Just Plain Ruff

How hard did you look? Not busting your balls but I did a search for Online EMR courses via Google and found this one in my first page of search results. All of these courses if you are wanting to get certified require a visit to their approved sites for the skills portions. Why are you not requiring your staff just to go to EMR classes in your area OR better yet, already be certified? I mean you have the next several months (march, april and may) to get them a EMR course. Heck you could possibly even get them EMT certified if you found them the right program. Honestly, Online courses for saving lives always seemed to me to be the lazy way to do things. but that's just me. Business classes or philosophy classes maybe, but classes that teach you to save lives, not so much. Here's the search that I found - click here and refine it if you must. https://www.google.com/search?q=online+EMR+course&oq=online+EMR+course&aqs=chrome..69i57j0l3j69i60.2943j0j7&sourceid=chrome&es_sm=122&ie=UTF-8 http://lifesavereducation.homestead.com/ecademy_eca.html And this one http://www.emtsacademy.com/index.php?option=com_content&view=article&id=113&Itemid=188

I think if I worked for this company and I was forced to do this, I would do the following. 1. Refuse to start any IV that I did not feel was clinically appropriate. 2. Refuse to put on any monitor that was not clinically appropriate. 3. Document reasons in my report for 1 and 2 above 4. Keep a private journal with run numbers (NO PT names) that I transported and if monitors/IV's were appropriate or not. 5. make a informal visit to the medical director to get his/her opinion of this practice 6. Call CMS and ask their opinion, initially as a anonymous report but if they begin to discuss fraud and criminal penalties, ask them about whistleblower protection for myself and if they would offer it then and only then would I give any more information to them. But then at number 6, you get into the weeds I think, you have already opened that can of worms, you have told them a story, they have said it's fraud, and you now have a decision, do you give them your companies name and subject yourself to penalties for not telling them in the first place or do you give them the information, have whistleblower protection and then become a pariah in the industry in your area for turning in your company for medicare/insurance fraud. I don't know many companies who if they find out you turned your previous company in for medicare fraud that will hire you for fear of you doing the same to them. So rock meet hard place. Hope you like the middle.

well It's been a while for me, but we used to fill out charge forms. 150 for transport fees, Iv STart charge, Iv fluids fee, monitor charge, ET fee etc etc and yes, the patient is charged for all that individually. So that is definately the issue here.

And we are revisiting this why? Other than to discuss this again. It is good to discuss Hipaa I believe because it makes us better providers but Frank, you need to not just quote the original thread but please tell us why you resurrected a 6 year old thread topic instead of making up your own? what are your thoughts on this? you just posted the original thread and you gave no points of your own. I'm interested in your thoughts and why you thought it was important enough to bring it up again. Did you have an instance where this happened in your neck of the woods? But I'll chime in - Yes this guy violated HIPAA and should not have posted anything about his call. In my opinion, we should not be posting about calls we run except in the most VAGUE OF VAGUE WAYS. No identifying items, no names, no ages, no sex, no reasons for the call, no pictures(GOD NOT a picture at all). If you cannot mask it to where the family member couldn't pick it out of a line up of 200 people, then don't post it. And don't be upset if you get called into the principals office to defend your actions, if you post it defend it.

I already know about the reward, I have a good friend who is now a very rich person based on his whistleblower to the office of civil rights based on his report against his employer and what they uncovered. For every violation (10K) that they levied, he received 10% of that fine. They levied 5000 violations. you do the math. He owns a nice little horse ranch outside lexington kentucky. He didn't receive the entire amount but he did receive a hefty chunk. Plus it ended up costing about 25 people their jobs. Pretty big deal. It was not EMS related though but it was health care related. I've been to his ranch and I've ridden his horses, talk about green pastures. He made out pretty well.

Exactly, I can't imagine any ED physician who would not say something to a provider who would start an IV and put a monitor on a patient with an isolated thumb fracture. And the minute you told that physician that "it's protocol" or "I'm supposed to according to our firms rules" you would probably be the butt of many a joke. a simple anonymous call to the CMS office in your area, you can get the number via a simple google search would put a bug in any CMS investigator's ear. Doc, just how would one go about getting whistleblower protection? Would that be based on the first one to make the call "non-anonymously" to CMS?

