HERBIE1

Wouldn't the problem with volunteering for your employer depends on what duties you would be performing? If you are representing your company- regardless of whether you are being paid or not, in a legal sense, doesn't that mean an assumed approval and a tacit liability for what you do? There's a legal concept called "respondeat superior", which means the employer answers for their employee. It's used in cases of misconduct/negligence of a person in the course of their duties where the employer assumes some accountability for a lack of training, supervision, etc if something goes wrong. I would assume that as long as the person is acting in some manner as an agent of their company the employer's liability extends to that situation whether the person is being paid or not. Need some clarification from a lawyer here.

As I suspected, a recent emergency proclamation by our governor has authorized medics to provide these vaccinations for LEO, fire, and EMS providers. (I'm actually amazed, since according to some here, we are so woefully undereducated, we should not be allowed to administer an IM injection without a PHD in EMS, but I digress..) A call went out for volunteers to assist- off duty, no pay- and interestingly enough(or not) they have had few takers. No matter, since it seems the volunteers still far outweigh the needs for the shots within this group. Right or wrong, many in public safety have declined to receive these shots. As is the case around the country, the problem is not a lack of providers to give the vaccinations, but with the lack of the H1N1 vaccine itself.

Here's a story that illustrates my reluctance to accept the premise that we are somehow obligated to solve a patient's social service problems. A few years ago, our area came up with a program to assist seniors at risk. A department of aging/gerontology expert was paired up with a police officer liaison for community outreach. As a result, we were informed that we needed to respond to these calls to medically assess and transport these patients as needed. We were also instructed to make every effort to comply with this advocate's wishes. One day we received such a call in a VERY expensive area of town. We were met at the door of a nice 2 flat brownstone by a frantic senior advocate and a LEO and told that they received a call from a nephew of this woman who lived out of state. He claimed his aunt was no longer able to care for herself, was not eating properly, and lived in a dangerous environment. As the outreach pair arrived, they knocked on the door, and announced they were there to help. The elderly woman let them in and went to her kitchen- she said she needed to finish doing her dishes. As they explained why they were there, the woman was first incredulous, then became afraid. She grabbed her coat and ran out of the house, screaming that nobody was going to take her from her home. As we looked around the home, it was IMMACULATE. Not a speck of dirt anywhere. Full refrigerator and shelves, vitamins and an aspirin bottle neatly lined up on her counter. This advocate said we HAD to go after this woman. I asked the officer her opinion, and she said this seemed like a family matter. The woman had apparently lived in this area all her life- around 80 years, which means she bought the building when the neighborhood was very seedy. The house and lot were now worth well over a million dollars and the officer thought- and we agreed- the nephew was looking for a windfall by getting his aunt put in a nursing home. We obliged, drove around looking for the woman, and we did catch up with her a couple blocks away- briefly. She was crying, saying that her family was trying to put her away to get her property and money. We could not examine her, but standing on the street, we asked her a couple quick medical questions and she said she had glaucoma- nothing more. She refused to allow further exam or transport and suddenly ran away from us as soon as she saw the advocate again. By this time, the advocate showed up and was yelling that we had to "grab her", and that the patient needed "help". I explained that we had no legal authority or medical reason to do that unless the officer placed her in protective custody, but the officer refused, saying she had no reason to do this.. I was asking the advocate the basis for why we needed to kidnap this patient- what she saw/knew that made her believe the patient was in danger or needed help. The advocate became irate with us, telling us to "do your job", threatening to call our bosses, the mayor, everyone else she could think of, and even threatened our jobs. We should take her in and the appropriate papers(I assume she meant involuntary commission) would be provided later. This is what the mayor wants us to do, she told us. As we left the scene, the advocate was frantically dialing her cell phone. I documented the encounter and within a few minutes, I was indeed explaining to bosses via phone, what happened. I have no idea how this case turned out, but this is my point. We have NO idea the back story of situations we walk into and how complicated the family components can be. We had a supposed expert on seniors who took the word of an essentially anonymous 3rd party call as enough evidence that an intervention was needed on behalf of someone, even though all the claims of this concerned family member seemed to be BS. If we find someone living in squalor or an unsafe situation , then yes, it is our moral and legal obligation to help rectify that situation, but our jobs are about immediate care and life threats. We medically assess, describe our concerns, and relay the info to the APPROPRIATE people to follow up. I think it's the height of arrogance to walk into a situation and within a couple minutes assume we can "fix" or even correctly address what may be a very complex problem. That's like treating a chest pain patient with a couple of nitros and tell them not to worry, we don't feel it's necessary for them to go to the ER. There is ALWAYS more to the story, and like the doctor's creed, we must first do no harm. I am NOT an expert on gerontology or social services but know enough to point someone in the right direction for help, or at the very least notify someone who is qualified to provide that help.

