HERBIE1

Patient care? Since when is doing social service needs assessments and follow ups considered "patient care"? BTW- I'm still waiting for you to show me your SOP/SMO for homelessness.

Ultrasound sure has come a long way in the last few years. Even with a Level 2, it was still hard to tell if the kid was human or an alien life form. Congrats on the soon to be bundle of joy!

Agreed, but like I said, not always easy to enforce. Ever had "concerned bystanders" and/or family members suddenly descend on the rig and start rocking it because they were concerned about a loved one? Ever have them follow you even if you relocate to a "safer" location?

Yep. Years ago we had them issued. I hated it. It was indeed a weight belt and it was in the way most of the time. Problem is, most people I know with back injuries received them during awkward lifts(myself included), where proper lifting mechanics is almost irrelevant and a back brace isn't practical. Pulling someone out of a tight spot, out of a bathtub, in a tight area, etc. A friend had 2 cervical discs blown when a 90lb little old lady grabbed a doorway as they were carrying her on a stairchair. It was just enough to torque his neck- no fall, no massive patient. He's had multiple surgeries, is in constant pain, and is out of the business.

Probably very little- I was thinking more for my own information. Still need large bore IV's, fluids, but maybe hook up blood tubing in cases where the blood loss wasn't immediately obvious. Maybe be able to notify the ER so they can contact the blood bank?

You win, crochity. Because of racism and slavery, if you are black, you get first crack at any job, promotion, school aid, spot in a program- whatever, and everyone else can fight over the leftovers. Qualifications, grades, resumes, test results-all irrelevant. No more numbers games, no need for race norming or banding, quotas, set asides, affirmative action, or special incentives. Icing on the cake- reparations too. Pay back to the nth degree. Would this satisfy your thirst for revenge? Would this solve the problem, or would it STILL not be enough for you? What else is necessary-spitting and stomping on the graves of plantation owners and the forefathers who allowed slavery to flourish? Would that do it for you? Would that even the score?

In this country, we have the same issue. Back in the 70's our mental health programs underwent a similar change. As a result, many people who used to be admitted- at least short term until they were stabilized and medicated- were set loose to be treated as outpatients. Yes, some have ended up homeless as a result of their inability to cope and remain compliant with therapy and medications. Contrary to what vent medic claims, NOBODY is saying we should ignore these people, NOBODY is saying that nothing should be done, and NOBODY is saying that all homeless are drunks and drug addicts. Problem is, as a prehospital provider, you are kidding yourself if you think you can do what entire teams of social service people cannot. Given up- no. Realistic about the options- yes. I dare you to show me where I said or implied anything like that. Stop building strawmen. Grow up and stop the sanctimonious pontificating. You insist on building strawmen and ignoring what is actually said. Pick your battles. Everyone has their pet projects and issues and clearly this is something you are passionate about. Good for you, but to vilify someone because they don't share the same passion for your interest is wrong. Some people are passionate about education, some are passionate about innovative equipment and techniques, others love being politically active, but the bottom line is in our name: EMERGENCY MEDICAL SERVICES. Until we have established an expanded scope of practice, advanced provider licensure, or your specialty, social service provider- then we need to focus on what we have been trained to do. Last time I checked, we can make a huge difference by treating ALL patients with dignity and respect, and solving the complex social, financial, medical, and emotional needs of someone is NOT what we are trained to do.

Nothing quite like the smell of a GI bleed. Too bad we can't do a rapid hematocrit test sometimes- we'd at least know what we are dealing with and how anemic/hypovolemic they are.

Yep. Not always so simple though. A completely benign scene can quickly turn bad with no warning. Part of the "fun" of the job. Problem is if these adults are parents or guardians, they have every right to be there. Denying them access could create more problems. Glad to see the crew is OK.

Apparently you even know more about being homeless than someone who has been in that situation. You really need to get over yourself.

