Guest guest Posted March 25, 2004 Report Share Posted March 25, 2004 To all regarding my comment about San paramedics: I received an e-mail from someone I have a lot of respect for, and have myself taken courses from in the past. In NO WAY was I commenting about him, or any of the other outstanding instructors that I have worked and learned for, under and with from UTHSC. The problem with SAFD paramedics laziness and poor patient care is one they themselves, as individual adults, choose to make. I know there are a lot of good SAFD paramedics, but there are some that have gotten lazy, and they are the ones that make the comments about getting paid for what they know and not what they do. This is also a combined growing problem involving the whole hospital diversion thing. In San , the hospitals are grouped by the region that they are in. Say there are 3 hospitals in the " north " region. If 2 of them go on diversion then the third gets creamed with all the remaining EMS traffic. There is a hospital system in San that has recently been bought out by a big corporation. Big corporations want money, if they allow the ER doctors to go on diversion, they lose patients and consequently, money. Simplified, what is happening is ER's 1 & 2 in the " north " region close, ER 3 is forced to accept the fallout. ER 3 is owned by the big corporation, and does not want to leave the decision to close up to the physicians actually working the ER, they prefer to have the administrators make it in the interest of lining their own pockets. This puts the physicians actually working in ER 3 in a VERY bad position. They get overloaded with patients not only walking in, but coming in by EMS, the floors have no beds, so the ER can't move patients and gets stagnant. The ER physicians don't have to rooms to treat the patients coming in, therefore, people that are really sick and need immediate attention can't get it, because there's nowhere to put them. All the while, EMS continues to bring in more and more patients, because no one keeps track of how many times any given ER gets hit in a certain timeframe with ambulances. When the paramedics radio in that they are transporting to XYZ ER, no one in the dispatch center says, " No, why don't you divert to ABC ER instead, because XYZ has been hit with 5 other units in the last 30 minutes? " But we're not just talking about SAEMS, you figure there are anywhere from 10-15 private ambulance companies that are also transporting patients to the ER. Granted, this is not a problem with SAFD, or any of their staff, nor is it a new problem due to the takeover by the " big corporation. " It's one that has been and has just continued to grow, and puts a lot of good physicians, and their licenses in danger. Not to mention the welfare of the patients that are already in the ER, and the ones trying to get in rather it be by ambulance or walk-in. While we're bitching about the way things run, I think this is an issue that needs to be addressed. Forget the money, EMS is a circle of physicians, EMS providers and patients, when one part of the circle gets broken, the other parts suffer. WHY CAN'T WE JUST ALL GET ALONG???? To that particular staff member of the UTHSC though, I was not making any specific reference to you or you staff. You have no control over what the FD proper, or any of it's members do after they complete your program. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 25, 2004 Report Share Posted March 25, 2004 HE wouldn't be any business for very long, but if he belonged to a big corporation, there's no telling how long he'd get away with it before someone took action. Please also reference the e-mail I sent you on and off list. I'm willing to be a part of the solution, and not just sit here and bitch about the problem, but where do you start? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 25, 2004 Report Share Posted March 25, 2004 I'm reminded of what a cop I once knew told me -- " The call may not be important to you, but to the person who called it is the important thing that happened to them all day. " -Wes Ogilvie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 25, 2004 Report Share Posted March 25, 2004 It's the CP and SOB refusals that scare me... I've told plenty of " I need my foley emptied " 911 callers in my day that they DID NOT need an ambulance. There is a difference between BS calls and " it's 3am and I'm pissed off about having to get out of bed. " As with anything, there just needs to be accountability for your actions. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 25, 2004 Report Share Posted March 25, 2004 I guess I should jump in here to defend those big city dewds but I'll let the silence speak for itself. However I will say that my vision for EMS has Paramedics working in a much more clinical/primary care environment while staying in an 'ambulance' role but I'll save that for another discussion. I think you'll agree Gene that ANY system, large or small, needs to realize that everytime a medic doesn't transport a patient who calls, makes the patient fell guilty for calling 911 (even though we advertise on our ambulances, fire trucks, and police cars to call us), thinks that they make too many 'BS' calls, and you can go on and on, will only verify to the public or policy makers that maybe paramedics aren't really needed let alone give them more money to do the 'work' they're trying to re-define. Here's an analogy to consider: If I called a plumber to fix a dripping faucet on my sink and the plumber came over, told me that I didn't need to call a plumber for this stupid drip, that I should go to Home Depot and get a new washer and do it myself, that he needed to be available for more serious plumbing