As EMS/PHC Providers; Are We That Lazy?

[crotchitymedic1986]

OH, I see you dont want to talk about this universe, you want to talk about an alternate universe that is somewhere in the future. Your argument is similar to we drive cars, but in the future we will all have personal hover-crafts, so we should stop using cars now. Having an attitude of "patients should suffer because I do not agree with the way the world operates" is very scary.

[DwayneEMTP]

... Being a paramedic advocate is the same as being a patient advocate...

Right there, that kind of thinking is why you will not get along, nor ever be well liked by the majority of the people you work with, and never with the Crotchities of the world. Though I'm going to change it just a little bit for you..."Being a paramedicine advocate is the same as being a patient advocate." as sometimes you have to burn down shithead medics to improve the mean value for the the delivery of the science.

I wish I could give you 20 points for that line alone but I'd already burned up my daily quota before I got halfway through this thread..

Dwayne

Definitive care does not equal the ER in every scenario. The CURRENT EMS standard of care in the U.S. How about you show me where you got those numbers? And since when did every patient need (or actually get) labs and X-rays at the ER?

Ok, I take back what I said before about your lady graduating and becoming to good for you. After she graduates I think that there is every chance she will still want to get naked with you...She'll just think that you're medic buddies are idiots.

Keep on keeping on Mr. Justin. And during this argument perhaps you could have Crotchity give examples of the other countries that have a right of refusal...surely they have innocent patients dropping dead daily.

And is it just me? Or did anyone else find Crotchity demanding a source to be friggin' hilarious?

Dwayne

[usalsfyre]

Do y'all honestly believe diagnostic services are that important? That the educated provider can't use physical exam and history to determine how emergent the condition is in 99% of cases? Or are you figuring because y'all are incapable of it no one is.

The ED is FAR from definitive care in a lot of cases. In things like acute psychosis the ED environment will probably exacerbate the issue at hand.

People like Beiber who understand there has to be some level of cost benefit analysis will rise to lead EMS in the future. The era of EMS being "at any cost hero/lifesavers" are over. Unless we are able to SHOW benefit to people uneducated in medicine (which we can't right now) EMS will be deskilled to taxi drivers. Want to stop this and have a say? Get involved in research, push for better education and work on changing our reimbursement scheme so it focuses on services performed and not the expensive as hell taxi service it is right now. Repeating idiotic crap about "saving lives" and trying to maintain the (not working) status quo is only hastening our demise.

[NYCEMS9115]

No, if the only people who called for an ambulance actually needed one, the system would no longer be overwhelmed, and things like prehospital primary care would probably flourish. The only way to change the system and the problems within is making everyone shoulder some responsibility for their choices and their care. Everyone- even those with top of the line insurance- needs to follow procedures to receive that care. Don't contact your insurance provider prior to seeking care? You get stuck with the ambulance and/or ER bill. Same should be for someone on public assistance. Pay a nominal fee for your care and ride(deducted from your monthly subsidy) and suddenly folks would need to be judicious about obtaining that care.

That isn't going to happen. You've heard of Medicaid? Optional copay? Means no copay. Given oxygen, start an IV, traction splinted, 12lead ECG, med admin, ET, needle decompressed, paced, cardioverted, CPR, and defibrillated; MEDICAID pays just under $140. So knowing that; we shouldn't transport everyone. Especially on Medicaid. Right? But what's 1,000,000 x 0? $140 is better than $0. You can't bill for a visit, counseling, and treatment. Transports is the only thing you can bill. Insurances do have an ALS and BLS rate but Medicaid is not insurance...

Do y'all honestly believe diagnostic services are that important? That the educated provider can't use physical exam and history to determine how emergent the condition is in 99% of cases? Or are you figuring because y'all are incapable of it no one is.

99%? You should footnote that. I'm sure its a tad less than that. Now I need to footnote.

Edited April 18, 2011 by NYCEMS9115

[usalsfyre]

So it's a completely made up by me figure, but I don't think it's all that inaccurate. I'm not talking about coming up with a discharge diagnosis, simply determining emergent, delayed (both transported) or able to be directed to other, less expensive treatment options. An example would be say chest pain. Emergent would be a STEMI, delayed would be a 50 YOM with risk factors but a non-diagnostic EKG and non-emergent is the 22 year old with sharp chest pain while coughing after three days of cold symptoms.

If we want to start getting really technical, portable sonography and point-of-care labratory testing exist and would give you the tools most seem to think are needed to do this safely. The issue? No reimbursement....

Edited April 18, 2011 by usalsfyre

[NYCEMS9115]

If we want to start getting really technical, portable sonography and point-of-care laboratory testing exist and would give you the tools most seem to think are needed to do this safely. The issue? No reimbursement....

I already mentioned that. So, we agree. We need to transport these patient because its not about what we can do but if we took them to the ER or not. If I did 5 transports and you did 5 RMAs; I made the service money; you didn't. Healthcare is a business, unfortunately. But the issue of my original entry is DOCUMENTATION not patient care. All the best...

