Guest guest Posted November 3, 2009 Report Share Posted November 3, 2009 I am tired of the attacking and making snide rude remarks toward anyone with a different opinion. So often I have seen remarks from the dino medic group saying they do not see any stepping forward to take over yet I have seen many try to voice opinions and get squashed. It is fine to say I disagree and present your side, your reasoning but to call someone ignorant because they feel differently than you is unprofessional and uncalled for. Admission to the hospital does not equal needs an ambulance, it does not even equal needs ER. Also even with a denial protocol you would not be saying they did not need more medical care just that they could get there safely by other means. Honestly you would still end up transporting the majority of those that request transport. You also would be assisting them to get the care they actually need and saving them the stress of a large ambulance bill. This is not " supermedic " stuff. This is being a patient advocate, doing what is right for the patient. So in conclusion how about respectfully disagreeing with people rather than attacking. And if in any of my posts I have seemed to attack I apologize. Lets get back to a professional discussions of differing views to work to find a way to move EMS forward. Have a great day. Renny Spencer Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 3, 2009 Report Share Posted November 3, 2009 Who's attacking? When you post a reply accusing someone of ad hominem attacks, it helps to be specific as to *who* you say is engaging in the unprofessional and uncalled for behavior. spenair wrote: > > > I am tired of the attacking and making snide rude remarks toward > anyone with a different opinion. So often I have seen remarks from the > dino medic group saying they do not see any stepping forward to take > over yet I have seen many try to voice opinions and get squashed. It > is fine to say I disagree and present your side, your reasoning but to > call someone ignorant because they feel differently than you is > unprofessional and uncalled for. > > Admission to the hospital does not equal needs an ambulance, it does > not even equal needs ER. > > Also even with a denial protocol you would not be saying they did not > need more medical care just that they could get there safely by other > means. Honestly you would still end up transporting the majority of > those that request transport. You also would be assisting them to get > the care they actually need and saving them the stress of a large > ambulance bill. This is not " supermedic " stuff. This is being a > patient advocate, doing what is right for the patient. > > So in conclusion how about respectfully disagreeing with people rather > than attacking. And if in any of my posts I have seemed to attack I > apologize. Lets get back to a professional discussions of differing > views to work to find a way to move EMS forward. > > Have a great day. > > Renny Spencer > > -- Grayson www.kellygrayson.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 3, 2009 Report Share Posted November 3, 2009 Who's attacking? When you post a reply accusing someone of ad hominem attacks, it helps to be specific as to *who* you say is engaging in the unprofessional and uncalled for behavior. spenair wrote: > > > I am tired of the attacking and making snide rude remarks toward > anyone with a different opinion. So often I have seen remarks from the > dino medic group saying they do not see any stepping forward to take > over yet I have seen many try to voice opinions and get squashed. It > is fine to say I disagree and present your side, your reasoning but to > call someone ignorant because they feel differently than you is > unprofessional and uncalled for. > > Admission to the hospital does not equal needs an ambulance, it does > not even equal needs ER. > > Also even with a denial protocol you would not be saying they did not > need more medical care just that they could get there safely by other > means. Honestly you would still end up transporting the majority of > those that request transport. You also would be assisting them to get > the care they actually need and saving them the stress of a large > ambulance bill. This is not " supermedic " stuff. This is being a > patient advocate, doing what is right for the patient. > > So in conclusion how about respectfully disagreeing with people rather > than attacking. And if in any of my posts I have seemed to attack I > apologize. Lets get back to a professional discussions of differing > views to work to find a way to move EMS forward. > > Have a great day. > > Renny Spencer > > -- Grayson www.kellygrayson.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 3, 2009 Report Share Posted November 3, 2009 Who's attacking? When you post a reply accusing someone of ad hominem attacks, it helps to be specific as to *who* you say is engaging in the unprofessional and uncalled for behavior. spenair wrote: > > > I am tired of the attacking and making snide rude remarks toward > anyone with a different opinion. So often I have seen remarks from the > dino medic group saying they do not see any stepping forward to take > over yet I have seen many try to voice opinions and get squashed. It > is fine to say I disagree and present your side, your reasoning but to > call someone ignorant because they feel differently than you is > unprofessional and uncalled for. > > Admission to the hospital does not equal needs an ambulance, it does > not even equal needs ER. > > Also even with a denial protocol you would not be saying they did not > need more medical care just that they could get there safely by other > means. Honestly you would still end up transporting the majority of > those that request transport. You also would be assisting them to get > the care they actually need and saving them the stress of a large > ambulance bill. This is not " supermedic " stuff. This is being a > patient advocate, doing what is right for the patient. > > So in conclusion how about respectfully disagreeing with people rather > than attacking. And if in any of my posts I have seemed to attack I > apologize. Lets get back to a professional discussions of differing > views to work to find a way to move EMS forward. > > Have a great day. > > Renny Spencer > > -- Grayson www.kellygrayson.