HERBIE1

Ever hear of defensive medicine? Sorry, but CYA is what health care is all about- from the level of a neurosurgeon to a first responder. That's why we have protocols to follow and we don't get to free lance and make up the rules as we go along. Here in the US, lawyers are the reason we do much of what we do.

If you've already done it once, I would keep it up- at least until there is some resolution to the new policies. It's far better to have it in your back pocket and not need it than to scramble at the last minute.

Like any treatment, I would simply put it back on the patient and/or family members. Say "In order for us to properly assess and treat this person we need to do A, B, and C. We will be as respectful of modesty as possible, but if you refuse to allow us to do our jobs, then you must sign this release from liability that says you acknowledge and understand the possible risks and consequences(and clearly outline those details for them) for refusing to let us properly do our jobs." Essentially it's no different than if someone refuses spinal immobilization or IV access. I do remind the patient that they called for EMS, not a taxi, and this is what we are trained to do. I explain we take every step possible to protect the patient's privacy and modesty. In the case of a critical and/or incompetent patient, I know things get trickier. Law enforcement is an option, as is treating outside the view of family(in my experience, the patient is generally not the one who objects the most). At this point your responsibility is to the patient, not to honor the religious preferences of the family. If at all possible, get verbal and/or written consent from the patient, DOCUMENT that fact, and do what you have to do. Obviously if you feel threatened, and LEO's are not an option, then do what you need to do to protect yourself, rapid transport, and document the hell out of the call in case there is a bad outcome.

Well, like nearly any urban area, call volume may have prohibited a quicker response. Inherent manpower and/or resource shortages could be another issue.Dispatch error. All of the above. Definitely need more information here, but hopefully they won't hang the crews out to dry- and they had nothing to do with the delay.

I love those. Thanks, Annie...

Is this a question of a personality conflict, a different teaching style, technique, or is the instructor giving incorrect information? If the latter, do some homework, find the answer- preferably from multiple sources- to support your opinion, and present it Say something like- "I do not understand, and need some help grasping the concept." Be as nonthreatening and nonconfrontational as possible. Sounds like the instructor has some ego issues, so you probably need to be careful how you handle this- especially if you may see this instructor again in another class. It's up to the instructor to give out correct information, but mistakes can happen. Anyone who is worth their salt as a teacher needs to be able to admit when they are wrong.

I cannot speak to the specifics of Philly's system, but I can tell you how these things usually work. In order to work in an airport, there are multiple levels of ID badges mandated by the FAA. Each person gets a background check, and their information is cleared federally. For someone who works in a food service capacity in the terminal, for example, they have minimum level of access. Others are given driving privileges, while others- like police, security, fire, and EMS- are given all access badges that allow them to operate and/or drive in all secure areas. Each year, you are required to take FAA tests-the complexity of which is directly related to your job. You are required to know airport rules, locations, airport signage, lighting patterns, rules, and regulations. For those in the most sensitive/secure areas, these are 140+ question exams. Airports have always been highly secure areas, but In today's world, these security procedures are even more strict, for obvious reasons.. In an airport, there are dedicated assets(police, fire, and EMS) only for the airport itself. The airlines and FAA generally pay for the equipment, while the municipality pays the salaries of the personnel. In the case of private providers or FAA units, they would be fully funded by the government. The FAA has federal mandates that require crash rigs to be able to respond to an incident- generally an aircraft incident anywhere in the airport within a specified amount of time. Similarly, they require ALS care of some type to be available within a similar specified amount of time- whether that care be by an ambulance crew or FSR crew with ALS capabilities. If the dedicated ALS unit(s) are on a call, generally there is a protocol in place that brings off field assets onto the field to cover while the assigned units are tied up. In other words, ALS care must be available at all times. In this case, 40 minutes is far too long to have a relief unit available. When off field companies arrive to cover the airport, some have ID badges, while most do not, but the airport has operations people who's job is to escort any off field company through the secure areas to the incident to keep them and the aircraft safe, and escort them off the field when they are finished. Clearly there was a major fail here, and more information is needed to figure out what went wrong. To me, this sounds like a major failure of the dispatch system.

My only question is about the COMPANY'S policy, not medical protocols. If this injury occurred off the clock, then things may be a bit more simple. If it's an injury that occurred at work, often times workers comp or company insurance rules dictate how a person must receive their medical care. In most cases, if they refuse an ambulance, then the all costs incurred would be the responsibility of the worker- they would NOT be covered by company insurance. I'd check your company's rules and regulations. As for the wisdom of refusing recommended care, as with any other patient it is their right, but they need to be advised of not only the possible medical consequences but any financial impact they may see because of their choice. (All this being said from someone in the US. Not sure if the liability rules change north of the border...)

