Ridryder 911

Actually both.. if the service billed and the PCR describes a non-valid reason. Just because the physician signs a form does not excuse the EMS. The physician can be held liable for signing the document, or falsifying the need, which I have seen is a simple warning, until there is a pattern set. But when there is charges billed it is a total different thing. That is why coding and billing reviewers are essential in EMS. They are supposed to weed out or be able to enforce proper documentation to "justify" or an EMS will have to eat the bill. Our policy, is to assess the patient, inform the physician or ask the need for required stretcher. See if there can be an alternative transportation. Then, if all else fails inform the patient/family they might be responsible for a $800.00 bill, and have them sign insurance/medicare acknowledgement form that have been informed. That is all one can do... R/r 911

As well and good as that friend's intention was I bet he just ended his EMS career. Even though I totally agree with his principles and what he did. He will be branded (yes, his name will get out) as a trouble maker among EMS administrators and once he is terminated (of curse non-related incidence) finding another EMT position will be hard. Yes, I agree there is a lot of abuse. Especially, like the scenario described with returns or dismissals. I know we eat a lot of the bills because they do not "meet" criteria, but my administrator feels it is better to eat them than piss of the medical community. We are now placing our wheel chair van unit on more calls, and using a local van more. Actually, informing the patient "this may not be covered, by your insurance and medicare which you are legally bound to do, has deferred many. Good luck to your friend, R/r 911

Don't know the specifics; but do know that oxygen is a drug/medication. Carrying it on your own personal without a prescription can be a Federal offense. Yes, even oxygen. Quit trying to be a whacker & leave the 0[sub:40abdec395]2[/sub:40abdec395], to the EMS crews... for sugar carry a a packet of honey or a roll of life savers, if you are that worried. Remember, off duty you are NOT able to perform above a first responder level. R/r 911

That is why when I am teaching CHF vs. COPD vs. Pneumonia differential it is so essential that a thorough H & P be performed. Examine the med's; HTN med.'s such as Lisinopril, CHTZ, Ace inhibitors, Diuretics, Look at the onset, the skin temp., the adventitious lung sounds, the incidence of hepatojugular reflex, JVD, and one that is essential EtC02. Although, one may have a COPD/CHF patient even with pneumonia and as weird as this it occurs a lot, one needs to be very careful o the med.'s we administer. As AZCEP has posted we may be giving [/font:35e10c74b8]Beta [/font:35e10c74b8] we also remember these may also have some alpha effects as well. As Albuterol is simplistic, and easy to use, may actually increase an infarct size as well. Again, that why I strongly suggest EtCo2 noting the implication of obstruction, with the shark fin wave form. Basically, if they don't have it..... they don't get Beta's for COPD. R/r 911

Here is a story of how, what happened and the outcome from our mentor Dr. Bledsoe...what you have to notice is the pedestrian....with another link... http://www.defrance.org/dj/strollalong.htm R/r 911

Ace, this is so important it should be a separate topic. I know 3 of the original authors of the Houstan MAST studies. They are renowned and I respect them very much... now with this saying, research on how this started, whom did the research, and the criteria, as well as the variables and population control etc. THey hate to see me enter any symposium they are talking at.. there is a reason. Like all studies, one need to really understand research and statistics. As well the diversity of how studies are performed. The PASG Houston study DID NOT describe there was a increase in deaths, or injuries, rather it demonstrated there was no increase in survivability. Rather or basically there was NO difference. Now, one has to see what type of patients were studied, the application of PASG, the duration the patients had them on, as well as deflation procedures. If I can recall part of the study involved application of the PASG suit until the "pop off" valves occur. Has anyone ever been able to do this? I have tried on mannequins, and have had the Velcro split or rip apart.. but as of yet NEVER had the pop-off valves sound. I can assure you the pressure required to do this is very high. As well, most medics knew the theory.. pressure increase the lumen of a wound... as well as we had figured out auto transfusion was a myth. When examining the patients that was studied and the level of trauma they received, I doubt even a trauma sugeon being there in 3 minutes would change the outcome on some. (i.e multiple .357 hollowpoint to chest). No, believe it or not I am not a big proponent of PASG. Yes, they assist and help in some shock syndromes and situations when applied and used appropriately, but very few cases. What I am passionate for is true an valid studies, having more EMS professionals understanding research and possessing the knowledge of how to truly read and interpret studies as well. Hopefully, we will not have a "knee jerk" reflex again. * Ironically, PASG is now being marketed under a new name and used for O.B. situations for "hypotensive" patients. As funny, there is so many reports on how well this device works...lol R/r 911