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 3, 2009 Report Share Posted November 3, 2009 On Tuesday, November 3, 2009 09:07, " A Austin " abaustin+yahoogroups@...> said: > A nurse with no emergency experience has even less business then a new > graduate paramedic with making any decisions like these. Were you a nurse before, or after you were a medic? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 3, 2009 Report Share Posted November 3, 2009 On Tuesday, November 3, 2009 09:07, " A Austin " abaustin+yahoogroups@...> said: > A nurse with no emergency experience has even less business then a new > graduate paramedic with making any decisions like these. Were you a nurse before, or after you were a medic? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 3, 2009 Report Share Posted November 3, 2009 On Tuesday, November 3, 2009 09:07, " A Austin " abaustin+yahoogroups@...> said: > A nurse with no emergency experience has even less business then a new > graduate paramedic with making any decisions like these. Were you a nurse before, or after you were a medic? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 3, 2009 Report Share Posted November 3, 2009 Randy, " It is fine to say I disagree and present your side, your reasoning but to call someone ignorant because they feel differently than you is unprofessional and uncalled for. " I have read most of these post but have yet to see anyone called ignorant. Some, me included do not take ourselves seriously all the time. As far as being a Dino Medic, its like I tell my wife, " Hang in there honey for a few more years and you will get all my money and not just half " So to you younger guys that are just starting to write your name in the snow, hang in there and you too can learn the hard way. Henry Re: Call an Ambulance, Get a Taxi | NBC Dallas-Fort Worth I am tired of the attacking and making snide rude remarks toward anyone with a different opinion. So often I have seen remarks from the dino medic group saying they do not see any stepping forward to take over yet I have seen many try to voice opinions and get squashed. It is fine to say I disagree and present your side, your reasoning but to call someone ignorant because they feel differently than you is unprofessional and uncalled for. Admission to the hospital does not equal needs an ambulance, it does not even equal needs ER. Also even with a denial protocol you would not be saying they did not need more medical care just that they could get there safely by other means. Honestly you would still end up transporting the majority of those that request transport. You also would be assisting them to get the care they actually need and saving them the stress of a large ambulance bill. This is not " supermedic " stuff. This is being a patient advocate, doing what is right for the patient. So in conclusion how about respectfully disagreeing with people rather than attacking. And if in any of my posts I have seemed to attack I apologize. Lets get back to a professional discussions of differing views to work to find a way to move EMS forward. Have a great day. Renny Spencer ------------------------------------------------------------------------------ No virus found in this incoming message. Checked by AVG - www.avg.com Version: 8.5.424 / Virus Database: 270.14.47/2478 - Release Date: 11/03/09 07:36:00 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 3, 2009 Report Share Posted November 3, 2009 On Tuesday, November 3, 2009 08:15, " Henry Barber " hbarber@...> said: > I have been doing this for 35 years and have found that the longer you do this the > fewer calls you can fit into the BS category. Quoted for profundity. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 3, 2009 Report Share Posted November 3, 2009 On Tuesday, November 3, 2009 08:15, " Henry Barber " hbarber@...> said: > I have been doing this for 35 years and have found that the longer you do this the > fewer calls you can fit into the BS category. Quoted for profundity. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 3, 2009 Report Share Posted November 3, 2009 I'd tend to agree with . Sideways or snide commets are not attacks and in fact are a part of both EMS and life. I've seen no " attacks " in this thread per Se. Louis N. Molino, Sr. CET FF/NREMT/FSI/EMSI Typed by my fingers on my iPhone. Please excuse any typos (Cell) LNMolino@... > Who's attacking? When you post a reply accusing someone of ad hominem > attacks, it helps to be specific as to *who* you say is engaging in > the > unprofessional and uncalled for behavior. > > spenair wrote: > > > > > > I am tired of the attacking and making snide rude remarks toward > > anyone with a different opinion. So often I have seen remarks from > the > > dino medic group saying they do not see any stepping forward to take > > over yet I have seen many try to voice opinions and get squashed. It > > is fine to say I disagree and present your side, your reasoning > but to > > call someone ignorant because they feel differently than you is > > unprofessional and uncalled for. > > > > Admission to the hospital does not equal needs an ambulance, it does > > not even equal needs ER. > > > > Also even with a denial protocol you would not be saying they did > not > > need more medical care just that they could get there safely by > other > > means. Honestly you would still end up transporting