JPINFV

Imagine how bad it's going to be if noctors get independent practice rights. Know less than a physician, but with a chip on their shoulder about it.

I don't know, but with how I'm reading the following posts, it seems that a few people think it does. ...and when I proposed the office call as a reason why the physician wouldn't need to ride along, the following reply occured A patient in a doctor's office has begun care of the patient, determined that an emergency condition exists and that the patient needs to be referred expediently to an emergency department while being monitored. Given the above responses, it seems that some would want to force the referring physician to ride along with the ambulance.

Just curious (since this plays to the entire point of my post with various reasons why a physician might be on scene), but if you get called to transport a patient at a doctor's office, do you give the same speech/card to the office staff and physician?

It's going to really depend on the situation. In general, most protocols state that if a physician walks up and wants to assume care of the patient after EMS was started treatment, then they're required to go along with the transport. That, however, is a different situation than a crew responding to a scene where a physician has already started care and is willing to turn over care to the crew. Otherwise, it would be like saying that on a 911 call to a doctor's office or other health care facility with a physician on site that the physician would have to go with the transport.

D: Optional with parental opt-out. I vaguely remember "sex ed" (mostly focused on puberty than actual sex) in 5th and 7th grades. I don't really remember what in terms of contraception was covered. I don't know what was covered in high school because students with impacted schedules (in my case, band with a full load of AP courses meant that I didn't have any extra space in my schedule) were allowed to test out of the health course requirement. Apparently that is no longer an option with students required to take the course either over summer or at night if they can't legitimately accommodate the health class into their school schedule. One of the big issues is that the course is only a semester long, so it leaves a hole in students schedules that might not otherwise be there.

What surprises me is that so many administrators and managers are so bad at economics. It's like they don't realize the cost of new employees in both dollar amount (about $600 for an EMT to go through orientation and field training and orientation) and efficiency (the longer you're with a company, the more you know the ins and outs of that company and the local system, so the faster you are) to think that high turnover is saving money.

Yea, but anyone who watches NCIS knows that the book will eventually make it to the work place.

A bastardization of "LOL." It's called "Safe Surrender" in California and it's state wide.

Since it doesn't sound related to neuro (or at least the half covered so far), blood and lymph, or OMM, I'm going to have to take the physical challenge.

To be fair, the difficulty has ranged from the first question on "On You Smarter Than a 5th Grader" to Final Jeopardy level with most of the questions somewhere in the first round of Jeopardy.

Extracation and pelvic immobilization. What is the name for a pupil the constricts during accommodation, but not to direct light stimulation?

...or maybe it was a response to... How about we not put words in my mouth when I'm replying to one specific part of a post? If someone is going to have a legitimate gripe, it helps if parts of that gripe show ignorance of proper patient care.

...and this is why issues like emergency ambulance service needs to be regulated more than "Rotation Roulette." There are multiple sides that I can see. First off, why the hell not have a mutual aid contract? Next, I can completely understand not adding additional ambulance services onto a rotation. Add too many services and you spread them out so sparsely that no one wins. Hell, there should be 1 service providing primary response and the rest providing mutual aid. Similarly, I can completely understand the argument of "We'll respond, just put us on the rotation. No? Ok, we'll pick up our toys and go home." Similarly, if they are contracted to provide services to a specific area, what happens if they vacate that area for an area that didn't want them and then a call for that area comes in?

Here's something else when it comes to respect. How about adults try modeling respect, including showing children respect? Sorry, but adults aren't owed extra special bonus respect because we've manage to not die nor does managing to not die entitle someone to lord over someone else because they're younger than 18. However, all too often people expect "respect" from children while being grade A A-holes.

Here's an idea. How about first we focus on getting teachers who know how to actually teach. One of my main issues with the concept of corporal punishment in schools is that there are too many idiots working in schools. The last thing I want to hear about is some teacher beating little Johnny because little Johnny showed up the teacher and proved him/her wrong, and thus was "disrespectful" or "talked back." I don't want to hear stories about little Susie being beaten at school because little Susie was working ahead, and thus wasn't staying "on assignment" because she was already done with that assignment. Just as there are too many parents who think that it is everyone's but their own job to raise their kids, there are too many little tyrants holding teaching positions to allow the schools to spank children.

To be fair, my understanding is that a nasal cannula is appropriate for patients suffering from chest pain absent shortness of breath. If the hospital they are transporting to has a cathlab and it's only a 5 minute transport, why waste time calling for paramedics?

http://www.youtube.com/watch?v=xwBK31tC5QM

It's also why you never go full retard.

