Guest guest Posted September 28, 2006 Report Share Posted September 28, 2006 OK. I'll give you another example. I am headed to the grocery store recently and see medics off loading someone there (i.e. patient not being transported.) I nose around and found out the patient is 'refusing " transport. The original complaint is essentially aletered mental status. When the wife arrives the entire group of them decide it must be due to a new medicine that the patient is on and so he can go home with the wife. Is that appropriate? They may be right, but that seems like an ER evaluation decision (physician eval) and very dangerous to make in the parking lot by those involved. I'll give you another one. My friend gets stung by a bee and panics and calls 911 (allergic reaction.) EMS arrives and gives 50mg IM Benadryl. THey decide its not serious enough to transport. They courteously follow her home. Later she is found asleep on the couch which is now burned because she fell asleep smoking. She thought it was great care and was happy to be treated and receive no bill. I thought it was irresponsible. I have seen dialysis patients not transported for belly pain (peritoneal dialysis.) I have been flabbergasted so many times I can't remember. All of the above cases are hypothetical and should not be deemed admissible as fact in a court of law if found on the internet =) Kirk D. Mahon, MD, ABEM 6106 Keller Springs Rd Dallas, TX 75248 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 29, 2006 Report Share Posted September 29, 2006 work for Acadian Ambulance in Orange, TX, Our refusal system is we try not to get them if we have to get one the paramedic must take the first one,then the Jr. medic can take any others on scene. We also have a policy of " You call, We haul " as my wife posted in another thread. We ask which hospital do they want to go to not do you want to go to the hospital. i find that I've been getting less refusals now, in fact the only refusals I've gotten recently where from MVA " fender benders " H. Ben Ballard EMT-B, HSE Three Can Keep A Secret If Two Are Dead!!! <a href= " http://www.myspace.com/emtdragon1 " target= " _blank " ><img src= " http://x.myspace.com/images/Promo/myspace_4.jpg " border= " 0 " ><br><img src= " http://myspace-150.vo.llnwd.net/00417/05/11/417701150_s.jpg " border= " 0 " ><br><font size= " 1 " face= " Verdana, Arial, Helvetica, sans-serif " >Check me out!</font></a> __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 29, 2006 Report Share Posted September 29, 2006 Yea, not to mention the patient's day. LMc wegandy1938@... wrote: I can't remember where it was done, probably Mr. Bledson knows, but there has been a study done that attempted to measure the abilities of pre-hospital caregivers to determine which patients would be admitted to the hospital. The results were abysmal. Bledsoe, I think it was, or another astute physician, once told me that the scariest thing about being an ER doctor is making the decision who to admit and who to discharge. And this is from someone who has the education and training, all the toys, bells, and whistles, to diagnose. I like Henry's approach. Let's take that " anxious " patient. I want to know WHY the patient is anxious. Lots of times patients are anxious because they think they're about to die, and lots of the time they're right. It's extremely embarrassing to have left a patient, thinking that all they need is to take an aspirin and call their family doctor in the morning, only to be called back one hour later for a code. Ruins one's day. Gene G. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 29, 2006 Report Share Posted September 29, 2006 Good patient advocacy and good documentation are the best lawyer repellants. When writing a " critical " refusal, you SHOULD write more than you do in the actual report. A repeat: Every refusal form must show through independent facts, not conclusions: 1. The patient had the present mental capacity to understand and appreciate their medical condition, the possible consequences of refusal, and to form a rational judgment based upon facts. 2. Evidence that the patient was given specific and adequate information about his condition, as then known or reasonably discoverable by the medics, so as to enable him to make an informed decision about his health care. 3. Evidence that the patient received and understood the information given, documented with facts, not conclusions. " Understood " is a conclusionary term. It takes factual demonstration based upon the patient's quoted statements, to show this. 4. The patient's documented statement to the effect that he is making the decision not to be treated and transported based upon the documented facts that he has demonstrated that he understood. 5. Signatures of patient and witnesses with identifying data. Check your refusal form. Does it meet this standard? Gene G. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 29, 2006 Report Share Posted September 29, 2006 My $0.02 for those interested: I've always worked under the assumption, " if you feel it necessary to give medication, then transport them. " The only times this hasn't always been the case has been known diabetics who have received D50, wake up and refuse transport, or (in one system in Missouri) known asthmatics who have one treatment (of their usual meds) using our equipment and then refuse. I ALWAYS call med control with these and ensure there is family there that get the speel and sign the refusal as well. If I do an EKG on scene, I also call med control. (And that's usually because I think they need to go, but they refuse anyway.) I worked the hard core ghetto for a while, and it's a bit different. MANY, MANY, MANY a time we were called for mere taxi service. And I mean just that-- " I wanna go see my social worker, she's near the hospital, so you hafta take me cuz I called 911s! " If they wanted to go, away we went. When it came to refusals, if it was a third party call, such as in an MVA, if no one was injured and refused transport, we did not do refusals on them, we did a " cleared from scene, third party call. " Many a time, we were called just to " check them out. " I spent many a day doing blood pressure checks, blood sugar checks, " does this look like it needs stitches? " checks, " does this look infected? " checks, " can you cut this hangnail for me? " checks, " can I get some drugs? " checks...And the list goes on. And we always did the same. We took vitals, blood sugar, cleaned and dressed any cuts, called cops if necessary, etc. I repeated something along these lines a lot: " I have done all the assessment that I am able to, and your vitals/blood sugar/etc. are average/high/low by average standards and by our equipment. However, this may not be normal for you. I am not a doctor, nor do I have all of the tests and equipment available that the hospital has. I am more than happy to transport you to the hospital of your choice, but I also cannot force you to go. " Maybe this is bad, I dunno. I'm not thrilled with refusals, either; I write more on refusals than transports (for the most part). Maybe we should all get the cameras that police have, mic up, and record every refusal for posterity and lawsuits. Blake- TX LP, NREMT-P, TX EMSI AIM: SinaptiK " Medicine, the only profession that labors incessantly to destroy the reason for its existence. " Bryce Facebook me! --------------------------------- Stay in the know. Pulse on the new Yahoo.com. Check it out. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 1, 2006 Report Share Posted October 1, 2006 A well thought out form can be an aid in getting the right information down, no question about it. However, it all cames back to the person filling out the form. If the right questions are not asked, and the right assessments done, no piece of paper can help. It depends upon education, experience, and judgment. GG > > So what is the problem actually? > > Is it the forms? > > Or is it the personnel doing the refusals? > > Or is it a combination of both? > > Perhaps better training of what a patient refusal form is for and what it is > not for would be a good starting point? > > Perhaps then a refusal form that would meet the requirements and not leave > such a gap for lawsuits to occur? > > Or do we just leave it at transport everyone that wants to ride in the > woo-woos'? > > Or is it that the patients rights are flung out the door and we make then > ride in our bus regardless? > > I am pretty sure of the questions. Not so sure about the answers. > > > > wegandy1938@wegandy wrote: > The main reason I don't refuse patients who I'm tempted to think don't have > anything serious wrong with them is NOT what I know, but what I know that I > DON'T know. > > For example, here are some of the causes of abdominal pain: > > parietal peritoneal inflammation due to infection (appendix, PID) > parietal peritoneal inflammation due to chemical irritation (perforated > gastric or peptic ulcer; pancreatitis, Mittelschmerz, ruptured ectopic > pregnancy) > inflammation of bowel wall > Crohn's disease, > ulcerative colitis, > microscopic colitis > diverticulitis > gastroenteritis > lactose intolerance > celiac sprue > sarcoidosis > vasculitis > mechanical obstruction of hollow viscera > gallstones > vascular disturbances > embolism > thrombosis > vascular rupture > torsional occlusion (volvulus) > sickle cell anemia > renal vein entrapment > superior mesenteric artery syndrome (nutcracker syndrome) > mesenteric traction > muscle trauma > muscular infection > distention of visceral surfaces such as hepatic or renal capsule > referred pain from the thorax (MI, pneumonia), spine, genitals (testicular > torsion) > metabolic disturbance (lead poisoning, black widow spider bite, uremia, DKA, > porphyria, C1-esterase inhibitor deficiency, adrenal insufficiency) > tabes dorsalis > herpes zoster > Lyme disease > Irritable Bowel Syndrome > torsion of the ovary, endometriosis > diarrhea > meningitis > cholecystitis > pyelonephritis > hepatitis > mesenteric adenitis > subdiaphragmatic abscess > cancer of the ovary, bowel, stomach, liver, kidney, etc > ascites > > And there are surely others > > Any medic who feels comfortable telling someone with vague abdominal pain > that it's just an upset stomach is playing with fire, and will soon see the > judge > and jury. And that's the kindest thing I can say about such a person. > > If I were a board certified general surgeon or gastroenterologist in the > ambulance, I still wouldn't street such a patient. Yet paramedics do it > every > day. > > It boggles the mind. > > Gene G. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 1, 2006 Report Share Posted October 1, 2006 So surely for the person who called for the taxi service with the below statement was turned in for false report of an emergency???? Blake- wrote: My $0.02 for those interested: I've always worked under the assumption, " if you feel it necessary to give medication, then transport them. " The only times this hasn't always been the case has been known diabetics who have received D50, wake up and refuse transport, or (in one system in Missouri) known asthmatics who have one treatment (of their usual meds) using our equipment and then refuse. I ALWAYS call med control with these and ensure there is family there that get the speel and sign the refusal as well. If I do an EKG on scene, I also call med control. (And that's usually because I think they need to go, but they refuse anyway.) I worked the hard core ghetto for a while, and it's a bit different. MANY, MANY, MANY a time we were called for mere taxi service. And I mean just that-- " I wanna go see my social worker, she's near the hospital, so you hafta take me cuz I called 911s! " If they wanted to go, away Blake- TX LP, NREMT-P, TX EMSI Recent Activity 7 New Members 2 New Files Visit Your Group Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 1, 2006 Report Share Posted October 1, 2006 So what is the problem actually? Is it the forms? Or is it the personnel doing the refusals? Or is it a combination of both? Perhaps better training of what a patient refusal form is for and what it is not for would be a good starting point? Perhaps then a refusal form that would meet the requirements and not leave such a gap for lawsuits to occur? Or do we just leave it at transport everyone that wants to ride in the woo-woos'? Or is it that the patients rights are flung out the door and we make then ride in our bus regardless? I am pretty sure of the questions. Not so sure about the answers. wegandy1938@... wrote: The main reason I don't refuse patients who I'm tempted to think don't have anything serious wrong with them is NOT what I know, but what I know that I DON'T know. For example, here are some of the causes of abdominal pain: parietal peritoneal inflammation due to infection (appendix, PID) parietal peritoneal inflammation due to chemical irritation (perforated gastric or peptic ulcer; pancreatitis, Mittelschmerz, ruptured ectopic pregnancy) inflammation of bowel wall Crohn's disease, ulcerative colitis, microscopic colitis diverticulitis gastroenteritis lactose intolerance celiac sprue sarcoidosis vasculitis mechanical obstruction of hollow viscera gallstones vascular disturbances embolism thrombosis vascular rupture torsional occlusion (volvulus) sickle cell anemia renal vein entrapment superior mesenteric artery syndrome (nutcracker syndrome) mesenteric traction muscle trauma muscular infection distention of visceral surfaces such as hepatic or renal capsule referred pain from the thorax (MI, pneumonia), spine, genitals (testicular torsion) metabolic disturbance (lead poisoning, black widow spider bite, uremia, DKA, porphyria, C1-esterase inhibitor deficiency, adrenal insufficiency) tabes dorsalis herpes zoster Lyme disease Irritable Bowel Syndrome torsion of the ovary, endometriosis diarrhea meningitis cholecystitis pyelonephritis hepatitis mesenteric adenitis subdiaphragmatic abscess cancer of the ovary, bowel, stomach, liver, kidney, etc ascites And there are surely others Any medic who feels comfortable telling someone with vague abdominal pain that it's just an upset stomach is playing with fire, and will soon see the judge and jury. And that's the kindest thing I can say about such a person. If I were a board certified general surgeon or gastroenterologist in the ambulance, I still wouldn't street such a patient. Yet paramedics do it every day. It boggles the mind. Gene G. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 1, 2006 Report Share Posted October 1, 2006 Why is a person who doesn't have transportation not afforded this by EMS? Why would a supervisor not see the need and transport in his supervisor vehicle? Where is the emergency, with us, or with our patients? Transport is still a transport, albeit BLS right? wegandy1938@... wrote: Dear Humble, You're right if the world were perfect. And you're probably right that SOME medics can make those distinctions. I have no problem with discussing alternatives with the patient with an isolated minor finger laceration, a stubbed toe, and so forth, but in all cases it is preferable for the patient to make the decision for treat and transport vs. no treat and transport. The abusers are a problem all their own. What they really need is social services to help them with the underlying problems that cause them to abuse. But all in all, if a patient really wants to go, I'm going to take them. I don't ever want to have it come back on me that I refused someone who actually needed treatment. I remember one night with a large city FD EMS where we made three calls to the same place for a 3 year old child with an earache. Each time the mother was told that this wasn't an emergency and that she should drive to the ER with the child herself. She pleaded that she did not have transportation, et cetera. I could hardly keep my mouth shut, but since I was a guest, I did. However, on the third call, one of the medics made the astute observation that we might as well go ahead and transport because we were going to get called all night if we didn't. So on the third time we transported. Of course, if that service had ANY sort of effective supervision at that time, that wouldn't have happened. The kid was sick. I'm told that things have changed. I certainly hope so. GG > > There are actually a number of studies out there that talk about Paramedic > initiated refusals. > > In some instances it is a liability looking for a place to happen, however, > there are instances that Paramedic initiated refusals are appropriate. Now > before we get a rope and look for a tall tree..let me explain. In instances > where a definitive cause of a sign or symptom cannot be found, then the > patient should in fact be transported, or be encouraged to be transported, > syncope in the elderly, as explained by Mike , is generally caused by a > cardiac event of some kind, and should never be ignored or played down, > treated with a high index of suspicion and cared for accordingly. Abdominal > pain is another catch all for transport, etc. etc. > > There area small number of abusers of the system. Those that require a > ride, and nothing more. Do they need a ride? Yep. Do they need a ride in an > ambulance? Nope. Can we arrange for alternative transportation? That's the > question. Then it comes down to, which patients qualify for alternative > transport. > > I do believe that with the right training, the right oversight and good QI, > that there are a number of patients that can be refused transport. > > Are there medics who are not astute enough to learn it? Are there some that > will get refusals because they are too lazy to transport? Yes on both > counts, and they need to find another career field, we cannot slow this > field down for the slowest person, we need to continue to move forward and > thin the herd as necessary. > > Just my humble opinion...being the humble person that I am.:-) > > Mike > > Hatfield FF/EMT-P > > www.canyonlakefire- www.ca > > " Ubi concordia, ibi victoria " > > Re: Patient Refusal Forms of Little Value > > I can't remember where it was done, probably Mr. Bledson knows, but there > has > been a study done that attempted to measure the abilities of pre-hospital > caregivers to determine which patients would be admitted to the hospital. > The > results were abysmal. > > Bledsoe, I think it was, or another astute physician, once told me that the > scariest thing about being an ER doctor is making the decision who to admit > and > who to discharge. And this is from someone who has the education and > training, all the toys, bells, and whistles, to diagnose. > > I like Henry's approach. Let's take that " anxious " patient. I want to > know WHY the patient is anxious. Lots of times patients are anxious because > they think they're about to die, and lots of the time they're right. It's > extremely embarrassing to have left a patient, thinking that all they need > is to > take an aspirin and call their family doctor in the morning, only to be > called > back one hour later for a code. > > Ruins one's day. > > Gene G. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 2, 2006 Report Share Posted October 2, 2006 The 911 call for transportation to the social workers office (or add your non medical reason for transportation) next to the hospital is much more common in many cities that you would believe. As far as reporting someone for a false report of an emergency - anything short of a federal funded FBI task force on 911 abuse with federal agents knocking down doors to make a late night arrest isn't going to make much of a difference. Tongue firmly in cheek!!! The cold truth is that most communities other than rural counties are not going to bother prosecuting a 911 abuse case. There isn't the time or the money to really bother with it. AJL ________________________________ From: texasems-l [mailto:texasems-l ] On Behalf Of Danny Sent: Sunday, October 01, 2006 7:35 PM To: texasems-l Subject: Re: Re: Patient Refusal Forms of Little Value So surely for the person who called for the taxi service with the below statement was turned in for false report of an emergency???? Blake- <paramedicbbt@... <mailto:paramedicbbt%40yahoo.com> > wrote: My $0.02 for those interested: I've always worked under the assumption, " if you feel it necessary to give medication, then transport them. " The only times this hasn't always been the case has been known diabetics who have received D50, wake up and refuse transport, or (in one system in Missouri) known asthmatics who have one treatment (of their usual meds) using our equipment and then refuse. I ALWAYS call med control with these and ensure there is family there that get the speel and sign the refusal as well. If I do an EKG on scene, I also call med control. (And that's usually because I think they need to go, but they refuse anyway.) I worked the hard core ghetto for a while, and it's a bit different. MANY, MANY, MANY a time we were called for mere taxi service. And I mean just that-- " I wanna go see my social worker, she's near the hospital, so you hafta take me cuz I called 911s! " If they wanted to go, away Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 2, 2006 Report Share Posted October 2, 2006 I have been working in a system that has been doing paramedic initiated no transports for 7 years now. Simple trauma only, no medical complaints and the elderly and pediatrics are excluded. A patient with any other intervention besides an assessment and vital signs are also excluded. We still consider it to be a pilot program - longest pilot program that I have ever encountered - but it has moved over the years with baby steps. So far no lawsuits or adverse patient outcomes. It's not something you can do in a vacuum nor can you just go out and instruct people to say no we aren't going to transport you. We were prepared to invest in time (seven years and we are still tweaking it) training, education, oversight and yes learning from a few mistakes. Is adding more ambulances to run more calls the answer to rising call volumes? Although finances were never a consideration for us what else can be done (other than adding more ambulances) especially when you are confronted with ever decreasing reimbursements? AJL ________________________________ From: texasems-l [mailto:texasems-l ] On Behalf Of Hatfield Sent: Thursday, September 28, 2006 8:57 PM To: texasems-l Subject: RE: Patient Refusal Forms of Little Value There are actually a number of studies out there that talk about Paramedic initiated refusals. In some instances it is a liability looking for a place to happen, however, there are instances that Paramedic initiated refusals are appropriate. Now before we get a rope and look for a tall tree..let me explain. In instances where a definitive cause of a sign or symptom cannot be found, then the patient should in fact be transported, or be encouraged to be transported, syncope in the elderly, as explained by Mike , is generally caused by a cardiac event of some kind, and should never be ignored or played down, treated with a high index of suspicion and cared for accordingly. Abdominal pain is another catch all for transport, etc. etc. There area small number of abusers of the system. Those that require a ride, and nothing more. Do they need a ride? Yep. Do they need a ride in an ambulance? Nope. Can we arrange for alternative transportation? That's the question. Then it comes down to, which patients qualify for alternative transport. I do believe that with the right training, the right oversight and good QI, that there are a number of patients that can be refused transport. Are there medics who are not astute enough to learn it? Are there some that will get refusals because they are too lazy to transport? Yes on both counts, and they need to find another career field, we cannot slow this field down for the slowest person, we need to continue to move forward and thin the herd as necessary. Just my humble opinion...being the humble person that I am.:-) Mike Hatfield FF/EMT-P www.canyonlakefire-ems.org " Ubi concordia, ibi victoria " Re: Patient Refusal Forms of Little Value I can't remember where it was done, probably Mr. Bledson knows, but there has been a study done that attempted to measure the abilities of pre-hospital caregivers to determine which patients would be admitted to the hospital. The results were abysmal. Bledsoe, I think it was, or another astute physician, once told me that the scariest thing about being an ER doctor is making the decision who to admit and who to discharge. And this is from someone who has the education and training, all the toys, bells, and whistles, to diagnose. I like Henry's approach. Let's take that " anxious " patient. I want to know WHY the patient is anxious. Lots of times patients are anxious because they think they're about to die, and lots of the time they're right. It's extremely embarrassing to have left a patient, thinking that all they need is to take an aspirin and call their family doctor in the morning, only to be called back one hour later for a code. Ruins one's day. Gene G. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 2, 2006 Report Share Posted October 2, 2006 I appreciate what you're saying. I think you've got the right approach. There are alternatives to transporting everyone by ambulance. For various reasons, those have not been tried or have been tried and deemed not to work. I would be in favor of the service providing non-ambulance transportation in a service owned vehicle, with a trained driver, that do not really need immediate care but who should be seen before their regular physician could see them. Some of those could be triaged to a Doc-In-The-Box perhaps. These are people who might need a dressing change and don't have home health care, who have minor sprains, or a dislocated finger, or a stubbed toe, or a finger mashed in the door, et cetera. Although those might need pain relief, in which case they'd get transported by ambulance. The regs don't allow this sort of transport, but maybe it's something that should be looked at in a thoughtful way to see whether or not some money and manpower could be saved by using alternative transportation provided by the EMS service. That said, service initiated refusals are still a river full of piranhas. Gene G. > > I have been working in a system that has been doing paramedic initiated > no transports for 7 years now. Simple trauma only, no medical > complaints and the elderly and pediatrics are excluded. A patient with > any other intervention besides an assessment and vital signs are also > excluded. We still consider it to be a pilot program - longest pilot > program that I have ever encountered - but it has moved over the years > with baby steps. So far no lawsuits or adverse patient outcomes. It's > not something you can do in a vacuum nor can you just go out and > instruct people to say no we aren't going to transport you. We were > prepared to invest in time (seven years and we are still tweaking it) > training, education, oversight and yes learning from a few mistakes. > > Is adding more ambulances to run more calls the answer to rising call > volumes? Although finances were never a consideration for us what else > can be done (other than adding more ambulances) especially when you are > confronted with ever decreasing reimbursements? > > AJL > > ____________ ________ ________ _ > > From: texasems-l@yahoogrotexasem [mailto:texasems-l@yahoogrotexasem] On > Behalf Of Hatfield > Sent: Thursday, September 28, 2006 8:57 PM > To: texasems-l@yahoogrotexasem > Subject: RE: Patient Refusal Forms of Little Value > > There are actually a number of studies out there that talk about > Paramedic > initiated refusals. > > In some instances it is a liability looking for a place to happen, > however, > there are instances that Paramedic initiated refusals are appropriate. > Now > before we get a rope and look for a tall tree..let me explain. In > instances > where a definitive cause of a sign or symptom cannot be found, then the > patient should in fact be transported, or be encouraged to be > transported, > syncope in the elderly, as explained by Mike , is generally caused > by a > cardiac event of some kind, and should never be ignored or played down, > treated with a high index of suspicion and cared for accordingly. > Abdominal > pain is another catch all for transport, etc. etc. > > There area small number of abusers of the system. Those that require a > ride, and nothing more. Do they need a ride? Yep. Do they need a ride in > an > ambulance? Nope. Can we arrange for alternative transportation? That's > the > question. Then it comes down to, which patients qualify for alternative > transport. > > I do believe that with the right training, the right oversight and good > QI, > that there are a number of patients that can be refused transport. > > Are there medics who are not astute enough to learn it? Are there some > that > will get refusals because they are too lazy to transport? Yes on both > counts, and they need to find another career field, we cannot slow this > field down for the slowest person, we need to continue to move forward > and > thin the herd as necessary. > > Just my humble opinion...being the humble person that I am.:-) > > Mike > > Hatfield FF/EMT-P > > www.canyonlakefire- www.ca > > " Ubi concordia, ibi victoria " > > Re: Patient Refusal Forms of Little Value > > I can't remember where it was done, probably Mr. Bledson knows, but > there > has > been a study done that attempted to measure the abilities of > pre-hospital > caregivers to determine which patients would be admitted to the > hospital. > The > results were abysmal. > > Bledsoe, I think it was, or another astute physician, once told me that > the > scariest thing about being an ER doctor is making the decision who to > admit > and > who to discharge. And this is from someone who has the education and > training, all the toys, bells, and whistles, to diagnose. > > I like Henry's approach. Let's take that " anxious " patient. I want to > know WHY the patient is anxious. Lots of times patients are anxious > because > they think they're about to die, and lots of the time they're right. > It's > extremely embarrassing to have left a patient, thinking that all they > need > is to > take an aspirin and call their family doctor in the morning, only to be > called > back one hour later for a code. > > Ruins one's day. > > Gene G. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 2, 2006 Report Share Posted October 2, 2006 I think you're right on both points. The more I think about it, I doubt that alternative transport is prohibited. I'll have to seek the advice of one of the DSHS people before I'm sure. I think we should be allowed to transport to clinics and other non-hospital destinations where appropriate. The problem is that there are some medics who don't have sense enough to know which ones to take where. And that's sad. On the subject of reimbursement, who the heck knows? I've never understood reimbursement very well except that you never get paid what your services are worth. Gene > > Gene, > > A couple of questions. The regs don't allow these type of transports? I am > not sure the type of transport you describe is regulated... A couple of > questions. The regs don't allow these type of transports? I am not sure the type of > transport you describe is reg > > The other question I have is why don't we transport, even as ambulances, > transport to minor emergency clinics...community health clinics, etc? > > Now, I know payment for these services probably isn't available... Now, I > know payment for these services probably isn't available...<wbr>and that > certainly would prevent many from doing this...but since many insurances are > encouraging their customers to NOT call 911 and to call an 800 number so that a > more appropriate " preferred provider " can be contacted that will respond from 20 > minutes away while the 911 ambulance 4 minutes away sits in the barn....so w > Now, I know payment for these services probably isn't available...<wbr>and > that certainly would prevent many from do > > Thoughts? > > Dudley > > > Re: Patient Refusal Forms of Little Value > > > > I can't remember where it was done, probably Mr. Bledson knows, but > > there > > has > > been a study done that attempted to measure the abilities of > > pre-hospital > > caregivers to determine which patients would be admitted to the > > hospital. > > The > > results were abysmal. > > > > Bledsoe, I think it was, or another astute physician, once told me that > > the > > scariest thing about being an ER doctor is making the decision who to > > admit > > and > > who to discharge. And this is from someone who has the education and > > training, all the toys, bells, and whistles, to diagnose. > > > > I like Henry's approach. Let's take that " anxious " patient. I want to > > know WHY the patient is anxious. Lots of times patients are anxious > > because > > they think they're about to die, and lots of the time they're right. > > It's > > extremely embarrassing to have left a patient, thinking that all they > > need > > is to > > take an aspirin and call their family doctor in the morning, only to be > > called > > back one hour later for a code. > > > > Ruins one's day. > > > > Gene G. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 2, 2006 Report Share Posted October 2, 2006 Gene, A couple of questions. The regs don't allow these type of transports? I am not sure the type of transport you describe is regulated...all that is regulated is ambulance transport from what I have read...and that is (now anyway) someone being moved by stretcher.... The other question I have is why don't we transport, even as ambulances, transport to minor emergency clinics...community health clinics, etc? Now, I know payment for these services probably isn't available...and that certainly would prevent many from doing this...but since many insurances are encouraging their customers to NOT call 911 and to call an 800 number so that a more appropriate " preferred provider " can be contacted that will respond from 20 minutes away while the 911 ambulance 4 minutes away sits in the barn....so why wouldn't they be willing to pay for transport to a minor emergency...seems they could pay for these transport since the cost savings will be in not having to pay the hospital charges.... Thoughts? Dudley Re: Patient Refusal Forms of Little Value > > I can't remember where it was done, probably Mr. Bledson knows, but > there > has > been a study done that attempted to measure the abilities of > pre-hospital > caregivers to determine which patients would be admitted to the > hospital. > The > results were abysmal. > > Bledsoe, I think it was, or another astute physician, once told me that > the > scariest thing about being an ER doctor is making the decision who to > admit > and > who to discharge. And this is from someone who has the education and > training, all the toys, bells, and whistles, to diagnose. > > I like Henry's approach. Let's take that " anxious " patient. I want to > know WHY the patient is anxious. Lots of times patients are anxious > because > they think they're about to die, and lots of the time they're right. > It's > extremely embarrassing to have left a patient, thinking that all they > need > is to > take an aspirin and call their family doctor in the morning, only to be > called > back one hour later for a code. > > Ruins one's day. > > Gene G. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 3, 2006 Report Share Posted October 3, 2006 So surely for the person who called for the taxi service with the below statement was turned in for false report of an emergency??? ? We filled in a report and all that jazz, but I highly doubt anything came of it. This was in the hardcore ghetto; the woman (and I use the term loosely) had no permanent address, had a history of all sorts of criminal and drug-related charges, etc. etc. If we actually prosecuted everyone that pulled that, there would be no cops left to run the county. (They usually have enough presence of mind to make up some excuse like " I have a headache " when we started questioning them after the " oh, my ride's here; I'll meet ya at Sha-naynay's crib in a few " statement when we walked in.) I thought maybe the idea that the service won't get paid might make a difference, but nah. Blake- TX LP, NREMT-P, TX EMSI AIM: SinaptiK " Medicine, the only profession that labors incessantly to destroy the reason for its existence. " Bryce Facebook me! --------------------------------- Get your email and more, right on the new Yahoo.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 3, 2006 Report Share Posted October 3, 2006 The problem with 'taxi patients' is that many studies have shown that paramedics are poor at determining who needs treatment and transportation, and who will actually be admitted to the hospital. One of the reasons is that we don't have access to radiology and labs, but, sadly, another one is that we are not trained well in general medicine. So about the time you think that Miss EMS Abuser has called you one too many times, and you're mad and tempted to " no-ride " her, that's the time that she actually has PID and dies from septic shock. And low and behold, out of the woodwork come relatives who see her death as winning the lottery. I few days ago I posted a list of differential diagnoses for abdominal pain. We can find similar lists for practically every pain that can be described. I am not skilled in lie detection, although I have my ideas, but if challenged in Court, I would never be able to explain why I denied a patient treatment and transport for a " headache. " I have had lots of experience in talking with people who lie, and I have been fooled. Not often, but enough times that I never rely upon my gut reaction when making a treatment/transport decision. Even polygraphs are not reliable enough to be admissible in court. I see us using alternative means of transport for those patients who are looking for a taxi ride. That would take the pressure from overworked EMS crews. But if that is not available, then we must do the right thing FOR THE PATIENT, NOT FOR US, OR THE SERVICE. Most of the abusers have some medical problems and lots of social problems. Drug addiction is a medical problem, and lack of transportation is a social problem. The bad thing about it all is that we do not have a pervasive public health plan for dealing with these patients. The public health service people don't talk to EMS, and they should. But communication is two way. We don't reach out to the public health service people and say, " HEY, we've got some big problems caused by these prostitutes and drug abusers who use our services for other reasons than for emergency medical care. We need to get together and work out some plans. " Unfortunately, that almost never happens. I would like to hear