# My BIGGEST pet peeves



## Sasha (Jul 21, 2011)

"Dont drop me"

"easy on the bumps"

Aaaaaarggghhhhh!!!!!!!!!


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## STXmedic (Jul 21, 2011)

"You can turn here"

"I don't know if we can do that"

Inefficiency is a BIG one of mine!


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## sirengirl (Jul 21, 2011)

"but how long will i be in the hospital? i dont want to be there long."





let me consult my crystal ball :glare:


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## Lifeguards For Life (Jul 21, 2011)

"why are you such a jerk?"

"how can i get in touch with your supervisor?"

"where can i file a complaint?"


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## LucidResq (Jul 21, 2011)

You can usually tell how bad an accident is up in dispatch by how many calls we get and who's calling (in serious injury accidents, the involved parties usually aren't the first on the phone).

When you call me because you got in an accident, it's the only call and you spend the first 5 minutes telling me how it was the other person's fault because they're an idiot and yada yada yada, and I ask you if anyone's hurt you declare "YES! I need an ambulance! I AM IN _*SHOCK*_!!!" but tell me you're not in pain, you're not bleeding or have any other complaint besides "shock," I am compelled to ask you if you need an ambulance every time someone throws you a surprise birthday party.

"He/she verbally assaulted me" is another surprisingly common and irritating phrase.


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## rmabrey (Jul 21, 2011)

whats this rash that ive been getting that looks like every rash thats caused by any number of things.


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## Sasha (Jul 21, 2011)

And she worked in five more dont drop mes on drop off aaaaaahhhhhhhhhhhvh! And i was supposed to clock out 20 minutes ago.


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## STXmedic (Jul 21, 2011)

"How long has this been going on?"
"Ohhhh.... For *insert any time frame imaginable that could be chronic*"


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## Lifeguards For Life (Jul 21, 2011)

- How bad is your pain?

- 10/10.....it's getting worse....OH GOD!

      *patient proceeds to answer cell phone and talk normally, hangs up

- Oh Dear Lord Help me, it hurts so bad ahhhh!


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## JPINFV (Jul 21, 2011)

LucidResq said:


> You can usually tell how bad an accident is up in dispatch by how many calls we get and who's calling (in serious injury accidents, the involved parties usually aren't the first on the phone).



This actually got me thinking. If involved with an accident that looks worse than it actually is, especially when the parties can clear the accident from the road and no one is hurt, would it be a good idea to call 911, report the accident, and let them know that no assistance is needed (except, if needed, a police report)? It could head off the drive by callers from sending the cavalry.


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## LucidResq (Jul 21, 2011)

JPINFV said:


> This actually got me thinking. If involved with an accident that looks worse than it actually is, especially when the parties can clear the accident from the road and no one is hurt, would it be a good idea to call 911, report the accident, and let them know that no assistance is needed (except, if needed, a police report)? It could head off the drive by callers from sending the cavalry.



It probably depends on the jurisdiction. I know that I appreciate it because although we only send fire/EMS on confirmed injury accidents (or biggies like rollovers/fires/etcs), we have to send PD hot if it's an unknown injury accident... and I'd rather NOT send anyone hot especially if we don't have to. I bet there are some places that roll out PD, Fire and EMS hot to every accident. We don't have the resources. 

If someone stops, talks to the drivers, and confirms no injuries, I appreciate it and won't send anyone hot or Fire/EMS until one of the drivers gets Allstateitis and decides to call us back 5 minutes later complaining of neck pain.  

Also, license plates are nice if you can get them. It's shocking how many hit and run accidents we get in which both drivers pull over, even talk to each other for a bit, and all of a sudden one of them panics and splits.


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## Shishkabob (Jul 21, 2011)

"I'm a hard stick, you ambulance drivers can never get an IV in..."


Me: "Ta-da.  You were saying?"


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## mycrofft (Jul 21, 2011)

*"Oh, give me the needle! You guys can't get a vein on me!".*

Then pt indicates between the fingers or the back of the knee as venous access sites.


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## STXmedic (Jul 21, 2011)

mycrofft said:


> Then pt indicates between the fingers or the back of the knee as venous access sites.



Gotta love the heroine junkies! "My only good vein is here.... No, no, you're off... Damnit I showed you where to go, you blew it!!" Ahahaha I love them!


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## Epi-do (Jul 21, 2011)

I am telling you, I always have a vein RIGHT THERE!

Am I/Is he/Is she going to go to jail?


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## Lifeguards For Life (Jul 21, 2011)

Epi-do said:


> Am I/Is he/Is she going to go to jail?



YES! this one.

I usually respond with "I hope so".

More so with the Is he going to jail question.

I have been to too many calls where a woman has been badly beaten by her boyfriend/fiance whomever, and they are almost always concerned about him going to jail.

In these situations, I always reply with "I sure hope so"


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## bigbaldguy (Jul 22, 2011)

"but can't you just pop it so I don't have to go to the hospital"


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## DesertMedic66 (Jul 22, 2011)

Patient agrees and wants to go to the hospital. Half way there they say "I don't think I need to go anymore can I go home?" 

On 5150 holds "NO!! I am not getting on the gurney!" and "I gotta pee!" even though we just offered to let them at the hospital and they say no. 

In SNFs you have a Spanish speaking patient and none of the nurses are willing to give you any info on the patient at all.


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## adamjh3 (Jul 22, 2011)

"Has he been medicated?" *indicating our patient who is about as big as Donkey Kong and is banging on the window behind us*
"No... don't you guys have restraints?"


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## Sasha (Jul 22, 2011)

adamjh3 said:


> "Has he been medicated?" *indicating our patient who is about as big as Donkey Kong and is banging on the window behind us*
> "No... don't you guys have restraints?"



A pet peeve with psychs. "Don't worry sweetheart, you're going home."

No they are NOT going home. They are smart enough to realize pretty much when we get out of the parking lot that they're not going home because their home is going to the right and we are turning left. 

I'm the one who has to deal with the schizophrenic or psychotic freaking the eff out. 

Because of this phrase I nearly got elbowed by a big buff schizophrenic before. 

When we saw the nurses later in the day again, we gave them a "Dont you EVER say that again" lecture.


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## usalsfyre (Jul 22, 2011)

"How much is this going to cost me" 
I really have no freaking clue....

"I want to go to (insert major medical center 40 miles away) because my heart/lung/stomach/cancer doctor's there"
I'm fairly certain your cardiologist isn't going to come see you for a GI complaint at 3am...

"Tell them they need to keep me this time!" 
I fairly certain, this being your third ED visit in as many days for a chronic complaint that hasn't warranted an admission before, they're probably going to discharge you from the ED. I wish they would admit you though, then I wouldn't have to pick you up next shift.

"I hate that hospital! They're so rude!" 
Perhaps because last time you were up there was ED visit number 20 this year for a vague non-specific complaint? If you go to major medical center way the heck away as much they're probably going to start being rude as well...

It's been a long past four or five shifts.


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## Elk Oil (Jul 22, 2011)

Linuss said:


> "I'm a hard stick, you ambulance drivers can never get an IV in..."
> 
> 
> Me: "Ta-da.  You were saying?"



Me: Yep... you're right.


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## mycrofft (Jul 22, 2011)

*"You're a nice young man, here, let me give you a little something"*

Hey! Where's my wallet?! POLICE!!POLICE!! HELP!!!! THIEF!!!".

(Pt is in SNF type hospital gown).


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## 46Young (Jul 22, 2011)

"I'm alergic to Toradol"

"I want detox"

"You my taxi"

Mispronouncing medical conditions and meds, or such as "peanut butter balls," "albatrawl," "a ferocious liver," "sick as hell," "I gots da sugars"

If I had a potentially deadly or debilitating disease, I might want to know how to at least pronounce it


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## Pheonsix (Jul 22, 2011)

This one gets me every time.....
Person calls 9-1-1......when I get there, the first thing they say.... Do I have to go to the hospital? Or a some version thereof.

This truly makes my blood boil.  And not much gets to me.


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## Shishkabob (Jul 22, 2011)

46Young reminded me....


ANY time a patient has no frikin clue what disease they have or why they were put on a medication... I now half to ask multiple ways for the same disease.



"you dont have high blood pressure or any heart disease? "
"I said no"
•Reads off multiple beta blockers, calcium channel blockers, etc etc•
"What do you take those for? "
"my heart"


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## LucidResq (Jul 22, 2011)

46Young said:


> Mispronouncing medical conditions and meds, or such as "peanut butter balls," "albatrawl," "a ferocious liver," "sick as hell," "I gots da sugars"



:rofl:

Congratulations. "I gots da sugars" just became a new catchphrase in our home.


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## STXmedic (Jul 22, 2011)

Lol down here it's "chugars"


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## Epi-do (Jul 22, 2011)

46Young said:


> Mispronouncing medical conditions and meds, or such as "peanut butter balls," "albatrawl," "a ferocious liver," "sick as hell," "I gots da sugars"



Don't forget "I gots high blood."


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## StickySideDown (Jul 23, 2011)

3 AM, call for a "Medical Emergency"

Dispatch : Caller reporting "Belly Pain"

Get on location PT states he no longer has pain and refuses transport. Sign my RMA form, get back to the station, snuggle into my cozy bunk, fall asleep, *GONG* repeat address for a "Medical Emergency".

A few more :

"Can I have some of that air?"
"Can't you give me some water?"
"Do you think I have to go to the hospital, because I don't want to be there all night."


