Just Plain Ruff

Try building the evidence based medicine requirements into an EMR system. Many times the EMR system that you are using does not support the functionality that the EBM is requiring. Often we have to do workarounds and build the system to do what we want it to rather than the system being designed to follow the EBM.

On the other hand, is a checkbox protocol policy and a mandate to put in a bunch of invasive lines and focus on central venous numbers make a difference for doctors who couldn't recognize sick patients in the first place, at a hospital that won't staff up ratios to allow nurses to give antibiotics quickly when needed, where people are just slammed through as fast as possible to make room for the next easy-collect quick in-and-out level 3 preferred "customer"? This scared the heck out of me doc. We had a pneumonia protocol in our hospital that when the doctor diagnosed a pneumonia or a sepsis we had a set of 3 or 4 antibiotics that we had to start within 4 hours of the diagnosis because JCAHO or whoever mandated that we did this. Didn't matter but dammit we had to start the antibiotics or our department would get dinged at the next nursing roundtables because we didn't start that golden nectar in time. It didn't matter that we were slammed with patients that were much sicker and we only had one nurse and two paramedics working to cover 12 patients in the ED and if an ambulance call came in, both medics left the ED and the nursing supervisor came down to help us or we got a nurse from the floor. Hows that for short staffed. So to arbitrarily tell hospitals that if you don't meet these pulled out of the sky and cloud numbers or you might lose your JCAHO accreditation is just ludicrous. Let the health professionals practice medicine and leave it to the professionals, and stop mandating things that clog up the system that is already close to overload and collapse. Our numbers were always good but if they kept adding things there is a tipping point.

And I can tell you this, I try not to put the patient in a full up position but sometimes it happens. But I can tell you that I'm not going to try to catch a patient when the cot goes down, As heartless as that sounds, the cot weighs at least as much as the patient does and there is no way that I can right that sinking ship. Best thing to do is to not get into the situation in the first place.

Yeah, the facility I work for (huge system in baltimore) sends mass emails out to everyone telling us that jcaho or medicare or whoever is here. They send documents out on how to deal with them. And I've only talked to a investigator once and it was stress free (NOT). They are just looking(at least in my oponion) for stuff to gig you on. And what are you talking about doc, I have no problem telling an investigator that I don't know an answer.

No you aren't lucky, my area has the same type of system and we bless the EMS gods that they are available to us.

actually I was nice, in my own particular way. I have a feeling that this was not this guys first rodeo in the telling his brother things. He seemed to know a lot about what was in our ambulance and focused just on that piece of equipment. He even said "Where's the tubing for that suction machine, I don't see it" or somthing like that. I didn't know what he was driving at at that time but boy did we ever find out.

Yeah, but how many of us wheel the patient from place to place in the full upright position. It's how I was taught and experience is often the best remedial tutor. (I speak from expereince but not as bad as this one). So maybe we should be teaching our colleagues that the cot should be at a lower level rather than at the fully extended height.

I transported a patient one night, about 2am. His brother was a state inspector for the bureau of EMS. The patient noticed that we had a suction machine that did not have any tubing attached to it and he told his brother. We were spot checked and inspected at 3:30 am. We passed. The tubing was underneath the suction machine and easily reached but our entire fleet of 3 ambulances were inspected for deficiencies. We got finished at 6am. NOT FUN> On another instance, had an OSHA inspector as a patient, he noticed one of our employees recap a needle. He called his partner and when the patient was released they inspected our department. He cited us for what he witnessed. Our management countered and filed a complaint and OSHA's answer was that their inspectors are on duty 24 hours a day even when they are patients and when they see a violation they are within their rights to initiate a investigation. You never know who your patient is. And one final note, a friend of mine said that they were witnessed giving a medication error by a member of the board of pharmacy for the state of missouri and they were investigated on the spot.

