nypamedic43

This is a link to HIPAA. Its not the law itself but breaks some things down. http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html A patient that is rolled in on a stretcher has no expectation of privacy, in a community great room, like an ER waiting room. A person that walks in also has no expectation of privacy. The HIPAA law is in place to protect a person's health information and how its shared and with whom. Just because a patient gets stared at, doesnt mean that thier privacy is being invaded.

The service I work for pays by the hour. Everyone has a set schedule. I work 5 9 hour days. There are some guys that work 57 hours weekly and some that work 66 or 72. Each hour over 40 pays time and a half. There is a service just north of us that pays per call. I have heard that the pay is pretty good. However both areas are more city than country. I wish I could give you some kind of comparison of wages but in talking to people that work for the other service, they like the pay per call wages.

You made me snort coffee out my nose LOL

You're most welcome I couldnt remember what it was so looking it up helped me too

EMTALA is a law that guarantees a person emergency services regardless of thier ability to pay. https://www.cms.gov/emtala/

You are joking right? Seriously? Give me a break. To think that I would even consider that type of thing is ludicrous. How do I know that you would be truthful....you can't even get your story straight as to why you lied about your age. You hold no credibility as far as I'm concerned.

HLPP.... Lacking resources in a NON EMERGENT situation is called WAIT until said resources can be arranged. Lacking resources in an EMERGENT situation is called an MCI, and you do what you have to, just like you would in an EMERGENT BARIATRIC situation. Putting 2 patients in the back of the ambulance was absolutely appropriate given the situation where a second ground unit is over an hour away and the helicopter can't get closer than 15 to 30 minutes. You can't just leave one to transport the other. Take them both and meet your incoming resources. I have to agree with Dwayne. I'm not arguing with you anymore.

It's really hard to armchair this because we didn't actually see the patient. That being said however, if she was breathing, albeit poorly, a bvm and supporting her own respirations is appropriate. Intubation is way down the list in ACLS. I'm assuming that she gad a gag reflex if you had to force the tube into place and she was biting on it. Some kind of sedation should have been given. We dont have RSI yet and the only thing I could have given was some Valium. But something is better than nothing. I am confused as to why your partner was concerned about knocking out her resp drive if you already had the tube. It's irrelevant at that point. You've taken the responsibility for it. I'm interested in your follow up on this patient...especially since someone has assumed that the patient was put on a respirator, drugged into a coma and sent to the ICU to die. ( ya know what happens when you assume things). Not all patients with COPD exacerbation die. Good post. It definitely got me thinking about what I would do in the same situation. Thank you

Welcome to the City Eric!

I would have the helicopter land at the closest landing zone and take both patients. Drop the most critical patient with the flight crew and then ground transport the second to the closest ED or interface with the other ground crew somewhere along the line. Now, she may die enroute, but at least I will have her traveling in the direction of definitive care. I've taken 2 patients dozens of times. It's hectic and nerve wracking with 2 bad patients. Maybe I shouldn't have but it was better than choosing which one lives and which one dies there on scene. Especially with family watching.

We have one person that does all of our QA/QI. I have always written detailed reports but he yelled at because they were so long. Told me that he had too many to do and mine take along time to read. I havent taken anything out, just condensed what I write.

Good report writing comes with practice. As for trauma injuries, this is how I write it ie: dcap-btls noted in left arm and left leg, no other dcap-btls noted. I write very detailed reports and its gotten me into trouble. So over time, I have adjusted my report writing so that the chief complaint is there, how the patient presents,my assessment,how I get them to the stretcher, vital signs,interventions, how the patient responds to said intervention, what my findings are, radio report noted, med control orders, transfer of care to ED staff. All the pertinent information is in my report, but I've pared it down to a paragraph or 2, depending on the call.

