# Why the hate on dialysis runs?



## SurfEMT (Oct 21, 2013)

I've been an EMT for several years in the LA area and have never IFT'd a dialysis patient. Yep. True story. When I mention this to others, the response is that I'm lucky, or that being a "dialysis taxi" sucks, or words and sentiments to that effect. So excuse my Mary Poppins moment when I ask: "What's so awful about transporting dialysis pts.? Why the hate on dialysis runs? What can I expect when I finally get one?"
Thanks.


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## Tigger (Oct 21, 2013)

Nothing.

It's the people that thought getting their EMT would immediately get them a ticket to running shootings, rollovers, and cardiac arrests every shift who complain incessantly about it. 

In reality, many EMT jobs are almost purely IFT. Dialysis patients make companies a lot of money. Almost a guaranteed six transports a week until well, often times death. Anyone that thinks these patients are beneath them compared to other IFT transports is not seeing the whole picture. Often times EMTs will moan about how dialysis patients don't _really_ need an ambulance to get to the clinic. Whether or not they are right are wrong does not get around the fact that many of the ED to SNF discharges or BLS hospital to hospital calls also probably don't need ambulance level of care. BLS IFTs by definition are not acutely ill, but that does not mean they do not need medically trained transportation, and like it or not the BLS ambulance is about all that exists in this country to provide that.


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## unleashedfury (Oct 21, 2013)

Generally dialysis runs the patients require no medical attention, and you become a shuffle truck so to speak. 

You run one to dialysis, return another, and that's your day shuffling dialysis patients. 

Which gets kinda boring after a while, But reality is IFT dialysis runs pay the bills. Your paycheck and keeps the company in the green. 

911 doesn't always guarantee a payday. Some insurances will pay some, if you get any money at all. 

IFT is almost a guaranteed 100% pay, or your company would not do the transport.


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## Tigger (Oct 21, 2013)

unleashedfury said:


> Generally dialysis runs the patients require no medical attention, and you become a shuffle truck so to speak.
> 
> You run one to dialysis, return another, and that's your day shuffling dialysis patients.
> 
> A lot of dialysis pts have a GCS incompatible with life so you can't even talk to them. Which gets kinda boring after a while.



Most BLS transfers don't require any treatment period. All require your attention, even if that means concentrating on providing excellent customer service along with transportation.


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## unleashedfury (Oct 21, 2013)

Tigger said:


> Most BLS transfers don't require any treatment period. All require your attention, even if that means concentrating on providing excellent customer service along with transportation.



Much better put than I could say it. Ive been trying to get my company to start to dip into the IFT side of things but they don't want to add another crew to start IFT transports, So we let the IFT company down the street take it all.


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## Bullets (Oct 21, 2013)

As a 911 provider, going to the dialysis centers are usually calls that result in aggravation. Getting called for variances in blood pressure happen often but require little interventions and take a 911 ambulance from the street for a complaint that will rectify itself given some time


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## mountainmomma (Oct 21, 2013)

I have run quite a few dialysis PT's when I worked for a small private transport. These folks are human beings and generally have more going on then just dialysis. I found I liked all of them very much, even the ones with dementia,Alzheimer's and some that had strokes in the past. Quite a few of them had PEG tubes and foley's. This is not the kind of Pt that can just take a Taxi ride for dialysis. I enjoyed it very much but unfortunately the company I was working for just closed up shop one day and that was it.
 Good luck and I will say Dialysis PT's are not bad at all!


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## Ewok Jerky (Oct 21, 2013)

double the paperwork and rude staff plus lots of time waiting "just a few minutes" for the machine to finish.


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## Jon (Oct 21, 2013)

It's a combination of factors. One is that many of the runs are on shaky medical necessity to begin with. Often the patients are more "demanding" than the average patient. A big part of this is that they are more comfortable with the setting, so they ask for it things that the average patient doesn't feel comfortable asking for. 

You have to write 2 charts...  coming and going.

