air ambulance transports

I think it's time for people to get a re-design. Might the designers of these products have thought this through and said to themselves, these look a whole lot like candy and that kids maybe, just maybe, might get into them. Why do we need to have detergent in any more of a pretty package than a box of white powder or blue liquid? The powder and blue liquid have worked for years and have gotten our clothes clean and why now do we have to have these pods that look like candy. But on the flip side, Parents need to take responsibility and put these chemicals up above where their children can get there hands on them as well. It's time that we all take responsibility as parents as well. My laundry room is in the basement and my 2 year old can't get to the basement unless I allow her access to that area and if she's down in the basement then she's down there where I can see her so she's not gonna get into the laundry soap. But I guess it's nobodies fault, so to keep up the nobodies fault theme, we will just change the packaging and all is well.

Try this. They helped me recert last time I needed. NOt too expensive. I got unlimited hours for 100 bucks. Can't argue with that price for medic. NOt sure your need though so they may not have that many hour of CEU's for other levels though. Good luck http://www.ems-ce.com/

Guys, I think that you can use the machine interpretation as a adjunct to your own interpretation. But don't just use the machine. You should use your own knowledge and then use the machine as a second opinion but don't use it as the source of truth. Like we always say here, look at your patient not the monitor, if the patient looks ok and is talking to you but the monitor shows V-fib then the monitor is wrong. It's the same concept and I think Dwayne is the biggest advocate for that thought process here. Trust your own clinical skills and use the machine interpretation as a backup or a 2nd opinion. That's all I'm saying.

True this could go a lot of different directions. I agree.

For those initially opposed and who felt this was a terrible idea, what would you think of the ability to be able to print a bill to those patients who requested a bill. To not print one out to all patients but just to those who asked at any time during the call what the ambulance run would cost. the provider could say "I don't know what this will cost but we do have the ability to print you a summary of charges or a bill after I complete my run report. would you like me to do that?" What do you think of that?

Bieber, I think it was awareness for the patients who asked what the bill was going to be. The initial discussion question went like this. "Does anyone have the capability to print out a bill for the patient on the spot so the patient can pay it?" I belive that was the initial question by a paramedic. Maybe that should have been the inital question I asked. Does anyone have the ability to print out a bill for a patient who wishes to pay the ambulance bill at the culmination of the transport?

And Mike Excellent point. That's why the discussion we had lasted for several hours with no real answers to come from it. Some were totally for giving every single patient a bill, including the family members of those in arrest. Others were totally against it. WE never came to any conclusion as to what was acceptable or not. What a couple of those at the table came up with, myself included was to offer those patients this. We would tell the patient that asked us at the beginning of the call what this would cost, we would tell them at the end of the call that we could provide them with a list of approximate charges. The "summary of charges" and print it out. We would offer it and if they accepted then we would print it out and give it to them. But of course this would have to be offered by each service not just one service. But that was the only option we could come up with that was mutually agreeable. LIke I said, we spent several hours sitting around batting this around and never came to consensus which I'm sure this will end up the way that our discussion did but I'm still interested in what others think as well. But the bills aren't usually received several days later, they usually go through insurance and then to the patient. My wife was transported by Belton ambulance twice, WE didn't receive an ambulance bill for at least a month. And it was not itemized, it was a single number. We had to call and request an itemized bill. That took another 3 weeks. So it's not as fast at some services as others.

no, this is not to scare the abusers off. That's not the point of this. It was simply a discussion between a group of about 15 providers like I said. We were sitting around the table after a full meal discussing how to make patients more aware of what the service will cost them when they get their bill after insurance pays their share, or if insurance doesn't pay or if they don't have insurance. This is not to say F you to the patient, don't get me wrong, this was a heartfelt discussion to help the patient understand that there would be a charge because in this economy we were seeing a huge trend of patients asking us this question. how much is this going to cost me and we were not able to tell them or we were only able to say "I don't know, you will have to call our billing office". WE were kicking around the prospect of how could we give the patients who asked or give all patients, barring severity of conditions, a informational piece of paper that would give them some understanding of what they would be paying for their ambulance bill. At no time was there a discussion or mention of giving them the info prior to transport. We did not come up with any consensus so this is why I brought it to the smartest group of people I know. There is no malice towards any patient demographic in the intention of this thread.

Why is it disrespectful? And in a sense we do work for the money and the people but I do understand that patients are fickle people. They get pissed when they are asked for insurance cards and all that. I know that I'm going to get beat over the head on this one, and I'm ready for it so here goes. In all other industries out there we tend to get a service and have to pay for it immediately. I know of very very few other industries that we get the service initially for free (yes ems is free initially) and then we get either the bill or insurance pays the bill minus a copay from your insurance. So if you take your car into the shop, you get your car fixed and you pay for it immediately. If you don't pay, you don't get your car back. If you get a new roof, you pay some up front, then pay the rest at completion and if you don't pay the roofers usually don't haul away the trash and the big truck with the wasted roofing material until you pay So you go and purchase something you don't get the item until you pay for it. All I'm saying is that you don't expect payment now and you tell the patient that up front when you hand them the summary of charges. Let's call it that. Let's take the word Bill out of this whole discussion because that's what people have seem to have latched onto and are against. All I'm advocating is that you provide the patient with the means to understand what the bill will be if insurance does not pay their bill from the EMS servic. Be that a bill or a summary of charges. Why is that unethical? Why is that wrong? I am NOT advocating anywhere in this thread that you even consider to give them a summary of charges until the call is completed and the patient is on the hospital bed and your run report is complete. It is medics discretion to give the summary of charges or the bill. IF the medic decides never to give the summary of charges to any patient then by all means that is the medics prerogative. No discipline on the medic. Maybe let the medic offer the patient this "We have the ability to offer you a summary of charges sir. I can print them out if you wish. If not you will recieve the same in 2 weeks. Which would you like?" something like that. I am also not advocating that the medic print off this summary on any patient that is critical or suffering a major medical condition such as CVA, MI, Major trauma or other comparable condition.

