BS calls

[tniuqs]

It definitely won’t collapse anytime soon in places like Calgary. Holy resources batman (at least compared to what I’m used to dealing with). I realise there are some very busy units in Calgary but ALS on every single unit with enough units to almost guarantee back-up whenever you need it is rather luxurious compared to what some of us are used to. Calgarians haven’t a clue how fortunate they are to have that. Sections of the Greater Vancouver Regional District however run on the verge of collapse on an almost daily basis. There are times when a single unit is left covering the entire tri-cities area. Alpha and Omega calls going for hours prior to a response (and we all know how accurate AMPDS is). Even outside of the GVRD. Kamloops, a city of over 80,000 people, has one 24 hour ALS unit. The only other ALS resource in the city is a dedicated ground/rotary CCT unit that runs dayshift only. I know what a system on the brink looks like because I’ve worked it. Zero rural ALS resources, city resources spread far too thin, and a nurses union so hostile with other healthcare workers they’ve actually been booted from the BC Federation of Labour. The problems don’t even stem from the fact BC has a provincial based service. It’s largely due to an inadequate resource allocation plan. Throw in a few too many calls for “stubbed toes” and collapse causing death actually becomes a possibility.

Query: So are the Police and Fire departments stretched this thin in BC as well ?

One would logically think after complaints that BC would hire more Paramedics, via reciprocity agreements.

[systemet]

It's hard to keep up with all the directions this thread has bounced in.

I think we all know that a large percentage of our patients aren't experiencing an acute life-threat. We probably all suspect that a substantial proportion could take a private vehicle to the ER without detriment, and that a fair portion of the people who end up in the ER via ambulance, or personal vehicle / public transport, probably could just wait until the morning or have no medical needs. I think it would be really hard to argue that this isn't the case.

However, in North America, at least, there's a heavy burden of medical litigation, that results in our systems being designed to avoid legal liability as much as to provide appropriate care. A case in point is the awesome failure inherrent in AMPDS dispatching. If a random cell-phone caller drives by a seemingly unconscious man in a bus shelter in an area with a lot of homeless people / drug use, this becomes a cardiac arrest. But god help you if you're an elderly lady, fall and break your hip. Because this ends up being a low priority alpha response in a lot of instances. Far better to be drunk and sleeping in the bus shelter, than have a legitimate painful but verified not-immediately life-threatening extremity injury.

Once contact with the medical system has been established (and EMS is increasingly becoming part of the medical system), there's a duty of care. Even if the patient's condition is trivial, it's going to be hard to convince a risk management team that the benefit of denying service outweighs the potential cost of a damage settlement for being wrong. Unless there's fundamental reform of medical tort law within the legal system, it's going to be hard to see how this changes. Us turning up to a 911 call and telling someone they don't need to go to the ER is essentially the same thing as a patient presenting at the ER triage, and having a physician take a blood pressure, do a finger-stick glucose and tell them to go home. This just isn't something that's supported within the framework of the medical systems in North America. There's just too much concern (justified or not) about liability. It's tempting to imagine how different the world might look if physicians were simply allowed to use their best judgment.

When you start thinking about the uncertainty involved in EMS, it becomes even clearer that paramedic-initiated refusals of care are less likely to happen in the future. We lack the education and training of the physicians, and don't seem to be too interested in starting to close that (incredibly) large gap. And we lack their tools. How many physicians would be comfortable discharging a patient using only the tools available in the ambulance? And how many would be supported by risk management in their ED? It's not just an issue of provider training. Increased education only solves part of this problem.

I think the answer in the future is likely to be referral to other agencies, which will have less liability than an outright refusal, but this is going to require upgrading the primary care skills of the average paramedic, which are lacking, as tniuqs has pointed out. In the US, the tort law is going to continue to be a problem, and in Canada the responsible agencies are going to continue acting as if the medicolegal environment is as litigious, even if it isn't.

While healthcare spending is a huge political issue, I'm not sure that I'm willing to take the personal risk to try and reduce it by initiating refusals in an environment where the medical community and the woefully small amount of available research isn't going to support me. System issues seem equally difficult to handle, and seem likely to remain with us for a long time.

I'm a little irritated with flaming right now. But, I think the attitude that you help the patient put in front of you, no matter how stupid or healthy or irritating they may be, is the correct one. If we want to become a profession, we must first act as if we already are one. I think that means leaving the political issues to management and the politicians, and taking a lot of no- to low-needs patients to the ER, until a better solution is presented. While some situations are blatant abuse, getting angry about them doesn't seem to offer any tangible solution, and just adds to the stress of an already difficult job. Perhaps the more survivable attitude is just to accept that the problem exists, treat the people you encounter as best you can, and let someone else agonise over it.