I have. He was a gentleman that I took every other day to his dialysis. We would talk and joke around on the way over and the way back. I would stop and visit him on my days off when I came to visit my Grandmother, while she was there at the nursing home for rehab. He had no family either but he felt compelled to tell me one day that he had decided to stop going to dialysis. No matter how much I tried to talk him out of it, he stood by his decision. He was tired, he said. That last week was pretty rough. I stopped in to see him the day he died. He was laying in bed, shaking, I just held his hand and told him that it was ok to go. Cried the whole time I was there. He passed about an hour later. I felt so bad that he was all alone through his life, that I couldnt let him be alone when he died. Broke my heart to sit there and watch him go. Sometimes the best thing you can do for someone...is just...hold thier hand.

I didn't say state...I said county. There is another unit just over the border in PA, and there are another 10 or more bariatric units scattered around the state

We cover the entire county I live in. And we have one unit that is dedicated to bariatric equipment and patients. There are no other services in the area. So the sum total of that rig to purchase and outfit was in excess of 300k. And we use it every day. It has more than paid for itself in the 3 years it's been in service.

No experience with this type of transport?? I do them everyday..with the proper equipment. I've been doing this for 20 years...so please hlpp do not assume that I or the majority of this forum has no real life experience. Or that somehow YOUR experience is better than anyone elses. 4 to 6 bariatric transport where a patient weighs in excess of 600 pounds...yeah your experience far outweighs mine in an area where we do at least one a day.

You are unfortunately preaching to the choir Brett. HLPP steadfastly believes that she is in the right and absolutely refuses to have her mind changed, even with presented with facts. I keep telling myself that I am going to stop reading this thread, but its like a train wreck...you know you shouldnt look, but you do it anyway.

I've been keeping up on the responses to this thread but have bit my tongue and remained quiet since my last post. I've read the argument that in a crash that the stretcher will come loose and fly around. Heres a study that proves otherwise, granted its only one study but with 2 types of tests. http://www-nrd.nhtsa.dot.gov/pdf/esv/esv21/09-0471.pdf or how about this one that studies stretcher adverse events. 1% of adverse events involved failure of the fastening system and 1% involved an adverse event while transporting the stretcher in the ambulance. http://mhf.georgetownemergencymedicine.org/wp-content/uploads/downloads/ambulance_stretcher_ae_160609.pdf Now I realize that these studies will require some reading and are not nearly as much fun as videos on youtube. And they dont involve bariatric patients. OH and on a side note HLPP...being on the "rag" doesnt excuse rude behavior or statements. If you want to continue to defend the indefensible, so be it. As I said in a previous reply to this thread, I will gladly be terminated if it means that my safety and that of the patient is gauranteed by refusing to do this type of transport. Your company policy of not "allowing" a medic to refuse is, to be honest, stupid and dangerous, and needs to be changed. For everyone's well-being.

One of my preceptors told me this.."Be a duck..calm on the surface and paddling like Hell under the water". The only person stopping you....is you. One of the EMT's that rode with me and my preceptor alot ( RIP Ryan) looked at me and told me this.." You have the makings to be great in you...you just have to get out of your head. DO what needs to be done". I had HUGE confidence issue while I was in school. I didnt want to cause the patient anymore discomfort. Then, like someone flipped a switch, it didnt matter if I did or not. They needed an IV, they got one, even when they flinched, tensed up or pulled away. It will only get easier with time.

I have to agree with MG. Dont buy anything until you what is going to be required in the way of equipement and "uniform". I bought a cheap stethoscope because I have a phobia about using a "community" one. I did that once...in medic school and ended up with a raging inner ear infection. As for studying, it really depends on how you learn. Do you learn by reading? talking it out? writing it down? A study group is a great idea. Good luck to you and welcome to the City edited for spelling

The silence speaks volumes.

Hi Krysteen I have been pinched, scratched, bitten, punched, kicked spit at/on and groped. For the most part the patients that have done these things have had extensive histories of dementia and in these cases they cannot be held accountable for thier actions. Being groped and hit on by drunks is just a natural as well, as they are impaired by the alcohol. Although my counselor, many years ago, told me that alcohol only takes thier inhibitions away and makes it easier to act this way. But then again, some people just dont care who they hurt.