ok, maybe not the ones who are having CPR or being treated for a MI OR stroke, but the ones who are let's say being transported for less life threatening illnesses. I'm not sure where to draw the line. This is something that not just I have thought of in the past but a group of providers discussed in the past from a luncheon that I attended in the past year. It was a group of providers from Fire medics all the way up to flight providers to physicians. We were actually just looking at ways to help patients know what their bill would be since we have all been asked "how much is this going to cost me". And if you have never been asked that question, you will be. Maybe the wording "Bill" was wrong, maybe a summary of charges would be different. I'm not advocating giving this to the dying grandma or the guy having the heart attack, it should be up to the medic's discretion on when to give this to the patient or their family member. I'm not that callous or heartless but seriously, I don't see the harm nor the cold heartedness to give a summary of charges to the guy who broke his ankle a summary of charges or a "bill". I don't see the harm to give the minor MVA patient this piece of paper or the patient who didn't have a ride to the hospital this summary of charges. I'm just throwing this out there to the community here as to is it completely wrong to inform the patient that their ambulance charges are this amount and they should begin to think about the cost of the transport? Maybe it's completely wrong to give this info to patients but I tend to think it isn't. For those who say that this is unethical - please explain why this is unethical. I'm willing to take some hits on this here but please do not make this a personal thing.

So let me ask the city members this. If the big earthquake hits. Are you going to remain on duty to help those who are not your family or are you going to head home to make sure you family is safe and sound? Assume all lines of communication to your family are out? Cell phone, morse code, smoke signals and semifore are not working. You have no way of communicating with your family. Do you stay and help those who you do not know or do you leave the job and make sure your family is safe? This leads me into the next question - if you are working and the above happens, does your family have a emergency plan for this type of situation?

Does anyone print out a bill to patients on completion of the call? I was wondering if this was done anywhere in the United States? What is the Cities stance on this type of practice. I mean the EMS agency has provided a service and the bill would be for services rendered. It could come with a disclaimer that this was the patient would owe if they didn't have insurance. That the amount owed would be different once insurance paid. My physician gives me a bill when I set up my follow up appointment and then sends me a bill like this all the time, showing me what I will owe if insurance fails to pay any of the amount so why cannot ambulance services do this? Is it unethical? Is it wrong? What are the thoughts of the City denizens?

I as a diabetic as well, agree that instaglucose won't do much to cause harm. AS a matter of fact, over all this hullaballoo this past couple of days I had a round of a low sugar. Now my lows are in the 70s and the only thiing I had on hand was a tube of instaglucose. I was in my car. I was feeling funny, not like before with a low, so I pulled over, yanked out my kit that has all my diabetic testing stuff, insulin and all that and I tested my sugar. it was 73. I opened the tube of instaglucose and emptied it. Damn that stuff tasted nasty. I waited 10 minutes before calling 911 which I didn't have to. My sugar jumped to 185 and I was able to drive 5 miles to the next exit and get to the mcdonalds and have lunch which is why I was low because I didn't get a chance to have lunch yet. This was my first experience with having a low that affected me like this. So I don't think that giving instaglucose without a blood sugar reading will really do much damage at all. I think that if they are profoundly hypoglycemic that they would not be eligible for that anyway, they should be unconscious. And before anyone jumps on me, Had I have felt worse than I did, I would have called 911 before I took the instaglucose.

HIPPA or HIPAA OH NO you are violating HIPPA or HIPAA There someone said it. Now Dwayne, you don't know where I live and besides that electricity facebook I had puts you paddling a long long time so I think I have time to prepare for your arrival to kick my balls to my tonsils so I'll wear a cup when you get here. But seriously, Biebs, great thread, and I agree with the majority on the interpretations. Plus how many medics do you know that will take the machine interp and go with it and when they get to the hospital the cardiologist will say "nope, it's actually this"? I know a lot and I've actually fallen into that trap myself. So For number 4 Biebs, can you explain how you got the discordance finding in V1? I'm a little confused how you came to that confusion as I'm not seeing it. Thanks and great thread. Bring it on Dwayne but you better start paddling. For those of you who are confused as to the paddling reference, if you aren't facebook friends with me then you wouldn't have gotten the reference.

Damn steve, I sat back and thought about my last post about committee and you are completely right. I really looked at it and realized that while committee may have worked in one of my orgs before, I remembered the total hell we wemt through to find common ground and then I thought about it on a national level and said No freaking way my idea would work but I just didnt get back to the thread to say that my ideas no matter how awesome I thougjt they were, they just were total crap. I have no answers now exvept to help my former co workers make small imcremental chsnges from witjin their very small system. To make changes that will affect them and then hopefully help them take those changes to the nect level which is to their surrounding EMS systems and then beyond. Baby steps one at a time.