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## sirengirl (Jul 23, 2011)

StickySideDown said:


> 3 AM, call for a "Medical Emergency"
> 
> Dispatch : Caller reporting "Belly Pain"
> 
> ...



That happened to me... except the second time they called they thought to tell us the patient had MRSA. Thanks for telling me that when I was leaning close being comforting and stuff. Jerks.


Also, the water part, super irks me. No you can not have water. No you can not grab a snack. I don't care if you're old enough to be my grandparent, I forbid you from putting anything in your mouth unless I am putting it there and it is either glucose, aspirin, or Nitro. If you're hungry or thirsty you better frickin' eat or drink before I walk in the door. My ambulance is not a meal-on-wheels van. :glare:


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## vamike (Jul 23, 2011)

Yep had a 85 year old male patient the other day we were taking to ER for back pain and dehydration.  AFTER we get to ER the family informs us he has MRSA and hep C.  Why didnt they tell us at the house?   GGGGRRRR.  Glad I always glove up before i hit the door.


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## Sasha (Jul 23, 2011)

How would that change your treatment of the patient?

Sent from LuLu using Tapatalk


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## Epi-do (Jul 23, 2011)

I don't think it is really about changing treatment for the patient as much as it is wanting to be aware of infectious diseases and allowed the opportunity to take any extra precautions, if needed.


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## Sasha (Jul 23, 2011)

You wear gloves regardless. What other percautions do you feel you should be taking?

Sent from LuLu using Tapatalk


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## usalsfyre (Jul 23, 2011)

vamike said:


> Glad I always glove up before i hit the door.


Speaking of pet peeves, this is one of mine. Everything you touch with gloves on increases the chance of the glove ripping or tearing. Not to mention gloves are not even recommended unless you expect to come in contact with bodily fluids. It's insane for you to put gloves on in the ambulance on the way to the call. Unless I'm doing invasive procedures or expect my hand might go in somewhere nasty I often don't put them on at all. 

For all the emphasis put on gloves when was the last time you saw an EMS provider put on eye protection and a mask when controlling an airway? EMS doesn't practice appropriate precautions. EMS puts on gloves....


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## JPINFV (Jul 23, 2011)

usalsfyre said:


> For all the emphasis put on gloves when was the last time you saw an EMS provider put on eye protection and a mask when controlling an airway? EMS doesn't practice appropriate precautions. EMS puts on gloves....




...but they're magical gloves CHARLIE, magical gloves that protect from all diseases entering at any location CHARLIE. Don't you believe in the magical gloves?


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## Elk Oil (Jul 23, 2011)

usalsfyre said:


> Not to mention gloves are not even recommended unless you expect to come in contact with bodily fluids. It's insane for you to put gloves on in the ambulance on the way to the call.
> 
> EMS doesn't practice appropriate precautions. EMS puts on gloves....



I'd argue that the basis of all our practical testing begins with stating we're taking body substance isolation precautions, so not only are gloves recommended, we're trained and certified in their use.  

I agree that many of us don't practice appropriate precautions.  What gets under my skin is watching EMTs handle blood and bloody items, insert IVs and touch nasty things without gloves on.

Personally, I put gloves while responding.  I don't think doing so is insane, I consider it appropriate.  Heck, I'd even recommend it!  It just makes one less thing to remember when on scene, and it means I can work faster because I don't have to stop and put a pair on (which is darn near impossible if I worked up a sweat carrying a patient anyway).


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## JPINFV (Jul 23, 2011)

Elk Oil said:


> I'd argue that the basis of all our practical testing begins with stating we're taking body substance isolation precautions, so not only are gloves recommended, we're trained and certified in their use.


You have to be trained and certified in the use of gloves?

Of course PPE stupidity isn't just limited to EMS. The amount of researchers who are terrified over ethidium bromide as some sort of cancer causing superagent that they faithfully wear latex gloves, despite evidence showing that latex gloves won't stop it anyways.


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## Elk Oil (Jul 23, 2011)

JPINFV said:


> You have to be trained and certified in the use of gloves?



Yes.  Critical criteria on each practical station of the NREMT certification begins with stating you're taking BSI.  So if you don't say it or demonstrate it, you fail the station.


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## Sasha (Jul 23, 2011)

While responding? That defeats the purpose of gloves, which can also be to protect the patient from the ickies you brought from the truck to them.

I wear gloves for pts on neutropenic percautions, when im dealing with body fluids (i may take a bgl without gloves, its fairly easy to do without touching blood) or open wounds or wet sheets

Be smart about glove use and not counterproductive.

Sent from LuLu using Tapatalk


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## Sasha (Jul 23, 2011)

Ps i probably wash my hands more than my glove wearing counterparts

Sent from LuLu using Tapatalk


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## usalsfyre (Jul 23, 2011)

Elk Oil said:


> I'd argue that the basis of all our practical testing begins with stating we're taking body substance isolation precautions, so not only are gloves recommended, we're trained and certified in their use.


I didn't say there wasn't a reason for the insanity, or that it's not deeply rooted in our psyche by tradition, but:






Elk Oil said:


> I agree that many of us don't practice appropriate precautions.  What gets under my skin is watching EMTs handle blood and bloody items, insert IVs and touch nasty things without gloves on.


While we shouldn't be doing any of these, your intact skin is a wonderful defense against blood borne pathogens. That's why we don't wear a full body condom. The issue with you hands specifically is that you skin is often non-intact due to microabraions and cracks from dryness (like the kind that comes from wearing gloves to much).



Elk Oil said:


> Personally, I put gloves while responding.  I don't think doing so is insane, I consider it appropriate.  Heck, I'd even recommend it!  It just makes one less thing to remember when on scene, and it means I can work faster because I don't have to stop and put a pair on (which is darn near impossible if I worked up a sweat carrying a patient anyway).


As I'm walking up to the patient I can make a pretty good assessment on the need for gloves. It only takes a couple of seconds to put them on.

Do you see physicians, nurses or other allied health professions putting gloves on for every patient encounter? My opinion on why gloves are stressed so much in the EMT curriculum is they consider is too uneducated to make a good needs assessment with regards to PPE. 

Every profession has its idiotic holdovers. Nursing has nursing diagnosis, we have this ridiculous notion that saying "scene safe, BSI" while waving our hands is a substitute for real education in these areas.


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## JPINFV (Jul 23, 2011)

Elk Oil said:


> Yes.  Critical criteria on each practical station of the NREMT certification begins with stating you're taking BSI.  So if you don't say it or demonstrate it, you fail the station.



1. BSI!=gloves. 
2. Trained in BSI!=certified in the use of "gloves." 
3. This entire line of thought exposes everything wrong with the piecemeal approach to interventions and knowledge that EMS has. 
4. JPINFV is proud to introduce 2 new courses. Advanced Glove Life Support and Basic Glove Life Support. Sign up today to get your card! We're also currently designing an International Glove Life Support class too!


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## usalsfyre (Jul 23, 2011)

Elk Oil said:


> Yes.  Critical criteria on each practical station of the NREMT certification begins with stating you're taking BSI.  So if you don't say it or demonstrate it, you fail the station.


Any service worth its salt is going to give you the boilerplate "BBP" course "certifying" you in the use of PPE anyway. NR's hand wave is in a word, insulting. If they REALLY wanted to test whether you knew about BSI, they'd have someone start projectile vomiting blood in the middle of a scenario and see if you stopped to don glasses, mask and gowns.


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## usalsfyre (Jul 23, 2011)

Sasha said:


> Ps i probably wash my hands more than my glove wearing counterparts
> 
> Sent from LuLu using Tapatalk



Agreed, the lack of hand washing I see among EMS providers sometimes is, in a word, disturbing.


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## usalsfyre (Jul 23, 2011)

JPINFV said:


> 1. BSI!=gloves.
> 2. Trained in BSI!=certified in the use of "gloves."
> 3. This entire line of thought exposes everything wrong with the piecemeal approach to interventions and knowledge that EMS has.


Similar to the reasons trying to teach why the renal system is important in heart failure beyond "fluid overload" and "lasix" makes me want to claw my eyes out at times.



JPINFV said:


> 4. JPINFV is proud to introduce 2 new courses. Advanced Glove Life Support and Basic Glove Life Support. Sign up today to get your card! We're also currently designing an International Glove Life Support class too!


Don't forget CC-Glove...


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## mikie (Jul 23, 2011)

*2 pet peeves, as a student*

"You don't need to know that as a paramedic..." - usually a RN preceptor during ER clinicals...I'm there to learn!  

and my biggest:

"The protocols says..."


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## JPINFV (Jul 23, 2011)

mikie said:


> "You don't need to know that as a paramedic..." - usually a RN preceptor during ER clinicals...I'm there to learn!



...which is why paramedics should spend the majority of their time following physicians instead of nurses. I'd even argue that paramedics have more in common with emergency physicians than emergency nurses.


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## Elk Oil (Jul 23, 2011)

You sure are one argumentative bunch of folks.  Your collective desire to pounce on someone and call him wrong, insane and idiotic speaks to larger issues I'm not going to address.  It also speaks to an issue I despise in EMS: calling others wrong simply because they don't do something the way you would or see it the way you do.  In my experiences, those who are so quick to tell others how wrong they are lack more than those they call wrong.

I cannot believe I'm in a position to defend reasonable statements promoting the use of gloves in EMS.  But then again, on another thread, I had to defend kindness and compassion, too  :sad:.  But I feel particularly up to a challenge, so if I have to, here 'goes:



Sasha said:


> While responding? That defeats the purpose of gloves, which can also be to protect the patient from the ickies you brought from the truck to them.



