RE: The Most Fundamental Problem with EMS

[Guest guest]

What's wrong with accepting the fact that a good chunk of our job involves

taking people to the hospital??? Folks, it's what we do.? Period.

Besides, I've yet to see a physician tell a patient, " I don't think your problem

warrants my attention.? Go down the street and buy some Tylenol. " ? What makes us

think we're more special than doctors?

We're in a service profession.? That's an honor in itself.? And sometimes a

curse as well....

-Wes Ogilvie, MPA, JD, Lic.P./NREMT-P

-Attorney at Law/Licensed Paramedic/EMS Instructor

-Austin, Texas

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://\

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[Guest guest]

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

[Guest guest]

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

>

> 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)

>

>

>

[Guest guest]

Wes,

I am saying we are actually doing more for the patient by helping them get into

the services they need rather than just dumping them on the ER. I have no

trouble transporting a person, used to take them 90+ miles to the nearest

hospital, now work where most calls only 10 minutes to hospital.

Even though it would be quicker/easier just to transport I feel we do a

disservice to our patients by not actually helping them get the help they

actually need. Often people call us because they do not know what they need.

So what is the standard currently, load them and take them where they don't need

to be. So we did not help the person, perhaps you could even argue we did harm,

as at least financially they have a huge bill that will not be paid by insurance

as it was not an emergency.

I am not saying they do not warrant our attention. I am saying they deserve our

undivided attention. If we listen we would see that many are just needing

someone to point them in the right direction. Sadly many ER doctors will be to

busy to listen so the patient just gets checked and released. Patient still has

no clue. Calls 911 next day, cycle begins again.

So I am saying we are being lazy and doing a disservice by transporting all

callers rather than actually being patient advocates and helping them. If we

were a real profession I feel we would do all we could for the patients rather

than just being a horizontal taxi.

More worthless ramblings of mine.

Renny Spencer

Paramedic

>

>

> What's wrong with accepting the fact that a good chunk of our job involves

taking people to the hospital??? Folks, it's what we do.? Period.

>

>

>

> Besides, I've yet to see a physician tell a patient, " I don't think your

problem warrants my attention.? Go down the street and buy some Tylenol. " ? What

makes us think we're more special than doctors?

>

> We're in a service profession.? That's an honor in itself.? And sometimes a

curse as well....

>

>

>

> -Wes Ogilvie, MPA, JD, Lic.P./NREMT-P

>

> -Attorney at Law/Licensed Paramedic/EMS Instructor

>

> -Austin, Texas

>

[Guest guest]

Wes,

I am saying we are actually doing more for the patient by helping them get into

the services they need rather than just dumping them on the ER. I have no

trouble transporting a person, used to take them 90+ miles to the nearest

hospital, now work where most calls only 10 minutes to hospital.

Even though it would be quicker/easier just to transport I feel we do a

disservice to our patients by not actually helping them get the help they

actually need. Often people call us because they do not know what they need.

So what is the standard currently, load them and take them where they don't need

to be. So we did not help the person, perhaps you could even argue we did harm,

as at least financially they have a huge bill that will not be paid by insurance

as it was not an emergency.

I am not saying they do not warrant our attention. I am saying they deserve our

undivided attention. If we listen we would see that many are just needing

someone to point them in the right direction. Sadly many ER doctors will be to

busy to listen so the patient just gets checked and released. Patient still has

no clue. Calls 911 next day, cycle begins again.

So I am saying we are being lazy and doing a disservice by transporting all

callers rather than actually being patient advocates and helping them. If we

were a real profession I feel we would do all we could for the patients rather

than just being a horizontal taxi.

More worthless ramblings of mine.

Renny Spencer

Paramedic

>

>

> What's wrong with accepting the fact that a good chunk of our job involves

taking people to the hospital??? Folks, it's what we do.? Period.

>

>

>

> Besides, I've yet to see a physician tell a patient, " I don't think your

problem warrants my attention.? Go down the street and buy some Tylenol. " ? What

makes us think we're more special than doctors?

>

> We're in a service profession.? That's an honor in itself.? And sometimes a

curse as well....

