# Speak out against triage?



## vquintessence (Mar 10, 2009)

This is aimed at dual response systems, and I'll admit this is kind of a dumb poll, but I'm curious nonetheless.  How often do you get triaged something you don't feel comfortable with and why/what are those instances.  I'm not talking blatant negligence either, but for example:  Pleuretic CP, N/V, etc.


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## medic417 (Mar 10, 2009)

If you are not comfortable with it you should not take it.  That is why I hate the two seperate responses.  The ALS can decide hey its BLS and leave but if the BLS is not comfortable so what according to many.  Should always have a Paramedic on every ambulance then if the BLS patient turns ALS just switch whos driving.


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## boingo (Mar 11, 2009)

Why are they not comfortable?  If they aren't they should say something.  EMT's can and do take people to the hospital.  Not everyone will benefit from an ALS transport.


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## medic417 (Mar 11, 2009)

boingo said:


> Why are they not comfortable?  If they aren't they should say something.  EMT's can and do take people to the hospital.  Not everyone will benefit from an ALS transport.



But if a BLS feels more care could be done and they accept the step down to bls they have not done what is right for the patient.  

While not all calls end up being ALS all patients deserve the opportunity to have ALS if they go down hill.


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## Sasha (Mar 11, 2009)

> Not everyone will benefit from an ALS transport.



But everyone can benefit from an ALS assesment. Just because they called for a stubbed toe doesn't mean there isn't something else going on.



> How often do you get triaged something you don't feel comfortable with and why/what are those instances



This problem could be eliminated with a medic on every truck.


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## BossyCow (Mar 11, 2009)

Sasha said:


> This problem could be eliminated with a medic on every truck.



And a chicken in every pot, two cars in every garage, cradle to the grave healthcare and education for all, honest politicians in DC, ethics in the used car industry and a cell phone plan I can count on.... ah.. the wish list!


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## medic417 (Mar 11, 2009)

BossyCow said:


> And a chicken in every pot, two cars in every garage, cradle to the grave healthcare and education for all, honest politicians in DC, ethics in the used car industry and a cell phone plan I can count on.... ah.. the wish list!




Dreams do come true.


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## PapaBear434 (Mar 11, 2009)

We had ALS dump a woman with abdominal pain 10/10 on us (a BLS truck) a few weeks back.  Woman reported that she had an aortic dissection previously, and it felt exactly like this.

Turns out that she DID have just that.  Doctor said it extended down past her iliac crest, and looked like a peeled banana.  

Granted, there wasn't a terrible lot the Medic could have done for this, but if she would have crashed out in the back of the truck on the way to the hospital I imagine they could have did a hell of a lot more than we could back there.

We should have insisted that he come along, but I was new and stupid.  Won't happen again, I assure you.


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## BossyCow (Mar 11, 2009)

medic417 said:


> Dreams do come true.



ROFL yeah, but so far clicking my heels together and repeating "I do believe in ALS, I do believe in ALS, I do believe in ALS, I do believe in ALS," hasn't helped! Maybe I need to get some ruby slippers.


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## PapaBear434 (Mar 11, 2009)

BossyCow said:


> ROFL yeah, but so far clicking my heels together and repeating "I do believe in ALS, I do believe in ALS, I do believe in ALS, I do believe in ALS," hasn't helped! Maybe I need to get some ruby slippers.



Oh, those would be awful for EMS work.  Get some ruby steel toes, maybe.  Much safer.


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## boingo (Mar 11, 2009)

Why is it that the systems with a medic on every truck tend to be the same systems with poor intubation success rates and cardiac arrest survival?  LA has medics on all their fire trucks, yet the survival rate for OOH cardiac arrest is piss poor.  Should patients be inappropriately downgraded to BLS?  No.  There should be a robust QA/QI program in place to ensure its done properly, after a proper assesment, however putting medics in every truck for every stubbed toe does nothing to improve patient outcomes.


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## medic417 (Mar 11, 2009)

boingo said:


> Why is it that the systems with a medic on every truck tend to be the same systems with poor intubation success rates and cardiac arrest survival?  LA has medics on all their fire trucks, yet the survival rate for OOH cardiac arrest is piss poor.  Should patients be inappropriately downgraded to BLS?  No.  There should be a robust QA/QI program in place to ensure its done properly, after a proper assesment, however putting medics in every truck for every stubbed toe does nothing to improve patient outcomes.




