Ratting on your employer...

[Aidey]

What is your point? Not everyone gets their drugs from the same supplier. Sometimes agencies are locked into contacts that make it difficult to order things from a different supplier. Other agencies may have stockpiled before the shortages became this bad.

Look, I hate it as much as the next guy when we run out of supplies. It annoys me to no end, but I also know that the logistics behind the situation are more complicated than just saying "I want this" and getting it.

We order supplies weekly, and there is about a 2 week delay between when the order is placed and when it gets delivered. We also use ePCRs, and one of the features is that reports can be searched for certain criteria. For example, they can look me up, and then find out how many intubations or IVs I have done in X amount of time. Or how many IVs have been done in the last month by all paramedics. This means they can get a rough idea of how frequently certain supplies are used.

The problem is EMS is not a consistent business. You may have 3 codes in 1 week and then none for 3 months. This means that you may go through things faster than expected. Whoever is ordering supplies has to make their best guess based on current inventory, anticipated usage, and budget available. There has to be a balance between ordering enough and ordering too much. Most of the stuff we use has an expiration date and that has to be taken into consideration. In addition other crews may be stockpiling in their units, the supplier may not have the amount available that was ordered and shipments may be delayed due to weather or other problems.

Like I said, it isn't as easy as it looks.

 

[JeffDHMC]

CO is currently looking into to using expired meds that are unvail fr vendors due to the shortage.

To the OP; the issue is not the lack of meds, but communication from mgmt to the end user (you) about the issue.

Jeff

 

[RanchoEMT]

In lieu of recent events Ive delayed my response to this discussion board until i could figure out how to upload this picture.

http://s1146.photobucket.com/albums/o535/RanchoEMT/?action=view&current=1335583987.jpg

This is a picture of my newly acquired Mag Sulfate. **Note the pretty Pink Tops** After thinking hard on the subject I decided to contact my new Union Rep about my concerns. I was delighted to find, a shift later, this neat little container in our jump bag. With the exception of Procainamide(which Im told is soon to be included) all of our previously missing drugs have somehow found their way into our unit.... Ive been told it was a 'long story' but Im sure that story doesn't include regional shortages as I somehow now have drugs a day later...

It might 'behoove' you USALSFYRE to take a closer look at this picture. You'll see this is also a picture of a win. A huge life changing one in fact, for some patient who is going to need this little vial in the future.
I don't wish to make this post a back and forth slander fest, but your position as I see it, is not one I wish any of the other medical providers on this forum to see and adopt. People who seek consult and guidance from this site need positive and encouraging examples to follow.
Today we've hit the underlining topic of Patient Advocacy. I advocated for it and I got it. You excepted the 'reality' of what you felt could not change, And You Got Just That. Our particular circumstances are of course different, but telling everyone who expresses issues from an employer should Not just 'Except the Reality' of what is currently present. Change maybe possible with a little encouragement.
I'm not saying Im better than you, your probably smart as all hell, but I feel your still wrong.
That drug is going to be used some day, and it will enter into somebodies body because I cared enough to make it happen. Can u say the same about your future Torsades patient? I'll end this back and forth right here.

 

[Tigger]

In lieu of recent events Ive delayed my response to this discussion board until i could figure out how to upload this picture.

http://s1146.photobucket.com/albums/o535/RanchoEMT/?action=view&current=1335583987.jpg

This is a picture of my newly acquired Mag Sulfate. **Note the pretty Pink Tops** After thinking hard on the subject I decided to contact my new Union Rep about my concerns. I was delighted to find, a shift later, this neat little container in our jump bag. With the exception of Procainamide(which Im told is soon to be included) all of our previously missing drugs have somehow found their way into our unit.... Ive been told it was a 'long story' but Im sure that story doesn't include regional shortages as I somehow now have drugs a day later...