problems...how long would he be in business do you think?!? Lance Villers UT Health Science Center at the Big City ____________________________________________________________________ ________________________________________________________________________ Message: 11 Date: Thu, 25 Mar 2004 17:53:42 EST From: wegandy1938@... Subject: Re: Trends Steve says good things, but the big city medics such as those San dewds described by one writer will eventually compose their own obituary. As those who pay the bills begin to realize that they're paying a bunch of high-powered LazyBoys to take shortcuts and avoid using their skills, they'll figure out a way to get rid of them. Unions or no unions. GG Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 25, 2004 Report Share Posted March 25, 2004 Well said Lance......I have always believed that most people call for a reason and it is not our duty to tell them that they do or dont need a ambulance. It is our job to help them. athan Estes EMT-P > [Original Message] > > To: < > > Date: 3/25/2004 8:45:50 PM > Subject: RE: Trends > > > I guess I should jump in here to defend those big city dewds but I'll let > the silence speak for itself. > > However I will say that my vision for EMS has Paramedics working in a much > more clinical/primary care environment while staying in an 'ambulance' role > but I'll save that for another discussion. > > I think you'll agree Gene that ANY system, large or small, needs to realize > that everytime a medic doesn't transport a patient who calls, makes the > patient fell guilty for calling 911 (even though we advertise on our > ambulances, fire trucks, and police cars to call us), thinks that they make > too many 'BS' calls, and you can go on and on, will only verify to the > public or policy makers that maybe paramedics aren't really needed let alone > give them more money to do the 'work' they're trying to re-define. > > Here's an analogy to consider: If I called a plumber to fix a dripping > faucet on my sink and the plumber came over, told me that I didn't need to > call a plumber for this stupid drip, that I should go to Home Depot and get > a new washer and do it myself, that he needed to be available for more > serious plumbing problems...how long would he be in business do you think?!? > > Lance Villers > UT Health Science Center at the Big City > ____________________________________________________________________ > ________________________________________________________________________ > > Message: 11 > Date: Thu, 25 Mar 2004 17:53:42 EST > From: wegandy1938@... > Subject: Re: Trends > > Steve says good things, but the big city medics such as those San > > dewds described by one writer will eventually compose their own > obituary. As > those who pay the bills begin to realize that they're paying a bunch of > high-powered LazyBoys to take shortcuts and avoid using their skills, > they'll figure > out a way to get rid of them. Unions or no unions. > > GG > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 25, 2004 Report Share Posted March 25, 2004 That's a whole 'nother thread, and in tune with Lance's post, to become an extension of the physician, we would be called upon to make more intense clinical decisions. WE would have to, dare I say it? Diagnose things and not be afraid. In essence, we would be doing the exact opposite of what you are talking about. This thread has gone round and round, and I posed the question, and never received a good answer. Does every patient who dials 911 require ambulance transport to the hospital? No. Paramedic initiated refusals are OK, they really are, they are new, and they may be scary to those who don't have the confidence in their skills, but they really are acceptable. I don't deny that the call to 911 may be because they were afraid, or hurt, etc., being afraid, with no medical issues, does not constitute a medical necessity for an ambulance. Stubbed toes? 3 day old fevers? These need ambulance transport to the ER? I think not. Mike Re: Trends > > > > Steve says good things, but the big city medics such as those San > > > > dewds described by one writer will eventually compose their own > > obituary. As > > those who pay the bills begin to realize that they're paying a bunch of > > high-powered LazyBoys to take shortcuts and avoid using their skills, > > they'll figure > > out a way to get rid of them. Unions or no unions. > > > > GG > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2004 Report Share Posted March 27, 2004 Question: What type of service do you work for (Municipal, Private, Hospital Based)???? Re: TRENDS In a message dated 3/27/2004 2:33:05 PM Central Standard Time, mpate1104@... writes: I'm a little curious as to how you " mandate " that these patients be transported. If you have an alert, well-oriented adult patient who has been informed of the risks (and who may very well understand his illness just as well, or better, than you do), and that patient chooses to not go to the ER, how do you " mandate " that he go? Maxine Pate ----- Original Message ----- From: Salvador Capuchino Jr What if your D50 pt's BS drops again after you leave? What if your Epi pt goes into PSVT or worse? Our company mandates that everyone who receives a medication be transported to ER for f/u care/tx. If you have an alert, oriented pt who wants to refuse and hasn't been given any meds, then let them. A lot of Medical Directors mandate as Salvador says that your pt understand that if they're given meds, they're taking a ride. Because it's their license, they don't want to leave that decision making to you. For them Meds=Transport. Quote Link to comment Share on other sites More sharing options...
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