LA is a bad example of a bad example.  That system is just broken.  When a system does not allow their Paramedics to interpet EKG that should tell you there are problems.  

Haveing properly educated Parmedics on every ambulance common sense says would improve patient outcomes.


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## AJ Hidell (Mar 11, 2009)

BossyCow said:


> ROFL yeah, but so far clicking my heels together and repeating "I do believe in ALS, I do believe in ALS, I do believe in ALS, I do believe in ALS," hasn't helped! Maybe I need to get some ruby slippers.


So you suggest that we simply accept that things suck, that there is nothing we can do about it, and that we should not even try to improve things?  Doesn't sound like a real plan to me.


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## AJ Hidell (Mar 11, 2009)

boingo said:


> Why is it that the systems with a medic on every truck tend to be the same systems with poor intubation success rates and cardiac arrest survival?


Mostly because those systems are typically fire-based and inadequately educated.


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## daedalus (Mar 11, 2009)

medic417 said:


> LA is a bad example of a bad example.  That system is just broken.  When a system does not allow their Paramedics to interpet EKG that should tell you there are problems.
> 
> Haveing properly educated Parmedics on every ambulance common sense says would improve patient outcomes.



AMEN!
Los Angeles = EMS stone age. Actually, at least paramedics in the stone age probably cared about there patients! That is even too much to say of Los Angeles "Fire medics".


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## vquintessence (Mar 12, 2009)

Prologue:Please... no more ALS vs BLS discussion in this thread, it's already infected a good deal of the threads lately.  We all know where most stand. h34r:

Well Papabear, thanks for providing the only post.  It's good to hear the woman didn't crash on you.  Why did the medics triage a woman in horrendous pain?  I'm curious the story they gave you and how they wrote their PCR.  Why did you & your partner go along with it at the time?

_Others please add your triage stories!_   I know you've got em!  Quick, before the thread codes. :sad:


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## Sapphyre (Mar 12, 2009)

sorry, VQ, I've already posted my one inappropriate triage story elsewhere on this site.  Not going to post it again.


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## AJ Hidell (Mar 12, 2009)

The most common mis-triage I see is in nursing home patients.  Dispatch seems to lower the priority level of nursing home patients at least one level below what they would prioritize any other citizen.  Consequently, units respond with less urgency, and without the benefit of first responders.  I can't count the number of times I have ended up with a critical or otherwise labor intensive patient in a nursing home that needed me faster than I got there, and with no extra hands to help me out.


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## EMT007 (Mar 12, 2009)

PapaBear434 said:


> Granted, there wasn't a terrible lot the Medic could have done for this, but if she would have crashed out in the back of the truck on the way to the hospital I imagine they could have did a hell of a lot more than we could back there.



If she had crashed on the way to the hospital, there isn't jack squat an MD could have done 

And Los Angeles doesn't have a medic on every truck, although that is their goal over the next few years. But yes, they are far from progessive.

As for the topic at hand, we don't really have any problems with triage. We have an excellent working relationship with the medics in our area. We tend to be comfortable with a lot, but the medics are always willing to take anything we say "hey, I'm not super comfortable with this one - can you take it?"

Works out well for us


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## PapaBear434 (Mar 13, 2009)

AJ Hidell said:


> The most common mis-triage I see is in nursing home patients.  Dispatch seems to lower the priority level of nursing home patients at least one level below what they would prioritize any other citizen.  Consequently, units respond with less urgency, and without the benefit of first responders.  I can't count the number of times I have ended up with a critical or otherwise labor intensive patient in a nursing home that needed me faster than I got there, and with no extra hands to help me out.



I've had that, as well as the flip side.  How many times have you arrived at a nursing home to have them tell you that their BP is 120/78, pulse is 82, and so on... Only to have NONE of those vitals actually be anywhere NEAR what they really are?  

I love made up turnovers.  Especially when they call for a "general illness."  In other words:  "We took the night shift for an easy gig, and this sick old codger that needs vitals checked every twenty minutes really cuts into my Harly-Quinn novel time.  Let's just call the Rescue Squad and let them take him to the ER."


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## PapaBear434 (Mar 13, 2009)

EMT007 said:


> If she had crashed on the way to the hospital, there isn't jack squat an MD could have done



Oh, I know.  But it was really more than we should have been handling as Basics.  Not cool of him to dump him on us.


