Guest guest Posted August 27, 2009 Report Share Posted August 27, 2009 Ease up spelling police! LMAO! Lee From: texasems-l [mailto:texasems-l ] On Behalf Of ExLngHrn@... Sent: Thursday, August 27, 2009 1:27 PM To: texasems-l Subject: Re: Re: The Most Fundamental Problem with EMS Renny -- If you proposed something like giving?carbon monoxide?to cardiac patients instead of oxygen, and we said it didn't work, would you be upset at " total opposition " ? By the way, spell check.? :-) -Wes Re: The Most Fundamental Problem with EMS You guys can't get rid of me that easy. Heck somebody has to be here to drive peoples blood pressure up. LOL. I understand disagreement but just am surprised to see total oposition rather than ideas that could possibly make it work. Renny Spencer The Idealistic Paramedic > > Renny, > Hey, buddy, you are starting to take it personally, don't do that. Just > because someone disagrees with you, you don't want to take your toys and go > home, trust me. I am glad you stopped signing your posts " my worthless > opinion " , because you obviously don't think your opinion is worthless. Good. But > this idealistic thing has got to go. There is absolutely not room in EMS for > that. > (EASY, I am KIDDING) HA > Chris > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 27, 2009 Report Share Posted August 27, 2009 And where has your EMS experience been?? If I remember correctly, you work in rural/frontier EMS, which has a very unique set of challenges.?? Urban, inner-city EMS is an entirely different set of challenges.?? I think that where is some of the hesitation comes from. -Wes Re: The Most Fundamental Problem with EMS Henry, LOL. I respect you guys with the experience and will keep throwing ideas out here. In fact I will at some point post a denial guideline for you all to pick apart for me. That may be a ways away though. Wish I was young. I guess I'm EMS young as only 6 or 7 years experience, but age wise i'm old. Renny Spencer The Idealistic Paramedic > > > > Wes for president. I agree 100%. If I remember only 10% of our calls are true emergency. Where do you stop. Sorry mam your call is not a true emergency and thus not worthy of my much inflated opinion of myself and super hero skills. > > > > > > Henry > > Re: Re: The Most Fundamental Problem with EMS > > > > Renny, > > I get what you are saying, and I am onboard, it just wont work. " But why do > > we always presume that people will abuse if implemented " . It is because > > they WILL. > > I dont get it either, it would be so easy, but some people would rather be > > back at the station getting paid to play x-box. There are several services > > that I am aware of that are either considering or have already gone to a > > system where 100% of denials MUST be approved by online medical control. This > > tells me that someone in the system screwed it up bad enough that the powers > > that be took the option for denial completely out of the medics hands because > > of exactly what we are talking about. I was speaking to a guy that worked > > for one of these services, and he said he just transported everyone because > > it was too much trouble to try to get permission to deny. Everybody that > > sneezes does not need an ambulance, and we should educate customers to what we > > really do, but, as long as we have (NOT ALL) some medics that can't > > differentiate and a general public that frankly, (in my experience), doesn't care > > about getting educated on these issues and keeps calling, you are not going to > > change things, my friend. > > **************A Good Credit Score is 700 or Above. See yours in just > > 2 easy steps! > > (http://pr.atwola.com/promoclk/100126575x1222846709x1201493018/aol?redir=http://\ www.freecreditreport.com/pm/default.aspx?sc=668072 & > > hmpgID=115 & bcd=JulystepsfooterNO115) > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 27, 2009 Report Share Posted August 27, 2009 Sorry darn red neck spell check missed that one. You mean we shouldn't give carbon monoxide. ;0 lol > > > > Renny, > > Hey, buddy, you are starting to take it personally, don't do that. Just > > because someone disagrees with you, you don't want to take your toys and go > > home, trust me. I am glad you stopped signing your posts " my worthless > > opinion " , because you obviously don't think your opinion is worthless. Good. But > > this idealistic thing has got to go. There is absolutely not room in EMS for > > that. > > (EASY, I am KIDDING) HA > > Chris > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 27, 2009 Report Share Posted August 27, 2009 Wes, I agree there are major differences. But a patient that needs something besides an ambulance rural/urban needs that need met rather than just transported. I do want the input of all areas as I try and design a guideline for denial. Renny Spencer The Idealistic Paramedic > > > And where has your EMS experience been?? If I remember correctly, you work in rural/frontier EMS, which has a very unique set of challenges.?? Urban, inner-city EMS is an entirely different set of challenges.?? I think that where is some of the hesitation comes from. > > > > -Wes > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 27, 2009 Report Share Posted August 27, 2009 Dudley has pinpointed the problem. While I do appreciate Renny's position and embrace it philosophically, what he's promoting is, in fact, a sort of primary care done by EMS. Jane correctly identified three of the components of a system that permits refusals, but there are other aspects as well which are simply not in place. The Red River Project in New Mexico attempted to implement the sort of practices that Renny's talking about, but it was a rather spectacular failure because there is no way to fund it under present reimbursement schemes. Further, the level of education and training available to paramedics did not support it without significant further training. Such a system would require a coordination of efforts among not only EMS but social service agencies that does not widely exist. Tucson is attempting to do some of that by using what they call " Alpha Trucks " to respond to calls that are triaged as low priority and possibly in need of something other than EMS treatment and transport. The Alpha Folks do work with the social agencies and the system appears to be working to some degree. Phoenix tried the same thing and disbanded it because its experience was that it did not work. If all medics in the system had Renny's dedication and values, such a system might work; sadly, the kind of dedication, training, and judgment needed to carry out primary care in the field is lacking in current paramedic education, training and practice in most areas of the country. I spent a year working offshore as a rig medic, in a job that is basically primary care. During that time I first began to realize how little about medicine I really knew, how incompetent I was at dealing with non-emergency conditions, and how great a resource The Merck Manual, on's Principles of Internal Medicine, and Tintinalli's Emergency Medicine, and a good medical director with which I had instant communication are. I learned that paramedics are well trained in a very narrow scope of practice and that when outside that narrow scope things can get very sticky indeed. It was the scariest thing I ever did. When we begin to make determinations about who needs a ride to the hospital and who does not, we are placing one foot on a sheet of ice and the other on a banana peel. Even ER physicians make errors in diagnosis with the compendium of resources available to them. Most medics do not know either how to order labs or how to interpret them, if we had them available, and most can't read an x-ray or a CT or MRI scan. I can't see myself telling a patient with vague signs and symptoms that care is not needed without those tools, assuming I were able to use them. Yet that's what medic-initiated refusals invoke. As for the notion that people are going to sue no matter what we do, I'll say this: No, they're not. People sue when they are done wrong. They sue when they're harmed by somebody else. They do not sue over nothing, common myth to the contrary notwithstanding. Few understand how expensive it is to file and maintain a lawsuit. It takes many thousands of dollars worth of resources. Lawyers simply do not file unwarranted suits based upon the whims of their clients. A close analysis of cases that are filed reveal a level of so-called frivolous suits that is minuscule. We have all hear the Poster Cases that are batted around, but when one looks at the bulk of cases that are filed, they exist because good lawyers have determined that the four elements of negligence are present and provable by a preponderance of the evidence to a jury. Nevertheless, if we put ourselves into a position where we are sure to make errors, then we can and should expect lawsuits. I can tell you that lawsuits are no fun for anybody. To be sued is a wrenching experience even if you're completely in the right. I had rather run 1000 codes than run one malpractice suit. The stress is immense. Of course, common sense says that not every injury