# Paged out as an overdose



## garett1979 (May 7, 2009)

Me and my partners got paged out at 3am to a possible overdose, Got on scene the gentleman had taken 3 tylenol. You can imagine my level of bs tolerence was gone by this time


----------



## NRNCEMT (May 7, 2009)

garett1979 said:


> Me and my partners got paged out at 3am to a possible overdose, Got on scene the gentleman had taken 3 tylenol. You can imagine my level of bs tolerence was gone by this time



Ouch, that sucks man.  Sounds like the time my partner and I were paged out to a chest pain with SOB at a Chinese restaurant, we get there and the lady had put too much hot mustard on her food.  We were also fuming quite a bit.


----------



## VentMedic (May 7, 2009)

What was the dose of each tablet and how many were taken within 24 hours?  Any other products containing acetaminophen taken?   

The maximum amounts for adults are 1 gram (1000 mg) per dose and 4 grams (4000 mg) per day.

Any history of alcohol use in history or during that day?
Liver function problems?    

Patient's age? 

What was the reason for taking the Tylenol?


----------



## garett1979 (May 7, 2009)

55yo pt, no other  acemetohphine taken that day, no alcohol consumption, pt had a head ache, the bottle said take two as needed he took three thought he had od


----------



## VentMedic (May 7, 2009)

garett1979 said:


> 55yo pt, no other acemetohphine taken that day, no alcohol consumption, pt had a head ache, the bottle said take two as needed he took three thought he had od


 
Dosage? 

Prescription or OTC? 

Other hx?

The ads they have been running in the media for acetaminophen OD are pretty frightening. I can see where some might get concerned.


----------



## garett1979 (May 7, 2009)

otc, no other history


----------



## VentMedic (May 7, 2009)

garett1979 said:


> otc, no other history


 
Regardless of a med being OTC or prescription, always get into the habit of documenting the dosage.


----------



## garett1979 (May 7, 2009)

If the pt had taken more than the sugested dosage in a 24hr period i could understand, but he took 3, which i think is 2000mg if im not mistaken i would have understood, but come on man u called rescue cuz u took 3 tylenol


----------



## garett1979 (May 7, 2009)

But thank you for your advice, i always look for constructive criticism, and ways to do it better


----------



## VentMedic (May 7, 2009)

garett1979 said:


> If the pt had taken more than the sugested dosage in a 24hr period i could understand, but he took 3, which i think is 2000mg if im not mistaken i would have understood, *but come on man u called rescue cuz u took 3 tylenol*


 
I can also tell you about people on a liver transplant list because they took a couple of tylenol but didn't realize all the other cold medicine they took also contained tylenol. 

You might want to check that dosage again which should have been included in your patient care report.  Not having the correct information together for the ED report will make you look sillier than the patient for calling.


----------



## garett1979 (May 7, 2009)

the pt took  3 tylenol, thats it, no other meds, just three tylenol, if the pt had a history and on other meds i would be more concerned, but he had no history, and had a headache.


----------



## VentMedic (May 7, 2009)

garett1979 said:


> the pt took 3 tylenol, thats it, no other meds, just three tylenol, if the pt had a history and on other meds i would be more concerned, but he had no history, and had a headache.


 
I guess telling the ED the patient took 3 Tylenol even if you didn't record the dosage is better than saying 3 white pills.

I may sound critical but proper documentation in the medical profession is extremely important and especially if you are going to use it to criticize a patient or document abuse of the system.


----------



## garett1979 (May 7, 2009)

Wow! I was told id meet medics who were refered to as paragods, but i never have until tonight thank you sir


----------



## reaper (May 7, 2009)

This was an emergency to him! Did you take the time to educate the man? Someone on a clinical should not have a "BS tolerance level". You are there to learn something, no matter how BS it seems to you.

He thought he had OD, because he took to many. As Vent pointed out, a full history is needed. Did he call for an underlying reason? If it was just the fact that he took one to many, then use the time to educate him on the normal dosage and why it can be bad to exceed it. A lot of providers look at most calls as BS. But, they all need a full assessment to make sure that there are underlying problems, that may be why they really called 911.

This is just for your future knowledge. Learn all you can, even from the smallest calls that seem minor.


----------



## reaper (May 7, 2009)

garett1979 said:


> Wow! I was told id meet medics who were refered to as paragods, but i never have until tonight thank you sir



It is called educated, not Paragod!