Man, what is the medical necessity of putting a monitor on a thumb fracture? what is the medical necessity of putting a iv in a patient with a isolated thumb fracture? How do you justify the need for both in a "Isolated thumb fracture" and how do you write it in your report to justify it to medicare and medicaid or even any private insurance company. Or even how would you justify it to a person who had no insurance? You can't and your company can not either. I remember way back when, when AMR came into my coverage area and took over our service. They forced us to write in our reports that the patient was bedridden and needed to be assisted to our cot via 2 man lift and then the same when we put them onto the ER bed or Nursing home bed. If we didn't do this for both trips we would be called into the supervisors office to re-write the report to make it "billable" for medicare/medicaid even if we had already given the nursing home or hospital our original report. If we refused we were threatened with suspension or even termination. The reports had to be written this way even for patients who could walk to our cot or who could move themselves to our cots. I took a stand and told them NO, I would not rewrite my reports and they tried to suspend me. I told them if they did that, I would call medicare(CMS) and ask them if this practice was legal or ethical. They backed down and soon stopped requiring us doing this on every patient except the ones who were truly bedbound as I believe they truly knew that this was fraud. Unfortunately, I left the service soon after under not so great circumstances, not sure if that is what was the catalyst but it was for the best. Career wise for me at least.

yeah, hat was powerful, slow down this applies to all of us as well. We can be just as bad at scenes. I remember one night, dark road, car wreck. There was one volunteer FF directing traffic with a small light. No protective/reflective clothing. They directed me to go on past and no where did I see the second person directing the other direction of traffic. I nearly hit them. We can indeed be our own worst enemies.

TheOldGuy, I disagree to a point. I don't see the need for getting experience first as a emt. I never have understood why we tell people to be an EMT first when we aren't telling the same thing to nurses and doctors and fire fighters as well. You don't tell a doctor to get experience as a nurse first do you? You don't tell a nurse to get experience as a CNA or a LPN first do you? You don't tell a firefighter to get experience outside of something else first. So why are we telling people to get experience as an EMT first? The only reason why we are telling people to get experience as an EMT first before they go on to get their medic is because you have to get your EMT first before you can get your medic. Sure there are pre-requisites to get in to nursing school or med school but it's education based not experience based. I think they should do away with EMT altogether and just have a Medic licensure or at least have two tracks, an EMT track for those who just want to be firefighters and that's all they want to be and then a Medic track for those who want to be a paramedic. this would allow those who don't want to waste their time with a EMT class when they know they are going to go on to a paramedic program. But this will never happen because of the status quo in education and certification and too many sticks in the mud. But the experience gained by working in the field as an EMT to me is limited based on the service you work for. If you work for a service top heavy with medics, then EMT's would be hard pressed to get any valuable experience at all other than to be a "ambulance driver" or if you work for a transfer service, well that speaks for itself. The most valuable experience an EMT can gain is to be partnered up with a strong knowledgeable Medic partner who understands the value of a good EMT and is there to nurture and grow that EMT partner and that medic involves that EMT in all facets of patient care and even allows them to attend at times. That's the type of experience that is the most valuable. But if the only experience an EMT is getting is driving and an occasional set of vitals, then I say that experience is just worthless. Anyone and their mother can drive and take vitals.

I think some people might need a safe space set up after they read this.

Ventilating with a BVM and no End Tidal CO2? When does the mantra "DO NO HARM" come into play? well hell, I remember in band camp, errr in the 1990's and early 2000's when not a single service had anything like ETCO2 monitors. We had pulse oximetry and that was it. Man how far we've come. I think we did most of our patients good when we didn't have it. But to claim, "Do No Harm" mantra, is a bit of a stretch. I have worked in several systems (not lately) but in 2014 that didn't have ETCO2's which based on budget, kept them from purchasing them.