requires EMT/Paramedic treatment and transport. If I sprain my ankle, I'm going to drive myself to the ER or the Doc-in-the-Box or have my neighbor do it and I won't call EMS. But I have a car and a neighbor. Many folks who need care do not have transportation, and so forth. We are in a service business, and we should concentrate on service. It's nice to think globally about helping the frequent flyer who forgot to get her Lopressor refilled not to call us, but if she does call, she gets a trip to the ER if she wants it in my service. On the street is not the place to be counseling her about watching her prescriptions, lining up transportation for the next time she needs it, et cetera. As Renny correctly recognizes, taking care of the social needs may be the right thing to do, but it's also the most time consuming much of the time. Where I differ with him is here: The needs that he's targeted do need to be addressed, but not at the point of contact after a 911 call. If a service wants to engage in that sort of service, then I can surely see specialized crews following up and attempting to ameliorate the situation, but I cannot see it happening on the streets. There are likely differing views, and mine is only one. Service areas differ widely in geographics, demographics, and needs. Not all solutions work everywhere. That this topic is being debated civilly is good. Bottom line: Always do what is in the patient's best interest and you'll generally be fine. Remember the first tenet of the law: You have a DUTY to your patient. Many seem unclear as to whom they owe their duty. Well, it is not to the hospital, the nurse, the doctor, or the accountant. It is to the patient. If we remind ourselves of that as we start to every call, we'll do good care and stay out of trouble. Gene Gandy, JD, LP, NREMT-P Doctor of Illusionism, Grade II, in Residence >  > > > Now someone else said we only get paid if transport. I ask why? We should > be billing for all responses. If you go see the doctor and decide not to > get treated you still get charged. So if you call we should charge. > > ABSOLUTELY!! ABSOLUTELY!! !!? But there is a HUGE difference between > getting paid and charging people.? The majority of EMS reimbursement comes > from insurance companies, Medicare and Medicaid.? Very few insurance c > ompanies, and NO Medicare or Medicaid dollars are spent paying for EMS to do > anything but load the patient up and transport.? (I know about BLS Emergency > for DOS's...)? That is the crux of this.? Some places (google Wake County > EMS) are doing some of the social services and primary care things you are > talking about and are having some success...but no one but local tax payers > are paying for it...and they are not going to fund a system like that for too > long without > > We can bill and charge who ever we want for what ever we want...but if we > want to seriously look at doing primary care we need tort reform issues > addressed and we need structural change in how EMS is reimbursed.? > > Dudley > > Re: The Most Fundamental Problem with EMS > > > I see where you are coming from. I agree there are some lazy people in our > profession. Thats why I say if it were to work it would have to be tougher > to deny than to transport. Maybe extra forms to fill out on top of the run > report that must be sent to the supervisor and medical director for > review. If someone abuses the denial process fire them. If that doesn't motivate > people to do it right they do not have any business in EMS. > > And I know some would say if it takes longer how does it benefit us. Well > in the long run it will help stop certain calls. But more importantly it > will actually get the patient in touch with whatever resource they need > quicker. Perhaps we help them schedule with mental health, or learn about the > medical transportation transportation program if they are just having trouble > financially getting to the doctor. > > Now someone else said we only get paid if transport. I ask why? We should > be billing for all responses. If you go see the doctor and decide not to > get treated you still get charged. So if you call we should charge. > > Just more of my worthless rambling. > Renny Spencer > Paramedic > > --- In texasems-l@yahoogrotexasem, Clgrote126@., Clgrote > > > > Renny, > > I get what you are saying, and I am onboard, it just wont work. " But why > do > > we always presume that people will abuse if implemented " we always presu > > they WILL. > > I dont get it either, it would be so easy, but some people would rather > be > > back at the station getting paid to play x-box. There are several > services > > that I am aware of that are either considering or have already gone to a > > system where 100% of denials MUST be approved by online medical control. > This > > tells me that someone in the system screwed it up bad enough that the > powers > > that be took the option for denial completely out of the medics hands > because > > of exactly what we are talking about. I was speaking to a guy that > worked > > for one of these services, and he said he just transported everyone > because > > it was too much trouble to try to get permission to deny. Everybody that > > sneezes does not need an ambulance, and we should educate customers to > what we > > really do, but, as long as we have (NOT ALL) some medics that can't > > differentiate and a general public that frankly, (in my experience), > doesn't care > > about getting educated on these issues and keeps calling, you are not > going to > > change things, my friend. > > **** A Good Credit Score is 700 or > Above. See yours in > > 2 easy steps! > > ( > http://pr.atwola.http://pr.atwhttp://pr.atwolahttp://pr.atwolahttp://pr.http://p\ r.ahttp://pr.atwolahttp://pr.atwolahttp://pr.atwo& > hmpgID=115 & amp; bcd=Julamp; > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 27, 2009 Report Share Posted August 27, 2009 Renny, Yes, I think that's the way to do it. Followup is where we can do some good. I'm due to meet with some folks at Tucson FD soon and talk about their Alpha Truck program. Their dispatch system is sophisticated enough that they can identify call similarities at an address and make some determinations based on call histories. Their Alpha Trucks then go to work to set up appointments, et cetera. They can also do some street and treat care. They can do this because they are totally tax supported and do not count on reimbursement for their budget. I hope to find out more about how they work in practice soon. I do hear them calling for BLS and ALS ambulances from time to time, so I understand also that many times they see that the patients need treatment and transport. Stay tuned. GG >  > Gene, > > Thanks for a clear reason rather than just dismissing my ideas. > > So I gather based on your thoughts maybe I should look at in my future > dream guidelines to maybe establish some sort of follow up with patients that > the crews felt really needed something besides an ambulance. Then at that > point make sure the patient was helped to find resources they really needed > if they had not already gotten the help. > > I still think I can establish a guideline for saying no to transport but > I'll play with it some more. Hopefully in a few weeks/months I can submit my > idea here for all to honestly look it over make suggestions etc. > > Sadly even while making the guidelines I know because of money my ideas > might never come together in reality but who knows maybe I can help start > something new by stirring up everyones BP's. > > Renny Spencer > The Idealistic Paramedic > > --- In texasems-l@yahoogrotexasem, wegandy1938@, wegandy1 > > > > Dudley has pinpointed the problem. While I do appreciate Renny's > position > > and embrace it philosophically, what he's promoting is, in fact, a sort > > of primary care done by EMS. Jane correctly identified three of the > > components of a system that permits refusals, but there are other > aspects as well > > which are simply not in place. > > > > The Red River Project in New Mexico attempted to implement the sort of > > practices that Renny's talking about, but it was a rather spectacular > failure > > because there is no way to fund it under present reimbursement schemes. > > Further, the level of education and training available to paramedics did > not > > support it without significant further training. > > > > Such a system would require a coordination of efforts among not only EMS > > but social service agencies that does not widely exist. Tucson is > attempting > > to do some of that by using what they call " Alpha Trucks " to respond to > > calls that are triaged as low priority and possibly in need of something > other > > than EMS treatment and transport. The Alpha Folks do work with the > social > > agencies and the system appears to be working to some degree. Phoenix > > tried the same thing and disbanded it because its experience was that it > did not > > work. > > > > If all medics in the system had Renny's dedication and values, such a > > system might work; sadly, the kind of dedication, training, and judgment > needed > > to carry out primary care in the field