the majority of > > those that request transport. You also would be assisting them to > get > > the care they actually need and saving them the stress of a large > > ambulance bill. This is not " supermedic " stuff. This is being a > > patient advocate, doing what is right for the patient. > > > > So in conclusion how about respectfully disagreeing with people > rather > > than attacking. And if in any of my posts I have seemed to attack I > > apologize. Lets get back to a professional discussions of differing > > views to work to find a way to move EMS forward. > > > > Have a great day. > > > > Renny Spencer > > > > > > -- > Grayson > www.kellygrayson.com > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 3, 2009 Report Share Posted November 3, 2009 I'd tend to agree with . Sideways or snide commets are not attacks and in fact are a part of both EMS and life. I've seen no " attacks " in this thread per Se. Louis N. Molino, Sr. CET FF/NREMT/FSI/EMSI Typed by my fingers on my iPhone. Please excuse any typos (Cell) LNMolino@... > Who's attacking? When you post a reply accusing someone of ad hominem > attacks, it helps to be specific as to *who* you say is engaging in > the > unprofessional and uncalled for behavior. > > spenair wrote: > > > > > > I am tired of the attacking and making snide rude remarks toward > > anyone with a different opinion. So often I have seen remarks from > the > > dino medic group saying they do not see any stepping forward to take > > over yet I have seen many try to voice opinions and get squashed. It > > is fine to say I disagree and present your side, your reasoning > but to > > call someone ignorant because they feel differently than you is > > unprofessional and uncalled for. > > > > Admission to the hospital does not equal needs an ambulance, it does > > not even equal needs ER. > > > > Also even with a denial protocol you would not be saying they did > not > > need more medical care just that they could get there safely by > other > > means. Honestly you would still end up transporting the majority of > > those that request transport. You also would be assisting them to > get > > the care they actually need and saving them the stress of a large > > ambulance bill. This is not " supermedic " stuff. This is being a > > patient advocate, doing what is right for the patient. > > > > So in conclusion how about respectfully disagreeing with people > rather > > than attacking. And if in any of my posts I have seemed to attack I > > apologize. Lets get back to a professional discussions of differing > > views to work to find a way to move EMS forward. > > > > Have a great day. > > > > Renny Spencer > > > > > > -- > Grayson > www.kellygrayson.com > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 3, 2009 Report Share Posted November 3, 2009 I'd tend to agree with . Sideways or snide commets are not attacks and in fact are a part of both EMS and life. I've seen no " attacks " in this thread per Se. Louis N. Molino, Sr. CET FF/NREMT/FSI/EMSI Typed by my fingers on my iPhone. Please excuse any typos (Cell) LNMolino@... > Who's attacking? When you post a reply accusing someone of ad hominem > attacks, it helps to be specific as to *who* you say is engaging in > the > unprofessional and uncalled for behavior. > > spenair wrote: > > > > > > I am tired of the attacking and making snide rude remarks toward > > anyone with a different opinion. So often I have seen remarks from > the > > dino medic group saying they do not see any stepping forward to take > > over yet I have seen many try to voice opinions and get squashed. It > > is fine to say I disagree and present your side, your reasoning > but to > > call someone ignorant because they feel differently than you is > > unprofessional and uncalled for. > > > > Admission to the hospital does not equal needs an ambulance, it does > > not even equal needs ER. > > > > Also even with a denial protocol you would not be saying they did > not > > need more medical care just that they could get there safely by > other > > means. Honestly you would still end up transporting the majority of > > those that request transport. You also would be assisting them to > get > > the care they actually need and saving them the stress of a large > > ambulance bill. This is not " supermedic " stuff. This is being a > > patient advocate, doing what is right for the patient. > > > > So in conclusion how about respectfully disagreeing with people > rather > > than attacking. And if in any of my posts I have seemed to attack I > > apologize. Lets get back to a professional discussions of differing > > views to work to find a way to move EMS forward. > > > > Have a great day. > > > > Renny Spencer > > > > > > -- > Grayson > www.kellygrayson.com > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 3, 2009 Report Share Posted November 3, 2009 I chose to take the high road and not lead to more unprofessional attacks. If I start singling out those that did so it leads to more defensive responses which leads to even more unprofessional responses and thus a vicious cycle. > > > > > > I am tired of the attacking and making snide rude remarks toward > > anyone with a different opinion. So often I have seen remarks from the > > dino medic group saying they do not see any stepping forward to take > > over yet I have seen many try to voice opinions and get squashed. It > > is fine to say I disagree and present your side, your reasoning but to > > call someone ignorant because they feel differently than you is > > unprofessional and uncalled for. > > > > Admission to the hospital does not equal needs an ambulance, it does > > not even equal needs ER. > > > > Also even with a denial protocol you would not be saying they did not > > need more medical care just that they could get there safely by other > > means. Honestly you would still end up transporting