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## VentMedic (Mar 13, 2009)

PapaBear434 said:


> I've had that, as well as the flip side. How many times have you arrived at a nursing home to have them tell you that their BP is 120/78, pulse is 82, and so on... Only to have NONE of those vitals actually be anywhere NEAR what they really are?
> 
> I love made up turnovers. Especially when they call for a "general illness." In other words: "We took the night shift for an easy gig, and this sick old codger that needs vitals checked every twenty minutes really cuts into my Harly-Quinn novel time. Let's just call the Rescue Squad and let them take him to the ER."


 
You really don't like nursing homes or nurses. 

Night shift at a NH is not a picnic. For one, they have fewer CNAs and may even have less licensed staff. I know the RRTs, PTs and OTs usually only work the day shift at NHs so the licensed will assume some of their responsibilty at night. The same charting and meds will have to be done. Wound care is around the clock. 

They do not provide ICU care. It the patient needs more than q shift vitals, except for those with some meds, they do not belong in the NH and need a higher level of care. No one should expect an RN taking care of 30+ patients to do adequate care on a patient requiring q 20 minute vitals and the other 29+ patients also. 

I think you need to broaden your knowledge about patient care and other professions before you make such a critical judgment. As an EMT you have the luxury of having only one patient to care for at a time and often some complain that is too much or screw up due to lack of attentiveness to the person on the cot. 

The sooner respect is given to others, the more likely you will get respect in return. 

BTW, vitals can change quickly. The RN may have taken the vitals one moment with them being relatively normal but then as he/she is letting you into the door, the patient's vitals can dump.


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## Sasha (Mar 13, 2009)

> "We took the night shift for an easy gig, and this sick old codger that needs vitals checked every twenty minutes really cuts into my Harly-Quinn novel time. Let's just call the Rescue Squad and let them take him to the ER."



Kind of like the EMTs who get bad attitudes because they got woken up or taken away from the internet time to run someone to the hospital.


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## firecoins (Mar 14, 2009)

Sasha said:


> But everyone can benefit from an ALS assesment. Just because they called for a stubbed toe doesn't mean there isn't something else going on.
> 
> 
> 
> This problem could be eliminated with a medic on every truck.



In the OP, the patient got an ALS assessment but the EMT is uncomfortable. Is this really a problem that requires a medic on every truck or an EMT-B level that requires more than a 150 hour course?


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## AJ Hidell (Mar 14, 2009)

firecoins said:


> Is this really a problem that requires a medic on every truck or an EMT-B level that requires more than a 150 hour course?


I don't really care what you label the final product, it does require at least about two years of education to produce.


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## PapaBear434 (Mar 14, 2009)

VentMedic said:


> You really don't like nursing homes or nurses.
> 
> Night shift at a NH is not a picnic. For one, they have fewer CNAs and may even have less licensed staff. I know the RRTs, PTs and OTs usually only work the day shift at NHs so the licensed will assume some of their responsibilty at night. The same charting and meds will have to be done. Wound care is around the clock.
> 
> ...



A lot of the homes around here employ LPN's almost exclusively at night.  The "Doctor on Call" usually gets a call and just tells them to call Rescue.

Incidentally, they are suppose to call medical transport for most of these calls, as they are non-emergent and the Doc just doesn't want to come in and wants the ER to look at them.  They call us since we don't charge patients for transport or treatment, so it saves the home money by not using all of their contracted transports with the transport company.

Look, my wife is an RN, and she did some time at a nursing home.  I did some volunteer work at one myself.  I saw what most of these nurses think of their patients.

Obviously I can't paint all nursing home nurses with the same brush, but there are enough that makes me assume incompetence unless proven otherwise.  When I show up and the standard answer of "I don't know, he's not my patient" is given while she's staring at the TV, I get a little upset.


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## PapaBear434 (Mar 14, 2009)

Sasha said:


> Kind of like the EMTs who get bad attitudes because they got woken up or taken away from the internet time to run someone to the hospital.



True enough.  I haven't got to the point of being angry at my patients yet, being fairly new, but I do have a healthy dislike of people charged with taking care of someone and only give it their passing interest.


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## VentMedic (Mar 14, 2009)

PapaBear434 said:


> A lot of the homes around here employ LPN's almost exclusively at night. The "Doctor on Call" usually gets a call and just tells them to call Rescue.
> 
> Incidentally, they are suppose to call medical transport for most of these calls, as they are non-emergent and the Doc just doesn't want to come in and wants the ER to look at them. They call us since we don't charge patients for transport or treatment, so it saves the home money by not using all of their contracted transports with the transport company.
> 
> ...