Excellent summation. NOBODY is saying these social service issues are not important, but we disagree when we are told this is somehow within the context of our jobs. As noted, some areas may have the time to address these problems while on duty, while in a busy area, it is simply impractical and essentially impossible.

Going in circles here. Look, I'm not here looking to get my ego stroked, I don't need validation that I do a good job, or for someone to tell me I know a thing or 2 about the business. I am here to learn whatever I can, get a laugh or 2, and exchange ideas. We are talking about opinions here- nothing more. Expressing it "louder" than everyone else doesn't make that opinion any more important.

I like some type of encephalitis, w/ the edema, but... Poisoning of some type- could explain the symptoms? Accidental/intentional prescription drug ingestion? Amy meds in the house?

Doc, this is a societal problem, not just here. I make a special point to tell my students to use spell check, and proof read their work before submitting it. I said it is NOT appropriate to use slang or text language in papers submitted in a university setting. Despite my warnings, students still submitted work with "LOL", or j/k in it. I marked them down for it and they were sheepish because they never even realized they were doing it. Even basic word processing programs have spell check, so there is NO reason to submit work with improper spelling. Here, obviously spell checker is not familiar with medical terms so we need to be more vigilant. In emails, I be sure to use proper grammar, full sentences, and proper punctuation. Takes longer, but I think it also makes a statement.

There are several people here with that much experience or more- myself included. Look, there is no reason for a condescending attitude. NONE. If someone is trying to show how important/knowledgeable/brilliant/experienced/educated they are, then they are trying too hard. The opinions someone expresses are based on their experiences, and since this is truly a world wide community here, what is appropriate for a big city urban area are not necessarily applicable to a small rural service. Additionally, a service in Australia may be very different than something from the UK or here. There are too many variables to make blanket assumptions about someone, where they work, or what they should do. This is an anonymous public forum, and as such, some people are prone to hyperbole, exaggeration, or even adopt a completely different persona, so a person who claims to be brand new is actually a 20 year vet, and vice versa. Whatever, so I always take these things with a grain of salt. Personally, I am who I am and am not prone to BS. It's too much trouble to play some role here. I would never assume to be an expert on a rural system since my experience in one is limited to 30 years ago. Similarly, when someone tells me what will or will not work in a busy urban system, they had better be familiar with the what goes on in such a place. The basics don't change, but as several urban providers here have said, in a busy system, back to back calls are the norm, and like it or not, there simply is not enough time to solve a patient's complex social service issues, nor do I feel we are even qualified to do this.

I think preventative care and education is an ongoing process, during every call. We educate patients and their families as to proper ways to take medication, the importance of checking blood sugars for diabetics, the importance of monitoring BP's and compliance with meds in hypertensive patients. Things like fire safety, medical screenings, home safety, etc are generally done OFF duty, especially when the service is a busy one.

I don't know about your area, but there is a specific training program around here run by the State Police and certain children's hospitals for installing car seats. It's a liability issue- unless you have a certification, you should NOT be doing something like that. As for public safety programs- that's NOT what was being discussed here. We provide education on every call-fire safety, proper dosing of medications, proper diet, compliance with doctors orders, seat belts- it's done all the time. How would "education" help deter someone from calling 911 to help find their glasses? Do you really think this person would define their problem as an emergency? All we can do is provide advice, suggestions, and if possible make proper notifications. Again, if you are running 25 or more calls a shift, tell me how it is possible to provide detailed education programs for every patient we encounter? If you have a busy system, do you really think it's appropriate use of resources to have a rig out of service, making calls to social service agencies, food pantries, mental health professionals? If this is an abuse/neglect situation, then I absolutely agree that anything that needs to be done SHOULD be done, no matter how long it takes. Real life vs idealistic. This isn't all to say that there isn't abuse of the system, but unless we do something to educate and solve the problem the abuse is going to continue and probably get worse. WOAH... I just saw this... When is it EVER okay to damage an alarm box for a patient???? It's the Boy Who Cried Wolf Story...and in my eyes as the patient...they have every right to sue those medics! Also, why is it the higher ups job to get them into a nursing home...why not be proactive and take the steps yourself?? Patients always need our respect. Unless you yourself have been disabled and faced what they face you have no right to judge them and treat them with a lack of respect.

Well put. Just as not everyone is cut out for medical school, not everyone is cut out to rise through the ranks and become an administrator. I equate this issue with the world of academia, a world my wife is intimately involved in, and I dabble in as adjunct faculty in a university. Many ideas come out of the hallowed halls of a university, but thankfully precious few of them are ever implemented. Why? Because they are impractical and do not take into account the problems of applying them to the real world. The bottom line is that NOBODY is advocating disrespecting someone who is an invalid, or ignoring their needs. I simply know that I am NOT trained to be a social worker, a gerontologist, a psychologist, or a rehab expert. People spend YEARS training for these professions and I would not presume to understand the intricacies involved with addressing the needs of this population, nor would I expect someone who saw Rescue 911 to be an expert on prehospital care.