from anybody who has a plan in place to deal with those patients through social services and public health resources. Gene G. > > So surely for the person who called for the taxi service with the below > statement was turned in for false report of an emergency??? ? > > We filled in a report and all that jazz, but I highly doubt anything came of > it. This was in the hardcore ghetto; the woman (and I use the term loosely) > had no permanent address, had a history of all sorts of criminal and > drug-related charges, etc. etc. If we actually prosecuted everyone that pulled that, > there would be no cops left to run the county. (They usually have enough > presence of mind to make up some excuse like " I have a headache " when we started > questioning them after the " oh, my ride's here; I'll meet ya at Sha-naynay's > crib in a few " statement when we walked in.) I thought maybe the idea that > the service won't get paid might make a difference, but nah. > > Blake- > TX LP, NREMT-P, TX EMSI > AIM: SinaptiK > " Medicine, the only profession that labors > incessantly to destroy the reason for its > existence. " Bryce > > > Facebook me! > > ------------ -------- -------- -- > Get your email and more, right on the new Yahoo.com > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 4, 2006 Report Share Posted October 4, 2006 On a related note, last weekend local news reports Dallas Fire Rescue responded to a man with severe abdominal pain and in front of multiple witnesses told the patient to take some antacid and then they packed their stuff and left. One witness told the news reporter that the medics told her on the way out not to call them back. The man was found dead in his apartment the next morning reportedly from a bleeding ulcer. You can say whatever you want about it but I personally think that you are better off just giving them a 10 minute ride to the ER than spending 20 mins talking them out of going and I fully believe that as a public provider (or private sole provider of 911) you don't have the right to refuse anyone services, " you call we haul " . If you have a system (not specifically referring to Dallas Fire Rescue) that has no accountability (or a weak one) process and allow your medics to refuse transport you are always going to have these situations come up. Just my 2 cents Lee Re: Re: Patient Refusal Forms of Little Value The problem with 'taxi patients' is that many studies have shown that paramedics are poor at determining who needs treatment and transportation, and who will actually be admitted to the hospital. One of the reasons is that we don't have access to radiology and labs, but, sadly, another one is that we are not trained well in general medicine. So about the time you think that Miss EMS Abuser has called you one too many times, and you're mad and tempted to " no-ride " her, that's the time that she actually has PID and dies from septic shock. And low and behold, out of the woodwork come relatives who see her death as winning the lottery. I few days ago I posted a list of differential diagnoses for abdominal pain. We can find similar lists for practically every pain that can be described. I am not skilled in lie detection, although I have my ideas, but if challenged in Court, I would never be able to explain why I denied a patient treatment and transport for a " headache. " I have had lots of experience in talking with people who lie, and I have been fooled. Not often, but enough times that I never rely upon my gut reaction when making a treatment/transport decision. Even polygraphs are not reliable enough to be admissible in court. I see us using alternative means of transport for those patients who are looking for a taxi ride. That would take the pressure from overworked EMS crews. But if that is not available, then we must do the right thing FOR THE PATIENT, NOT FOR US, OR THE SERVICE. Most of the abusers have some medical problems and lots of social problems. Drug addiction is a medical problem, and lack of transportation is a social problem. The bad thing about it all is that we do not have a pervasive public health plan for dealing with these patients. The public health service people don't talk to EMS, and they should. But communication is two way. We don't reach out to the public health service people and say, " HEY, we've got some big problems caused by these prostitutes and drug abusers who use our services for other reasons than for emergency medical care. We need to get together and work out some plans. " Unfortunately, that almost never happens. I would like to hear from anybody who has a plan in place to deal with those patients through social services and public health resources. Gene G. In a message dated 10/3/06 6:41:08 PM, paramedicbbt@... <mailto:paramedicbbt%40yahoo.com> writes: > > So surely for the person who called for the taxi service with the below > statement was turned in for false report of an emergency??? ? > > We filled in a report and all that jazz, but I highly doubt anything came of > it. This was in the hardcore ghetto; the woman (and I use the term loosely) > had no permanent address, had a history of all sorts of criminal and > drug-related charges, etc. etc. If we actually prosecuted everyone that pulled that, > there would be no cops left to run the county. (They usually have enough > presence of mind to make up some excuse like " I have a headache " when we started > questioning them after the " oh, my ride's here; I'll meet ya at Sha-naynay's > crib in a few " statement when we walked in.) I thought maybe the idea that > the service won't get paid might make a difference, but nah. > > Blake- > TX LP, NREMT-P, TX EMSI > AIM: SinaptiK > " Medicine, the only profession that labors > incessantly to destroy the reason for its > existence. " Bryce > > > Facebook me! > > ------------ -------- -------- -- > Get your email and more, right on the new Yahoo.com > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 4, 2006 Report Share Posted October 4, 2006 Gene, One of the many thousands of reasons that EMS should be in the Public Health Department is exactly as you mentioned. Beaumont EMS is in the health department and we have a referral form that can go to many of the social services, CPS, APS, Public Health, Environmental Health, Animal Control, Transportation Services, and Public Health Nursing. Each day, as members of our team encounter problems that can be referred to these services, this form is filled out, with a copy of the run sheet, history of calls to our ambulance, etc. It is a wonderful tool that can cut responses for many reasons. Beaumont EMS takes the time on all calls to see if the elderly have their meds in order, not taking 2 of the same meds each day, have food in their refrigerator, running water, toilets operating, etc. We also make sure that they have someone coming by their home and checking on them regularly, are they under Home Health Care and if not and they need to be, we initiate that process. Mental illnessess are referred to the proper channels, unclean environments due to 28 dogs and cats in the house, needs for transportation to stores and doctors. This has proven to be one of the greatest tools that we can offer the citizens of our City. If you would like more information feel free to contact me. Andy Foote Beaumont EMS Manager Re: Re: Patient Refusal Forms of Little Value The problem with 'taxi patients' is that many studies have shown that paramedics are poor at determining who needs treatment and transportation, and who will actually be admitted to the hospital. One of the reasons is that we don't have access to radiology and labs, but, sadly, another one is that we are not trained well in general medicine. So about the time you think that Miss EMS Abuser has called you one too many times, and you're mad and tempted to " no-ride " her, that's the time that she actually has PID and dies from septic shock. And low and behold, out of the woodwork come relatives who see her death as winning the lottery. I few days ago I posted a list of differential diagnoses for abdominal pain. We can find similar lists for practically every pain that can be described. I am not skilled in lie detection, although I have my ideas, but if challenged in Court, I would never be able to explain why I denied a patient treatment and transport for a " headache. " I have had lots of experience in talking with people who lie, and I have been fooled. Not often, but enough times that I never rely upon my gut reaction when making a treatment/transport decision. Even polygraphs are not reliable enough to be admissible in court. I see us using alternative means of transport for those patients who are looking for a taxi ride. That would take the pressure from overworked EMS crews. But if that is not available, then we must do the right thing FOR THE PATIENT, NOT FOR US, OR THE SERVICE. Most of the abusers have some medical problems and lots of social problems. Drug addiction is a medical problem, and lack of transportation is a social problem. The bad thing about it all is that we do not have a pervasive public health plan for dealing with these patients. The public health service people don't talk to EMS, and they should. But communication is two way. We don't reach out to the public health service people and say, " HEY, we've got some big problems caused by these prostitutes and drug abusers who use our services for other reasons than for emergency medical care. We need to get together and work out some plans. " Unfortunately, that almost never happens. I would like to hear from anybody who has a plan in place to deal with those patients through social services and public health resources. Gene G. > > So surely for the person who called for the taxi service