Ridryder 911

From what I understand it will be cash up-front. I am sure that will be part of the requirement before sending anyone out. I would predict that they will leave a T-form and insurance info to be sent in for reimbursement, and as described will be up to the patient. As well, I would assume they will have a call screener to take the information, I am presuming there might be "foul ups" but any indicators of urgent type illnesses, will be directed to EMS. This Doc is too smart not to cover his rear. Knowing of this physician, he usually does not jump into anything half hazardously without a lot of pre-thoughts. It will be interesting to see. Although, the hospital he is associated with is one of the smaller ones, they are one of the busiest as well. Ironically, he just opened up a "Doc in the Box" minor ER clinic as well. Apparently, from what I have been informed it is doing well. If this idea does catch on, it will definitely be profitable for him as well as those that can afford it, much rather await at home and not have to be in the ER. Not really a bad idea for those "snotty noses and routine illnesses". R/r 911

Ironically, he is a very progressive ER and EMS Doc, probably seen what has been described as EMS "getting the patient better". He is only seeing the light of a 30 minute visit as $250 and the patient costs is cheaper, no wait, the insurance company much rather pay $250 than $800 for an EMS unit and $3000 for an ER bill for the exact same thing. Now, which do you taking off? EMS advancement with increase in reimbursement, or $250 for visiting Doc. R/r 911

http://newsok.com/article/3213744/1204955530 I posted the link, but I believe one has to sign up. A little background on the physician. He is a progressive EMS medical director and entrepreneur-owning Minor ER Clinics, strip malls, banks, etc. Very well known ER Doc and businessman. 'Two medical workers co-found business that helps people regain health without visiting an emergency room by Jim Stafford Business Writer It is an all-too-familiar scenario. Someone develops a high fever late at night. They need medical treatment, so they show up at a hospital emergency room — and the long wait begins. After suffering for hours with others just as ill in the crowded waiting room, the patient is finally seen by a physician. The cost in terms of time and expense is high. So is the frustration level. "When hospitals get full, there is no place for an admitted patient to go, so they frequently get stuck in the emergency room for an extended length of time,” said Dr. Dan Donnell, who is emergency room director at Midwest Regional Medical Center in Midwest City. Donnell has co-founded a business that might relieve some of that emergency room congestion. It is called House Calls Instead, which pretty well sums up the mission of the new business. House Calls Instead is sort of a throwback to another era in which doctors routinely made house calls, carrying a black bag of medical equipment to patients' homes. Donnell's partner in the venture is Eileen Ravella, a physician assistant who also works in the Midwest Regional emergency room. Donnell is company president; Ravella, a former Oklahoma physician assistant of the year, is vice president. The pair began to develop their concept of a house call-based medical business in July and launched the venture last week. The idea was germinated in the busy emergency room environment, Ravella said. "We are allowing you to have more convenience. We're going to save you some time, because your time is worth something,” Ravella said. "If you are sitting in an emergency room or urgent care office for two or three hours, your time is worth something. I think it's a pretty good deal to come to you. "You don't even have to get out of your pajamas.” The company will accept Medicare patients, too. But like other patients with insurance, Medicare recipients will have to file their own forms. House Calls Instead is not in competition with patients' primary physicians, Donnell said. In fact, the House Calls' staff will file follow-up reports with patients' family doctors. "Obviously, if they can see their primary care physician, they will,” Donnell said. House Calls Instead staff is available for home or office visits from 8 a.m. to 8 p.m., Ravella said. The founders anticipate many of their patients will be busy workers who can't shake loose from their office or who can't get to see their primary care physician on a same-day basis. Medical professionals from House Calls Instead can provide injections, strep tests and breathing treatments, and write prescriptions for patients. House Call doctors will follow up with a phone call to the patient the next day, Ravella said. "Our initial thought is we can probably bring the urgent care center to your house,” Donnell said. Midwest Regional Chief Executive Officer Doug Arnold said he sees value in a medical business that makes house calls. But it won't make much of an impact on emergency room visits at a hospital that has 65,000 such visits a year. "There are probably a number of people out there who would really benefit from this,” he said. "It's certainly going to help caregivers when they have a patient they are taking care of that can't easily be moved. "And then there are people who are just wanting the convenience so they don't have to go to the emergency room.” House Calls Instead staff will recommend hospital admission to patients if the situation warrants it, Donnell said. But their first mission is helping patients regain health without the hassle of a marathon emergency room visit. "What happens is you get a large percentage of people who need to be seen but can't be seen, so they end up getting sicker,” Donnell said. "This is trying to do a pre-emptive strike and trying to keep people out of the emergency room.” How does it work? Who is House Calls Instead? The company has recruited more than a dozen experienced emergency room physicians, physician assistants and nurse practitioners who will travel anywhere in the metro area or as far as Stillwater. What's the cost? The business offers home or office calls for $150 by a physician assistant or nurse practitioner, or $250 for a doctor's call. Will insurers pay? Most of the patient cost will be recovered though insurance payments, although it will be up to patients to file insurance claims. But the savings in time should motivate many patients to call House Calls Instead, Vice President Eileen Ravella said. "

