Guest guest Posted August 25, 2009 Report Share Posted August 25, 2009 I know it comes with the job.? Just a bit of humor there. -Wes Re: The Most Fundamental Problem with EMS Yea but Wes that toothache is just as important to the caller as the Heart Attack is. Just comes with the job. Henry RE: The Most Fundamental Problem with EMS To: texasems-l Date: Tuesday, August 25, 2009, 10:03 AM ? On Tuesday, August 25, 2009 09:58, " McGee " said: > So are you implying that all of us that are still practicing EMS providers are > either lazy or stupid?? Do you really intend to open that can of worms? So are you implying that I'm stupid enough to make a universal assumption about every practising EMS provider? We're talking statistics here, not absolutes. Keep your worms to yourself. Rob __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2009 Report Share Posted August 25, 2009 This is a fairly robust study given the methodology. Read the whole paper. BEB > > > > > Agreed, but if the data is flawed or skewed due to unforseen variables, then > the data itself is subject to incorrect evaluation. > > Live for today, tomorrow is not here yet and laugh at yourself often before > someone else does. > > McGee, EMT-P > > > > > > From: rob.davis@... > rob.davis@... > > Subject: Re: The Most Fundamental Problem with EMS > To: texasems-l > Date: Tuesday, August 25, 2009, 12:55 PM > > > > On Tuesday, August 25, 2009 11:53, lnmolino (AT) aol (DOT) com said: > >> > Of course one can also choose to sit in the truck and study their way to a >> > better job and the " smart " ones often do just that. > > Bingo. Before we get too worked up over the superficial implications of this > study, we have to step back and intelligently consider the deeper and more > significant issues it raises. This is only data, and nothing more. The > absolute meaning of that data is still to be determined. > > Rob > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2009 Report Share Posted August 25, 2009 Can you send the link Dr. Bledsoe? I would like to read it. Live for today, tomorrow is not here yet and laugh at yourself often before someone else does. McGee, EMT-P > > From: rob.davis@armynurse corps.com > > > Subject: Re: The Most Fundamental Problem with EMS > To: texasems-l@yahoogro ups.com > Date: Tuesday, August 25, 2009, 12:55 PM > > > > On Tuesday, August 25, 2009 11:53, lnmolino (AT) aol (DOT) com said: > >> > Of course one can also choose to sit in the truck and study their way to a >> > better job and the " smart " ones often do just that. > > Bingo. Before we get too worked up over the superficial implications of this > study, we have to step back and intelligently consider the deeper and more > significant issues it raises. This is only data, and nothing more. The > absolute meaning of that data is still to be determined. > > Rob > > ____________ _________ _________ _________ _________ __ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2009 Report Share Posted August 25, 2009 I practice because it's what I want to do. I gave up a lucrative career as a lawyer because I hated practicing law and I love teaching people to be paramedics. When I worked the streets I loved that too. However, that said, I was luck enough to have made enough money for my retirement before I quit the law practice, and I didn't have kids to put through college and so forth. I can understand someone who just can't afford to stay in the profession. GG >  > Gene, Wes, you both still practice I believe. What are your thoughts? > > Live for today, tomorrow is not here yet and laugh at yourself often > before someone else does. >  > McGee, EMT-P > >  > > > > > Subject: RE: The Most Fundamental Problem with EMS > To: texasems-l@yahoogrotexasem > Date: Tuesday, August 25, 2009, 10:03 AM > >  > > On Tuesday, August 25, 2009 09:58, " McGee " > said: > > > So are you implying that all of us that are still practicing EMS > providers are > > either lazy or stupid? Do you really intend to open that can of worms? > > So are you implying that I'm stupid enough to make a universal assumption > about every practising EMS provider? We're talking statistics here, not > absolutes. Keep your worms to yourself. > > Rob > > ____________ ________ ________ ________ ________ _ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2009 Report Share Posted August 25, 2009 Tucson is currently using a system where they run " Alpha Trucks " for the " Help, I've Fallen And I Can't Reach My Beer " and toothache calls. They are basic EMT trucks and they are taking a lot of the load off the regular ones. They do not transport. They are able to refer people to other agencies, make calls for them to set up appointments, and so forth. They