usalsfyre

Ruff, EMTALA covers that situation specifically, as you noted. If the hospital choose to try to intervene in this case, I'd probably tell them to take a flying fornication at a rolling donut and get out of my truck. We can deal with the specifics later, including forwarding them a copy of the applicable EMTALA regulation later.

Dwayne, I think it's the lack of looking at the bigger picture that bothers me in this case. What the OP wanted was for the ED staff to transfer care to him....then him transfer care right back to the ED. Why does he wish to act as the middle man? Unless they were a couple of blocks from the ED, doing anything would be a waste of time (are you going to sit in the ED driveway and perform interventions?). As far as the respect issue, respect is earned. Actions like the one above don't do anything to earn respect, in fact they do the opposite. Despite our "upside down in a ditch" bluster, there are few experienced ED nurses that wouldn't be able to operate in the average (like this one) EMS environment. Showing respect towards other healthcare providers (even the dreaded nursing home staff) and showing you know your stuff goes alot farther than Eric Cartman style displays.

That's called a good call where I'm from...

Can't say anything about Zantac, but we've had very good results with famotidine here, the only difficulty for some services is the refrigeration issue (we have Engle coolers on our trucks, so it's a moot point for us).

Dust adds the insight that I don't have about a lot of those services, I can tell you a lot about the majors here in the east, but I'm biased as I've worked for both and very much prefer one to the other. The job market in east Texas is, surprisingly, fairly good. Both large services are hiring for medics and basics. The pay is not great (one of my frustrations is managements refusal to believe being in the same neighborhood pay wise as DFW and Houston will attract better applicants) but its better than many parts of the state. Depending on where you work the experience is as good or better than you'll get in many municipalities. Granted your living in east Texas...but Tyler is not THAT bad. I wouldn't rule it completely out, I'm fairly happy at my service.

There's many EDs (and more and more floors from what I hear) that don't place the staff's last name on their badges either. If they know my first name, how am I not identifying myself? Again, any organization worth its salt should be able to quickly identify the involved party in a complaint. It's not any different in hospital. I have no issue with last names being left off of badges there either.

Both of them were designed to run the local big FD medics through as quickly as possible. What's ironic is UTSW is obviously at the top of it's game as a med school and TEEX (the A&M attachement) is world renowned for it's fire and techincal rescue training, so both of them could have put together top notch programs but that's not what Dallas and Houston wanted. To the OP, MedStar is the big non-fire 911 provider in the Metroplex, they're gaining a reputation of being a top notch service after years in the gutter. Careflite has a few 911 contracts, but these are usually filled internally, and you don't see a lot of turnover at Careflite as their employees are extremely well paid and treated. AMR is the lowest paid service, and you pretty much have to statr on the Dallas transfer side to get into ANY of their 911 operation (Hunt County or Arlington EMS). There's a smattering of small 911 services around (Rockwall County east of Dallas, Hood County south of FW, Wise County northwest of FW), as well as the more westward counties of the major east Texas services(Kaufman and Ellis counties for ETMC, Van Zandt, Rains and parts of Wood for Champion). There's also a number of small transfer services around, Lone Star, TLC, ect. For the most part anything with "FD" on the side of it will require at least a TCFP Basic cert as well, the exception being Dallas Fire, they run you through from the ground up (including reattending paramedic school). I work for one of the east Texas companies, PM me if you want more info, I'll provide what I can.

Not the healthiest things in the world, and I'm sure you'll find all sorts of people with horror stories, but just like most things in moderation they're probably fine. I like Red Bull myself, taste better than the others (to me), plus it's my contribution to RBR winning another F1 constructors championship .

Hey, a significant portion of my raising was spent in the DC area, so I haven't hit banjo black belt level 8 yet .

I take serious offense to being called unprofessional. Patient's have a right to know who's treating them, this is true. First name should suffice. Is someone going to refuse to be treated by me based on what my last name is?

300 yards, I believe. Off topic, but "divert" really doesn't exist, outside of a hospital having to physically close it's doors for an emergency condition. As far as EMTALA is concerned, your arrival is the same as a patient walking in the ED doors.

As noted above, I simply don't see EEG as having a lot of utility in emergency medicine, especially in out-of-hospital medicine.

This doesn't even make sense. Does you service have some problem of absolutely epic proportions? One med used to to treat a condition I have pops positive for amphetamines on a urinalysis, should people taking this med not be allowed to work anywhere because we might be secretly smoking crystal on breaks? I see several people mentioning how no offer of EAP is made to medics. Often one of the parts of an EAP agreement for drug addiction is that the healthcare provider will refrain from handling controlled substances for "X" amount of years. This simply isn't possible for a medic.

I can't say that even when I was new and sparky I ever thought this way.... A little to melodramatic for me.

Another East Texan here, glad to have you.

Which is why I have absolutely no issue first name, or just surname. If the agency can't follow up on issues with one name, a patient name, a time, date and address of call then there's a serious tracking issue. If the complaintaint isn't willing to provide the above, then I can't say they should be taken all that seriously. Just as the patient has rights, the provider has some right to know where a complaint originates from. First Name is in large bold letters. Full name and job title is much smaller. I introduce myself as "Hi, I'm usalsfyre a paramedic......"

In reality, if someone ask for my name, I'll give it to them. If they want to make a complaint, I'll give them my name and the approprite supervisor's contact information. What not having a last name does is give me some level of control of who my name gets out to. It's nice to know that the guy that's threatening to kill me and rape my wife (yeah it's happened) might have to jump through a few hurdles to get that info, rather than looking up my adress on Google.

Bullcrap, I'm professional and courteous in all of my interactions and have still been threatened and assaulted. Your spouting typical administrative BS. "We can't control the publics reaction, so therefore the problem must be you".

flamingEMT, I'm not a "public servant" any more than any other healthcare worker. To answer your question, I've never had anyone ask to see my credentials prior to allowing me to treat them. I like first name only personally. If a complaintaint is unwilling to give enough information to track down who the complaint pertains to, it shouldn't be taken seriously anyway.

If I'm not mistaken, Intercourse is just down the road from Blue Ball (you can't make this up...)

This isn't physician opinon or belief, it's medical fact. To answer the question, I've seen far more cases where too large a scope caused patient harm than too small a scope. I think our current scope needs to be adjusted more than anything, for instance as I noted in the other thread I don't see a convincing reason early antibiotic therapy couldn't be started for sepsis patients in the field, but have real reservations about RSI and even intubation. Lasix is probably inapproprite in the field but the homeopathic doses of pain control authorized by the same places are madening. And so on and so forth..... Education is of course the elephant in the room, as usual.

www.survivingsepsis.org Their reccomendations are pretty much THE last word on sepsis care.

Early, emperic broad spectrum antibiotics are useful in sepsis. Cultures should ideally be drawn before administration (and really, how hard is it to pull cultures if your starting a line) but it's not an absolute. I don't know about y'all, but I see urosepsis about once a week. In systems with a 5 minute transport, it's probably not worth the trouble. However, if your like my system and transports are from 30 min up to 90 minutes, it's worth considering.

So your advocating agencies understaff so everyone has to "work"?

Why buy two $200,000 ambulances when brand new, serviceable trucks are available for half that? Medium duty trucks are overkill in all but a very cases.