Just Plain Ruff

YOU REPORT THIS NUFF SAID It's your licensure too, you are on the report also. If you do not report it you give tacit approval that this medic can falsify a patient run report. If it goes to court and you say you didn't report this then you are on the hook for the jury award and that does not look good. screw being the new person, there are just some things that you do not allow or let go on. Falsifying medical records is one of them I worked for a big company a number of years ago and got called into the supervisors office. I was told to re-write several reports I had written because that big company was not gonna get paid. I put down the patient walked to the cot yet the company wanted me to write that I had to lift the patient via sheets to the cot. That way they would get paid. I refused and I was threatened with termination. I said do what you have to do. They did not make me re-write them. They didn't fire me but I was deemed a trouble maker and was given my walking papers a couple of weeks later. I went to medicare about it. Not sure what happened but my conscience was clear. So stand your ground and report it. This is a prime example of a lazy ass provider who shouldn't be working in EMS. What else does he not do. The possiblities are endless and very very frightening.

Ok, what about stopping at accidents outside your state of licensure? Do you stop at accidents and render aid in states you are not licensed in? What happens when you do something that the Good samaritan law does not cover? A question to the smarter people on this thread than I. Once I stop at a accident and say I'm a paramedic, am I no longer covered by the Good Sam laws? If you are in your state of licensure and you identify yourself as a paramedic and where you work what liability do you open yourself up to? What happens when you pull up on a wreck and you pull out your medical pack that you have in your car. Are you now no longer considered to be a good samaritan and are you open to liability? What about stopping in your coverage area and you pull a medical pack and begin to treat by starting an IV or putting oxygen on? Just what kind of liability are you opening yourself up to?

Ok, how bout these Same Kind of Different, As me (I don't remember the author) a story of redemption and forgiveness A Knights Quest by Mark Creech (I know this author personally) The Bourne Objective -- Eric Von Lustbader Pillars of the Earth -- Ken Follett

supposedly unconscious male subject, lying in pool of blood. When we started to assess him he came too, started going nucking futts and we saw the glint of a knife in his hand. How that freaking knife got into his hands, nobody knows but after a heated battle with 2 cops, 2 medics and 2 firemen first responders we got him down. He expended his last bit of energy with this fight and 5 minutes later we were coding him. The knife was scary but the blood that we got in our eyes and nose and face with the guy going crazy on us the scariest part was waiting for his HiV and Hepatitis results to come back. Luckily it was negative. But I did not like the HIV cocktail we had to take. My other scary moment was when I had a extremely positive TB skin test. Taking 6 months of Isoniazid and then hoping that I did nt have TB was pretty scary too.

I think it directly correlates with the maturity of those who stop. The majority of those I've known to stop have been those either in paramedic or EMT classes or a brand new EMT/Medic who has the delusions of grandeur and fame that stop. I think that those of us who stop won't stop at any old accident. But those who are very new to the field who have a "I can fix anything because I'm an EMT or Medic" mentality that stop and sometimes do the worst good. Am I speaking in generalities, I think that if those of you who take offense at my generalizations take a step back, you would see that I'm right or at least partially right. I have many friends who have been in EMS for over 10 - 20 years and none of them would stop or if they did they would have to witness the accident. I have many friends who would not even stop in their jurisdiction.

