Re: MANDATORY READING ----- How can I fix EMSAT??

[Guest guest]

Be careful what you ask for Wes...with less than 10% of what EMS does being

classified as emergency...that is why I believe we set people up to fail by only

talking about the crash-burn-die scenarios in training classes...we need to be

talking about the slow ride holding the hand stuff too...that is the realistic

side of EMS...

Dudley

Re: MANDATORY READING ----- How can I fix EMSAT??

THEDUDMAN@a... wrote:

>

> And I ask why should it...as long as we keep looking at your example

as

> 2 separate issues instead of one (transportation) then we are doomed

to

> do both poorly. It isn't until someone grasps ALL aspects of

> transportation under one hat that you can find the optimal plan to

do

> it all.

So perhaps we should send all bus and taxi drivers to paramedic

school? Same thing.

Rob

[Guest guest]

" , " <manemtp@y...> wrote:

>

> My analgoy is as valid as it gets. But let me simplify it even more,

I didnt

> realize it was soo complicated.

Your analogy was not complicated. It was, however, invalid.

Comparing levels of medical care to methods of transportation is not

even remotely relevant to the current discussion.

If that is " as valid as it gets " for you, then the discussion is

apparently over your head.

Rob

[Guest guest]

" , " <manemtp@y...> wrote:

>

> My analgoy is as valid as it gets. But let me simplify it even more,

I didnt

> realize it was soo complicated.

Your analogy was not complicated. It was, however, invalid.

Comparing levels of medical care to methods of transportation is not

even remotely relevant to the current discussion.

If that is " as valid as it gets " for you, then the discussion is

apparently over your head.

Rob

[Guest guest]

I agree about that. We spent more time in my EMT class on various atypical

types of trauma (occlusive dressings and disembowelments come to mind) than we

did on " generalized sickness " and " abdominal pain. " Something's wrong with that

picture.

-Wes

Re: MANDATORY READING ----- How can I fix EMSAT??

THEDUDMAN@a... wrote:

>

> And I ask why should it...as long as we keep looking at your example

as

> 2 separate issues instead of one (transportation) then we are doomed

to

> do both poorly. It isn't until someone grasps ALL aspects of

> transportation under one hat that you can find the optimal plan to

do

> it all.

So perhaps we should send all bus and taxi drivers to paramedic

school? Same thing.

Rob

[Guest guest]

I agree about that. We spent more time in my EMT class on various atypical

types of trauma (occlusive dressings and disembowelments come to mind) than we

did on " generalized sickness " and " abdominal pain. " Something's wrong with that

picture.

-Wes

Re: MANDATORY READING ----- How can I fix EMSAT??

THEDUDMAN@a... wrote:

>

> And I ask why should it...as long as we keep looking at your example

as

> 2 separate issues instead of one (transportation) then we are doomed

to

> do both poorly. It isn't until someone grasps ALL aspects of

> transportation under one hat that you can find the optimal plan to

do

> it all.

So perhaps we should send all bus and taxi drivers to paramedic

school? Same thing.

Rob

[Guest guest]

" , " <manemtp@y...> wrote:

>

> I think in a broad, general sense you have a valid point. But,

what's

> scarce?

Now who is missing the point? Wes was talking about EMS, not

transfer cars. EMS resources are scarce.

> In Dallas County alone there has to be 15 competing for-profit

> providers. Let them compete, it's no different, in my mind, than

Medical

> City Childrens and Childrens_Dallas, competing for patients.

And that, Sir, is exactly the point that Wes and I have been trying

to make. Let those providers do all the non-emergency transfers

they want, because EMS resources are both scarce and specialized.

> Make the fee $20,000 instead of $200. Plenty of

> options.

I hope the rest of your options are better than that one. What does

it accomplish?

Rob

[Guest guest]

Okay...so if it is crash-burn-die...then let us at it...but if it is merely

helping out someone who needs to move from point A to point B and can't manage

it on their own...but all they need is maybe someone to sit next to them, talk

to them, and let them know they are still a valid person that deserves

respect...well that doesn't measure up to our " Higher Level of Care and

Education " so send them with the " other folks who don't measure up to our

stature " . That is all they deserve...er...uh...I mean need.

