Just Plain Ruff

Holy Crapola this hit a bit to close to home with the adoption aspect. You did well grasshopper. I have a pm coming to you.

I have to consider myself the ultimate in mystery shoppers. I have worked on automating 15 or so hospitals in as many states. I have worked thru processes, worked thru workflow and many other issues and I have to say, there is 1 million different ways to skin a cat. The bottlenecks that I consistently see are the triage process, the registration process, the ambulances bringing patients into the ER and the discharge process. A large list that is not easily remedied. Yes consultants can come in and say, make this change or make that change but in the end if that change does not fit the workflow of the ER then those dollars spent on those consultants amount to dollars wasted. You can say, move patients this way or flow them that way but if the ER's processes or workflow does not fit that suggestion then it won't work no matter how much money you shovel out. When you have an ER that see's 250 patients a day and 80-90 of those patients are brought in by ambulance, many times 10 at a time there is nothing that will make the flow of patients go smoother. No matter what anyone says, it just will not go smoother. When you have a waiting room of 100 people which during the busy time often occurs there is often the feeling of intense frustration that patient's who have been waiting for nearly 8 hours continually see patients who have been there for 3 hours going in quicker than them. This results in the most frequent complaint to nurses, administrators and doctors. Let's take one of my hospitals that I worked at out of Miami. Average patient wait time to see a doctor for a generic medical complaint is a 8 - 12 hour wait and then 2-8 hours in the ER bed and if you need to be admitted you can expect to be there an entire day. I can actually attest to this because I was the patient above. I spent 4 hours waiting for triage, another 4 hours after triage to go in a room. I then spent 4 hours in the room waiting for the ER Doc and then an additional 8 hours for treatment, labs, x-rays and medications and then another 3 hours waiting for the doc to discharge me. I was working at that time so I had plenty to do, thank goodness for laptops and electrical outlets and wireless. As a matter of fact I got more work done that time spent waiting than I did for the rest of the week. I know the processes to go in the ER and get in and out so I knew that I was just a number. I could go on and on with experiences (no others as patients) but I spend time working very very closely with ER staff's and I hear the issues that they have. Process issues, workflow issues, patient issues and many other issues. To think this is an easy fix is naivity at it's best. There is no easy fix and to throw more money at this problem will not make it go away. One thing that could be tried is to begin educating on when to call 911 when people are in grade school. EMS agencies and hospitals could do outreaches to pre-schools, grade schools and middle/high schools and begin to educate them as to when to call 911 and when to go to the ER instead of their doctor. Educate the public early and often. That would be one suggestion from a highly paid consultant. There is a saying in the consulting world, "If you are not part of the solution, there is plenty of money to be made in prolonging the problem."

the criteria for level I's in missouri are the same as level II's but they have less time to get in. I believe that they have to have in house surgeons 24 hours a day. But I totally agree that a patient dying because of no ems notification would not fly in any type of court case.

but I would hazard to guess that 98% of the services out there, especially the private services would can your butt in a New York minute if you came to them and said, "I can't work 24 hour shifts but I can work extended shifts but I need 4 hour breaks built in to my schedule" I have a cousin who has some neuro issues and she is on light duty at AMR but only because AMR has some light duty jobs that she can do. They have so much already said that when the light duty jobs end then she either needs to be ready to work the streets or she's out. She's biding her time apprehensively because she doesn't know how long she will still work at AMR.

No apologies needed my friend. I was just trying to get a handle on the industrywide speculation comment, was it your area or nationwide which you answered very succinctly. It appears that having a physician call them is not a bad idea especially if there were lots of trauma alerts that were called which never never should have been called. All you can do is recommend a trauma alert or give the doc what you have and let him make the call. If he doesn't call the alert and things go sour for the patient then who's butt is on the line, not yours unless you didn't give him all the info.

and the FAA investigation is 1/2 complete since there was a FAA guy involved.

Good thinking all. you drive up on the scene and you see one person with no legs and another on the ground you better order an additional ambulance. If one person has no legs but should then you can bet the 2nd person on the ground is even worse off. Call for the 2nd ambulance, you can always cancel em.

ok, here is a solution you transport everyone but if they are abusers of the EMS system then you just garnish their wages to recoup some of the cost of the abuse. If they don't work and they are on welfare then you take a certain percentage of their welfare check. When it comes to EMS I don't think universal healthcare is a bad idea. Everyone is covered. Unfortunately universal healthcare overall is a terrible idea.

where are you getting this industry wide speculation that trauma alerts are going away or will go away? That's a pretty broad claim. I have worked over the past 5 years in nearly 15 different cities ER's (computerizing them) and not once have I heard that trauma alerts are going away or there is talk about them going away. At the client I'm at right now, 110K patient visits per year they rely on the trauma alerts to get their teams ready to go. There is no way in hades that they are going to stop receiving trauma alerts. This is in Springfield Massachussetts, the trauma center there. So where are you getting your claims of Industrywide speculation? Or are you just saying your Area wide speculation focusing on your specific area?

here are my time killers when I'm bored www.cybernations.net (no it's not porn) www.battleknight.us http://www.candystand.com/play.do?id=17995

but rolling that diesel guzzling fire truck on Every single medical call no matter what the medical call is is how most fire departments justify their budgets. No calls - no money.

