RE: The Most Fundamental Problem with EMS

[Guest guest]

I have no idea. I doubt there are any stats on that yet. This has been

in practice for less than a year, I think.

GG

>  

> Wow, great system.  What is the compliance rate of the frequent flyers?

>

> Live for today, tomorrow is not here yet and laugh at yourself often

> before someone else does.

>  

> McGee, EMT-P

>

>  

>

>

>

> From: wegandy1938@wegandy

> Subject: Re: Re: The Most Fundamental Problem with EMS

> To: texasems-l@yahoogrotexasem

> Date: Tuesday, August 25, 2009, 6:32 PM

>

>  

>

> 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

> In a message dated 8/25/09 3:12:43 PM, rick.moore@csmedcen ter.com writes:

>

> >  

> > 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@yahoogro texasem [mailto:texasems- l@yahoogrotexase m]

> On

> > Behalf Of ExLngHrn (AT) aol (DOT) ExL

> > Sent: Tuesday, August 25, 2009 5:04 PM

> > To: texasems-l@yahoogro texasem

> > 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@yahoogro texasem

>

> >

> > > 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]

I agree. My old service the medical director allowed some of us to say no to

transport. Was never a problem and many times as we drove away we actually got

a serious call. Had we transported the toothache the next ambulance would have

taken more than an hour to arrive.

A denial of transport should actually take more effort than it would just to

load and take them. Why? Because you will take time to educate them on proper

use of 911. You will help them find proper services. You will document more

than you would have had you transported.

Yes very time consuming at first but in the long run will save money for the

patients and the service as the ambulance will no longer be the favorite mode of

transport. It will save money in the budget for the EMS company's because you

can downsize. Oh no I may have just written my way out of a job, what being

budget time and all.

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]

But admission to the hospital does not an ambulance transport require. Many

people are sick and will need to spend time in the hospital getting treatment

but have no need of an ambulance. So I say the study based on saying if you

said no to transport and they were then admitted makes you wrong is flawed.

Sorry Dr Bledsoe no offense meant.

When I used to be able to say no to someone I advised them of where to go for

treatment/followup. Yes some spent time in the hospital. But the only thing

that was different between the car ride they took and the ambulance ride it

seems the study says I should have given is a huge bill.

So I still favor being able to say no even if it is very restricted as to when

it can be used. There needs to be a balance rather than having the scale

falling over onto the transport all callers.

Renny Spencer

Paramedic

>

> 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. >

> GG

>

[Guest guest]

I would be interested. Az is my home state and I do speak fondly of Phoenix fire

but admittedly mostly due to the hype not first hand knowlege. Please respond to

rick.moore@...

Thanks

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]

Wow, great system.  What is the compliance rate of the frequent flyers?

Live for today, tomorrow is not here yet and laugh at yourself often before

someone else does.

 

McGee, EMT-P

 

Subject: Re: Re: The Most Fundamental Problem with EMS

To: texasems-l

Date: Tuesday, August 25, 2009, 6:32 PM

 

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

In a message dated 8/25/09 3:12:43 PM, rick.moore@csmedcen ter.com writes:

>  

> 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@yahoogro texasem [mailto:texasems- l@yahoogrotexase m] On

> Behalf Of ExLngHrn (AT) aol (DOT) ExL

> Sent: Tuesday, August 25, 2009 5:04 PM

> To: texasems-l@yahoogro texasem

> 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@yahoogro texasem

>

> > 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]

Even with our narrow scope of practice, Rob,don't you think that we have more

autonomy then RN's?

Live for today, tomorrow is not here yet and laugh at yourself often before

someone else does.

 

McGee, EMT-P

 

Subject: Re: Re: The Most Fundamental Problem with EMS

To: texasems-l

Date: Tuesday, August 25, 2009, 6:48 PM

 

On Tuesday, August 25, 2009 18:32, wegandy1938@ aol.com 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]

Generally speaking, yes. However that obviously varies greatly from system to

system, both for medics and RNs. The issue here though is not so much who has

the most autonomy, but who is best educationally prepared to assess the needs of

a patient, especially those patients who fall outside the scope of EMS

education, which are the ones who would typically need such screening.

Rob

On Tuesday, August 25, 2009 20:20, " McGee " summedic@...> said:

> Even with our narrow scope of practice, Rob,don't you think that we have more

> autonomy then RN's?