It's not sexy.

No one tells war stories about "that good dialysis transfer"


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## Bullets (Oct 22, 2013)

beano said:


> double the paperwork and rude staff plus lots of time waiting "just a few minutes" for the machine to finish.



Also this, when we do actually get sent for what seems to be an emergency, Cardiac or Pulmonary, we have to wait for them to disconnect the machine and stop the bleeding before we can transport. 

If you are calling 911, why are you only disconnecting the machine when we arrive?


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## chaz90 (Oct 22, 2013)

Bullets said:


> Also this, when we do actually get sent for what seems to be an emergency, Cardiac or Pulmonary, we have to wait for them to disconnect the machine and stop the bleeding before we can transport.
> 
> If you are calling 911, why are you only disconnecting the machine when we arrive?



I see what you mean, but think about how many of these cardiac and pulmonary problems are caused by electrolyte or fluid issues. In many cases, dialysis is just what the patient needs, and leaving them on the machine as long as possible is the best fix we can provide.


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## NomadicMedic (Oct 22, 2013)

And the clot time can be lengthy for some of these folks. I've started interventions while a patient is still getting D/Ced from the dialysis machine. I guess I just got there too quickly. :/


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## johnrsemt (Oct 22, 2013)

Dialysis transfers are educational; if you approach them the right way.

That is where I learned about medications;   I had a program in my PDA (you can get them in apps, on smartphones/I-phones now) that you enter the medication and it gives you what it is for, what the side effects are, etc.    
  That gave me a large head start for medic school;  knowing the medications ahead of time.

   Also you can usually talk to the patients:  ask them questions, what their symptoms are when they have problems;  etc.     

  Always do at least 2 sets of vital signs;  at the unit and as you get to destination.     Saves alot of headaches.    wait till you get back to the ECF to take the only set of VS and find out that the patient has a BP of 50/20,  when the Dialysis center could have fixed it for thepatient before you transported them.   Now you have to write more on your chart of why you had to go to the ED


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## Rano Pano (Oct 22, 2013)

SurfEMT said:


> I've been an EMT for several years in the LA area and have never IFT'd a dialysis patient. Yep. True story. When I mention this to others, the response is that I'm lucky, or that being a "dialysis taxi" sucks, or words and sentiments to that effect. So excuse my Mary Poppins moment when I ask: "What's so awful about transporting dialysis pts.? Why the hate on dialysis runs? What can I expect when I finally get one?"
> Thanks.



It's not the act of one run that does it. It's solely doing ifts all day long.

Run 24's for dialysis for 6 months..... Then we shall see who stays "Mary popping" and who gets burnt out.


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## Bullets (Oct 22, 2013)

chaz90 said:


> I see what you mean, but think about how many of these cardiac and pulmonary problems are caused by electrolyte or fluid issues. In many cases, dialysis is just what the patient needs, and leaving them on the machine as long as possible is the best fix we can provide.



Oh I agree as to the cause but once you decide to call an EMERGENCY ambulance, for whatever reason, then it's time for dialysis to end.

my favorite is the complaints that had an onset of around 4 hours....how long is the treatment? 4 hours


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## Tigger (Oct 22, 2013)

Rano Pano said:


> It's not the act of one run that does it. It's solely doing ifts all day long.
> 
> Run 24's for dialysis for 6 months..... Then we shall see who stays "Mary popping" and who gets burnt out.



Did it for a year. Not 100% dialysis, but the majority. Didn't really hate it that much, certainly wasn't burnt out.


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## NomadicMedic (Oct 22, 2013)

I did it too. Learned a lot about chronically ill patients, moved a lot of patients to bed and back. Met some really nice people.


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## abckidsmom (Oct 22, 2013)

I spent a couple of years doing mostly IFT. Rural dialysis runs hurt more, just saying. 

But I got to know a few really interesting old people, and I read a lot of books while getting paid. 

It's all part of the job, just not glamorous.