is lacking in current paramedic > > education, training and practice in most areas of the country. > > > > I spent a year working offshore as a rig medic, in a job that is > basically > > primary care. During that time I first began to realize how little about > > medicine I really knew, how incompetent I was at dealing with > non-emergency > > conditions, and how great a resource The Merck Manual, on's > Principles > > of Internal Medicine, and Tintinalli's Emergency Medicine, and a good > > medical director with which I had instant communication are. I learned > that > > paramedics are well trained in a very narrow scope of practice and that > when > > outside that narrow scope things can get very sticky indeed. It was the > > scariest thing I ever did. > > > > When we begin to make determinations about who needs a ride to the > hospital > > and who does not, we are placing one foot on a sheet of ice and the > other > > on a banana peel. Even ER physicians make errors in diagnosis with the > > compendium of resources available to them. Most medics do not know > either how > > to order labs or how to interpret them, if we had them available, and > most > > can't read an x-ray or a CT or MRI scan. I can't see myself telling a > > patient with vague signs and symptoms that care is not needed without > those > > tools, assuming I were able to use them. Yet that's what medic-initiated > > refusals invoke. > > > > As for the notion that people are going to sue no matter what we do, > I'll > > say this: No, they're not. People sue when they are done wrong. They > > sue when they're harmed by somebody else. They do not sue over nothing, > > common myth to the contrary notwithstanding. > > > > Few understand how expensive it is to file and maintain a lawsuit. It > > takes many thousands of dollars worth of resources. Lawyers simply do > not > > file unwarranted suits based upon the whims of their clients. A close > > analysis of cases that are filed reveal a level of so-called frivolous > suits that > > is minuscule. We have all hear the Poster Cases that are batted around, > but > > when one looks at the bulk of cases that are filed, they exist because > good > > lawyers have determined that the four elements of negligence are present > > and provable by a preponderance of the evidence to a jury. > > > > Nevertheless, if we put ourselves into a position where we are sure to > make > > errors, then we can and should expect lawsuits. I can tell you that > > lawsuits are no fun for anybody. To be sued is a wrenching experience > even if > > you're completely in the right. I had rather run 1000 codes than run one > > malpractice suit. The stress is immense. > > > > Of course, common sense says that not every injury requires > EMT/Paramedic > > treatment and transport. If I sprain my ankle, I'm going to drive myself > to > > the ER or the Doc-in-the-Box or have my neighbor do it and I won't call > > EMS. But I have a car and a neighbor. Many folks who need care do not > have > > transportation, and so forth. > > > > We are in a service business, and we should concentrate on service. It's > > nice to think globally about helping the frequent flyer who forgot to > get > > her Lopressor refilled not to call us, but if she does call, she gets a > trip > > to the ER if she wants it in my service. On the street is not the place > to > > be counseling her about watching her prescriptions, lining up > transportation > > for the next time she needs it, et cetera. As Renny correctly > recognizes, > > taking care of the social needs may be the right thing to do, > > but it's also the most time consuming much of the time. Where I differ > > with him is here: The needs that he's targeted do need to be addressed, > but > > not at the point of contact after a 911 call. If a service wants to > engage > > in that sort of service, then I can surely see specialized crews > following > > up and attempting to ameliorate the situation, but I cannot see it > happening > > on the streets. > > > > There are likely differing views, and mine is only one. Service areas > > differ widely in geographics, demographics, and needs. Not all solutions > work > > everywhere. That this topic is being debated civilly is good. > > > > Bottom line: Always do what is in the patient's best interest and you'll > > generally be fine. Remember the first tenet of the law: You have a DUTY > > to your patient. Many seem unclear as to whom they owe their duty. Well, > > it is not to the hospital, the nurse, the doctor, or the accountant. It > > is to the patient. If we remind ourselves of that as we start to every > > call, we'll do good care and stay out of trouble. > > > > Gene Gandy, JD, LP, NREMT-P > > Doctor of Illusionism, Grade II, in Residence > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 27, 2009 Report Share Posted August 27, 2009 Gene, Thanks for a clear reason rather than just dismissing my ideas. So I gather based on your thoughts maybe I should look at in my future dream guidelines to maybe establish some sort of follow up with patients that the crews felt really needed something besides an ambulance. Then at that point make sure the patient was helped to find resources they really needed if they had not already gotten the help. I still think I can establish a guideline for saying no to transport but I'll play with it some more. Hopefully in a few weeks/months I can submit my idea here for all to honestly look it over make suggestions etc. Sadly even while making the guidelines I know because of money my ideas might never come together in reality but who knows maybe I can help start something new by stirring up everyones BP's. Renny Spencer The Idealistic Paramedic > > Dudley has pinpointed the problem. While I do appreciate Renny's position > and embrace it philosophically, what he's promoting is, in fact, a sort > of primary care done by EMS. Jane correctly identified three of the > components of a system that permits refusals, but there are other aspects as well > which are simply not in place. > > The Red River Project in New Mexico attempted to implement the sort of > practices that Renny's talking about, but it was a rather spectacular failure > because there is no way to fund it under present reimbursement schemes. > Further, the level of education and training available to paramedics did not > support it without significant further training. > > Such a system would require a coordination of efforts among not only EMS > but social service agencies that does not widely exist. Tucson is attempting > to do some of that by using what they call " Alpha Trucks " to respond to > calls that are triaged as low priority and possibly in need of something other > than EMS treatment and transport. The Alpha Folks do work with the social > agencies and the system appears to be working to some degree. Phoenix > tried the same thing and disbanded it because its experience was that it did not > work. > > If all medics in the system had Renny's dedication and values, such a > system might work; sadly, the kind of dedication, training, and judgment needed > to carry out primary care in the field is lacking in current paramedic > education, training and practice in most areas of the country. > > I spent a year working offshore as a rig medic, in a job that is basically > primary care. During that time I first began to realize how little about > medicine I really knew, how incompetent I was at dealing with non-emergency > conditions, and how great a resource The Merck Manual, on's Principles > of Internal Medicine, and Tintinalli's Emergency Medicine, and a good > medical director with which I had instant communication are. I learned that > paramedics are well trained in a very narrow scope of practice and that when > outside that narrow scope things can get very sticky indeed. It was the > scariest thing I ever did. > > When we begin to make determinations about who needs a ride to the hospital > and who does not, we are placing one foot on a sheet of ice and the other > on a banana peel. Even ER physicians make errors in diagnosis with the > compendium of resources available to them. Most medics do not know either how > to order labs or how to interpret them, if we had them available, and most > can't read an x-ray or a CT or MRI scan. I can't see myself telling a > patient with vague signs and symptoms that care is not needed without those > tools, assuming I were able to use them. Yet that's what medic-initiated > refusals invoke. > > As for the notion that people are going to sue no matter what we do, I'll > say this: No, they're not. People sue when they are done wrong. They > sue when they're harmed by somebody else. They do not sue over nothing, > common myth to the contrary notwithstanding. > > Few understand how expensive it is to file and maintain a lawsuit. It > takes many thousands of dollars worth of resources. Lawyers simply do not > file unwarranted suits based upon the whims of their clients. A close > analysis of cases that are filed reveal a level of so-called frivolous suits that > is minuscule. We have all hear the Poster Cases that are batted around, but > when one