[Bieber]

OH, I see you dont want to talk about this universe, you want to talk about an alternate universe that is somewhere in the future. Your argument is similar to we drive cars, but in the future we will all have personal hover-crafts, so we should stop using cars now. Having an attitude of "patients should suffer because I do not agree with the way the world operates" is very scary.

The future is now, it's happening all the time, by the time you read this, it'll be the future. The one thing left standing still as time passes us by at such an alarming rate that many of us are looking in the mirror and wondering where in the hell all the time went is EMS. I was twenty-one what seemed like a few months ago, now I'm twenty-four, pretty soon I'll be fifty and I won't even have realized where all the time went. EMS is the same way, we've lost track of just how quickly time and medicine moves. Maybe it's because we've grown up outside of the mainstream medical system, we're not used to the way things really work in medicine. Maybe it's just because we've become so content with the way we do things, that by the time we're at that point in our careers where we could change things, we've either finally reached that golden position of administrator, but are too scared to rock the boat and risk returning to the streets, or maybe we just see retirement on the horizon and just want to put in our last few days in peace and move on to greener pastures. Either way, we seem to have our feet stuck in the mud and can't get them out.

None of what I've proposed, either here or in any one of the many threads where I've shared my views about what I think paramedicine should become is ever going to happen until we increase our educational standards. At the same time, if there's one thing I've learned it's that nothing in this world--NOTHING--ever changes without some sort of motivating force. And whether that's the next generation of paramedics demanding more from EMS than what your generation saw, or the inevitable changes in the healthcare environment that are calling for more and more accountability and justification for payment, EMS is going to change.

The way I see it, EMS has two paths in front it it. We have the option to continue the way we've been going, but you know what? I've said it before and yes, I'm going to say it again. We're not that good at what we do, and what we do is coming under a lot of scrutiny. Are we worth the money that's invested in us? Maybe not. Seriously, think about that. What if a cost-benefit study was done tomorrow on EMS systems. How sure are YOU that we're worth the buck? Because I'm not sure we could survive that kind of scrutiny. I'm really not. And if we continue down the path we're headed, you and I and every paramedic out there could be out of a job some day.

Then there's the other path. The path where we stop holding ourselves back, we stop insisting that we can't and we won't, and we man up, grow some, get our educational standards where they ought to be, and start implementing these practices which have been shown in other EMS systems across the world to not only improve the cost-benefit ratio of EMS, but also elevate our profession and provide the best possible and the most competent care for our patients.

And you all may think I get ahead of myself at times, and maybe I do, but you know what? If come tomorrow, it became national mandate for paramedics to have a Bachelor's degree, what would most paramedics say? "Fuck that, they're not paying me enough and it's not going to change what I do, anyway." So why in the hell is anyone going to further their education, when it's not going to do anything for them? You HAVE to have some sort of goals in mind, some sort of changes in care that having a higher education is going to grant people. Right now, people do it to get into admin. That's the incentive to get the degree. Until we start advocating a system that permits paramedics who have achieved higher degrees to expand their clinical skills, there is absolutely NO incentive for people to get that degree. A paramedic with a B.S., M.S., and PhD. is still just as restricted and paid just the same as the certificate mill paramedic.

You have to have some bait to dangle in front of them to get them to jump. I'm not saying we should be doing these kinds of practices without degrees, I'm saying, "Hey, everyone, here are some things where we in EMS could do better, some things we could do that will really help our patients. But here's the catch... you gotta get your big boy degree first." I'm sorry, but the average paramedic in this country is not so enlightened that they're simply going to go out and get their four year degree out of the goodness in their heart and out of their deep, overwhelming desire to have more clinical knowledge. That's the reality of it. We have to not only advocate higher educational standards, but have some rewards waiting at the finish line for those who jump on board the boat. It's the same with changing medicare, you want to be paid like a healthcare professional, you've got to become a healthcare professional first.

And thanks, Dwayne. I accept your edition to my statement and back it one hundred percent!

[akflightmedic]

I hate you for making me say this as I never thought such words would ever come from me, however:

BIEBER ROCKS!!!

(Just not the Bieber most think of when hearing that name)

[paramedicmike]

Bieber,

You seriously need a new screen name. Something more befitting the "wise beyond your years" attitude and thought process you've brought to many discussions here would be good.

Well said!

[usalsfyre]

I already mentioned that. So, we agree. We need to transport these patient because its not about what we can do but if we took them to the ER or not. If I did 5 transports and you did 5 RMAs; I made the service money; you didn't. Healthcare is a business, unfortunately. But the issue of my original entry is DOCUMENTATION not patient care. All the best..

Your assuming insurance is going to continue to pay for in many cases is a fx awfully expensive taxi. If you'll notice I mentioned changes to the reimbursement model in another post. Our current model is unsustainable. We need to get it changed before it collapses.