If I correctly recall a subject of another thread you started, whose safety comes first?  The purpose of BSI is to benefit the EMT, not the patient.  Would you also use a DuoDote on a patient???



JPINFV said:


> 1. BSI!=gloves.
> 2. Trained in BSI!=certified in the use of "gloves."
> 3. This entire line of thought exposes everything wrong with the piecemeal approach to interventions and knowledge that EMS has.
> 4. JPINFV is proud to introduce 2 new courses. Advanced Glove Life Support and Basic Glove Life Support. Sign up today to get your card! We're also currently designing an International Glove Life Support class too!



Am I supposed to believe that somehow by wearing gloves I am not taking BSI precautions?  I've handled many body fluids with gloved hands and am still living to tell the tales.



usalsfyre said:


> your intact skin is a wonderful defense against blood borne pathogens. That's why we don't wear a full body condom. The issue with you hands specifically is that you skin is often non-intact due to microabraions and cracks from dryness (like the kind that comes from wearing gloves to much).
> 
> Every profession has its idiotic holdovers. Nursing has nursing diagnosis, we have this ridiculous notion that saying "scene safe, BSI" while waving our hands is a substitute for real education in these areas.



There are many levels of BSI and PPE.  Gloves are simple and effective.  If the situation dictated, wouldn't you wear gown, mask, goggles, etc.?  Plus the fact that clothing provides a small measure of protection and our hands are always exposed.  We've all been bled or vomited on and haven't contracted anything because our shirts or pants took the brunt of it.  I think you're over-complicating a very simple concept here.  

And I, for one, don't contend that the notion of drilling into our minds the concept of BSI and scene safety is ridiculous.  Perhaps the cursory way of presenting it during our testing could be emphasized more, but the idea behind it is that it hopefully gets people to take the time they need to consider they myriad of safety variables at a call; to keep your eyes open; identify potential problems before they turn into real ones.



usalsfyre said:


> Any service worth its salt is going to give you the boilerplate "BBP" course "certifying" you in the use of PPE anyway. NR's hand wave is in a word, insulting. If they REALLY wanted to test whether you knew about BSI, they'd have someone start projectile vomiting blood in the middle of a scenario and see if you stopped to don glasses, mask and gowns.



Agreed, but they don't.  You can spend time in the "shoulda, coulda, woulda" mind set, but you're only spinning your wheels.  We've been given simple tools.  Don't talk yourself out of using them.

If you guys want to analyze every call to the Nth degree, deciding exactly at what point to put on gloves, be my guest.  But throwing a pair of gloves on shouldn't be the subject of a major debate.


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## crazycajun (Jul 23, 2011)

usalsfyre said:


> Speaking of pet peeves, this is one of mine. Everything you touch with gloves on increases the chance of the glove ripping or tearing. Not to mention gloves are not even recommended unless you expect to come in contact with bodily fluids. It's insane for you to put gloves on in the ambulance on the way to the call. Unless I'm doing invasive procedures or expect my hand might go in somewhere nasty I often don't put them on at all.
> 
> For all the emphasis put on gloves when was the last time you saw an EMS provider put on eye protection and a mask when controlling an airway? EMS doesn't practice appropriate precautions. EMS puts on gloves....



WE are required to wear safety glasses on every call. We are also required to glove up upon arrival and use mask and face shield for any invasive airway procedures. Our shift supervisors will ride to calls on occasion and do check.


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## usalsfyre (Jul 23, 2011)

Elk Oil, 

The idea that gloves are appropriate to put on prior to ever touching a patient IS wrong. The CDC publishes guidelines on the subject of PPE. For physical exam, which is 90% of what we do, what's recommend? Hand hygiene. Not gloves, gown, mask, ect. Does your PCP put gloves on to touch you? Do you put gloves in to shake hands? Why does arriving in an ambulance make you more susceptible to disease? It's perhaps not insane to don your gloves prior to arrival, maybe merely dumb. What happens when you rip a glove on the door and have to perform an invasive procedure? Do you carry an extra pair with you? Do you touch the ED keypad with contaminated gloves, then touch it again barehanded? You've defeated the purpose.

Meanwhile, how often do you see mask, glasses ect being employed when appropriate? You want to really protect yourself wear glasses, the eye is the one constantly exposed mucous membrane in our body. I've been through an eye splash exposure. Not fun.

As far as being argumentative? Yep, guilty as charged. Arguing that EMS dogma is wrong. Arguing that the ridiculous idea saying "BSI and scene safe" at the start of a scenario (which is as far as most programs take it) somehow prepares students to accurately assess the need for PPE and the safety of a scene. Arguing that inappropriate donning and use of PPE decreases it's effectiveness. Arguing against the idea that it's somehow acceptable for companies to skip out on OSHA mandated training. I'm an argumentative @ss. I personally think EMS needs more argumentative @sses to make anything of itself. But then that doesn't fit with some people's rosy world view, and others are afraid to run against the prevailing dogma. I prefer to be a heretic myself.


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## Shishkabob (Jul 23, 2011)

Honestly, I put gloves on 90% of the time before touching a patient.


People are icky.


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## JPINFV (Jul 23, 2011)

Elk Oil said:


> You sure are one argumentative bunch of folks.


What sort of discussion board would this be if there wasn't any discussions. 



> It also speaks to an issue I despise in EMS: calling others wrong simply because they don't do something the way you would or see it the way you do.  In my experiences, those who are so quick to tell others how wrong they are lack more than those they call wrong.


...however not everything can be chocked up to "personal preference" or the "art of medicine."



> Am I supposed to believe that somehow by wearing gloves I am not taking BSI precautions?  I've handled many body fluids with gloved hands and am still living to tell the tales.



The problem with the EMS mentality with gloves is that gloves protect against everything and that gloves are always needed. Sometimes gloves aren't needed. Often gloves aren't enough, but unless the patient is under isolation precautions then a lot of providers won't take appropriate precautions for an acute onset disease.


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## DesertMedic66 (Jul 23, 2011)

The only patient I have not put gloves on for was my grandma. I wear gloves for every patient that I am going to have to touch. We are required to carry another set of gloves, CPR mask, N95 mask, earplugs, hand wipes, safety glasses, and alcohol prep pads with us whenever we are on duty. As we unload the gurney from the ambulance I put gloves on. In my normal life I don't wear gloves when I shake peoples hands. But I'm only shaking hands with my friends and not total strangers. I've never seen a medic or EMT at my service not wear gloves when doing any kind of patient care.


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## Elk Oil (Jul 23, 2011)

Linuss said:


> Honestly, I put gloves on 90% of the time before touching a patient.
> 
> 
> People are icky.



And really... it doesn't have to be any more complicated than that.


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## Sasha (Jul 23, 2011)

Putting yourself before the patient in life or death situations is reasonable. Spreading disease to immunocompromised patients because you dont know when its appropriate to put on your gloves is negligent. You are failing to protect your patient when it is prudent and safe for you to do so.

Dont wear gloves before you even make contact, its really simple. You are being counterproductive and making the situation worse.

It is as silly as using a paper towel on a water faucet then opening a door with your barehand.

Sent from LuLu using Tapatalk


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## Elk Oil (Jul 23, 2011)

Sasha said:


> Putting yourself before the patient in life or death situations is reasonable. Spreading disease to immunocompromised patients because you dont know when its appropriate to put on your gloves is negligent. You are failing to protect your patient when it is prudent and safe for you to do so.
> 
> Dont wear gloves before you even make contact, its really simple. You are being counterproductive and making the situation worse.
> 
> ...



I'm just going to go ahead and continue to be wrong.

And I ALWAYS put on a pair of gloves before licking a door knob.


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## ffemt8978 (Jul 23, 2011)

Elk Oil said:


> And I ALWAYS put on a pair of gloves before licking a door knob.


Uh, wait...what?!?!?


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## Epi-do (Jul 23, 2011)

Sasha said:


> You wear gloves regardless. What other percautions do you feel you should be taking?
> 
> Sent from LuLu using Tapatalk




It isn't just about gloves.  There's more to PPE than slipping on a pair of gloves, but if you don't know there is a reason to use a different form of PPE, how are you going to know you should even use it?  

What if you show up to find someone with active TB who is coughing every 5 seconds, refuses to cover their mouth, and thinks they need to invade your personal space to speak to you.  Gloves won't do a darn thing to protect you in that instance.  However, if you are made aware of the situation, there are other things you can do to help prevent exposure or the risk of spreading the infection.

The need for any type of PPE is situation dependent.  Not every patient requires the use of all PPE available to us.  Heck, despite what is drilled into us in EMT class, not every patient requires gloves.  It's a shame that as a whole, EMS doesn't truly understand what PPE is or how to effectively and appropriately use it.


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## ffemt8978 (Jul 23, 2011)

Working 911, I wore gloves during any initial patient contact.  

Working IFT, I rarely wore gloves on initial patient contact unless I was informed by staff that the patient was on any precautions.  

Either way, once I had chance to assess the scene for myself, I could make a determination if I needed to continue with the PPE's, increase them, or remove them.


----------



## Sasha (Jul 23, 2011)

Elk Oil said:


> I'm just going to go ahead and continue to be wrong.
> 
> And I ALWAYS put on a pair of gloves before licking a door knob.



Then one could argue that you are a danger to your immunocompromised patients.

