Your typical Lifeline call

[spenac]

Just as a side note, there are state and federal laws against volunteering time for your company. If you were to come in on your day off, and do patient education in the name of your company for free, you would be setting them up for a wage and labor lawsuit.

Actually as long as it is strictly voluntary it is not a problem. If it is like military volunteering where you are told you are volunteering then you open a can of worms. Now there may be some states that have different laws but in Texas you can have a combination service where some are paid and others are volunteer.

[HERBIE1]

Important side note there Brent thanks.

You interpreting someone's intent is pretty much invaluable. My interpretation of her intent differs, as I'm sure herbie's does and I'm sure that also differs from the other posters. Understanding patients feelings is one thing, I understand the patients need for their glasses to be picked up, I understand their need for the smoke detectors to be checked. I also understand they don't need to and shouldn't need to dial 9-1-1 for these things to get done. The solution for their problems is a 'complex social service issues' which I can not help. Being disgusted with a call is not the same as being disrespectful or unprofessional on a call.

Excellent summation.

NOBODY is saying these social service issues are not important, but we disagree when we are told this is somehow within the context of our jobs. As noted, some areas may have the time to address these problems while on duty, while in a busy area, it is simply impractical and essentially impossible.

[brentoli]

Ill clarify spen. You can't put in 8 hours at 10/hr and then the next 2 at 0/hr for the same company.

[HERBIE1]

Here's a story that illustrates my reluctance to accept the premise that we are somehow obligated to solve a patient's social service problems.

A few years ago, our area came up with a program to assist seniors at risk. A department of aging/gerontology expert was paired up with a police officer liaison for community outreach. As a result, we were informed that we needed to respond to these calls to medically assess and transport these patients as needed. We were also instructed to make every effort to comply with this advocate's wishes. One day we received such a call in a VERY expensive area of town. We were met at the door of a nice 2 flat brownstone by a frantic senior advocate and a LEO and told that they received a call from a nephew of this woman who lived out of state. He claimed his aunt was no longer able to care for herself, was not eating properly, and lived in a dangerous environment. As the outreach pair arrived, they knocked on the door, and announced they were there to help. The elderly woman let them in and went to her kitchen- she said she needed to finish doing her dishes. As they explained why they were there, the woman was first incredulous, then became afraid. She grabbed her coat and ran out of the house, screaming that nobody was going to take her from her home.

As we looked around the home, it was IMMACULATE. Not a speck of dirt anywhere. Full refrigerator and shelves, vitamins and an aspirin bottle neatly lined up on her counter. This advocate said we HAD to go after this woman. I asked the officer her opinion, and she said this seemed like a family matter. The woman had apparently lived in this area all her life- around 80 years, which means she bought the building when the neighborhood was very seedy. The house and lot were now worth well over a million dollars and the officer thought- and we agreed- the nephew was looking for a windfall by getting his aunt put in a nursing home.

We obliged, drove around looking for the woman, and we did catch up with her a couple blocks away- briefly. She was crying, saying that her family was trying to put her away to get her property and money. We could not examine her, but standing on the street, we asked her a couple quick medical questions and she said she had glaucoma- nothing more. She refused to allow further exam or transport and suddenly ran away from us as soon as she saw the advocate again. By this time, the advocate showed up and was yelling that we had to "grab her", and that the patient needed "help". I explained that we had no legal authority or medical reason to do that unless the officer placed her in protective custody, but the officer refused, saying she had no reason to do this.. I was asking the advocate the basis for why we needed to kidnap this patient- what she saw/knew that made her believe the patient was in danger or needed help. The advocate became irate with us, telling us to "do your job", threatening to call our bosses, the mayor, everyone else she could think of, and even threatened our jobs. We should take her in and the appropriate papers(I assume she meant involuntary commission) would be provided later. This is what the mayor wants us to do, she told us. As we left the scene, the advocate was frantically dialing her cell phone. I documented the encounter and within a few minutes, I was indeed explaining to bosses via phone, what happened.

I have no idea how this case turned out, but this is my point. We have NO idea the back story of situations we walk into and how complicated the family components can be. We had a supposed expert on seniors who took the word of an essentially anonymous 3rd party call as enough evidence that an intervention was needed on behalf of someone, even though all the claims of this concerned family member seemed to be BS. If we find someone living in squalor or an unsafe situation , then yes, it is our moral and legal obligation to help rectify that situation, but our jobs are about immediate care and life threats. We medically assess, describe our concerns, and relay the info to the APPROPRIATE people to follow up. I think it's the height of arrogance to walk into a situation and within a couple minutes assume we can "fix" or even correctly address what may be a very complex problem. That's like treating a chest pain patient with a couple of nitros and tell them not to worry, we don't feel it's necessary for them to go to the ER.

