Nurse/home heatlh on scene becoming an issue

[TLettuce]

At the same time you aren't managing chronic hypertension. You aren't reducing and casting fractures. You aren't prescribing antibiotics. I could go on with the rest of medicine outside of emergency medicine.

Yes of course I don't work in long term care. But to say that I am totally useless in non-emergent situations is wrong in my opinion. Here our transport times can be well over an hour, on top of that all of our IFTs are anywhere from 1-6 hours one way. Not every person we take is critical, why not send a taxi in these cases if I am simply useless outside of emergency situations?

 

[JPINFV]

How often do you provide interventions to your patients outside of transport and supplemental oxygen? I'm excluding oxygen because it's often given needlessly.

 

[TLettuce]

How often do you provide interventions to your patients outside of transport and supplemental oxygen? I'm excluding oxygen because it's often given needlessly.

Probably over 9,000... times a day.

If you took everyone out of a hospital or a nursing home that does not administer medication do you think that it would be just as efficient?

If you want to say that an EMT serves no purpose in a non-emergency environment then say it.

 

[ffemt8978]

 

[JPINFV]

Probably over 9,000... times a day.

:blink:

If you took everyone out of a hospital or a nursing home that does not administer medication do you think that it would be just as efficient?

The problem is that the housekeeping staff and the kitchen staff do not confuse themselves with the medical staff or the nursing staff. Is there a need for a horizontal taxi service? Yes. Does that service, when looking at the abilities actually called for, need an ambulance? The vast majority of time that answer is no. The vast majority of non-emergent IFT require nothing more than two strong backs, a gurney, a vehicle that can accept said gurney, and an oxygen tank. It's not that EMTs fit the job well, it's just the closest thing available in most states.

If you want to say that an EMT serves no purpose in a non-emergency environment then say it.

I believe I already have, at a minimum, alluded to it in this thread. However, to be clear, that answer is yes, EMTs serve no purpose outside of medical taxi drivers when it comes to non-emergent/non-acute care. The education and skill set does not match up appropriately with non-emergent transport. The training and education of EMTs regarding non-emergent situations is pretty much none (how much training on bed to bed and bed to wheel chair transfers did you get? How much training on hip replacement precautions did you get? What level of understanding of hemodialysis do you have? What's the difference between contact, droplet, and airborne precautions? I can go on...).

However, there is much value in knowing our limitations, and addressing them appropriately. Similarly, there's nothing wrong with addressing that most EMTs invovled in non-acute/non-emergency care do so as a proverbial taxi driver. It's an important and necessary, albeit not glorious, service.

 

[TLettuce]

So I suppose you are saying CNA's also do not fit into non-emergent, non-acute care?

 

[JPINFV]

How would you rationalize statement?

 

[Veneficus]

I'm brand new to this forum and already I've upset somebody. :wub:.

No, not upset. Just somewhat philosophical about challenging long held beliefs.

The point I was trying to convey is that she was extremely rude about it, and acted as though her paperwork was priority over the patient...

We were called via 911 for general weakness in a slightly disoriented patient. Not sure about you but I can't diagnose in the field. So was it really "serious"? probably not... but when there's a possibility we don't tend to waste a whole lot of time. Especially within blocks of the hospital.

paperwork is the worst part of medicine, unfortunately it usually is equally important as the patient if you want anything done for them.

I cannot send a pt to xray or ct or blood to the lab if the paperwork isn't filled out.

I am willing to bet you do diagnose in the field. But you may have been erroneously told you just treat signs and symptoms. It happens a lot.

In fact I do diagnose in the field, and I am rather good at it if I do say so myself.

What you see as all due haste, looks to me like panic.

Not sure if you read what I wrote... It was conflicting because it was untrue. Pt. claimed to have had a seizure that morning, RN claimed pt. didn't have a seizure. (RN was not at the house that day until the time of the call so she couldn't have known) We figured she could probably use the hospital visit to at least get her meds adjusted to help the patients recent seizure activity. Maybe you could understand why this would be a little frustrating?

Did you actually see any evidence of a seizure? Many patients I have seen don't recall having one. I remain unconvinced the word of a patient is enough to prove you were right.

I nor my partner dismissed anybodies report. The health care nurse and the health care worker are two different people. The worker, from what I understand, does not have any training other than maybe first aid/cpr, their responsibility is simply to prepare meals. Also, we never got a report from the worker other than "she can't get out of her chair and I'm not strong enough to lift her"

The nurse DOES have plenty of medical training and hopefully knows a lot more about the patient than I do. But the fact of the matter is she was not at the house that day to attest to what events did or didn't take place..