ok, I have stopped a couple of times but that was back in my younger more stupid days I had the belief that if I stopped I could save them or at least help. the couple times I did stop I had nothing but my hands and a pair of gloves, but one time sticks out, I waited till the ambulance got there all the while holding c-spine on a woman who fell down in the middle of the road (I damn near hit her) and whacked her head on the concrete resulting in a bad head injury with unresponsiveness. I was holding c-spine and when the fire guys got there the fire medic got out walked up to me and said "We got it from here, you can leave" I said, "Not until someone takes C-spine over for me" he then proceeded to grill me about what my level of EMS involvement was. I told him I was a medic from Missouri. He again said "You can leave" I repeated "Not until someone relieves me of c-spine" He was truly pissed now and he said "Fine, I'll take over" I turned it over to him and as I walked away to talk to the trooper, I witnessed this idiot get up and walk away from the patient to go get some equipment. I asked the trooper where they would take her and they said "UMMS Baltimore shock trauma" and I said ok. The funny thing was is that my client was the ER of Shock Trauma which I was putting in their ER Computer system so I was on first name basis with many of the nurses there. I watched this fire medic put the woman on the cot without c-spine, no backboard and still unresponsive and left the scene running hot. I made a phone call telling the nurse who then put me on the phone with a specific doctor working in the shock trauma center. I explained what I saw, he said thanks. Turns out I talked to that doctor again the next week and he said that he let the medic have it based on how they brought the patient to the ER and my report to him on the phone. After that incident I do not stop period. No matter if it happens in front of me or not. If I'm there and cannot get away from it then that's another story but I can easily drive by the accident and no one will be the wiser.

It died out due to political correctness.

I think this mosque is a bad idea. That's all I'll say about it but the conspiracy theorist in me can't help but wonder what other purposes this serves? Will it be a gathering place where people who hate america will gather and work on their nefarious deeds and future deeds? Or will it be a place that will turn against the radical islamists and do exactly what they say they intend which is to memorialize and honor those who died? My only question is who will they be honoring? The terrorists or the innocent citizens who died in the plane's aftermath. Only time will tell but I can say this, We reap what we sow.

No We need to give them a diesel bolus. Woo hoo. Does anyone else think that's a silly statement. Although I did have a nurse friend of mine tell a doctor that the reason why he upped the oxygen from 2lpm nasal cannula to 15lpm NRB was he was giving the patient an oxygen bolus.

I rarely run hot to the ER unless the patient is crashing. I see more and more in cities I visit a disturbing trend. Case in point. I have spent time in a town in florida and our office is right above the ER. I spend time day dreaming at times and looking out the window. I one time this week counted 18 ambulances coming to the ER with patients. Of those 18 ambulances in that hour 11 of them came emergently, lights and sirens. Did they have 18 critical patients? NOPE as a matter of fact I went down to the ER and asked about the patients in the past hour. I asked how many were critical. They said 2 which were the trauma alerts that came in. So why the emergent transport? I also spent some time a number of years ago in New York at the New York Hospital Queens and every ambulance that arrived to their ER came with lights on, rarely with sirens. What is this trend I'm seeing. It occurred in Jacksonville when I was there, I saw it in Springfield Mass, I saw it in Detroit and also in Patterson New Jersey. Are these isolated places that just do this to do it or is there something else going on? Is it to save time because we on this forum surely know that running hot does not save time. Just some observations. Nothing more.

The point of this thread was to put some of my thoughts out there on who we have to look to as our customers and stakeholders in making EMS services better. I didn't think that people would not get the point of the thread. These were my thoughts. I'd delete it if I could but can't. Maybe instead of not knowing what the point of the thread is, maybe you should respond with your opinions to what I posted. Who are the main stakeholders in an ems system? How do we involve those stakeholders in the decision making process of an EMS agency? I think I said that what I wrote was a work in progress but maybe I didn't.