Ditto to what Dust's comments. R/r 911

You know what they call practitioners that only use the ECG to r/o an AMI?.... ...Defendants.

Not to retaliate back to medictx, but in all seriousness it was obviously difficult to understand their posts. Many times trust has to be ensured before "standing orders", and not having the ability to logically communicate, they may have to "ask permission"? I as well as many apparently have not seen that type of medical control since the late 70's. Personally, I am lucky and would not even consider working such a place. My same opinion in regards to protocols; if the services protocols are > 100 pages, something is wrong. Only pertinent medical conditions should be covered, the rest should be assumed and discussed per medical director as "standard of care". Everyone should know to place oxygen on a hypoxic patient, I really do not need a paper telling me such. The real subject again goes back to educational values. Although, it appears we are sometimes "beating a dead horse"; posts similar to those in question brings out that we are sometimes our worst enemy. Just when we thought we have progressed in areas, we find out that many still have direct medical control. Apparently, many feel at unease on making diagnostic type decisions and need a set guideline. Unfortunately, as many have alluded to medicine is never black and white, rather gray. Medicine is made up of science, but practiced as an art, therefore really never repetitious. Each case is really unique and cannot be handled step by step, nor the person delivering the care only have a "shake & bake" training to only understand and allow those type of protocols. Really, to even be discussing "locks or fluids" is sad. Not having the common sense or knowledge to know when and treat accordingly, if and when the patient needs fluids or not? Really, think about it. The one thing about EMS forums is that it does awaken me unfortunately on how little EMS has advanced. Both in the little progression of the systems and of the educational requirements needed to provide care to the sick & injured. Apparently we are not as progressive as we had assumed we were nationally. Really, this is shameful and discouraging, basically it is kinda sad. R/r 911

Yeah, no one e-v-e-r talks about things in EMS :roll: R/r 911

Maybe the "Quincy" method of crisco and an extension cord stripped. R/r 911

Wow! Why does this type of behavior not surprise me? R/r 911

In the earlier days of EMS, I can say it was more alike that, but nowadays if I was to find someone else in my bunk I would be pissed. Sorry, that is avoidable and if you want trouble then proceed. EMS is a business, paid or not. Not that I am a prude, but one can not have it both ways. We all know things go on at the work place, but condoning it only opens yourself up for problems. I have seen many good medics ruin their professional life for being naive and stupid. One can be comfortable without crossing the line. One would not act or do this with a teenage child, it would be considered inappropriate, so why would one be able to act with such behavior at the work place? Being comfortable, working with one another is one thing but one has to know and realize the boundaries. Sorry, after seeing some false accusations made, I recommend not to even to get into a potential predicament to have to justify anything. R/r 911

What are you talking about? What procedure? Do you know what a lock is? Harm on what? Placing a tubing filled with saline and flushing it or hanging an IV ? If I called medical control on this, my Doc would either examine me for a stroke or fire me! R/r 911