 
Wow! You really just have a bad attitude toward these nurses. If I had 30+ patients to look after and had a chance to sit for a moment, I think I would also. If you are in the ED with one patient and a doctor asks you about a patient another EMS crew brought in, what could you say? Do you know everything or anything about that patient? Don't waste time. Go to the source.

And, now you are blaming the doctor who might live an hour away. After the doctor finally arrives, he/she has access to no labs, X-rays, EKG or any other diagnostics. As good as some doctors may be, they don't rely on guessing to make a "field diagnosis". They are responsible for too many other disease processes, meds and therapies for that patient and must think of the whole plan of care to do something definitive...not just 15 minutes of band-aid first aid. 

The nursing home may have a non-emergent contract but hopefully they can still call EMS if the RN or physician believes it to be necessary. Unfortunately due to attitudes about NHs (like yours) and lack of understanding about patient care, some contracts discourage EMS calling regardless of the urgency. The nurse gets stuck in the middle with doing what should be right for the patient and bowing to the "Nursing Home calls are BS" attitudes from some EMS agencies. 

We also know what many EMT(P)s think of their patients. Some even entered the profession not realizing that there was patient care involved. Some just do it to ride in pretty trucks playing with the sirens or to get a good pension with the FD or county

Trying to show fault with others does not excuse the mess EMS is in and the attitudes of some providers. The sooner those in EMS start taking responsibilty for its own backyard, the sooner it can move forward. 

Maybe you should try to understand the difficult task of warehousing our nation's elderly instead of criticizing those who at least make an effort to care for them. It is a difficult job and their burn out rate is lot higher than EMS. These nurses must deal with many patients, their families, doctors, other professionals as well as EMT(P)s with crappy know it all attitudes who feel their time is too precious to waste on some BS old person call in a nursing home.


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## medic417 (Mar 14, 2009)

VentMedic said:


> Wow! You really just have a bad attitude toward these nurses. If I had 30+ patients to look after and had a chance to sit for a moment, I think I would also. If you are in the ED with one patient and a doctor asks you about a patient another EMS crew brought in, what could you say? Do you know everything or anything about that patient? Don't waste time. Go to the source.
> 
> And, now you are blaming the doctor who might live an hour away. After the doctor finally arrives, he/she has access to no labs, X-rays, EKG or any other diagnostics. As good as some doctors may be, they don't rely on guessing to make a "field diagnosis". They are responsible for too many other disease processes, meds and therapies for that patient and must thing of the whole plan of care to do something definitive...not just 15 minutes of band-aid first aid.
> 
> ...



My gripe is not the lazy nurses or lazy doctors but the lazy respiratory people that refuse to stay and volunteer at night to take care of the patients. If they would stay it would eliminate the majority of NH calls.


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## VentMedic (Mar 14, 2009)

medic417 said:


> My gripe is not the lazy nurses or lazy doctors but the lazy respiratory people that refuse to stay and volunteer at night to take care of the patients. If they would stay it would eliminate the majority of NH calls.


 
We're working on that. We've been trying to get Medicare to see it our way to pay for us the whole 24 hours. But, RT already has a few other Bills on the burner to improve patient care and enhance the profession. 

Besides, we wouldn't want some in EMS or on the transport ambulances to think no one needs them.


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## medic417 (Mar 14, 2009)

VentMedic said:


> We're working on that. We've been trying to get Medicare to see it our way to pay for us the whole 24 hours. But, RT already has a few other Bills on the burner to improve patient care and enhance the profession.
> 
> Besides, we wouldn't want some in EMS or on the transport ambulances to think no one needs them.




But if you really cared for the patients money would not be an issue.  Why should only those in EMS be expected to work for free?  h34r:


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## Sasha (Mar 14, 2009)

PapaBear434 said:


> True enough.  I haven't got to the point of being angry at my patients yet, being fairly new, but I do have a healthy dislike of people charged with taking care of someone and only give it their passing interest.



I'm not talking about towards your patients. Would you be sunshine and roses if everytime you called 911 for a patient you got someone with such a low opinion of you giving you grief? If they call it's "This is BS!" or "You should have called earlier!" it's like they can do no right and get bad attitudes 90% of the time. I have never read any post on this board praising nursing home nurses.