Sorry but when I start hearing " they don't need what we provide " or they simply

need " just someone to move them " like they are some piece of furniture it

nauseates me...you want to know what is wrong with this entire picture...we keep

forgetting that we are talking about mothers, dads, brothers, sisters, aunts and

uncles of people. We prefer to just concentrate on their problems and the heck

with their psychological needs....the heck with talking to them. Lets keep

cramming stuff into the curriculum for the one patient in the next 50 years we

may or may not see with " ipsy-dipsy-dolittle disease " so that we will know what

to do if we find them standing on their head in a bathtub full of jello. Lets

keep not teaching basic human interaction and customer service skills and

working with our students to be able to conduct a simple conversation for 20

minutes about the person we are treating....is it that hard to be a human and

NOT a technician?

C'mon people...that is what we are arguing here...they don't need my technical

skills...so they don't need me...send them a lesser thing...that is all they

deserve.

I fear for you or your family when they get ill or disabled...don't complain

here...because the rough ride in the back of a truck with two " transport techs "

who talk to each other and on their cell phones instead of talking to your loved

one...making them feel like a nuisance or a hindrance...after all....what else

do they deserve? Care, compassion, a listening ear??? Not in EMERGENCY medical

services or medical transport...we don't do that....no one pays us to do it.

Dudley

Re: MANDATORY READING ----- How can I fix EMSAT??

>

> And for the record, not all interfacility transfers are non

emergent...

And for the record, that is why we have been careful to note the

difference. Wes very specifically said non-emergency interfacility

transfers.

Rob

[Guest guest]

see below

Re: MANDATORY READING ----- How can I fix

EMSAT??

THEDUDMAN@a... wrote:

>

> And I ask why should it...as long as we keep looking at your example

as

> 2 separate issues instead of one (transportation) then we are doomed

to

> do both poorly. It isn't until someone grasps ALL aspects of

> transportation under one hat that you can find the optimal plan to

do

> it all.

So perhaps we should send all bus and taxi drivers to paramedic

school? Same thing.

Rob

[Guest guest]

Amen Dudley, preach on

Re: MANDATORY READING ----- How can I fix EMSAT??

THEDUDMAN@a... wrote:

>

> And I ask why should it...as long as we keep looking at your example

as

> 2 separate issues instead of one (transportation) then we are doomed

to

> do both poorly. It isn't until someone grasps ALL aspects of

> transportation under one hat that you can find the optimal plan to

do

> it all.

So perhaps we should send all bus and taxi drivers to paramedic

school? Same thing.

Rob

[Guest guest]

Is it the " i'm too good for that " mentality?

Re: MANDATORY READING ----- How can I fix EMSAT??

>

> And for the record, not all interfacility transfers are non

emergent...

And for the record, that is why we have been careful to note the

difference. Wes very specifically said non-emergency interfacility

transfers.

Rob

[Guest guest]

I don't think anyone here is debating the need for all people to get

respectful service, that's not what this discussion is about.

The financial paradigm has changed but our operational model has stayed

the same. We are taking on new missions (a population living older and

needing more services) but we have not changed the way we do things.

This discussion is about how to solve operational problems and not about

treating people any less respectful.

AJL

The definition of insanity - doing the same thing over and over again

expecting different results. - A. Einstein

________________________________

From: [mailto: ] On

Behalf Of THEDUDMAN@...

Sent: Monday, October 10, 2005 11:31 AM

To:

Subject: Re: Re: MANDATORY READING ----- How can I fix

EMSAT??

Okay...so if it is crash-burn-die...then let us at it...but if it is

merely helping out someone who needs to move from point A to point B and

can't manage it on their own...but all they need is maybe someone to sit

next to them, talk to them, and let them know they are still a valid

person that deserves respect...well that doesn't measure up to our

" Higher Level of Care and Education " so send them with the " other folks

who don't measure up to our stature " . That is all they

deserve...er...uh...I mean need.

Sorry but when I start hearing " they don't need what we provide " or they

simply need " just someone to move them " like they are some piece of

furniture it nauseates me...you want to know what is wrong with this

entire picture...we keep forgetting that we are talking about mothers,

dads, brothers, sisters, aunts and uncles of people. We prefer to just

concentrate on their problems and the heck with their psychological

needs....the heck with talking to them. Lets keep cramming stuff into

the curriculum for the one patient in the next 50 years we may or may

not see with " ipsy-dipsy-dolittle disease " so that we will know what to

do if we find them standing on their head in a bathtub full of jello.