----------



## garett1979 (May 7, 2009)

And for documentation purposes the ed laughed when we arrived and sent the pt straight to triage


----------



## NRNCEMT (May 7, 2009)

garett1979 said:


> Wow! I was told id meet medics who were refered to as paragods, but i never have until tonight thank you sir



OT: Hey man, add me to your yahoo, just click on the red Y under my name.  I live in Evergreen, work in Tabor and Myrtle Beach.


----------



## garett1979 (May 7, 2009)

Oh im very thankful for every min i get on that truck, ive learned 1000 times more on it than ive learned in class, but like vent said, if the patient had taken any other meds, or had a history, i woould have understood, but when the bottle of an otc says dont exceed four and youve only taken 3 come on, but your both medics, and im only a student so i have no room to say im right your wrong, other than the paragod part lol


----------



## VentMedic (May 7, 2009)

garett1979 said:


> And for documentation purposes the ed laughed when we arrived and sent the pt straight to triage


 
They will probably still do a tox screen especially if you did not provide the amount taken or just to confirm the patient's story. Sometimes people with suicide idealations back out of their attempts but know they screwed up enough for some damage. They don't want to be thought of as a psych patient but know they still should get medical help.

Do not let your attitude prevent you from doing a proper assessment and documentation. This will be exactly the type of patient you may get called for a deposition later.

Keep on learning.


----------



## garett1979 (May 7, 2009)

vent i did provide the amount taken, three pills, i may not be a medic, or an intermidiate, but i think the ed can calculate the dosage of three otc acemetaphine


----------



## VentMedic (May 7, 2009)

garett1979 said:


> vent i did provide the amount taken, three pills, i may not be a medic, or an intermidiate, but i think the ed can calculate the dosage of three otc acemetaphine


 
Okay. Just get used to looking at the dosages of meds especially on med reports on the routine calls. That will help as you continue your education. You won't be stessing out in the pharmacology section of paragod school if you start now.


----------



## garett1979 (May 7, 2009)

LOL thank you vent i appreciate that


----------



## Buzz (May 7, 2009)

I had a B.S. overdose call one night. He called 911 saying he'd taken over 10 doses of Benadryl because he was unable to sleep. Upon arrival, he is up and walking around talking to us. Turns out he'd meant over the course of a few weeks, with the last time he'd taken it 36 hours prior to calling. Then he signed off.


----------



## garett1979 (May 7, 2009)

my point exactly


----------



## Sapphyre (May 7, 2009)

garett1979 said:


> but i think the ed can calculate the dosage of three otc acemetaphine



Hey, garett, you did know that OTC acetametaphine comes in 2 doses, right?  That is part of the reason why you need to look at, and document dosing.


----------



## VentMedic (May 7, 2009)

I am going to hijack this thread slightly since OD is being discussed.

Over the past two years Asthma meds in the U.S. have changed dramatically and unfortunately we are seeing more deaths from asthma and from the medications. The patients are sometimes having their asthma managed out of a General Physician's sample closet at random with very little instruction about technique, how much, when and why. It is no longer enough to just blow off an MDI as "took his/her inhaler". Which inhaler and how much? Dose per inhalation? How many different inhalers laying around? OTC or prescription? Initial HR and BP? Heart sounds, palpation for perfusing pulse or actual electrical activity? During an Albuterol tx? 

Here's a little presentation on the many different inhalers out there.

http://www.asthmanow.net/EPR%203%20Asthma%20Training%20Series-Asthma%20Medications.ppt


----------



## rescuepoppy (May 7, 2009)

While this is not an emergency this patient was having a crisis. Sometimes when people see the take two at one time or no more than a certain amount over a set time period they can think that if they exceed that dosage they will have some reaction. This is probably what was going through his head. Like I said this was not an emergent situation to us but to him he needed the reassurance that he was not going to die from the extra tablet. What we consider to be b.s. can be at least temporarily an emergency to the person it is happening to. Yes in a career in this service you will run b.s. calls Just rember you are not the one with the emergency.


----------



## Jon (May 9, 2009)

3 pills of what dosage?

325mgx3=975mg
500mgx3=1500mg

Normal dose is 1-2 pills - so if 3 pills of the "regular" dose was taken, it is the SAME as the normal max dose of Extra Strength

So... is there a low-level OD, or NOT?