looks at the bulk of cases that are filed, they exist because good > lawyers have determined that the four elements of negligence are present > and provable by a preponderance of the evidence to a jury. > > Nevertheless, if we put ourselves into a position where we are sure to make > errors, then we can and should expect lawsuits. I can tell you that > lawsuits are no fun for anybody. To be sued is a wrenching experience even if > you're completely in the right. I had rather run 1000 codes than run one > malpractice suit. The stress is immense. > > Of course, common sense says that not every injury requires EMT/Paramedic > treatment and transport. If I sprain my ankle, I'm going to drive myself to > the ER or the Doc-in-the-Box or have my neighbor do it and I won't call > EMS. But I have a car and a neighbor. Many folks who need care do not have > transportation, and so forth. > > We are in a service business, and we should concentrate on service. It's > nice to think globally about helping the frequent flyer who forgot to get > her Lopressor refilled not to call us, but if she does call, she gets a trip > to the ER if she wants it in my service. On the street is not the place to > be counseling her about watching her prescriptions, lining up transportation > for the next time she needs it, et cetera. As Renny correctly recognizes, > taking care of the social needs may be the right thing to do, > but it's also the most time consuming much of the time. Where I differ > with him is here: The needs that he's targeted do need to be addressed, but > not at the point of contact after a 911 call. If a service wants to engage > in that sort of service, then I can surely see specialized crews following > up and attempting to ameliorate the situation, but I cannot see it happening > on the streets. > > There are likely differing views, and mine is only one. Service areas > differ widely in geographics, demographics, and needs. Not all solutions work > everywhere. That this topic is being debated civilly is good. > > Bottom line: Always do what is in the patient's best interest and you'll > generally be fine. Remember the first tenet of the law: You have a DUTY > to your patient. Many seem unclear as to whom they owe their duty. Well, > it is not to the hospital, the nurse, the doctor, or the accountant. It > is to the patient. If we remind ourselves of that as we start to every > call, we'll do good care and stay out of trouble. > > Gene Gandy, JD, LP, NREMT-P > Doctor of Illusionism, Grade II, in Residence > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 27, 2009 Report Share Posted August 27, 2009 Renny you are starting to sound too much like ME. I am SOOOO proud!!!! LOL Jane Dinsmore To: texasems-l From: spenair@... Date: Fri, 28 Aug 2009 03:04:17 +0000 Subject: Re: The Most Fundamental Problem with EMS Gene, Thanks for a clear reason rather than just dismissing my ideas. So I gather based on your thoughts maybe I should look at in my future dream guidelines to maybe establish some sort of follow up with patients that the crews felt really needed something besides an ambulance. Then at that point make sure the patient was helped to find resources they really needed if they had not already gotten the help. I still think I can establish a guideline for saying no to transport but I'll play with it some more. Hopefully in a few weeks/months I can submit my idea here for all to honestly look it over make suggestions etc. Sadly even while making the guidelines I know because of money my ideas might never come together in reality but who knows maybe I can help start something new by stirring up everyones BP's. Renny Spencer The Idealistic Paramedic > > Dudley has pinpointed the problem. While I do appreciate Renny's position > and embrace it philosophically, what he's promoting is, in fact, a sort > of primary care done by EMS. Jane correctly identified three of the > components of a system that permits refusals, but there are other aspects as well > which are simply not in place. > > The Red River Project in New Mexico attempted to implement the sort of > practices that Renny's talking about, but it was a rather spectacular failure > because there is no way to fund it under present reimbursement schemes. > Further, the level of education and training available to paramedics did not > support it without significant further training. > > Such a system would require a coordination of efforts among not only EMS > but social service agencies that does not widely exist. Tucson is attempting > to do some of that by using what they call " Alpha Trucks " to respond to > calls that are triaged as low priority and possibly in need of something other > than EMS treatment and transport. The Alpha Folks do work with the social > agencies and the system appears to be working to some degree. Phoenix > tried the same thing and disbanded it because its experience was that it did not > work. > > If all medics in the system had Renny's dedication and values, such a > system might work; sadly, the kind of dedication, training, and judgment needed > to carry out primary care in the field is lacking in current paramedic > education, training and practice in most areas of the country. > > I spent a year working offshore as a rig medic, in a job that is basically > primary care. During that time I first began to realize how little about > medicine I really knew, how incompetent I was at dealing with non-emergency > conditions, and how great a resource The Merck Manual, on's Principles > of Internal Medicine, and Tintinalli's Emergency Medicine, and a good > medical director with which I had instant communication are. I learned that > paramedics are well trained in a very narrow scope of practice and that when > outside that narrow scope things can get very sticky indeed. It was the > scariest thing I ever did. > > When we begin to make determinations about who needs a ride to the hospital > and who does not, we are placing one foot on a sheet of ice and the other > on a banana peel. Even ER physicians make errors in diagnosis with the > compendium of resources available to them. Most medics do not know either how > to order labs or how to interpret them, if we had them available, and most > can't read an x-ray or a CT or MRI scan. I can't see myself telling a > patient with vague signs and symptoms that care is not needed without those > tools, assuming I were able to use them. Yet that's what medic-initiated > refusals invoke. > > As for the notion that people are going to sue no matter what we do, I'll > say this: No, they're not. People sue when they are done wrong. They > sue when they're harmed by somebody else. They do not sue over nothing, > common myth to the contrary notwithstanding. > > Few understand how expensive it is to file and maintain a lawsuit. It > takes many thousands of dollars worth of resources. Lawyers simply do not > file unwarranted suits based upon the whims of their clients. A close > analysis of cases that are filed reveal a level of so-called frivolous suits that > is minuscule. We have all hear the Poster Cases that are batted around, but > when one looks at the bulk of cases that are filed, they exist because good > lawyers have determined that the four elements of negligence are present > and provable by a preponderance of the evidence to a jury. > > Nevertheless, if we put ourselves into a position where we are sure to make > errors, then we can and should expect lawsuits. I can tell you that > lawsuits are no fun for anybody. To be sued is a wrenching experience even if > you're completely in the right. I had rather run 1000 codes than run one > malpractice suit. The stress is immense. > > Of course, common sense says that not every injury requires EMT/Paramedic > treatment and transport. If I sprain my ankle, I'm going to drive myself to > the ER or the Doc-in-the-Box or have my neighbor do it and I won't call > EMS. But I have a car and a neighbor. Many folks who need care do not have > transportation, and so forth. > > We are in a service business, and we should concentrate on service. It's > nice to think globally about helping the frequent flyer who forgot to get > her Lopressor refilled not to call us, but if she does call, she gets a trip > to the ER if she wants it in my service. On the street is not the place to > be counseling her about watching her prescriptions, lining up transportation > for the next time she needs it, et cetera. As Renny correctly recognizes, > taking care of the social needs may be the right thing to do, > but it's also the most time consuming much of the time. Where I differ > with him is here: The needs that he's targeted do need to be addressed, but > not at the point of contact after a 911 call. If a service wants to engage > in that sort of service, then I can surely see specialized crews following > up and attempting to ameliorate the situation, but I cannot see it happening > on the streets. > > There are likely differing views, and mine is only one. Service areas > differ widely in geographics, demographics, and needs. Not all solutions work > everywhere. That this topic is being debated civilly is good. > > Bottom line: Always do what is in the patient's best interest and you'll > generally be fine. Remember the first tenet of the law: You have a DUTY > to your patient. Many seem unclear as to whom they owe their duty. Well, > it is not to the hospital, the nurse, the doctor, or the accountant. It > is to the patient. If we remind ourselves of that as we start to every > call, we'll do good care and stay out of trouble. > > Gene Gandy, JD, LP, NREMT-P > Doctor of Illusionism, Grade II, in Residence > _________________________________________________________________ Windows Live: Keep your friends up to date with what you do online. http://windowslive.com/Campaign/SocialNetworking?ocid=PID23285::T:WLMTAGL:ON:WL:\ en-US:SI_SB_online:082009 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 27, 2009 Report Share Posted August 27, 2009 Dudley<  I appreciate that thought pattern, but I have to say that just because a number of people DON'T call EMS when they should, doesn't preclude us from teaching the ones that abuse us, of what we are really for.  