Lets keep not teaching basic human interaction and customer service

skills and working with our students to be able to conduct a simple

conversation for 20 minutes about the person we are treating....is it

that hard to be a human and NOT a technician?

C'mon people...that is what we are arguing here...they don't need my

technical skills...so they don't need me...send them a lesser

thing...that is all they deserve.

I fear for you or your family when they get ill or disabled...don't

complain here...because the rough ride in the back of a truck with two

" transport techs " who talk to each other and on their cell phones

instead of talking to your loved one...making them feel like a nuisance

or a hindrance...after all....what else do they deserve? Care,

compassion, a listening ear??? Not in EMERGENCY medical services or

medical transport...we don't do that....no one pays us to do it.

Dudley

Re: MANDATORY READING ----- How can I fix EMSAT??

>

> And for the record, not all interfacility transfers are non

emergent...

And for the record, that is why we have been careful to note the

difference. Wes very specifically said non-emergency interfacility

transfers.

Rob

[Guest guest]

those people have no medical necessity for ambulance transport, and

therefore don't qualify for reimbursement. So their ride is paid for by

them, and if they want to pay for a physician to ride along it's their

prerogative.

No, in many if not most of these cases you and I (the taxpayer) or the

transporting agency pays for these trips.

AJL

________________________________

From: [mailto: ] On

Behalf Of ,

Sent: Monday, October 10, 2005 9:56 AM

To:

Subject: RE: Re: MANDATORY READING ----- How can I fix

EMSAT??

I think my point is, the nurse is the nurse is the nurse, just as the

medic

is the medic is the medic. Initial training, and minimum training are

the

starting point, where you go from there is a gamble. But the

Certification,

or Registry, or licensure is just that. Nurses are regulated by the

BNE,

the places they work for are regulated by DSHS, JCAHO standards, etc.

If

you don't like the specific business you've gotten into, change to

something

else.

<does it require EMS skills and knowledge merely to provide transport to

someone who is unable to walk?>

those people have no medical necessity for ambulance transport, and

therefore don't qualify for reimbursement. So their ride is paid for by

them, and if they want to pay for a physician to ride along it's their

prerogative.

Re: MANDATORY READING ----- How can I fix

EMSAT??

Danny <petsardlj@s...> wrote:

>

> Transportation is EMS. That is where we are and that is where we

came from.

By that logic, funeral services are also EMS. That's where I came

from.

There is nothing " emergency " nor " medical " about funeral services.

And there is nothing " emergency " nor " medical " about invalid

transportation. So are we now reducing EMS to nothing but a fancy

semantic with no actual meaning?

Rob

[Guest guest]

While all you people are debating as to who's urine stream goes the

farthest distance, I'm gonna break in. What link can I use to join

EMSAT? Sounds like if the rest of Texas did this, then we can actually

debate something and still get things done.

[Guest guest]

not if its a private service, there is no transport without payment. Which

brings u back to Public Vs Private. For some reason Public services feel an

obligation to transport those without medical necessity and good payors,

which drives up rates, and taxes, and so on and so forth. and the cycle

continues.....WILL IT EVER END?

Re: MANDATORY READING ----- How can I fix

EMSAT??

Danny <petsardlj@s...> wrote:

>

> Transportation is EMS. That is where we are and that is where we

came from.

By that logic, funeral services are also EMS. That's where I came

from.

There is nothing " emergency " nor " medical " about funeral services.

And there is nothing " emergency " nor " medical " about invalid

transportation. So are we now reducing EMS to nothing but a fancy

semantic with no actual meaning?

Rob

[Guest guest]

>

> C'mon people...that is what we are arguing here...they don't need

my

> technical skills...so they don't need me...send them a lesser

> thing...that is all they deserve.

Dudley, you're attempting to emotionalize an issue which is not

emotional. It simple common sense. It's not about what they

deserve. It's about what is appropriate. And they don't need a big

box with red lights, a siren, and 2 LPs on board to go home from the

podiatrist.