with the below > statement was turned in for false report of an emergency??? ? > > We filled in a report and all that jazz, but I highly doubt anything came of > it. This was in the hardcore ghetto; the woman (and I use the term loosely) > had no permanent address, had a history of all sorts of criminal and > drug-related charges, etc. etc. If we actually prosecuted everyone that pulled that, > there would be no cops left to run the county. (They usually have enough > presence of mind to make up some excuse like " I have a headache " when we started > questioning them after the " oh, my ride's here; I'll meet ya at Sha-naynay's > crib in a few " statement when we walked in.) I thought maybe the idea that > the service won't get paid might make a difference, but nah. > > Blake- > TX LP, NREMT-P, TX EMSI > AIM: SinaptiK > " Medicine, the only profession that labors > incessantly to destroy the reason for its > existence. " Bryce > > > Facebook me! > > ------------ -------- -------- -- > Get your email and more, right on the new Yahoo.com > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 4, 2006 Report Share Posted October 4, 2006 That is why I like this profession soooo much. We get to meet interesting people. Learn about their troubles. Take them for a nice Cruise in our pimped up rides. All the while with a smile on our faces and joy in our hearts(but usually nothing in our pocketbooks.) Danny L. Owner/NREMT-P PETSAR INC. (Panhandle Emergency Training Services And Response) Office Fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 4, 2006 Report Share Posted October 4, 2006 Perhaps the sole providers have too much to do. Maybe the municipalities that have this problem should allow them some help. Maybe? Danny L. Owner/NREMT-P PETSAR INC. (Panhandle Emergency Training Services And Response) Office Fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 4, 2006 Report Share Posted October 4, 2006 Lee: What a great segue into something that was discussed at EMS Expo 2006! At Expo, Dr. Wesley discussed the role of a medical director in an EMS system. As we all know, there are a variety of medical directors with varying levels of involvement in the EMS system. Not having practiced in the BioTel system, I can't speak to what involvement BioTel would have in addressing such allegations involving patient care. Question for all: ASSUMING that this happened as described, is this an issue for discipline through the FD chain of command? Or, is it a credentialing/training/remediation issue that should be addressed through the medical director and/or QA/QI folks? -Wes Ogilvie, MPA, JD, EMT-B Austin, Texas Re: Re: Patient Refusal Forms of Little Value The problem with 'taxi patients' is that many studies have shown that paramedics are poor at determining who needs treatment and transportation, and who will actually be admitted to the hospital. One of the reasons is that we don't have access to radiology and labs, but, sadly, another one is that we are not trained well in general medicine. So about the time you think that Miss EMS Abuser has called you one too many times, and you're mad and tempted to " no-ride " her, that's the time that she actually has PID and dies from septic shock. And low and behold, out of the woodwork come relatives who see her death as winning the lottery. I few days ago I posted a list of differential diagnoses for abdominal pain. We can find similar lists for practically every pain that can be described. I am not skilled in lie detection, although I have my ideas, but if challenged in Court, I would never be able to explain why I denied a patient treatment and transport for a " headache. " I have had lots of experience in talking with people who lie, and I have been fooled. Not often, but enough times that I never rely upon my gut reaction when making a treatment/transport decision. Even polygraphs are not reliable enough to be admissible in court. I see us using alternative means of transport for those patients who are looking for a taxi ride. That would take the pressure from overworked EMS crews. But if that is not available, then we must do the right thing FOR THE PATIENT, NOT FOR US, OR THE SERVICE. Most of the abusers have some medical problems and lots of social problems. Drug addiction is a medical problem, and lack of transportation is a social problem. The bad thing about it all is that we do not have a pervasive public health plan for dealing with these patients. The public health service people don't talk to EMS, and they should. But communication is two way. We don't reach out to the public health service people and say, " HEY, we've got some big problems caused by these prostitutes and drug abusers who use our services for other reasons than for emergency medical care. We need to get together and work out some plans. " Unfortunately, that almost never happens. I would like to hear from anybody who has a plan in place to deal with those patients through social services and public health resources. Gene G. In a message dated 10/3/06 6:41:08 PM, paramedicbbt@... <mailto:paramedicbbt%40yahoo.com> writes: > > So surely for the person who called for the taxi service with the below > statement was turned in for false report of an emergency??? ? > > We filled in a report and all that jazz, but I highly doubt anything came of > it. This was in the hardcore ghetto; the woman (and I use the term loosely) > had no permanent address, had a history of all sorts of criminal and > drug-related charges, etc. etc. If we actually prosecuted everyone that pulled that, > there would be no cops left to run the county. (They usually have enough > presence of mind to make up some excuse like " I have a headache " when we started > questioning them after the " oh, my ride's here; I'll meet ya at Sha-naynay's > crib in a few " statement when we walked in.) I thought maybe the idea that > the service won't get paid might make a difference, but nah. > > Blake- > TX LP, NREMT-P, TX EMSI > AIM: SinaptiK > " Medicine, the only profession that labors > incessantly to destroy the reason for its > existence. " Bryce > > > Facebook me! > > ------------ -------- -------- -- > Get your email and more, right on the new Yahoo.com > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 4, 2006 Report Share Posted October 4, 2006 Another black eye for Dallas Fire Rescue. Will they never learn? This conduct has been repeated again and again and again, and in spite of the terrible, sometimes national publicity, they haven't changed. Gene Gandy In a message dated 10/4/06 7:06:15 AM, lrichardson@... writes: > > On a related note, last weekend local news reports Dallas Fire Rescue > responded to a man with severe abdominal pain and in front of multiple > witnesses told the patient to take some antacid and then they packed > their stuff and left. One witness told the news reporter that the > medics told her on the way out not to call them back. The man was found > dead in his apartment the next morning reportedly from a bleeding ulcer. > You can say whatever you want about it but I personally think that you > are better off just giving them a 10 minute ride to the ER than spending > 20 mins talking them out of going and I fully believe that as a public > provider (or private sole provider of 911) you don't have the right to > refuse anyone services, " you call we haul " . If you have a system (not > specifically referring to Dallas Fire Rescue) that has no accountability > (or a weak one) process and allow your medics to refuse transport you > are always going to have these situations come up. > > Just my 2 cents > > Lee > > Re: Re: Patient Refusal Forms of Little Value > > The problem with 'taxi patients' is that many studies have shown that > paramedics are poor at determining who needs treatment and > transportation, and who > will actually be admitted to the hospital. > > One of the reasons is that we don't have access to radiology and labs, > but, > sadly, another one is that we are not trained well in general medicine. > > So about the time you think that Miss EMS Abuser has called you one too > many > times, and you're mad and tempted to " no-ride " her, that's the time that > she > actually has PID and dies from septic shock. And low and behold, out of > the > woodwork come relatives who see her death as winning the lottery. > > I few days ago I posted a list of differential diagnoses for abdominal > pain. > We can find similar lists for practically every pain that can be > described. > > I am not skilled in lie detection, although I have my ideas, but if > challenged in Court, I would never be able to explain why I denied a > patient treatment > and transport for a " headache. " I have had lots of experience in talking > > with people who lie, and I have been fooled. Not often, but enough times > that I > never rely upon my gut reaction when making a treatment/transport > decision. > > Even polygraphs are not reliable enough to be admissible in court. > > I see us using alternative means of transport for those patients who are > > looking for a taxi ride. That would take the pressure from overworked > EMS crews. > But if that is not available, then we must do the right thing FOR THE > PATIENT, NOT FOR US, OR THE SERVICE. > > Most of the abusers have some medical problems and lots of social > problems. > Drug addiction is a medical problem, and lack of transportation is a > social > problem. > > The bad thing about it all is that we do not have a pervasive public > health > plan for dealing with these patients. > > The public health service people don't talk to EMS, and they should. But > > communication is two way. We don't reach out to the public health > service > people and say, " HEY, we've got some big problems caused