It all depends what you are looking for. There is a difference between journals and magazines. Journals usually do not have a lot of commercials, cartoons, or pictures. As well Journals have research positions, etc.. not stories. If you are looking for medical education and knowledge in EMS, there is limited journals strictly EMS related. There are some magazines that declare themselves as journals and are attempting to raise the bar. JEMS, appears to be trying to. Authors like Bledsoe, Cherry, etc. are attempting to. Part of the problem is that most journals will not allow college level publications. The reason again is has been studied that most EMT's and Paramedics do not read above the high school level. Again, some are attempt to raise this level, one being JEMS. There is others such as EMS magazine and Firehouse. These are more trade magazines, that have articles which basically contains review of material, or new products. Of course they contain pretty pictures because again, most EMS are more visual than analytical in nature. So if you want to know about new treatments, education I suggest the following: I have placed links: JEMS www.jems.com Pre-Hospital Disaster Medicine http://pdm.medicine.wisc.edu/, Air Medical Journalhttp://www.airmedicaljournal.com/ Journal of Trauma http://www.jtrauma.com/pt/re/jtrauma/home. Emergency Nursing WWW.ENA.ORG If you want a magazine to read while in the john... EMS Firehouse etc. Oh come on Ace can enlighten us on some more :wink: R/r 911

What is the dillema...? except I knew some whackers that wore them as jewelry. R/r 911

Geez, can't wait for high school to start back again.. every summer it is same old thing. Get a bunch of newbies that have innercranialrectoinversion syndrome. Some have a terminal case, others the symptoms subside in a few years. R/r 911

Now, re-read that study! It is a horribly flawed and very tainted study. This is the reason medics and physicians really need to learn more about studies. If you will notice that all comparisons were based upon BnP levels. Great.. hell, even a 5'th grade could figure that one out. Hell, yes it's easy to say hold the lasix when you have conclussive findings such as CXR and labs! Let's do a real comparison of assessment skills for a study. Those of paramedics, physicians, internist, cardiologist and then see what is ordered or not before labs and x-ray. I have seen physician order lasix way before HBnP ever was drawn and be wrong, and a another concern is that HBnP takes a while for it to process. Again, treat the patient accordingly, BnP is a wonderful tool, that especially gives a precursor of CHF. I agree, use of CPAP, Nitrates should used more often, but administration of Lasix can be of wise choice not just as a diuretic, but anti-hypertension use as well. R/r 911

Why would anyone have a problem, if they are innocent? We work as health care professionals, and part of this responsibility to have and present high ethical standards. One way of policing ourselves is by running checks. As the above post describes, the public has to be able to trust us. Just because one can provide good care, is only part of the responsibility of an being a good employee. I would advise, have nothing to hide, then don't worry, if they are worried I would be worried as a peer as well. R/r 911

Really, there is reason for this madness of learning. It is called treating the etiology. Finding the cause. Like other have pointed, it does no good to even check the4 pulse if the patient is not breathing, (again this may be the underlying cause) as well as priority. Getting back to basics, the brain (most essential organ) has to survive... I also suggest, that you look at new literature and standards in regards of rapid defibrillation. As studies has now proven, that good CPR has a more likelihood of converting ventricular fibrillation , than initially just shocking someone. Things has changed. R/r 911

C'mon .. surely you get more ribbing when you were a a probie. I have been through all your so called "fire schools & Cert.'s"; even have a degree in Fire Science, so please let's not get in a turf war. Yes, everyone has a role... next we will be picking on LEO... heck, everyone on here does it; the nurses and even the Doc's get their fair share. You have to admit over-all, a lot of the hose jockeys do not care or attempt to further their education. Many NOT all, chose the Fire Department, because of the bronze over brains. It is still true, once your on, it is very hard to remove one from the department .. good or bad, how many firefighters have you seen fired or dismissed after 5 years on duty? Speaking of fat.. I have seen a lot of firefighters after being promoted to driver or officer that outweigh many medic(s) and yes I mean plural. Yes, they are part of the team..not the whole team, and yes they are an asset in assisting and rendering care in certain circumstances and departments.

Don't know about specific California laws, however most are universal written. Basically if you are on duty (paid or not) they do NOT apply. If you are a bystander and acted as a bystander would.. (hence NO one is above bystander off duty, unless they are a physician), then one would be covered. R/r 911

I always chuckle and reply better than a half arrest. Actually, the term full arrest was coined from respiratory and then into a "full respiratory and cardiac arrest" hence "full arrest". R/r 911

Not bad for a institution that does not require education. I agree the fire has great benefits, and great pay, but like all other services they too are beginning to get looked at as wasted money. If it was not for ISO ratings, I can assure you there would be a lot less of them. Many cities are now examining privatization since fire incidences has been reduced. The old "did such a great job. put ourself out of business" theory. These private industries dont have or pay the same as cities, but cost much less to operate and do not have to deal with Union issues as well. R/r 911