can always call for a BLS transport or an ALS truck if needed, but most of the time one is not. They also attempt to educate frequent flyers about the system and try to find ways for them to stop calling EMS when they really don't need it. The system depends upon good dispatch protocols, and Phoenix tried it and found it didn't work there. But it seems to be working in Tucson. I think they generally have a couple of them in service at any given time. GG > Â > Agreed but as I remember in the Dallas incident that was telephone > based. I do believe that the truck needs to respond and assess the > patient. It is also up to us as educators to teach patient assessment in > such a manner that proper assessments are performed. Perhaps the answer > is to have specially trained supervisors that could respond with the > truck and perform the denial assessment. > > In short there is not a good answer to this problem right now and work > needs to be done to come up with the answer. > > > > ____________ ________ ________ __ > > From: texasems-l@yahoogrotexasem [mailto:texasems-l@yahoogrotexasem] On > Behalf Of ExLngHrn@... > Sent: Tuesday, August 25, 2009 5:04 PM > To: texasems-l@yahoogrotexasem > Subject: Re: Re: The Most Fundamental Problem with EMS > > > > > > > Rick -- > > You and I both know the horror stories of denial protocols.?? Ask any of > the old-timers on here about Dallas and Nurse Myrick. > > Great concept, but fraught with peril, especially considering what some > of us have seen for patient assessments. > > -Wes > > RE: The Most Fundamental Problem with EMS > > To: texasems-l@yahoogrotexasem > > > Date: Tuesday, August 25, 2009, 10:03 AM > > > > ? > > > > On Tuesday, August 25, 2009 09:58, " McGee " com> said: > > > > > So are you implying that all of us that are still practicing EMS > providers are > > > either lazy or stupid?? Do you really intend to open that can of > worms? > > > > So are you implying that I'm stupid enough to make a universal > assumption about every practising EMS provider? We're talking statistics > > here, not absolutes. Keep your worms to yourself. > > > > Rob > > > > ____________ ________ ________ ________ ________ ___ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2009 Report Share Posted August 25, 2009 Ah, Jane, and then pigs will fly! LOL. I agree with you 100% but........... Just to be a meanie because I feel like it today, how many programs do we know that REALLY have a strong QA/QI program that REALLY WORKS? I submit that they are few and far between. Perhaps I have seen one or two. Lots of services THINK they have a good QA/QI program, but I have not been impressed with most I've been close enough to be familiar with. How many training programs do we know that fulfill the requirements you list? Some actually do, but far more do not. And we all know that initial training is only the first step in learning to be a functioning street medic with the smarts it takes to make these decisions. And worst, how many have " heavy medical control involvement? " I have to say that I only know of one or two systems that have anywhere close to what I would call heavy medical control involvement. One is Houston FD, and the other is Chicago FD. I'm sure there are others, but I have not seen them. So there's the rub. Those ingredients that Jane lists are precisely the right ones, but they seldom all exist at the same time. I know plenty of medics who are capable of determining MOST OF THE TIME when somebody doesn't need to go to the hospital. But as Dr. Bledsoe will state, studies show that we've been very bad historically at predicting which patients would be admitted and which would not. As he said to me once, even for physicians, the scariest decision is who to admit and who to send home, and that's with Superman Eyes and labs available. I think there are times when patients can be told no, but with today's level of education, training, and supervision, service-initiated refusals are still a lawsuit magnet, I'm afraid. GG > > I think that it is a viable thing that CAN be one - crew initiated no > transports - and I have seen it done well. The keys are: > > > > 1. A strong QA/QI program that looks at no transports to be sure they are > handled within guidelines. > > 2. A strong training program that also reviews and enforces good, sound > patient assessment, developing solid differential diagnosis lists, and > identifying emergent versus non-emergent situations based on those assessment > and diagnosis. > > 3. Heavy medical control involvement. > > > > If any one of those three items is missing, then it is a very precarious > liability slope. > > > > Jane Dinsmore > > > > To: texasems-l > From: ExLngHrn@... > Date: Tue, 25 Aug 2009 17:38:09 -0400 > Subject: Re: Re: The Most Fundamental Problem with EMS > >  > > > > > Ideally, EMS would have a public education program to inform people about > the proper use of EMS.? (Yes, this includes when to call as much as when > not to call.)