As EMS/PHC Providers; Are We That Lazy?

[HERBIE1]

So I really don't see why were posting things like; not all patients should be transported, EMS are knowledgeable Providers, patients sometimes don't know when to call 911, we can provide emergent care to the sick or injured, or just because you need to go to the ER it doesn't mean you need an Ambulance.

We're talking about not DOCUMENTING; your verbal recollection is nice but if the written version is not the same or at least similar to the oral one; then it means nothing in the Court of Criminal or Civil Law. That's what's being pondered on.

The 2 cases; the Provider's documentation was lacking or not done at all. Attorneys will have a field day with them. We need to learn from their mistakes; not justifying them...

There were several issues here, and Kiwi offered that his service allows the provider to advise the patient they do not need an ambulance transport to an ER. I don't think anyone would argue that point is true, but like I said, most services do not have protocols in place that cover this.

The knowledge of the provider is not the issue, the failure to follow protocols is.

[Richard B the EMT]

NYCEMS9115, I think I figured out our descrepancy. While basic EMT instruction might not give the "how to" of filling out call reports, or ambulance driving, I was referring to my NEOP (New Employee Orientation Program) given me by the NYC Health and Hospitals Corportation EMS, circa my Appointment Day in 1985. I could post instructor's names, but they aren't on EMT City, that I am aware of.

[zippyRN]

Bieber, since when is leaving patients home to die a sign of clinical excellance ? Thats the problem with this generation, you are too concerned about the procedures and treatments you can do to a patient, versus good old fashion assessment. As long as you can do RSI or use a drill to IO someone, you think you have accomplished something. Be a patient advocate first, a paramedic practicum advocate second.

So you advocate being a taxi driver over using professional, education, knowledge and skills to direct your practice and determine what (if any )interventions you need to perform and what advice and information you give your patients? let's swap the LP12 for a AED and a taximeter ...

[crotchitymedic1986]

Hate to break the bad news to you zippy, but if you are a cop, you sometimes have to direct traffic in the rain, if you are a plumber you sometimes have to smell other peoples feces, and if you are a vet you sometimes get bit by animals. If you are a medic, sometimes you are a taxi driver. Let me ask you this zippyRN, I will assume you are a nurse since you have RN in your name; so how many patients do you routinely refuse to treat once you have done simple V/S in triage ? NONE !

[usalsfyre]

Hate to break the bad news to you zippy, but if you are a cop, you sometimes have to direct traffic in the rain, if you are a plumber you sometimes have to smell other peoples feces, and if you are a vet you sometimes get bit by animals. If you are a medic, sometimes you are a taxi driver. Let me ask you this zippyRN, I will assume you are a nurse since you have RN in your name; so how many patients do you routinely refuse to treat once you have done simple V/S in triage ? NONE !

So the appropriate treatment for everything is transport?

People are discharged from the ED with referrals to the appropriate services daily.

You fail at understanding if medicine as a whole...

[NYCEMS9115]

We need to forward this to a news media source. We need to educate the public. We need to advise them of their choices. We need to direct them to the proper resources.

Ok. Let's Re-Educate the aforesaid Providers regarding DOCUMENTATION. Remind them about signatures on the Call Report on Refusals.

I hope we can agree on this... We will not so; let the bashing restart again...

[zippyRN]

Hate to break the bad news to you zippy, but if you are a cop, you sometimes have to direct traffic in the rain, if you are a plumber you sometimes have to smell other peoples feces, and if you are a vet you sometimes get bit by animals. If you are a medic, sometimes you are a taxi driver. Let me ask you this zippyRN, I will assume you are a nurse since you have RN in your name; so how many patients do you routinely refuse to treat once you have done simple V/S in triage ? NONE !

hate to break it to you, we can re-direct from triage to other services ( usually out of hours primary care) and discharge from triage if there is no requirement to see another practitioner ( no need for legislation to prevent WALLET-ABC) ...

oh yeah, that's because I work in an evil socialised system where everyone has access to primary care, Registered Nurses and (Health Professional) Paramedics are trusted to use their knowledge, skills and experience as Practitioners and Doctors don't get paid per item of service.

Edited April 17, 2011 by zippyRN

[usalsfyre]

Ok. Let's Re-Educate the aforesaid Providers regarding DOCUMENTATION. Remind them about signatures on the Call Report on Refusals.

Reducate? If your too stupid to realize you need to doccument any time you assess a patient I think the reeducation will most likely be lost on you. Decertification, and don't let the door hit you in the ass on the way out...

I agree failure to doccument was probably these folks biggest failing.

[HellsBells]

I actually agree with Crotchity on this one; to a point. Now matter how good of a practitioner one is, we can't rule out every possible outcome for our pts.

Why? Two reasons: time and diagnostic tools. Our time of contact with pts is limited, over time the clinical picture can change. Sometimes, this may become obvious over the course of an ambulance transport, or while the pt sits in an ER waiting room.

The diagnostic tools we have are good, but limited. Labs can be important in determining pt Dx. For instance, a may be borderline septic, to the point its not overwhelmingly obvious, but a lactate measurement may help direct timely Tx in the ER.

[NYCEMS9115]

Reducate? If your too stupid to realize you need to doccument any time you assess a patient I think the reeducation will most likely be lost on you. Decertification, and don't let the door hit you in the ass on the way out...

I agree failure to doccument was probably these folks biggest failing.

They were Municipal Providers, probably unionized; it will be difficult to just de-certify them. That's a different argument.