the majority of > > those that request transport. You also would be assisting them to get > > the care they actually need and saving them the stress of a large > > ambulance bill. This is not " supermedic " stuff. This is being a > > patient advocate, doing what is right for the patient. > > > > So in conclusion how about respectfully disagreeing with people rather > > than attacking. And if in any of my posts I have seemed to attack I > > apologize. Lets get back to a professional discussions of differing > > views to work to find a way to move EMS forward. > > > > Have a great day. > > > > Renny Spencer > > > > > > > -- > Grayson > www.kellygrayson.com > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 3, 2009 Report Share Posted November 3, 2009 Does anyone else see attacks? Anyone? Louis N. Molino, Sr. CET FF/NREMT/FSI/EMSI Typed by my fingers on my iPhone. Please excuse any typos (Cell) LNMolino@... > I chose to take the high road and not lead to more unprofessional > attacks. If I start singling out those that did so it leads to more > defensive responses which leads to even more unprofessional > responses and thus a vicious cycle. > > > > > > > > > > > I am tired of the attacking and making snide rude remarks toward > > > anyone with a different opinion. So often I have seen remarks > from the > > > dino medic group saying they do not see any stepping forward to > take > > > over yet I have seen many try to voice opinions and get > squashed. It > > > is fine to say I disagree and present your side, your reasoning > but to > > > call someone ignorant because they feel differently than you is > > > unprofessional and uncalled for. > > > > > > Admission to the hospital does not equal needs an ambulance, it > does > > > not even equal needs ER. > > > > > > Also even with a denial protocol you would not be saying they > did not > > > need more medical care just that they could get there safely by > other > > > means. Honestly you would still end up transporting the majority > of > > > those that request transport. You also would be assisting them > to get > > > the care they actually need and saving them the stress of a large > > > ambulance bill. This is not " supermedic " stuff. This is being a > > > patient advocate, doing what is right for the patient. > > > > > > So in conclusion how about respectfully disagreeing with people > rather > > > than attacking. And if in any of my posts I have seemed to > attack I > > > apologize. Lets get back to a professional discussions of > differing > > > views to work to find a way to move EMS forward. > > > > > > Have a great day. > > > > > > Renny Spencer > > > > > > > > > > > > -- > > Grayson > > www.kellygrayson.com > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 3, 2009 Report Share Posted November 3, 2009 Even a nurse WITH emergency department experience may be totally at sea in the field setting. Working in the field requires a different mindset and skill set from working in an ER. Working in industrial medicine (rig medic, for example) requires still another mindset. Most ER nurses do not have to dodge speeding traffic, work in an atmosphere where you cannot hear breath sounds, heart sounds, or blood pressures, your patient is constantly moving away from that catheter you're trying to get into his arm as your driver hits the speed bump she didn't see, you have to carry a ton of stuff with you to the patient's side sometimes, compete with mad family members over who's going to win the argument over where to take granny, and so forth, deal with stupid state troopers who want to tell you how to do your work, and so forth. Most physicians haven't been there either unless they were medics before they were doctors. When I had been a medic for 3 years I was confident that I could determine who needed to go to the hospital and who shouldn't get a ride. After 30 years I know that I am not able to do that reliably for a number of reasons. For one thing, I now have a much better notion of the vast amount of things I do NOT know about medicine. My friends and former students (you know who you are! ) who have been advocating medic-initiated refusals will come around eventually, trust me. Tincture of time heals many conditions. When they are asked to review a case for a lawyer to determine whether or not a legitimate claim exists, they'll get a reality check. GG In a message dated 11/3/09 8:08:30 AM, abaustin+yahoogroups@... writes: >  > > One edit: Nurse -practitioners- and physician assistants. > > A nurse with no emergency experience has even less business then a new > graduate paramedic with making any decisions like these. > > Austin > > > > > Until EMS education is reformed in such a way as to make the *average* > > medic capable of doing this, it just ain't gonna happen. And there > > is a > > ceiling to that knowledge; there are already providers trained to that > > level. They call themselves nurses and physician assistants, and they > > won't work for the chump change that CMS pays for EMS reimbursement. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 3, 2009 Report Share Posted November 3, 2009 Oh well. If disagreeing with someone, and pointing out the logical fallacies in their position is unprofessional, then I'll cop to it. I'm really not against your position, Renny. And speaking as one of those dino medics, I applaud idealism and striving to be better at what we do. Obviously those two traits describe you fairly well. But when someone counters your arguments as unrealistic and points out why, it doesn't make *you* look very professional when you reply with an argument primarily based on emotion and anecdote- and regardless of whether you acknowledge it or not, your argument *is* based on emotion and opinion: " I think I can recognize a bullshit call when I see one, and decide whether they need my ambulance or not. " History proves you wrong on that subject. And when you hinge your argument on semantics - " It's not a refusal, it's just directing them to more appropriate avenues of seeking care! " - it still doesn't address the issue, which is not whether Renny Spencer, or Rob , or Grayson, or Dudley Wait or any one medic can be expected to accurately make those calls. The issue is whether *paramedics in general* are capable of making those decisions, under the framework of the existing tort system, EMS educational standards, and CMS reimbursement rates. And the answer to that question is NO. A couple of posts back, you lashed out at your opponents in this debate with a sarcastic little retort, full of imagined slights and hyperbole. Such petulance doesn't help your argument either. One statement you made earlier is particularly telling, and that is the mention of a " denial protocol. " Bledsoe makes an excellent point in one of his lectures, outlining the difference between novices, experienced practitioners, and expert practitioners in a given profession. He points out that the mark of a novice practitioner is the rigid adherence to protocols, and the mark of an expert is knowing the limitations of protocols. And the fact that you believe a written protocol can adequately address denial of transport issues is one indicator of the category in which you stand. That's not a slap at YOU in particular; 99% of paramedics out there probably fit in the novice category as well, myself included. We're still thinking about protocols and tools and toys and doodads, and all it does is show that our mindset is still far too limited to grasp the larger issues. WE SIMPLY AREN'T NUANCED ENOUGH THINKERS TO EVEN GRASP THE INTRICACY OF THE PROBLEM, MUCH LESS SOLVE IT. Now, we COULD achieve that level of knowledge, but it's going to take a lot more formal education than most paramedics currently possess, and that's just a start. Along the way, we're going to have to reform the tort system, the educational system, the health care reimbursement model, and oh, by the way, the whole damned health care system. That's a pretty tall order for a 40 year old profession that still can't decide whether it belongs in health care or public safety, and over half of whose practitioners give their services away for free. Read my take on this whole matter over on EMS1.com http://www.ems1.com/ems-products/education/articles/599894-EMS-2-0-Critical-Thi\ nking-in-Prehospital-Training/>, and leave a comment if you'd like. Then go visit some of the EMS bloggers who are talking about EMS 2.0, and see what they have to say on the issue. You'll find plenty of supporters for your position, and plenty of skeptics like myself. Just keep in mind that the skepticism of many of those dino medics is based in reality and hard-won experience. They know what it's like to have been a medic for 5 years, but you don't know what it's like to have been a medic for 20. And by the way, " dinosaur " is a misnomer. Dinosaurs were unable to adapt, and they all became extinct. You'd do better to think of them as the " naturally selected medics. " Something about them gave them the ability to reconcile idealism with reality. Might be a good idea to see how you can mimic those traits. spenair wrote: > > > I chose to take the high road and not lead to more unprofessional > attacks. If I start singling out those that did so it leads to more > defensive responses which leads to even more unprofessional responses > and thus a vicious cycle. > > > > > > > > > > > I am tired of the attacking and making snide rude remarks toward > > > anyone with a different opinion. So often I have seen remarks from > the > > > dino medic group saying they do not see any stepping forward to take > > > over yet I have seen many try to voice opinions and get squashed. It > > > is fine to say I disagree and present your side, your reasoning > but to > > > call someone ignorant because they feel differently than you is > > > unprofessional and uncalled for. > > > > > > Admission to the hospital does not equal needs an ambulance, it does > > > not even equal needs ER. > > > > > > Also even with a denial protocol you would not be saying they did not > > > need more medical care just that they could get there safely by other > > > means. Honestly you would still end up transporting the majority of > > > those that request transport. You also would be assisting them to get > > > the care they actually need and saving them the stress of a large > > > ambulance bill. This is not " supermedic " stuff. This is being a > > > patient advocate, doing what is right for the patient. > > > > > > So in conclusion how about respectfully disagreeing with people > rather > > > than attacking. And if in any of my posts I have seemed to attack I > > > apologize. Lets get back to a professional discussions of differing > > > views to work to find a way to move EMS forward. > > > > > > Have a great day. > > > > > > Renny Spencer > > > > > > > > > > > > -- > > Grayson > > www.kellygrayson.com > > > > -- Grayson www.kellygrayson.