It might 'behoove' you USALSFYRE to take a closer look at this picture. You'll see this is also a picture of a win. A huge life changing one in fact, for some patient who is going to need this little vial in the future.
I don't wish to make this post a back and forth slander fest, but your position as I see it, is not one I wish any of the other medical providers on this forum to see and adopt. People who seek consult and guidance from this site need positive and encouraging examples to follow.
Today we've hit the underlining topic of Patient Advocacy. I advocated for it and I got it. You excepted the 'reality' of what you felt could not change, And You Got Just That. Our particular circumstances are of course different, but telling everyone who expresses issues from an employer should Not just 'Except the Reality' of what is currently present. Change maybe possible with a little encouragement.
I'm not saying Im better than you, your probably smart as all hell, but I feel your still wrong.
That drug is going to be used some day, and it will enter into somebodies body because I cared enough to make it happen. Can u say the same about your future Torsades patient? I'll end this back and forth right here.

Never mind that your lame strawman argument makes you sound like a five year old.

Posters here have provided rational and well documented reasons why certain aspects of your service may not be up to your personal standards. You chose to discredit them. Great. Stop there, you're not doing yourself any favors by calling out others for not meeting your (ridiculous) personal standards of moral and ethical compliance..

 

[RanchoEMT]

Posters here have provided rational and well documented reasons why certain aspects of your service may not be up to your personal standards. You chose to discredit them. Great. Stop there, you're not doing yourself any favors by calling out others for not meeting your (ridiculous) personal standards of moral and ethical compliance..

My ridiculous personal standards of moral and ethical compliance do NOT entertain the good fight of pursuing that which is not feasible. "If we cant get it, we cant get it!" COPY. Understood. Im NOT contesting this fact. As I think the lot of you seem to think. Infact it is the opposite. If supplies are possible to get than we should make an every effort.(WHICH I FEEL MY COMPANY DID NOT) "Why do you feel this way Rancho???" Because my company does it every other week. Last week there was no tournaquetts(There a shortage of those?). The previous week no bed sheets, before that no AED's for the bls crews, etc etc. Does this mean my company is guilty of neglecting to order critical supplies? NO. There could be a very legitemit reason why we have no drugs. Shortages are a very real and understandable reality. These "rational and well documented reasons" may be the reasons of many EMS providers. But! Was it My Reality??? Was it the reason my company had no drugs??? After inquiry, No answer given from direct questioning.

If every provider in my area is able to obtain and keep a current sufficiency of supplies I should at least be able to ask Why Not Us. I did infact ask this. I asked our union Rep to find out why this is. The Next day we have drugs! What do we conclude from this??? ABSOLUTELY NOTHING. But more than likely my company as I had suspected was able to come up with drugs if they really needed. This need may or may not have been catalyzed by union pressures.
Regardless, the only discredit I have to offer is to those who assume every situation is the same and any further investigation into the matter is subject to being scrutinized as a naive puppydog lost in a big old confusing EMS system. Say what you will, twist things however you like, I asked what to do about a problem and it is now fixed.

Sorry to be discreditting.

 

[exodus]

I see rancho being in the right here. Obviously they weren't dealing with a shortage, they were just being stingy.

 

[RanchoEMT]

And judging by your location I assume you understand the stinginess of this company O'mine.

 

[exodus]

And judging by your location I assume you understand the stinginess of this company O'mine.

I've heard of it, but our division is pretty good about keeping everything stocked and good. I haven't had a problem, but I've only been here for ~7 months on a BLS unit.

 

[jon51]

Nice job rancho, I applaud your decision to pursue what you believe is right. I personally have not seen or heard of shortages of those drugs and I geographically close to you. I think going to ICEMA would have been detrimental to your job due to the relationship they have with your employer.

 

[Tigger]

I see rancho being in the right here. Obviously they weren't dealing with a shortage, they were just being stingy.