by these > prostitutes and > drug abusers who use our services for other reasons than for emergency > medical > care. We need to get together and work out some plans. " Unfortunately, > that almost never happens. > > I would like to hear from anybody who has a plan in place to deal with > those > patients through social services and public health resources. > > Gene G. > In a message dated 10/3/06 6:41:08 PM, paramedicbbt@paramedic > <mailto:paramedicbbmailto:parmai> writes: > > > > > So surely for the person who called for the taxi service with the > below > > statement was turned in for false report of an emergency??? ? > > > > We filled in a report and all that jazz, but I highly doubt anything > came of > > it. This was in the hardcore ghetto; the woman (and I use the term > loosely) > > had no permanent address, had a history of all sorts of criminal and > > drug-related charges, etc. etc. If we actually prosecuted everyone > that pulled that, > > there would be no cops left to run the county. (They usually have > enough > > presence of mind to make up some excuse like " I have a headache " when > we started > > questioning them after the " oh, my ride's here; I'll meet ya at > Sha-naynay's > > crib in a few " statement when we walked in.) I thought maybe the idea > that > > the service won't get paid might make a difference, but nah. > > > > Blake- > > TX LP, NREMT-P, TX EMSI > > AIM: SinaptiK > > " Medicine, the only profession that labors > > incessantly to destroy the reason for its > > existence. " Bryce > > > > > > Facebook me! > > > > ------------ -------- -------- -- > > Get your email and more, right on the new Yahoo.com > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 4, 2006 Report Share Posted October 4, 2006 That's the way it SHOULD be done. Gene > > Gene, > > One of the many thousands of reasons that EMS should be in the Public Health > Department is exactly as you mentioned. Beaumont EMS is in the health > department and we have a referral form that can go to many of the social services, > CPS, APS, Public Health, Environmental Health, Animal Control, Transportation > Services, and Public Health Nursing. Each day, as members of our team > encounter problems that can be referred to these services, this form is filled out, > with a copy of the run sheet, history of calls to our ambulance, etc. It is > a wonderful tool that can cut responses for many reasons. > > Beaumont EMS takes the time on all calls to see if the elderly have their > meds in order, not taking 2 of the same meds each day, have food in their > refrigerator, running water, toilets operating, etc. We also make sure that they > have someone coming by their home and checking on them regularly, are they > under Home Health Care and if not and they need to be, we initiate that process. > Mental illnessess are referred to the proper channels, unclean environments > due to 28 dogs and cats in the house, needs for transportation to stores and > doctors. > > This has proven to be one of the greatest tools that we can offer the > citizens of our City. If you would like more information feel free to contact me. > > Andy Foote > Beaumont EMS Manager > > > Re: Re: Patient Refusal Forms of Little Value > > The problem with 'taxi patients' is that many studies have shown that > paramedics are poor at determining who needs treatment and transportation, > and > who > will actually be admitted to the hospital. > > One of the reasons is that we don't have access to radiology and labs, but, > sadly, another one is that we are not trained well in general medicine. > > So about the time you think that Miss EMS Abuser has called you one too many > times, and you're mad and tempted to " no-ride " her, that's the time that she > actually has PID and dies from septic shock. And low and behold, out of the > woodwork come relatives who see her death as winning the lottery. > > I few days ago I posted a list of differential diagnoses for abdominal pain. > We can find similar lists for practically every pain that can be described. > > I am not skilled in lie detection, although I have my ideas, but if > challenged in Court, I would never be able to explain why I denied a patient > treatment > and transport for a " headache. " I have had lots of experience in talking > with people who lie, and I have been fooled. Not often, but enough times > that > I > never rely upon my gut reaction when making a treatment/transport decision. > > Even polygraphs are not reliable enough to be admissible in court. > > I see us using alternative means of transport for those patients who are > looking for a taxi ride. That would take the pressure from overworked EMS > crews. > But if that is not available, then we must do the right thing FOR THE > PATIENT, NOT FOR US, OR THE SERVICE. > > Most of the abusers have some medical problems and lots of social problems. > Drug addiction is a medical problem, and lack of transportation is a social > problem. > > The bad thing about it all is that we do not have a pervasive public health > plan for dealing with these patients. > > The public health service people don't talk to EMS, and they should. But > communication is two way. We don't reach out to the public health service > people and say, " HEY, we've got some big problems caused by these > prostitutes > and > drug abusers who use our services for other reasons than for emergency > medical > care. We need to get together and work out some plans. " Unfortunately, > that almost never happens. > > I would like to hear from anybody who has a plan in place to deal with those > patients through social services and public health resources. > > Gene G. > In a message dated 10/3/06 6:41:08 PM, paramedicbbt@paramedic writes: > > > > > So surely for the person who called for the taxi service with the below > > statement was turned in for false report of an emergency??? ? > > > > We filled in a report and all that jazz, but I highly doubt anything came > of > > it. This was in the hardcore ghetto; the woman (and I use the term > loosely) > > had no permanent address, had a history of all sorts of criminal and > > drug-related charges, etc. etc. If we actually prosecuted everyone that > pulled > that, > > there would be no cops left to run the county. (They usually have enough > > presence of mind to make up some excuse like " I have a headache " when we > started > > questioning them after the " oh, my ride's here; I'll meet ya at > Sha-naynay's > > crib in a few " statement when we walked in.) I thought maybe the idea that > > the service won't get paid might make a difference, but nah. > > > > Blake- > > TX LP, NREMT-P, TX EMSI > > AIM: SinaptiK > > " Medicine, the only profession that labors > > incessantly to destroy the reason for its > > existence. " Bryce > > > > > > Facebook me! > > > > ------------ -------- -------- -- > > Get your email and more, right on the new Yahoo.com > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 4, 2006 Report Share Posted October 4, 2006 So, in essence, Dallas Fire Rescue is an organization with many flaws, involving long standing culture, lack of adequate command structure, and insufficient funds to make corrections. Dallas is a sad place. Once it was a great city, but it has fallen into the trashcan over the last 20 years. The police department has as many problems as fire, or more. They haven't been able to keep a police chief, and their last fire chief left in the middle of the night. I know that there are some folks who are working hard to try to change things, but they're butting their heads against a wall of ignorance, bureaucracy, and bad culture. I'll ask this question: what power does the new medical director have over medics? Taking them off the ambulance won't work; that's what everybody would like to happen, so he would be rewarding the bad actors. I'm sure he cannot fire them, because under civil service you can't fire anybody for less than 1st degree murder. So what real power could he have? Dallas Fire Rescue is the perfect example of why EMS should not be in fire department. EMS should be a governmental 3rd service. Only then will change occur. But in a city like Dallas, fat chance. They cannot fix the chugholes in the streets, buy decent police cars, or fund enough MICUs. And so the story goes.......... Gene G. In a message dated 10/4/06 5:50:58 PM, lrichardson@... writes: > > It is a multifaceted problem that has been created over the past 30+ > years the system has been in place. I think the answer lies in the > middle of changing SOG's to not allow the medics to electively no-ride > people (BTW, there is a SOG related to " Mandatory Transports " but > compliance is sporadic at best) this would most likely require a > significant capital investment as well as the hiring of a bunch of > people to either place more MICU's in-service or make Paramedic > Engines/Truck Companies to supplement due to the volume of calls. Then > you have the QI part that needs to be greatly enhanced, again this will > require money to hire more people to do chart audits, ride along > evaluations etc etc etc, this is not likely to happen either. Regarding > the education part of the problem, I don't think it is the school (UTSW) > I believe it is due to new medics being partnered with old medics and > over time their bad habits either rub off or are forced on them and the > problem goes on and on. I know that DFR has recently got their own > Medical Director (just for them), he came for San Francisco I believe > and from what I hear is going to be a great asset for DFR and probably > the system in general. Again, this is not a bash of DFR, there are > other departments within the system that do the same things you just > don't hear much about them, this