Lone Star

Welcome back!

Reading all the replies to this topic, I'm seriously wondering just how 'redundant' I am when writing the narrative portion of my PCR. Maybe I'm just being too verbose while trying to 'paint the picture'? My typical narrative starts out like this: Arrived to find age/gender, position found/location (supine in bed, sitting upright in a chair). Chief complaint is:_________________. Patient is CAO x (insert orientation level 1-4 here). I normally use alert to day/date/place/self as qualifiers. CAO is an acronym for 'conscious/alert/oriented'. In most PCR's I've filled out, the GCS is required; and I normally include it in my radio report to the receiving facility. The rest of the narrative will include information about past medical history, meds, allergies, treatments and results of treatments performed on scene/en route; with obvious responses to treatments. I note how often vitals were checked as well. I try to stay away from symbology and acronyms (unless relevant to the narrative, AND are universally accepted). These can be found here:Medical terms/symbols.

Rosie Red-Ass? Is she a member here? *Hands Dwayne a cookie for each hand, so he's too busy to type*

Could you be thinking of the Kount and Kountess?

*Takes Dwayne's hat off his head and looks closely at his forehead* I'll be damned! He DOES have 'GULLIBLE' stamped there! AK, I do believe I owe you an apology here.....I know I sent you a PM saying that you'd have to try harder than that to get ANYONE here....but thanks to Dwayne, I was proven wrong....

I use the GCS on every patient, and I keep a paperclip on the appropriate page of the pocket field guide for quick reference. Some BLS pocket field guides also have the appropriate page tabbed at the bottom for quick reference. Currently in GA *edited to add last line*

*tackles the Beegsasaurus* How you been sweets?

Having worked the 'inner city' and suburbs of metro Detroit, I have yet to find a situation where I've ever had to try to justify kicking the shit out of a patient! I've had a couple calls where I've backed out and called for a cruiser, but even on the involuntary committals, I've rarely had to rely on Law Enforcement to stabilize a situation. This may be in part becase I've treated my patients with respect, dignity and compassion; but on top of that, I've paid careful attention to scene/personal safety. If it "didn't feel right", we didn't go in until it was deemed 'safe' to do so. The worst injury I've recieved from a patient was getting kicked in the face by a 92 year old granny with dementia. She asked that we put her slippers on before we took her to the truck, and apparently 'forgot' why we were there. Yes, I've worked shootings, overdoses and even worked in some of the more 'hostile areas' (like the Cass Corridor, also locally known as 'Blood Alley).

In the original post, the ambulance was pulled over in a routine traffic stop for allegedly following too close to the vehicle in front of it (even though there was no vehicle in front of the rig). This truck was also being used in a long distance transfer, so it was not from that particular area. (This is a more plausible reason for pulling the rig over in the first place). Even in your example (victim of a violent crime/GSW) the officer isn't entitled to read the information in the PCR, simply because it has no direct bearing in the investigation of the crime. All he would need is the patient's name and the fact that they're a victim of a crime. The PCR contains other information, such as past medical history and medications, which the responding officer is NOT entitled to know. Furthermore since the officer is not directly involved in the continuity of care, there is no need to violate the patient's confidentiality by associating an individual with a specific illness or disease. How is knowing that shooting victim, Joe Schmoe, also is HIV positive or has HTN going to help nab the guy that shot him? Since the call was a long distance transfer, what possible reason could the officer have for saying ANYTHING to the patient on board? HIPAA isn’t just about releasing information to the general public, it’s about keeping the patient’s privacy intact from ANYONE and EVERYONE not directly involved in the continuity of patient care. Unless the responding officer is a doctor, and is directly involved in the continuum of care, there is NO reason under the sun that he would need ANY information from the PCR. Nothing was said about the patient’s competency level, it was said that they could not give consent, which is the ONLY way short of a subpoena that the officer could obtain ANY information from the PCR. It doesn’t matter if the officer is going to as appropriate or inappropriate questions; they have no business questioning the patient in the first place, since they were not involved in any crime, (victim or perpetrator). What it sounds like to me, was that the officer spotted an ambulance that was from another state, and thought that they could increase revenues for their department and for the state by trying to find some reason to pull them over and issue a citation (notice that both the driver and attendant verified that there was no vehicle in front of them, and thereby couldn’t be ‘following too closely’). We can 'what if' this all day long, but based on the information presented by the OP, clearly the officer was wrong to attempt to gain ANY information from the PCR, and to simply acquiesce and voluntarily give the information to the officer IS a violation of HIPAA and a breech of patient confidentiality. *edited to add last paragraph*

You're right about 'not getting a response' when running the plate being the crew's problem. Ultimately, if it WAS stolen, he would have gotten some type of 'response' to the querry about the license plate, vehicle number (from the company) and then would have had 'probable cause' to start looking deeper into the situation. I highly doubt that the common criminal would know enough about HIPAA to even cite it to prevent a vehicle search, and simply peeking into the windows of the back doors would confirm that there was indeed, a patient on board; without having to see the PCR to confirm the existance of a patient.