Paddles? What are paddles? I haven't used them since the early 90's. Yes, pads are safer. Do a Google on it. most of them were performed in the late 80's, describing other advantages as well. I have seen pads arc, gel causing rescuer sliding across chest, poor contact again causes arcing, even seen flames on a few. Paddles are a great back up tool. R/r 911

Simple, they are all locked unless they need fluids (hypovolemia, dehydration, etc.) Even cardiac patients get a lock, it is simple just to attach a line to the lock, if one needs a bolus. R/r 911

It's not really a Us vs. Them issue. Let's just change the situation. L Let's pretend it was a medic instead of a firefighter that was in Fire Academy. Now let's say that medic could not handle the smoke without an asthmatic attack. What would one think would occur? Yeah, we know the answer and no one would even be discussing it. R/r 911 R/r 911

Dwayne, it sounds like you have the makings of a great thinking Paramedic. It reminds me of myself during my education (and continuous) process, I analyze things to death. Of course I was challenged by my professors to do such. I believe this is why I still enjoy the challenge of medicine still today... Don't feel bad, you have the typical syndrome of receiving overwhelming information. As one of my Paramedic Professors used to say..."If it feels like we are force feeding your brain with information through an NG tube, then we are doing our job well"... . As someone mentioned the light bulb does come on.. sometimes in the most unexpected times and places. I believe in the House of God methods.. if no IV then create one. I am not too proud of establish an IJ on a conscious patient or if need be an EZ I/O (p.s. 1 mg into a liter presents a good analgesic effect of the process and pressure infusion). Remember, I was a burn nurse and nothing is sacred. I've even started them in dorsal penile veins.. hey a vein is a vein, when everything is burnt.. Yeah, thank goodness for I/O's! The point of the original post was it not so much bad care, as it was inappropriate care. The medic (from what was posted) apparently is not abreast of good thorough cardiac care. As well, it speaks poorly on their system to pair up newbies together... God help them & the patient. R/r 911

Dwayne, I believe you are making it too hard. Think on the line of preload and after load effect. )Starling Law effect) Actually NTG is not really contraindicated but not suggested, especially when you have a presentation of such. I agree if possible a line should have been attempted, in which I believe the poster described. I know many services have policies on how many and as well, many do not allow EJ's on conscious patients. The difficulty of establishing a line is not really surprisingly though, bradycardia and low blood pressure ( brady producing low B/P or low ejection fraction r/t AMI). Then especially, after NTG is administered. Something I am sure that the medic learned off, and hopefully will never do that it again. R/r 911

I alike others keep his family and coworkers in my prayers and thoughts. Although that is an interesting point, in this case the person also shot at others (not r/t EMS or uniforms) so it is mute point in this case. From what I have read, it is ironic that the Paramedic returned back into to retrieve an inappropriate toy that was given to his child. Alike many other EMS and Fire was married to another emergency worker, typical. It is such a shame, we can no longer go eat a meal in a public restaurant, attend school without worrying some nut job will come in and have to take a few out, before ending their pathetic life. I am sure they will attempt to attach PTSD to the assailant, because he accidentally ran over a child several years ago. Really, what is becoming of this planet? R/r 911

As an EMS manager, I would say she's....o-u-t of here! Sorry, she is under a one year probationary period (which means, I can discharge for no reason). I don't need a reason, and why should I increase my risks and liability? I know, it sounds cold. So be it. It's a business and that business involves lives (both patients and employees). It's called risk management, she's a risk and I managed it. Life sucks, but in reality she has known she has problems (even before Dx.). Choosing a highly stressful profession is not a wise decision, but I did not choose it for her. Do her a favor and direct her to another profession. R/r 911