Also - WHY did the patient take the OD? Intentional? Accidental?

What is the underlying cause? Are they depressed? Do they verbalize suicidal idealization?

Did he take an extra pill because he's confused? Is he CAOx4? Did you do a stroke assessment? Check a blood glucose level? 

Garett - you aren't "just a BLS provider" you are an EMS Provider... and should be a patient advocate. Rather than blow the patient off as B.S., treat and document the underlying issues to the best of your ability, and pass that same info along to the ED staff.


----------



## subliminal1284 (May 9, 2009)

LOL Ive taken up to 8 Extra strength tylenol in one day for a bad migraine before and had no visible side effects.


----------



## VentMedic (May 9, 2009)

subliminal1284 said:


> LOL Ive taken up to 8 Extra strength tylenol in one day for a bad migraine before and had no visible side effects.


 
What type of *visible* side effects are you expecting?

If you continue to take that amount of Tylenol on a fairly occasional or frequent basis, you might consider getting  liver function tests done.


----------



## trevor1189 (May 9, 2009)

subliminal1284 said:


> LOL Ive taken up to 8 Extra strength tylenol in one day for a bad migraine before and had no visible side effects.



Yeah most of the max doses on OTC meds seem like they really don't mean anything. I once found myself drinking dayquil out of the bottle when I had to work a third shift to get rid of the symptoms. Would I do everyday just because there were no adverse rxns that night, no way! Long term it would definitely cause damage, no doubt in my mind.


----------



## vquintessence (May 13, 2009)

trevor1189 said:


> Yeah most of the max doses on OTC meds seem like they really don't mean anything. I once found myself drinking dayquil out of the bottle when I had to work a third shift to get rid of the symptoms. Would I do everyday just because there were no adverse rxns that night, no way! Long term it would definitely cause damage, no doubt in my mind.



*So were you "robo tripping" while on duty?!!?!!?*   Lots of kids around here were pounding DXM (found in dayquil, cough syrup, etc) to get high before legislation required photo ID, 18+ Y/O and limited purchases.


----------



## exodus (May 13, 2009)

I'm guessing you messed up saying they took 2000 mg because i'm trying to figure out how 2000mg out of 3 pills works?!

And YOU ARE A STUDENT. DO NOT even start to call calls BS. For all you know the patient is unable to remember taking other medications. Other than immediate S/S, do not take the patients information as FACT!  Find out why he took them? Did he have a really bad head ache? What is the head ache from? Why was it so bad to him that he went "outside normal dose" to fix it.  Did he take it on accident, did he want to subtely try to get help for a pysch problem?

And there are pretty much NO paragods on this forum, the person you called one, is most definetly not, if anything they are very much an amazing paramedic! The medics in this thread are actually compeltely for giving EVERYONE a full ALS treatment, even your "BS" patients.  By you calling this patient BS, you are on a one way road to becoming a paragod, a paragod is someone who feels they are above the patient and other medical providers, and looks down upon them. So by you calling this patient BS even though you don't know if there's underlying problems.

And even if it was a BS call, it's a perfect time for you to practice your ASSESSMENT SKILLS, AND VITAL SKILLS. This was apparently a non-emergent call, so why not spend more time on scene, and have you fully do the assessment by yoursef? If you only do assessments on SICK patients, you will never know how an assessment will look on a NOT SICK patient....


Thank you.


----------



## MRE (May 13, 2009)

VentMedic said:


> What type of *visible* side effects are you expecting?



You would start to turn the color of the pills of course.  Works with carrots.



exodus said:


> I'm guessing you messed up saying they took 2000 mg because i'm trying to figure out how 2000mg out of 3 pills works?!



That was the new 666.66mg pill that Tylenol was proposing.  I guess they decided against it as some people are put off by the number and cutting the ends off the pills to get down to 500mg.


Legal Note:  The content of this post is in no way meant to diagnose or treat any injury or illness.  Its information has no basis in fact and due to it's content should not be taken seriously by anyone.


----------



## Lunah (May 13, 2009)

trevor1189 said:


> Yeah most of the max doses on OTC meds seem like they really don't mean anything.