I would not be so quick to dismiss the cook. It is sort of like dismissing the driver. Both health aides and family members without formal medical training usually have considerable insight into patients.

That insight is extremely valuable.

My skills are only valuable in an acute emergency? Really? I feel as though a lot of people on this forum would disagree...

Well, you probably can hold somebody's hand and offer reassurance.

As for people in disagreement. I am not really concerned.

What is it that makes you think we didn't gather the correct information anyways? I'm at a loss for a response to that one.

Experience.

Patients lie. They usually don't know what they are describing, and as I said often give a different story to different providers.

Wether I am on a call or not I don't appreciate people being rude to me and interrupting me when I'm busy. Besides like I said, there was no conflict the entire call. It seems like you have the idea that I acted out or something?.

No, not acting out, just not cooperating, I am trying to point out that if you are that "busy" you are probably not comfortable. I offered some advice on how to work well with other providers because you will encounter this same situation many times.

If I am transporting a patient and don't get the necessary paperwork the patient probably won't move until I get it. That worker has plenty of other means to prove that she was there, I don't need to sign her silly paper.

Her paper is no more silly than yours. They both make sure somebody gets paid so the patient can continue to receive help. It doesn't matter what you do for the patient if she never eats.

What we did for the patient... all I personally did was do vitals, convince her to go in to get looked at, get her in the ambulance and drive her to the hospital. The medic started an IV and that was it otherwise. But in the grand scheme of things we got her to go in get checked out and hopefully get her seizures a little more under control than they are now. We recognized an issue and started the process for further patient care. Which is our job a lot of the time..

So you gave her a ride to the hospital?

If you don't mind my asking, do you even work 911? It doesn't sound like you know that much about the field.

I think many people are expecting this is where I will really make you feel small and swallow a big crow.

Instead I will just say I was last on an ambulance on Dec. 28 2012, in the 5th country I have provided healthcare in starting from 1989. My resume is unfortunately too many characters to post here, and I wouldn't bore you with it

I hope you understand originally... I wasn't taking shots at you. Clearly I offended you and hopefully you will get over it. No hard feelings brother.

You never offended or upset me. I am an old man, it takes more.

 

[TLettuce]

I am willing to bet you do diagnose in the field. But you may have been erroneously told you just treat signs and symptoms. It happens a lot.

In fact I do diagnose in the field, and I am rather good at it if I do say so myself.

What you see as all due haste, looks to me like panic.

It was far from panic, we just didn't spend an hour on scene playing house with home health.

I'm glad to hear that you're never wrong. But we are fortunately not as confident in our diagnostic abilities. Now if I had some CT scan goggles or something it might be a different story.

Even the most experienced medic here does not carelessly rule out improbable possibilities.

Did you actually see any evidence of a seizure? Many patients I have seen don't recall having one. I remain unconvinced the word of a patient is enough to prove you were right.

Well, she was not incontinent. But she was more disoriented than normal, and weaker than normal. Home health thought so as well as was my impression having been on her more than 20 times in the last year.

Her claim is that she has petite mal seizures regularly, and that she has a good sense of when they are about to happen.

And what are you going to do, ignore her and forget she ever said it? Maybe that's what you would do because you're old and apparently know everything <_<. But our approach was what it was.

I would not be so quick to dismiss the cook. It is sort of like dismissing the driver. Both health aides and family members without formal medical training usually have considerable insight into patients.

That insight is extremely valuable.

She gave us a little information and what she did we didn't ignore. But most of the questions we asked she would just say "I have no idea" and then scurry about the house as if we were only in her way.

No, not acting out, just not cooperating, I am trying to point out that if you are that "busy" you are probably not comfortable. I offered some advice on how to work well with other providers because you will encounter this same situation many times.

I have encountered similar situations enough times before, I just started the thread as a way to vent a recent call and use it as sort of a conversation piece. (boy did that go south quick...)

Her paper is no more silly than yours. They both make sure somebody gets paid so the patient can continue to receive help. It doesn't matter what you do for the patient if she never eats.

I can verify that she got paid without the signature. So to me... it's still just a silly paper.

So you gave her a ride to the hospital?

Yes... a glorified taxi ride. I know.

I think many people are expecting this is where I will really make you feel small and swallow a big crow.

Instead I will just say I was last on an ambulance on Dec. 28 2012, in the 5th country I have provided healthcare in starting from 1989. My resume is unfortunately too many characters to post here, and I wouldn't bore you with it

Wow what a big ego.