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 3, 2009 Report Share Posted November 3, 2009 On another list one writes about a young male patient who has visited three emergency rooms over a couple of weeks complaining of a sinus infection that won't go away. Was never admitted to the hospital. Has seizures and EMS responds. Patient codes and dies. Autopsy shows a massive abscess that eroded well into the brain. Now, think about it. Three emergency doctors missed this. And we expect that an EMT or a Paramedic would have caught it? How many of us who think we " know who needs to go and who does not " would have no-rode this patient if given the chance? I fully expect that each and every ER this patient visited will be sued, along with the physicians who discharged him. EMS won't because they did transport and they coded him, with negative patient outcome. If you had been a medic who had responded to his first call for a " male with a headache " and you had said, " Dude, you don't need an ambulance, so we're not going to transport you. Go see your doctor, " can you see the process server arriving to drop the paper on you? And when your deposition is taken, how will you answer the lawyer's question: " How many different causes of headache can you think of? " And then the inquisition begins. Further Affiant Sayeth Not. GG >  > Good point. You know, even physicians struggle with the decision whether > to admit someone to the hospital or not, and that is with a wide array > of diagnostic information at their disposal. It smacks of hubris to > assert that paramedics can make these decisions, system-wide. Everyone > on this list has had calls that they *know* didn't need an ambulance, > but that isn't the point. What they don't *know* is how many patients > they've thought that of, who turned out to be ill enough for an admission. > > We're talking about implementing a *policy* of paramedic-initiated > refusals, system-wide. That is going to include more than Supermedic > making the decisions, and more than the obvious system abusers that we > all know and loathe. There are so many shades of gray in between " needs > an ambulance " and " bullshit, " and the range so open to education, > experience and interpretation, that to think that EMS systems are > capable of implementing such policies - utilizing the current > educational model - is ludicrous. > > To assert otherwise just demonstrates that we don't even know what we > don't know. > > A Austin wrote: > > > > > > One edit: Nurse -practitioners- and physician assistants. > > > > A nurse with no emergency experience has even less business then a new > > graduate paramedic with making any decisions like these. > > > > Austin > > > > > > > > > Until EMS education is reformed in such a way as to make the *average* > > > medic capable of doing this, it just ain't gonna happen. And there > > > is a > > > ceiling to that knowledge; there are already providers trained to that > > > level. They call themselves nurses and physician assistants, and they > > > won't work for the chump change that CMS pays for EMS reimbursement. > > > > > > -- > Grayson > www.kellygrayson. ww > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 3, 2009 Report Share Posted November 3, 2009 That pretty much sums it up, . Well said. > > > Oh well. If disagreeing with someone, and pointing out the logical > fallacies in their position is unprofessional, then I'll cop to it. > > I'm really not against your position, Renny. And speaking as one of > those dino medics, I applaud idealism and striving to be better at what > we do. Obviously those two traits describe you fairly well. But when > someone counters your arguments as unrealistic and points out why, it > doesn't make *you* look very professional when you reply with an > argument primarily based on emotion and anecdote- and regardless of > whether you acknowledge it or not, your argument *is* based on emotion > and opinion: " I think I can recognize a bullshit call when I see one, > and decide whether they need my ambulance or not. " > > History proves you wrong on that subject. And when you hinge your > argument on semantics - " It's not a refusal, it's just directing them to > more appropriate avenues of seeking care! " - it still doesn't address > the issue, which is not whether Renny Spencer, or Rob , or > Grayson, or Dudley Wait or any one medic can be expected to accurately > make those calls. The issue is whether *paramedics in general* are > capable of making those decisions, under the framework of the existing > tort system, EMS educational standards, and CMS reimbursement rates. And > the answer to that question is NO. > > A couple of posts back, you lashed out at your opponents in this debate > with a sarcastic little retort, full of imagined slights and hyperbole. > Such petulance doesn't help your argument either. > > One statement you made earlier is particularly telling, and that is the > mention of a " denial protocol. " Bledsoe makes an excellent point > in one of his lectures, outlining the difference between novices, > experienced practitioners, and expert practitioners in a given > profession. He points out that the mark of a novice practitioner is the > rigid adherence to protocols, and the mark of an expert is knowing the > limitations of protocols. > > And the fact that you believe a written protocol can adequately address > denial of transport issues is one indicator of the category in which you > stand. That's not a slap at YOU in particular; 99% of paramedics out > there probably fit in the novice category as well, myself included. > We're still thinking about protocols and tools and toys and doodads, and > all it does is show that our mindset is still far too limited to grasp > the larger issues. WE SIMPLY AREN'T NUANCED ENOUGH THINKERS TO EVEN > GRASP THE INTRICACY OF THE PROBLEM, MUCH LESS SOLVE IT. > > Now, we COULD achieve that level of knowledge, but it's going to take a > lot more formal education than most paramedics currently possess, and > that's just a start. Along the way, we're going to have to reform the > tort system, the educational system, the health care reimbursement > model, and oh, by the way, the whole damned health care system. That's a > pretty tall order for a 40 year old profession that still can't decide > whether it belongs in health care or public safety, and over half of > whose practitioners give their services away for free. > > Read my take on this whole matter over on EMS1.com > < > http://www.ems1.com/ems-products/education/articles/599894-EMS-2-0-Critical-Thin\ king-in-Prehospital-Training/>, > > and leave a comment if you'd like. Then go