Oh, but they certainly do. I do NOT like Tylenol. It is a nasty, nasty drug. I've run teens who took a bunch of Tylenol in a fit of depression, then decided not to tell anyone ... a day or so later, their livers are hosed. One pt. took 65 (yes, 65) extra-strength -- so 32,500 mg. Even though she was outside the window of time, she still got Mucomyst in the ED (this was before IV Acetadote was available). I've often wondered how she fared. Very sad.


----------



## VentMedic (May 13, 2009)

W1IM said:


> You would start to turn the color of the pills of course. Works with carrots.


 
By the time you turn that same orange color with the pills as you do with carrots, you're liver is probably very damaged. 



Lunah said:


> Oh, but they certainly do. I do NOT like Tylenol. It is a nasty, nasty drug. I've run teens who took a bunch of Tylenol in a fit of depression, then decided not to tell anyone ... a day or so later, their livers are hosed. One pt. took 65 (yes, 65) extra-strength -- so 32,500 mg. Even though she was outside the window of time, she still got Mucomyst in the ED (this was before IV Acetadote was available). I've often wondered how she fared. Very sad.


 
I had referred to this in an earlier post. Some people do take a lot of tylenol out of a moment of anger or depression and then regret it. They may then realize they could have done some damage but don't want to admit to a suicide attempt when they call 911 or go to the ED which will get them a 72 hour psych hold. Thus, they say they took just a couple more than the recommended dose.


----------



## MRE (May 13, 2009)

VentMedic said:


> By the time you turn that same orange color with the pills as you do with carrots, you're liver is probably very damaged.



But you could probably see in the dark.

Vent has a really good point about a patient not telling the "whole" truth.  We all should remember that what comes out of a patient's/family member's/bystander's mouth should always be taken with a grain of salt.


----------



## VentMedic (May 13, 2009)

W1IM said:


> Vent has a really good point about a patient not telling the "whole" truth. We all should remember that what comes out of a patient's/family member's/bystander's mouth should always be taken with a grain of salt.


 
While what they say should be considered, your own assessment and judgment should also play a large role. However, if you enter with an "attitude" about the call just by the way it was dispatched, you may miss some very important factors in your assessment of the scene and the patient. 

Another example of this would be spouse or child abuse. Often the child or spouse will deny injuries that are clearly visible. Or, they may call for some other reason in hopes of being removed from a very bad situation and taken to safety without raising suspicion of their "loved" one.


----------



## lightsandsirens5 (May 14, 2009)

How 'bout this:

Monday night we get paged to the lobby of a local motel for a male pt w/ possible allergic reaction. On scene find pt vomiting into a trash can. He is the color of plumbers putty, (If you haven’t seen it, it is a horrible pale beige/grey color) sweaty like you would not believe and said he had never been so tires in his life. Anyhow, we do I/A and find he is allergic to almonds. Well, he ate some walnuts or something and thought he felt some symptoms like his reaction to almonds coming on _"so I took 5 or 6 Benadryl about, oh a half hour, forty-five minutes ago and that seemed to help some, Then I started getting sick like this, oh and by the way, I'm really tired."_

Long story short, hospital thinks he just had simple food poisoning and no reaction to walnuts. (How about a slight OD on Benadryl? Gosh, one knocks me out!!!!)


----------



## CAOX3 (May 22, 2009)

exodus said:


> And YOU ARE A STUDENT. DO NOT even start to call calls BS. For all you know the patient is unable to remember taking other medications. Other than immediate S/S, do not take the patients information as FACT!  Find out why he took them? Did he have a really bad head ache? What is the head ache from? Why was it so bad to him that he went "outside normal dose" to fix it.  Did he take it on accident, did he want to subtely try to get help for a pysch problem?
> .



Yeah....cause only sick people call 911. Where do you work 

So you want to interrogate him?  He took three 500mg tylenols, not even half the daily recommended dose. 

Put the helicopter on standby.

Subtle help for a psych problem...........WTF.

Im all for helping sick people, some are not sick.


----------



## VentMedic (May 22, 2009)

CAOX3 said:


> Yeah....cause only sick people call 911. Where do you work
> 
> So you want to interrogate him? He took three 500mg tylenols, not even half the daily recommended dose.
> 
> ...


 
And you are assuming all of this as an EMT-B? 110 hours of training and you are making decisions most doctors wouldn't by just assumptions.

BTW, it is called an assessment.


----------



## garett1979 (May 22, 2009)

All of 1500MG of Tylenol lol And for the record The MD at the ED laughed when told of the call.