Well that just sucks, what a way to be a group of ASSHOLES to do that

Off label, great post, but unfortunately, many I've worked with, some in the hiring side, consider the person in dreds as less than desireable as an employee. I for one consider the person and not the hairstyle. I have several friends with crazy ass hair styles. I know the person behind the style, but they have been passed over for jobs they were qualified for, passed over based on their appearance. Sucks, and we should be past all this, but appearance is very important. If you look like a thug(not saying you do) but generally, if you do, then you probably won't get the job

Many organizations have a dress code including hair length but the majority of places I've worked your dreds would not be an issue. Be prepared to not get hired if your dreds are really long or if they look bad.

Damn Braille, I can't read it on my computer monitor. What's really funny is the OP came back to edit his original post.

Offlabel here posting as someone else. System error.

offlabel here.... my posts (none on this thread) are being linked to this user name.

Sounds like strictly control ventilation. Pretty narrow operating range for patients that are at least completely apneic from whatever reason. Bottom line for me would be as close to 6 cc/kg as possible with at least 5 of peep with airway pressures less than 30 if possible. I don't think you'd do any harm if you stuck close to that for the time it took for a transport. Not optimal, but you'd be ok with that.

It appears that someone is linked to my user name again. I've been seeing some real issues with this site. Database errors, critical failures, unable to connect with the database, incorrect user name issues. and now someone is linked ot my user name. some times I have one unread posts and then the next time I will have 9 and then it goes back to just one even though I didn't read all the 9. ADMIN what's going on with this site. And by the way, I did not say what's in the above quote.

No one is debating this. We have all had experiences like this. Sadly, people who are competent enough to follow directions and understand it are far and few between. Although I am glad to truly help someone, a majority of our patients have no interest in helping themselves, and I will not waste my breath on them. Get you shoes, coat, purse and lets go ma'aam. What I refer to is this new approach being floating around where EMS makes appoints to go to someones house and follow up with them after a hospital discharge. Being in a municipal service, and have no employment with a hospital or private company I frown upon being their lackey to help them retain more money for themselves in preventing readmissions. I am lucky though, we have 75 ambulances on the Chicago Fire Department and that isn't even enough. So some idea like this would never work, looks like I will be spared.

Dude, those are for Physicians and not paramedics and emts. It seems like a good site to find employment if you are a physician but your site has no value for emt's or paramedics. Doing a search on paramedic returns zero results.

James, thanks for coming back, but I saw nothing on your site that you linked that would have been helpful to EMT's or medics. The only jobs available are for physicians and not emt's or paramedics. While it's appreciated that you linked this for us, without any way for emt's and paramedics to search for jobs on that site, that's what makes it spam and inappropriate for this site.

Exactly, this is the reason why first responders are part of community EMS.

Rock_shoes here. For some reason the system tagged me as Ruff when I signed in. Admin?

So what's wrong with a medic or an EMT working at a CVS or a stand alone clinic? 60% of your work in a community hospital ER is exactly what they do at the CVS and it sounds like from your post that you do about 60% of that where you work as well. So explain what a PAR is? I'm not following, again with the abbreviations like the 10 codes, one area uses them, another doesn't. gmd And you'd never entertain the CVS concept even by direct order, be out of a job long enough and you just might if the money paid the bills, but thankfully you probably don't have to right now. And Community based medicine is a HUGE part of what we do in EMS already, you get that right? We are already doing much of that when we respond to the 2pm chronic diabetic patient who is low on their sugar who you bring the levels up and they refuse to go to the hospital and you spend an hour on scene with them making them a sandwich and helping them with their meds. And then you help them to call their doctor's office or you do that yourself for them and get them an appointment for the following day. That's community medicine, or do you just get them to sign a refusal and go on your merry way? We already do community based medicine but many new medics don't realize that, they are so freaking focused on that next "cool call" that they forget that there's a human element in these patients and that spending the extra time with the patient can mean a big difference in the health and longevity of the patient. If you are hospital based you have an even bigger impetus to look to yourself as a community based practitioner because you see these patients regularly and more long term than just the run of the mill street provider. So Medcom Radio, You did Miss the part that community based medicine involves first responders - it involves all of us working together to promote the better health of our patients. The title "Community Based Medicine" practitioner is just that - at title.