HOSP-ITALITY ABUSE

[Adam Swartz]

I think that it is proof of how screwed up the current Health Care System is as a whole. What needs to happen when they fix the healthcare system is start at the bottom. Has anybody ever thought about the fact that maybe the hospital's give them the info but don't offer these people a way to get there? Or they see them soo much that they don't feel like helping them at all anymore? We need to fix the system and stop just bandaging it. To fix it though you need a strong foundation that will not collapse with each additional floor that is added.

Thanks for letting me rant,

Adam Swartz.

[VentMedic]

It is overwhelming which is why I say if I can make a difference for one patient, I've accomplished something.

Hospital Case Managers may have over 100 open cases at any given time and get 30 more each shift if they have ED call.

However, if attitudes persist or become prevalent throughout a system like an ED or even EMS that what good is it to try or who care since they don't care, then the whole process starts to break down.

Sometimes it just takes one person being persistent that there is a better way and they can make a difference.

Here's a feel good story.

http://www.kcbs.com/pages/194580.php?

Paramedic's H.O.M.E. Team Reaches Out to Homeless

(CBS 5) If you shop or work in downtown San Francisco, chances are good you've passed Larry in his wheelchair. But Niels Tangherlini doesn't pass by - he knows Larry's name, and all about his health problems and alcohol dependency.

"I've a little bit worried about some of the stuff I've been hearing," he tells Larry. "We picked you up two or three times on Thursday with the ambulance."

Niels is a San Francisco Paramedic Captain, and he's determined to get people like Larry to stop calling 9-1-1 and start getting their lives back on track.

"I have people who have made literally 100s of 911 calls," Niels explains. "The calls are often related to chronic alcoholism, seizures, intoxication, falls."

A paramedic for 15 years, Niels grew frustrated seeing the same faces again and again. So he envisioned a program where paramedics would partner with social service agencies, keeping the chronically homeless off the streets and getting them out of the emergency room.

"I realized you can sit and complain about it or really do something about it!" says Niels.

So in 2004, Niels founded HOME - the Homeless Outreach and Medical Emergency team. He recruited social workers to ride with paramedics and together, they began to coordinate different city services for the homeless. Two years later, there are only a third as many chronic callers to 9-1-1.

"We've been able to get people into supportive housing, ongoing alcohol and substance abuse treatment," he says. "Just the act of getting someone a case manager.. can just really change their life."

Social worker and nurse practitioner James Eskridge rides with Niels.

"This program is different because we are doing actually outreach on the streets with is basically front-line work," says James. "This is where we make the most difference."

They're not only making a difference to people on the street, but countless people who call 9-1-1 with a real emergency.

San Francisco Fire Chief Joanne Hayes-White says, "We're able to keep our units in service to respond to those Code 3 life-threatening emergencies that we otherwise might not be able to in the event of responding to a homeless person."

And she adds, Neil's' HOME Team is a win-win for the homeless and everyone else.

"Niels now is sort of an ambassador for the fire department as he works closely with other agencies reaching out to the homeless population. And we're really proud of him and we're really proud of the effectiveness of the program."

"I knew this would work," Niels says determinedly. "We really can make a huge difference in dealing with public health problems and that collaborative efforts like this are the best way to handle problems."

So for making non-emergencies a priority so that everyone gets the help they need, this week's Jefferson Award in the Bay Area goes to Niels Tangherlini.

[HERBIE1]

So because a few people know how to play the game we stereotype everyone that resembles them. Have some in EMS become so jaded that they take one story and say, "yep that sums it all up and none of them deserve the benefit of the doubt?"

Explain that statement.

Our job is to evaluate their immediate needs and transport them to the hospital.

At least John Q Citizen still cares enough to make a call. He/she could easily look the other way. But then they may be under the impression that they are calling people who might care and not cop an attitude that it is just another mucked up homeless junkie wanting something. After all, for some in EMS it is not about what we can do for the patient.

When John Q Citizen sees a homeless person lying on the street, they call for a multitude of reasons depending on where they are. Yes, usually they think the person is sick, but often they want him off their property, he's an eyesore they want out of their area, etc. When we arrive, we take care of their immediate medical needs and provide transport for them to the hospital for DEFINITIVE CARE.

Problem is, I find that the 5 -7 minute transport time is generally not enough to solve their chemical dependency issues, provide shelter for them, provide therapy for their emotional and psychological issues, offer financial advice, provide job training skills. and obtain gainful employment for them. Those are just some of the reasons someone lives on the streets. For all these years, I mistakenly thought that people like therapists, social workers, crisis workers, interventionists, financial planners, detox centers, housing advocates, and counselors were TRAINED to handle those things. Clearly, I have failed in my duties as an EMS provider, but thankfully we have people like you to pick up the slack. I bow to your prehospital care prowess.