If the company is truly being stingy and failing to stock rigs when the supplies exist, then yes there is a problem. Nowhere however is it evident that this is necessarily the case. I take more offense with his calling out of usalfyre for attempting to provide a potential couterpoint (not that he needs any help defending himself, nor does he really care I am sure). There is no point in posing a question if you already have decided on answer.

 

[usalsfyre]

It might 'behoove' you USALSFYRE to take a closer look at this picture. You'll see this is also a picture of a win. A huge life changing one in fact, for some patient who is going to need this little vial in the future.
I don't wish to make this post a back and forth slander fest, but your position as I see it, is not one I wish any of the other medical providers on this forum to see and adopt. People who seek consult and guidance from this site need positive and encouraging examples to follow.
Today we've hit the underlining topic of Patient Advocacy. I advocated for it and I got it. You excepted the 'reality' of what you felt could not change, And You Got Just That. Our particular circumstances are of course different, but telling everyone who expresses issues from an employer should Not just 'Except the Reality' of what is currently present. Change maybe possible with a little encouragement.
I'm not saying Im better than you, your probably smart as all hell, but I feel your still wrong.
That drug is going to be used some day, and it will enter into somebodies body because I cared enough to make it happen. Can u say the same about your future Torsades patient? I'll end this back and forth right here.

Whatever helps you sleep at night.

Of course we're ignoring the fact that this med might not be available for use on an OB, peds or med surg floor where it is vastly more likely to be used and make a life changing difference to stop pre-term labor, treat a refractory asthma attack or prevent Torsades due to hypomagnesia rather than expire sitting in your med box (what the majority of mag I've ever carried did).

But again, whatever helps you sleep....

 

[RanchoEMT]

Of course we're ignoring the fact that this med might not be available for use on an OB, peds or med surg floor where it is vastly more likely to be used and make a life changing difference to stop pre-term labor, treat a refractory asthma attack or prevent Torsades due to hypomagnesia rather than expire sitting in your med box (what the majority of mag I've ever carried did).

I'm all broken up about stocking the 911 system with a medication our ER's are already in supply of. Truly immoral.

There is no point in posing a question if you already have decided on answer.

Did I not research further into the shortage? Did I not ask my employer why we had no drugs initially? Did I not ask the local ALS providers what their situation was? Did I not ask a union Rep to investigate? Was I really preset into a decided and desired explanation?? Or did I formulate an opionion based on the evidence presented? Was this opinion verified by the end of the day outcome? Is this thing on? Is there anybody out there????

I think we're all just alittle butt hurt from this thread. Let's end it with, "When in doubt ask a union Rep."

 

[abckidsmom]

Simmer down a bit. Usals is presenting a different perspective. When you come here looking for a discussion, you're going to get a full on discussion sometimes, complete with opposing viewpoints.

 

[RocketMedic]

My big worry is how do we, as in the health-care industry, secure our supply of drugs?

 

[ShannahQuilts]

When I looked at the very long list of medications in short supply, that was my concern, as well, Rocketmedic40. I see on the list medications that I know are essential to a lot of people on a daily basis, and I wonder how we got to the point where supply is even a problem.

Are the drug companies not getting the raw materials? Are they making little enough to keep prices high? Are they regulated by the government to have a maximum production limit? Or is it like flu vaccine where making it depends on something really perishable?

If a medic having meds for his/her drug box means that someone on an OB floor or in some other critical need doesn't get the meds they need, I think that's a big concern. But I think the concern is: why is there not enough for both the medic and the hospital?

 

[usalsfyre]

I'm all broken up about stocking the 911 system with a medication our ER's are already in supply of. Truly immoral.



Did I not research further into the shortage? Did I not ask my employer why we had no drugs initially? Did I not ask the local ALS providers what their situation was? Did I not ask a u,.nion Rep to investigate? Was I really preset into a decided and desired explanation?? Or did I formulate an opionion based on the evidence presented? Was this opinion verified by the end of the day outcome? Is this thing on? Is there anybody out there????