Sent from LuLu using Tapatalk


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## Sasha (Jul 23, 2011)

ffemt8978 said:


> Working 911, I wore gloves during any initial patient contact.
> 
> Working IFT, I rarely wore gloves on initial patient contact unless I was informed by staff that the patient was on any precautions.
> 
> Either way, once I had chance to assess the scene for myself, I could make a determination if I needed to continue with the PPE's, increase them, or remove them.



Maybe my relaxed attitude towards gloves is because i have worked ift long enough to educate myself on my patients communicable diseases.

Sent from LuLu using Tapatalk


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## usalsfyre (Jul 23, 2011)

Epi-do said:


> .The need for any type of PPE is situation dependent.  Not every patient requires the use of all PPE available to us.  Heck, despite what is drilled into us in EMT class, not every patient requires gloves.  It's a shame that as a whole, EMS doesn't truly understand what PPE is or how to effectively and appropriately use it.


 Thank you for making my point much more eloquently than I could. It's not wearing gloves that irks me. It's the lack of education on how to assess the situation and over reliance on one item that causes veins in my forehead to bulge.


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## Elk Oil (Jul 23, 2011)

Sasha said:


> Then one could argue that you are a danger to your immunocompromised patients.
> 
> Sent from LuLu using Tapatalk



Yes.  Exactly.  That is exactly what one could argue.


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## mycrofft (Jul 23, 2011)

*Eh. Break out the Level 3 suits.*

It is refreshing not to hear the old chestnut "Don't you know an AIDS viron is small enough to get through the pores in latex?".

Yeah, and if rattlesnakes could fly we'd be in trouble.


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## Melclin (Jul 24, 2011)

Wavers in situations where the location is obvious. Like a massive accident and the a bystander waves enthusiastically saying later they didn't want you to miss it or drive past of some s**t.

When you turn up for insignificant complaint where the pt is ambulant reasonably well for all intents and purposes and there are 2-6 cars in the driveway with 3-15 relative sitting around looking worried. One day I'll have the balls to suggest that one of the 190 people in the living room might have taken the pt with the runny nose down to hospital. 


RE gloves, I know they're only necessary to put them on in certain situations, but you really do never know what you're going to find where you get in there. Pausing to apply gloves in front of people sometimes bothers them and it interrupts my flow. I wear gloves into most jobs then ditch them once I know more about whats going on.


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## the_negro_puppy (Jul 24, 2011)

Melclin said:


> Wavers in situations where the location is obvious. Like a massive accident and the a bystander waves enthusiastically saying later they didn't want you to miss it or drive past of some s**t.
> 
> When you turn up for insignificant complaint where the pt is ambulant reasonably well for all intents and purposes and there are 2-6 cars in the driveway with 3-15 relative sitting around looking worried. One day I'll have the balls to suggest that one of the 190 people in the living room might have taken the pt with the runny nose down to hospital.
> 
> ...



LOL @ the wavers, I always laugh at them too.

All people need to do is a simple:








when most people do this:






I also rage when we pull up to an RTC/MCA/RTA and a bystander starts using hand signals to try and direct us where to park 

What's even more infuriating is when people are out the front and watch you drive past their un-numbered house and do nothing, and watch you drive down the street looking for the 'right house'.


I went to a cut finger the other day. 40 year old man, virtually crying because he had cut his finger on furniture, would require 2 stitches maybe. 4 cars and 8 family members all gathered around. We put a pad on the hand and walked him to the ambulance. Drove him the 4km to hospital.


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## MrBrown (Jul 24, 2011)

the_negro_puppy said:


> I went to a cut finger the other day. 40 year old man, virtually crying because he had cut his finger on furniture, would require 2 stitches maybe. 4 cars and 8 family members all gathered around. We put a pad on the hand and walked him to the ambulance. Drove him the 4km to hospital.



Brown would refuse to transport him - we do not have to transport somebody if it is medically unnecessary and especially another appropriate means of transport exist.

Brown hates those people who stand round or gorp over your shoulder and go "so is my mate/uncle/friend/brother/random stranger I don't know OK/going to be OK?" or shouting at you "do something do something!" like, 

"should we have taken Nana to the medical centre?"
"No you did the right thing by calling us because Nana is not breathing and her heart has stopped"
"Oh ... um"
"Yeah, it's not good mate but we are working on it"

Read:  Shirt mate, if you took Nana to the GP clinic the poor GP would have had kittens and hidden in the corner until the ambos showed up, you know how those GPs are with super crook people


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## vamike (Jul 24, 2011)

Sasha said:


> How would that change your treatment of the patient?
> 
> Sent from LuLu using Tapatalk



It wouldn't change my treatment of the patient in any way.  I'd like to be aware of any infectious diseases the patient is carrying.  Wouldn't you?


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## usalsfyre (Jul 24, 2011)

vamike said:


> It wouldn't change my treatment of the patient in any way.  I'd like to be aware of any infectious diseases the patient is carrying.  Wouldn't you?



Want to be aware because it's medical history? Or want to be aware because your scared of the disease? From what it sounds like you weren't going to run across the transmission routes for either one, unless it was active MRSA in the respiratory tract, which gloves won't do a darn thing to help.

Thank you for proving my earlier point.


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## Shishkabob (Jul 24, 2011)

When a patient looks at me and coughs on me without covering their mouth or attempting in any way to be a polite human being.



Just makes you want to hit someone, doesn't it usal?


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## Sasha (Jul 24, 2011)

vamike said:


> It wouldn't change my treatment of the patient in any way.  I'd like to be aware of any infectious diseases the patient is carrying.  Wouldn't you?



Airborne crap like TB? Yes. But run of the mill stuff like hep c? Oh well. I know how things like that are picked up and wont put myself at the risk whether or not i know they have them. Glove for blood and body fluids and open wounds. 

Sent from LuLu using Tapatalk


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## thegreypilgrim (Jul 24, 2011)

Update status.

What's your ETA?

We need you to run this call across the county, even though a closer unit will be clearing fairly soon; but, we're panicking because we're awful at resource management. So even though you just got back to quarters, and we're in peak traffic hours, you must run this call.


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## usalsfyre (Jul 24, 2011)

Linuss said:


> When a patient looks at me and coughs on me without covering their mouth or attempting in any way to be a polite human being.
> 
> 
> 
> Just makes you want to hit someone, doesn't it usal?



Patients who expectorate unkindly have been known to make me react oddly:unsure:....


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## Aidey (Jul 24, 2011)

The patient who is perfectly capable of speaking to you, but either mumbles, whispers or whatever else so that you can't understand a damn thing they say. 


Partners that aren't capable of independent thought. If we are looking at a patient with a GCS of 3 and respirations of 6 and you ask me "What do you want me to do", I want you to GTFO and find me someone with a brain.


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## Epi-do (Jul 24, 2011)

Melclin said:


> Wavers in situations where the location is obvious. Like a massive accident and the a bystander waves enthusiastically saying later they didn't want you to miss it or drive past of some s**t.



Awww!  But like it when bystanders do the EMS dance!  It makes me laugh.


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## adamjh3 (Jul 24, 2011)

Another one: Dispatch telling a BLS IFT crew to "Expedite" to a call. 

Fricken' unnecessary unless a code response is authorized, and most (all...) of those are unnecessary. I'm going to get there as quickly as safety allows and not a damn second sooner. No need to put pressure on folks who don't know any better by basically telling them to hurry the hell up to a psych transfer.


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## Sasha (Jul 24, 2011)

If they tell me to expedite i go slower.

Dont friggin rush me.

Sent from LuLu using Tapatalk


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## phideux (Jul 25, 2011)

My pet peeves, had one today. If you twist your ankle at 0400, and can walk on it at noon, with almost no limp,  but it hurts "a 10 out of 10", and  you are able to walk out and climb into the ambulance by yourself, You don't need us, call a cab.

Had another one the other day, 300lb welfare mom, and her 325lb welfare daughter, after a rear ender that barely took some paint off her bumper.  She was ambulatory on scene for 5 minutes, got into and out of her car twice. Got back into her car a third time to drive it off the roadway for PD. But is suddenly in so much pain she needs to be immobilized, and so does her daughter, and "Dat muther%^(*$# dat hits dem, gonna be payin fo it. We bof bein transpoted".

Calling 911, getting us out to you, then signing a waiver. If you weren't gonna go, why did you call.


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## Foxbat (Jul 25, 2011)

"Ambulance ***, respond to a motor vehicle accident with entrapment at ****".
A minute later:
"Ambulance ***, police on scene requests to expedite".
Oh, it's a good thing they told us to expedite. Before that, we were going to stop at Walmart to get some groceries, but now that you told us to...


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## jjesusfreak01 (Jul 25, 2011)

Foxbat said:


> "Ambulance ***, respond to a motor vehicle accident with entrapment at ****".
> A minute later:
> "Ambulance ***, police on scene requests to expedite".
> Oh, it's a good thing they told us to expedite. Before that, we were going to stop at Walmart to get some groceries, but now that you told us to...



This is really just badly disguised police code for, "it looks really bad and i'm afraid to get blood on my hands".


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## sirengirl (Jul 25, 2011)

I know it's not related to EMS, but, I HATE when I'm at work and I count back change for a customer, and they grab the cash and re-count it. It's like, :censored: you, I JUST counted that back for you!!! 


And, related to EMS, I hate when....
*tones*
"Unit 2, dispatch to 123 sesame street for chest pain."
"Copy, en route, request ALS assist." (per protocols)
5 mins later...
"Hi, my name's Kara, what's goin on today?"
Pt: "Oh, I have just been having this diarrhea for 2 hours/my ankle hurts/I cut my finger..."