visit some of the EMS > bloggers who are talking about EMS 2.0, and see what they have to say on > the issue. You'll find plenty of supporters for your position, and > plenty of skeptics like myself. Just keep in mind that the skepticism of > many of those dino medics is based in reality and hard-won experience. > They know what it's like to have been a medic for 5 years, but you don't > know what it's like to have been a medic for 20. > > And by the way, " dinosaur " is a misnomer. Dinosaurs were unable to > adapt, and they all became extinct. You'd do better to think of them as > the " naturally selected medics. " Something about them gave them the > ability to reconcile idealism with reality. Might be a good idea to see > how you can mimic those traits. > > spenair wrote: > > > > > > I chose to take the high road and not lead to more unprofessional > > attacks. If I start singling out those that did so it leads to more > > defensive responses which leads to even more unprofessional responses > > and thus a vicious cycle. > > > > > > > > > > > > > > > > I am tired of the attacking and making snide rude remarks toward > > > > anyone with a different opinion. So often I have seen remarks from > > the > > > > dino medic group saying they do not see any stepping forward to take > > > > over yet I have seen many try to voice opinions and get squashed. It > > > > is fine to say I disagree and present your side, your reasoning > > but to > > > > call someone ignorant because they feel differently than you is > > > > unprofessional and uncalled for. > > > > > > > > Admission to the hospital does not equal needs an ambulance, it does > > > > not even equal needs ER. > > > > > > > > Also even with a denial protocol you would not be saying they did not > > > > need more medical care just that they could get there safely by other > > > > means. Honestly you would still end up transporting the majority of > > > > those that request transport. You also would be assisting them to get > > > > the care they actually need and saving them the stress of a large > > > > ambulance bill. This is not " supermedic " stuff. This is being a > > > > patient advocate, doing what is right for the patient. > > > > > > > > So in conclusion how about respectfully disagreeing with people > > rather > > > > than attacking. And if in any of my posts I have seemed to attack I > > > > apologize. Lets get back to a professional discussions of differing > > > > views to work to find a way to move EMS forward. > > > > > > > > Have a great day. > > > > > > > > Renny Spencer > > > > > > > > > > > > > > > > > -- > > > Grayson > > > www.kellygrayson.com > > > > > > > > > -- > Grayson > www.kellygrayson.com > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 3, 2009 Report Share Posted November 3, 2009 Okay brother... take a deep breath and count to ten... well stated, now let's move forward... we have real issues to tackle! BTW - I talked to the cop you e-mailed me about... he said they are not all worthless on medical scenes, just most of them! He did learned CPR kinda young.... OH! and he made the shift report..... Les NREMT-Paramedic, HM-M, CSST, SAPA, RSO, AHA-TCF Senior Safety Coordinator / Emergency Response Coordinator Westlake Chemical P.O. Box 228 36045 Highway 30 Geismar, LA 70734-0228 e-Mail: lpowell@... Telephone: Fax: Cell: 225.439-6552 Captain / Training Officer - 7th District Fire Department - http://www.apfire.us/ e-Mail: FD707@... %20FD707@...> Industrial Fire World Advisory Board - Industrial Fire World http://www.fireworld.com/> Secretary - Geismar Area Mutual Aid Association (GAMA) - http:www.gamaid.org Affiliate Advisory Council - Texas: National Association of Emergency Medical Technicians http://www.naemt.org/> Board of Directors - Emergency Medical Services Association of Texas (EMSAT) http://www.texasemsat.org/> The information transmitted (including attachments) is covered by the Electronic Communications Privacy Act, 18 U.S.C. 2510-2521, is intended only for the person(s) or entity/entities to which it is addressed and may contain confidential and/or privileged material. Any review, retransmission, dissemination or other use of, or taking of any action in reliance upon, this information by persons or entities other than the intended recipient(s) is prohibited. If you received this in error, please contact the sender and delete the material from any computer, disk drive, diskette, or other storage device or media. " Next to creating a life, the finest thing a man can do is save one. " - Abraham Lincoln " EMS does not save lives. God does! Our job is to entertain the patient until He makes up his mind. " - Dr. Red Duke SAVE THE DATE! Industrial Fire World Emergency Responder Conference & Expo Crowne Plaza Hotel - Baton Rouge, LA 22-26 February 2010 ________________________________ From: texasems-l [mailto:texasems-l ] On Behalf Of Grayson Sent: Tuesday, November 03, 2009 14:52 To: texasems-l Subject: Re: Re: Call an Ambulance, Get a Taxi | NBC Dallas-Fort Worth Oh well. If disagreeing with someone, and pointing out the logical fallacies in their position is unprofessional, then I'll cop to it. I'm really not against your position, Renny. And speaking as one of those dino medics, I applaud idealism and striving to be better at what we do. Obviously those two traits describe you fairly well. But when someone counters your arguments as unrealistic and points out why, it doesn't make *you* look very professional when you reply with an argument primarily based on emotion and anecdote- and regardless of whether you acknowledge it or not, your argument *is* based on emotion and opinion: " I think I can recognize a bullshit call when I see one, and decide whether they need my ambulance or not. " History proves you wrong on that subject. And when you hinge your argument on semantics - " It's not a refusal, it's just