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## Hunter (Oct 23, 2013)

Jon said:


> No one tells war stories about "that good dialysis transfer"



45 y/o m post dialysis, scheduled customer and we transport goon a few times a week, bp of 90/40 and dropping, BLS truck so can't get a line or ekg, keeps going in and out of consciousness. Transported to ER which was less than 3 minutes away, coded 30 seconds after we dropped him off, they brought him back after a shock, fluid bolus and dopamine helped stabilize him. The dialysis clinic hasn't checked his bp in the last 30 minutes, if we weren't there and didn't do our job correctly he would've coded on the way home would've been 5-10 minutes before als and probly wouldn't have noticed right away. We saved that guys life. He was discharged a few days later, no deficiencies.


Edit
This was the easiest, best job I've ever had in my entire life, writing a report during a 20+ minute transport was cake, taking vital signs every 15 was a joke. I got to drive around and get to know my city better than most people. Learned a lot from stone really good people, lessened a lot about medications and history and how they relate. I could go on and on. That job is what you make of it, people just don't know how to see the good and positive.


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## unleashedfury (Oct 23, 2013)

Hunter said:


> 45 y/o m post dialysis, scheduled customer and we transport goon a few times a week, bp of 90/40 and dropping, BLS truck so can't get a line or ekg, keeps going in and out of consciousness. Transported to ER which was less than 3 minutes away, coded 30 seconds after we dropped him off, they brought him back after a shock, fluid bolus and dopamine helped stabilize him. The dialysis clinic hasn't checked his bp in the last 30 minutes, if we weren't there and didn't do our job correctly he would've coded on the way home would've been 5-10 minutes before als and probly wouldn't have noticed right away. We saved that guys life. He was discharged a few days later, no deficiencies.
> 
> 
> Edit
> This was the easiest, best job I've ever had in my entire life, writing a report during a 20+ minute transport was cake, taking vital signs every 15 was a joke. I got to drive around and get to know my city better than most people. Learned a lot from stone really good people, lessened a lot about medications and history and how they relate. I could go on and on. That job is what you make of it, people just don't know how to see the good and positive.



I had a Dialysis patient code on me once, we brought him back to find out later he was a DNR. (dialysis transfer paperwork said nothing about DNR) So honoring his wishes family came out and had him extubated to die on a floor in the hospital. Needless to say he lived another week.


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## FireMedic22 (Oct 23, 2013)

For some it's easier but I've had a few coworkers that couldn't handle watching the same people day after day slowly die.


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## unleashedfury (Oct 23, 2013)

I used to have one I took every Tuesday morning. I worked 7a-7p that day on a 911 truck. This woman was in a assisted living facility who would go for dialysis and her appt. was at 7am. in the town I worked in. 

She was a sweet old lady and to save the hassle of having a non emergency driver come in that early for one call, I used to take a wheel chair van home Monday night and pick her up at 6am. The company would punch me in at 530 when I left my home I would pick her up take her to dialysis and report for my shift. I never minded doing it I took her every Tuesday until she passed. She was the sweetest old lady you would ever meet. and that was the last of my dailsys runs


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## Kevinf (Oct 25, 2013)

I went to pick up a patient to take them to routine dialysis only to find the pt completely unresponsive at the ECF. I had taken the pt back from dialysis the previous day, aware that that they had not been able to successfully complete dialysis several times that week; severe sepsis was an easy conclusion. Off to the hospital we went. I was at the same ED later that day and I saw that they were able to wake the patient long enough for the family to say their goodbyes. This patient had been in constant pain and had a very low quality of life, so no more suffering at least.

On a not-so-side note, the staff at the facility we had gone to pick the patient up from didn't seem to realize that they had dressed an unresponsive patient in a profound medical emergency that morning, so we walked into the facility for a nice little gotcha. :glare:


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## PaulEMT (Oct 25, 2013)

I guess I don't like the "Renal Roundup" because it's not what I was trained to do. Spent 4 months in EMT school, learning how to try to save lives, and suddenly I'm a UPS driver for people....