I guess I missed that, I stand corrected. Yes, I AM willing to take that chance, simply because I'm not going to allow fear or intimidation jeopardize what I've worked so hard to achieve, especially when I have the backing of the federal law on my side.

I know my 'problem' is mostly with technique, and the fact that I'm out of practice. Part of my technique issue is that my 'angle of attack' is probalby too shallow and that when I was learning how to do them, one hand was in a cast. I'm pretty sure that once we start doing them in class, I'll get better (can't get much worse, can I?) Would the tubing that is used for air pumps in fish tanks qualify as 'iv tubing'? One would probably have better luck getting their hands on that as opposed to true 'iv tubing' or the extension oxygen tubing. The biggest question I've got is this: We're taught to start as distally as possible, and work proximally, yet I find many medics going straight for the AC. Sure, it's a bigger target, but it's NOT proper technique. Additionally, if we're going to follow proper technique (starting in the hand when appropriate) do we HAVE to apply the tourniquet above the elbow, or can we apply the tourniquet distally to it?

First off, since no one has said anything I guess I'll say it....It’s HIPAA , not 'HIPPA' Secondly, even though disobeying a lawful order from law enforcement is a misdemeanor criminal offense, they CANNOT order you to break a law. Since HIPAA is federally mandated, law enforcement CANNOT order you to break that law. When you consider that a simple license plate check (and possibly checking the VIN) would determine if the vehicle in question is stolen or not, I think the probability of getting a warrant or subpoena based on that ‘evidence’ would be slim to none. 1. Doesn’t matter if they carry bazookas, unless they have a REASON to draw said weapon and then use it, they could be dragging a 105mm Howitzer every where they go….they have to have a justifiable reason to ‘clear leather’ and start blasting. Anything less would constitute aggravated assault with intent to do great bodily harm or worse yet, attempted murder/murder. 2. There is nothing to find you ‘guilty’ of! You’re only following a FEDERAL LAW that they cannot force you to violate. 2-A) Since they cannot find you ‘guilty’ of anything, there should be no reason that this encounter should prevent you from renewing your license. Even if you ARE arrested, by the time you step into court and the judge finds that you’ve only adhered to federal law, getting your arrest record expunged is a matter of a court order. Additionally, ‘wrongful arrest’ and ‘wrongful imprisonment’ are highly frowned upon. This could also open up civil litigation against the officer and his department/municipality. 3. Since the officer was wrong in the first place, how can it really be a ‘negative effect’ on the EMS agency, or the EMT in question? Sure, it’s going to make the officer look like an overbearing buffoon, but in this case; it appears that the perception IS reality.

Am I the only one who gets 'popunder ads' on every image in the forums?

The ONLY ways the officer had ANY business viewing the patient's PCR and any pertinent patient iformation is if: 1. The had a valid subpoena, or warrant signed by a judge 2. The officer was directly involved in patient care Since he had neither, he either had to get one or live with the fact that he couldn't view the paperwork. If we're going to acquiesce to breeching patient confidentiality simply because some nosy cop wants to know who’s in the back of the truck, then we have ultimately FAILED at patient advocacy and failed to protect the patient’s right to confidentiality. In the event that the officer really wanted to push things, he would have found out in very short order that he was on the loosing side of a set of serious charges. I’ve worked WAY too hard and WAYYY too long to obtain my EMS license, and I’ll be damned and go straight to hell before I let some chucklehead put me in a position to endanger not only my job, but my professional credentials and credibility! Part of my primary responsibilities is to protect my patient’s privacy at all costs. If I have to sit in the local hoosegow because of it, then that is something that I’m willing to do. Not only am I bound by professional ethics concerning this matter, I’m morally against sacrificing said ethics just to keep my butt out of jail; especially when facing charges that will never stand up in ANY court. I’ll give you any and all information that law enforcement is entitled to, but anything above that; the officer will have to get a subpoena. I doubt that any judge wants to step into the legal shit storm that would ensue, as it would ultimately come back to bite him in the posterior pleats of his nice black robe! There are many reporters who would gladly sacrifice their freedoms in order to protect their sources based on the first amendment. Why shouldn't I protect my patient with the same zeal? When given an order to produce certain papers, we are bound by law to hand them over. Unfortunately for the officer involved, the Federal Government has decreed that the patient’s confidentiality WILL be protected more fiercely than the last grey wolf on the endangered species list.