? > > At this time, given the educational standards, I'm very uncomfortable with > giving medics the right to deny treatment/transport.? Too many of us don't > have the patient assessment skills (much less the resources) to accurately > determine what's the real problem with the patient. > > Of course, London Ambulance Service in the UK has gone so far as to print > a poster with a taxi and an ambulance with the caption, " Only one of these > is a taxi. " ? Yet, somehow, we would never do something so politically > incorrect here.?? On this count, I'm with the Brits. > > -Wes > > RE: The Most Fundamental Problem with EMS > > To: texasems-l > > Date: Tuesday, August 25, 2009, 10:03 AM > > > > ? > > > > On Tuesday, August 25, 2009 09:58, " McGee " > said: > > > > > So are you implying that all of us that are still practicing EMS > providers are > > > either lazy or stupid?? Do you really intend to open that can of > worms? > > > > So are you implying that I'm stupid enough to make a universal > assumption about every practising EMS provider? We're talking statistics here, not > absolutes. Keep your worms to yourself. > > > > Rob > > > > __________________________________________________ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2009 Report Share Posted August 25, 2009 Rick, Ummm, no I don't, and now that I've learned more about them I would not agree with your statement about their being ahead of the curve on anything. I had the same notion before I moved here and began to talk to folks who work for and with them and have worked for and with them, including some high ranking ex-officers. Their reputation does not match their hype. More off-list if you are interested. GG > Â > Do you know what the issue in Phoenix was? They are always ahead of the > curve on new practices. > Rick > > Sent from my GoodLink synchronized handheld (www.good.com) > > > RE: The Most Fundamental Problem with EMS > > > To: texasems-l@yahoogro To: tex > > > > > Date: Tuesday, August 25, 2009, 10:03 AM > > > > > > ? > > > > > > On Tuesday, August 25, 2009 09:58, " McGee " > com> said: > > > > > > > So are you implying that all of us that are still practicing EMS > > providers are > > > > either lazy or stupid?? Do you really intend to open that can of > > worms? > > > > > > So are you implying that I'm stupid enough to make a universal > > assumption about every practising EMS provider? We're talking statistics > > > > here, not absolutes. Keep your worms to yourself. > > > > > > Rob > > > > > > ____________ ________ ________ ________ ________ ___ > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2009 Report Share Posted August 25, 2009 Rob, I don't think they're putting rookie EMTs on those trucks. And I don't think they're using them to triage serious calls. Those get a paramedic response. Perhaps I was not clear. My understanding is that they are used for calls that are identifiable as low-grade calls, as determined by their dispatch system. Now, I am not a great fan of emergency medical dispatch systems, but I do think we can identify some calls that don't need a full-cavalry charge. These are what we call patient assist calls, for lack of a better word. These are those where all the patient needs is help getting back in bed, et cetera. And I think they lean strongly on sending all the troops if there's the slightest chance a full response is needed. I would certainly agree that if we're letting medics make service-initiated refusals, it should be done by the best and brightest. That's not what I think's happening with the Alpha trucks. GG > Â > On Tuesday, August 25, 2009 18:32, wegandy1938@wegandy said: > > > Tucson is currently using a system where they run " Alpha Trucks " for the > > " Help, I've Fallen And I Can't Reach My Beer " and toothache calls. They > are > > basic EMT trucks and they are taking a lot of the load off the regular > ones. > > Maybe it's just me, but sending out the least educated and qualified > persons in the system to do a patient assessment and determine medical needs > seems counterintuitive at best, considering that others have failed even with > RNs doing it. > > Funny, when you hear of a third service doing this, they are usually > employing their best and brightest for the screening. When a fire department > does it, they're sending out rookie EMT-Bs. What's wrong with that picture? > > Rob > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2009 Report Share Posted