Which is more important? Obviously the ones that need us.  I have long been a proponent of PIR, but I also know it isn't just around the corner, and for all I know, not in my lifetime. My feeling in favor of PIR are not from laziness, rather from working in some short staffed systems, buth rural and metropolitan.  I believe training is a big thing. I have heard that some systems don't want it because they don't trust their medics making such assessments, then those medics shouldn't be there anymore. There ARE services that have contests to see who can get the fastest refusal, and post times on the wall at the house, wrong indeed. That doesn't mean that ALL the medics need to be disciplined or fired, only the ones who act irresponsibly. Those are your liabilities, find them and weed them out. Get rid of them, and you'll have a service with medics who are intelligent enough to make solid rational decisions, and definitely smart enough to say, 'this time, I just don't know, therefore I WILL transport'  Sorry for those that carry the thought pattern that the patients feelings that an issue is an emergency MAKES it an emergency, no it doesn't.  I like the Alpha Truck concept providing it is done right, I have gone to patients and left after making a doctors appointment for them HUNDREDS of times, I have transported patients from homes to nursing homes for admission because that's what they needed, not an ER, they needed the long term thing.  QA/QI, we all agree, no need to flog the long dead horse.  Just a few thought from an old guy. Time for bed. Subject: Re: Re: The Most Fundamental Problem with EMS To: texasems-l Date: Thursday, August 27, 2009, 11:50 AM  I would think we should work on getting them to call us for the really important things before we start educating them about not calling us for the unimportant things.? Right around 50% of STEMI's self-present to the ED despite the evidence that calling 911 gets you care 25-50 minutes faster...people don't call 911 soon enough for signs and symptoms of stroke...so before we start telling people " you don't need an ambulance for that problem... " ; which will naturally lead to people who need EMS to not call because " last time I called they said it wasn't important... so lets just go in the car " or " I don't want to bother those nice ambulance drivers " ; maybe we should work on getting the right people to call us first. I would think if we can figure out how to educate those who need to call us to call us...we could probably use the same mechanisms to educate people not to call us for things that we don't need to be called for...of course, that is much harder. I just see it as a slippery slope. Dudley Re: The Most Fundamental Problem with EMS Well thanks for the ride. Oh and thanks for the couple of thousand dollar taxi ride. lol But why do we always presume that people will abuse if implemented. If the criteria Jane mentioned is in place you should catch those that abuse denials. Honestly if done right denials will be harder than just transporting. The only reason to deny is part of educating the public of other resources rather than the ambulance. In time the public would realize that every time they sneeze that they do not need an ambulance or ER. So our actions could benefit the entire medical establishment. We need to get proactive in educating our customers when they call as to what we really do. Then as a professional group help them locate additional resources. We may even need to make calls for them to help them get into places. I really feel that often people call us because they do not know where to turn and we make it worse by just pushing them off on the ER. Lets be medical professionals, patient advocates and actually help the patient by getting them headed where they actually need to be. If you guys have not figured it out I am very much against the you call we haul idea. I hope to eventually see a time when that is not the slogan of EMS. Renny Spencer Paramedic > > Renny, > And if you had called, we would have taken you. Sure, you would have been a > waste of our resources, but that is the way that goes. (That was a joke, > don't get mad) Your five percent theory works well for your plan here, but it > is human nature. If we give (NOT ALL medics of course) some medics the > ability to deny, before you know it, they will be turning that five percent > denial into a fifty-five percent denial rate. " I know that your left arm is numb, > but you are not having chest pain, and it is numb in ONLY ONE of your arms " > etc, etc. You mentioned yourself, " a break of a major bone would not allow > denial " . I guarantee the definition of a " major bone " would be argued right > and left before long. And down here, lets say it is a kid with a simple > wrist fracture from skateboarding. What happens if mom has no car, and you deny > because it is not a major bone. I have personally seen a medic take twenty > five minutes attempting to talk a patient out of going by ambulance, when the > hospital was literally a five minute transport away. (And they got called > back about twenty minutes later, and ended up transporting after all) I tell > the cadets all the time, if the patient wants to go, take them. You get paid > for twenty-four hours, and it is not your diesel fuel. I have no hard data, > but I imagine what I would call " critical " calls for us is less than 10%. > The start of this whole thread was that: if you dont like it, or get tired of > it, go to nursing school and get paid more. But, listen to the nurses, they > are not sitting in a bed of roses either, they just get paid more. > Anyway, dont worry, we would have transported you for your surgery if you > wanted to go. HA > Chris > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 27, 2009 Report Share Posted August 27, 2009 And by the way, Renny, I agree with everything that Gene said and your reply.?? My apologies if I came across a bit harsher than I intended. -Wes Re: The Most Fundamental Problem with EMS Gene, Thanks for a clear reason rather than just dismissing my ideas. So I gather based on your thoughts maybe I should look at in my future dream guidelines to maybe establish some sort of follow up with patients that the crews felt really needed something besides an ambulance. Then at that point make sure the patient was helped to find resources they really needed if they had not already gotten the help. I still think I can establish a guideline for saying no to transport but I'll play with it some more. Hopefully in a few weeks/months I can submit my idea here for all to honestly look it over make suggestions etc. Sadly even while making the guidelines I know because of money my ideas might never come together in reality but who knows maybe I can help start something new by stirring up everyones BP's. Renny Spencer The Idealistic Paramedic > > Dudley has pinpointed the problem. While I do appreciate Renny's position > and embrace it philosophically, what he's promoting is, in fact, a sort > of primary care done by EMS. Jane correctly identified three of the > components of a system that permits refusals, but there are other aspects as well > which are simply not in place. > > The Red River Project in New Mexico attempted to implement the sort of > practices that Renny's talking about, but it was a rather spectacular failure > because there is no way to fund it under present reimbursement schemes. > Further, the level of education and training available to paramedics did not > support it without significant further training. > > Such a system would require a coordination of efforts among not only EMS > but social service agencies that does not widely exist. Tucson is attempting > to do some of that by using what they call " Alpha Trucks " to respond to > calls that are triaged as low priority and possibly in need of something other > than EMS treatment and transport. The Alpha Folks do work with the social > agencies and the system appears to be working to some degree. Phoenix > tried the same thing and disbanded it because its experience was that it did