Makes me want to punch a baby.


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## Aerin-Sol (Jul 25, 2011)

Working IFT during the winter, we would transfer the pt to the cot and the family would immediately go "He needs blankets! It's cold outside! Are you going to give him any blankets?!" 

Like... duh?


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## Sasha (Jul 25, 2011)

Aerin-Sol said:


> Working IFT during the winter, we would transfer the pt to the cot and the family would immediately go "He needs blankets! It's cold outside! Are you going to give him any blankets?!"
> 
> Like... duh?



Blankets cost extra and i need payment up front.

Sent from LuLu using Tapatalk


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## DesertMedic66 (Jul 25, 2011)

Sasha said:


> Blankets cost extra and i need payment up front.
> 
> Sent from LuLu using Tapatalk



We just load up the back of the gurney/ambulance with sheets and blankets from the hospital. At any given time I will have 3 sheets and 2 blankets on the back of the gurney h34r:


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## Sasha (Jul 25, 2011)

firefite said:


> We just load up the back of the gurney/ambulance with sheets and blankets from the hospital. At any given time I will have 3 sheets and 2 blankets on the back of the gurney h34r:



We get fired for taking linen from facilities

Sent from LuLu using Tapatalk


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## DesertMedic66 (Jul 25, 2011)

Sasha said:


> We get fired for taking linen from facilities
> 
> Sent from LuLu using Tapatalk



During company orientation they told us the same thing. But when I got placed in my division we have an on going relationship with the 3 hospitals in our response area that we can restock from them and use their sheets and blankets. I like using actual sheets instead of the cheap paper sheets that rip all the time.


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## Anjel (Jul 25, 2011)

Sasha said:


> We get fired for taking linen from facilities
> 
> Sent from LuLu using Tapatalk



A few hospitals here have packs of sheets and blankets for the EMS crews. Call em squad packs I think. They are in the ambulance bay.


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## Bullets (Jul 26, 2011)

Sasha said:


> We get fired for taking linen from facilities
> 
> Sent from LuLu using Tapatalk



wait, what? what do you guys use on your cots? does your company provide its own linens? 

Every hospital ive ever been to provides prewrapped packs, 2 sheets and a towel in the summer, 1 sheet and 2 blankets in the winter

and speaking of blankets...when pt family says they need this specific blanket or pillow from home. Like i really want to take your dirty comforter into my ambulance, its bad enough i have to take your dirty butt


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## Sasha (Jul 26, 2011)

We have a bunch of sheets and blankets that get sent to laundry every week i think twice a week

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## Elk Oil (Jul 26, 2011)

Foxbat said:


> Before that, we were going to stop at Walmart to get some groceries, but now that you told us to...



I could tell you a story that would boggle your mind.


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## jjesusfreak01 (Jul 26, 2011)

Sasha said:


> We have a bunch of sheets and blankets that get sent to laundry every week i think twice a week
> 
> Sent from LuLu using Tapatalk



So when you drop patients off you pull the sheet from under them and the blanket off the top?


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## emscrazy1 (Jul 26, 2011)

Elk Oil said:


> I could tell you a story that would boggle your mind.



Well tell it...


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## Shishkabob (Jul 26, 2011)

Sasha said:


> We get fired for taking linen from facilities
> 
> Sent from LuLu using Tapatalk



That's dumb.



I don't know of a single agency that doesn't grab sheets from a hospital when dropping off a patient, and I don't know a single hospital who doesn't allow it.


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## medicdan (Jul 26, 2011)

Absolutely. Its generally a 1:1 swap, though. I do know 2 hospitals, one on the south shore, the other in Western MA that have separate EMS linen... and at one it is a firable offense to take hospital linens. 


Sent from my DROID2 using Tapatalk


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## adamjh3 (Jul 26, 2011)

Posting out for 11hrs on a 24hr crew. Especially when your company has no major contracts... and your post is three miles from your station. Eff. That. Noise.


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## Elk Oil (Jul 26, 2011)

emscrazy1 said:


> Well tell it...



I'll spare all the details because for all I know some of the people on this forum are some of the EMTs who were involved.

Once upon a time there was a 9-1-1 call for an ambulance.  The ambulance crew that was dispatched placed a priority on picking up coffee at a local Dunkin' Donuts.  Other townsfolk (our service are is rather small and EVERYBODY talks to each other) later recalled seeing the crew standing in line waiting for their order instead of responding to the scene.

Not to be dissuaded by someone's call for help, they waited to pick up their order and then responded with their new, piping hot beverages.

Upon arriving and entering the patient's home, they had to take great care to not spill their coffees while managing to carry them along with the jump kit and oxygen cylinder.  Understandably, they had to perform a limited assessment due to them having to stand over the patient, cups in hand, taking occasional sips.

The end.


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## johnrsemt (Jul 26, 2011)

Hate being told by citizens that we shouldn't be:  shopping, eating, ordering etc;  
   I actually told a person one day (who got mad at me about being at McD's on a 72 hour shift); that if he thought I should be out saving lives 'to go run in front of a bus'.

  It is fun to get chewed out by management when they can't stop laughing.


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## sirengirl (Jul 26, 2011)

johnrsemt said:


> Hate being told by citizens that we shouldn't be:  shopping, eating, ordering etc;
> I actually told a person one day (who got mad at me about being at McD's on a 72 hour shift); that if he thought I should be out saving lives 'to go run in front of a bus'.
> 
> It is fun to get chewed out by management when they can't stop laughing.



My first ride -along, after our 2nd or 3rd call we swung by the nearest Publix (groery store for those who don't know) on the way back from the ER to grab some subs. Cue me standing in a grocery store with a ff/emt and a ff/medic (who of course grabbed their portables). Literally, everyone in that store was thrilled to see us. Publix is a progressive, equal opportunity employer and our bagger happened to be of special needs. He saw me (the only one with a nametag) and asked me if we saved any lives yet today. To this day that particular emt/medic crew mocks me about it.

I don't doubt you at all though. People are idiots.


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## Sasha (Jul 26, 2011)

johnrsemt said:


> Hate being told by citizens that we shouldn't be:  shopping, eating, ordering etc;
> I actually told a person one day (who got mad at me about being at McD's on a 72 hour shift); that if he thought I should be out saving lives 'to go run in front of a bus'.
> 
> It is fun to get chewed out by management when they can't stop laughing.



Most people love us. They ask all sorts of questions. Never got anyone ticked cause we are eating.

Sent from LuLu using Tapatalk


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## adamjh3 (Jul 26, 2011)

While standing in line to get some food

"So... what happened over at (obscure address I've never been to in my life)"

1. I don't know
2. If I did I wouldn't tell you.


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## Sasha (Jul 26, 2011)

If i am sleeping in the truck dont come and tap on my window for directions. 

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## Sasha (Jul 26, 2011)

jjesusfreak01 said:


> So when you drop patients off you pull the sheet from under them and the blanket off the top?



No we use paper sheets for the stretcher, and then yes we take them off and i shove them into a cabinet til end of shift

Sent from LuLu using Tapatalk


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## Shishkabob (Jul 26, 2011)

Sasha said:


> If i am sleeping in the truck dont come and tap on my window for directions.




Dont come to my ambulance station asking for directions as I'm probably sleeping.




If the garage door to the ambulance bay is open, you are NOT allowed to just walk in to the station like it's some public building:  It's not.  It's my house and you must be invited before you step foot inside, or else you'll get a nasty look and a stern "Can I help you?"... not much else because I have to be "nice".


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## DesertMedic66 (Jul 26, 2011)

The backend of my 36 hour shift, if you clearly see that we are sleeping in the ambulance please do not walk up and bang on the window to make sure we are still alive. I like the concern you showed but I need some sleep. 

Don't tap on the window and ask if we can give you morphine. Walk out infront of a car and then maybe you will get some painkillers.


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## Aerin-Sol (Jul 26, 2011)

Linuss said:


> That's dumb.
> 
> I don't know of a single agency that doesn't grab sheets from a hospital when dropping off a patient, and I don't know a single hospital who doesn't allow it.



There's a hospital in Louisville that dyed all of their sheets a non-white color and will NOT let EMS take them -- they claim they have a special elevated thread count. It may be simply apocryphal but I've had crews tell me of nurses making the ambulance turn around (with the pt still on board) to return the sheets.


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## Epi-do (Jul 26, 2011)

I am not a maid at an upscale hotel that offers turn down services.  (Yep, been called to tuck a frequent flier into bed.)

I am also not a meteorologist or traffic reporter.  (Didn't realize there was any confusion until we were called by the family who had just driven home from another town to give them a weather and road conditions report before they decided if they wanted to take their baby to the doctor.)

And last but not least, I am not an insurance agent or police officer (even though I do wear a navy blue uniform).  (Apparently, if you do not know how to fill out the mandatory proof of insurance form from the state of Indiana after being involved in an MVC over 8 hours ago, you call 911 and request an ambulance rather than call PD's nonemergency number or going to your insurance agent's office - which you have to do anyway, to give them the form so they can fill out their portion and return it to the state.)


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## Sasha (Jul 26, 2011)

Don't hand me vitals when I'm talking to a nurse!


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## adamjh3 (Jul 26, 2011)

Not getting to do crew workouts when it gets busy


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## medicdan (Jul 27, 2011)

Sasha said:


> Don't hand me vitals when I'm talking to a nurse!