>

>

>

> -Wes Ogilvie, MPA, JD, Lic.P./NREMT-P

>

> -Attorney at Law/Licensed Paramedic/EMS Instructor

>

> -Austin, Texas

>

[Guest guest]

Renny, I dont think your ramblings are worthless. I think you just hit the nail

on the head. ---------- Sent from my Verizon Wireless mobile phone

Re: The Most Fundamental Problem with EMS

Wes,

I am saying we are actually doing more for the patient by helping them get into

the services they need rather than just dumping them on the ER. I have no

trouble transporting a person, used to take them 90+ miles to the nearest

hospital, now work where most calls only 10 minutes to hospital.

Even though it would be quicker/easier just to transport I feel we do a

disservice to our patients by not actually helping them get the help they

actually need. Often people call us because they do not know what they need. So

what is the standard currently, load them and take them where they don't need to

be. So we did not help the person, perhaps you could even argue we did harm, as

at least financially they have a huge bill that will not be paid by insurance as

it was not an emergency.

I am not saying they do not warrant our attention. I am saying they deserve our

undivided attention. If we listen we would see that many are just needing

someone to point them in the right direction. Sadly many ER doctors will be to

busy to listen so the patient just gets checked and released. Patient still has

no clue. Calls 911 next day, cycle begins again.

So I am saying we are being lazy and doing a disservice by transporting all

callers rather than actually being patient advocates and helping them. If we

were a real profession I feel we would do all we could for the patients rather

than just being a horizontal taxi.

More worthless ramblings of mine.

Renny Spencer

Paramedic

>

>

> What's wrong with accepting the fact that a good chunk of our job involves

taking people to the hospital??? Folks, it's what we do.? Period.

>

>

>

> Besides, I've yet to see a physician tell a patient, " I don't think your

problem warrants my attention.? Go down the street and buy some Tylenol. " ? What

makes us think we're more special than doctors?

>

> We're in a service profession.? That's an honor in itself.? And sometimes a

curse as well....

>

>

>

> -Wes Ogilvie, MPA, JD, Lic.P./NREMT-P

>

> -Attorney at Law/Licensed Paramedic/EMS Instructor

>

> -Austin, Texas

>

[Guest guest]

Renny, I dont think your ramblings are worthless. I think you just hit the nail

on the head. ---------- Sent from my Verizon Wireless mobile phone

Re: The Most Fundamental Problem with EMS

Wes,

I am saying we are actually doing more for the patient by helping them get into

the services they need rather than just dumping them on the ER. I have no

trouble transporting a person, used to take them 90+ miles to the nearest

hospital, now work where most calls only 10 minutes to hospital.

Even though it would be quicker/easier just to transport I feel we do a

disservice to our patients by not actually helping them get the help they

actually need. Often people call us because they do not know what they need. So

what is the standard currently, load them and take them where they don't need to

be. So we did not help the person, perhaps you could even argue we did harm, as

at least financially they have a huge bill that will not be paid by insurance as

it was not an emergency.

I am not saying they do not warrant our attention. I am saying they deserve our

undivided attention. If we listen we would see that many are just needing

someone to point them in the right direction. Sadly many ER doctors will be to

busy to listen so the patient just gets checked and released. Patient still has

no clue. Calls 911 next day, cycle begins again.

So I am saying we are being lazy and doing a disservice by transporting all

callers rather than actually being patient advocates and helping them. If we

were a real profession I feel we would do all we could for the patients rather

than just being a horizontal taxi.

More worthless ramblings of mine.

Renny Spencer

Paramedic

>

>

> What's wrong with accepting the fact that a good chunk of our job involves

taking people to the hospital??? Folks, it's what we do.? Period.

>

>

>

> Besides, I've yet to see a physician tell a patient, " I don't think your

problem warrants my attention.? Go down the street and buy some Tylenol. " ? What

makes us think we're more special than doctors?

>

> We're in a service profession.? That's an honor in itself.? And sometimes a

curse as well....

>

>

>

> -Wes Ogilvie, MPA, JD, Lic.P./NREMT-P

>

> -Attorney at Law/Licensed Paramedic/EMS Instructor

>

> -Austin, Texas

>

[Guest guest]

Renny,

I think we're going to have to agree to disagree.?? I recognize you've got a lot

of great rural experience and that's the perspective you've come from.?