Kudos for you for saving her. My hats off to you. It's amazing what the body can do when traumatized that way. I had a similar call where a kid was all but dead due to a head injury(large 6inch elliptical piece of skull pushed into the brain) yet he survived. What happened to the 2nd victim?

if only she was nekkid

they are dead, finish up the paperwork and go back in service.

Dwayne, something's always hinky with ya!!!

'True' Friendship Enough of that Sissy Crap and dont pass it aint no stupid daisy chain bs either. Are you tired of those sissy 'friendship' poems that always sound good, But never actually come close to reality? Well, here is a series of promises That actually speak of true friendship. You will see no cutesy Little smiley faces on this card - Just the stone cold truth 1. When you are sad -- I will Help you get drunk and plot revenge Against the sorry bastard who made you sad 2. When you are blue -- I will Try to dislodge whatever is choking you. 3. When you smile -- I will Know you are plotting something That I must be involved in. 4. When you are scared -- I will Rag on you about it every chance I get. 5. When you are worried -- I will Tell you horrible stories about How much worse it could be, Until you quit whining. 6. When you are confused -- I will Use little words. 7. When you are sick -- I will Tell you to stay the hell away from me Until you are well again. I don't want whatever you have. 8. When you fall -- I will Point and laugh at your clumsy ass. This is my oath.... I pledge it to the end. 'Why?' you may ask. 'Because you're my friend!' Friendship is like Peeing your pants: Everyone can see it, But only you can Feel the true warmth.

Congrats on the baby thing. Just remember, according to some it's not a good thing to crave recognition. But maybe if you had just held her legs and talked to her you would have gotten your picture in the paper. Headline reads: Grizzled ole medic delivers baby without green firefighters help. Mom and new firefighter did all the work, Medic just caught the baby.

do you take mastercard? Visa? American Express? Just swipe your card and go. What's next, taking chickens in lieu of payment like the old country docs used to do. I actually have a physician friend who treated an amish boy for a fractured hip from a fall from the roof of the barn he was helping build. You know, an Amish Barn Raising. The Amish community pitched in and built the physician a new detached garage. He saved 20K on building costs and the amish family saved the entire cost of the medical procedure.

i had a girl who drove off the road after a night of drinking. She ended up upside down in a creek, her front bumper was on one side of the creek, and her rear bumper was on the other side of the creek making a suitable bridge for someone to walk across the bottom of her car from bank to bank. She was held in place by the steering wheel. She says she went off the road at 1am or so and we got the call at 11am that same day. She had bilat femur fractures, open ankle fracture, closed head injury, bilat pneumos and other assorted injuries. We flew her to the trauma center of course her golden hour was shot to crap but she made it out alive and just walks with a limp now. I was in the water under her for about an hour before we got her out of the car. I lacerated my knee on something in the water. Never know what you are gonna get.

The list includes assaults, severe respiratory attacks, burns, choking, stabbings, accidents and emergency baby deliveries Careful, the probie might not get his picture in the paper for helping to deliver the baby if they don't respond to these calls anymore.

but remember the more calls that a fire department runs the more money they can ask for come budget time. We ran X number of calls in the past 365 days so we need this amount of money. The more trucks that go on a call will exponentially increase that number. I'm all for sending fire trucks on calls that are considered life threat's like shortness of breath, chest pain, long falls and rescue types but to send a pumper on a call that is for a injured foot or a head ache is just stupid and puts the public at risk. When you run emergency for a hurt foot it's just silly. Sort of sending a fire truck to a trash can fire with it's lights and sirens. That's another pointless thing.

No arguments there with ya dust. Yes that 1% is probably the number of patients who really deserve our bias. But with people who say that they would put aside their opinions and provide unbiased care I have to disagree with their premise also. And that also proves my premise.

my question and of course this is armchair quarterbacking but the comment of upon initiating ventillations the child was immediately paralyzed. Just how did the person doing the ventillations ventillate him? Head tilt chin lift? If he was just hit by a car wouldn't you have held in-line stabilization and ventillate? It's a question that needs to be asked.

this is tragic tragic tragic. Imagine what his son will remember on his birthday for the rest of his life? May the shooter rot in hell.