One would think EMS is a very complex subject that has been addressed in too few directions. There are many users of EMS that need to be accommodated by a good system: 1. The primary person involved and needing to be treated best is the patient. They are users of the system in their personal access via 911. Repeat calls to their homes serve as an outcome of the EMS clinicians actions, and most importantly, in defining how they view their EMS experience. The current systems seem to leave them mostly out of the design process and their use is marginalized and they are required to change whenever the others involved see a need. This not only relates to how ambulances are staffed but also how they are put into action. Patients only really care about one thing. Whether or not that EMS provider who comes into their home or to the scene of their accident and provide competent and quality EMS care. They also care that their feelings and beliefs are going to be held it the highest esteem and not be derided by a medic who thinks that their complaint is below their purveyance. 2. The crews are the next most important users of the system. Remember to include not only EMT's and Medics but also the medical director. The main issue it seems is that the routine/usage must match the flow through the tools. I suspect there is a lot of change needed in the EMS systems and in how the EMS crews use them to get the system to be ready to respond. 3. The EMS administrators are next in priority as they need to manage the outcomes and the clinicians. This is the group who has been buying the tools and thus, their needs are probably best met by the tools. 4. The insurers are next, and they need to be able to be given accurate codes and accurate billing information. The main issue seems to be standardizing the delivery of the data to the insurers from the clinical billing process to their form based input methods, etc. 5. The research community is next and I think the most important new user or stakeholder of these EMS systems collectively if we can do it right. It should be possible to get aggregate data from all patients similarly situated to evaluate what the best practices should be without doing clinical trials in many cases, or focusing what clinical trials for EMS are done based on what actually worked. And, when we can see what works, we can work on protocols that can be delivered effectively and productively in EMS Systems across the country and then weed out what does not work. Why aren’t things going right? One reason is that most EMS System developers do not work in a EMS System setting. You need to have the developers working with the users regularly. Google does very fast development because they can put out new “beta” versions to a sampling of users very easily. You need to work directly with people in the field, office and hospitals, etc. who can tell you if the change you want to make is going to be effective for them. I give credit to a colleague who posted this out there on the net. I modified it to fit the EMS side of things. Am I on to something? Maybe, I don't really know but Who knows.

Ok, you are the non-contracted ambulance service that if the contracted 911 service no-services these people then they call you to get taken to the ER? Do I have that right? So the contracted service said that the person did not need to go to the ER via ambulance and then they call you and you take them? If you aren't contracted then you certainly should be able to say, "Hey buttkis, the 911 guys said you didn't need to go so that's what we are saying" and leave. I would suspect that if you transported them and turned it in to insurance that the insurtards are gonna refuse to pay your servicde based on the original no service. Plus I do know that most insurance companies won't pay a hospital claim if you AMA and then come back to be seen again. Your service is under no obligation to transport these people but to say that you have the medical training to know when a patient needs to go to the ER or not with just 120 hours of classwork and 2 days of ride time is making a huge assumption and it's going to get you in trouble. I have had many emt's working with me who bitch and moan about transporting patients who they think do not need to be transported. It's like it's inconvenient to them. I usually tell these know it all's, to go back, get their paramedic and then they can make those decisions. I had a paramedic partner tell me once when I was an EMT. Until I get my paramedic license, have 1-3 years in the field, and know a crapload more than I knew then, I needed to learn my place in the EMS hierarchy and stop trying to be a medic. I am not digging at you but maybe you need that talk too. It's like my son. He says Dad, I want to do so and so. I say no to him, he goes and does it anyway, he gets hurt or fails at it and I tell him, I told you so Liam, Daddy knows more about this than you and that's why I didn't want you to do it. I compare that to the EMT who tries to no service a patient or whatever and things go wrong. Do I think you can tell the difference between a stubbed toe and a broken ankle YEP but can you tell the difference between a cold and pneumonia or chest pain versus PE? I'll end with this. I know a medic who went on a chest pain call. Diagnosed it as costochondritis. Told the guy it wasn't cardiac related, guy refused. Time of refusal was 2330 or so. Next shift, other EMS crew goes out on a Dead body call. Same patient. Coroner ruled time of death around 2300 last night. The cause of death, Myocardial Infarction. Medic being sued for negligence and she says to me that "They are gonna kill me in court" One other thing, if everytime that your service brings a patient in to the ER maybe you should step back and think of why this is happening? Is it just that the nurses are overworked or is there another reason? What are the attitudes of your EMS Staff? Do you treat the nurses at the ER with respect? Or do your crews act like this patient is a burden to you and the nurses see that attitude and relay it back to you? Does your service have a good reputation? You would be surprised at how often this is the underlying proximal cause of this type of ER reception. If your reputation is that you do not do a good job with the patients you bring then that might be the reason. I've worked in areas where one service was despised by the nurses at the local ER based on the fact that the service was full of poor providers, had been caught stealing supplies (the ems service had financial issues and supplies were in short "supply") and had been accused of inapprorpriately treating patients with very outdated protocols. That service no longer exists though. When you get a feeling that people are not giving you a good reception, look inward at yourself and your service and see what might be the underlying issue. If indeed they are bitchy because of their workload and taking it out on your crews, then definately a discussion with not only the hospital administration but with the ED administration as well. Don't go in half cocked to air your grievances about how you are treated by the nurses, your service needs to have a formulated outline of what is happening with CONCRETE examples. The generic "this happened one day" or "the other day one of your nurses" NO that does not cut it. Your management has to have valid concrete examples with dates and times, patient names, nurses names and anyone else who may have witnessed the behavior. You should be prepared for criticism of your companies actions if they perceive your service to be poor. Once you have had a discussion with management on both sides, then you can formulate a plan between the hospital and the service to begin to improve relationships between the two entities. A solid game plan will help you out with a lot of things. ok ok ok I just have one more thing to say. The nurses cannot control who brings who in to the ER. But since they can't bitch and moan to the patients who walk in or drive themselves they can do the next best thing. Bitch about and to the people who also have no control over who or what they bring to the ER but you are a very easy target because their bitching and complaining does not get back to the patient. It stays with you. What you can say is when they bitch about you bringing a certain patient in to the ER, tell em this "I'll go tell the patient what you just told me. I'll go tell that patient that you are mad at me for bringing them to the ER" That will for sure, shut that nurse up for a long time. I'd then follow it up with this "I'd like to talk to your nurse manager please" and discuss that nurses attitude in front of her. That will also shut the nurse up but she would of course be your enemy for life but for every time she complains to you, you just go to her supervisor. Eventually the nurse will either be fired or you will have found a better job with a bunch of other nurses to bitch about you. I tell you this because talking to the nurse manager in front of the offending nurse works, or at least it did for me.