We don't send lawyers out to domestic disturbances. We send cops.

We don't drop smoke jumpers on house fires. We send structural fire

fighters.

Why would you believe that a paramedic is somehow more qualified to

hold the hand of these people than anybody else who cares?

Rob

[Guest guest]

" , " <manemtp@y...> wrote:

>

> slinging mud now? Whats over my head, is my desire to continue to

have a

> conversation with someone like you.

Oh, so you're the victim now? Get real, dude. You took the first

shot. You reap what you sow. And my reply was quite restrained,

considering.

Rob

[Guest guest]

" , " <manemtp@y...> wrote:

>

> Is it the " i'm too good for that " mentality?

No. It is the " I am not an ambulance driver " mentality. And that

mentality is what it is going to take to advance our profession.

Rob

[Guest guest]

" , " <manemtp@y...> wrote:

>

> If you don't like the specific business you've gotten into, change

> to something else.

Aren't you missing the entire point of this discussion? Most of us in

this profession care enough about it to CHANGE it instead of just

walking away, or worse yet, accepting things the way they are. That

is what EMSAT is all about. That is what this discussion is all about.

If you are perfectly happy with EMS just the way it is,

congratulations. But you're in a blissful minority.

Rob

[Guest guest]

" mysoundman " <walker_jonathon@h...> wrote:

>

> While all you people are debating as to who's urine stream goes the

> farthest distance, I'm gonna break in. What link can I use to join

> EMSAT? Sounds like if the rest of Texas did this, then we can

actually

> debate something and still get things done.

You aren't interested enough to Google it or search the archives? Now

that's enthusiasm!

http://www.texasemsat.org/

[Guest guest]

I have seen many public services look into or adopt paramedic initiated

refusals/referral to alternative transportation policies. I don't think

many private services would go to that direction.

On the other hand I have seen private services no bill a non medical

necessity transport in order to keep happy the management of a

contracted nursing home. In the old days it wasn't always no billed

either.

AJL

________________________________

From: [mailto: ] On

Behalf Of ,

Sent: Monday, October 10, 2005 12:11 PM

To:

Subject: RE: Re: MANDATORY READING ----- How can I fix

EMSAT??

not if its a private service, there is no transport without payment.

Which

brings u back to Public Vs Private. For some reason Public services

feel an

obligation to transport those without medical necessity and good payors,

which drives up rates, and taxes, and so on and so forth. and the cycle

continues.....WILL IT EVER END?

Re: MANDATORY READING ----- How can I fix

EMSAT??

Danny <petsardlj@s...> wrote:

>

> Transportation is EMS. That is where we are and that is where

we

came from.

By that logic, funeral services are also EMS. That's where I came

from.

There is nothing " emergency " nor " medical " about funeral services.

And there is nothing " emergency " nor " medical " about invalid

transportation. So are we now reducing EMS to nothing but a fancy

semantic with no actual meaning?

Rob

[Guest guest]

I suppose that ambulance just " arrives " there, and no one drives it?

Re: MANDATORY READING ----- How can I fix EMSAT??

" , " <manemtp@y...> wrote:

>

> Is it the " i'm too good for that " mentality?

No. It is the " I am not an ambulance driver " mentality. And that

mentality is what it is going to take to advance our profession.

Rob

[Guest guest]

I for one categorically oppose paramedic initiated refusals at any level, by

any service. My opinion. It will just force the someone to initiate an

EMTALA law for EMS.

Re: MANDATORY READING ----- How can I fix

EMSAT??

Danny <petsardlj@s...> wrote:

>

> Transportation is EMS. That is where we are and that is where

we

came from.

By that logic, funeral services are also EMS. That's where I came

from.

There is nothing " emergency " nor " medical " about funeral services.

And there is nothing " emergency " nor " medical " about invalid

transportation. So are we now reducing EMS to nothing but a fancy

semantic with no actual meaning?

Rob

[Guest guest]

" , " <manemtp@y...> wrote:

>

> I have been in Public safety my entire adult life, over 17 years.

So have I. Over thirty years.

> But what I stopped doing, was condeming a segment of my industry

> just because it didn't fit into my perfect little model of what an

> ambulance should be.