Could be a million reasons. The cancer has metastasized to and compromised other organs. Many chemos are very toxic and could indeed by the source of his problems. Dehydrated because a loss of appetite from chemo, and/or N/V/D, which could result in his vertigo. Sounds like the person needs a complete work up.

True, sub. The dirty little secret here is that many of the shelter beds are not used- except for a couple days with severe cold or heat. In most areas, there ARE plenty of options and resources for people to change their situation IF THEY SO CHOOSE. I'm certainly not diminishing the tragic situations that happen to people, but those are NOT the chronic abusers of the system- the original subject of this marathon thread.

And there you have it. This is all about payback. Couch all this in racist accusations, and the inevitable invocation of slavery, but in the end, this is about settling a score. That tactic is working out well so far, isn't it? I would just love to know when that score will be even- if ever. I'm sick of being expected to apologize for something I never did, and having to pay for something none of my ancestors were even responsible for since they were too busy being indentured servants at the time.

Save the "education" speech- I'm a lifelong learner. I've been taking and teaching classes my entire adult life. It's not about paper work or not wanting to get involved, it's about time management, and proper utilization of resources. In a busy urban system, crews may essentially run back to back calls their entire 24 hour shift. Tell me how much time should we take ensuring the proper social service agencies are notified, a case manager is assigned, a therapist is notified, etc? Every time I have initiated these contacts- mainly for issues of elderly abuse and/or neglect, after countless phone calls, and a couple hours, in the end, the person and/or their family are still the ones who need to follow up and seek this help. They need to make and keep the appointment, and unless you suggest we also drive someone to their AA meetings or housing assistance agencies, how far should we take this? I don't know about your area, but our system cannot afford to have units and personnel tied up for that length of time. We have very strict turn around time limits because there is usually another call waiting. We need to justify any delay in returning the unit to service. I'm sorry, but this is like triage. We can spend hours on personally obtaining social services for one person or we can notify the MANY TRAINED people who do this for a living all day, every day, and have all the necessary contact information at their fingertips. I have a hard time justifying playing social worker for 2 hours when we could be helping a couple people who need the skills we have been trained to use. If a department wants to assign a social service liaison whose only job is to track the homeless and frequent flyers, that's fine. I suggest it is an inappropriate use of your street assets to have them playing social worker, and most organizations would have a hard time selling that idea to their bean counters. If a unit is tied up, another one must cover their area, which delays the response, the snowball effect ensues, and it may take hours before the system recover. Again, if you want to be a social worker, change careers. We should do what we can- within reason. Sorry, I'm being honest.

Most contracts in this business have a no strike clause. There are job actions that could make a statement, but refusing to work goes against the reason we are supposed to be doing this job. It would be pretty selfish to put the public at risk to make a point. For instance, the police have the option to stop writing tickets, which directly impacts the department/municipality's bottom line. In the end, the only thing most employers care about is money, so anything that would affect that would get their attention. Appealing to the public or airing your problems in the media isn't the best idea- especially in these times- everyone is hurting financially. I can think of many ways an EMS person could similarly impact finances which could get your point across, but I won't list them in an open forum. You need to be creative in your approach, which is not an easy task, but you do what is necessary.

Don't know about their rules, but we have strict guidelines about uniforms. No clever sayings, only the department name on the back and the Maltese Cross with company assignment if you prefer on the front. Must be blue, must be clean, must be free of anything else. As for union wear, a small pin is all we can have.

The parent company of AMR used to be Laidlaw, which among other things, is a waste disposal firm. I'm not sure what that means, but... They are also Canadian, if I am not mistaken, but I won't hold that against them... (Just kidding, Canucks)

LOL Good luck with that, Lone Star. Let me know how it works out for you.

Very true. I've encountered many people in public housing who were actively trying to change their situation and make something better for their kids. I recall one family who's tiny apartment was immaculate, and nearly every wall had bookshelves loaded with all types of literature, text books, SAT/ACT prep manuals- (the kids were in jr high). Unfortunately, these folks were the exception rather than the rule.