I've worked a bit of rural EMS along with suburban and urban EMS.? Additionally,

I'm only in EMS part-time, working full time as an attorney.

From my background as an attorney and working in inner-city, urban EMS, what you

propose is great in concept.? It's idealistic and fraught with risk.? Imagine,

if you will, a large urban fire department.? That fire department has paramedics

who don't want to be paramedics and feel that they're being punished by being

assigned to the ambulance instead of the ladder truck.? Let's now imagine that

they're on call 20 on a 24 hour shift.? They're dispatched for " indigestion. " ??

How much do you want to bet that the thought of a " medic-initiated refusal "

enters their mind at least as often as performing a 12-lead?

When your medical director is willing to sign the protocols for medic-initiated

refusals and you're willing to put your patch and checkbook on the line, let's

talk.? ?? Until then, I'd respetfully suggest that you continue to?gain

experience and continue improving your local EMS system.

-Wes Ogilvie, MPA, JD, Lic.P./NREMT-P

-Attorney at Law/Licensed Paramedic/EMS Instructor

-Austin, Texas

Re: The Most Fundamental Problem with EMS

Wes,

I am saying we are actually doing more for the patient by helping them get into

the services they need rather than just dumping them on the ER. I have no

trouble transporting a person, used to take them 90+ miles to the nearest

hospital, now work where most calls only 10 minutes to hospital.

Even though it would be quicker/easier just to transport I feel we do a

disservice to our patients by not actually helping them get the help they

actually need. Often people call us because they do not know what they need. So

what is the standard currently, load them and take them where they don't need to

be. So we did not help the person, perhaps you could even argue we did harm, as

at least financially they have a huge bill that will not be paid by insurance as

it was not an emergency.

I am not saying they do not warrant our attention. I am saying they deserve our

undivided attention. If we listen we would see that many are just needing

someone to point them in the right direction. Sadly many ER doctors will be to

busy to listen so the patient just gets checked and released. Patient still has

no clue. Calls 911 next day, cycle begins again.

So I am saying we are being lazy and doing a disservice by transporting all

callers rather than actually being patient advocates and helping them. If we

were a real profession I feel we would do all we could for the patients rather

than just being a horizontal taxi.

More worthless ramblings of mine.

Renny Spencer

Paramedic

>

>

> What's wrong with accepting the fact that a good chunk of our job involves

taking people to the hospital??? Folks, it's what we do.? Period.

>

>

>

> Besides, I've yet to see a physician tell a patient, " I don't think your

problem warrants my attention.? Go down the street and buy some Tylenol. " ? What

makes us think we're more special than doctors?

>

> We're in a service profession.? That's an honor in itself.? And sometimes a

curse as well....

>

>

>

> -Wes Ogilvie, MPA, JD, Lic.P./NREMT-P

>

> -Attorney at Law/Licensed Paramedic/EMS Instructor

>

> -Austin, Texas

>

[Guest guest]

What?  You never heard of " Take two aspirin and call me in the morning " ???

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

To: texasems-l

Date: Thursday, August 27, 2009, 8:49 AM

 

What's wrong with accepting the fact that a good chunk of our job involves

taking people to the hospital??? Folks, it's what we do.? Period.

Besides, I've yet to see a physician tell a patient, " I don't think your problem

warrants my attention.? Go down the street and buy some Tylenol. " ? What makes us

think we're more special than doctors?

We're in a service profession.? That's an honor in itself.? And sometimes a

curse as well....

-Wes Ogilvie, MPA, JD, Lic.P./NREMT- P

-Attorney at Law/Licensed Paramedic/EMS Instructor

-Austin, Texas

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/ 100126575x122284 6709x1201493018/ aol?redir=

http://www. freecreditreport .com/pm/default. aspx?sc=668072& amp;

hmpgID=115 & bcd=Julystepsfoo terNO115)

[Guest guest]

Wes,

Why would they take the harder way of denying transport. If done properly the

lazy medic will just transport as denying will take more effort.

