HERBIE1

LOL Beat me to it. One of my favorite lines. Another favorite of mine: I'm not prejudiced- I hate everyone equally.

Anyone with proper training can determine if someone is dead, but only a doctor can sign a death certificate. In our area, for a death the field, when we verify the person is pulseless, apneic, and asystolic, law enforcement uses the time we assess the patient's vitals as the confirmed time of death. Barring things like decomp, dismemberment, or decapitation, the EKG is the gold standard- no electrical activity equals dead. You can miss a faint heart beat or very bradycardic pulse, but the electrical activity does not lie. At that point the LEO's contact the ME, who determines if the body can be released to a funeral home or they need to do a post mortem.

Damn shame. I don't know what area you are in, but for many areas- especially larger cities- privitization does not save money for anyone, and it's simply not cost effective for the company to assume the debt all the self insured and government assistance folks cause. Good luck in your search. I hope they come to their senses.

I have no idea what it feels like to be working from home such as that. Unlike some here, I take my hat off to all volunteers, paid on call workers, and local agencies that may operate on a shoestring budget. I do know- as we all do- what it's like to be interrupted during meals, bathroom breaks, important phone calls, and obviously sleep. When away from home for 24 hours, we miss important events, milestones in the lives of our kids, family emergencies, parties, and plain old family time. Such is the way of our profession, because it seems just when folks get on your last nerve, the profession makes you question your career choice, you end up really making a difference in someone's life. When you have a day filled with nonsense, non-emergency calls, as well as verbal and physical abuse, it can certainly give you pause. Hopefully your next shift will be better.

A key question to ask people who want to refuse- especially someone who you may not feel comfortable allowing to refuse(assuming the meet all the above listed criteria- oriented, competent, age appropriate, unimpaired, etc) is WHY they want to refuse. Most of us DO ask that question, but you need to allow them to answer that question and expand on it as much as possible. Once they articulate that to you- they want to see their own doctor, they want to wait, they don't think their problem is serious, they feel better, they don't like doctors- the actual reason can shock you. But, at that point you can address their stated reason, show them the possible flaws in their thinking, they may change their minds. I have found that this technique works well, because often times they really cannot express a valid reason and if you show them the potential for harm in their point of view, they tend to change their minds. Personally I much prefer to transport a person- properly handled refusals take far more effort, documentation, and "CYA'ing" than simply giving them a ride. I have known providers who pride themselves on talking people out of transports and I have never understood that mentality. Most of them also do not properly document their encounters- or probably do creative report writing to cover themselves, but too often that can come back to haunt you. Another "trick"- tell them that after they get to the hospital, they can tell the same things to the triage nurse and/or doctor, and sign themselves out if that's what they still want. At that point, several possibilities present themselves- they can think about their refusal/reluctance and maybe change their minds, especially if they do have a problem that needs attention, their complaints return and they are reminded why they called for EMS, or they still refuse care, but you simply transfer responsibility for that patient to the hospital staff and cover your own arse.

Well, I've had male PCP's my whole life. As a kid, and for the last 30 years as an adult, I've had the same family practice guy. I can call him and tell him I need more Flexeril for my back, or Zithromax for a nasty infection. He scolds me when I need it, he applauds me when appropriate. He still gives me grief for not going to medical school, but he also treats me as a health care professional- when discussing issues. Point is, we have an excellent relationship, which is what you want with your doctor. It happens he's a male, but I don't think I would have a problem with a woman, but I've never dealt with one in that capacity. I can certainly see why some women would be more comfortable with a female OB/GYN- for obvious reasons.

And then what? If someone does not pay their bill, does that mean we won't respond if they owe money on previous services? I've seen stacks of bills at people's homes, for the previous trips for alcohol abuse, a taxi ride to the hospital to deliver their latest baby, or a person's 10th seizure of the month because they are noncompliant with their meds and are drinking. You can't get blood from a turnip, and for the ones who (ab)use the system, they aren't exactly worried about their credit scores taking a hit because they do not pay their bills. Put some accountability in the system and watch the abuse drop dramatically. Allow a certain number of "free" rides, but after that, just like anyone else, it will cost. Same for (ab)using ER's. As it stands now, there is no incentive to properly access EMS, nor is there a penalty for abusing it. In other words, what is the down side for abusing the system? A few dollars out of their monthly government check and just maybe they are more compliant with their medications and do what they are supposed to do.

