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This guy doesn't seem to happy with Rural Metro's services in Arizona: http://www.ripoffreport.com/inspections-hazards/rural-metro/rural-metro-southwest-ambulanc-58fba.htm Wow, 2500 smackers for driving by some steam? That's a lot. Then there's this little criticism of their financial practices: http://www.sandiegoreader.com/news/2011/may/04/radar-rural-metro-million-secret/ Wahn wahn wahhhnnnn

The problem I have with the OWS protesters is that they are a group of the most dependent, tech-crippled group ever. No generation ever more in history has depended on the service industry to supply their basic needs. At any time any one of them could get a group of friends together and form a socialist based subsistence agriculture commune. They used to do it in the 1960's all the time. But then there would be no Twitter, no Xbox, no iPhone. They are absolute hypocrites. They are the generation that wasn't ever allowed to use a knife or climb a tree or keep score in baseball. Give up those things first, then talk to me about making a change.

And yet again, profit-driven healthcare is at odds with quality healthcare administration. Rural settings have the problem of retaining employees. If you pay them less, they will leave for higher wages.

IMHO, the fact that your employer has to come out with a policy statement about ringtones says a lot about the level of professionalism of the people they employ. When exactly did common sense die and how come I wasn't invited to the funeral?

Pros: Professional, objective discussion about prehospital care without the usual jingoism bullshit. Cons: Not always being the smartest guy in the room. Actually being proven to be wrong. Or so I've heard. When you come in and talk amongst your friends and colleagues, a beer does not pop out of your computer and put on ErDoc's tab.

I don't get people. On one hand they scream that any regulation or enforcement actions are an intrusion into the free-market economy, then they complain when that same lack of regulation and enforcement results in people writing "ambulance" on the side of a van and having all sorts of fun and hijinks. It happens every single time. Deregulate banks, Wall Street fraud and toxic mortgages happen. Deregulate medical systems, and horrible patient care happens. Deregulate food standards, and allowable insect parts per scoop of ice cream increases. The argument that a free-market would self-regulate this by allowing intelligent consumer choices to favor the superior product is not valid. A consumer cannot be expected to know what drugs need to be administered and when to their family member, nor can they be expected to be able to detect if each and every one of those specks in their ice cream is a piece of vanilla or a piece of cockroach. In my mortgages and lending example, even I would argue that getting a 30 year mortgage when you have no job is a really stupid idea and you only have yourself to blame when you can't make payments is your own damn fault, but it should be clear that the problems we had with Wall Street happened after banks were allowed sweeping deregulation. Whether an entity is public or private, if they provide a public service they need to be directly accountable to the public, whether its the KCFD or AMR.

The free market enforces good quality patient service? You can't back up that argument. The consumer can not be expected to be educated enough in all matters of emergency medicine to make appropriate healthcare decisions based on quality of service. Private EMS runs on the hot cocoa principle. That is, patients won't really care if your service completely f---ed up and failed to treat a routine malady and resulted in the death of one of their loved ones so long as you say nice things and bring them hot cocoa in the "quiet room". That's why your mantra is "customer service," "customer service, "customer service." Not "Quality healthcare!" When it works is the operative word there. With a substantial lack of oversight in EMS, it relies on local entities that suffer from underfunding, disinterest, and sometimes out and out conflict of interest when it comes to those same checks and balances. That would be "trade secrets" protected by law versus the Freedom of Information Act, now wouldn't it?

You mean having your supporters boo American soldiers and cheer the though of people dying isn't a guaranteed win? What do you mean?

At least he's honest. Relatively speaking.

