crotchitymedic1986

Well I think EMS/FIRE/PD would rank higher than most departments on the evolutionary chain, whether you want to call them "essential" or not. The problem is, as noted by someone else, most departments have been cutting for a long time now, and may not be able to cut any further without closing down the department all together. So those "more essential" services may have to start sharing the pain.

Sorry, I misinterpreted what you typed. Anyway, you have phrased the questions perfectly, so I am sure others will respond, and the discussion will begin.

OK, guess I misinterpreted what you meant. Anyway, you phrased the questions perfectly, I am sure others will respond to what you have stated.

Well I will certainly conceed that I am not the best at "framing questions" in a feel-good-cuddley fashion. But isnt that like being a little bit pregnant ? I mean once i justify which documents I can and can not falsify, havent I already went down the slippery slope ? I admitted my own guilt, so I am in know way taking a superior position against those who have also done it. Are some documents more important than others, of course; but it is still falsification.

Answering Wendy's question: That is good advice, but if you know when I am playing devils advocate, it isnt as fun. Although this hurts my credibility in the short run, I am willing to temporarily conceed that to poke and prod and see what you guys are really passionate and knowlegeable about. Life is like a sled dog team, if you arent the lead dog, the scenery never changes. Which means you often have to step out of your comfort zone of yourself and the team, to get a fresh look at the scenery. You have to take a leadership role, and say why not go left, when everyone is is sure we should turn right ? Sometimes you have to question yourself and what is known to be "right" to validate it, and sometimes you find that maybe you invalidate some things along the way. There was a time in this world when the smartest people "Knew" the earth was flat. There was a time when the brightest doctors knew menstral cycles were a result of mental illness (they might have been right -- just kidding). Just because you know something to be "right" today, doesnt make it right tomorrow or a year from now. Did you vote in the last election wendy ? There was a time when the smartest people didnt think you should be allowed to do that, and it wasnt that long ago.

Ummmmhhh. Let us stick our head in the sand and pretend there is nothing to fix in the EMS world. All is perfect. And about the "millions of patient's thread": Give it 12 months, and about 15-20 more examples of patient deaths, and I believe I will be vindicated. I posted a few more statistics, studies, and examples -- you might want to take a look. The deaths will continue, and I will highlight it each time it makes the news. Sooner or later someone will say, "maybe there is a problem here --- Nah, lets go back to bashing firefighters, that is more fun".

For all of those who refuse to look at a problem until they have statistics or scientific proof, scroll down this page: http://www.bmj.com/cgi/content/full/325/7359/330/DC1

For all of those who refuse to look at a problem until they have statistics or scientific proof, scroll down this page: http://www.bmj.com/cgi/content/full/325/7359/330/DC1

Doesnt surprise me at all. But the good news is that this just allows the case to be heard by a jury, doesnt mean she will win the suit (this time).

Oh, and be nice and lubricate the tube before you give her anal D50, and try to get it out and get her dressed again before she regains consciousness.

For those who love statistics: 11 Years of Research Paramedics cannot safely determine which patients do not need ambulance transport or ED care. This was a prospective survey and linked with medical record review. There were 183 patient charts that were reviewed. Of those, paramedics recommended alternative transport for 97 patients. 23 of those actually needed ambulance transport (thats 23.7% - love crotchity). Paramedics also recommended non-ED care for 71 patients. 32 of those needed emergency department care ( Thats 45% - love crotchity) . This study was done in Albuquerque, New Mexico. This is quoted from this site: http://www.loyolaems.com/ce_mar07.html But if you want to get really mad, read the nursing comments on this forum, about what EMS should and should not do. I warned you to take a HBP pill: http://allnurses.com/forums/f8/furious-amb...ent-353520.html

Of coarse course I agree with you, I dont think they should be allowed on the ambulance at all, but if we are going to have "drivers", lets make sure they are qualified "drivers".

It seems about 1o days to long to me. All they really need is a good EVOC coarse.