----------



## VentMedic (May 22, 2009)

garett1979 said:


> All of 1500MG of Tylenol lol And for the record The MD at the ED laughed when told of the call.


 
But he did do an assessment on the patient? Right? 

Because you find something humorous does not relieve of your responsibility to performing an adequate assessment.

I suggest you study a little more about Tylenol and its affect on various organs and disease processes.


----------



## trevor1189 (May 22, 2009)

vquintessence said:


> *So were you "robo tripping" while on duty?!!?!!?*   Lots of kids around here were pounding DXM (found in dayquil, cough syrup, etc) to get high before legislation required photo ID, 18+ Y/O and limited purchases.



No no no... This was before EMS days. I was night stocking a retail clothing store. I wouldn't be anywhere near a patient under the influence... h34r:

Any job in healthcare requires are clean background check, I wouldn't be dumb enough to mess it up. :excl:

I remember someone who made a joke to the pharmacist of "so how much meth can I make from this psuedoephedrine..." They didn't think it was so funny. Of course they were just messing around cause they knew why it required ID.


----------



## VentMedic (May 22, 2009)

trevor1189 said:


> Any job in healthcare requires are clean background check, I wouldn't be dumb enough to mess it up. :excl:


 
I'm sure you could find a county in California that would hire you.


----------



## garett1979 (May 22, 2009)

No the MD didnt cause the patient refused care. The MD was told of the call on a later transport, and found it quite humerous a person would call 911 for taking three tylenols. And yes i have and understand the affects of tylenol on the body's organs specifically the liver


----------



## CAOX3 (May 22, 2009)

VentMedic said:


> And you are assuming all of this as an EMT-B? 110 hours of training and you are making decisions most doctors wouldn't by just assumptions.
> 
> BTW, it is called an assessment.


----------



## trevor1189 (May 22, 2009)

VentMedic said:


> I'm sure you could find a county in California that would hire you.



That is disturbing. Seriously...

I don't even have a traffic ticket. I want to keep it that way. I think someday I could be a really good healthcare provider and I don't want to jeopardize that in any way.

The only time I have been pulled over was for swerving, I was on a new medication and was starting to get drowsy. Officer asked if there was anyone I could call to give me a ride and verified my prescription. Very nice about it. Frankly, he could have given me a DUI, but he understood the circumstances and helped me out. Lesson learned. When starting a new medication make sure you are ok to operate a vehicle while on it. I had been on it for a few days and had not had any problems with it making me drowsy. But that day it did. A ride came  for me and car was left at the scene, he shook my hand and said be careful. I am very much appreciative for his discretion and glad he pulled me over. If I would have fallen asleep at the wheel and injured someone I could never live with myself. :sad:


----------



## VentMedic (May 22, 2009)

garett1979 said:


> No the MD didnt cause the patient refused care. The MD was told of the call on a later transport, and found it quite humerous a person would call 911 for taking three tylenols.


 
If the patient did not get transported was it because the Paramedic with you gave the patient some assurance?  Or, did you and the Paramedic try your best to humiliate the patient into not going to the hospital?

As it has been stated before and you should also know this, there have been numerous public service announcements about Tylenol. 

I find it totally immature for some healthcare professionals to criticize patients when they have been the ones that have put the fear of some things into the minds of the patients.   

I can see from you posts you also got a good laugh.  You are too new to be blowing off patient assessments.


----------



## VentMedic (May 22, 2009)

trevor1189 said:


> That is disturbing. Seriously...


 
No, this is disturbing.

http://www.emtlife.com/showthread.php?t=12834


----------



## trevor1189 (May 22, 2009)

VentMedic said:


> No, this is disturbing.
> 
> http://www.emtlife.com/showthread.php?t=12834



Correction: THAT is disturbing. I wouldn't want anyone with that history treating anyone I KNEW let alone loved.


----------



## garett1979 (May 22, 2009)

Yes the medic gave the pt assurance he would be fine. A proper assesment was done. But next time i will tell medflight to stand by!!


----------



## VentMedic (May 22, 2009)

garett1979 said:


> Yes the medic gave the pt assurance he would be fine. A proper assesment was done. But next time i will tell medflight to stand by!!


 
And another fine attitude for EMS.  When oh when will EMS ever become a medical profession with medical professionals?