Bieber, first off, your captain was completely and utterly flat assed wrong, and you can tell him I said that. Unfortunately, working under supervisors who lack the medical knowledge and training to adequately discharge their duties is just one of the many joys of working EMS. He was wrong on many levels. First off, as people have pointed out, having a patient with an ETT tube in place without some form of sedation is inhumane, and tantamount to torture in my mind. Secondly, what the hell is he talking about "respiratory drive"? You know that thing called the BVM? That's the patient's respiratory drive. Unless we do something to permanently alter the patient's physiology, once they have a secured airway, we can depress the respiratory functions all we want. We can even paralyze it. That's what paralytics like succinylcholine do. The dilemma that EMS runs into is that administrative hierarchy vs. medical hierarchy, especially in a paramilitary themed service. While the captain/lieutenant/commodore/admiral of your service may be the one who will be making your life miserable when you go and pretty disorder, ultimately, patient care will fall on you, and your orders rely on what the doctor and your protocols tell you. The advice I always give is that you want to serve medical hierarchy first. Not only is in the realm of good ethics to disobey an order that is contrary to the patient's best interest (even the Uniform Code of Military Justice basically says that disobeying an illegal order is as much of duty as obeying direct orders is), but from a practical, selfish standpoint, the worse thing that can happen if you disobey a supervisor is you that you get fired. It happens. You can get another job. If you disobey a medical order or act against the patient's best interests, you can lose your entire certification and your career in EMS. The best thing to do in a situation like that is politely state to your superior that you don't feel comfortable and would like to contact telemetry with how to proceed. Do it diplomatically. But there is no captain or chief or supreme allied commander who will go against a director order from a physician. Everybody answers to somebody, and everybody fears the physician.

Excuse me, but the statements I take most from nurse's professional literature is that nurses can and do heal with their magical angel hands. So watch yourself, mister.

There is one question I would like to specifically pose to one candidate, Michelle Bachman. That question is: "If you believed in your heart that God was speaking to you and telling you to launch a nuclear weapon at a specific target, would you do so?" I would like to pose that question to her and any other candidate that talks about God speaking to them before handing over the nuclear launch codes. I'm paranoid about that type of thing. Prayer: Good. Religion: Fine. Voices in your head telling you to do things: WHOA HOLD UP THERE A SECOND GIVE ME BACK THE NUCLEAR FOOTBALL...

I heard a car crash killed Princess Diana. Geez man, at least go with Michael Jackson's physician if you want a good example. Yes, he wasn't on an ambulance, but boy, what a screw up. I think paramedics trained as RN's are the best providers out there. Your day to day RN on an emergency scene? Ummmm, not so much. I'm not sure what it is about RN training that makes them fall apart on the scene of an emergency but its been my luck that it has happened unilaterally with me. I can give you the horror stories of ACLS instructors and RN sometimes but you probably get the picture. Paramedics: Good in an emergency, bad at just about everything else. RNs: Good at everything else except emergencies.

IHLPP seems to be dodging my questions, but I'll try again: IHLPP: Has your company discussed with your State EMS oversight department about transporting patients in the manner you described? I mean, that would end the argument right there.

Wow... not knowing the difference between 'restraint' as in "a device to prevent injury during a motor vehicle collision" and 'restraint' as in "a device used to prevent the movement of an unruly patient." Really? That's what you're saying? I also find your logic dubious. "They don't always put the rails up in the ER, so its perfectly okay to go routinely transporting patients unrestrained." As for 911 'paragods' (really? you went there? I'd expect that from a 19 year old EMT-B but a manager for an organization?) the issue is that there is an urgent, life threatening situation occurring and that is the ONLY time where it is ethical or proper to make adjustments to written protocol. When someone's life depends on it. Not when its convenient. Not when its getting close to the end of your shift or when it'll save your company a buck. This is fairly obvious logic. At this point you're just at the bottom of the hole and keep asking for shovels.

HLPP, there is a difference between a 911 emergent transport and a routine interfacility transport. A 911 transport (supposedly) is for a life threatening condition. In a true emergent situation, you can get a little creative. They had to use a flat bed truck to get a 1000+ man to the hospital in one case I am aware of. But the situations of discharge to rehab or discharge to home are not emergent situations, they are routine medical transport situations. You might even be able to sell me on doing it in with a person going from a local ER to an angioplasty or stroke center, but routinely doing it for medical transport purposes is not safe nor ethical. If you service anticipates routinely transporting bariatric patients in non-emergent situations, then it needs to have equipment to do so.