Ok, I'm sold. Too bad most of my instructors and model victims look like Bess Truman rather than the girls in these videos. They have the making of a classy porno if one of those types truly exist. Rescue Babes - the movie or Put my Fire Out Or my favorite "Inlubation"

It's a disgusting habit. Imagine being evaluated by a dipping paramedic and he's hovering over your face talking to you and out pops a big ole glob of tobacco juice right in your eye. Yep I've seen it happen, happened about 2 years ago to a patient I was treating, my EMT partner was hovering over the patient asking her questions and out dropped a big ole mess of tobacco juice into her right eye. To say the least the patient was PISSED as woudl I have been.

How far is Hillsborough from Pinellas county?

Who is he attacking What is the website of the canadian site?

If the examiner thought it required 3 helpers and he only had one then the exam should not have taken place or there should have been modifications made. I see your point on this one but once you get out in the EMS world(not sure if you are there yet) you will realize that you have to sometimes modify things to make them work. You also should have spoken up and addressed this with the person running the exam. I have no idea whether you have a case or not but I think you have been told you don't. I'd move on to other things now. I think you have pushed this as far as it can go here.

Dude, you are saying the same thing without giving us any more information. I believe you have said this already in this thread. Do you see where your credibility is lacking here and this is why you are getting hammered. If you would give concrete examples as to where this academy and it's agents performed below this standard of care it would help your case incredibly. Just saying that you believe the instructor and academy performed below this standard. Maybe you should get a attorney to review the standards of the act you are relying on to make your case. Plus, what the heck are you coming here for? Seriously, all this place is good for (for complaints like yours) is to armchair quarterbacking. I don't think there is anyone in any level of power at the EMA that can help you here. I would have thought by your reception the last time you came here you would have realized that you have to make a better case than just explaining your feelings and opinions without truly giving us facts. In fact, you have not even given us the protocol you failed which makes it very difficult to give you good advice. If indeed your instructor was a boob and you got bad instruction, it was incumbent on you to study the stuff that he didn't cover. Spenac has it right, if students would study more than they currently do instead of expecting the stuff to be spoonfed to them, we'd have little use for instructors at all. Seriously, paramedicine isn't rocket science, what you get from class is only the tip of the iceberg. Do students these days expect to get spoonfed the information they need to work the streets? Or are there preceptors that make their preceptees have to think and only jump in when they are going to make a mistake? If anyone remembers the old ACLS (torture class) where you actually had to learn and GASP, you could actually fail unlike now where we can't offend the sensibilities of the masses and not fail them no matter how horribly awful they performed. Ahhh now we get some solid things to look at. What part did you fail? You should not have failed the modified jaw thrust You also should not have failed the OPA So I assume you failed the 1st one. WEre you able to veribalize that you'd be using a third person for this or did they not allow it. See now we're getting somewhere.