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

> Live for today, tomorrow is not here yet and laugh at yourself often before

> someone else does.

>  

> McGee, EMT-P

>

>  

>

>

>

>

>

> Subject: Re: Re: The Most Fundamental Problem with EMS

> To: texasems-l

> Date: Tuesday, August 25, 2009, 6:48 PM

>

>

>  

>

>

>

> On Tuesday, August 25, 2009 18:32, wegandy1938@ aol.com 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]

Agreed,but an EMT or a paramedic should be able to assess a patient enough with

our " rough " assessment skills todetermine if a patient was in need of emergent

transport by an ambulance or a ride with family or friends in a car, don't you

agree?  Of course, any situation with doubt should be transported.

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: Re: The Most Fundamental Problem with EMS

> To: texasems-l@yahoogro ups.com

> Date: Tuesday, August 25, 2009, 6:48 PM

>

>

>  

>

>

>

> On Tuesday, August 25, 2009 18:32, wegandy1938@ aol.com 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]

Bledsoe wrote >>> This is a fairly robust study given the methodology.

Read the whole paper. <<<

READ? FOR OURSELVES?

Can't we just have someone inaccurately summarize the report and misinterpret

the results for us? It would be so much easier!

If I read the paper myself, I might learn something. Then, I would have to

leave the profession.

Kenny Navarro

Dallas

[Guest guest]

Ok, I would be interested to find out.

Live for today, tomorrow is not here yet and laugh at yourself often before

someone else does.

 

McGee, EMT-P

 

>

> From: wegandy1938@ wegandy

> Subject: Re: Re: The Most Fundamental Problem with EMS

> To: texasems-l@yahoogro texasem

> Date: Tuesday, August 25, 2009, 6:32 PM

>

>  

>

> 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

> In a message dated 8/25/09 3:12:43 PM, rick.moore@csmedcen ter.com writes:

>

> >  

> > 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@yahoogro texasem [mailto:texasems- l@yahoogrotexase m]

> On

> > Behalf Of ExLngHrn (AT) aol (DOT) ExL

> > Sent: Tuesday, August 25, 2009 5:04 PM

> > To: texasems-l@yahoogro texasem

> > 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@yahoogro texasem

>

> >

> > > 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]

Maybe we should all leave the profession and let the morticians have it back. 

That will teach them.  How would they like a hearse showing up for the 4am

toothache calls?

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, 9:02 PM

 

Bledsoe wrote >>> This is a fairly robust study given the methodology.

Read the whole paper. <<<

READ? FOR OURSELVES?

Can't we just have someone inaccurately summarize the report and misinterpret

the results for us? It would be so much easier!

If I read the paper myself, I might learn something. Then, I would have to leave

the profession.

Kenny Navarro

Dallas

[Guest guest]

Ok, so the open humerus fx from a 8 foot fall can be splinted and sent with the

wife to the ED?? How about the GSW to the lower leg or through and through the

thigh with stable vital signs and no significant bleeding?? Probably needs

hospital care, maybe even surgery and an overnight stay....but does it really

need an ambulance??

What about the patient with an angina history who called for chest pain because

it feels different right now at 0300...the 12-lead shows no STEMI....so the wife

can take 'em into the ED.? That surely doesn't need an ambulance either.?

I am not opposed to finding ways to not transport those who do not need

transportation...but be very careful stating that people who need admission do

not need ambulance transport for 2 reasons:

??????? 1.? If someone is sick enough to get admitted to a hospital

now-a-days....I would argue they are sick enough to require transport....the

problem is we can't predict who that subset is...and if we can't predict who can

be admitted...how can we be trusted to predict who is sick enough to require an

ambulance...unless of course it is just those that each individual paramedic

FEEL are sick enough based upon their presentation, time of day, other stuff we

were doing, etc.

????????2.? If we ignore admission as someone sick enough to require ambulance

transport...then someone may seriously ask " what patients does ambulance

transport make a difference for " ?? That is a question we probably are not

prepared for payers, elected officials or citizens to be asking as a

profession.? If they did...there could seriously be a whole host of EMS folks

" moving on " to other jobs.

Dudley

Re: The Most Fundamental Problem with EMS

But admission to the hospital does not an ambulance transport require. Many

people are sick and will need to spend time in the hospital getting treatment

but have no need of an ambulance. So I say the study based on saying if you said

no to transport and they were then admitted makes you wrong is flawed. Sorry Dr

Bledsoe no offense meant.