directing them to more appropriate avenues of seeking care! " - it still doesn't address the issue, which is not whether Renny Spencer, or Rob , or Grayson, or Dudley Wait or any one medic can be expected to accurately make those calls. The issue is whether *paramedics in general* are capable of making those decisions, under the framework of the existing tort system, EMS educational standards, and CMS reimbursement rates. And the answer to that question is NO. A couple of posts back, you lashed out at your opponents in this debate with a sarcastic little retort, full of imagined slights and hyperbole. Such petulance doesn't help your argument either. One statement you made earlier is particularly telling, and that is the mention of a " denial protocol. " Bledsoe makes an excellent point in one of his lectures, outlining the difference between novices, experienced practitioners, and expert practitioners in a given profession. He points out that the mark of a novice practitioner is the rigid adherence to protocols, and the mark of an expert is knowing the limitations of protocols. And the fact that you believe a written protocol can adequately address denial of transport issues is one indicator of the category in which you stand. That's not a slap at YOU in particular; 99% of paramedics out there probably fit in the novice category as well, myself included. We're still thinking about protocols and tools and toys and doodads, and all it does is show that our mindset is still far too limited to grasp the larger issues. WE SIMPLY AREN'T NUANCED ENOUGH THINKERS TO EVEN GRASP THE INTRICACY OF THE PROBLEM, MUCH LESS SOLVE IT. Now, we COULD achieve that level of knowledge, but it's going to take a lot more formal education than most paramedics currently possess, and that's just a start. Along the way, we're going to have to reform the tort system, the educational system, the health care reimbursement model, and oh, by the way, the whole damned health care system. That's a pretty tall order for a 40 year old profession that still can't decide whether it belongs in health care or public safety, and over half of whose practitioners give their services away for free. Read my take on this whole matter over on EMS1.com < http://www.ems1.com/ems-products/education/articles/599894-EMS-2-0-Criti cal-Thinking-in-Prehospital-Training/ http://www.ems1.com/ems-products/education/articles/599894-EMS-2-0-Crit ical-Thinking-in-Prehospital-Training/> >, and leave a comment if you'd like. Then go visit some of the EMS bloggers who are talking about EMS 2.0, and see what they have to say on the issue. You'll find plenty of supporters for your position, and plenty of skeptics like myself. Just keep in mind that the skepticism of many of those dino medics is based in reality and hard-won experience. They know what it's like to have been a medic for 5 years, but you don't know what it's like to have been a medic for 20. And by the way, " dinosaur " is a misnomer. Dinosaurs were unable to adapt, and they all became extinct. You'd do better to think of them as the " naturally selected medics. " Something about them gave them the ability to reconcile idealism with reality. Might be a good idea to see how you can mimic those traits. spenair wrote: > > > I chose to take the high road and not lead to more unprofessional > attacks. If I start singling out those that did so it leads to more > defensive responses which leads to even more unprofessional responses > and thus a vicious cycle. > > > > > > > > > > > I am tired of the attacking and making snide rude remarks toward > > > anyone with a different opinion. So often I have seen remarks from > the > > > dino medic group saying they do not see any stepping forward to take > > > over yet I have seen many try to voice opinions and get squashed. It > > > is fine to say I disagree and present your side, your reasoning > but to > > > call someone ignorant because they feel differently than you is > > > unprofessional and uncalled for. > > > > > > Admission to the hospital does not equal needs an ambulance, it does > > > not even equal needs ER. > > > > > > Also even with a denial protocol you would not be saying they did not > > > need more medical care just that they could get there safely by other > > > means. Honestly you would still end up transporting the majority of > > > those that request transport. You also would be assisting them to get > > > the care they actually need and saving them the stress of a large > > > ambulance bill. This is not " supermedic " stuff. This is being a > > > patient advocate, doing what is right for the patient. > > > > > > So in conclusion how about respectfully disagreeing with people > rather > > > than attacking. And if in any of my posts I have seemed to attack I > > > apologize. Lets get back to a professional discussions of differing > > > views to work to find a way to move EMS forward. > > > > > > Have a great day. > > > > > > Renny Spencer > > > > > > > > > > > > -- > > Grayson > > www.kellygrayson.com > > > > -- Grayson www.kellygrayson.com ***** Named to Fortune’s 1000 list for 2009**** ***** Ranked in Industry Week’s “1000 Largest Manufacturing Companies in the World†2009 list. ***** * Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 3, 2009 Report Share Posted November 3, 2009 Wonder if I count as both? If you deny both I will understand. Don't worry I do understand that the Paramedic education is enough to kill a patient and not nearly enough to properly assess them and treat them. But I still hold out hope that we can design a much better system. Renny > > My friends and former students (you know who you are! ) who have been advocating medic-initiated refusals will come around eventually, trust me. > GG > Quote Link to comment Share on other sites More sharing options...
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