Even though I am a hard core coffee junkie, I do love Earl Grey tea. They sell it loose and in bags. Why do some think it's an acquired taste? If it's strong, I wouldn't know because I drink the darkest roast coffee I can find.

I would also add that besides leaving out names, I would also leave out/change any potentially identifying characteristics as well. Hospitals, nurses, docs, locations, towns- all need to be concealed or altered because patient privacy isn't the only thing you need to worry about. Good luck with the book.

LMAO Careful- your tin foil beanie is slipping...

I agree that it's unclear exactly if and how EMS will be impacted by this- too soon to tell, but you can certainly extrapolate, based on what has been proposed. Because this is so complicated, it's hard to know what's in store.

Do yourself a favor, Richard. There are plenty of sites that offer a summary of the changes this bill will create. I don't know your political affiliation, but if you like the principles this country was founded on, many of these changes will scare the hell out of you. I don't agree with an armed revolt either, but there are always the lunatic fringes on these things Sadly, most people are simply too lazy to do what's necessary to make the changes we need. As for the "vote", too many people vote along party lines and enable Congress people to stay in office for 30 or more years. I'm sorry, but NOBODY is that good. What does it say about a district when they feel that for decades, they couldn't find anybody in their district with a better idea than the incumbent? Term limits, folks. If it's good enough for the POTUS, it should be good enough for Congress- especially since they are actually the ones responsible for how our tax dollars are spent.

When we did our required FEMA classes, the answers were floating around. Whomever took the test checked the answers and circulated them for all to see. I never looked at them. First, I would never trust these clowns to even have the right answers- most are dumb as a bag of hammers. Good guys, but most are not MENSA candidates. Second, the material for these tests is NOT difficult. They are written at around a 5th grade level, so anyone who cannot comprehend the material should probably be pushing a broom or making lattes at Starbucks. I simply do not trust someone else to do my work for me. I've been made fun of by some for my moral compass- if I feel something is wrong, then it's wrong. Either you have a strong sense of morals, principles, and ethics, or you do not. These days, people are vilified for expressing their beliefs- you are unflexible, narrow minded, bigoted- simply for not yielding to the latest agenda. Political correctness has run amok and I think it has a lot to do with the state of our country. So be it- I am what I am. There simply seems to be a lack of pride and a poor work ethic for too many people. As was noted above, we have become an entitlement society-too many feel they deserve something without putting forth the effort to do it- whether it be a job, a promotion, a grade, or even health insurance (sorry, I couldn't resist). We all need to make decisions about things like this, and every day we are faced with moral dilemmas, big and small. There is an appropriate quote here. I've seen it used in countless contexts but I heard it in a management class: I have seen the saying attributed to several authors and I am paraphrasing here, but you'll get the idea: Integrity is how you behave when nobody is looking.