As to the law suits etc, I was even allowed to deny as a basic. My old medical

director allowed some of us to actually work with patients and help them get the

services they needed. Now we were small and at the time we were allowed to deny

my medical director was also the ER director so we could easily catch her to

discuss. We still transported 95%+ of those that asked. And we got in trouble

for some transports because as my medical director pointed out bluntly we just

cost the patient a bunch of money when the person actually needed other services

that the ER did not provide. I sure miss those days.

And as to your example of the medics getting a refusal QA/QI should be looking

at how often close to end of shifts refusals are attained. Then follow up with

the patients to see what happened. If found that refusals are being basically

coached out of people then some people need to be removed from our profession.

I for one will focus on doing whats right for patients rather than focusing on

law suits as people can find a lawyer that will sue for any and every thing. If

I lived my life in fear I would have to do a 15 lead every patient, even the the

one that sneezed last week and called tonight because they can't sleep thinking

about that sneeze. Would not start an IV as it could cause pain or get

infected. etc etc. Anything we do or don't do can cause a law suit if someone

wants to try.

I do not pretend to have any understanding of the law as it seems to be so

screwed up it needs thrown out and someone with some common sense come in and

rewrite it.

And I hope someday that my current job will be able to adopt a progressive

denial protocol.

Respectfully,

Renny Spencer

The idealistic Paramedic.

>

>

> Renny,

>

>

>

> I think we're going to have to agree to disagree.?? I recognize you've got a

lot of great rural experience and that's the perspective you've come from.?

>

>

>

> I've worked a bit of rural EMS along with suburban and urban EMS.?

Additionally, I'm only in EMS part-time, working full time as an attorney.

>

>

> From my background as an attorney and working in inner-city, urban EMS, what

you propose is great in concept.? It's idealistic and fraught with risk.?

Imagine, if you will, a large urban fire department.? That fire department has

paramedics who don't want to be paramedics and feel that they're being punished

by being assigned to the ambulance instead of the ladder truck.? Let's now

imagine that they're on call 20 on a 24 hour shift.? They're dispatched for

" indigestion. " ?? How much do you want to bet that the thought of a

" medic-initiated refusal " enters their mind at least as often as performing a

12-lead?

>

>

>

> When your medical director is willing to sign the protocols for

medic-initiated refusals and you're willing to put your patch and checkbook on

the line, let's talk.? ?? Until then, I'd respetfully suggest that you

continue to?gain experience and continue improving your local EMS system.

>

>

>

> -Wes Ogilvie, MPA, JD, Lic.P./NREMT-P

>

> -Attorney at Law/Licensed Paramedic/EMS Instructor

>

> -Austin, Texas

[Guest guest]

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)

[Guest guest]

" If nominated, I will not run.? If elected, I will not serve. " --

Tecumseh Sherman

-Wes Ogilvie

Re: Re: The Most Fundamental Problem with EMS

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)

[Guest guest]

Henry,

Why when some one suggests a way to improve patient care that is different than

the present way is it made fun of? I have never suggested we would not provide

care, I have actually stated we would provide the right care.

How many times do I have to say if done properly it would take more work and

time than just transporting but would actually get the patient the type of care

they actually need? Eventually leading EMS to actually being a part of the

healthcare solution rather than a part of the problem.

But oh well I'm trying to suggest something that would require more effort and

education so that is a bad thing. I'm suggesting we actually move our

profession out of the era of being just an ambulance driver, shame on me.

Perhaps I should shut up and just do the same thing everyone else does just

because thats the way its always been done. Guess that is best since so much we

do in EMS is done that way rather than based on scientific proof.

Perhaps I will just do like almost everyone else and not get involved at all

with trying to improve EMS. I'll just sit back and complain about how bad

things are but not try to do anything to fix it.

Respectfully

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)

>

>

[Guest guest]

if caught will not swing

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)

[Guest guest]

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

>

>

>

[Guest guest]

Exactly...like the terrorism prevention thing...the caller can be wrong 100% of

the time...but the EMS agency has to be right 100% of the time and that is a

very tough target to hit.? Perfection seems to always slip away at the most

inopportune time.

