Patient Advocate

[DFIB]

We don't talk about how I met Harold.

Ha! I have a couple of reinds and kinfolk we hide from public as well.

We don't talk about how I met Harold.

Ha! I have a couple of reinds and kinfolk we hide from public as well.

[Paramagic]

You're forgetting the important part: safety. It is important you maintain the high level of safety at all times, so you should dispense with the ratchet straps, remove all but 2 bolts holding the axle on the trailer, weld some random pieces of sharp, angular steel around the superstructure, store lots of flammable liquid on the trailer, and have a policy that the driver travels at no less than 20MPH over the speed limit, with one eye shut. (Do not question the policy! The policy is right! The policy is perfect! All Hail the Policy) And maybe add some snakes.

This will make it as safe as a modern ambulance. I've seen youtube.

[hatelilpeepees]

The point is that I am following your logic. If I agree with you that these patients should never be transported on the floor, I wonder why most 911 services transport them that way. I am sure in the larger cities there is "1" bariatric truck in every surrounding county, but I do not think that is the case in the rural areas and poorer states.

So to ensure patient safety, every ambulance should be mandated to be bariatric, as it would not make sense to make a critical obese patient to wait on the bariatric truck to come from the next county over. Right ?

[Asysin2leads]

HLPP, there is a difference between a 911 emergent transport and a routine interfacility transport. A 911 transport (supposedly) is for a life threatening condition. In a true emergent situation, you can get a little creative. They had to use a flat bed truck to get a 1000+ man to the hospital in one case I am aware of. But the situations of discharge to rehab or discharge to home are not emergent situations, they are routine medical transport situations. You might even be able to sell me on doing it in with a person going from a local ER to an angioplasty or stroke center, but routinely doing it for medical transport purposes is not safe nor ethical. If you service anticipates routinely transporting bariatric patients in non-emergent situations, then it needs to have equipment to do so.

[DwayneEMTP]

Hlpps, the last service that I worked at didn't have a bariatric rig, and it was about 90 miles from the closest one. The next closest, about 200 miles. We'd had units from both to transport patients in this dinky little town..transfers of just a few miles.

We had a 900lb patient fall while trying to get to the bathroom. Acute abd, severe lower back pain, unable to get a decent B/P even on her forearm. This is one of the few calls in my career that bothers me as I was, for some reason, so completely, and constantly aware of her humiliation at having fallen before making it the the bathroom and then being unable to get up.

I called in our other unit, called in both fire depts, yet we still couldn't lift her really. Our cot was rated at 750#. Finally we managed to get her onto a tarp, with 14 people crammed into her small-ish kitchen we were able to get her balanced on the cot. We used it kind of like a dolly, in the down position, and scooted her out the door, down a bunch of stairs, and onto the floor of the ambulance where the antlers had been removed and transported her non emergent/unsecured on the floor.

At the hospital I had the maint guy attach my cot and an identical cot together with ratchet straps, to make one, pretty solid (yet untested/unapproved) cot, and we used that to move her about the hospital. We finally got her into a bariatric bed, but she needed add'l tests that this small hospital couldn't provide. The hospital looked around until they found a bariatric unit available in Denver, 200 miles away and arranged the transport. I think it was 8-9 hrs before they managed to get to the hospital.

Pt was relatively stable and moving her out the way that we'd moved her in was unsafe for all involved. Right? Had she proved or appeared to be unstable then I would likely have found the 8-9hr time frame unacceptable and loaded her onto the floor of my ambulance for the transport. It's completely insane to be that your service won't allow those decisions from a paramedic and would even considers hiring a medic that they wouldn't trust with such simple decisions.

It seems to me that your argument has been, "Well, if you weren't willing to risk her life and well being to transfer her after she was stabilized at the hospital then you shouldn't have been willing to do it emergent! You should have just left her home to die you hypocrite. Show her some respect!"

I had no friggin' idea what to do to get her out of her home, so I made the best bunch of bad decisions that I knew how and hoped that the EMS gods would smile upon me and I wouldn't hurt her further.

At the hospital, in their bed, she was much safer than she would have been on the floor of my ambulance when an alternative existed.