...getting paid less than the actual UPS drivers.


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## STXmedic (Oct 25, 2013)

PaulEMT said:


> I guess I don't like the "Renal Roundup" because it's not what I was trained to do. Spent 4 months in EMT school, learning how to try to save lives, and suddenly I'm a UPS driver for people....
> 
> ...getting paid less than the actual UPS drivers.



How much life saving did you actually learn in 4 months. That mentality won't last you too long in this field- dialysis derby or not.


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## PaulEMT (Oct 25, 2013)

STXmedic said:


> How much life saving did you actually learn in 4 months. That mentality won't last you too long in this field- dialysis derby or not.



The "E" stands for "Emergency". The "T" stands for "Technician", not "transport".

It's not in my job description, not what I trained for, not what I studied for.


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## STXmedic (Oct 25, 2013)

PaulEMT said:


> The "E" stands for "Emergency". The "T" stands for "Technician", not "transport".
> 
> It's not in my job description, not what I trained for, not what I studied for.



I'm willing to bet transporting patients, emergency or not, is in your job description.

Again, how much about saving a life could you actually learn in roughly 120hrs.

Out of curiosity- how long have you been an EMT, bud?


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## Carlos Danger (Oct 25, 2013)

PaulEMT said:


> I guess I don't like the "Renal Roundup" because it's not what I was trained to do. Spent 4 months in EMT school, learning how to try to save lives, and suddenly I'm a UPS driver for people....



I think this very honest statement speaks to a much larger issue within EMS culture and EMS education.

EMS education, marketing, equipment, clothing, vehicle design, culture, etc. is still almost _solely_ focused on response to and identification, management, and transport of people experiencing life-threatening emergencies. The reality though, is that out of all responses / transports, EMS personnel probably perform a life-saving intervention way less than 1% of the time. A higher % in 911 of course, but still very low compared to what the training and culture would indicate.

No one should be surprised at predominantly young, "type-A" people feeling bored and disenfranchised when they were told that EMT's "respond to emergencies and save lives", then went to EMT school where they were taught  how to "respond to emergencies and save lives", and then were put to work doing nothing of the sort.

I'm not saying it's right or wrong for people to dislike non-acute transports, I'm just saying it's very predictable and understandable.


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## Tigger (Oct 25, 2013)

PaulEMT said:


> I guess I don't like the "Renal Roundup" because it's not what I was trained to do. Spent 4 months in EMT school, learning how to try to save lives, and suddenly I'm a UPS driver for people....
> 
> ...getting paid less than the actual UPS drivers.



You were trained to provide patient care. Sometimes, that care could save a life. But most times, no matter what the setting, that's not really what goes down.

I don't understand how everyone is so surprised to find that their first EMT job is doing mostly BLS transports. It doesn't take very long to do a little research before the class to realize you probably aren't gonna land a full time 911 job right out of EMT school. People do it, but for the most part if you live in a city you're going to have to cut your teeth like everyone else. 

Also, you probably "save more lives" transporting dialysis patients in a week than a 911 crew does in a month if you really want to look at it like that. One is just more acute than the other.


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## chaz90 (Oct 25, 2013)

PaulEMT said:


> The "E" stands for "Emergency". The "T" stands for "Technician", not "transport".
> 
> It's not in my job description, not what I trained for, not what I studied for.



Do you think technician is some glorified term worthy of respect? The primary job of an EMT is absolutely to provide transport. That's what the position was designed for, and that remains the primary goal of every EMS system in this country. I won't go on too much as everything I would like to say has already been mentioned in the previous few posts, but prepare for an attitude adjustment. Your expectations for what EMS is appear to be wildly inaccurate.


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## wanderingmedic (Oct 25, 2013)

PaulEMT said:


> I guess I don't like the "Renal Roundup" because it's not what I was trained to do. Spent 4 months in EMT school, learning how to try to save lives, and suddenly I'm a UPS driver for people....
> 
> ...getting paid less than the actual UPS drivers.