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## Sasha (Mar 14, 2009)

medic417 said:


> But if you really cared for the patients money would not be an issue.  Why should only those in EMS be expected to work for free?  h34r:



Because only those in EMS are willing to work for free!


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## medic417 (Mar 14, 2009)

Sasha said:


> I have never read any post on this board praising nursing home nurses.



I've seen one.


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## Sasha (Mar 14, 2009)

medic417 said:


> I've seen one.



Cheater!!

10


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## medic417 (Mar 14, 2009)

Sasha said:


> Cheater!!
> 
> 10




You were right and it needed to be done.  Thanks for a great idea.


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## PapaBear434 (Mar 14, 2009)

VentMedic said:


> Wow! You really just have a bad attitude toward these nurses. If I had 30+ patients to look after and had a chance to sit for a moment, I think I would also. If you are in the ED with one patient and a doctor asks you about a patient another EMS crew brought in, what could you say? Do you know everything or anything about that patient? Don't waste time. Go to the source.
> 
> And, now you are blaming the doctor who might live an hour away. After the doctor finally arrives, he/she has access to no labs, X-rays, EKG or any other diagnostics. As good as some doctors may be, they don't rely on guessing to make a "field diagnosis". They are responsible for too many other disease processes, meds and therapies for that patient and must think of the whole plan of care to do something definitive...not just 15 minutes of band-aid first aid.
> 
> ...



1) They don't have 30+ patients.  They have no more than eight, mandated by Virginia State law.  My issue comes with the fact that "The source" never seems to be available.  It's never their patient, they're just covering them.

2) The Doc on call stays there, in the home, while on call.  They have their own room on the other side of the facility.  It's, maybe, a fifteen minute walk.  "On Call" typically means "being available."  If they are slacking on their duties to not take the golf cart the plaza makes available to them, then it's their breach of duty, not mine in judging them to be lazy.

3) I have absolutely no problem coming and taking someone to the ER when they need it.  Most of the time, however, we show up and the nurse has no idea what the vitals are, pt. has a low grade fever, and we're lucky if we can get the nurse to take us down to the room.  Normally, she points from the desk and says "it's that way, turn left at the end of the hall, room 244, first bed."  If we are lucky enough to get a nurse to follow us down there, she sighs in an annoyed manner and generally acts like we are inconvieniencing her by asking about pt. meds or allergies (usually accompanied by a nasally sounding "Ttssk!  I don't know...").

4) I can't speak to the attitudes of the medics and EMT's out there.  All I know is my own view.  I got in to help people.  That's what I wanted to do.  There are much higher paying jobs I could be doing out there, but I choose to do this.  So when I see people that are charged with taking care of folks and see that they are nothing but cold and detached, yeah I get a little annoyed.  Same when I see one of our own talking about an unresponsive pt. like they are a smelly lump of meat right in front of them.  

5) Those that "make the effort," I like quite a bit.  My wife, for instance.  I am on a first name basis with a few of the nurses at the local complex, because I know that they go out of their way to make sure these poor souls are comfortable.  Even if they can't outwardly tell them so, they make sure they do whatever they can to make their lives a little bit better.  Gloria, Mrs. M (long Filipino name I can't say, so Mrs. M it is), and Samantha are great folks.  But even they say that most of their coworkers should get out of the job, because they obviously hate doing it.

In short:  You do your job, even if you don't like it, I'm cool with you.  You take care of the people you are charged with, whether you like them or not, I'm cool with you.  But I refuse to have any sympathy for those who let patient care suffer just because they are lazy or feel sorry for themselves.  If you are that burned out on the job, it's time to move on because you're doing more harm than good.


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## VentMedic (Mar 14, 2009)

PapaBear434 said:


> 1) They don't have 30+ patients. They have no more than eight, mandated by Virginia State law. My issue comes with the fact that "The source" never seems to be available. It's never their patient, they're just covering them.


 
Good for Virginia. Are you sure that law covers LTC facilites? Calfornia also has Nurse to patient ratio laws but it doe NOT apply to the nursing homes or any other LTC facility. 

You haven't been in many nursing homes or hospitals for that matter. In some areas, RN in the hospital may easily have 12 patients on med-surg and 7 on tele. In the sub-acutes with ventilators they have up to 10 vent patients and even a couple more that aren't. If the facilities do have an RRT, it may only be one for up to 30 ventilator patients and another 10 trachs for a total of 40 patients. Usually these facilities do not have RRTs at night and it is up to the RNs to do what they have been only minimally trained to do but are expected to know everything. 