For anyone that wants to see a conscious intubation and the use of a whistler device: (O.R. setting) I use this video for teaching my advanced airway class. They are using a fastrach airway then intubationg through it. http://www.youtube.com/watch?v=HXjPdNSL96c R/r 911

Waa!...Waaa!!. I agree with Ays.. wanna be ! Must have passed that physcial agility test.. well good for yyou ! That will help you, when you carry my equipment. Actually, I did the line firefighting, yes there are some good ones.. and then ther are ...whoa boy! There is a reason they have academy type schools, and paramilitary structure ranks. C'mon even some of the most seasoned ones will tell you some are definitely cut out only as task management material... "see fire.... run in and. put fire out!... come back outside.. okay?".. Yes, we have idiots too.. I work well with my F.D, the medics are just card carrying members only, but do pack my stuff in and out.. and I help them when I can. Unfortunately, this is like a lot FD's only on certain shifts etc.. A lot of FD's resent EMS and really could care less about EMS, as much as most EMS could care less about Fire Service. We are medical .. period. Wherever that might be. R/r 911

I have seen some major soft tissue damage from "deep" looking with laryngoscopes and pushing around the cords. I have only seen one lateral cord tear.. (thank god, it occurred after I left the patient). Subglottic emphysema usually occurs with tracheal ruptures as well. I have seen several of these with residents insisting to over inflate the cuff... sudden sub-q, air escaping above and below the cuff. Usually a trach has to be performed. These are usually the Oh He*l ! scenarios.... R/r 911

What I love is those that have a pocket full pf prescriptions that has yet to be filled and discharge instructions from the ER and ink is yet not dry with the same c/c. But, alas do something for me!.. Yes, I wish we could have the same radio or whatever communication device they use.. it appears when one call comes in there will be a flood, then peace for a while, only to return in waves. R/r 911

Hmm I smell another lock coming .. thanks Whit. Another thing I guess I should add valuable experience should add maturity. Apparently not all experience is good. R/r 911

Wow.. so that means I was in EMS 18 years prior to you even knew what EMT was? So does that does that mean I am now the alpha male dominance? Should we go mark some trees or something? I do know that experience is essential; however only good experience really counts. If you have education, one can always obtain experience, the opposite is not true. Give me an educated person, it will not be long until they have the essential experience. Can you imagine if we had followers like you, where EMS would be? Telemetry and bicarb would be still routine, never challenge the system or back it up with educational facts. Status quo.... Short and simple.. basics have their place..as providers in very remote communities. Otherwise they are only trained as to provide initial care as first responders, again compare it with advanced first aid, very little changes. The curriculum is and has never been detailed enough to provide any additional skills, care. If one wants to become advanced, then on should perform an advanced class with proper curriculum to do so, but these EMT's would no longer be considered basics, rather they are now advanced. One call the color purple green if they want, it still does not change what it truly is. I don't care what state, area, region one is located, right is right and wrong is wrong. Ignoring or denying it does not alter or change the fact. R/r 911

Here is another site.. Dr. Bledsoe's drug cards..free http://www.ssgfx.com/CP2020/medtech/procedures/protocols.htm R/r 911

Race and MedicDude, you both bring out some very important points, as well as Dust. Part of the adult learning is to properly evaluate your students needs and background. As a professional educator, I do understand our dilemma as well, but try to observe all situations. Yes, I agree it is foolish to re-teach veteran Paramedics on "chin-lift maneuvers" after they have been performing these for several years. Yes, it does make sense to "modify' your course to fulfill you students needs and requirements. To accelerate and zoom into the "meat" of the course. However; here lies the potential problem. Standards and measures. Yes, we can assume that seasoned and even those that grasp things can accelerate faster. Yes, the instructor should be able to modify their courses to adapt and meet the expectations of the course sponsor and participant. But, recent research has shown that we are not properly doing that, especially in CPR, etc. In fact recent studies have shown that we are lecturing more than we are teaching. This is one of the reasons AHA has went to DVD interactive education. More emphasis is placed onto didactic, visual and psychomotor skills all at one setting. The instructor is only there to facilitate and assist in practice and to ensure the standards are met. So many instructors were adding or deleting national standards. I might suggest writing notes or documenting the reason classes were shortened such as " participants were able to properly demonstrate ____ skills, after practice without any noted errors. or These participants had previous experience that enhanced their learning time or class size ratio decreased practice time.. Hopefully administrators will understand the need of personalized attention. Some may need lengthened classes as well as those that grasp the subject in a shorter time... Good luck, R/r 911

Simple...... $ R/r 911