I love these. I get paid to sit and study (I'm still in college). It's a super job if you are trying to finish a degree...which I highly recommend you do.


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## Kevinf (Oct 25, 2013)

PaulEMT said:


> I guess I don't like the "Renal Roundup" because it's not what I was trained to do. Spent 4 months in EMT school, learning how to try to save lives, and suddenly I'm a UPS driver for people....
> 
> ...getting paid less than the actual UPS drivers.



Around here transport employers pay significantly better than 911 employers (to the tune of several dollars an hour better).

I work full time in a transport company. I've not terribly infrequently had to redirect to the ED to or from dialysis runs. And given the amount of time we're on the road it is not unusual for us to witness an accident and thus be the very first crew on scene... no PD, no fire, no help waiting for you. Just you and your partner. We've witnessed major accidents, found people lying unconscious in ditches, even had a bicyclist fall of his bike and start seizing in front of us. Just because you are doing "just transport" that day doesn't mean you'll never see anything else. 

If you are concerned about money, go be an RN or PA or MD... or a delivery driver. They make a very respectable living. 

BTW, even most ED docs often spend most of their day doing "scut" work, very little life saving at any given moment.


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## AtlasFlyer (Oct 25, 2013)

In my EMT class last spring, we were told quite honestly that a lot of of what we were being trained for was called "patient care", and that the "glory" and "lifesaving" were pretty rare and not really a part of daily EMT life. Anyone who left the EMT class I took with any delusions of life being like "Chicago Fire" or "Emergency!" weren't paying attention in class.


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## PaulEMT (Oct 26, 2013)

STXmedic said:


> I'm willing to bet transporting patients, emergency or not, is in your job description.
> 
> Again, how much about saving a life could you actually learn in roughly 120hrs.
> 
> Out of curiosity- how long have you been an EMT, bud?



15 years. Done volunteer, paid, works with medics.


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## STXmedic (Oct 27, 2013)

PaulEMT said:


> 15 years. Done volunteer, paid, works with medics.



One would think somebody with 15 years would know and understand what our job and "job description" was...  :unsure:


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## ZombieEMT (Oct 27, 2013)

PaulEMT, I do think chaz90 is correct, but I also feel that you took it the wrong way. EMS and/or IFT was created for the purpose of transport. Yes, we do emergencies, but even in emergencies our primary purpose is transport. We provide care and attempt to promote life, but we are not a clinic. It is a not our goal to treat and release every patient, it is our mission to get people to the hospital or dialysis if needed.

I do not think any of the other responses were disrepectful, just accurate.


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## usalsfyre (Oct 27, 2013)

What's funny is I probably dealt with more genuine life threats doing IFT than 911 (and that excludes the CCT portion of that job). The "renal round up" patients are train wrecks. Answering the phone for med consults now I can usually count on diverting at least one and often more scheduled transports to the ED because the patient is decompensating. 

But of course we're only providing competent medical care and not running around at breakneck speeds with the woo woo's and flashies going so what the heck do we know?


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## MMiz (Oct 27, 2013)

I notice this thread is quickly degenerating into name calling and other childish games.

Prove your point with solid arguments.  Name calling is necessary and violates our rules.


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## Hunter (Oct 27, 2013)

HaleEMT said:


> PaulEMT, I do think chaz90 is correct, but I also feel that you took it the wrong way. EMS and/or IFT was created for the purpose of transport. Yes, we do emergencies, but even in emergencies our primary purpose is transport. We provide care and attempt to promote life, but we are not a clinic. It is a not our goal to treat and release every patient, it is our mission to get people to the hospital or dialysis if needed.
> 
> I do not think any of the other responses were disrepectful, just accurate.