That may be true that the nurse is just covering but that nurse is also covering his/her own patients for a combined of up to 60 patients in some places.



PapaBear434 said:


> 2) The Doc on call stays there, in the home, while on call. They have their own room on the other side of the facility. It's, maybe, a fifteen minute walk. "On Call" typically means "being available." If they are slacking on their duties to not take the golf cart the plaza makes available to them, then it's their breach of duty, not mine in judging them to be lazy.


A nursing home with its own doctor in house? Wow that is a luxury and unheard of in most areas. I stand corrected. You not only have a low opinion of nurses but also of doctors. If you are so certain they are negligent or breaching their duty, then grow some and confront them through your medical director or their licensing board. 



PapaBear434 said:


> 3) I have absolutely no problem coming and taking someone to the ER when they need it. Most of the time, however, we show up and the nurse has no idea what the vitals are, pt. has a low grade fever, and we're lucky if we can get the nurse to take us down to the room. Normally, she points from the desk and says "it's that way, turn left at the end of the hall, room 244, first bed." If we are lucky enough to get a nurse to follow us down there, she sighs in an annoyed manner and generally acts like we are inconvieniencing her by asking about pt. meds or allergies (usually accompanied by a nasally sounding "Ttssk! I don't know...").


 
Again, you only have one patient. The nurse still has many others that need care or you will be coming back for them also. He/She may think you can not move a patient with just two EMTs when a little CNA has been moving patients all night by her/his self. 



PapaBear434 said:


> 4) I can't speak to the attitudes of the medics and EMT's out there. All I know is my own view. I got in to help people. That's what I wanted to do. There are much higher paying jobs I could be doing out there, but I choose to do this. So when I see people that are charged with taking care of folks and see that they are nothing but cold and detached, yeah I get a little annoyed. Same when I see one of our own talking about an unresponsive pt. like they are a smelly lump of meat right in front of them.


 
Maybe they are just cold and detached toward you as your attitude toward them and for being there for just a little fever probably speaks for itself. 



PapaBear434 said:


> 5) Those that "make the effort," I like quite a bit. My wife, for instance. I am on a first name basis with a few of the nurses at the local complex, because I know that they go out of their way to make sure these poor souls are comfortable. Even if they can't outwardly tell them so, they make sure they do whatever they can to make their lives a little bit better. Gloria, Mrs. M (long Filipino name I can't say, so Mrs. M it is), and Samantha are great folks. But even they say that most of their coworkers should get out of the job, because they obviously hate doing it.


 
Again, the only thanks you get is from knowing you've helped some patients. You won't feel the love coming at you from all of the patients, the families, doctors, administrators and definitely not the pi**** off EMT(P)s you woke up to transport someone to the hospital. 




PapaBear434 said:


> In short: You do your job, even if you don't like it, I'm cool with you. You take care of the people you are charged with, whether you like them or not, I'm cool with you. But I refuse to have any sympathy for *those who let patient care suffer just because they are lazy or feel sorry for themselves. If you are that burned out on the job, it's time to move on because you're doing more harm than good*.


 
Funny how I get the same feeling about you by some of the things you have written on this forum. 

You only see these nurses for a few minutes. You know nothing about what their shift has been like and you immediately form an opinion which will then be present in your presentation to the staff and the patient. Maybe if you dropped your own negative attitude you might see things differently and even get treated differently.


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## Ridryder911 (Mar 14, 2009)

Never heard of such "nice restrictions". I know for a fact that one LPN in many nursing homes are responsible for up to a 50 and I have even seen up to 100 patients. The RN who is more management, oversees the LPN and others. 

A physician within a nursing home. Your kidding, right? It's must be nice thing to see ER's without doc's and you get nursing homes with them? Wow! Then if that is the case; why ship them? Personally, soon to be thirty two years in the biz.. and never seen nor heard of one actually that is within a nursing home. Makes rounds.. maybe?  I even think that is doubtful; that is why they have P.A.'s for. Can't imagine the costs; I bet it is a helluv 
a cost. 

I agree they don't always have the best nurses (usually get for what you pay for) and usually I don't discuss much; because it is usually wasting time. Yet again, I have seen EMT's that are unable to give me report of recent vital signs and a report.. (again, you get what you for.. maybe, we got short changed). The problem is they only had one patient and one task. 