I never got how this is really a problem. Even where it snows, the vast majority of times it doesn't get that cold while you're on scene to necessitate keeping the engine running while out of the vehicle. All you have to do is make it a habit to have the heat on in the back whether a patient is on board or not. Similarly, if the ambulance is parked anyplace outside of the middle of the road (parking lots, almost anyplace with a curb, etc), then you really don't need your rolling disco show to be operating. Unless you have a huge problem locating where you parked, this eliminates another huge reason why crews leave the engine running. Of course if the engine isn't running, there's no reason to leave the keys in it and there's never a reason to leave the ambulance unlocked.

"Horak said San Bernardino paramedics have recently taken on training to detect heart attacks with what's called 12 lead EKG technology and to deliver medication directly into the bone marrow if a patient's lungs are collapsed."

I think a part of the problem is the "related" threads that show up on the bottom of a thread. More than once I've caught myself looking at them and thinking, "Gee... I remember that thread from a while ago, who bumped it" only to see that there is no bump (or spoon).

I honestly don't have the time right now to pour over statistics for your arguments. If you have easy access to the statistics, then just post them. You brought them to the table, it's your job to provide a citation. So until you decide to post the source, this is going to be decisively a [citation needed]. If I'm bashing NRP, then the AAP is bashing its own program. Of course, everything stated here could just as easily be stated about the hospital. Maybe the hospital realized their limitations in caring for this patient? There's a big difference between advocating for a particular system and realizing a "damned if you do, damned if you don't" situation. Stopped reading here as ERDoc has already posted a refute to this. Not every hospital has those devices. Strangely enough. I'll ask again, since apparently you didn't see it. Is neonatal intubations within the scope of practice for paramedics in Florida? If it is, then the baby was with someone who should have been able to intubate the patient. Are you going to expect a little miniskills exam in the hospital prior to every transport? What would you do if you were on a CCT and the first thing the physician said to you was, "Intubate this manikin"? Furthermore, if a neonatal recovery team arrived, then they aren't going to be transporting anyone until the baby is born (which, in reality, could take a while. Remember, we're seeing this with 20/20 hind sight) because I highly doubt that they're going to be able to transport the mother in the same ambulance as the isolette. There simply isn't enough room for the isolette and a stretcher in the same vehicle. So if it had taken 2 hours instead of 15 minutes, then the team would be standing around for 2 hours in the ER. Again, damned if they do, damned if they don't. That's a good idea... Let's deliver the baby in a helicopter at 5,000 feet. Also, (I'll ask it again in this thread, in case you missed it), if paramedics are allowed to do neonatal intubations, then the paramedic supposedly has the ability to establish an airway. If the mother is not progressing or has contractions pharmaceutical suppressed, how long do you wait until you transport? It's all situational dependent. As I've said earlier, the trauma patient at the little community hospital may require procedures outside the scope of the transporting crew, however you aren't going to just let the trauma patient sit at the local community hospital with no trauma services all day long. Similarly, and since we're talking generalities, I'm not going to expect the hospital to send one of the 2 nurses in the ER or the only physician available for a 2 hour ride when there is no other options. Sometimes both ends of the stick are dirty. Additionally, you use the resources you have available, not the resources you ideally want. To properly compare this, if an EMT-B crew assesses a patient as outside of their ability, they should go to the nursing station, tell them to call 911, and then leave. That is what is being advocated in this case and I guarantee you that any EMT-B who does this (just ups and leaves telling the SNF "no") will be hung. If a paramedic is allowed to do something then they should be trained and educated to do it. Period. Otherwise remove it from the scope of practice. The transferring physician doesn't know what each and every paramedic's competency level is and has no real method of checking said competency. Furthermore, if the physician can't be sure what part of the scope of practice any crew is comfortable with or not comfortable with, then why even have those providers?

I went through your public records page listed on the first page. No where does it list a study that says that in-hospital resuscitation rates for 25 week premature babies is 80% in the hospital and 50% elsewhere. You cited JEMS in your original post. The JEMS article does not make such a distinction. I'm not going to do your research for you. I'm not arguing about competence. I'm purely quoting from the AAP's website that you posted from, and I'm sure that the AAP can attest as to what their course does an does not do. Again, "Completion of the program does not imply that an individual has the competence to perform neonatal resuscitation. Each hospital is responsible for determining the level of competence and qualifications required for someone to assume clinical responsibility for neonatal resuscitation" is a direct quote from their website, and not something I just made up on the spot. http://www.aap.org/nrp/about/about_coursedescrp.html I enjoy how you talk about physicians coming into contact with these patients because EM physicians are not working in areas where they regularly come into contact with these patients. So... alphabet soup courses are all the same except when it comes to this one course? Even though the people running the course state otherwise? The GP vs OB is a non-sequitar since there is no OB present. I checked Bert Fish's physician directory on their website. They don't even have an OB on staff. Hence it is an apples to oranges comparison. What I'm arguing is that the hospital isn't some sort of magical fairyland where every service is always offered, of procedure atrophy doesn't apply, and every piece of medical equipment ever made is readily available. I guess we could be making the argument that how dare that hospital not have a NICU and labor and delivery services. EMS loves saying, "Any port [ER] in a storm," but sometimes that means you are the Exxon Valdez in Valdez harbor. I'm also arguing that if the clinical assessment was that the patient would be able to make it through the transport without problems, then that's what you work off of. Not everyone, but enough that OB services in many parts of the country are hampered because of a lack of OBs willing to practice there. Sure, it might not be 100%, but it doesn't have to be anywhere close to that. Sigh... Yea... because I'm the great Defender of the EMS Faith who has never, NEVER criticized EMS education. Yep... that's me. :/