is a system problem in general. > > Lee > > Re: Re: Patient Refusal Forms of Little Value > > The problem with 'taxi patients' is that many studies have shown that > paramedics are poor at determining who needs treatment and > transportation, and who > will actually be admitted to the hospital. > > One of the reasons is that we don't have access to radiology and labs, > but, > sadly, another one is that we are not trained well in general medicine. > > So about the time you think that Miss EMS Abuser has called you one too > many > times, and you're mad and tempted to " no-ride " her, that's the time that > she > actually has PID and dies from septic shock. And low and behold, out of > the > woodwork come relatives who see her death as winning the lottery. > > I few days ago I posted a list of differential diagnoses for abdominal > pain. > We can find similar lists for practically every pain that can be > described. > > I am not skilled in lie detection, although I have my ideas, but if > challenged in Court, I would never be able to explain why I denied a > patient treatment > and transport for a " headache. " I have had lots of experience in talking > > with people who lie, and I have been fooled. Not often, but enough times > that I > never rely upon my gut reaction when making a treatment/transport > decision. > > Even polygraphs are not reliable enough to be admissible in court. > > I see us using alternative means of transport for those patients who are > > looking for a taxi ride. That would take the pressure from overworked > EMS crews. > But if that is not available, then we must do the right thing FOR THE > PATIENT, NOT FOR US, OR THE SERVICE. > > Most of the abusers have some medical problems and lots of social > problems. > Drug addiction is a medical problem, and lack of transportation is a > social > problem. > > The bad thing about it all is that we do not have a pervasive public > health > plan for dealing with these patients. > > The public health service people don't talk to EMS, and they should. But > > communication is two way. We don't reach out to the public health > service > people and say, " HEY, we've got some big problems caused by these > prostitutes and > drug abusers who use our services for other reasons than for emergency > medical > care. We need to get together and work out some plans. " Unfortunately, > that almost never happens. > > I would like to hear from anybody who has a plan in place to deal with > those > patients through social services and public health resources. > > Gene G. > In a message dated 10/3/06 6:41:08 PM, paramedicbbt@paramedic > <mailto:paramedicbbmailto:parmai> > <mailto:paramedicbbmailto:parmai> writes: > > > > > So surely for the person who called for the taxi service with the > below > > statement was turned in for false report of an emergency??? ? > > > > We filled in a report and all that jazz, but I highly doubt anything > came of > > it. This was in the hardcore ghetto; the woman (and I use the term > loosely) > > had no permanent address, had a history of all sorts of criminal and > > drug-related charges, etc. etc. If we actually prosecuted everyone > that pulled that, > > there would be no cops left to run the county. (They usually have > enough > > presence of mind to make up some excuse like " I have a headache " when > we started > > questioning them after the " oh, my ride's here; I'll meet ya at > Sha-naynay's > > crib in a few " statement when we walked in.) I thought maybe the idea > that > > the service won't get paid might make a difference, but nah. > > > > Blake- > > TX LP, NREMT-P, TX EMSI > > AIM: SinaptiK > > " Medicine, the only profession that labors > > incessantly to destroy the reason for its > > existence. " Bryce > > > > > > Facebook me! > > > > ------------ -------- -------- -- > > Get your email and more, right on the new Yahoo.com > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 4, 2006 Report Share Posted October 4, 2006 Man, I hate getting sucked into this list. I much prefer to just read. I did my Paramedic Internship with DFR in 1989. Same song different verse. I have one thing to say ... NO CONSEQUENCES, NO CHANGE!!! There are some good folks that work there and try to do the right thing. Unfortunately, the good is never outshined by the bad. Just the way it works. , LP, RN, FP-C Montgomery, Texas In a message dated 10/4/2006 5:17:20 PM Central Standard Time, wegandy1938@... writes: Another black eye for Dallas Fire Rescue. Will they never learn? This conduct has been repeated again and again and again, and in spite of the terrible, sometimes national publicity, they haven't changed. Gene Gandy In a message dated 10/4/06 7:06:15 AM, _lrichardson@lrichardson@<WBlrich_ (mailto:lrichardson@...) writes: > > On a related note, last weekend local news reports Dallas Fire Rescue > responded to a man with severe abdominal pain and in front of multiple > witnesses told the patient to take some antacid and then they packed > their stuff and left. One witness told the news reporter that the > medics told her on the way out not to call them back. The man was found > dead in his apartment the next morning reportedly from a bleeding ulcer. > You can say whatever you want about it but I personally think that you > are better off just giving them a 10 minute ride to the ER than spending > 20 mins talking them out of going and I fully believe that as a public > provider (or private sole provider of 911) you don't have the right to > refuse anyone services, " you call we haul " . If you have a system (not > specifically referring to Dallas Fire Rescue) that has no accountability > (or a weak one) process and allow your medics to refuse transport you > are always going to have these situations come up. > > Just my 2 cents > > Lee > > Re: Re: Patient Refusal Forms of Little Value > > The problem with 'taxi patients' is that many studies have shown that > paramedics are poor at determining who needs treatment and > transportation, and who > will actually be admitted to the hospital. > > One of the reasons is that we don't have access to radiology and labs, > but, > sadly, another one is that we are not trained well in general medicine. > > So about the time you think that Miss EMS Abuser has called you one too > many > times, and you're mad and tempted to " no-ride " her, that's the time that > she > actually has PID and dies from septic shock. And low and behold, out of > the > woodwork come relatives who see her death as winning the lottery. > > I few days ago I posted a list of differential diagnoses for abdominal > pain. > We can find similar lists for practically every pain that can be > described. > > I am not skilled in lie detection, although I have my ideas, but if > challenged in Court, I would never be able to explain why I denied a > patient treatment > and transport for a " headache. " I have had lots of experience in talking > > with people who lie, and I have been fooled. Not often, but enough times > that I > never rely upon my gut reaction when making a treatment/transport > decision. > > Even polygraphs are not reliable enough to be admissible in court. > > I see us using alternative means of transport for those patients who are > > looking for a taxi ride. That would take the pressure from overworked > EMS crews. > But if that is not available, then we must do the right thing FOR THE > PATIENT, NOT FOR US, OR THE SERVICE. > > Most of the abusers have some medical problems and lots of social > problems. > Drug addiction is a medical problem, and lack of transportation is a > social > problem. > > The bad thing about it all is that we do not have a pervasive public > health > plan for dealing with these patients. > > The public health service people don't talk to EMS, and they should. But > > communication is two way. We don't reach out to the public health > service > people and say, " HEY, we've got some big problems caused by these > prostitutes and > drug abusers who use our services for other reasons than for emergency > medical > care. We need to get together and work out some plans. " Unfortunately, > that almost never happens. > > I would like to hear from anybody who has a plan in place to deal with > those > patients through social services and public health resources. > > Gene G. > In a message dated 10/3/06 6:41:08 PM, paramedicbbt@ In a mes > <mailto:paramedicbbmailto:parame> writes: > > > > > So surely for the person who called for the taxi service with the > below > > statement was turned in for false report of an emergency??? ? > > > > We filled in a report and all that jazz, but I highly doubt anything > came of > > it. This was in the hardcore ghetto; the woman (and I use the term > loosely) > > had no permanent address, had a history of all sorts of criminal and > > drug-related charges, etc. etc. If we actually prosecuted everyone > that pulled that, > > there would be no cops left to run the county. (They usually have > enough > > presence of mind to make up some excuse like " I have a headache " when > we started > > questioning them after the " oh, my ride's here; I'll meet ya at > Sha-naynay's > > crib in a few " statement when we walked in.) I thought maybe the idea > that > > the service won't get paid might make a difference, but nah. > > > > Blake- > > TX LP, NREMT-P, TX EMSI > > AIM: SinaptiK > > " Medicine, the only profession that labors > > incessantly to destroy the reason for its > > existence. " Bryce > > > > > > Facebook me! > > > > ------------ -------- -------- -- > > Get your email and more, right on the new Yahoo.com > > > > [Non-text portions of this message have been removed] > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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