Change, for change's sake is not the answer. You have a clear bias toward providing social services to our patients. I do not agree that is an appropriate or even logical use of EMS services and resources in cash strapped communities, especially when these are best addressed by another profession that has the proper education, training, and resources. I don't care how many levels of providers there are if they can be justified. That's like saying that a small town looking for a doctor should not be satisfied with anything less than a John Hopkins trained neurosurgeon to be the town's sole Family Practitioner. It's not your material I have the problem with, it's your attitude. Everyone has their own opinions and are entitled to them, but you pontificate, belittle, and generally act superior to most here. Generalizations are fun, aren't they? I wondered if you would get that part. I also made the generalization that most here are not as lazy as you describe them to be. Why no comment on that? As for "burnt out", like many I went through a phase, but got over it years ago. Like many in busy urban areas, things beyond our control DO affect you. Some remain that way, some self medicate or engage in self destructive behaviors, some leave the profession completely, and others change their attitudes. I learned to adapt, get educated, understand how things work, and a stint in administration also opened my eyes to a lot of things most street level providers have never seen. Things are never as simple as they appear. I prefer to be proactive in my own venue and use my experience and education to effect change from within. I teach, mentor, and explain why certain policies are the way they are. I dispel common and long held myths about how public safety works, citing appropriate references from my studies. I am also not arrogant enough to claim proficiency in an area I received no formal training in.

Offhand, without any literature to back it up, I think that because in the VAST MAJORITY of cases of peds arrests, the arrhythmia is due to a a respiratory/metabolic problem that when fixed, negates the need for electricity. That said, I think your question is valid- always ask "what if".

Gupta, welcome to the city. You will learn much here, and I'm certain there is plenty we can learn from you as well. Enjoy your time here.

Welcome to the community, from the dad of 2 competitive Highland Dancers!

If your times are automatically sent to a computer/lap top, mobile data terminal, use the times given to you. It certainly wouldn't hurt to make a note about a time discrepancy as crochity noted- on paper it may appear you arrived at a call before you were even disptatched. That would be quite a bonus for your response times, wouldn't it? LOL

Woe is me. Feeling a bit persecuted? You're over the top because it's easy to talk the talk when you aren't working in the real world. What you ask are social services tasks, NOT EMS. People get advanced degrees and devote their careers to solving problems like these. If someone wishes to take it a step further and contact a company, discuss patient advocacy issues, that is far over and above the responsibilities of an EMS provider. More arrogance. I'm consistent because I'm not trying to BS anyone. What happened to you in your career that you seem to have such a dim view of EMS providers? If you started spouting your personal opinions and generalizations about EMS around 99% of the people I work with, you would be quickly shown the door- if you were lucky. Other professions have professional, paid lobbyists and arms of their groups to push their agendas. IT is also their FULL TIME JOB. Again, another generalization I completely disagree with. Based on my experiences- and from people even on this board, I see nothing to back up your claim. People here are looking to exchange ideas, obtain information, and verify things. They want to be able to do a better job and help their patients. You need to separate street level providers from administration. Very few providers have the time, resources, or connections to lobby on the behalf of their profession, especially when many work OT and second jobs just to make ends meet. The administration/leaders of the industry are the ones tasked with these functions, and many are in those positions by default- they've risen through the ranks and attained a certain level of accomplishment, but not necessarily the knowledge needed to lobby or push legislation. Often they base their opinions and efforts on experiences when they worked the streets 25 years ago or more. Every one of these folks that I have met or read opinions from is out of touch. Save you faux outrage for the people you claim to rub elbows with- the leaders and administrators. THEY make the policies, not a street level provider. It's easy to blame someone else, but in order to effect change, you need to have the proper "vehicle" to get it done. The different levels of certification are not a convenience, they are based on the needs of an individual area. You can trumpet how you think every EMS provider should have 12 years post grad under their belts before they can ever touch a patient, but yours is an unreasonable opinion, with no basis in reality. You think providers should be more educated- so do I, but I also see the value of a volunteer EMTB in an area that cannot afford anything else. Your smug claim as a "patient advocate" does not wash if you cannot see the value of having any provider vs having nothing at all, because a community cannot afford to hire an EMTP(and all the other costs associated with ALS care) with a college degree and 12 initials behind their name. That college education would be far more valuable if it concentrated on management, leadership, and business, as this is the real need if we want to move forward from here. Like it or not, EMS is in the health care BUSINESS, and needs to be treated as such. Again- talk to someone in a busy area. They could operate out of the nicest firehouse, station, garage, ER in the world, but if you run back to back calls, how much time do you have to enjoy the perks and amenities you speak of? As for busy providers being glad to have a nonemergent call like a Lifeline alert- I call more BS. Most providers in busy areas LIKE to be busy and do the jobs they were trained to do. Although nonemergent calls are part of the game, belittling an EMS PROVIDER because they haven't solved all their nonemergent patient's social service needs is nothing more than arrogance and shows a lack of understanding of the basic issues involved in this problem.