Honestly, my experience in the past with the Autovents was strictly for patients in full arrest where the autovent allowed us to ventillate and have two hands free. But we never used the autovents on patient transfers, too few parameters to set for patients that need them. To me the autovent is a one size fits all (which when it comes to airway maintenance is never a good thing) For our transports we always used the portable ventillator that our respiratory therapy department used.

yes I agree on all counts Triemal. this is a teachable moment for all in EMS, your cot is not infallable and it can fail and most of the time will fail at the most inoportune moment, especially the moment when the family will see you and turn on their camera phones. This I am going to bet will not end well for the transport company nor the emt's in question. They might want to start polishing up their resume's and try to find some good wordings on how to polish the turd that they were given when they dropped poor ole gramma. But there is really no way to shine a turd, it in the end is still a turd and in the end, they still dropped granny and that's all any good ole compassionate jury will see if it gets to a jury.

Again, the media is making this out like it's a HUGE world ending story. http://www.jems.com/video/news/family-blames-new-mexico-medics-fall-cot And the reported made sure to put in that both employee's will be drug tested. Plus not once in the cell phone video does is the family seen by their grandmothers side. And one other thing, why did the ambulance service who dropped her get to transport her back to the hospital. if this was my grandmother, I would be on the phone with 911 asking for the emergency provider in my area to respond.

Neat.

6 points with one ticket. What the heck was the ticket for? Failure to report a mva or leaving the scene in maryland is 5 points so one can only assume that yours is similar. Going 40 miles per hour over the posted speed limit is 5 points in maryland. DWI is 12 points in maryland So depending on the violation and how far back your 6 pointer is, I am betting that NO company in your state will touch you with a 10 foot or mile long pole. My advice if you really want to be an EMT is this 1. Stop getting tickets that put 6 points on your license 2. Go talk to a lawyer about getting that 6 pointer off your record 3. Wait for the requisite time for the points to come off normally. The most optimal option would be to continue on to paramedic afteryour emt classes and that way you can possibly avoid having to drive. And one final thing, depending on what you got the ticket for, I'm not sure if I would want you or anyone else who gets a 6 point ticket on their license driving my family member or more close to home, ME in your ambulance. Good luck but I think that this might be a NO GO on the part of any insurance company who looks at your record.

I worked all the way through college except my freshman year. It is possible. I also worked all the way through my master's degree program as well. It's not only possible, it's doable albeit a little slower if you have to truly support yourself. Throw in children and a wife/husband and then the game really changes.

The fastest way to a hostile workplace accusation that I've ever heard. All that you just wrote is indeed harassment.

no I think they got their butts sued over providing alcohol to underage students who then went out driving. Plus there were I believe prosecutions of the people bringing in the alcohol trucks(think trucks with multiple spigots in the sides). They were the ones who were arrested. But that was just rumors from my friend who went there. But I do know that the providing of the alcohol was a truth because I partook a number of weekends.

Washington University in St Louis Mo also has a student EMS team. I think they still do. That was many years ago. I experienced it first hand when my friend collapsed from low blood sugar and an over indulgence of the Free alcohol the anheuser busch (major benefactor to the university) provided on every friday and saturday night in the Quad.

Onlyinnewyork, you will NOT lose everything you have learned for EMT, what you will be doing is augmenting what you have learned in EMT School. Consider this analogy. You as a baby learned to crawl, now if you jumped right into learning to run a marathon? No, you would first be learning to walk and then learning to run and then learning to run for longer distances every day. You will not lose everything you have learned in EMT school because honestly, you really haven't learned but the tip of the iceberg in EMS and for that you need to branch out and get your paramedic to prove to you how much you don't quite yet know. I second ParamedicMike's recommendation to go directly to paramedic School.

Their reply has been sitting in your spam folder all that time.

Just what "new toy" is he talking about?

Hey Island, make sure you check him for the bends.

I love the Diving technician field, I never went through it but I did read a text book that taught the basics all the way up to the advanced processes and procedures. It was a great read. It allowed me to hone my treatment of diving injuries which we saw a smattering of diving injuries in our area as we had some nice areas for diving. DAN is a great organization and you should be proud to be a part of it. And you are like a couple hours from my domicile place of residence so maybe we can get together for dinner.

Emergency Department

Yes, if the programmes are working, let's use what works and see how it goes. I'm not against this mind you, I'm for it actually.

I've attached a file here that is pretty good. the title is "How well do General EMS 911 dispatch protocols predict ED resource utilization for pediatric patients?" And the answer is apparantly not very well except for low acuity patients. Let me know if you can't see open the document. 911 dispatch protocols.pdf