When I used to be able to say no to someone I advised them of where to go for

treatment/followup. Yes some spent time in the hospital. But the only thing that

was different between the car ride they took and the ambulance ride it seems the

study says I should have given is a huge bill.

So I still favor being able to say no even if it is very restricted as to when

it can be used. There needs to be a balance rather than having the scale falling

over onto the transport all callers.

Renny Spencer

Paramedic

>

> 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. >

> GG

>

[Guest guest]

People would spend more time and cause a longer waits for other patients than it

would if you just treat them and get on with your business.

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]

I guess that means when I got hurt I should have had the ambulance take me.

Then when scheduled for surgery I should have called for the ambulance to come

get me and take me back to the hospital because I had a real problem. That

would have been a waste of resources but would have been ok based on what you

said.

Yes many things could be taken safely by personal car. And yes if the public

understood that many services could downsize.

The treatmenet and denial guidelines would only allow denial of very few.

Perhaps it would include taxi vouchers to the clinic or dentist since toothache

has been used in this discussion.

A break of a major bone would not allow denial. Chest pain would not allow a

denial. And if QA/QI caught someone abusing this guideline someone would be out

of a job real quick.

It always makes me laugh when I mention denying transport. People always think

it means we will say no to everyone. When in fact it only lets you say no to

maybe 5% of callers and we all know that in reality a whole lot more than 5% of

all callers really could safely go by other means to the doctor or to walmart

for pepto.

So yes after my long winded post I say the study is flawed as admission to the

hospital does not mean a person needed an ambulance to get there.

Again just my worthless opinion.

Renny Spencer

Paramedic

>

> >

> > 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. >

> > GG

> >

>

>

>

>

>

>

>

>

>

[Guest guest]

In a message dated 8/26/2009 1:03:54 P.M. Central Daylight Time,

kellow.bob@... writes:

Since reimbursement is based on patient transport,

One can stop right there. Even with the greatest QA/QI, trained medics and

Medical oversight until we " fix " the TRUE fundamental problem with ems the

FUNDING stream we can't really and truly fix these other issues (as many as

there are).

It takes MONEY to do nearly all things. Money to pay a living wage, money

to buy the right tools and maintain them, money to train to the levels we

aspire to and so on and so on.

EMS is one minor cog in the " healthcare debate " and at the highest level I

am not sure if they even see the cog but anyone that has every driven a

clunker knows that one cog that gets broken will cause the engine to die in

time.

Money is the real Fundamental Problem with EMS or lack thereof that is.

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]

no, but there are many emergency departments that are doing a physician

triage, followed by either a cash payment or a referral to a more appropriate

center of treatment if no treatable urgent or emergent problem is found.

ck

S. Krin

In a message dated 8/26/2009 12:04:04 Central Standard Time,

kellow.bob@... writes:

Have you ever gone to your doctor's office only to be told that your chief

complaint didn't warrant the good doctor's time, assessment and treatment?

I

didn't think so.

[Guest guest]

Having worked for a service that does paramedic initiated no

transports I strongly agree. All three items must be in place.

Anything less dont even think about it.

If you are not willing to invest the time and money on a strong QI

program, additional training and medical control involvement and more

importantly - buy in from the medical community at large - dont even

think about it.

AJL

On Tue, Aug 25, 2009 at 5:56 PM, Jane

Dinsmoretexas.paramedic@...> wrote:

>

> 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]

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

[Guest guest]

They are also referred to as " Medic-Initiated Patient Refusals " , many of

which result from system overload, poor diagnosis and downright laziness.

Some medics pride themselves on how many citizens that they can talk out of

going to a hospital. To say that this is a slippery slope is an enormous

understatement. I've personally seen it go as high as 38% of all patient

contacts for a single paramedic over the course of a single year (excluding

MVA's of course.)

Since reimbursement is based on patient transport, how many medic-initiated

patient refusals would occur if medics were independently compensated

through fee for service billing based on transport and all EMS immunity laws

were stricken from the books? Medics could lease their ambulances, pay for

their own equipment, supplies and fuel, and pay their pro rata share for

indirect expenses like dispatch services, medical control, etc.

I suspect that there would be very few medic initiated patient refusals,

indeed.