not > work. > > If all medics in the system had Renny's dedication and values, such a > system might work; sadly, the kind of dedication, training, and judgment needed > to carry out primary care in the field is lacking in current paramedic > education, training and practice in most areas of the country. > > I spent a year working offshore as a rig medic, in a job that is basically > primary care. During that time I first began to realize how little about > medicine I really knew, how incompetent I was at dealing with non-emergency > conditions, and how great a resource The Merck Manual, on's Principles > of Internal Medicine, and Tintinalli's Emergency Medicine, and a good > medical director with which I had instant communication are. I learned that > paramedics are well trained in a very narrow scope of practice and that when > outside that narrow scope things can get very sticky indeed. It was the > scariest thing I ever did. > > When we begin to make determinations about who needs a ride to the hospital > and who does not, we are placing one foot on a sheet of ice and the other > on a banana peel. Even ER physicians make errors in diagnosis with the > compendium of resources available to them. Most medics do not know either how > to order labs or how to interpret them, if we had them available, and most > can't read an x-ray or a CT or MRI scan. I can't see myself telling a > patient with vague signs and symptoms that care is not needed without those > tools, assuming I were able to use them. Yet that's what medic-initiated > refusals invoke. > > As for the notion that people are going to sue no matter what we do, I'll > say this: No, they're not. People sue when they are done wrong. They > sue when they're harmed by somebody else. They do not sue over nothing, > common myth to the contrary notwithstanding. > > Few understand how expensive it is to file and maintain a lawsuit. It > takes many thousands of dollars worth of resources. Lawyers simply do not > file unwarranted suits based upon the whims of their clients. A close > analysis of cases that are filed reveal a level of so-called frivolous suits that > is minuscule. We have all hear the Poster Cases that are batted around, but > when one looks at the bulk of cases that are filed, they exist because good > lawyers have determined that the four elements of negligence are present > and provable by a preponderance of the evidence to a jury. > > Nevertheless, if we put ourselves into a position where we are sure to make > errors, then we can and should expect lawsuits. I can tell you that > lawsuits are no fun for anybody. To be sued is a wrenching experience even if > you're completely in the right. I had rather run 1000 codes than run one > malpractice suit. The stress is immense. > > Of course, common sense says that not every injury requires EMT/Paramedic > treatment and transport. If I sprain my ankle, I'm going to drive myself to > the ER or the Doc-in-the-Box or have my neighbor do it and I won't call > EMS. But I have a car and a neighbor. Many folks who need care do not have > transportation, and so forth. > > We are in a service business, and we should concentrate on service. It's > nice to think globally about helping the frequent flyer who forgot to get > her Lopressor refilled not to call us, but if she does call, she gets a trip > to the ER if she wants it in my service. On the street is not the place to > be counseling her about watching her prescriptions, lining up transportation > for the next time she needs it, et cetera. As Renny correctly recognizes, > taking care of the social needs may be the right thing to do, > but it's also the most time consuming much of the time. Where I differ > with him is here: The needs that he's targeted do need to be addressed, but > not at the point of contact after a 911 call. If a service wants to engage > in that sort of service, then I can surely see specialized crews following > up and attempting to ameliorate the situation, but I cannot see it happening > on the streets. > > There are likely differing views, and mine is only one. Service areas > differ widely in geographics, demographics, and needs. Not all solutions work > everywhere. That this topic is being debated civilly is good. > > Bottom line: Always do what is in the patient's best interest and you'll > generally be fine. Remember the first tenet of the law: You have a DUTY > to your patient. Many seem unclear as to whom they owe their duty. Well, > it is not to the hospital, the nurse, the doctor, or the accountant. It > is to the patient. If we remind ourselves of that as we start to every > call, we'll do good care and stay out of trouble. > > Gene Gandy, JD, LP, NREMT-P > Doctor of Illusionism, Grade II, in Residence > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 28, 2009 Report Share Posted August 28, 2009 Jane, Guess you corrupted me with that good education. So if I educate some Paramedic students maybe I can corrupt them as well and eventually will have the people needed to make changes. Renny Spencer The Idealistic Paramedic > > > > Dudley has pinpointed the problem. While I do appreciate Renny's position > > and embrace it philosophically, what he's promoting is, in fact, a sort > > of primary care done by EMS. Jane correctly identified three of the > > components of a system that permits refusals, but there are other aspects as well > > which are simply not in place. > > > > The Red River Project in New Mexico attempted to implement the sort of > > practices that Renny's talking about, but it was a rather spectacular failure > > because there is no way to fund it under present reimbursement schemes. > > Further, the level of education and training available to paramedics did not > > support it without significant further training. > > > > Such a system would require a coordination of efforts among not only EMS > > but social service agencies that does not widely exist. Tucson is attempting > > to do some of that by using what they call " Alpha Trucks " to respond to > > calls that are triaged as low priority and possibly in need of something other > > than EMS treatment and transport. The Alpha Folks do work with the social > > agencies and the system appears to be working to some degree. Phoenix > > tried the same thing and disbanded it because its experience was that it did not > > work. > > > > If all medics in the system had Renny's dedication and values, such a > > system might work; sadly, the kind of dedication, training, and judgment needed > > to carry out primary care in the field is lacking in current paramedic > > education, training and practice in most areas of the country. > > > > I spent a year working offshore as a rig medic, in a job that is basically > > primary care. During that time I first began to realize how little about > > medicine I really knew, how incompetent I was at dealing with non-emergency > > conditions, and how great a resource The Merck Manual, on's Principles > > of Internal Medicine, and Tintinalli's Emergency Medicine, and a good > > medical director with which I had instant communication are. I learned that > > paramedics are well trained in a very narrow scope of practice and that when > > outside that narrow scope things can get very sticky indeed. It was the > > scariest thing I ever did. > > > > When we begin to make determinations about who needs a ride to the hospital > > and who does not, we are placing one foot on a sheet of ice and the other > > on a banana peel. Even ER physicians make errors in diagnosis with the > > compendium of resources available to them. Most medics do not know either how > > to order labs or how to interpret them, if we had them available, and most > > can't read an x-ray or a CT or MRI scan. I can't see myself telling a > > patient with vague signs and symptoms that care is not needed without those > > tools, assuming I were able to use them. Yet that's what medic-initiated > > refusals invoke. > > > > As for the notion that people are going to sue no matter what we do, I'll > > say this: No, they're not. People sue when they are done wrong. They > > sue when they're harmed by somebody else. They do not sue over nothing, > > common myth to the contrary notwithstanding. > > > > Few understand how expensive it is to file and maintain a lawsuit. It > > takes many thousands of dollars worth of resources. Lawyers simply do not > > file unwarranted suits based upon the whims of their clients. A close > > analysis of cases that are filed reveal a level of so-called frivolous suits that > > is minuscule. We have all hear the Poster Cases that are batted around, but > > when one looks at the bulk of cases that are filed, they exist because good > > lawyers have determined that the four elements of negligence are present > > and provable by a preponderance of the evidence to a jury. > > > > Nevertheless, if we put ourselves into a position where we are sure to make > > errors, then we can and should expect lawsuits. I can tell you that > > lawsuits are no fun for anybody. To be sued is a wrenching experience even if > > you're completely in the right. I had rather run 1000 codes than