I started a separate thread on this to specifically address this question. I am referring to only how our jobs may or may not change, not our personal lives. I had someone ask me this question the other day, and I had to stop and think because my first instinct is to express my personal displeasure for the idea. Personal opinions- First, a lot of this is predicated on the notion that we WILL see a single payer, government run, public option plan- which is the ultimate goal of Democrats. I think there will be many consequences, but many may not necessarily be immediately felt. I think that restrictions on Medicare payments will be further reduced(Medicare is being cut 500 billion under the plan) so we will see more and more doctors refuse to take new Medicare patients-similar to what happens now with Medicaid. More stress on ER's. I think that like salary caps on CEO's and execs of companies the government has now taken over, I see the salaries of doctors being regulated in order to cut costs- less insurance pay outs. Look at the salaries of docs in Canada vs the US. (More stress on ERs.) I think that because there already is a severe shortage of docs in many specialties, it will only get worse. Things like tort reform and enormous malpractice insurance(which causes docs to opt out of high risk practices) has not even been addressed in this bill. These specialties include trauma, OB/Gyn, high risk neonatal, neurosurgery, which directly impacts the quality of care available for our patients and what facilities will be available to them(and us). Medical school enrollment is already down, and the shortage of family practioners will only get worse for the above reasons. Medical school(and education debt in general) has skyrocketed, which means future docs will opt for more higher paying specialities. Family practice and preventative care is supposedly a cornerstone of this bill, so how do they address this? Additionally, the government will now be controlling the issuance of most student loans, and as such, they could have a huge impact in potentially deciding what type of education they will finance. Will a future doc want this type of regulation and control? Will many of the best and brightest opt for another career? More shortages. I have more, but I'll cede the floor now. As for EMS in particular, I think that by necessity our roles will expand under Obamacare. Couple the push for expanded primary care, the huge influx of more patients who are "covered", and the shortages of primary care providers, and I cannot see how our roles would not be changed and expanded. They can provide extra training for EMS providers, and pay us a few extra bucks, we will be doing far more primary care to cover the shortages in this field, and they will save billions. For many problems, the difference will probably be negligible, but what happens when you really need a doc and none is available, or the wait is too long? We're back to square one again. I know it's happening in some places, but it would be a huge departure for most providers and a fundamental shift in our focus. Would the AMA fight such initiatives? Good or bad for EMS? That remains to be seen. So- what say you, folks? How do you think EMS will change- if at all? Short term? Long term? Will these changes affect whether or not you stay in the business? How do you think it will affect future providers? Personally, since I'm in the home stretch of my career, I'll probably be retired before our jobs significantly change, but it also depends how quickly things move ahead.

I hate to repeat myself, but... The problem we have now is that we have elected the most liberal president in recent memory. If anyone knows his background, who his advisers are, and the place they all came from, they would have a better understanding of WHY this is happening. Obama has surrounded himself with far more academics and left leaning activists then veteran politicians, who could temper the violent swing to the left. As such, they BELIEVE the left's utopian ideologies that are born from the halls of academia. Social engineering, entitlements, and yes, a SOCIALIST philosophy is at the core of what they promote. Those ideas look great on paper, but look much different when put in actual real world situations. People were so angry with Bush that the pendulum HAD to swing the other way, so the left saw a perfect storm that got Obama elected. They want to vilify big business, punish the evil corporations, and anyone who has had success. Does anyone recall the "sharing the wealth" promise that Obama made? I will not argue that some businesses make obscene profits, but that will ALWAYS be the case- even in a pure communist society. The problem is, once you remove the incentive to succeed and reduce everyone to some "acceptable" level of wealth, how does this country as we know it survive and thrive? How does the current path reward or encourage the entrepreneurial spirit we were founded on? Anyone who works in a busy urban system sees the results that decades of an entitlement mentality has gotten us. Ghettos are still locked in violence, unemployment, underducation, gangs, and drugs. Little has changed there in decades. Why? Because these entitlement ideas DO NOT WORK. It's a simple human response: Why should I work to better myself, with no guarantee of success, when I can exist my entire life without doing what is expected of most people- stay in school, work hard, take responsibility for my own actions and inactions, and contribute to society? Where is the motivation to change- especially when the down side of not changing means I still have food on the table, running water, electricity, and a roof over my head? That's not real poverty if you compare it to other places on this earth, and it's clearly not bad enough to change one's situation and/or behavior. You don't motivate someone to change by removing the motivation. I believe in a safety net for people- that's simple human decency, but for far too many that "safety net" has turned into a "career" for generations of families. This is NOT the mentality that made this country great, folks. As with any social engineering type idea, the ones who shoulder the responsibility for supporting it are the middle class, and they are tired of being asked to dig deeper, make do with less, and that anger is now being expressed. This push for Obamacare is only a part of the problem, and it is radical enough to scare the hell out of people, but I think this is just the beginning. I am truly scared about the direction this country is heading- not only in terms of the policies and how they will change our lives, but in the attitudes of those that are adversely affected by them. For decades, folks complain that Congress was not doing the work of the people, and the passage of this bill- against the wishes of the majority of Americans, should cement that feeling. People say that Obama is a transformative figure in our nation's history. I will not disagree with that, but the TYPE of transformation is what I do not want.