Before you say NO, consider these common falsifications to see if you have ever been guilty. Be honest now: Have you ever: 1. Falsified an inventory or checklist, basically just pencil-whipping the check-offs when you actually didnt lay hands on that piece of equipment or medication ? 2. Changed the actual time a drug was given during a cardiac arrest, rather than documenting the real time (either because you didnt keep up with the real time, or because the real time fell outside the ACLS time parameter -- you gave a drug that was supposed to be q5 minutes at 8 minutes) ? 3. Ever made up a vital sign, or documented a vital sign that you didnt take (ie... you recorded two B/Ps but really only took one. 4. Documented that a patient refused AMA, when they really didnt ? 5. Documented that a patient refused immobilization or an IV, when they really didnt ? 6. Realized that you made a medication error, but documented that you did it right ? 7. Documented that no patient was found at the scene, when in reality there was a patient with a minor injury or illness (maybe a wreck, where the walking wounded claim that their knee is sore, and you tell them to get it xrayed if it continues to bother them) ? 8. Ever falsified an incident report to cover you or your partner's hind quarters: Yes, we had a backer on the ground, but my foot slipped off the brake ? And just so you dont think that I am holier than thou, If i had to answer the question honestly, I would have to answer YES ! Remember you can vote without commenting or admitting guilt

Damn vent, I dont think anyone could have said it better. I bow before you.

Yes, you can always give it rectally via ETT to the tuckus --- which is all the motivation I needed to find a vein. LOL

I have to disagree (big shock there). Even when you are not overly rude to a patient, your body language and speech inflection (rolling your eyes, constant sighs) often indicate your attitude. I dont know who said it, but it is a true EMS Axiom: "You can kill a patient with your treatment, but as long as you smile, hold their hand, and show compassion, you will never get a complaint. But you can save someone's life with a poor bedside manner, and you will get a complaint every time."

You find your male partner is unconscious, because he fell in love with this beautiful female patient, and had been swapping spit with her. Then he finished his secondary survey, and found out that she had a bigger penis than he did.

It could be 24/48 with having your OT shift covered by other medics every third week (one crew would always work Wed/Sat -- covering the crews that would be scheduled off during the 72 hour week to cut you back to 48. Or it could be 24/72, which many think is less expensive, but is usually more expensive.

You cant. Because of the abuse to the medical system, you often find this attitude among doctors, nurses, and EMS workers. I think alot of it has to do with our perception of what the job should be, and the reality of what it was. Two things that happened in my career that changed my attitude: 1. I had this attitude in EMS, working for a very busy urban 911 system, and often found my blood pressure sky high, because of the idiot patient i had just dealt with. Then the system changed from 24/48 to 40 hour week. I realized that during my shift, I could either transport 6 or 7 patients, or not transport 10-12 patients, I would have to do about the same amount of paperword either way. Once I started transporting and not argueing, I no longer had high blood pressure, and my shifts were very pleasant. 2. Same thing when I first started working ER, the minute any of our regular drug seekers walked into triage, my BP would go sky-high. Once I accepted that this was a function of the ER, and started treating these patients with the same attitude and compassion that I treated everyone else with, my BP went down, and my shifts were enjoyable again. I am not saying this abuse is right, but once you accept it as part of the job, life gets better. If you are a cop, sometimes you have to direct traffic in the rain. If you are a proctologists, you have to look at asses all day. If you are in the medical profession, you have to deal with people who abuse the system.

I already answered that I would have worked the child, just because it has always been the automatic thing to do, even when the child has rigor and is purple, I know many medics will work the corpse to give the parents the thought of everything that could be done, was done. But with that being said, bedridden with a disease that has no cure, should probably equate into NOT being worked, regardless of age.

I was one of the guilty ones, who thought a well-run EMS was recession-proof, but I am not so sure now.

how about showing a little love to your arch-nemesis ? I know it hurts to say I was right, but you will survive the encounter, unlike the patients we continue to leave behind. Again, I ask, How many deaths are too many ? The FDA and communities are all in an outrage because 62 hospital patients have died from Heparin errors in the US during the past 24 months. Do you really believe that nationwide, EMS has not been responsible for atleast as many deaths ?

