Re: Call an Ambulance, Get a Taxi | NBC Dallas-Fort Worth

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

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

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

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

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?

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?

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?

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

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07:36:00

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.

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.

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

>

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

>

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

>

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

>

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

> >

>

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:

> Â

>

> 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.

>

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

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

> Â

> 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

>

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

>

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

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Secretary - Geismar Area Mutual Aid Association (GAMA) -

http:www.gamaid.org

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Medical Technicians http://www.naemt.org/>

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________________________________

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