August 25, 2009 Most places running a tiered system pretty much transport 100% of those " Alpha " truck jobs. I sit here every day and watch a million dollars worth of rolling stock (Engine and ALS Ambulance) with 5-6 folks, 90% of whom are Medics, they drive through a crowded city " Code 3 " with both vehicles blowing lights and other traffic control devices and they show up at a call that was literally for a skinned knee off a tricycle call where Mom has no car to take kid for his 4 stitches. Yea that systems works. Louis N. Molino, Sr., CET FF/NREMT-B/FSI/EMSI Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant Training Program Manager, Fire and Safety Specialists, Inc. (www.fireandsafetyspecialists.com) Technical Editor, Industrial Fire World (www.fireworld.com) LNMolino@... Lou@... (Cell Phone) (IFW/FSS Office) (IFW/FSS Fax) " A Texan with a Jersey Attitude " " Great minds discuss ideas; Average minds discuss events; Small minds discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) In a message dated 8/25/2009 7:03:42 P.M. Central Daylight Time, wegandy1938@... writes: Rob, I don't think they're putting rookie EMT's on those trucks. And I don't think they're using them to triage serious calls. Those get a paramedic response. Perhaps I was not clear. My understanding is that they are used for calls that are identifiable as low-grade calls, as determined by their dispatch system. Now, I am not a great fan of emergency medical dispatch systems, but I do think we can identify some calls that don't need a full-cavalry charge. These are what we call patient assist calls, for lack of a better word. These are those where all the patient needs is help getting back in bed, et cetera. And I think they lean strongly on sending all the troops if there's the slightest chance a full response is needed. I would certainly agree that if we're letting medics make service-initiated refusals, it should be done by the best and brightest. That's not what I think's happening with the Alpha trucks. GG In a message dated 8/25/09 4:50:01 PM, _rob.davis@..._ (mailto:rob.davis@...) writes: > > On Tuesday, August 25, 2009 18:32, wegandy1938@ On Tuesday, > > > Tucson is currently using a system where they run " Alpha Trucks " for the > > " Help, I've Fallen And I Can't Reach My Beer " and toothache calls. They > are > > basic EMT trucks and they are taking a lot of the load off the regular > ones. > > Maybe it's just me, but sending out the least educated and qualified > persons in the system to do a patient assessment and determine medical needs > seems counterintuitive at best, considering that others have failed even with > RNs doing it. > > Funny, when you hear of a third service doing this, they are usually > employing their best and brightest for the screening. When a fire department > does it, they're sending out rookie EMT-Bs. What's wrong with that picture? > > Rob > > > > [Non-text portions of this message have been removed] Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2009 Report Share Posted August 25, 2009 And just another reason every service needs a denial protocol that includes educating the person of the proper place to seek help for that toothache and perhaps even keeping a tube of toothache medicine to leave with them until the dentist opens in the morning. Then the ambulance is freed up to respond to the heart attack. I really think many choose to leave as they get frustrated being low paid taxi drivers. Just my worthless thoughts. Renny Spencer Paramedic > > From: rob.davis@... > Subject: RE: The Most Fundamental Problem with EMS > To: texasems-l > Date: Tuesday, August 25, 2009, 10:03 AM > > ? > > On Tuesday, August 25, 2009 09:58, " McGee " said: > > > So are you implying that all of us that are still practicing EMS providers are > > either lazy or stupid?? Do you really intend to open that can of worms? > > So are you implying that I'm stupid enough to make a universal assumption about every practising EMS provider? We're talking statistics here, not absolutes. Keep your worms to yourself. > > Rob > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2009 Report Share Posted August 25, 2009 Ideally, EMS would have a public education program to inform people about the proper use of EMS.? (Yes, this includes when to call as much as when not to call.)