I think we're all just alittle butt hurt from this thread. Let's end it with, "When in doubt ask a union Rep."

Not butt hurt at all. Simply trying to get the point across things are not as simple as they seem. You sought the opinion of a couple of end users who have no idea what the supply chain looks like. How exactly does a bucket FF or an ED nurse have any idea what their stock of medication is? Are you sure they didn't give you medication being held for another purpose just to placate you?

I'm simply used to dealing with your type (righteous indignation over imagined ethical issues), from shortages at my service. Heck I was your type at one point. Others have tried to make the point there's a huge number of issues regarding shortages you don't understand. You simply choose to ignore this fact, and instead point to four vials of mag sulfate (which are highly unlikely to be used in a normal ALS system) as some form of victory. When you can figure out how to ensure the supply chain of the drugs everyone is running out of I'll grant you a victory.

You can call me a morally bankrupt, evil, burnout, whatever. Those of us who are involved in the upper levels will continue to ignore you until it becomes impractical to do so while we figure out how to provide for the majority of patients while dealing with the crappy set of alternatives we're given. The key to medicine, management and many things in life is the color "gray".

Good luck with the life of a proletariat.

 

[Aidey]

I think you had decided on a position, which was that your company was out to screw you. I thought I had done a pretty good job explaining why a company may accidentally run out of something like tourniquets but apparently not. Just because someone was able to conjure up some drugs does NOT mean there is not a significant shortage of medications. Do you know where those drugs came from? Are you sure you employer didn't buy whatever drugs a hospital could spare? How do you know it isn't coincidence your employer was able to obtain the medications around the same time you talked to your union rep?

The entire county I work in is out of some drugs. Do you really think it is because none of us are patient advocates? Do you really think that the ordering people for the several ALS agencies haven't tried multiple routes to get the medications? You are delusional if you think talking to a union rep will help at this point.

 

[Aidey]

When I looked at the very long list of medications in short supply, that was my concern, as well, Rocketmedic40. I see on the list medications that I know are essential to a lot of people on a daily basis, and I wonder how we got to the point where supply is even a problem.

Are the drug companies not getting the raw materials? Are they making little enough to keep prices high? Are they regulated by the government to have a maximum production limit? Or is it like flu vaccine where making it depends on something really perishable?

If a medic having meds for his/her drug box means that someone on an OB floor or in some other critical need doesn't get the meds they need, I think that's a big concern. But I think the concern is: why is there not enough for both the medic and the hospital?

E. All of the above. The link I posted gives reasons manufacturers are in short supply of certain meds. I don't think the FDA sets production limits on many listed, but the FDA has had to shut down some plants due to quality control issues. If one manufacturer shuts down it increases the demand on the others, who may not be able to keep up.

 

[Sandog]

At any rate, one should not bite the hand that feeds them...

 

[RanchoEMT]

I'm simply used to dealing with your type (righteous indignation over imagined ethical issues), from shortages at my service. Heck I was your type at one point. Others have tried to make the point there's a huge number of issues regarding shortages you don't understand. You simply choose to ignore this fact, and instead point to four vials of mag sulfate (which are highly unlikely to be used in a normal ALS system) as some form of victory. When you can figure out how to ensure the supply chain of the drugs everyone is running out of I'll grant you a victory.

You can call me a morally bankrupt, evil, burnout, whatever. Those of us who are involved in the upper levels will continue to ignore you until it becomes impractical to do so while we figure out how to provide for the majority of patients while dealing with the crappy set of alternatives we're given. The key to medicine, management and many things in life is the color "gray".

Good luck with the life of a proletariat.

Oh a thousand pardons noble gentry, i was oh so unaware i was taping into the upper echelon, supply shortages are so beyond my college level education. please ignore my petty rebukes. Your absolutely right sir, the key to medicine is grey, thats why the reason behind it all MUST have been supply shortages. After all we were able to get drugs a day later, makes sense.... Gos speed thank you for the insults.