Why not? If my partner's giving report to a nurse at triage, I grab a set of vitals, either copying them off our monitor, or getting my own (or taking a temp) using hospital equipment. The nurse is going to ask for a recent set, and i'm giving them to you on a neat 3x5 card. You might not be at that point in your report yet (or the nurse on that screen), but at least they know they're there...


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## Sasha (Jul 27, 2011)

Because that is when he tried to start the "The patient has a...." while I was still in the middle of getting report. The nurse is hard to track down and corner for a report, once she gets away because I have to stop and listen to you, she might not come back.

Vitals can wait. Report can't.


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## JPINFV (Jul 27, 2011)

Sasha said:


> Because that is when he tried to start the "The patient has a...." while I was still in the middle of getting report. The nurse is hard to track down and corner for a report, once she gets away because I have to stop and listen to you, she might not come back.
> 
> Vitals can wait. Report can't.



I can so picture this as some sort of hunting show. "Ain't she a beut? Charge nurses can be hard to find, and even harder to trap. We have to be really quiet while stalking her and moving between gurney bays, least she takes flight to the break room."


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## Nerd13 (Jul 27, 2011)

I really hate how there is apparently no appropriate speed for us to drive to an emergency. The patient complains about how long it took for us to get there and the citizens complain that we were driving too fast through town. I actually had someone tell us one time that if he saw us driving that fast (lights and sirens) again he would pull out in front of us. All of this for the company approved speed with due regard for the safety of others. 

"Why didn't you do x, y or z before bringing them in?" from nurses when you were literally a block away. 

I really hate it when I give a radio report and apparently nobody ever bothers to listen to it because I have to do it all over again when I get there. 

It's always fantastic when you drive priority to a scene and walk in to find the pt on the phone (not with the dispatcher) laughing and requesting that you wait a few minutes so they can finish their conversation. 

Home health care that calls and then has no idea what's really wrong with the pt or why they called us. 

"Do I HAVE to go to the hospital?" You don't HAVE to do anything but you did call an ambulance so what did you expect would happen when we got there?

Finally, the well known and loved "I said I had chest pain so you would get here faster but really my stomach hurts". This phenomenon presents itself in a multitude of ways also including "If I have chest pain do I get seen before everyone else?".


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## katgrl2003 (Jul 27, 2011)

Nerd13 said:


> Finally, the well known and loved "I said I had chest pain so you would get here faster but really my stomach hurts". This phenomenon presents itself in a multitude of ways also including "If I have chest pain do I get seen before everyone else?".



I have a frequent flyer in my area that does this all the time. We went on him 3 times in one shift, day shift went on him 2 times in their shift. He calls for chest pain all the time, and we usually walk in saying, "So what's wrong now, Mr. ****? Belly pain? Foot pain? Constipation?" And those are his 3 main complaints. The only times we don't say that is when our supervisor is on scene, and we have to be nice. :glare:


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## DesertMedic66 (Jul 27, 2011)

Nerd13 said:


> It's always fantastic when you drive priority to a scene and walk in to find the pt on the phone (not with the dispatcher) laughing and requesting that you wait a few minutes so they can finish their conversation.



That's when I stop with my nice guy attitude. I make them say bye and hang up the phone.


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## fast65 (Jul 27, 2011)

When you actually improve the patients condition prior to arriving at the hospital and the nurse says "well, they don't look that bad, I don't what you guys were worried about." <_<


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## 325Medic (Jul 27, 2011)

(1):Giving report and being interupted by the nurse in the process of giving said report. 

(2):My partner not getting linens or blankets when he makes the cot. Yes folks...I like my patients, sick trauma patients to be warm.

(3)irty squads.

(4):The E.C.G. cables should not be tied OR bungled in a large heap of crap because you are lazy and want to go home @ the end of tour.

(5)eople that don't further their education or at least study / review important info pertaining to the job.

I have more but will post later.

325.


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## 325Medic (Jul 27, 2011)

325Medic said:


> (1):Giving report and being interupted by the nurse in the process of giving said report.
> 
> (2):My partner not getting linens or blankets when he makes the cot. Yes folks...I like my patients, sick trauma patients to be warm.
> 
> ...




W.T.F. is that with the smilies. I did not put that there and cannot get rid of it!

325.


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## katgrl2003 (Jul 27, 2011)

325Medic said:


> W.T.F. is that with the smilies. I did not put that there and cannot get rid of it!
> 
> 325.



get rid of the : after each number
: D without the space is 
: P without the space is


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## JPINFV (Jul 27, 2011)

325Medic said:


> W.T.F. is that with the smilies. I did not put that there and cannot get rid of it!
> 
> 325.



...Yes you did. : p (without the space) is . : D is .

If you have smilies appearing because you're using a colon, the best option is to click the "disable smilies in text" box in the "miscellaneous options" section below the submit reply button.


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## 325Medic (Jul 27, 2011)

JPINFV said:


> ...Yes you did. : p (without the space) is . : D is .
> 
> If you have smilies appearing because you're using a colon, the best option is to click the "disable smilies in text" box in the "miscellaneous options" section below the submit reply button.



Oh, o.k. makes sense. Thanks.

325.


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## Chimpie (Jul 27, 2011)

You can also click this button to created a numbered list.







Now, back on topic.


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## nwhitney (Jul 27, 2011)

JPINFV said:


> I can so picture this as some sort of hunting show. "Ain't she a beut? Charge nurses can be hard to find, and even harder to trap. We have to be really quiet while stalking her and moving between gurney bays, least she takes flight to the break room."



When I read this I had the voice of Steve Irwin in my head.  My boss gave me a weird look as I was reading your post.


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## katgrl2003 (Jul 27, 2011)

nwhitney said:


> When I read this I had the voice of Steve Irwin in my head.  My boss gave me a weird look as I was reading your post.



Great, now I'm the one getting weird looks. :wacko:


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## Bullets (Jul 27, 2011)

Nerd13 said:


> It's always fantastic when you drive priority to a scene and walk in to find the pt on the phone (not with the dispatcher) laughing and requesting that you wait a few minutes so they can finish their conversation.


i ask them to hang the phone up nicely one time. if they ignore me, i hang it up for them. especially on MVCs. Unless my favorite LEO is there. he has a device that jams cell phones



Nerd13 said:


> Finally, the well known and loved "I said I had chest pain so you would get here faster but really my stomach hurts". This phenomenon presents itself in a multitude of ways also including "If I have chest pain do I get seen before everyone else?".



I tell them you get seen based on what wrong with you, im always honest. Foot pain? im probably going to wheel you straight into the waiting room and put you in a chair with everyone else. and we are driving code 1 too


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## Sasha (Jul 27, 2011)

JPINFV said:


> I can so picture this as some sort of hunting show. "Ain't she a beut? Charge nurses can be hard to find, and even harder to trap. We have to be really quiet while stalking her and moving between gurney bays, least she takes flight to the break room."



Sometimes you must lure them in with the sounds of bed alarms.

You want to get a bunch of nurses at once, knock something heavy to the ground and go "OH CRAP!"right before the thud.

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## firetender (Jul 27, 2011)

*Late night calls...*

I'm driving, and once on the scene I have to wake up my partner!


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## Sasha (Jul 27, 2011)

firetender said:


> I'm driving, and once on the scene I have to wake up my partner!



Im guilty of that every weekend!

Sent from LuLu using Tapatalk


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## Epi-do (Jul 27, 2011)

I hate having to go to the ER on my day off...


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## guttruck (Jul 28, 2011)

The Ambulance Dance............Wow how did I ever miss that MVA


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## truetiger (Jul 28, 2011)

I hate sheets that are folded the incorrect way....


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## mommak90 (Jul 28, 2011)

one of my partners would throw every bit of trash on the floor and leave it there aaaalllllllllll day long. It would tick me off. I'm fine if its a code or something, but other than that its just as easy to put it in a neat little pile or even the trash instead of throwing it all over the floor just to spend more time picking it all back up later!


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## sirengirl (Jul 28, 2011)

truetiger said:


> I hate sheets that are folded the incorrect way....



this. 
we actually have designated an area to re-fold all our laundry the correct way after we get it.


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## guttruck (Jul 28, 2011)

You cant expect perfection when pilfering laundry from the local hospitals lol


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## BrickEMT (Jul 28, 2011)

The hospitals by us actually have clean linens & a towel saran wrapped for us, we just have to put em on the stretcher, pretty self explanatory. 

One of the things that annoys me is when crews call in saying "Headquarters XXX, you can put us on with a crew until XX:00 hours". I always say I sincerely hope you have a crew if your calling a rig in service.


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## Blessed187 (Jul 28, 2011)

mycrofft said:


> It is refreshing not to hear the old chestnut "Don't you know an AIDS viron is small enough to get through the pores in latex?".
> 
> Yeah, and if rattlesnakes could fly we'd be in trouble.




LMFAO!!! That's awesome! :rofl:


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## Sasha (Jul 28, 2011)

If you insist on holding my hand, don't squeeze it to death.


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## Blessed187 (Jul 28, 2011)

Sasha said:


> If you insist on holding my hand, don't squeeze it to death.



Is that really a pet peeve of yours? Why are you in the EMS field if that's honestly something that bothers you?


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## Sasha (Jul 29, 2011)

Did I say holding my hand bothers me? No.

I said don't squeeze it to death. Today someone dug their nails into my hand they were squeezing so hard. THAT does bother me, especially when it's over something so silly as "I was afraid I was going to fall off the locked in stretcher after being shown the rails, and the fact I am secure via 3 straps so everytime I think there MIGHT be a turn or bump I crush your hand because you were stupid enough to leave it in my reach."