Dudley

Re: Re: The Most Fundamental Problem with EMS

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

>

>

>

[Guest guest]

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!!!!? 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 companies, 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 some assistance.?

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

>

> 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)

>

>

>

[Guest guest]

Renny,

Henry isn't making fun of you...it is just we would all like to do these

idealistic things but it is often hard to work on those when the realities of

the day take up all our time.

It is hard enough to make ends meet, pay a respectable salary and pay all the

bills on the measly stuff we get paid now...so it is tough to find a way to

figure out how to do something that in today's climate would lose money (no

reimbursement) and potentially cost more money (liability of making a mistake

and the associated fallout of that in the media).?

I am not saying give up your dream...but you can't discount reality in achieving

your dream either.

Keep up the fight...it is nice to see/hear/read.

Dudley

Re: The Most Fundamental Problem with EMS

Henry,

Why when some one suggests a way to improve patient care that is different than

the present way is it made fun of? I have never suggested we would not provide

care, I have actually stated we would provide the right care.

How many times do I have to say if done properly it would take more work and

time than just transporting but would actually get the patient the type of care

they actually need? Eventually leading EMS to actually being a part of the

healthcare solution rather than a part of the problem.

But oh well I'm trying to suggest something that would require more effort and

education so that is a bad thing. I'm suggesting we actually move our profession

out of the era of being just an ambulance driver, shame on me. Perhaps I should

shut up and just do the same thing everyone else does just because thats the way

its always been done. Guess that is best since so much we do in EMS is done that

way rather than based on scientific proof.

Perhaps I will just do like almost everyone else and not get involved at all

with trying to improve EMS. I'll just sit back and complain about how bad things

are but not try to do anything to fix it.

Respectfully

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)

>

>

[Guest guest]

Amen Brother preach on.

Henry

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

>

>

>

[Guest guest]

But then, when has EMS had a really good public education effort?

-Wes

Re: Re: The Most Fundamental Problem with EMS

Amen Brother preach on.

Henry

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

>

>

>

[Guest guest]

Ok Renny,

First of all I usually poke fun at just about anything in EMS. I do so because I

tend to see the lighter side of just about every argument because at one time or

another I have fought that battle over the last 35 years. I am not resistant

change, at least not all change. I do not see the need for change if I have

tried to accomplish something and have found it can't be done. I know you are a

serious young man that wants to see improvement ( I assume you are young)

Without a doubt if you stay in this business you will affect some change and I

applaud you for that. If you think about it simply implying that us old timers

are resistant to all change is akin to me making fun of everything. I have to be

convinced by the fire eaters in my department that something will work and be a

benefit to our patients before we change it. I truly believe we must fight the

battles that we have a chance of winning. When I was younger ( and you can ask

Bob Koonce) I would fight them all. I bet I stormed into his office a million

times. I have since learned that I must think things through before I go into

battle.

I hear daily from our medics that our frequent flyers are abusing the system.

That may be so but sooner than later they will have a real emergency that really

needs our attention. Some folks spend more time and energy trying to say no to

something than it takes to do it. I know you see this in everyday life.

When the public calls our comes to my office, the first thing I say is how can I

help you. Many just say we can't do that.

Heck I was against taking away the option of running Code II. I finally did away

with it, not because I thought it was bad, but instead because it became a

standard of care. Same thing with mast pants. (Seen them work) To many studies

to fight.

Keep on fighting, you might win one. When you get older you will choose your

battles.

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)

>

>

[Guest guest]

Dudley,

I understand more money in transport and I understand very few pay up for

ambulance services. But if it is non emergent you are not getting reimbursement

for the transport either. So now you have even more expense and a higher bill

that is not being paid.

Does Medicaid/Medicare still have the form that states that the EMS crew does

not feel this meets criteria for reimbursement and that by still going by

ambulance they agree to pay the bill, thus giving you a legal contract to pursue

reimbursement?

Renny

>

>

>

> 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!!!!? 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 companies, 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 some assistance.?

>

>

>

> 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

[Guest guest]

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

>

>

>

[Guest guest]

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://\

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> > hmpgID=115 & bcd=JulystepsfooterNO115)

> >

> >

[Guest guest]

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

>

>

>