[VentMedic]

Problem is, I find that the 5 -7 minute transport time is generally not enough to solve their chemical dependency issues, provide shelter for them, provide therapy for their emotional and psychological issues, offer financial advice, provide job training skills. and obtain gainful employment for them. Those are just some of the reasons someone lives on the streets. For all these years, I mistakenly thought that people like therapists, social workers, crisis workers, interventionists, financial planners, detox centers, housing advocates, and counselors were TRAINED to handle those things. Clearly, I have failed in my duties as an EMS provider, but thankfully we have people like you to pick up the slack. I bow to your prehospital care prowess.

Have you even bothered to read any of the posts by myself or docharris? If you did you would have seen how and where EMS providers fit in.

You believe that the EMS provider can do nothing more than provide a ride to the hospital but fail to see where you could make even a slight difference without even getting anymore of that awful education stuff.

Since you also brought al of this up, let me give you more examples and you may even be who I am talking about.

Even though it is mandatory in all states to report elder and child abuse, many in EMS believe they just need to drop the patient off at the ED and say, "I think this person is living in an abusive enviroment" and then leave. The EMS providers believe the RNs will notify Case Managers and the State agency as well as filling out the report. The problem is they may not have witnessed what those in EMS saw. Yet, those in EMS believe "it's not my job", "I just bring them to the hospital", "I don't want to get involved", "It means more paper work".

I

Edited July 15, 2009 by VentMedic

[subliminal]

Have you even bothered to read any of the posts by myself or docharris? If you did you would have seen how and where EMS providers fit in.

You believe that the EMS provider can do nothing more than provide a ride to the hospital but fail to see where you could make even a slight difference without even getting anymore of that awful education stuff.

Since you also brought al of this up, let me give you more examples and you may even be who I am talking about.

Even though it is mandatory in all states to report elder and child abuse, many in EMS believe they just need to drop the patient off at the ED and say, "I think this person is living in an abusive enviroment" and then leave. The EMS providers believe the RNs will notify Case Managers and the State agency as well as filling out the report. The problem is they may not have witnessed what those in EMS saw. Yet, those in EMS believe "it's not my job", "I just bring them to the hospital", "I don't want to get involved", "It means more paper work".

I

Its been my experience that 9 times out of 10 homeless people are in the positions they are in because it is their own choice, No amount of assistance is going to help them until if and when they themselves ever decide to change. You could walk up to one and give them enough money to live off of for a few years and they would be in the exact same spot tomorrow. I have no sympathy whatsoever for those types of people. It is not our job as EMS providers to save them from themselves. Just treat them as you would any other patient

[HERBIE1]

Have you even bothered to read any of the posts by myself or docharris? If you did you would have seen how and where EMS providers fit in.

You believe that the EMS provider can do nothing more than provide a ride to the hospital but fail to see where you could make even a slight difference without even getting anymore of that awful education stuff.

Save the "education" speech- I'm a lifelong learner. I've been taking and teaching classes my entire adult life.

Since you also brought al of this up, let me give you more examples and you may even be who I am talking about.

Even though it is mandatory in all states to report elder and child abuse, many in EMS believe they just need to drop the patient off at the ED and say, "I think this person is living in an abusive enviroment" and then leave. The EMS providers believe the RNs will notify Case Managers and the State agency as well as filling out the report. The problem is they may not have witnessed what those in EMS saw. Yet, those in EMS believe "it's not my job", "I just bring them to the hospital", "I don't want to get involved", "It means more paper work".

It's not about paper work or not wanting to get involved, it's about time management, and proper utilization of resources. In a busy urban system, crews may essentially run back to back calls their entire 24 hour shift. Tell me how much time should we take ensuring the proper social service agencies are notified, a case manager is assigned, a therapist is notified, etc? Every time I have initiated these contacts- mainly for issues of elderly abuse and/or neglect, after countless phone calls, and a couple hours, in the end, the person and/or their family are still the ones who need to follow up and seek this help. They need to make and keep the appointment, and unless you suggest we also drive someone to their AA meetings or housing assistance agencies, how far should we take this?

I don't know about your area, but our system cannot afford to have units and personnel tied up for that length of time. We have very strict turn around time limits because there is usually another call waiting. We need to justify any delay in returning the unit to service.