And PS.. I am compassionate, I am respectful. I sat and ran a hand through a patient's hair for an HOUR trip because that's what calmed her down. I spent time cleaning up a dead body to make it presentable to family. But nowhere in my job description does it state I must hold a patients hand. That is an above and beyond thing and has no bearing as to whether I should be in EMS or not.


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## Blessed187 (Jul 29, 2011)

Sasha said:


> Did I say holding my hand bothers me? No.
> 
> I said don't squeeze it to death. Today someone dug their nails into my hand they were squeezing so hard. THAT does bother me, especially when it's over something so silly as "I was afraid I was going to fall off the locked in stretcher after being shown the rails, and the fact I am secure via 3 straps so everytime I think there MIGHT be a turn or bump I crush your hand because you were stupid enough to leave it in my reach."
> 
> And PS.. I am compassionate, I am respectful. I sat and ran a hand through a patient's hair for an HOUR trip because that's what calmed her down. I spent time cleaning up a dead body to make it presentable to family. But nowhere in my job description does it state I must hold a patients hand. That is an above and beyond thing and has no bearing as to whether I should be in EMS or not.







"I must cross the line often then, i will hold hands, sometimes without being asked. Ive also been known to run a hand through a patients hair. Touch shows them you care, caring makes them feel better. Your partner needs to gtfo of ems."
__________________
Your words, not mine.


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## Sasha (Jul 29, 2011)

That was completely different and a different thread.

And WHERE did I say I minded holding a hand? Nowhere. Don't want it crushed.


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## 325Medic (Jul 29, 2011)

325Medic said:


> (1):Giving report and being interupted by the nurse in the process of giving said report.
> 
> (2):My partner not getting linens or blankets when he makes the cot. Yes folks...I like my patients, sick trauma patients to be warm.
> 
> ...



(6) Not covering my patients with blankets, especially when it is cold out.

(7) Looking like a slob. Lets face it... We are invited into a back bedroom of a second floor walk up, we see your nakedidity for lack of a better term, touch you and take care of you and you look like 5 pounds of chewed bubblegum? No liking that.

325.


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## fast65 (Jul 29, 2011)

Blessed187 said:


> "I must cross the line often then, i will hold hands, sometimes without being asked. Ive also been known to run a hand through a patients hair. Touch shows them you care, caring makes them feel better. Your partner needs to gtfo of ems."
> __________________
> Your words, not mine.



You misinterpreted what she said, no need to start a fight over it.

Pet Peeve:

You called the ambulance and then whine about EVERY SINGLE thing I do (BP, pulse ox, IV). 

When crews argue over the radio about who's going to take an IFT, then devise a plan to get out of it.


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## guttruck (Jul 29, 2011)

325Medic said:


> (6) Not covering my patients with blankets, especially when it is cold out.
> 
> (7) Looking like a slob. Lets face it... We are invited into a back bedroom of a second floor walk up, we see your nakedidity for lack of a better term, touch you and take care of you and you look like 5 pounds of chewed bubblegum? No liking that.
> 
> 325.



in regards to no. 1 .......a medic giving useless BS on reports lol......i just sit at the radio doing a /facepalmh34r:


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## Nerd13 (Jul 29, 2011)

Another one I remembered:

"When I called the ambulance this morning/last night/last week THEY didn't start an IV/put those stickers on me/put oxygen on me."


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## Elk Oil (Jul 29, 2011)

Sasha said:


> But nowhere in my job description does it state I must hold a patients hand. That is an above and beyond thing and has no bearing as to whether I should be in EMS or not.



Holy crow... holding someone's hand is above and beyond???  How low are your standards that you think this simple act is somehow overachieving?


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## Sasha (Jul 29, 2011)

Yeah it's above and beyond, it's not required or in protocol.

Do I do it? Absolutely. Do I want my hand crushed? Again, absolutely not. Like I said, no where is it required.


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## nwhitney (Jul 29, 2011)

Sasha said:


> Yeah it's above and beyond, it's not required or in protocol.
> 
> Do I do it? Absolutely. Do I want my hand crushed? Again, absolutely not. Like I said, no where is it required.



I'm honestly shocked that some folks are getting worked up over the fact that you would rather _NOT_ be injured by a patient. Ridiculous.


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## Sasha (Jul 29, 2011)

You too?


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## adamjh3 (Jul 29, 2011)

Elk Oil said:


> Holy crow... holding someone's hand is above and beyond???  How low are your standards that you think this simple act is somehow overachieving?



Let's put it this way, how many EMS providers do you personally know that would hold/have held a patient's hand? 

From the few I've seen, I'd say it's above and beyond. Unfortunately, that's the reality of it.


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## crazycajun (Jul 29, 2011)

adamjh3 said:


> Let's put it this way, how many EMS providers do you personally know that would hold/have held a patient's hand?
> 
> From the few I've seen, I'd say it's above and beyond. Unfortunately, that's the reality of it.



I as well as my partner and many others in my service do it all the time. If that is what it takes to calm the PT I am all for it.


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## Elk Oil (Jul 29, 2011)

adamjh3 said:


> Let's put it this way, how many EMS providers do you personally know that would hold/have held a patient's hand?
> 
> From the few I've seen, I'd say it's above and beyond. Unfortunately, that's the reality of it.



Too true.  I think so many people undervalue the small, compassionate acts we can do for our patients or they think doing such things are beneath them because it's not EMS or medicine.  

It certainly is above and beyond for those who are jaded, cynical or caring.  And for those of us who genuinely care, it's the least we should ever do.


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## fast65 (Jul 29, 2011)

Elk Oil said:


> Too true.  I think so many people undervalue the small, compassionate acts we can do for our patients or they think doing such things are beneath them because it's not EMS or medicine.
> 
> It certainly is above and beyond for those who are jaded, cynical or caring.  And for those of us who genuinely care, it's the least we should ever do.



I think you're missing the point. It doesn't matter if you're cynical, jaded, compassionate or "genuinely caring", the fact is that it's not something we have to do, ergo, it's above and beyond. 

Btw, you might want to change that last sentence, it sounds pretty judgmental.


Sent from my mobile command center


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## Elk Oil (Jul 29, 2011)

fast65 said:


> I think you're missing the point. It doesn't matter if you're cynical, jaded, compassionate or "genuinely caring", the fact is that it's not something we have to do, ergo, it's above and beyond.
> 
> Btw, you might want to change that last sentence, it sounds pretty judgmental.
> 
> ...



Whoops.  Thanks for catching me on that.  That last sentence should read:

"It certainly is above and beyond for those who are jaded, cynical or UNcaring."

I hope this doesn't turn into a discussion about the virtue of holding a patient's hand based on whether or not it's in our protocols.  That would be silly.


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## fast65 (Jul 29, 2011)

Elk Oil said:


> Whoops.  Thanks for catching me on that.  That last sentence should read:
> 
> "It certainly is above and beyond for those who are jaded, cynical or UNcaring."
> 
> I hope this doesn't turn into a discussion about the virtue of holding a patient's hand based on whether or not it's in our protocols.  That would be silly.



So anybody who doesn't, or doesn't want to hold a patients hand is cynical, jaded, or uncaring? 

Sent from my mobile command center


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## Elk Oil (Jul 29, 2011)

fast65 said:


> So anybody who doesn't, or doesn't want to hold a patients hand is cynical, jaded, or uncaring?
> 
> Sent from my mobile command center



Seriously?  Is that what you really though I meant?  What I meant was that there are those who are so jaded, cynical or uncaring that they don't have the interest, inclination or compassion to hold someone's hand if that's what called for.  

Don't you know any uncaring, burned out EMTs who have lost their sense of compassion?  Or is everyone you know in the industry so wonderful and caring that they treat all their patients as if they were their mothers?


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## fast65 (Jul 29, 2011)

Elk Oil said:


> Seriously?  Is that what you really though I meant?  What I meant was that there are those who are so jaded, cynical or uncaring that they don't have the interest, inclination or compassion to hold someone's hand if that's what called for.
> 
> Don't you know any uncaring, burned out EMTs who have lost their sense of compassion?  Or is everyone you know in the industry so wonderful and caring that they treat all their patients as if they were their mothers?



That is absolutely what I took it as. Actually, the ones that I have worked with do treat their patients with care and compassion, but they also don't enjoy having their hands crushed...

Pet peeve to stay on topic:

People calling EMS for a fever, when the hospital is LITERALLY two blocks away


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## usalsfyre (Jul 29, 2011)

fast65 said:


> People calling EMS for a fever, when the hospital is LITERALLY two blocks away



Ohhh, what about the laws that require MD offices to call EMS when they are in a medical building that is CONNECTED TO THE HOSPITAL BY A FREAKING SKYWALK!!


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## DesertMedic66 (Jul 30, 2011)

usalsfyre said:


> Ohhh, what about the laws that require MD offices to call EMS when they are in a medical building that is CONNECTED TO THE HOSPITAL BY A FREAKING SKYWALK!!



Skywalk really? I've have to do them across the street/ally way but not thru a skywalk.

That gives a whole new meaning to IFT.