Recently had a conversation with an old friend who owns a private ambulance service (and a very profitable one), and we started talking about the US economy. He painted a very bleak picture for the ambulance industry in 2009. Although he has perfect credit, his lenders are telling him that he may have to delay scheduled purchases (ambulances) because the bank may not have the millions to loan him, that they normally do. He went on to theorize that many private services would be going out of business in 09, because even if they have perfect credit, the bank may not be able to loan them the money, much like his situation; but the reality is, many services are barely getting by, and DO NOT have perfect credit, and will not be able to get a loan from any bank. Many may not know that ambulance services rely on lines of credit to meet payroll, as Medicare and Medicaid reimbursements are unpredictable, but payroll comes every two weeks. From this conversation, I am going to make some predictions about 2009, but I hope they do not come true: PREDICTIONS FOR 2009: 1. AMR will close its doors for good. 2. Many private services will go under, leaving 911 services to run non-emergencies. 3. Due to falling tax revenues secondary to home foreclosures (loss of revenue on those properties, and then the effect of foreclosures is that they drive down the values of homes around them, which again lessens the revenues into a municipality), many municipalities will have to cut back their Fire/EMS operations: Delaying equipment purchases, not filling vacant positions, offerring early retirement, witholding pay raises, running less trucks, or changing the schedule of trucks, or they may even have to lay-off employees. 4. The last remaining hospital-based services will also fold, there are very few hospitals making a profit at this time, and hospital-based EMS is usually a financial drain on the hospital. 5. Also note, that many municipalities are already over-levereged, and will not be able to float bonds as they usually do --- see California. If you are working for a major urban city or state, you should really be concerned. I hope none of this happens, but if you are working for a municipality that is struggeling, or you work for AMR, a hospital-based provider, or a private service that is barely getting by now, you should really start thinking about a Plan-B. Which isnt to say that it is time to get out of EMS, but ask yourself, if my OT money dried up, could I pay my bills ? If the private service I work part-time at goes under, could I pay my bills ? If I work for AMR or a struggeling hospital, how would I survive if I were told that I would be out of work in two weeks ? I think we are about to see some difficult times in our industry.

The answer would vary service to service, based on the issues that are unique to that service and geographic area: 1. If you have alot of low-acuity calls that do not require transport, you could add more BLS trucks, or ALS first responders to handle those calls and keep ALS transport units available. 2. Does your work schedule match peak call volume. Lets say you are running 10 24/48 trucks that all come up at the same time. Would you do better to shut down some of those 24 hour cars during the after midnight hours to put up some peak-time trucks during the day ? 3. Are you suffering because the hospital is too far away ? Could you use private ems to do the longer transports ? 4. Are supervisors being utilized to handle call-volume, or are the desk-jockeys. 5. Can you set longer response time parameters for BS calls. Who says everyone that calls 911 should get an ALS ambulance in 8 minutes. IF someone calls for the flu or stumped toe, why cant they wait 20-30 minutes for a non-emergent response ? 6. Can your service obtain free bus tokens from your transit authority. Hand the flu pt a bus token, and let him go to the hospital on his own ? 7. Should you embrace the non-emergent transports (convalescent), much like Fire has had to reluctantly embrace EMS calls to keep their budget alive ? The extra revenue could help, and allow you to have more ambulances on the road (it is more difficult for government agencies to do this, but often your competition is a fly-by-night sleeze service that may not have the intelligence to fight you in court). Edit: Forgot one: 8. Are you maximizing your collections ? How many days do the bills sit before they are processed ? Are you getting all of the revenue you can / Lets say you are the average 911 agency that only transports 60% of your calls. If you upped that to 70%, could you improve your revenues: Lets say you run 20,000 calls, and average $200.00 collected for every call (average includes calls not paid, semi-paid, and fully paid). Transport 60% = 12000 calls transported = 2.4 million --------- Transport 70% = 14000 calls transported = 2.8 million