In regards to your statement "_no more than eight"_ like to see the source. Here is a link to all States Nursing ratio and as of 12/2008 Virginia has NO ratio requirements. http://www.hpm.umn.edu/nhregsPlus/c...s_staff_ratios.htm#nursing_staff_ratios_table


Before you ***-u-me, look at that word r-e-a-l carefully.
R/r 911


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## AJ Hidell (Mar 14, 2009)

Sasha said:


> If they call it's "This is BS!" or "You should have called earlier!" it's like they can do no right and get bad attitudes 90% of the time.


This is the result of our EMT schools pumping their students heads full of lies.  They spend a whole 120 hours convincing them that they're going to be living heroic, exciting, and glamorous professional lives full of blood and guts, extricating victims, healing their trauma, and curing their cardiac arrest with a couple minutes of CPR.  Instead, the only extrications that most of them ever do is from a nursing home bed.  They heal nothing.  They cure nothing.  They just sit and stare at people for fifteen minute ambulance rides, not really knowing what is going on.  Consequently, they are very quickly disillusioned and cop a bad attitude, taking the frustration of their poor career choice out on their patients and the actual medical professionals who are making twice what the EMT is getting paid.  It's hard to imagine that anyone is still surprised by this.



Ridryder911 said:


> A physician within a nursing home. Your kidding, right?


Yeah, I'm calling BS on that one too.  Pics or it never happened.


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## PapaBear434 (Mar 14, 2009)

When I get off shift in the morning, I'll find the policy and post it up here.  Too tired to dig through Sentara's policy or state law statutes right now.  Just a quick clarification:

The doctor is NOT a live in Doc.  It's a rotating staff, like any other.  This place is run by Sentara, and it's a huge complex that takes up two square miles.  Some areas are assisted living, some are monitors living, and some are actual in patient, hospital-like wards that take care of the most sick and disabled.  And they have their own staff that works there.  

I don't mind getting called to the assisted living, or monitored living quarters.  In those cases, yes, a nurse may cover 30+ patients.  But those aren't the patients I'm talking about.  It's the folks in the hospital area.

During the day, it's fine.  They have plenty of Docs on hand, and we rarely get a BS call then.  But at night, each floor is covered by one Doc who is on call.  They have a room they can crash in, which is way nicer than any bunk room I've ever seen.  But, they went through 8-12 years of school, so I suppose they have earned the decorative pillows and mini-fridge.  

I don't know why you guys are ragging on me for being anti-lazy and anti-incompetent.  The nurses and doctors doing their jobs are great.  All the love in the world to them.  But the morons that sit there reading the paper and calling because the doc doesn't feel like putting on his pants deserve nothing but derision.


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## PapaBear434 (Mar 14, 2009)

AJ Hidell said:


> This is the result of our EMT schools pumping their students heads full of lies.  They spend a whole 120 hours convincing them that they're going to be living heroic, exciting, and glamorous professional lives full of blood and guts, extricating victims, healing their trauma, and curing their cardiac arrest with a couple minutes of CPR.  Instead, the only extrications that most of them ever do is from a nursing home bed.  They heal nothing.  They cure nothing.  They just sit and stare at people for fifteen minute ambulance rides, not really knowing what is going on.  Consequently, they are very quickly disillusioned and cop a bad attitude, taking the frustration of their poor career choice out on their patients and the actual medical professionals who are making twice what the EMT is getting paid.  It's hard to imagine that anyone is still surprised by this.



Yep.  Hate my wife with such a seething passion, because she makes so much more money and gets more respect than me.

I know where I am on the medical totem.  I have no problem with that.  I serve a purpose, and I'm ok with that.  But if you want to aspire to get that increased pay and responsibility, you should probably actually do the job assigned to you.  I am sure you and Rid would not abide one of your peers or one of your subordinates passing every buck that comes down their pike.  All I am asking is for them to do their job, not act like I am putting them out of their way by asking for a med list.


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## VentMedic (Mar 15, 2009)

PapaBear434 said:


> When I get off shift in the morning, I'll find the policy and post it up here. Too tired to dig through Sentara's policy or state law statutes right now. Just a quick clarification:
> 
> The doctor is NOT a live in Doc. It's a rotating staff, like any other. This place is run by Sentara, and it's a huge complex that takes up two square miles. Some areas are assisted living, some are monitors living, and some are actual in patient, hospital-like wards that take care of the most sick and disabled. And they have their own staff that works there.
> 
> ...