[WhiskeyTangoFoxtrot]

I have to agree in part SYSTEMET, it's not worth agonizing over. Each patient gets good service from me regardless of how I feel about their chief complaint. I don't see the calls we get changing and that's ok. The BS calls are often entertaining and give me a break from the heavier calls. Which was kind of the point to this whole thread when it was started. Due to Turnips astute observation that this is a public site, it has redirected. Reading a lot of these posts, we talk a lot about the burden on EMS but not so much the burden on the health care system. All these patients we bring in to emerg. for minor reasons tax the system dramatically. I can't speak to the hospitals in other countries but here in Canada we have huge wait times due to the volume of minor patients that could have gone elsewhere to get the same care. If we had the oportunity to triage some of these patients to minor emergency clinics instead of Emergency departments we could be a small part of a solution to these problems.

I work industrial where I essentialy run a minor emergency clinic (pardon the delusion of grandeur). I see the minor stuff and have the tools and education to treat and release quite a bit. The decision comes down to whether the patient needs labs and or antibiotics, more definitive care, etc. We do have the ability to make those calls. I think we just need the madate to choose where to take our patients. No we won't change how EMS is used, but we can change the burden that use puts on the health care system.

Edited November 14, 2011 by WhiskeyTangoFoxtrot

[Bernhard]

Having filtering options sure drops the rate of BS calls, at least what EMS will see as such. Over here, we can:

• deny transport to obvious non-medical cases
  
• treat ambulatory (minor bruises and such) and don't transport
  
• assist helpless people (sitting back into chair or something) without need to transport
  
• call a General Practioner (they have duty to cover 24/7) on scene and may leave
  
• bring a patient to a General Practioners office
  
• (in some cities) pass a "just drunk" person to a special facility, where they can sleep under supervision
  
• pass non-medical but otherwise helpless people to law enforcement, who in turn have several options for sheltering or social work
  

So, a real "BS" call (as in "thats not an emergency!") is reduced to a short on-scene time and not much additional load on the system. I tend to forget these calls as soon as I've documented them, unless they are very remarkable. Most remarkable (and, in retrospect, often funny) are those calls in the rare occasions, where above system doesn't work for a weird reason.

Edited November 14, 2011 by Bernhard

[cprted]

Query: So are the Police and Fire departments stretched this thin in BC as well ?

Fire is doing fine. Even in places with Volley FDs, training is usually administered by the JI so standards are often kept pretty high even in the tiny remote locations.

Municipal PDs (Vancouver, Victoria, Abbotsford, etc) have lots of resources to go around as well. Doesn't mean they don't get run off their feet busy from time to time, but they're in pretty good shape. The wonders of municipalities bargaining in good faith with the police union ...

RCMP policed jurisdictions can be a whole different story. Stretched thin is the status quo for BC RCMP. Add to that no union to enforce minimum staffing levels, command officers who's promotions are unofficially based on how well they stayed on/under budget and you get a lot of shenanigans.

Edited November 14, 2011 by cprted

[tniuqs]

I'm a little irritated with flaming right now. Agreed "tenor" is everything, some days I too need some improvement in that area, it just may well stem from my sexual dissatisfaction as this is my personal issue ..Te He (an inside joke) But, I think the attitude that you help the patient put in front of you, no matter how stupid or healthy or irritating they may be, is the correct one. If we want to become a profession, we must first act as if we already are one. I think that means leaving the political issues to management and the politicians, and taking a lot of no- to low-needs patients to the ER, until a better solution is presented. While some situations are blatant abuse, getting angry about them doesn't seem to offer any tangible solution, and just adds to the stress of an already difficult job. Perhaps the more survivable attitude is just to accept that the problem exists, treat the people you encounter as best you can, and let someone else agonise over it.

Another excellent post, observation's and far better composition than myself. You had me in whole hearted agreement until you said the RED above. I believe that as professionals in Alberta as we supposedly soon will be under the legislated Health Professions Act, a legal recognition of terms of agreement. That said why the acceptance has been delayed for many, many years one would have to ask our "non self regulating" entity the real reasons and in our failure to thrive.

My point being and disagreement with your statement, is that as valued members of society we the front line health care workers and voters ourselves, as after all the Polititions are supposed to be working for us ? In a democracy we should become part of the solution, unfortunately we do not have an true Association to represent us as Paramedical Professionals, just a now government directed regulatory body.

An issue as of late here has raised its head that of the "PERMIT" applied for by industrial EMS operators to transport injured workers in the back of an MTC, a 4x4 with a camper on the back, directly to a Hospitalps no AAA crash testing. This was under AB transportation and some how AHS ? was invited to the Knights of the Round Table Discussion with OH+S.

So once again the litigation / liability issue starts, curiously the front line workers and those travelling in the back giving the actual care were never consulted as a stakeholder group re: Safety and the entity responsible for "Safety of the Public" wasn't invited to the camp-fire, well as much as we the membership were apprised. Once again the PC in this province doing what's best for the huge multinational oil interests. I do not disagree totally with this concept of reducing burdens on local resources when required but the precedent now set, unfortunately once again the health care front line providers were ever consulted .