I'd argue that this is a case where the hospital isn't going to be at a huge advantage. Do you not think that physicians suffer from skill atrophy also? Yes, a physician who has more education than a paramedic, but I wouldn't want to be the first patient that a surgeon operates on if he hasn't operated on anyone in years. You say it does not take long, but why would it take a significantly shorter amount of time for the hospital recovery team to be dispatched, assemble, and respond then the ambulance that ended up transporting? Furthermore, since when does completing a merit badge course mean that someone is competent to direct care? Thread after thread, the point has been made that just because someone is "ACLS certified" doesn't mean that they are the right person to run a resuscitation. Heck, even the American Academy of Pediatrics states on their website in regard to NRP, that it "is an educational program that introduces the concepts and basic skills of neonatal resuscitation. Completion of the program does not imply that an individual has the competence to perform neonatal resuscitation." Emphasis added. I would advance that an entity settling isn't an indication of guilt or innocence. I'd also argue that this is a case of damned if you do, damned if you don't. If the baby was born an hour later while waiting for the recovery team and suffered any complication at all, the lawsuit would be that the hospital didn't transport, knowing that they lack the proper capabilities to care for patients in labor and neonates, little less premature neonates. After all, only birth that occurs on a set schedule is that of Baby New Year. Furthermore, the ambulance company would still be named for refusing the transport. After all, I guarantee you that the jury doesn't care about what the paramedics can and can't do for a premature neonate. Adverse outcome, especially in children, means someone has to pay, and the more the better. Additionally, if the cervix is "minimally dilated" according to the transfer physician, how long is it reasonable to believe that they have until the baby is delivered? Furthermore, every emergency interfacility transport results in a decrease in the level of care available to that patient with the end goal of getting the patient to a higher and more appropriate level of care. Should trauma patients that end up at Medical Center of Podunk Nowhere be required to be escorted by the transferring physician because the paramedics lack the same ability to intervene as the hospital? What happens if there is no staff available to send away for 2 hours. After all, you can't shut down all or half of the ER because one of the one or two physicians on has to escort the patient. Furthermore, are paramedics in Florida allowed to intubate newborns? If so, then why is it inconceivable that the transferring physician expect that the paramedic can perform to his scope of practice? Do you have a source for the actual statistic because the JEMS article does not specify which environment has the 50% survival rate, or if that's the overall survival rate. Nice false dichotomy and appeal to emotion in that first sentence. So apparently the only two choices are to blame the crew or blame the baby. Can we play the same blame game when ever there's an adverse outcome? After all, who's fault is it when someone dies due to a MVC at a non-trauma hospital? The patient or the hospital that didn't have the proper equipment or training to do trauma surgery? No, but if I use this as precedent, then I shouldn't accept care of a patient at a SNF suffering from any life threatening emergency. Sure, the emergency room might be only 5 minutes away (and, thus, closer than a paramedic response), but the SNF should be able to handle the patient better than I can. Also, really? We're going to compare EMT-Bs to paramedics now? Similarly, if the patient needs any intervention that the SNF can supply that the paramedics can't, then the paramedics should refuse to transport as well. Especially if there's a respiratory emergency and the SNF has an RT on site. After all, we wouldn't want the paramedics to decrease the level of care available, even if the emergency department can offer significantly better care than the SNF.

Serious question. What sort of expertise and equipment can be expected to be found at a community hospital that doesn't even offer OB services? While I have questions regarding destination and transport choices (for example, Medical Center of Daytona has NICU capabilities and is only 17 miles and a few turns away. I'd argue that any NICU is better than an emergency room at a hospital with zero L&D services past a physician whose last uncomplicated delivery was God knows when), I also have serious questions as to just how much better a community ED is especially if the possibility exists that the transport can be completed prior to delivery. As far as the verdict, all the jury needs to hear is "injured baby" and you get your checkbook out. There's a reason why OB/Gyn has enormous malpractice insurance premiums, and I refuse to believe that OB/Gyn is just filled with idiots who don't know how to practice. Of course malpractice suits often have more to do with outcome than actual malpractice.