You gotta love the "Munchkins"!

Not every ambulance company will issue portable radios (hand helds) for their field crews, let alone for each member; so we shouldn't count on that as a deterrent. Secondly, just because said employee/crew member HAS a radio, doesn't guarantee that they'll actually get a chance to use it before something 'bad' happens to them. What happens when you're STATIONED in those 'crappy neighborhoods'? When I worked in Detroit, I was stationed in Highland Park, Riverview and a few other 'less than desireable neighborhoods'. The only choice I had for refusing my station assignment was to 'self-terminate' my employment. Secondly, when company policy states that you WILL go where 'posted', what choice do you REALLY have? *DISCLAIMER: THE FOLLOWING STATEMENT IS INTENDED FOR HUMOR ONLY! In the great debate of gender equality, it has come to light that women will NEVER be 'equal to men' until: They can walk down the street, bald, pot bellied, belching and scratching their crotch... and still think they're 'sexy'

Every uniform I've ever worn that had a flag as part of it, had the flag on the right shoulder with the stripes pointing in the direction the wearer was facing. This was on the uniform shirt, but not on the 'Class A' jacket that went over it. As Richard was saying, the military style shirts (like the ones offered through Gall's) with the welted pleats/seams are by far the more professional looking shirts. I've also worn the ones that have the appearance of the classic 7 button shirt, with a concealed zipper.

First off, EMS isn't a 'full contact sport'. If you're finding yourself in a position to inflict bodily injury to your patients, then you've certainly failed at scene size-up/scene safety, and if you’re deriving pleasure from such actions; you really should consider a line of work that allows you to use those skills. Having to resort to incendiary type postings does nothing to add credence/credibility to your post or topic. Attacking those who can logically show you the errors of your premise does nothing to improve the already poor impression you’ve made in your first few posts in these forums! Most of your postings and replies have been incoherent, poorly written and formatted; and are difficult (if not impossible) to follow at best. You give the general impression that you’re nothing more than a thug and a bully; and IF you ARE trained in martial arts, you’ve definitely lost perspective of the ki of the whole concept of martial arts. IF you DO have martial arts training, you’re only practicing for the ‘ass kicking ability’, not the honor that is associated with the ‘arts’. As far as ‘courtesy’ is concerned; it is earned, like respect. You’ve shown no courtesy to either Paramedicmike, Dustdevil or Eyedawn; how can you expect them to show it to you? Resorting to name calling because someone disagrees with your perspective is neither mature nor intelligently arguing your point in a debate. It only results in hostility and a degradation of communication. To this point, I’ve noticed that you’re the ONLY one who has resorted to this tactic; which calls your communication skills into question. This would explain how you keep finding yourself in a position to have to resort to fisticuffs while on a call.

Kids....you'd think that there would come a day when we didnt have to tell them every step to take (or in this case, not to take).....obviously I've been proven wrong once again...

Artificial insemination? Bella was a tramp, and only BLAMED ‘vampire boy’? Ain’t it a bitch when logic beats the snot out of fantasy? ROFLMAO

You should wait until the transition is complete, as it's not an accepted title at this point. Secondly, when using titles, the accepted practice is first name, middle initial, last name and then your titles (in descending order of importance). For example: John Q. Public, AaS,NREMT-P

Of course you pissed alot of us off Dust, but you obviously saw something in us that inspired you to push us, either to think, or out the door. A topic came up the other day that I remember arguing with you, AK and a handful of others about the necessity of a degree in this profession. I remember pushing against getting one, and now look....[mock sarcasm]I hope you're proud of yourself![/mock sarcasm]. Really, you should be proud along with the others that kicked my ass into college. There are many of us that owe you so much for that 'boot in the ass' (or upside the head) to get us to plug our brains in and start really pushing to make a difference. I look for more posts from you! LS

Rob, It sure is good to see you around here again! I'm sure I speak for a great many people when I say that your presence around here has been sorely missed. I (we) wish you well, comfort and best wishes. I start my Medic class on Monday, and I've gotten all of my 'core classes' finished. I couldn't just sit on my haunches after the wreck, so I worked my ass off to get the majority of the classes for my degree out of the way; so I can focus only on Medic School. I may have to retake A&P II, (and hopefully will have a different instructor then), but shyte happens from time to time. I hope that you'll pop in more often, and are able to whip some of these noobs (at least noobs to you) into shape, like you did to the vast majority of us 'old timers'! Keep in touch, friend! LS

Somebody stop me before I pack my own lunch again!