What leads you to believe I am condemning any segment of the

industry? There is absolutely no condemnation involved. I am

simply trying to separate specialties, just like we eventually

separated ambulance services from funeral services. We

didn't " condemn " funeral homes when we did that. In fact, we took a

big money loser off their hands.

> We run 911, we run transfers, THAT is our industry.

No, it is a small segment of our industry. Ask the Dallas Fire

Department if non-emergency transfers are their industry. Be ready

for an education.

> I know good and well what EMSAT is about, I was at the last

> meeting and I spoke my mind, ask any one of the 12 people who were

> there. Were you one of them?

Nope. When they show me they are serious about priorities, I'll

support them. Until then, I seriously doubt they want me to come

and tell them how I think they ought to do things. Do you?

> Changing the industry for the People, thats the change I want.

> Not changing the nature of the job.

They go hand in hand.

> I want my father and mother to get the same care whether its at

> home, or going from hospital to hospital.

Interesting thought, but do you really think your father and mother

ought to be charged for two paramedics and an MICU just for a ride

to the podiatrist and back? I am quite confident that I love my

mother as much as you love yours, but I would be perfectly

comfortable with her taking that trip with somebody with just a CPR

card and save $500 dollars of her fixed income.

Rob

[Guest guest]

" , " <manemtp@y...> wrote:

>

> I have been in Public safety my entire adult life, over 17 years.

So have I. Over thirty years.

> But what I stopped doing, was condeming a segment of my industry

> just because it didn't fit into my perfect little model of what an

> ambulance should be.

What leads you to believe I am condemning any segment of the

industry? There is absolutely no condemnation involved. I am

simply trying to separate specialties, just like we eventually

separated ambulance services from funeral services. We

didn't " condemn " funeral homes when we did that. In fact, we took a

big money loser off their hands.

> We run 911, we run transfers, THAT is our industry.

No, it is a small segment of our industry. Ask the Dallas Fire

Department if non-emergency transfers are their industry. Be ready

for an education.

> I know good and well what EMSAT is about, I was at the last

> meeting and I spoke my mind, ask any one of the 12 people who were

> there. Were you one of them?

Nope. When they show me they are serious about priorities, I'll

support them. Until then, I seriously doubt they want me to come

and tell them how I think they ought to do things. Do you?

> Changing the industry for the People, thats the change I want.

> Not changing the nature of the job.

They go hand in hand.

> I want my father and mother to get the same care whether its at

> home, or going from hospital to hospital.

Interesting thought, but do you really think your father and mother

ought to be charged for two paramedics and an MICU just for a ride

to the podiatrist and back? I am quite confident that I love my

mother as much as you love yours, but I would be perfectly

comfortable with her taking that trip with somebody with just a CPR

card and save $500 dollars of her fixed income.

Rob

[Guest guest]

" , " <manemtp@y...> wrote:

>

> I have been in Public safety my entire adult life, over 17 years.

So have I. Over thirty years.

> But what I stopped doing, was condeming a segment of my industry

> just because it didn't fit into my perfect little model of what an

> ambulance should be.

What leads you to believe I am condemning any segment of the

industry? There is absolutely no condemnation involved. I am

simply trying to separate specialties, just like we eventually

separated ambulance services from funeral services. We

didn't " condemn " funeral homes when we did that. In fact, we took a

big money loser off their hands.

> We run 911, we run transfers, THAT is our industry.

No, it is a small segment of our industry. Ask the Dallas Fire

Department if non-emergency transfers are their industry. Be ready

for an education.

> I know good and well what EMSAT is about, I was at the last

> meeting and I spoke my mind, ask any one of the 12 people who were

> there. Were you one of them?

Nope. When they show me they are serious about priorities, I'll

support them. Until then, I seriously doubt they want me to come

and tell them how I think they ought to do things. Do you?

> Changing the industry for the People, thats the change I want.

> Not changing the nature of the job.

They go hand in hand.

> I want my father and mother to get the same care whether its at

> home, or going from hospital to hospital.

Interesting thought, but do you really think your father and mother

ought to be charged for two paramedics and an MICU just for a ride

to the podiatrist and back? I am quite confident that I love my

mother as much as you love yours, but I would be perfectly

comfortable with her taking that trip with somebody with just a CPR

card and save $500 dollars of her fixed income.

Rob