run one > > malpractice suit. The stress is immense. > > > > Of course, common sense says that not every injury requires EMT/Paramedic > > treatment and transport. If I sprain my ankle, I'm going to drive myself to > > the ER or the Doc-in-the-Box or have my neighbor do it and I won't call > > EMS. But I have a car and a neighbor. Many folks who need care do not have > > transportation, and so forth. > > > > We are in a service business, and we should concentrate on service. It's > > nice to think globally about helping the frequent flyer who forgot to get > > her Lopressor refilled not to call us, but if she does call, she gets a trip > > to the ER if she wants it in my service. On the street is not the place to > > be counseling her about watching her prescriptions, lining up transportation > > for the next time she needs it, et cetera. As Renny correctly recognizes, > > taking care of the social needs may be the right thing to do, > > but it's also the most time consuming much of the time. Where I differ > > with him is here: The needs that he's targeted do need to be addressed, but > > not at the point of contact after a 911 call. If a service wants to engage > > in that sort of service, then I can surely see specialized crews following > > up and attempting to ameliorate the situation, but I cannot see it happening > > on the streets. > > > > There are likely differing views, and mine is only one. Service areas > > differ widely in geographics, demographics, and needs. Not all solutions work > > everywhere. That this topic is being debated civilly is good. > > > > Bottom line: Always do what is in the patient's best interest and you'll > > generally be fine. Remember the first tenet of the law: You have a DUTY > > to your patient. Many seem unclear as to whom they owe their duty. Well, > > it is not to the hospital, the nurse, the doctor, or the accountant. It > > is to the patient. If we remind ourselves of that as we start to every > > call, we'll do good care and stay out of trouble. > > > > Gene Gandy, JD, LP, NREMT-P > > Doctor of Illusionism, Grade II, in Residence > > > > > > > > > > > > _________________________________________________________________ > Windows Live: Keep your friends up to date with what you do online. > http://windowslive.com/Campaign/SocialNetworking?ocid=PID23285::T:WLMTAGL:ON:WL:\ en-US:SI_SB_online:082009 > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 28, 2009 Report Share Posted August 28, 2009 Wes, No problem. I understand that each of us see things based on what we have experienced. I still want your opinions on my ideas. Who knows maybe we will be able to design a better system of making sure that patients get what they need. Renny Spencer The Idealistic Paramedic > > > > Dudley has pinpointed the problem. While I do appreciate Renny's position > > and embrace it philosophically, what he's promoting is, in fact, a sort > > of primary care done by EMS. Jane correctly identified three of the > > components of a system that permits refusals, but there are other aspects as well > > which are simply not in place. > > > > The Red River Project in New Mexico attempted to implement the sort of > > practices that Renny's talking about, but it was a rather spectacular failure > > because there is no way to fund it under present reimbursement schemes. > > Further, the level of education and training available to paramedics did not > > support it without significant further training. > > > > Such a system would require a coordination of efforts among not only EMS > > but social service agencies that does not widely exist. Tucson is attempting > > to do some of that by using what they call " Alpha Trucks " to respond to > > calls that are triaged as low priority and possibly in need of something other > > than EMS treatment and transport. The Alpha Folks do work with the social > > agencies and the system appears to be working to some degree. Phoenix > > tried the same thing and disbanded it because its experience was that it did not > > work. > > > > If all medics in the system had Renny's dedication and values, such a > > system might work; sadly, the kind of dedication, training, and judgment needed > > to carry out primary care in the field is lacking in current paramedic > > education, training and practice in most areas of the country. > > > > I spent a year working offshore as a rig medic, in a job that is basically > > primary care. During that time I first began to realize how little about > > medicine I really knew, how incompetent I was at dealing with non-emergency > > conditions, and how great a resource The Merck Manual, on's Principles > > of Internal Medicine, and Tintinalli's Emergency Medicine, and a good > > medical director with which I had instant communication are. I learned that > > paramedics are well trained in a very narrow scope of practice and that when > > outside that narrow scope things can get very sticky indeed. It was the > > scariest thing I ever did. > > > > When we begin to make determinations about who needs a ride to the hospital > > and who does not, we are placing one foot on a sheet of ice and the other > > on a banana peel. Even ER physicians make errors in diagnosis with the > > compendium of resources available to them. Most medics do not know either how > > to order labs or how to interpret them, if we had them available, and most > > can't read an x-ray or a CT or MRI scan. I can't see myself telling a > > patient with vague signs and symptoms that care is not needed without those > > tools, assuming I were able to use them. Yet that's what medic-initiated > > refusals invoke. > > > > As for the notion that people are going to sue no matter what we do, I'll > > say this: No, they're not. People sue when they are done wrong. They > > sue when they're harmed by somebody else. They do not sue over nothing, > > common myth to the contrary notwithstanding. > > > > Few understand how expensive it is to file and maintain a lawsuit. It > > takes many thousands of dollars worth of resources. Lawyers simply do not > > file unwarranted suits based upon the whims of their clients. A close > > analysis of cases that are filed reveal a level of so-called frivolous suits that > > is minuscule. We have all hear the Poster Cases that are batted around, but > > when one looks at the bulk of cases that are filed, they exist because good > > lawyers have determined that the four elements of negligence are present > > and provable by a preponderance of the evidence to a jury. > > > > Nevertheless, if we put ourselves into a position where we are sure to make > > errors, then we can and should expect lawsuits. I can tell you that > > lawsuits are no fun for anybody. To be sued is a wrenching experience even if > > you're completely in the right. I had rather run 1000 codes than run one > > malpractice suit. The stress is immense. > > > > Of course, common sense says that not every injury requires EMT/Paramedic > > treatment and transport. If I sprain my ankle, I'm going to drive myself to > > the ER or the Doc-in-the-Box or have my neighbor do it and I won't call > > EMS. But I have a car and a neighbor. Many folks who need care do not have > > transportation, and so forth. > > > > We are in a service business, and we should concentrate on service. It's > > nice to think globally about helping the frequent flyer who forgot to get > > her Lopressor refilled not to call us, but if she does call, she gets a trip > > to the ER if she wants it in my service. On the street is not the place to > > be counseling her about watching her prescriptions, lining up transportation > > for the next time she needs it, et cetera. As Renny correctly recognizes, > > taking care of the social needs may be the right thing to do, > > but it's also the most time consuming much of the time. Where I differ > > with him is here: The needs that he's targeted do need to be addressed, but > > not at the point of contact after a 911 call. If a service wants to engage > > in that sort of service, then I can surely see specialized crews following > > up and attempting to ameliorate the situation, but I cannot see it happening > > on the streets. > > > > There are likely differing views, and mine is only one. Service areas > > differ widely in geographics, demographics, and needs. Not all solutions work > > everywhere. That this topic is being debated civilly is good. > > > > Bottom line: Always do what is in the patient's best interest and you'll > > generally be fine. Remember the first tenet of the law: You have a DUTY > > to your patient. Many seem unclear as to whom they owe their duty. Well, > > it is not to the hospital, the nurse, the doctor, or the accountant. It > > is to the patient. If we remind ourselves of that as we start to every > > call, we'll do good care and stay out of trouble. > > > > Gene Gandy, JD, LP, NREMT-P > > Doctor of Illusionism, Grade II, in Residence > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 28, 2009 Report Share Posted August 28, 2009 , I agree with you. Why do we lower our standards to the lowest level Paramedic? Why don't we attempt to re-educate and if that fails