So this is what I've learned from the State of Georgia's website. 1. You have to wear a seatbelt in a motor vehicle if you are in the front seat. 2. You can't ride in the bed of a pickup truck on the interstate if you are under 18. You can ride on the interstate in the back of a pickup if you are over 18, or on back roads if under 18. 3. Ambulances are required to be equipped with seat belts for all passengers. I can't find anywhere it says conclusively that patients must be properly seat belted for transport, but I still have a sneaking suspicion that the State would go with #3 above when they were levying a hefty fine on you. The beauty part is that many times fines like that fall on the crew for engaging in an unsafe act rather than the company, even if the crew was under the threat of termination when doing so. Sucks, doesn't it?

I read back some of ihate's posts, and unfortunately as is all too common when reading what passes for operational standards in EMS, I am horrified. Let me get this straight about your service and apparently your facilities: 1. You transport people unsecured all the time. 2. You bend and break the rules all the time. 3. Your ICU nurses administer a powerful cardiac medication outside of the guidelines that is set. 4. This culture and manner of thinking is so entrenched that have no problem representing yourself as a person in a supervisory position and advertise on the internet that this the way your company does business. Unfortunately, I have seen this all the time. An ambulance company sets up shop and hires and fires through lists of EMT-B's while getting away with as much as possible when the State isn't looking. And just so you know, if a child is in cardiac arrest removal from a car seat is the proper course of action in that airway and circulatory compromise take precedence over spinal precautions, when necessary. The fact that you compare your taxi service to legitimate emergency response and transportation is pretty sad. Like I said unfortunately for patients supervisors like you and companies like yours are very commonplace and are poster children for increased standards in EMS and medical transport.

I hate little etc. etc. etc.... Question, if I relayed your company's policy of routinely transporting unrestrained patients to your local EMS governing body, what do you think their response would be? Here's the thing that managers like you in the privates miss from time to time: There are RULES and LAWS that govern the transportation and treatment of patients. Just because you say its safe, and just because you and other managers decided something its okay, does not make it so. While rules do vary from state to state, I can not imagine a State EMS agency that would tolerate shoehorning a hospital bed into the back of an ambulance. Now, if the great State of Georgia really says its a-okay to routinely transport unrestrained patients on hospital beds in the back of ambulances, well, color me surprised. But I don't think thats the case. I think the case is that your organization routinely breaks the law to make a buck.

I find your fellow student's desire to induce fractures in the thoracic area of patients to not be in keeping with the principle of primum non nocere. Please do me a favor and tell him I said that he should find alternate means of entertainment and leave medical care to the professionals, which he is not now, nor ever will be. Seriously. Tell him I said that and get back to me.

Congratulations!

Nobody waste anymore time on this guy. I was right in my original suspicion that it is a troll. Ignore him, lock the thread, move on.

Dammit, I knew he was trollbait. Flush him.

I would love too.

Mike, I feel for you. Unfortunately, of police, fire and EMS, EMS is currently the least disciplined and least professional. I don't say that as a criticism but more of a problem to be worked on. In my years of EMS, I too have been shocked at the level of unprofessionalism I have encountered. Now, I'm not saying my uniforms were always pressed, but really I never encountered the concept of showing up to work without being showered and having clean clothes until I worked in EMS. I don't know how people's parents raised them or what exactly goes on in people's minds, but I have come to the conclusion that an unprofessional employee in any profession is not so much an indictment of someone's character as it is an indication of serious flaws in management. Supervisors are paid for a reason, to supervise. Unfortunately, I have found the prevailing trend in EMS is to kick responsibility of an unprofessional employee back down onto their partner. Supervisors will go out of their way to make it seem like their behavior is somehow your responsibility, and by approaching them you are somehow at fault for not being able to rectify the situation. That is complete garbage. It is not the responsibility of field employee to make sure people's teeth are brushed or they aren't acting like a yutz. That is a supervisor's duty. An employee who acts in such a manner indicates an overall lack of supervision and accountability at all levels, and it has the makings of a toxic system. I feel very sorry for your plight.