The 10 commandments of ems

[certguy]

With my son about to start EMT academy,I figured I'd share some dad wisdom;
THE 10 COMMAMDMENTS OF EMS
1.THOU SHALT CONSIDER THE SAFETY OF YOURSELF&YOUR CREW OF UTMOST IMPORTANCE.
2.THOU SHALT HOLD THE SAFETY OF ALL OTHERS SECONDARY.
3.THOU SHALT PROVIDE THE BEST CARE POSSIBLE.
4.THOU SHALT NOT PUT BILLING COMSIERATIONS OVER PT CARE.
5.THOU SHALT,TO THE EXTENT POSSIBLE,BE COURTEOUS,KIND&SYMPETHETIC TO PTS,FAMILY&THE PUBLIC.
6.THOU SHALT KEEP A PROFESSIONAL ATTITUDE&APPEARANCE AT ALL TIMES.
7.THOU SHALT KEEP A CLEAN,WELL STOCKED UNIT.
8.THOU SHALT KNOW YOUR RESPONSE AREA.
9,THOU SHALT WORK WELL WITH OTHER AGENCIES.
10.THOU SHALT,IF PERSONALLY AFFECTED BY A CALL,GET ASSISTANCE WHEN NEEDED.REMEMBER,YOU'RE JUST AS HUMAN AS YOUR PTS.

 

[Veneficus]

4.THOU SHALT NOT PUT BILLING COMSIERATIONS OVER PT CARE.

But they are not seperable.

 

[bstone]

But they are not seperable.

Disgaree. If my PT doesn't have insurance and can't pay out of pocket that won't stop me from using every intervention possible.

 

[firecoins]

1. Ambulate before Carry

2. Thou shall transfer patients to hospital closest to the facility that will serve my next meal.

3. The amount of blood or vomit on your uniform is in inverse amount to the years you have in. Pros get none on their uniform.

4. Call for the lift assist anytime ABC is a problem. Heavy patients always seem to need to be carried down from small rooms on the top floor of walk up buildings.

5. Coffee is always in your drug box.


I lost the other tablet.

 

[Veneficus]

Disgaree. If my PT doesn't have insurance and can't pay out of pocket that won't stop me from using every intervention possible.

And that won't stop collections, bankruptcy, nor elimination of familial assets from an estate on futile treatments. Actually it only hastens it.

Tell me, what are the health and psycological implications that are affiliated of such, and how do they in anyway benefit the patient or relatives?

An EMS provider sticking their head in the sand to hide from issues they don't want to deal with is not patient advocacy.

In the bigger picture, prescribing treatments that a patient cannot afford means they get no treatment. So the ability of a patient to assume such costs has a direct implication on what treatment can be offered.

 

[bstone]

And that won't stop collections, bankruptcy, nor elimination of familial assets from an estate on futile treatments. Actually it only hastens it.

Tell me, what are the health and psycological implications that are affiliated of such, and how do they in anyway benefit the patient or relatives?

An EMS provider sticking their head in the sand to hide from issues they don't want to deal with is not patient advocacy.

In the bigger picture, prescribing treatments that a patient cannot afford means they get no treatment. So the ability of a patient to assume such costs has a direct implication on what treatment can be offered.

Are you suggesting that I take into consideration bills and balances when treating my patients?

 

[Veneficus]

Are you suggesting that I take into consideration bills and balances when treating my patients?

For certain.

 

[bstone]

For certain.

Absolutely, complete, 100% disagree. There is no way you will be able to convince me otherwise, so don't even try.

 

[Veneficus]

Absolutely, complete, 100% disagree. There is no way you will be able to convince me otherwise, so don't even try.

If you choose to cause harm to people in the name of "doing all you can," that is your decision.

But please consider if you are "doing all you can" for them or for you.

 

[bstone]

If you choose to cause harm to people in the name of "doing all you can," that is your decision.

But please consider if you are "doing all you can" for them or for you.

I think you have a seriously warped sense of morality if you place financial considerations over fully treating a patient. You're beginning to sound like an HMO exec.

 

[Veneficus]

double post, disregard.

 

[Veneficus]

I think you have a seriously warped sense of morality if you place financial considerations over fully treating a patient.

Perhaps I do have a warped sense of morality, but certainly not for considering the costs when treating patients. I just realize my personal responsibility in the damage I caused by not taking cost into account.

It is a bit troubling when you realize attempting resuscitation and transport on an obviously dead kid to give them every opportunity results in the family going bankrupt, breaking up, and the surviving siblings having less opportunity.

Similarly when you start performing ALS procedures on patients "just incase" and turn the $300 bill into a $600+ bill because you couldn't tell when those "what ifs" were anything more than the remotest of possibilities.

Or when you call that helicopter based on a mechanism that was based on the circumstances in 1965 and see somebody discharged home 30 minutes after getting to the hospital with a >$20,000 bill.

I say "you," but I am personally accountable for all 3 of those examples.

You're beginning to sound like an HMO exec.

There is an old saying: "Amateurs talk tactics, experts talk logistics."

No need to convince you. Sooner or later you will have to come to terms with it too.