Explain that statement. Our job is to evaluate their immediate needs and transport them to the hospital. When John Q Citizen sees a homeless person lying on the street, they call for a multitude of reasons depending on where they are. Yes, usually they think the person is sick, but often they want him off their property, he's an eyesore they want out of their area, etc. When we arrive, we take care of their immediate medical needs and provide transport for them to the hospital for DEFINITIVE CARE. Problem is, I find that the 5 -7 minute transport time is generally not enough to solve their chemical dependency issues, provide shelter for them, provide therapy for their emotional and psychological issues, offer financial advice, provide job training skills. and obtain gainful employment for them. Those are just some of the reasons someone lives on the streets. For all these years, I mistakenly thought that people like therapists, social workers, crisis workers, interventionists, financial planners, detox centers, housing advocates, and counselors were TRAINED to handle those things. Clearly, I have failed in my duties as an EMS provider, but thankfully we have people like you to pick up the slack. I bow to your prehospital care prowess.

You are talking about differences in sentencing based on the flavor of drug. THAT is wrong, but here's a little tip: If you don't sell or use drugs, you won't be "victimized" by the disparity in sentencing. Problem solved. As for your claim that whites and blacks commit crimes at the same rate, before you make a blanket statement like that, you need to back that up with some numbers or at least set some parameters. What areas are you talking about? Is this a local or national issue? What are the demograhpics of the areas you are referring to? Intuitively, if there is no difference between rates of crimes, then you would think there would be far more(as a percentage of their group) whites in jail than blacks- since the racial make up of the country is minority black. CLaims of profiling cannot explain those differences by themselves. As for "profiling", PC or not, I am ALL FOR IT. I've worked in ghettos my whole career where the only other white face I would see would be my partner and a couple firefighters. If we saw a nonminority in the neighborhood, they stood out, and chances are they were only in the area for one reason- purchasing drugs or other illicit activities. They simply had no other reason for being there. I think the police should have every right to stop them and check them out- SOLELY because of their race- "Driving while white". I'm no legal expert, but to me, that should qualify as probably cause to check them and their story out. I've seen it happen dozens of times, but strangely enough, I've never seen ONE of those cases featured on the news as someone having their rights trampled on. They are out of place, they don't belong, and if the police prevent a crime by this "profiling", it's a good thing. Maybe they stop an OD, maybe they prevent a robbery, maybe they prevent a drive by shooting. How is this a bad thing? If I'm driving through ANY area known for drugs, gangs, or prostitution, I should expect that my intentions should be questioned and my story should be verified. Switch the players around and suddenly this "Driving while black" thing is a horrible injustice. The race card cannot explain away everything.

LOL You are supposed to feel guilty about feeling oppressed.

Congrats!

\\Points to nose Thank you CB- someone gets it.

Obviously you have the wrong opinion of me, but I won't lose any sleep over it. If I had an ego or humility problem, I would have quit this business a long time ago. I remember fighting with nurses who thought we had no right to intubate patients or operate on our own without a doctor standing over us. Sorry for being honest. Read my reply to vent- no need for me to repeat myself. My point was, in our limited time with patients, other than offering them help, and advising them of some of their options, what else do you think we should do? Of course many homeless people have tons of underlying issues, and contributing factors that resulted in their situation. I know I am not capable of handling those issues- I leave it for the experts. Like I said, I knew many intimate details of the lives of these frequent fliers. Do you think they need to be told that they aren't dealing with their issues in a healthy manner? Do you think they need to be told that the reason they may be a chronic alcoholic is because their parents abandoned them at an early age, or that they were sexually abused as a child? People spend years in therapy to sort out issues such as these. Most of the time, they know EXACTLY what brought them to this point in their lives, but they simply aren't ready to do anything about it yet. If and when they are, and ask for assistance, I'll be more than happy to help in any way I can. I'm more than willing to listen to their stories and offer suggestions, but that's the limit of my expertise.