Now, I have no idea where you live specifically, but I now, and will continue, to disbelieve that there is not a single bariatric unit in your entire fucking state. Keep making the argument if you like, but I don't care how redneck/hillbilly you are, there was access to a bariatric unit.

The parties involved simply didn't want to make the effort to make it happen because this fat chick just wasn't worth it to them and/or they didn't want to pass up the fare. Or perhaps your service/community is still somewhat unsophisticated and not used to providing EMS at professional standards so is unused to solving these types of problems.

Either way, your inability to see ANYTHING wrong with your argument, despite some pretty intelligent folks questioning it smacks of, 1) you're full of shit when you talk about your EMS experience, or 2) you've worked nothing but very rural/super small volume areas, and/or 3) you work now, and have only worked for volly fire services.

The 3rd being my prediction should the truth ever come out.

I am though, happy to hear that you were off your game during some of those posts. You become kinda psycho while menstruating! But I'm guessing people have told you that before... :-)

Good on you for having the iron ovaries to continue the discussion. There are few on this site that would have.

Dwayne

[Lone Star]

Those of us with any kind of longevity in this field have been forced to 'think outside of the box' during emergent situations. Transporting a patient from one hospital to another isn't an emergency. It's not like the patient has anyplace to go right away.

I can understand the patient being transferred to another facility for more definative care, but I cannot fathom a patient not at least being stabilized at the sending facility. Once the patient becomes stabilized, the 'emergent status' is removed, and it becomes a 'non-emergent transfer'.

In a Utopian society, no one would be this large, thus there would be no need for ANY bariatric vehicles. Unfortunately, this ain't Utopia.

As a manager, if you're so quick to fire your employees simply for doing what they're morally and ethically bound to do, is utter nonsense! How can you expect to keep ANY valuable assets (employees) with that kind of B/S policy? This neither speaks well for you personally or the company you represent.

With someone who has as much experience as you claim to have; how can you, with a clear conscience, even entertain such an idea as firing an employee for being a patient advocate? Patent advocacy is PARAMOUNT in EMS; this is something you should not only KNOW but practice, on a daily basis.

Based on how fast you've advocated firing people, we can only surmise that you are nothing more than a corporate TYRANT who cares only about money. I would suggest that you go back and not only read the EMT/Paramedic oaths, but the Oath of Geneva and then seriously re-evaluate your position and practices.

Patient safety is secondary only to crew safety.

[ERDoc]

And this is why no one will ever take EMS seriously.

[hatelilpeepees]

I never said we did not have any, I am in Atlanta, and I am aware of 4 companies that have a bariatric truck that are spread around the area. I am not aware of any other service in GA that has them, but I have not taken a scientific poll to find out how many do.

The point you are missing is that in this scenario this was a non-emergent transport, in my situations it was usually an emergency call at home, because they refuse to call 911. If it is incredibly unsafe during a nonemergency, then it must be more dangerous in an emergent situation. I do not understand the logic that because the call is a psuedo-emergency with a 911 response, that you are suddenly allowed to do what I am being chastised for. Why do your safety concerns fly out the window the minute 911 is called ?

Dwayne, can you please argue a point without dropping the S and F bomb, you dont know who is reading this, and gentlemen do not curse at ladies. I have not cursed at you. But thank you for the compliment at the end of your post. Just because someone has a different opinion does not mean they right or wrong. This is a gray area, but I am guessing more patients in this country are transported on the floor versus a bariatric stretcher.

Edited October 16, 2011 by hatelilpeepees

[Paramagic]

The point is that I am following your logic. If I agree with you that these patients should never be transported on the floor, I wonder why most 911 services transport them that way. I am sure in the larger cities there is "1" bariatric truck in every surrounding county, but I do not think that is the case in the rural areas and poorer states.

So to ensure patient safety, every ambulance should be mandated to be bariatric, as it would not make sense to make a critical obese patient to wait on the bariatric truck to come from the next county over. Right ?

Right, I have to call absolute bullshit. You are either trolling, or actually retarded. There is no way on god's green earth that anyone who has any idea about medicine, EMS, or indeed life, can be so utterly ignorant of the concept of risk versus benefit.