There is ALWAYS more to the story, and like the doctor's creed, we must first do no harm. I am NOT an expert on gerontology or social services but know enough to point someone in the right direction for help, or at the very least notify someone who is qualified to provide that help.

[spenac]

Ill clarify spen. You can't put in 8 hours at 10/hr and then the next 2 at 0/hr for the same company.

Actually I will disagree at least on the Federal and Texas level. Maybe your state has something like that. Here I can work for and volunteer at the same agency. If I have misread the labor laws please correct me.

[HERBIE1]

Actually I will disagree at least on the Federal and Texas level. Maybe your state has something like that. Here I can work for and volunteer at the same agency. If I have misread the labor laws please correct me.

Wouldn't the problem with volunteering for your employer depends on what duties you would be performing? If you are representing your company- regardless of whether you are being paid or not, in a legal sense, doesn't that mean an assumed approval and a tacit liability for what you do?

There's a legal concept called "respondeat superior", which means the employer answers for their employee. It's used in cases of misconduct/negligence of a person in the course of their duties where the employer assumes some accountability for a lack of training, supervision, etc if something goes wrong. I would assume that as long as the person is acting in some manner as an agent of their company the employer's liability extends to that situation whether the person is being paid or not.

Need some clarification from a lawyer here.

[brentoli]

When our service transitioned from volly to part time coverage, the town attorney told us the above. If anyone wanted to work part time they had to completely resign from the volly side and could only run calls during scheduled hours.

[Mateo_1387]

You interpreting someone's intent is pretty much invaluable. My interpretation of her intent differs, as I'm sure herbie's does and I'm sure that also differs from the other posters. Understanding patients feelings is one thing, I understand the patients need for their glasses to be picked up, I understand their need for the smoke detectors to be checked. I also understand they don't need to and shouldn't need to dial 9-1-1 for these things to get done. The solution for their problems is a 'complex social service issues' which I can not help. Being disgusted with a call is not the same as being disrespectful or unprofessional on a call.

I never said I interpreted her intent. I simply stated my impression of her posts is that they are upfront and honest. Interpreting her posts is not that hard either. She did not say 'tskstorm, HERBIE1, fix these people's complex social issues. It seems obvious she promoted finding a solution to your problem, which is answering lifeline calls for non emergency reasons, rather than just bitch about it. This may mean that you push the issue up the chain to get it fixed. Fixing a service issue (non-emergency lifeline calls) and fixing complex social issues are two very different things.

Excellent summation.

NOBODY is saying these social service issues are not important, but we disagree when we are told this is somehow within the context of our jobs. As noted, some areas may have the time to address these problems while on duty, while in a busy area, it is simply impractical and essentially impossible.

I think we agree, to a point. In order to fix your problem of answering these calls, Ventmedic recommended contacting the local agencies dealing with these patients and to educate the lifeline services on the proper use of emergency services. Again, this is probably a push it up the chain deal. Not saying for you to do all the leg work, plus run a busy shift, but rather to start working on improvement to fix the problem in your service and at the same time get the correct resources to the patient.

Here's a story that illustrates my reluctance to accept the premise that we are somehow obligated to solve a patient's social service problems.

<snip>

There is ALWAYS more to the story, and like the doctor's creed, we must first do no harm. I am NOT an expert on gerontology or social services but know enough to point someone in the right direction for help, or at the very least notify someone who is qualified to provide that help.

Exactly the point trying to be made. Its not all about you having to do the work. Something as simple as pointing someone in the right direction is a good start to fixing issues. Many EMS agencies work along side of police departments and fire departments, some go and provide educational classes to help them understand the roles of EMS and vice versa. Why not use the same techniques when dealing with other agencies? Why not take a few minutes to point the patient towards the correct resources? It seems that in the long run, the amount of money used to truly fix the problem will be less than to answer the calls and just 'dealing with the problem'. A few extra minutes on scene to help point someone towards the correct resources should decrease the number of calls, thus keeping ambulances available for more urgent/emergent type calls.

[tskstorm]

I never said I interpreted her intent. ...

I believe the intent of Vent's posting was to one, ...

yea I can see how you didn't interpret her intent.

[Kaisu]

yea I can see how you didn't interpret her intent.

See now, you can take a few words out of the context of the entire statement and score "points" in the debate. You would score a lot more points if you attempt to understand the meaning of the entire post in the context of the discussion. You are upset with the tone of Vent's posts. Matty is suggesting you look beyond that tone and perhaps learn and grow. Fundamentally, that is what this site is for. The lady knows waaaaaaaaay more than you do about respiratory pathology AND has spent more years than you've been alive trying to get to real solutions to the delivery of emergency health problems. Use the information to become a better provider.