----------



## garett1979 (May 23, 2009)

Had the MD ripped our butts saying we were totally in the wrong, I would have never posted the thread, but when he laughs about it, most others will as well. Why oh why do most medics, not all but most think they no more than the MD? Most medics have enough attitude for all ems put together. Again not all medics, just ones who think they no more than the MD


----------



## VentMedic (May 23, 2009)

garett1979 said:


> Had the MD ripped our butts saying we were totally in the wrong, I would have never posted the thread, but when he laughs about it, most others will as well. Why oh why do most medics, not all but most think they no more than the MD? Most medics have enough attitude for all ems put together. Again not all medics, just ones who think they no more than the MD


 
Look at your posts. You have laughed and made the assumptions about this patient. You are not even an EMT-B yet but believe yourself to be able to make a judgement about a patient on the same level as a doctor. From you attitude about people who do have more education than you, you may not go very far in EMS. You will probably use you opinion of educated people to not get an education yourself. 

Did you not learn anything from this thread? 

Seriously, the EMT-B level in the U.S. must be redone. This thread could be the poster model for that.


----------



## garett1979 (May 23, 2009)

Again vent you seem to be one of the only people who had a problem with this thread. And for the record I'm one of my instructors best students, I take ems very seriously, when someone who has more knowledge, and training makes there judgement by know means am I gonna say No your wrong we should do it this way!


----------



## CAOX3 (May 23, 2009)

VentMedic said:


> And another fine attitude for EMS.  When oh when will EMS ever become a medical profession with medical professionals?



Medical professionals can conduct a thorough assessment and come to the conclusion that not everybody is sick, rather then just transporting everyone to disguise their incompetence as providers. They want to go they go, they dont there advised of the risks involved if any exist.  I dont loose sleep either way.


----------



## garett1979 (May 23, 2009)

Thank you caox3 my point exactly


----------



## CAOX3 (May 23, 2009)

Garret you could have saved everyone ten minutes of their life that they can never get back if you were a little more descriptive in your first post.

Hope you run forms and refusal are a little more informative.

Sorry everyone for the attitude someone pissed in my corn flakes this morning. I cant shake the taste.


----------



## garett1979 (May 23, 2009)

CAOX3 i thought i was, but my apologies for not being more detailed about the call


----------



## VentMedic (May 23, 2009)

CAOX3 said:


> Medical professionals can conduct a thorough assessment and come to the conclusion that not everybody is sick, rather then just transporting everyone to disguise their incompetence as providers. They want to go they go, they dont there advised of the risks involved if any exist. I dont loose sleep either way.


 
With the training at the EMT-B level, this is not advisable.


----------



## Sasha (May 23, 2009)

> Again vent you seem to be one of the only people who had a problem with this thread.



Actually, she isn't. I and another have discussed this thread in great length via AIM. But she's the one taking her time to try and educate you. 

Vent is a very smart lady, I suggest instead of getting defensive you try and listen to what she's saying so you can learn something for the next call.

You made a mistake by making an assumption, but that's okay. We all make mistakes, that's how you learn. Let's learn for the next call, so you know what questions to ask to do a thorough assesment!


----------



## CAOX3 (May 23, 2009)

VentMedic said:


> With the training at the EMT-B level, this is not advisable.



My medical directors feel different.

I dont know what to tell ya write a congressman.  

By the way professional has nothing to do with education.  You cant seem to grasp that concept.


----------



## VentMedic (May 23, 2009)

CAOX3 said:


> My medical directors feel different.
> 
> I dont know what to tell ya write a congressman.
> 
> By the way professional has nothing to do with education. You cant seem to grasp that concept.


 
Here we go again.

110 hours of training does NOT give you professional status.  The Congressmen have already spoken on that which is why ambulance services are reimbursed as they are now`.   

No EMT-B should be making a judgement on medical calls to refuse transport.


----------



## garett1979 (May 23, 2009)

I keep reading 110 hrs. I just finished my training, and we were required to have 200 class room hrs, not including ride time


----------



## CAOX3 (May 24, 2009)

VentMedic said:


> Here we go again.
> 
> 110 hours of training does NOT give you professional status.  The Congressmen have already spoken on that which is why ambulance services are reimbursed as they are now`.
> 
> No EMT-B should be making a judgement on medical calls to refuse transport.



Anyway....


----------