Starbucks operates on a very thin profit margin, so any change in their balance sheet has a huge impact on their net profit. They scaled back their expansion a few years ago when they realized they were overextended themselves. They also offer benefits to their part timers, which most companies do not offer. Not a good comparison to ATT.

That's a pretty rough way to go. A simple bullet to the head, walk in front of a high speed train- a jump- anything would seem preferable to asphyxia from chemicals. Yuck. I need to open windows after using anti mildew cleaners(with bleach), so I cannot imagine how nasty creating a sulfuric acid mix would be.

No idea, but nurses and doctors give medical advice via telephone all the time. Think of the gatekeepers for insurance companies that determine if your illness/injury warrants approval for an ER visit. Why is this any different? I really want to know what the cause of death was for this person. Comorbid factors? Underlying illnesses? What did the patient tell the doctor on the phone?

LMAO Sounds like a Rodney Dangerfield joke.

They key here is to see what happens with the Tea Party movement. If they decide to break off from the GOP and field their own candidate, the Democrats will retain control of Congress in 2010 and the POTUS in 2012. If they decide to come to an agreement with the GOP, their presence could prove to be a force to be reckoned with. Before HCR passed, we saw several states express their displeasure with the Democratic party- even in heavily Democratic Massachusetts. The reasons for this displeasure however may be because they feel the HCR bill did not go far enough left to suit them, NOT because they were unhappy with the party in general. I do however think many people feel that Obama and the Democrats are ignoring what the people really want. I read a poll that said health care reform was the 4th or 5th most important issue to Americans, yet Democrats spent the last year focusing on it. That singular focus, despite the will of the people, may cost Obama and the Democrats their majority as well as a second term for Obama.

Rather than derail the health care reform thread any further, I thought I would strike out on a new course here. I was a youngster in the 1960's so much of what was happening was beyond me, which means most of what I know is from books, TV shows, documentaries, movies, and other sources. The 60's were a very turbulent time. Protests, anger, and yes, even rage were common emotions. The Civil Rights movement, the Cold War, assassinations of JFK and later MLK and RFK, the Viet Nam war all served to incite passions, fear, anger, and yes, rage. These emotions often boiled over into displays of disobedience and yes, even violence. We were severely divided along political ideological lines, and the conflicts were often bitter. Although it's difficult to compare different generations, different political climates, and different world political issues, I see many similarities between the 2 eras. During the Bush era, we saw anger and resentment over the Iraq war, the issue of immigration, and the threat of terrorism. The primary "enemy" during the 60's was a singular one- the USSR, and on a larger scale, communism- "the big red menace". Today our enemy is terrorism, but it has no singular face- it's a threat on many fronts. Policies established in previous administrations- some dating back to the 60's- have shaped today's economy and society, and I think we are now at a crossroads as a nation. After 9/11, we were united as a people against a common enemy. Now, we seem to be just as divided today as we were back in the 60's. The election of Obama was indeed a pivotal moment in our history, he certainly inherited a fair amount of problems, but the debate now is how we should deal with these problems. Nobody expects Obama to wave a magic wand and fix everything in 1 year- or even during his entire term, so battle lines are drawn about what we should do about these problems. I won't get into the specifics, but suffice it to say that one side thinks we are on the wrong path, that we are changing the very fabric of this country and we are headed in the wrong direction. The other side thinks that major changes are necessary and the key to solve our problems and progress is to expand the role of government. As a result, diametrically opposing viewpoints are causing a great deal of anger and resentment, and where we go from here will determine how our nation will emerge from this recession. So- are we seeing a rebirth of the 60's, and an end to civility or will these emotions die down?