Come on tniugs, life is too short to drink Budweiser... LOL

Shoe covers? Really? Wow. Totally different environment than what I am used to working in. Yes, we can go into some incredibly nice homes, but the vast majority of house calls are not in the most expensive parts of town, and if they are, they are usually critical patients and the family is usually not concerned about such things. Our rigs can easily do 25-30+ calls a day. Many of them are in places where I am afraid to even touch anything, much less set down our equipment for fear of having critters hitching a ride in our gear. You guys know the drill- never stand still- always shifting from one foot to another, never lean on a wall or doorway, never lean on furniture unless absolutely necessary- it's almost an unconscious thing. Well, I guess we should probably invest in multiple rolls of Saran Wrap, bubble wrap, and full body condoms as well. LOL During winter months, our jump bag and other equipment can get salt on it, dirt, and gawd knows what else. What about the bottom of our drug box or monitor? Obviously we try to keep everything clean, but how far do we go with this? I realize some people like their homes to be museums, but my first priority is to the patient. I try to work as clean as possible, we always pick up our mess, but things happen.

Well said. +1

Well, most larger cities have areas and schools that are notoriously bad. Sorry, but teachers in those areas should get combat pay. They are required to be cops, bouncers, parole officers, drug counselors, shrinks, social workers, and if they have any time left over- oh yeah-MAYBE teach a class or 2. Teachers get a bad rap.

Every time I have a female Muslim patient, I have tried to have the husband- or father for a minor- present when we did our exam and treatment. Never had a problem. I always inform them I need to get at skin to attatch electrodes, access an IV, etc and they have always been OK with that. I know in some of our surrounding "nicer" suburbs, on medical calls, families have requested firefighters remove their boots as to not get their expensive Oriental rugs dirty. Usually they comply, or incur the wrath of their superiors for offending the wealthy tax payers. I'm all for making REASONABLE accommodations for people, but I do have my limits.

Well, I happen to agree with the FF's assessment that there probably is no way to stop fire from taking over EMS. I see no evidence that EMS is organized enough to put up much of a fight- it's the typical David vs Goliath scenario. Will fire based EMS work in all places? Will it provide better care? To both questions, I would say probably not, but yes, I know there are exceptions. The old guard in FSR ARE leaving now. Education is becoming more important than it used to be. Haz Mat training, NIMS, and medical training are becoming the standard, so the days of simply fire suppression are long gone, and the ones who like it that way are also becoming extinct. Whether or not the new guys will step up and change the organizational culture of the fire service to embrace education is still an unresolved question. As you note, guys like Bieber ARE the future, and hopefully they can succeed where so many others have failed. I would say EMS is in it's adolescence, and as such, needs proper guidance, good leadership, and probably most important- POSITIVE role models and mentors. It's up to the old timers to keep this in mind when dealing with new folks. Even after all this time- as frustrated as I get with this business- I still do it right. I hear grumbling from a couple new guys who do not understand why I care, or why so many others cut corners. I tell them I do it the way it's supposed to be done, and as long as they are with me, that is how things will go. I cannot control how others will act, but all I can do is lead by example. Hopefully some of that will rub off on a young impressionable soul.

I have to say this teacher is spot on in her assessment. Should she be fired for speaking her mind? Pa. teacher strikes nerve with 'lazy whiners' blog http://news.yahoo.com/s/ap/20110216/ap_on_hi_te/us_teacher_suspended_blog/print

There are no absolutes in special cases such as these. They do not happen every day, and even if there is a policy for such things. I'm thinking there is no way every possible scenario could be addressed. If a special needs kid needs a certain piece of equipment, a favorite toy, a favorite book, their favorite cup or plate, a blanket, etc, I will do everything in my power to make it happen. If an abled bodied kid needed something similar, I will do the same for them if at all possible. Here is a position paper by the DOH and NY EMS. It clearly states that based on ADA standards you cannot ban a service animal for any reason unless the dog is a threat- aggressive, etc. I have never seen something like this happen. They must be allowed anywhere normal business is being conducted. http://www.health.state.ny.us/nysdoh/ems/policy/07-01.htm and from the ADA directly: http://www.ada.gov/qasrvc.htm

I'm not sure, but I think that refusing to transport a service dog may actually violate the ADA (Americans with Disabilities Act). Again- I have zero problem with a dog in the rig with us. If someone is truly concerned about allergens, then we should probably fully decon the rig after each patient who has a dog or cat in their home. The pet dander would be present on their clothes and belongings and would probably be present long after the patient and their clothes are gone. Not trying to be callous here, but there is only so much we can worry about. A service dog is a disabled person's lifeline. They need these animals to be as independent as possible, and to deny them the right to have the animals with them seems completely wrong to me.