Oops. I've forgotten many pieces of equipment - even the cot, but never a patient.

System abuse is a dead horse. In many places, false alarms for fire and police- faulty burglar alarms, faulty fire alarms, etc DO generate fines after a certain number of responses. Is that a deterrent for someone to call 911 for a "real" emergency? No, but "automatic" systems are also prone to errors. In the Lifeline type systems I have seen, there is a telephone link from the patient to the company, which is supposed to verify the patient did not accidentally trip their alarm and does indeed need help. So, in the case of these nonemergencies, either the patient is lying to get someone to bring them a glass of water, the company is not properly screening the alerts, or it's a combination of the two. If the Lifeline type companies want to promote their service to be able to summon help for a patient that simply needs nonmedical assistance, that would be great, but they need to be able to provide that help in some way- alerting a friend, family member, or some 3rd party to provide that help. Defaulting that help to a 911 service simply because they know that help will ALWAYS be there is wrong. That would also be a departure from their advertised use- to alert responders to someone who is having an EMERGENCY. In these days of budget cuts, improper use of resources isn't just an annoyance, it costs a service money, and I know of no insurance company that reimburses for an FD, police, or EMS responder to fluff someone's pillow. Funding cuts, budget restrictions, and manpower reductions have finally hit public safety- the last sacred cow- so an honest look at things like this are not just to appease overworked first responders.

Who said anything about making derogatory comments about a patient? The crew responded to the call. The crew and FD assisted the patient. The crew and the FD asked the patient if he wanted medical attention. The patient/Lifeline requested assistance for a patient who needed to find his glasses. Was it an emergency that required the lights and siren response of an ALS fire apparatus and an ALS ambulance? Not in my book. Did the patient need help- yep, and he received it. Did anyone refuse to respond? Did anyone refuse to help this person? Were there any claims of verbal abuse by any responders on the scene? Maybe he had no other choice- no neighbor or family member to help him. If the area's service provides this type of help, fine. If you think it's an appropriate use of an EMERGENCY service, that's your opinion. I strongly disagree.

No argument with you whatsoever Mateo, but some people here are in serious need of a sense of humor.

I was worried about being offensive with a veiled sexist remark, but you guys have blown me out of the water. Thanks for taking the heat off me!

I could have bet my mortgage you would respond to this with a holier-than-thou post. You did not disappoint. Do you require people to avert their gaze when they meet you? Just wondering.

From my understanding, among the benefits of declaring an emergency at a state and national level is to remove restrictions so that first responders can indeed assist in this. I'm looking for a link, but I have been told our governor did exactly that and the language specific spelled this out.

Gotta love Lifeline. Vital for some, but in too many cases, it keeps a person who should be in an assisted living facility on their own but using the service- and EMS/Fire as their personal valet. True story- we had a regular who was blind and bed ridden. At least once a week we got a Lifeline call to this patient- for things like getting her a sip of water, bringing her a bag of cookies, and changing the TV channel for her(yeah, I know she was blind). She really was helpless, and we told her she would be safer and more comfortable in a different living arrangement. She steadfastly refused- she wanted to be on her own. Of course, the calls we got were for SOB, chest pain, etc, but the patient denied she said that to the Lifeline people. Of course Lifeline claimed the patient really did say she needed medical attention, but we'll never know the truth. Whatever. This was also a building full of handicapped people of various types- wheelchair bound, blind, deaf, but they were all self sufficient. They even helped our lady until they could no longer take her abuse and insults. They were pushing for her to leave the building- for personal reasons, and the fact that she was completely dependent on others for her care and safety. Of the 15-20 calls we had for her, we only transported one time because she was septic, barely responsive, and could not refuse. We all felt bad for the patient- even though she was one of the nastiest people I have ever met. She'd throw things, swear, and scream at the top of her lungs to get what she wanted. She was hit by a car a couple years prior which left her blind and a paraplegic, and clearly she was not coping well with her situation. She had a string of caretakers who were less than reliable, but were also only there during the day, so all night she was a prisoner in her own bed. I tried calling the home health company, but was essentially told that they had a hard time keeping good help. We finally got a social service worker to come out, assess this woman, and to no surprise to us, recommended the patient be placed in an assisted living facility. Last we heard she was in a nursing home. Bad situation.