I'm sorry, but this is like triage. We can spend hours on personally obtaining social services for one person or we can notify the MANY TRAINED people who do this for a living all day, every day, and have all the necessary contact information at their fingertips. I have a hard time justifying playing social worker for 2 hours when we could be helping a couple people who need the skills we have been trained to use. If a department wants to assign a social service liaison whose only job is to track the homeless and frequent flyers, that's fine. I suggest it is an inappropriate use of your street assets to have them playing social worker, and most organizations would have a hard time selling that idea to their bean counters. If a unit is tied up, another one must cover their area, which delays the response, the snowball effect ensues, and it may take hours before the system recover.

Again, if you want to be a social worker, change careers. We should do what we can- within reason.

Sorry, I'm being honest.

[subliminal]

Save the "education" speech- I'm a lifelong learner. I've been taking and teaching classes my entire adult life.

It's not about paper work or not wanting to get involved, it's about time management, and proper utilization of resources. In a busy urban system, crews may essentially run back to back calls their entire 24 hour shift. Tell me how much time should we take ensuring the proper social service agencies are notified, a case manager is assigned, a therapist is notified, etc? Every time I have initiated these contacts- mainly for issues of elderly abuse and/or neglect, after countless phone calls, and a couple hours, in the end, the person and/or their family are still the ones who need to follow up and seek this help. They need to make and keep the appointment, and unless you suggest we also drive someone to their AA meetings or housing assistance agencies, how far should we take this?

I don't know about your area, but our system cannot afford to have units and personnel tied up for that length of time. We have very strict turn around time limits because there is usually another call waiting. We need to justify any delay in returning the unit to service.

I'm sorry, but this is like triage. We can spend hours on personally obtaining social services for one person or we can notify the MANY TRAINED people who do this for a living all day, every day, and have all the necessary contact information at their fingertips. I have a hard time justifying playing social worker for 2 hours when we could be helping a couple people who need the skills we have been trained to use. If a department wants to assign a social service liaison whose only job is to track the homeless and frequent flyers, that's fine. I suggest it is an inappropriate use of your street assets to have them playing social worker, and most organizations would have a hard time selling that idea to their bean counters. If a unit is tied up, another one must cover their area, which delays the response, the snowball effect ensues, and it may take hours before the system recover.

Again, if you want to be a social worker, change careers. We should do what we can- within reason.

Sorry, I'm being honest.

Hit the nail on the head.

[VentMedic]

Its been my experience that 9 times out of 10 homeless people are in the positions they are in because it is their own choice, No amount of assistance is going to help them until if and when they themselves ever decide to change. You could walk up to one and give them enough money to live off of for a few years and they would be in the exact same spot tomorrow. I have no sympathy whatsoever for those types of people. It is not our job as EMS providers to save them from themselves. Just treat them as you would any other patient

I guess you haven't really looked at who is on the streets lately in this economy. Being blind to societies problems as humans and healthcare professionals is just a cop out.

It's not about paper work or not wanting to get involved, it's about time management, and proper utilization of resources. In a busy urban system, crews may essentially run back to back calls their entire 24 hour shift. Tell me how much time should we take ensuring the proper social service agencies are notified, a case manager is assigned, a therapist is notified, etc? Every time I have initiated these contacts- mainly for issues of elderly abuse and/or neglect, after countless phone calls, and a couple hours, in the end, the person and/or their family are still the ones who need to follow up and seek this help. They need to make and keep the appointment, and unless you suggest we also drive someone to their AA meetings or housing assistance agencies, how far should we take this?

Any you still didn't read any posts or probably have never examined the protocols of other services. Thus, it is useless to carry on an intelligent conversation with such a jaded and burnt out individual such as yourself. While you continue to make excuses, examples have been given how even a little can help a lot and differences have been made by those in EMS. Yes let's keep EMS in the stone age and let the other medical professions worry about how to treat everyone, homeless included, while you just stick to being an ambulance driver. Ever wonder why other healthcare professions are successful? They come together for what is best for the patient and not what the patient is supposed to do for the provider.

Edited July 16, 2009 by VentMedic

[Eydawn]

Ruh roh. Vent? The lack of grammar isn't like you. What's up?

--Wendy

[subliminal]

Coming from someone who has been on the street myself I can assure you MOST of the people on the street are there by their own choice and actions. The normal people who have a bit of bad luck and are put out on the street seek help and their situation is usually temporary, the bums and drug addicts out on the street have no desire whatsoever to change.

When I was younger my dad volunteered at a homeless shelter in Lee County Florida which I was with him there quite often. So needless to say I have plenty of experience with these types of people.

Its just like that old saying "You can lead a horse to water but you cant make him drink"

Edited July 16, 2009 by subliminal