Have you ever gone to your doctor's office only to be told that your chief

complaint didn't warrant the good doctor's time, assessment and treatment? I

didn't think so.

Bob

> Having worked for a service that does paramedic initiated no

> transports I strongly agree. All three items must be in place.

> Anything less dont even think about it.

>

> If you are not willing to invest the time and money on a strong QI

> program, additional training and medical control involvement and more

> importantly - buy in from the medical community at large - dont even

> think about it.

>

> AJL

>

> On Tue, Aug 25, 2009 at 5:56 PM, Jane

> Dinsmoretexas.paramedic@...> wrote:

> >

> > 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]

Comments in line

> They are also referred to as " Medic-Initiated Patient Refusals " , many of

> which result from system overload, poor diagnosis and downright laziness.

> Some medics pride themselves on how many citizens that they can talk out of

> going to a hospital. To say that this is a slippery slope is an enormous

> understatement. I've personally seen it go as high as 38% of all patient

> contacts for a single paramedic over the course of a single year (excluding

> MVA's of course.)

Not necessarly a system problem, more like a staff problem. Some

medics are doing this now in many systems by " talking a patient into

signing a refusal " . I will agree that this is not the medic that

should be doing medic initiated refusals.

This process is not for every medic nor is it for every EMS system.

If you are not ready to invest the time into creating a system that

can mangage this just dont do it.

>

> Since reimbursement is based on patient transport, how many medic-initiated

> patient refusals would occur if medics were independently compensated

> through fee for service billing based on transport and all EMS immunity laws

> were stricken from the books? Medics could lease their ambulances, pay for

> their own equipment, supplies and fuel, and pay their pro rata share for

> indirect expenses like dispatch services, medical control, etc.

Moot point, medics are not independently compensated.

>

> I suspect that there would be very few medic initiated patient refusals,

> indeed.

>

> Have you ever gone to your doctor's office only to be told that your chief

> complaint didn't warrant the good doctor's time, assessment and treatment? I

> didn't think so.

>

Yes I have, called in with my complaint, MD called the pharmacy for

meds. Saved me a copay and a visit to the office.

> Bob

>

>

>

>> Having worked for a service that does paramedic initiated no

>> transports I strongly agree.  All three items must be in place.

>> Anything less dont even think about it.

>>

>> If you are not willing to invest the time and money on a strong QI

>> program, additional training and medical control involvement and more

>> importantly - buy in from the medical community at large - dont even

>> think about it.

>>

>> AJL

>>

>> On Tue, Aug 25, 2009 at 5:56 PM, Jane

>> Dinsmoretexas.paramedic@...> wrote:

>> >

>> > 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]

Rernny et al,

The problem to a degree here is perception and PR.

If you were to implement a near fool proof close to perfect Medic Iniaited

Refusal system that was 99.9% effective you would have 1 out of 1,000

refusals have a negative outcome. If 99,9% of those are say " minor " you would

have 1 not so minor let's say lethal for arguments sake.

That's the one and the only one they will lead with on CNN etc.

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 8/26/2009 5:20:29 P.M. Central Daylight Time,

spenair@... writes:

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

--- In _texasems-l@yahoogrotexasem_ (mailto:texasems-l ) ,

Clgrote126@., Clg

>

> 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

>

>

> [Non-text portions of this message have been removed]

>

[Guest guest]

Rernny et al,

The problem to a degree here is perception and PR.

If you were to implement a near fool proof close to perfect Medic Iniaited

Refusal system that was 99.9% effective you would have 1 out of 1,000

refusals have a negative outcome. If 99,9% of those are say " minor " you would

have 1 not so minor let's say lethal for arguments sake.

That's the one and the only one they will lead with on CNN etc.

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 8/26/2009 5:20:29 P.M. Central Daylight Time,

spenair@... writes:

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

--- In _texasems-l@yahoogrotexasem_ (mailto:texasems-l ) ,

Clgrote126@., Clg

>

> 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

>

>

> [Non-text portions of this message have been removed]

>

[Guest guest]

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

>

>

>

[Guest guest]

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

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[Guest guest]

well, he is a government lawyer and he is here to help us...

ck

In a message dated 8/27/2009 08:59:16 Central Standard Time,

rick.moore@... writes:

Yes you did, but Wes has a short attention span. :-)