Why couldn't the FFEMT obtain a refusal here? Are they not allowed? This makes no sense. A patient is considered to be anyone you make contact with, even if they have no complaints. As for not wanting EMS, I understand how that works. Often times at accidents, police are afraid of liability and call for us even if a person claims they are not injured and do not want medical evaluation. Obviously if it's a very minor incident- dented bumper, scratched paint, etc, then the LEO's probably wouldn't insist on an EMS response, but if it's a more significant incident, the cops are simply CYA. I've tried to explain to cops that once called, we need to evaluate, examine, and document a patient encounter. Simply eyeballing them is not acceptable.

This bill is not really about health care, it's about creating another entitlement for people and forcing dependency on the government. We have a fundamental difference between ideologies in this country. One party believes in more self sufficiency, while the other feels the government should be intimately involved with- and in many cases, control- every aspect of our lives. As such, there will always be conflict. Once you create a dependency, as you say, you create a steady stream of votes. Nobody would argue that changes need to be made to the system, but the ones who are against this bill feel it's going way too far. Fix the problems but don't destroy the entire system.

No, in a public safety sense, a disaster is any situation that overwhelms the local resources. A disaster to Pittsburgh may be completely inconsequential to NYC- it's all relative. Don't confuse multi victim scenarios with a disaster- although they can be the same, it's not necessarily the case. Think beyond the EMS box here and look at the big picture. A snowstorm would tax nearly every city service. For example, streets would be impassable, manpower and equipment needs to be shifted to cover snow removal, and other services are put on the back burner. Mainstreets and highways take precedence so side streets would wait. Although the number of patients may not have changed, the ability for the city crews to respond IS affected, and in an already overburdened system, it doesn't take much to overload the available assets. A disaster could be a power outage, a heat wave, a cold snap, a hurricane, or yes, even a "simple" snow storm. It's not necessarily about the number of patients If the needs outweigh the available resources, then it's time to shift to a disaster mode, and yes, people will need to wait longer for help. Here's the deal- a doctor spoke with this patient over the phone and did not feel the problem was urgent. I have no idea what caused the death of this person, but the point is, in dire situations, public expectations should be adjusted. Folks are used to getting all the help they want- regardless of the severity of their problem. Should the crew have gotten out and at least evaluated the patient? Of course. Then what? Did they have the ability to request more help? Was it available? The bottom line- I REFUSE to believe there was no other option for this person to get to the hospital. When did we as a society become so helpless? What did people do before the advent of EMS and immediate responses- for everything from skinned knees to heart attacks? Then again, I'm a cold hearted SOB, but I happen to think that the ultimate responsibility for one's health and safety rests with THEM, and not someone else. Should the crew have gotten out and at least checked that patient? Of course, but a DOCTOR spoke with the patient on the phone. If the DOCTOR felt this was a life threat, then why didn't he/she insist the patient be evaluated and/or transported? Was this doctor part of that system's medical control? As for abandonment, apparently not, or the state would have ruled on that. I happen to think it was- once you are dispatched to a call, you are obligated to respond without delay and the patient is your responsibility until you are canceled or the patient cannot be found. I stated that this was a disaster situation and that normal rules do not apply. Horrible? Maybe, but what about triage in a multi victim scenario? You make life or death decisions and essentially decide who has a chance to live and who should be left because resources would be better suited on a more salvageable patient. What's the difference between that and telling someone with abdominal pain they should attempt to get themselves to a doctor for help because your resources are strained to the breaking point?

Guilt by association? Well, everyone is entitled to their opinions, but I also have been "recommended" for various things and always felt an obligation to justify that trust in me. You may be perfectly suited for a job or some opportunity, but often times you also need a "foot in the door" so you can present yourself and prove you are worthy of that opportunity. To me, that's all a recommendation is-it provides an opportunity. It happens in the "real world" every day- networking, businesses associates- you cultivate friendships and acquaintances all of which help you achieve success. If someone betrays that trust or is proven to be a liability, their reputation is ruined, not yours. Anyone can assign blame for any reason, but I think most reputable HR people understand what a recommendation is- someone believes in this person's abilities, character, or work ethic. You obviously would need to provide valid reasons WHY you vouch for someone- other than " They're a good guy, you should hire them." Yes, if your recommendation proves to be inaccurate, then you probably need to reconsider the standards you use to judge someone, but on some level, wouldn't that still be a failure on your part?