This, it's specially true in real emergencies, people don't need us they need a hospital to fix them. They need an OR, blood transfusion, insuline drip, thrombolitics, xrays or.... dialysis... and our job is to get them to the most appropriate facility alive and to monitor them en route. Taking people to dialysis is exactly what we were trained for. Paul, stop and think about it for a second you'll realise what we're saying.


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## NObama (Nov 17, 2013)

dialysis runs generally blow, theyre monotonous, con homes suck, and the patients are often lifeless shells, but they are also our bread and butter. Without them, most EMS workers would not be getting a paycheck...where I am, pay rate for 911 runs is about 28%(which is considered decent), then consider that BLS is all pre-scheduled and approved by insurance, so while medicare/medicaid may not pay the full amount, they are still getting payed almost 100% of the time....


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## Clipper1 (Nov 18, 2013)

NObama said:


> dialysis runs generally blow, theyre monotonous, con homes suck, and the patients are often lifeless shells, but they are also our bread and butter. Without them, most EMS workers would not be getting a paycheck...where I am, pay rate for 911 runs is about 28%(which is considered decent), then consider that BLS is all pre-scheduled and approved by insurance, so while medicare/medicaid may not pay the full amount, they are still getting payed almost 100% of the time....



It you read the chart you might find that the many of these patients may have been some EMS crew's "save".  No everyone walks out of the hospital and throws you a party after you save their life or screw up in the field. See if you can find out how many were botched intubations or given the wrong meds and might have had a chance of full recovery if something had not gone very wrong. Yeah it sucks to be in a nursing home but I doubt if any of these patients had a choice. Most are in less than desirable places because they can not afford more.  I doubt if any of these patients planned on being a dialysis patient either.  So cut these patients a little slack. Even if they made bad lifestyle choices they still deserve respect and care.


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## bill williams (Nov 18, 2013)

I enjoy riding with most of out dialysis patients. Alot of them are very nice people, however some of them treat you like you're the scum of the earth. 
Working for a company that does nothing but dialysis, discharges, IFT's, and Dr. Appts.....dialysis gets a little old after 6 years in the private industry.


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## Amberlamps916 (Nov 18, 2013)

Clipper1 said:


> It you read the chart you might find that the many of these patients may have been some EMS crew's "save".  No everyone walks out of the hospital and throws you a party after you save their life or screw up in the field. See if you can find out how many were botched intubations or given the wrong meds and might have had a chance of full recovery if something had not gone very wrong. Yeah it sucks to be in a nursing home but I doubt if any of these patients had a choice. Most are in less than desirable places because they can not afford more.  I doubt if any of these patients planned on being a dialysis patient either.  So cut these patients a little slack. Even if they made bad lifestyle choices they still deserve respect and care.



Pretty sure he wasn't insulting his patient's lifestyle choices. Just the fact that he had to transport armless/legless/on a vent Mrs. Rothsteinowitzpaletzkissingerberg to dialysis just so their family can reap the rewards of their prolonged and lifeless existense. (Financial rewards)


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## Clipper1 (Nov 19, 2013)

Addrobo said:


> Pretty sure he wasn't insulting his patient's lifestyle choices. Just the fact that he had to transport armless/legless/on a vent Mrs. Rothsteinowitzpaletzkissingerberg to dialysis just so their family can reap the rewards of their prolonged and lifeless existense. (Financial rewards)



Your description here is exactly what I was referring to. Several in EMS involved in transporting dialysis patients assume all dialysis patients are like you describe and that the families are collecting the money from some pension or welfare. Did you know that many of the patients are young and have renal disease due to cardiac arrest, diabetes and trauma? Their benefits barely cover the basic care and only if a family member gives up their job to become a full time care giver for a small monthly check is any money collected.  Even for the patient you described you probably have no idea what decisions this person made for their care. The are many people who require alot of care and most of us might not "right now" think we want to live that way. But, if you have something or someone to live for you might want to stick around no matter how bad the situation.  You need to not judge people by your own attitudes or personal feelings especially if you don't have all the details of this person's life.


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