? At this time, given the educational standards, I'm very uncomfortable with giving medics the right to deny treatment/transport.? Too many of us don't have the patient assessment skills (much less the resources) to accurately determine what's the real problem with the patient. Of course, London Ambulance Service in the UK has gone so far as to print a poster with a taxi and an ambulance with the caption, " Only one of these is a taxi. " ? Yet, somehow, we would never do something so politically incorrect here.?? On this count, I'm with the Brits. -Wes RE: The Most Fundamental Problem with EMS > To: texasems-l > Date: Tuesday, August 25, 2009, 10:03 AM > > ? > > On Tuesday, August 25, 2009 09:58, " McGee " said: > > > So are you implying that all of us that are still practicing EMS providers are > > either lazy or stupid?? Do you really intend to open that can of worms? > > So are you implying that I'm stupid enough to make a universal assumption about every practising EMS provider? We're talking statistics here, not absolutes. Keep your worms to yourself. > > Rob > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2009 Report Share Posted August 25, 2009 Great idea Wes, but in the Emergency Department world we all have public education programs on what is and isn't an emergency and when to and not to come to the ED. They do not work, because everybody thinks their " emergency " is real and even though it is plainly listed on the " not an emergency " list they have special circumstances. I think denial protocols are the way to go, especially if we could get some tort reform and end our silly anybody can sue anybody mentality. I can just see the ads now " Have you or a loved one been denied transport to the Emergency Department? Has your hangnail gotten worse because of it, call 1-800-legaleagles, you may qualify for a cash settlement " . Rick ________________________________ From: texasems-l [mailto:texasems-l ] On Behalf Of ExLngHrn@... Sent: Tuesday, August 25, 2009 4:38 PM To: texasems-l Subject: Re: Re: The Most Fundamental Problem with EMS Ideally, EMS would have a public education program to inform people about the proper use of EMS.? (Yes, this includes when to call as much as when not to call.)? At this time, given the educational standards, I'm very uncomfortable with giving medics the right to deny treatment/transport.? Too many of us don't have the patient assessment skills (much less the resources) to accurately determine what's the real problem with the patient. Of course, London Ambulance Service in the UK has gone so far as to print a poster with a taxi and an ambulance with the caption, " Only one of these is a taxi. " ? Yet, somehow, we would never do something so politically incorrect here.?? On this count, I'm with the Brits. -Wes RE: The Most Fundamental Problem with EMS > To: texasems-l > Date: Tuesday, August 25, 2009, 10:03 AM > > ? > > On Tuesday, August 25, 2009 09:58, " McGee " said: > > > So are you implying that all of us that are still practicing EMS providers are > > either lazy or stupid?? Do you really intend to open that can of worms? > > So are you implying that I'm stupid enough to make a universal assumption about every practising EMS provider? We're talking statistics here, not absolutes. Keep your worms to yourself. > > Rob > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2009 Report Share Posted August 25, 2009 Thank you Dr. Bledsoe for sending me the link to this study. But as Ms. states in her conclusion, " Although we found a significant relationship between our commitment constructs and turnover, we did not look at attrition directly. This would have required a very different study design. Although there is ample evidence of a correlation between the two, the results of this study should be evaluated cautiously so as not to induce a direct relationship to turnover or attrition. " This makes me wonder, just because we sometimes complain about our profession, and often about our employers, this does not mean we will leave either. It is also interesting to note from this study that those two groups, one with only EMS certification, second with EMS degree, were more committed to their profession then those with higher degrees outside EMS. Just my humble observations. Live for today, tomorrow is not here yet and laugh at yourself often before someone else does. McGee, EMT-P Subject: RE: The Most Fundamental Problem with EMS To: texasems-l Date: Tuesday, August 25, 2009, 9:48 AM On Tuesday, August 25, 2009 08:21, " Bledsoe " said: > Results: For occupational commitment, the participants with certificate > level of education had a > significantly higher score (88.9) than did those with either the degree > (83.6) or postbaccalaureate (80.9) > level of education. So what she's saying is that the smart, motivated people get out. Those too stupid or lazy to find options in life stay. Pretty much been my theory for thirty years. Glad to see someone validate it. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2009 Report Share Posted August 25, 2009 " just because we sometimes complain about our profession, and often about our employers, this does not mean we will leave either. " For many it will, I know I won't stay somewhere I am inherently unhappy at, and as much as I have put into this profession, give me a few more semesters and I will have my degree in engineering and I will sideline myself........ Hatfield www.michaelwhatfield.net From: rob.davis@armynurse corps.com Subject: RE: The Most Fundamental Problem with EMS To: texasems-l@yahoogro ups.com Date: Tuesday, August 25, 2009, 9:48 AM On Tuesday, August 25, 2009 08:21, " Bledsoe " said: > Results: For occupational commitment, the participants with certificate > level of education had a > significantly higher score (88.9) than did those with either the degree > (83.6) or postbaccalaureate (80.9) > level of education. So what she's saying is that the smart, motivated people get out. Those too stupid or lazy to find options in life stay. Pretty much been my theory for thirty years. Glad to see someone validate it. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2009 Report Share Posted August 25, 2009 Rick -- You and I both know the horror stories of denial protocols.?? Ask any of the old-timers on here about Dallas and Nurse Myrick. Great concept, but fraught with peril, especially considering what some of us have seen for patient assessments. -Wes RE: The Most Fundamental Problem with EMS > To: texasems-l > Date: Tuesday, August 25, 2009, 10:03 AM > > ? > > On Tuesday, August 25, 2009 09:58, " McGee " said: > > > So are you implying that all of us that are still practicing EMS providers are > > either lazy or stupid?? Do you really intend to open that can of worms? > > So are you implying that I'm stupid enough to make a universal assumption about every practising EMS provider? We're talking statistics here, not absolutes. Keep your worms to yourself. > > Rob > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2009 Report Share Posted August 25, 2009 I would present another potential factor as to why EMS professionals don't stay in this profession. We go to great lengths in school to teach them how to treat the patient with multi trauma but spend little time teaching how to handle the patient that calls with the toothache. I know that we only have a certain number of hours to teach the " core " material and maybe that needs to be reviewed as well. (where's my nomex underwear, sure to get flamed over that one) However, I know that the reason that I had a short career in law enforcement was because I wasn't spending my shift shooting bad guys and solving crimes. I was writing stolen bicycle reports and telling people to turn their stereos down. That's not what I expected to be doing because that's not what I was taught in the academy. Mi dos centavos, Dave Sent via BlackBerry by AT&T RE: The Most Fundamental Problem with EMS To: texasems-l Date: Tuesday, August 25, 2009, 9:48 AM On Tuesday, August 25, 2009 08:21, " Bledsoe " said: > Results: For occupational commitment, the participants with certificate > level of education had a > significantly higher score (88.9) than did those with either the degree > (83.6) or postbaccalaureate (80.9) > level of education. So what she's saying is that the smart, motivated people get out. Those too stupid or lazy to find options in life stay. Pretty much been my theory for thirty years. Glad to see someone validate it. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2009 Report Share Posted August 25, 2009 In a message dated 8/25/2009 9:03:00 P.M. Central Daylight Time, kenneth.navarro@... writes: Can't we just have someone inaccurately summarize the report and misinterpret the results for us? It would be so much easier! Why not? It seems to work for the American political Process...................oh wait that's your point isn't it? Louis N. Molino, Sr., CET FF/NREMT-B/FSI/EMSI Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant Training Program Manager, Fire and Safety Specialists, Inc. (www.fireandsafetyspecialists.com) Technical Editor, Industrial Fire World (www.fireworld.com) LNMolino@... Lou@... (Cell Phone) (IFW/FSS Office) (IFW/FSS Fax) " A Texan with a Jersey Attitude " " Great minds discuss ideas; Average minds discuss events; Small minds discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2009 Report Share Posted August 25, 2009 Agreed but as I remember in the Dallas incident that was telephone based. I do believe that the truck needs to respond and assess the patient. It is also up to us as educators to teach patient assessment in such a manner that proper assessments are performed. Perhaps the answer is to have specially trained supervisors that could respond with the truck and perform the denial assessment. In