 
Better yet, just give me a link or PM me the telephone number of a nursing home that has 24 hour inhouse doctor coverage. Is this part of a hospital? Our SNF is within our facility so it has access to one of the hospital doctors but even then the patient may be transferred back to the hospital part. The only thing having a doctor inhouse does is get the patient transferred faster with more orders. You must understand patient acuity and what nursing homes are licensed to do. They can not initiate or run nitro drip or most other IVs except maybe antibiotics. Thus, the patient MUST be moved to a higher level of care. Maybe if I described in terms of an EMT calling a Paramedic for their patient you might understand some of this.


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## VentMedic (Mar 15, 2009)

Nevermind. I found the company you are talking about. It owns several hospitals which are nearby as well as various levels of facilities all woven into one. This is a totally different situation when a nursing home patient has immediate access to a hospital next or with the facility. That is like my hospital which has a SNF, Rehab and subacute. But, that is not a true representation of free standing nursing homes.


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## Ridryder911 (Mar 15, 2009)

AJ Hidell said:


> This is the result of our EMT schools pumping their students heads full of lies.  They spend a whole 120 hours convincing them that they're going to be living heroic, exciting, and glamorous professional lives full of blood and guts, extricating victims, healing their trauma, and curing their cardiac arrest with a couple minutes of CPR.  Instead, the only extrications that most of them ever do is from a nursing home bed.  They heal nothing.  They cure nothing.  They just sit and stare at people for fifteen minute ambulance rides, not really knowing what is going on.  Consequently, they are very quickly disillusioned and cop a bad attitude, taking the frustration of their poor career choice out on their patients and the actual medical professionals who are making twice what the EMT is getting paid.  It's hard to imagine that anyone is still surprised by this.



This should be posted in the first chapter of every EMT Text book, with a test and them signing a contract that they fully understood this. Then again tested in full at the end of the course. 

R/r911


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## PapaBear434 (Mar 15, 2009)

VentMedic said:


> Nevermind. I found the company you are talking about. It owns several hospitals which are nearby as well as various levels of facilities all woven into one. This is a totally different situation when a nursing home patient has immediate access to a hospital next or with the facility. That is like my hospital which has a SNF, Rehab and subacute. But, that is not a true representation of free standing nursing homes.



Yeah, I know it's not the usual situation.  But we have numerous other nursing home areas that ARE like the ones you were thinking of.  

I'll admit to everyone here that I am generalizing quite a bit.  I had a bad day with four of those calls I was railing on within five hours, and I was venting.  Same nurse twice, and she looked up from her book only once to look up where the patient was.  

Better pour it out on a random internet forum than in real life on some patient or nurse, but I feel that I owe you guys an apology all the same.

As far as Sentara goes... They are evil.  They own all but one hospital in the area, almost all the acute care facilities, and likely have their hands in anything medical related in the area.  Seriously, if it wasn't for the military being so big in the area, they'd have a total monopoly.


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## PapaBear434 (Mar 15, 2009)

Ridryder911 said:


> This should be posted in the first chapter of every EMT Text book, with a test and them signing a contract that they fully understood this. Then again tested in full at the end of the course.
> 
> R/r911



I was in the police department previous to this.  Trust me, I got over my naivete about the guts and glory of emergency work long ago.  95% of that job was paperwork.


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## Ridryder911 (Mar 15, 2009)

PapaBear434 said:


> I was in the police department previous to this.  Trust me, I got over my naivete about the guts and glory of emergency work long ago.  95% of that job was paperwork.


Something that should be added to the paragraph, the amount of paperwork and the realism is that it is a job. Administrators and others depend upon you to be thorough enough in your paperwork and knowledge to prevent litigation's and to be able to receive compensation. So yes, others depend upon you. 

R/r 911


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## PapaBear434 (Mar 15, 2009)

Ridryder911 said:


> Something that should be added to the paragraph, the amount of paperwork and the realism is that it is a job. Administrators and others depend upon you to be thorough enough in your paperwork and knowledge to prevent litigation's and to be able to receive compensation. So yes, others depend upon you.
> 
> R/r 911



To make it more accurate, they should make that paragraph fifteen pages long, with lots of charts and check boxes to fill out, and don't forget to press REALLY hard to get through all six carbon-pages.


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