RE: The Most Fundamental Problem with EMS

[Guest guest]

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

__________________________________________________

[Guest guest]

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

>

> __________________________________________________

>

[Guest guest]

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

>

> ____________ _________ _________ _________ _________ __

>

[Guest guest]

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

>

> ____________ ________ ________ ________ ________ _

>

[Guest guest]

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

>  

> 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

> >

> > ____________ ________ ________ ________ ________ ___

> >

[Guest guest]

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

> >

> > __________________________________________________

> >

[Guest guest]

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

>  

> 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

> > >

> > > ____________ ________ ________ ________ ________ ___

> > >

[Guest guest]

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

>  

> 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

>

>

>

>

[Guest guest]

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]

[Guest guest]

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

>

> __________________________________________________

>

[Guest guest]

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

>

> __________________________________________________

>

[Guest guest]

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

>

> __________________________________________________

>

[Guest guest]

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

[Guest guest]

" 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

[Guest guest]

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

>

> __________________________________________________

>

[Guest guest]

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

[Guest guest]

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)

[Guest guest]

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

>

> __________________________________________________

>

[Guest guest]

'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

>

> ____________ _________ _________ _________ _________ __

>

[Guest guest]

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

[Guest guest]

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

     

[Guest guest]

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

[Guest guest]

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

>

> __________________________________________________

>

[Guest guest]

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

> >

> > ____________ ________ ________ ________ ________ ___

> >

[Guest guest]

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