Ok, just for Shits and grins let's take this route Suppose that his instructor indeed did do what he claims he did. That the instructor did not teach him something that was going to absolutely be on the test. Suppose that the instructor was too wound up in the pending strike that he let his instruction lapse and he indeed did not fulfill the terms of his teaching requirements. Let's all assume that the above is true. So what should Lifeguard do? What would you do if you were in his shoes?? Let's keep away from the pat answers of "you should have learned it on your own" or "it's your fault, you needed to take some initiative to learn the stuff if your instructor was lacking" Let's see where this one goes from here.

The only weapon that I've ever had on an EMS call was my Ambulance driver driving to the call.

Your socks have tended to try to take over the world at times. Their newest scheme is to steal the Moon. The socks you have have been known to disolve holes in 3 inch thick steel. can you imagine the smell of those socks. When Lonestar is driving his motorcycle without his boots, Birds drop from the sky, planes crash and clouds produce rain to wash away the smell.

I wrote out a post in response to the first initial post. It was a chastisement of those who do this indiscriminately just because they can. The topic was I believe meant to convey a negative meaning yet when the explanation given later in the thread, I understood why you cut them off. But seriously, If anyone out there does this just to piss off a certain type of patient, then they are showing why we sometimes deserve the disrespect of our peers. LIke Lonestar said, why pull off the boots yet cut off the socks? More force to pull off the boots. But from what I hear about LoneStar's feet, I'm sure they didn't want to stain their gloves and their scissors are disposable you know. My son has 3 of the "Cause" bracelets. He doesn't wear them to support the cause because they are actually non marked bracelets. I can pull them off in 2 seconds from his wrist. There is not any need to go after them with scissors unless like the OP said, they were impeding circulation based on bilat swelling. Cut em I say in that instance but I don't see any need to cut them otherwise. I once had a critical motorcycle accident patient. WE cut all his clothes off, decomp'd his chest, femur frax both sides, critical head injury the works. I cut his Sturgis shirt off. He came back to the ambulance service after 6 months rehab and said 2 things. 1. Thanks for saving my life - if it wasn't for you I'd be dead. (good feeling) 2. I have a bill for a replacement shirt - he wanted a thousand dollars for the shirt because it was irreplaceable. He said he found a replacement shirt on the internet for 1000.00 and wanted us to pay for it. He got nothing because it was medically necessary to cut it. Had it not have been necessary I don't know what would have happened. So the moral of the story here is this. 1. When you post an inflammatory title and then don't explain fully then expect some peoples ire to get up 2. Do not cut off stuff that you do not need to cut off. 3. I got to get back to work.

I think his failure to answer any of the questions we have posed to him sort of show why he may have failed his course and test. Simple questions posed to him get brushed aside and he goes off on tangents that were never asked. The only question I have of him at this time is why did he wait this long to complain? His posts sound painfully similar to the thread he put out there on the wrongful death/autopsy swept death under rug.

I should have prefaced this towards smaller departments. Those with less than say 20-30 people. Those seem to be the services which have the hardest time getting their staff relicensed and educated. For a big department there should be NO reason why you couldn't get a CEU program up and running with some of your smarter people. But then again, I don't work for a large department so I don't know the pitfalls. Maybe it isn't so easy. But there surely has to be some people who would step up and help out right?