short there is not a good answer to this problem right now and work needs to be done to come up with the answer. ________________________________ From: texasems-l [mailto:texasems-l ] On Behalf Of ExLngHrn@... Sent: Tuesday, August 25, 2009 5:04 PM To: texasems-l Subject: Re: Re: The Most Fundamental Problem with EMS Rick -- You and I both know the horror stories of denial protocols.?? Ask any of the old-timers on here about Dallas and Nurse Myrick. Great concept, but fraught with peril, especially considering what some of us have seen for patient assessments. -Wes RE: The Most Fundamental Problem with EMS > To: texasems-l > Date: Tuesday, August 25, 2009, 10:03 AM > > ? > > On Tuesday, August 25, 2009 09:58, " McGee " said: > > > So are you implying that all of us that are still practicing EMS providers are > > either lazy or stupid?? Do you really intend to open that can of worms? > > So are you implying that I'm stupid enough to make a universal assumption about every practising EMS provider? We're talking statistics here, not absolutes. Keep your worms to yourself. > > Rob > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2009 Report Share Posted August 25, 2009 'Great concept', Absolutely.... 'but fraught with peril,' No doubt about that...... 'especially considering what some of us have seen for patient assessments.' Then we need to work on inproving the assessment skills of those who are incapable, or weed them out. I personally like the idea of paramedic initiated refusals, not an easy task to make it work though. Hatfield www.michaelwhatfield.net Subject: Re: Re: The Most Fundamental Problem with EMS To: texasems-l Date: Tuesday, August 25, 2009, 5:04 PM Rick -- You and I both know the horror stories of denial protocols.?? Ask any of the old-timers on here about Dallas and Nurse Myrick. Great concept, but fraught with peril, especially considering what some of us have seen for patient assessments. -Wes RE: The Most Fundamental Problem with EMS > To: texasems-l@yahoogro ups.com > Date: Tuesday, August 25, 2009, 10:03 AM > > ? > > On Tuesday, August 25, 2009 09:58, " McGee " said: > > > So are you implying that all of us that are still practicing EMS providers are > > either lazy or stupid?? Do you really intend to open that can of worms? > > So are you implying that I'm stupid enough to make a universal assumption about every practising EMS provider? We're talking statistics here, not absolutes. Keep your worms to yourself. > > Rob > > ____________ _________ _________ _________ _________ __ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2009 Report Share Posted August 25, 2009 Very sorry to hear that. Live for today, tomorrow is not here yet and laugh at yourself often before someone else does. McGee, EMT-P From: rob.davis@armynurse corps.com Subject: RE: The Most Fundamental Problem with EMS To: texasems-l@yahoogro ups.com Date: Tuesday, August 25, 2009, 9:48 AM On Tuesday, August 25, 2009 08:21, " Bledsoe " said: > Results: For occupational commitment, the participants with certificate > level of education had a > significantly higher score (88.9) than did those with either the degree > (83.6) or postbaccalaureate (80.9) > level of education. So what she's saying is that the smart, motivated people get out. Those too stupid or lazy to find options in life stay. Pretty much been my theory for thirty years. Glad to see someone validate it. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2009 Report Share Posted August 25, 2009 Makes sense to me, and that would make room for the refusal of non-emergent protocol training as well. I like the idea, but how do we sell it to the powers that be? Live for today, tomorrow is not here yet and laugh at yourself often before someone else does. McGee, EMT-P Subject: RE: The Most Fundamental Problem with EMS To: texasems-l Date: Tuesday, August 25, 2009, 9:48 AM On Tuesday, August 25, 2009 08:21, " Bledsoe " said: > Results: For occupational commitment, the participants with certificate > level of education had a > significantly higher score (88.9) than did those with either the degree > (83.6) or postbaccalaureate (80.9) > level of education. So what she's saying is that the smart, motivated people get out. Those too stupid or lazy to find options in life stay. Pretty much been my theory for thirty years. Glad to see someone validate it. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2009 Report Share Posted August 25, 2009 On Tuesday, August 25, 2009 17:25, " McGee " summedic@...