Although V[sub:f9c43a1790]4[/sub:f9c43a1790]R is great, one can detect a ride side without such. Even basic XII lead interpretation along with other clinical indicators (borderline BP, Bradycardia) should be noted as red flags indicating right side, possible inferior wall involvement. Even without a XII lead, moderate blood pressure and bradycardia should have been a tale tale sign. With other indicators, it appears this medic may have good intentions, but that itself is not enough. It appears this medic needs to be reconditioned and possibly evaluated. Maybe some refresher over AMI, etc. then if not better, fired. Sorry, give a chance then not better time to move on. Hopefully, these physicians will make contact appropriate persons before this medic causes more harm than good. R/r 911

Well the best way the "brotherhood" could help is to get professional help for the person. Too many EMS experts attempt to enable many by either ignoring or "blowing it off" and condoning it, then under their breath talk about how "crazy" or "not surprised" that their dismissal occurred. In legal terms, behavior attitudes is probably one the easiest to document from associates and others giving their inputs, as well many of these type start receiving complaints from patients and allied health providers. The employer is responsible for the safety of all, and as well presenting a positive image to their business. Drug testing would not have to even be considered if enough documentation occurred. I believe some people are too concerned on how hard dismissing someone is. In actuality it is pretty easy, if there is proper justification or a good paper trail. Even then most will settle for unemployment. I just went through a seminar on "How to Fire people & feel Happy!"; I was surprised on the misconceptions and myths of discharging employees. R/r 911

As I am in a supervisory role, I would definitely be concerned about anyone describing that their sole existence was their job. Red flags would be waving. Really, that does describe and demonstrate some potential instability. Sorry, I have seen such behavior by those that could not return to EMS after an injury, even one that committed suicide... Guess what, no one thought he was a hero. Rather really shameful... it is just a job. Seriously, one can be passionate about their job without devoting their sole life into it. What would you do if you were injured and could not return to work, or something occurred (as an incident) and could not perform EMS again? Would you stop living? Really EMS is not a Nobel Prize job. Work to live, not live to work. Maintain a happy healthy medium. R/r 911

Not to be rude, and the thoughts are nice but let's be real. Is the employer going to pay her while she gets her poop together? I agree with AK if a possible desk job is available, that would be great. I had the unfortunate event of working with a great medic that had major Bi-Polar disorder. I could tell when they were off their medications. They literally cried about coming to work and the spontaneity of events. Although they were medically knowledgeable they were a horrible employee. I was able to detect their symptoms immediately and confronted them. I highly encouraged them to leave the field as this is not conducent with their illness. As AK described it tends to help that they are in a stable and predictable and routine environment. Unfortunately, they attempted at several other EMS agencies and have failed as well. Now having a reputation... Again, maybe we should recognize that this business is not for everyone. Alike other jobs that require physical and mental demands, we should empathise it is essential to have a well balance mental health as well. This should really be emphasized from the Basic level and especially as the responsibility increases. Sorry, we would not encourage students with severe osteoathritis and other illnesses to enter the field, why should we not provide the same information to those that have mental illnesses? R/r 911

Actually all law enforcement agencies, that I am aware of requires psychological testing and evaluation, as well as some Fire Services now do, why not especially EMS? Especially the clientele and the parts of the job we are exposed to. Would it not be better to see potential problems or even make limits alike LEO have that they are not psychologically suited for the profession? R/r 911

Not to quote out of context, but again I am seeing more and more drama everyday by our own folks. What is it? I see more and more drama kings and queens in this business. Everything is made to be a "big deal". Doing things in front of the children is even a good case to reveal such behavior. I too have seen real events of medics that had true depression and mental illness and yes, many did it successfully (with history of seeing what works and not works). I am not belittling any mental health issues, but I think we do need to consider the options of a "mental health" check for everyone that enters and alike physical exams a mental health check for all that work in it. I know the old saying." 1 out of 3 is crazy"; I know what profession they tend to be attracted to. Again, why don't we require a mental evaluation checking for stability, and potential problems? R/r 911

Yeah, sign me up at $40 hr and my Doc just said he will for a mere $250/hr... Are you on drugs Rocker? ... R/r 911