Sorry off topic a tad but this does open up the door way wide for routine transport in an EMS that of unregulated granny transport service's to the public at large .. hell with intentional under funding by the PC in Alberta the modus operandi / theme song is take over then cut but once again, lack of an input and organization representing we the "Professional" best Interests.

On a more positive note:

Whiskey Tango is most correct we in Industry by some forward looking EMS providers lead by an outstanding MD, hence why I jumped on board myself, We are delivering "enhanced' services a the form of treat and release, if we can prove the statistical analysis to prove to Industry our "worth in enhanced primary care" then we can prove it to government, in passing suture of minor wounds, providing bug juice, treating insomnia, low back pain and delivering vaccines, this has already happened in the UK on a much more grander scale. I am very hopeful that we in the colonies will follow this example.

I can proudly inform you that in 2007 while working with ASRD (forestry) I did such a statistical study on a Pine Beetle Project. It was accepted, this changing the policy for Forest Fires in some districts, if this level of Government In Alberta, fraught with the Medicine Chest Treaty Agreement's, was a win, win then there should be no reason that general service to the public can and will not follow the strides of Industry.

We just have to prove it on paper to become a more valuable service, if I could ever those understand PDF files a bit of humour for WTF over and LOL.

cheers

Edited November 14, 2011 by tniuqs

[systemet]

My point being and disagreement with your statement, is that as valued members of society we the front line health care workers and voters ourselves, as after all the Polititions are supposed to be working for us ? In a democracy we should become part of the solution, unfortunately we do not have an true Association to represent us as Paramedical Professionals, just a now government directed regulatory body.

Well, my position isn't set in stone. I'm willing to listen and be convinced otherwise. I wasn't trying to suggest that paramedics and EMTs shouldn't advocate for the growth of the field into a profession, more that to survive day-to-day, sometimes it's better to focus on aspects of patient care. If we can present a better solution, then I'm in favour of that.

[tniuqs]

Your application to squints army is being processed as we speak. I am looking a few good writers as apparently my last writer for my stand up comedy special has to re: negotiate his contract and from the crowds response its not looking good LOL !

cheers

[rock_shoes]

Query: So are the Police and Fire departments stretched this thin in BC as well ?

As already noted, not even close to the same extent.

One would logically think after complaints that BC would hire more Paramedics, via reciprocity agreements.

That and perhaps provide some form of support for those existing employees who’ve chosen educational institutions that allow us to complete a bachelor’s degree in health sciences unlike the JIBC. The number of complaints are low considering the lack of service, because as far as the public knows BLS is the standard of care. I and numerous others have been considered “ineligible” for every assistance program offered, not because we’ve failed to attend an accredited program, but because we didn’t attend the JIBC’s program. Over $20000 in potential funding each that’s been outright denied.

Add in allowable pharmacology that’s frankly embarrassing compared to most ALS services (with regard to ACP units, CCP units are an entirely different ball game), and the reasons any of us have to return are dwindling rapidly. They’re banking on the pull of family/friends back home to be enough to draw us back. What they fail to realise is that the majority of us adventurous enough to leave for our education are also young and single with minimal strings to any particular place. I can’t speak for everyone but after over a year away I’m no longer single. With both of us young and in the industry, when I’m finished this stint in school we can work anywhere we want.

Right now BC either gains two quality providers by attracting us both or it loses me entirely. Unless there’s a major shift in the next six to eight months it’s 50:50 and that’s only because both of us have a powerful attachment to living in the mountains. Canmore, Banff, Jasper, Hinton… they’re all looking pretty damn good right now.

[Siffaliss]

Yes I am all too aware of the down and outer's stacked like cord-wood in the Spady Type centre(s) our present political leaders in funding the right things, for example a 1.4 million dollar federal give away to you know who to accept FTMDs to be fast tracked to become Paramedics .. good grief batman.

Yeah that was a great idea. I think only 3, perhaps 4 actually passed and 2 of them didn't pass the first time. I'll talk more about that privately. Pisses me off, longer term employees, EMT's, can't get paid final practicums but (I will ramble on about this forever if I keep going at this point).

dearest Siffilass: the last time I will shred for buzz kill alone and demonstrate any support a flamingemt .. as the second after I posted, he in his wisdom chose to disrespect 11/11/11 2011 .. very poor judgment, yet I can forgive him he's just on the very sharp portion of the leaning curve.

Perhaps someone paved over him while he was entering the curve?

I wish him luck in his goal of promotion of gay rights in EMS .. quite clearly he has failed to gain any support from myself with the plagerising / paraphrasing ... a pitty that.

cheers

No, flaming had some good points, although it is rare> You can predict your call volume fairly easily, if nothing else, you can pick your busiest day and staff for that day everyday >Not efficient, but predictable> You should also have a plan for sickouts and injuries, but most municipal systems will not entertain the thought of using part-time employees to fill vacancies. At one service I worked at we had an extra medic for each batallion every day, and those extras floated all over the county to cover holes, if there were none, they took the mobile supervisors place so that they could do office work.

Extra staff would be a luxury ...