We are required to have 2 just as NY, but no ER's use them anymore around here, thus we cannot get them replaced. We use rolled up blanket or sheets PRN. We also use blanket rolls for c-spine immobilization- commercial products are expensive and hard to keep enough on hand, so blanket rolls are used as pillows as well. Spelling edit.

Service dogs are allowed in the ambulance. There is no reason to deny this. Heck, dogs are far cleaned than many of the humans we pick up. You can always clean the rig when you are done with the call.

You are correct. One of the perks of being an ER doc is that most often, you either work for a group that staffs your ER, or are a member of the hospital staff. That means you do not have your own practice, do not hire and fire employees, do not schedule, do not have HR issues, and unless you are a director, are not responsible for making policy or protocol decisions- although you certainly may have input. Does that mean an ER doc cannot do these things? Of course not.

Short answer to your question- Yes, an MD with no EMS experience CAN be an effective Medical Director IF- and only IF- he/she has a person or staff under him that IS familiar with that EMS system. This team needs to be well respected, educated, experienced, and keep up with current issues and trends in the business. No leader is well versed in everything, but as long as they surround themselves with people who ARE experts in their respective fields, they can be effective. I would hope that at least the doctor's specialty is Emergency Medicine, or I retract my original statement.

Questions were answered well. The only thing I would add for a layperson is to not worry about doing correct, textbook CPR. ANYTHING is better than nothing. You cannot hurt someone who is already dead, you cannot make their situation worse, and if you are performing CPR on anyone older than 60 or so, chances are you WILL break a rib or 2. At that point, as was mentioned, a fractured rib is the least of the person's problems. If they survive, you can apologize later about breaking a rib or 2, but trust me- they will not hold it against you.

Years ago- long before I got in this business, I worked overnight as a baker for Winchell's Donuts. I baked the product AND worked the counter. Not a bad gig, but I got really sick of donuts for awhile. I always comped the local police a donut and coffee. This was a smaller suburb and I got to know the guys pretty well. One night I was robbed, and as soon as the mope left the store, I called the police. Literally within one minute, there were cops everywhere. One crew checked on me while the rest chased the guy. They actually caught him at the other end of the parking lot(it was a big shopping center) and did quite a number on him too- apparently he "resisted arrest". A lot. LOL Point is, there can be valid reasons for this courtesy. Yes, these cops were simply doing their jobs, but it never hurts to have a good relationship with the folks you may need someday. I do agree that too often people take advantage of a good thing and ruin it for everyone. As for my coffee perk, I stopped at the usual shop one day- out of uniform and off duty- and they still wanted to comp me. I insisted on paying. They wouldn't take the money so I threw it on the counter and left. I've helped out the manager a couple times, which is why the freebies actually started- chasing away homeless guys- so she simply was showing her appreciation.

Well, the one and only speeding ticket I got was 2 years ago. I was doing 84 in a 65 on a wide open interstate, and I was certainly guilty. It was a trap- they nailed 4-5 of us at the same time. I never asked about courtesy and never expected it because it was a State Trooper, not a local cop. The state guys are notoriously hard nosed around here so I did not even consider asking for a break, although some have told me they do take care of EMS workers if possible. The only other time I was stopped was at 3AM, and I was heading to work to relieve someone who needed to go to an early morning clinical for nursing school. It was a local cop, and I had a jacket over my uniform. It was a clear night, good weather, I was doing 55 in a 45, and nobody was on the road. He asked where I was going, I told him, and he actually got mad at me for not mentioning I was a medic when he first approached me. He said he gives breaks to paramedics, but not usually to firefighters because he knows we work for a living.(His words, not mine) LOL He let me go. I never ask for favoritism, but sometimes it's offered. I always pick up a Starbucks coffee on my way to work, and 9 times out of 10 they do not charge me, but I always have money in my hand, ready to pay. I toss a buck or 2 in their tip jar as a thanks. I never expect it and certainly do not ask, but appreciate the offer. A couple weeks ago, my partner and I stopped for coffee, and as I approached the counter to place my order, a woman in front of us told us to wait. I looked at her, puzzled. She then purchased 2 $10 gift cards and presented them to us, saying she appreciates all we do. We tried to decline the offer- it always makes me uncomfortable- but she insisted. We thanked her profusely, and we were even given our order on the house as well. Nice. A cup of coffee? I see no huge moral or ethical dilemma there. If they make the offer, I appreciate it and will accept it but I certainly do not take undue advantage of the situation.

That's him. I remember buying Stephen Hawking's "A Brief History in Time." Fascinating stuff, but very dry, and unless you were really interested AND had a science background, it is hard to get through. I felt like I was back in college, reading my neuroscience text multiple times just to digest what was being said. LOL