fire them? Maybe more services need to consider would I feel confident with this Paramedic treating my loved one rather than hey he works cheap? Renny Spencer The Idealistic Paramedic > > > > Renny, > > And if you had called, we would have taken you. Sure, you would have been a > > waste of our resources, but that is the way that goes. (That was a joke, > > don't get mad) Your five percent theory works well for your plan here, but it > > is human nature. If we give (NOT ALL medics of course) some medics the > > ability to deny, before you know it, they will be turning that five percent > > denial into a fifty-five percent denial rate. " I know that your left arm is numb, > > but you are not having chest pain, and it is numb in ONLY ONE of your arms " > > etc, etc. You mentioned yourself, " a break of a major bone would not allow > > denial " . I guarantee the definition of a " major bone " would be argued right > > and left before long. And down here, lets say it is a kid with a simple > > wrist fracture from skateboarding. What happens if mom has no car, and you deny > > because it is not a major bone. I have personally seen a medic take twenty > > five minutes attempting to talk a patient out of going by ambulance, when the > > hospital was literally a five minute transport away. (And they got called > > back about twenty minutes later, and ended up transporting after all) I tell > > the cadets all the time, if the patient wants to go, take them. You get paid > > for twenty-four hours, and it is not your diesel fuel. I have no hard data, > > but I imagine what I would call " critical " calls for us is less than 10%. > > The start of this whole thread was that: if you dont like it, or get tired of > > it, go to nursing school and get paid more. But, listen to the nurses, they > > are not sitting in a bed of roses either, they just get paid more. > > Anyway, dont worry, we would have transported you for your surgery if you > > wanted to go. HA > > Chris > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 28, 2009 Report Share Posted August 28, 2009 Well you are definitely one of the people that I am in the process of handing the active duty torch to as I get older. Good to know I have made a wise choice. Jane Dinsmore To: texasems-l From: spenair@... Date: Fri, 28 Aug 2009 12:47:47 +0000 Subject: Re: The Most Fundamental Problem with EMS Jane, Guess you corrupted me with that good education. So if I educate some Paramedic students maybe I can corrupt them as well and eventually will have the people needed to make changes. Renny Spencer The Idealistic Paramedic > > > > Dudley has pinpointed the problem. While I do appreciate Renny's position > > and embrace it philosophically, what he's promoting is, in fact, a sort > > of primary care done by EMS. Jane correctly identified three of the > > components of a system that permits refusals, but there are other aspects as well > > which are simply not in place. > > > > The Red River Project in New Mexico attempted to implement the sort of > > practices that Renny's talking about, but it was a rather spectacular failure > > because there is no way to fund it under present reimbursement schemes. > > Further, the level of education and training available to paramedics did not > > support it without significant further training. > > > > Such a system would require a coordination of efforts among not only EMS > > but social service agencies that does not widely exist. Tucson is attempting > > to do some of that by using what they call " Alpha Trucks " to respond to > > calls that are triaged as low priority and possibly in need of something other > > than EMS treatment and transport. The Alpha Folks do work with the social > > agencies and the system appears to be working to some degree. Phoenix > > tried the same thing and disbanded it because its experience was that it did not > > work. > > > > If all medics in the system had Renny's dedication and values, such a > > system might work; sadly, the kind of dedication, training, and judgment needed > > to carry out primary care in the field is lacking in current paramedic > > education, training and practice in most areas of the country. > > > > I spent a year working offshore as a rig medic, in a job that is basically > > primary care. During that time I first began to realize how little about > > medicine I really knew, how incompetent I was at dealing with non-emergency > > conditions, and how great a resource The Merck Manual, on's Principles > > of Internal Medicine, and Tintinalli's Emergency Medicine, and a good > > medical director with which I had instant communication are. I learned that > > paramedics are well trained in a very narrow scope of practice and that when > > outside that narrow scope things can get very sticky indeed. It was the > > scariest thing I ever did. > > > > When we begin to make determinations about who needs a ride to the hospital > > and who does not, we are placing one foot on a sheet of ice and the other > > on a banana peel. Even ER physicians make errors in diagnosis with the > > compendium of resources available to them. Most medics do not know either how > > to order labs or how to interpret them, if we had them available, and most > > can't read an x-ray or a CT or MRI scan. I can't see myself telling a > > patient with vague signs and symptoms that care is not needed without those > > tools, assuming I were able to use them. Yet that's what medic-initiated > > refusals invoke. > > > > As for the notion that people are going to sue no matter what we do, I'll > > say this: No, they're not. People sue when they are done wrong. They > > sue when they're harmed by somebody else. They do not sue over nothing, > > common myth to the contrary notwithstanding. > > > > Few understand how expensive it is to file and maintain a lawsuit. It > > takes many thousands of dollars worth of resources. Lawyers simply do not > > file unwarranted suits based upon the whims of their clients. A close > > analysis of cases that are filed reveal a level of so-called frivolous suits that > > is minuscule. We have all hear the Poster Cases that are batted around, but > > when one looks at the bulk of cases that are filed, they exist because good > > lawyers have determined that the four elements of negligence are present > > and provable by a preponderance of the evidence to a jury. > > > > Nevertheless, if we put ourselves into a position where we are sure to make > > errors, then we can and should expect lawsuits. I can tell you that > > lawsuits are no fun for anybody. To be sued is a wrenching experience even if > > you're completely in the right. I had rather run 1000 codes than run one > > malpractice suit. The stress is immense. > > > > Of course, common sense says that not every injury requires EMT/Paramedic > > treatment and transport. If I sprain my ankle, I'm going to drive myself to > > the ER or the Doc-in-the-Box or have my neighbor do it and I won't call > > EMS. But I have a car and a neighbor. Many folks who need care do not have > > transportation, and so forth. > > > > We are in a service business, and we should concentrate on service. It's > > nice to think globally about helping the frequent flyer who forgot to get > > her Lopressor refilled not to call us, but if she does call, she gets a trip > > to the ER if she wants it in my service. On the street is not the place to > > be counseling her about watching her prescriptions, lining up transportation > > for the next time she needs it, et cetera. As Renny correctly recognizes, > > taking care of the social needs may be the right thing to do, > > but it's also the most time consuming much of the time. Where I differ > > with him is here: The needs that he's targeted do need to be addressed, but > > not at the point of contact after a 911 call. If a service wants to engage > > in that sort of service, then I can surely see specialized crews following > > up and attempting to ameliorate the situation, but I cannot see it happening > > on the streets. > > > > There are likely differing views, and mine is only one. Service areas > > differ widely in geographics, demographics, and needs. Not all solutions work > > everywhere. That this topic is being debated civilly is good. > > > > Bottom line: Always do what is in the patient's best interest and you'll > > generally be fine. Remember the first tenet of the law: You have a DUTY > > to your patient. Many seem unclear as to whom they owe their duty. Well, > > it is not to the hospital, the nurse, the doctor, or the accountant. It > > is to the patient. If we remind ourselves of that as we start to every > > call, we'll do good care and stay out of trouble. > > > > Gene Gandy, JD, LP, NREMT-P > > Doctor of Illusionism, Grade II, in Residence > > > > > > > > > > > > __________________________________________________________ > Windows Live: Keep your friends up to date with what you do online. > http://windowslive.com/Campaign/SocialNetworking?ocid=PID23285::T:WLMTAGL:ON:WL:\ en-US:SI_SB_online:082009 > > Quote Link to comment Share on other sites More sharing options...
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