> said: > Makes sense to me, and that would make room for the refusal of non-emergent > protocol training as well. I like the idea, but how do we sell it to the > powers that be? Of course " the powers that be " is an elusive entity. Who exactly are they? You've got TDSHS. But you also have the legislature with their hands in it. And, of course, both are highly influenced by the special interests in the fire, education, and volunteer lobbies. Anything the state or legislature tries to do without considering those special interests will result in thermonuclear war. Do you think the IAFC, the Houston, Dallas, or San Fire Departments would support a requirement for 2 year paramedic degree education? Not only would they not support it, they would fight it tooth and nail. They want that money, but they don't want to pay the price of the commitment we speak of. The sad truth is that the idea cannot be sold. It must be unilaterally forced upon the profession, just as it was for physicians a century ago. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2009 Report Share Posted August 25, 2009 I think that it is a viable thing that CAN be one - crew initiated no transports - and I have seen it done well. The keys are: 1. A strong QA/QI program that looks at no transports to be sure they are handled within guidelines. 2. A strong training program that also reviews and enforces good, sound patient assessment, developing solid differential diagnosis lists, and identifying emergent versus non-emergent situations based on those assessment and diagnosis. 3. Heavy medical control involvement. If any one of those three items is missing, then it is a very precarious liability slope. Jane Dinsmore To: texasems-l From: ExLngHrn@... Date: Tue, 25 Aug 2009 17:38:09 -0400 Subject: Re: Re: The Most Fundamental Problem with EMS Ideally, EMS would have a public education program to inform people about the proper use of EMS.? (Yes, this includes when to call as much as when not to call.)? At this time, given the educational standards, I'm very uncomfortable with giving medics the right to deny treatment/transport.? Too many of us don't have the patient assessment skills (much less the resources) to accurately determine what's the real problem with the patient. Of course, London Ambulance Service in the UK has gone so far as to print a poster with a taxi and an ambulance with the caption, " Only one of these is a taxi. " ? Yet, somehow, we would never do something so politically incorrect here.?? On this count, I'm with the Brits. -Wes RE: The Most Fundamental Problem with EMS > To: texasems-l > Date: Tuesday, August 25, 2009, 10:03 AM > > ? > > On Tuesday, August 25, 2009 09:58, " McGee " said: > > > So are you implying that all of us that are still practicing EMS providers are > > either lazy or stupid?? Do you really intend to open that can of worms? > > So are you implying that I'm stupid enough to make a universal assumption about every practising EMS provider? We're talking statistics here, not absolutes. Keep your worms to yourself. > > Rob > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2009 Report Share Posted August 25, 2009 Do you know what the issue in Phoenix was? They are always ahead of the curve on new practices. Rick Sent from my GoodLink synchronized handheld (www.good.com) RE: The Most Fundamental Problem with EMS > > To: texasems-l@yahoogrotexasem > > > Date: Tuesday, August 25, 2009, 10:03 AM > > > > ? > > > > On Tuesday, August 25, 2009 09:58, " McGee " com> said: > > > > > So are you implying that all of us that are still practicing EMS > providers are > > > either lazy or stupid?? Do you really intend to open that can of > worms? > > > > So are you implying that I'm stupid enough to make a universal > assumption about every practising EMS provider? We're talking statistics > > here, not absolutes. Keep your worms to yourself. > > > > Rob > > > > ____________ ________ ________ ________ ________ ___ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2009 Report Share Posted August 25, 2009 On Tuesday, August 25, 2009 18:32, wegandy1938@... said: > Tucson is currently using a system where they run " Alpha Trucks " for the > " Help, I've Fallen And I Can't Reach My Beer " and toothache calls. They are > basic EMT trucks and they are taking a lot of the load off the regular ones. Maybe it's just me, but sending out the least educated and qualified persons in the system to do a patient assessment and determine medical needs seems counterintuitive at best, considering that others have failed even with RNs doing it. Funny, when you hear of a third service doing this, they are usually employing their best and brightest for the screening. When a fire department does it, they're sending out rookie EMT-Bs. What's wrong with that picture? Rob Quote Link to comment Share on other sites More sharing options...
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