 

[bstone]

We will have to agree to disagree. I simply will not fail to stop a massive bleed or treat chest pain because the vascular surgeon or cardiac cath might cost too much. If a patient has a DNR/DNI and/or similar orders then I of course respect them. But never, never will I cease treating a patient who can be saved just because of money. Life is worth a lot more than money.

 

[Veneficus]

We will have to agree to disagree. I simply will not fail to stop a massive bleed or treat chest pain because the vascular surgeon or cardiac cath might cost too much.

That is an easy example to come to terms with. It is seldom that black and white.

never will I cease treating a patient who can be saved just because of money. Life is worth a lot more than money.

But how many are worth ruining to save one?

"Saving" a patient is a rather grey area. Let's look at an 86 year old male AML patient with >70% blasts with perhaps a few months to live. You could easily drain his life insurance and estate buying him chemo. You might prolong his life for a year. Maybe. You might also be leaving his widow to have to leave their life long home to move in with family or worse, a nursing facilty, with the money spent.

Like I said, you'll get to that point eventually, forwarned is forarmed.

 

[bstone]

That is an easy example to come to terms with. It is seldom that black and white.




But how many are worth ruining to save one?

"Saving" a patient is a rather grey area. Let's look at an 86 year old male AML patient with >70% blasts with perhaps a few months to live. You could easily drain his life insurance and estate buying him chemo. You might prolong his life for a year. Maybe. You might also be leaving his widow to have to leave their life long home to move in with family or worse, a nursing facilty, with the money spent.

Like I said, you'll get to that point eventually, forwarned is forarmed.

That 86 y/o PT has Medicare and the ambulance service is required to accept Medicare Assignment, so there will be no bankruptcy or massive bills.

 

[Veneficus]

That 86 y/o PT has Medicare and the ambulance service is required to accept Medicare Assignment, so there will be no bankruptcy or massive bills.

From the ambulance.

But hospitls and healthcare facilities often bill more than what medicare pays and what is not covered is passed on to the patient and by extension the estate.

Wonderful world isn't it?

 

[bstone]

From the ambulance.

But hospitls and healthcare facilities often bill more than what medicare pays and what is not covered is passed on to the patient and by extension the estate.

Wonderful world isn't it?

I don't think you understand how Medicare works. Medicare has modest deductibles and co-pays, just like any private insurance company. Once you meet those modest deductibles and co-pays you are not responsible for one penny more.

Most seniors also have what's called "Medicare Advantage" or, in some cases, a "Medicare Supplemental Policy". These plans, administrated by private insurance companies, cover above and beyond what Original Medicare covers. Medicare Part A (aka Hospital Insurance) along with a Medicare Advantage or Medicare Supplemental policy means that the person likely will receive *NO* hospitals bills. In the case of only having Original Medicare the bills are very modest as Medicare Part A covers hospitalizations.

Medicare Deductible and Coinsurance Amounts for 2010:

Part A: (pays for inpatient hospital, skilled nursing facility, and some home health care) For each benefit period Medicare pays all covered costs except the Medicare Part A deductible (2011 = $1,132)
Source: https://questions.medicare.gov/app/...icare-premiums-and-coinsurance-rates-for-2011

I know almost everything about Medicare. Something about a 30 page research project for a public health class on it.

 

[Veneficus]

I don't think you understand how Medicare works. Medicare has modest deductibles and co-pays, just like any private insurance company. Once you meet those modest deductibles and co-pays you are not responsible for one penny more.

Most seniors also have what's called "Medicare Advantage" or, in some cases, a "Medicare Supplemental Policy". These plans, administrated by private insurance companies, cover above and beyond what Original Medicare covers. Medicare Part A (aka Hospital Insurance) along with a Medicare Advantage or Medicare Supplemental policy means that the person likely will receive *NO* hospitals bills. In the case of only having Original Medicare the bills are very modest as Medicare Part A covers hospitalizations.

I know almost everything about Medicare. Something about a 30 page research project for a public health class on it.

Perhaps you might explain then how my mom who has both medicare and medicare advantage routinely receives $6000+ bills for her recent hospitalizations?

You might also consider not every country in the world is covered by US medicare. Some actually make you pay for what you get or you don't get it.

Don't like 86, try 36?

 

[bstone]

Perhaps you might explain then how my mom who has both medicare and medicare advantage routinely receives $6000+ bills for her recent hospitalizations?

You might also consider not every country in the world is covered by US medicare. Some actually make you pay for what you get or you don't get it.

Don't like 86, try 36?

Two answers-
1) She is receiving the EOB (Explanation of Benefits). It says that the hospital billed Medicare for $6000, but this is not what the hospital OR your mother pays. The numbers are strikingly high but they are never what is actually paid.

2) The treatment she received is not part of Medicare's covered treatment. It might be experimental, not FDA approved, herbal treatment, etc.

Look at the EOB. There are always several lines, including what the hospital billed Medicare, what Medicare paid, what they sent to the Medicare Advantage plan, etc.

There simply is no way she got a $6000 bill from a hospital even if she only has Original Medicare. The 2011 deductible is only $1100ish.

 

[truetiger]

I don't think he's asking you to withhold treatment, rather to see the bigger picture. You need to be aware of the consequences of your interventions.