The way you talked before it sounded like you might work in a clinic or something is all.

 

[TLettuce]

How would you rationalize statement?

Most of the arguments against me having even an iota of value in a non-emergency environment are also valid against someone that is a CNA. (Such as administering medications, managing a bone fracture and so on.)

 

[akflightmedic]

I'm glad to hear that you're never wrong.

Even the most experienced medic here does not carelessly rule out improbable possibilities.

Maybe that's what you would do because you're old and apparently know everything <_<.

Wow what a big ego.

The way you talked before it sounded like you might work in a clinic or something is all.

These were my favorites!!!

First no where did he say he was never wrong...in fact he was wrong in the very post you quoted him on (check the date people!)

I like the old comment and the know everything comment...classic!

I never witnessed an ego in your bag of tricks...did you keep it hidden?

Clinics...pfffttt!! Who has time to actually go work in a clinic...and even if you do; a clinic really...its not like you would ever treat myocardial infarctions, deliver babies, suture, set fractures, diagnose new illnesses, work a code, treat amputations or near amputations, chronic and acute respiratory conditions, STDs, and so on in a clinic...I mean really, thats just sniffles and psychos....

 

[akflightmedic]

And for the record, it takes all of a second for a signature to be performed.

That silly little paper was of extreme importance to this worker. Your attitude and inability to look at issues from a different perspective is quite disturbing.

Let me frame it this way:

1. You agree your patient was not critical and you did have a few seconds to spare but decided to show her by not signing, to demonstrate how "more important" you are than to this silly worker who was complicating your life.

2. If I understand correctly, she even rode into the hospital with you...more time to do the signature and win a friend instead of gain an enemy.

3. You have already recounted how little educated and useless she is...so apparently this means her paycheck reflects that background as well. Her paycheck could possibly be HALF of yours with such little experience and education.

4. She could have been scared by her employer...no proper signature, no pay. She could have mouths at home dependent on that check for food, for life. She could have extended family dependent upon that check.

***At that very moment, she could personally be wrestling internally with the fear of not getting a day's wage which could make or break a lot of families these days or create needless suffering. Despite her being there for "the patient", these tortuous thoughts could be racing through her mind despite her best efforts and YOU chose to be a douche and refuse to sign as you simply do not have the time.

There is ALWAYS time on a scene for 99% of our calls. I have taken a dump in a patient's bathroom while working a code, so do not tell me you did not have time to sign or allow her to get a signature on a piece of paper.

You simply let your ego get way out of control and despite the mass of responses, some gently guiding you, others being more direct, you still choose to debate the obvious as if you are completely in the right. Everyone is assisting you, giving insight, guidance....take it, learn from it and then go make the world a better place.

 

[Bullets]

(how much training on bed to bed and bed to wheel chair transfers did you get? How much training on hip replacement precautions did you get? What level of understanding of hemodialysis do you have? What's the difference between contact, droplet, and airborne precautions? I can go on...).

Just curious, but your system DOESNT tech your EMTs this stuff?

We spend a significant amount of time in the initial class reviewing lifting and moving patients, from chairs, beds, between toilets and bathtubs, using reeves, sheets, scoops, cravats, or pain old blankets. We spend some time reviewing proper movement of patients with joint replacements and how to protect the sockets from damage due to rotation


My agency runs a class with DaVita regarding special considerations in dialysis patients

Your agency doesn't review blood borne pathogens, infection control, and BSI precautions, EVERY YEAR? I thought NJ was backwards, but we get annual BBP/RTK training covering contact, droplet, and airborne precautions, which includes fit testing on N95 cloth respirators and full face cartridge masks. We are required by DOH to carry at least N95, but my agency issues Millenium masks to all field employees with filters for a variety of CBRNE pathogens and substances

What about people who call 911 for non-emergent transports? Do we as EMTs not render care because we aren't "suited" to do so? With a significant medical arts industry in my town, we see these calls from people who can't walk or ambulate well, and need transport to a hospital from home, a snf, or private practice. Should we just refuse these patients because we font have chronic care training?


Also, I feel its called ALLIED health for a reason. We are all working towards one common goal, provide THE BEST POSSIBLE care to all of our patients. You can't do it alone, these home health aids see these patients every day, they have a better idea of their baseline. You never know when you might need them or any provider, its easy to make enemies, its harder to make friends, but thats a sign of a true professional.

 

[ffemt8978]

Thread reopened for now.