Every single day, everything we do, in EMS and in life, is based on a risk/benefit assessment, whether we actually think of it in those terms or not. We decide on the risk versus the benefit when we give anyone a drug, from aspirin or oxygen to suxamethonium or ketamine. We decide if the benefit is worth the risk to drive emergently or not with a patient in the back. We decide if the benefit is worth the risk to push through that orange while running late to work. We decide if the benefit outweighs the risk when we park in the no standing zone to run into the bank. We decide if the benefit outweighs the risk when we go back inside to answer the phone, leaving the kids on the swing unattended.

If you genuinely cannot understand this incredibly simple and pervasive concept, you should probably be working in a sheltered workshop and having 24/7 care, because you are clearly incapable of surviving day to day life otherwise.

And this is why no one will ever take EMS seriously.

Amen to that!

[DwayneEMTP]

...

I never said we did not have any, I am in Atlanta, and I am aware of 4 companies that have a bariatric truck that are spread around the area.

Then why would you choose not to use one? Why would you, as you stated, fire an employee for choosing to utilize a more appropriate form of transport?

...The point you are missing is that in this scenario this was a non-emergent transport, in my situations it was usually an emergency call at home, because they refuse to call 911. If it is incredibly unsafe during a nonemergency, then it must be more dangerous in an emergent situation. I do not understand the logic that because the call is a psuedo-emergency with a 911 response, that you are suddenly allowed to do what I am being chastised for. Why do your safety concerns fly out the window the minute 911 is called ?

You're making quite a leap when you change the scenario to state, "Most 911 calls aren't truly emergent, so why are they different from a non emergent transport?" That was not the scenario state, nor the one that I believe that most of us have been arguing.

As well, if you don't know the differences in the legal issues involved in most locals between the duty to act in an emergency when compared to a non emergency then I have to question the honesty of your stated experience.

Had I been called emergent to transport a bariatric patient that I believe purposely called for reasons non emergent I would get my supervisor involved and explain the situation and almost certainly this person would be speaking with the police about mis use of 911 while they waited for the bariatric ambulance. Just sayin. Being fat doesn't mean that you also get to be stupid and irresponsible.

...Dwayne, can you please argue a point without dropping the S and F bomb...

Unlikely.

...you dont know who is reading this...

I've been here a few days, so yeah, I'm confident that I know who is reading and pay attention to the responses I get to my way of making my point. Which, for the record, as can be attested to by many here that know me personally, is the same way I make them in person.

...and gentlemen do not curse at ladies...

Nor do ladies in my experience publicly claim to hate small dicks, profess their love for hard bodied cops, nor publicly use being 'on the rag' in defense of rude and/or obnoxious behavior or comments.

Not completely true I guess, as I've known women that do all of those things that I consider ladies, though none of them would every be offended by my cussing while they were doing it.

Can't have it both ways babe. Be crude and aggressive and play with the boys, or act like a lady and, as I/we always do, I'll adjust my behavior to be respectful. But don't be crude and then play the, "you're hurting my delicate sensibilities" card when you get your...whatever...in a bind.

...I have not cursed at you...

Nor I at you, but at the your continued argument that if a posters company has no bariatric ambulances then they have no right to comment on the unsafe transport of an overweight patient. You I like, your argument I simply want to choke to death for it's intolerance, inflexibility and lack of respect for the obese and infirm.

...But thank you for the compliment at the end of your post. Just because someone has a different opinion does not mean they right or wrong. This is a gray area, but I am guessing more patients in this country are transported on the floor versus a bariatric stretcher...

And I agree completely, as most of EMS in our country is run by redneck knuckle dragger vollies/paid per call services instead of by professional, paid EMS services.

And, as I've said many times before here...justifying an action based solely on the fact that 'others do it too!" is an EMS pathology, and is proving to be terminal. You're too smart to say such a thing or use it as a basis for an argument, but I'm afraid that you've been inside of your services backwards, unprofessional bubble for so long that it's becoming opaque and is sheilding you from any new understanding.

And I believe that the compliment is well deserved. The fact that you have an argument that I disagree with, and that you piss me off sometimes certainly doesn't negate the fact that you have the courage to stay and participate. Staying is how we find the truth, and I have nothing but respect for that...

Dwayne