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## fafinaf (Jul 30, 2011)

If a patient wants to go to a hospital that is 30 minutes away because his insurance covers it, and there is a hospital that is 5 minutes away what do you do? you take him to his hospital. it's called customer service. it's called pleasing and satisfying the customer. it's how your company gets business and generates an income. that customer will tell someone about your service and so on. it is what you are paid to do. we are in the business of customer service. you can tell which companies train their employees to think like that and which companies don't. the companies that don't have 15 year old ambulances. the companies that don't, don't have many contracts. on the other hand, the companies that do (like mine) have over 100 ambulances and contracts in over 60 cities both 911 and IFT. The company that does train their employees to think about customer service have not 1 single ambulance older than 3 years old. companies that know how to please a customer stay in business for a long time and have an excellent reputation. 

just sayin'...  i love the company i work for and i love the values they instill in their employees. i couldn't be happier!


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## fafinaf (Jul 30, 2011)

mommak90 said:


> one of my partners would throw every bit of trash on the floor and leave it there aaaalllllllllll day long. It would tick me off. I'm fine if its a code or something, but other than that its just as easy to put it in a neat little pile or even the trash instead of throwing it all over the floor just to spend more time picking it all back up later!



that would be soooo annoying.. and dirty!


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## Aidey (Jul 30, 2011)

usalsfyre said:


> Ohhh, what about the laws that require MD offices to call EMS when they are in a medical building that is CONNECTED TO THE HOSPITAL BY A FREAKING SKYWALK!!



I've done that one. More than once. Like....5 times acctually. At 3 different hospitals. What is really sad is that they all have different starting points too.


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## Sasha (Jul 30, 2011)

fafinaf said:


> If a patient wants to go to a hospital that is 30 minutes away because his insurance covers it, and there is a hospital that is 5 minutes away what do you do? you take him to his hospital. it's called customer service. it's called pleasing and satisfying the customer. it's how your company gets business and generates an income. that customer will tell someone about your service and so on. it is what you are paid to do. we are in the business of customer service. you can tell which companies train their employees to think like that and which companies don't. the companies that don't have 15 year old ambulances. the companies that don't, don't have many contracts. on the other hand, the companies that do (like mine) have over 100 ambulances and contracts in over 60 cities both 911 and IFT. The company that does train their employees to think about customer service have not 1 single ambulance older than 3 years old. companies that know how to please a customer stay in business for a long time and have an excellent reputation.
> 
> just sayin'...  i love the company i work for and i love the values they instill in their employees. i couldn't be happier!



Uhm you dont judge a companys quality by something shallow like the age of their trucks.

Just a hunch but you seem new so i doubt you have many companies to compare it to.

And if taking him 30 minutes away leaves your response area uncovered you certainly do not take him when there is a reasonable alternative. EMS is not customer service, its health care. 



Sent from LuLu using Tapatalk


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## exodus (Jul 30, 2011)

Sasha said:


> Uhm you dont judge a companys quality by something shallow like the age of their trucks.
> 
> Just a hunch but you seem new so i doubt you have many companies to compare it to.
> 
> ...



If you take him to hospital A instead of B because B accepts his insurance, he may not get as good care or as quick care because before any procedure, they have to call his insurance provider and ask if they will reimburse for it. Otherwise they have to ask the PT if they're willing to pay for that specific procedure. If they can't pay for it, they will deny the procedure and not get better. OTHERWISE, if you take them to their hospital that the insurance works with and has guidelines set for reimbursement, they will get much quicker and better care... Oh lets hope he doesn't need to be hospitalized at A, because most insurance will transfer you where that night so you get back in their system.

EMS = customer service. They pay for our service.


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## Sasha (Jul 30, 2011)

exodus said:


> If you take him to hospital A instead of B because B accepts his insurance, he may not get as good care or as quick care because before any procedure, they have to call his insurance provider and ask if they will reimburse for it. Otherwise they have to ask the PT if they're willing to pay for that specific procedure. If they can't pay for it, they will deny the procedure and not get better. OTHERWISE, if you take them to their hospital that the insurance works with and has guidelines set for reimbursement, they will get much quicker and better care... Oh lets hope he doesn't need to be hospitalized at A, because most insurance will transfer you where that night so you get back in their system.
> 
> EMS = customer service. They pay for our service.



If you take him to B and left your area uncovered and Mrs C dies of a heart attack because the closest ambulance was taking Mr D to where his insurance is, then what kind of customer service are you providing?

Sorry, if he needs to go to a certain hospital and isnt serious enough where they will call for insurance prior to treatment then he can drive himself. Plus insurances do have out of network rates.

Sent from LuLu using Tapatalk


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## fast65 (Jul 30, 2011)

usalsfyre said:


> Ohhh, what about the laws that require MD offices to call EMS when they are in a medical building that is CONNECTED TO THE HOSPITAL BY A FREAKING SKYWALK!!



I can't say I've had to do that, but then again, there's like one hospital in Oregon that actually has a skywalk  Of course that's not the first time I've heard about something like that though :/



fafinaf said:


> If a patient wants to go to a hospital that is 30  minutes away because his insurance covers it, and there is a hospital  that is 5 minutes away what do you do? you take him to his hospital.  it's called customer service. it's called pleasing and satisfying the  customer. it's how your company gets business and generates an income.  that customer will tell someone about your service and so on. it is what  you are paid to do. we are in the business of customer service. you can  tell which companies train their employees to think like that and which  companies don't. the companies that don't have 15 year old ambulances.  the companies that don't, don't have many contracts. on the other hand,  the companies that do (like mine) have over 100 ambulances and contracts  in over 60 cities both 911 and IFT. The company that does train their  employees to think about customer service have not 1 single ambulance  older than 3 years old. companies that know how to please a customer  stay in business for a long time and have an excellent reputation.
> 
> just sayin'...  i love the company i work for and i love the values they instill in their employees. i couldn't be happier!



Ummmm, so customer service is your pet peeve?


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## Shishkabob (Jul 30, 2011)

fafinaf said:


> If a patient wants to go to a hospital that is 30 minutes away because his insurance covers it, and there is a hospital that is 5 minutes away what do you do? you take him to his hospital. it's called customer service. it's called pleasing and satisfying the customer. it's how your company gets business and generates an income. that customer will tell someone about your service and so on. it is what you are paid to do. we are in the business of customer service. you can tell which companies train their employees to think like that and which companies don't. the companies that don't have 15 year old ambulances. the companies that don't, don't have many contracts. on the other hand, the companies that do (like mine) have over 100 ambulances and contracts in over 60 cities both 911 and IFT. The company that does train their employees to think about customer service have not 1 single ambulance older than 3 years old. companies that know how to please a customer stay in business for a long time and have an excellent reputation.
> 
> just sayin'...  i love the company i work for and i love the values they instill in their employees. i couldn't be happier!




EMS isn't customer service, it's healthcare.  Abused healthcare at that.  

Where's the line drawn to going to a patients hospital?  45 miles?  60?  100?  If a patient wants to go to a hospital 30 minutes away and you oblige, who are you to deny a patient who wants to go to a hospital 2 hours away?




If it was emergent enough to call 911 for an ambulance, it's emergent enough to go to the closest appropriate facility, end of discussion.


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## fast65 (Jul 30, 2011)

Linuss said:


> EMS isn't customer service, it's healthcare.  Abused healthcare at that.
> 
> Where's the line drawn to going to a patients hospital?  45 miles?  60?  100?  If a patient wants to go to a hospital 30 minutes away and you oblige, who are you to deny a patient who wants to go to a hospital 2 hours away?
> 
> ...



100% agree

 We're there to treat our patient, and pending extenuating circumstances, they will be taken to the closest appropriate hospital. If they don't like that, then too bad, I'm not going to take an ambulance out of service any longer than necessary just because they want to go to another hospital. 

This is not Burger King, you can't have it your way all the time.

Sent from my mobile command center


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## Shishkabob (Jul 30, 2011)

The only time a patients "hospital" comes in to my mind is when the call to 911 matches their history.  If a lung cancer patient is coughing up blood, ok, we'll go to your cancer hospital.  However, if you broke your toe, your lung cancer has NO bearing on how your toe will be treated, and your oncologist will NOT see you, so we're going to the closest hospital.


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## Sasha (Jul 30, 2011)

Linuss said:


> The only time a patients "hospital" comes in to my mind is when the call to 911 matches their history.  If a lung cancer patient is coughing up blood, ok, we'll go to your cancer hospital.  However, if you broke your toe, your lung cancer has NO bearing on how your toe will be treated, and your oncologist will NOT see you, so we're going to the closest hospital.



I love the "my doctors at so and so hospital" oh is he meeting you im the er? No? Then the other hospital will be just fine.

Sent from LuLu using Tapatalk


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## Shishkabob (Jul 30, 2011)

Sasha said:


> I love the "my doctors at so and so hospital" oh is he meeting you im the er? No? Then the other hospital will be just fine.
> 
> Sent from LuLu using Tapatalk



I get that all the time..

"My doctor is at the hospital and they have all my information"

"Sir, your doctor doesn't work in the ER and will not see you at 2am for an impacted bowel. You'll be seen by whatever ER doc walks in.   This other hospital is part of the same hospital system, they have your information too."



People just are not logical.


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## Epi-do (Jul 30, 2011)

I could only hope that there were times I could take people to the closest facility.  We transport to the facility of choice, unless there is a reason to go to a closer, appropriate facility.  (i.e. All our STEMIs go to the heart hospital that is only 10 minutes away, rather than one of the other heart centers, but the back pain for 3 weeks that hasn't changed, hasn't filled the prescription for muscle relaxers, taken any OTC anti-inflamatories, or called the GP back for a follow-up appt gets to go to whatever ER they choose.  The only exception being if the chosen ER is on diversion.)


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## JPINFV (Jul 30, 2011)

Sasha said:


> I love the "my doctors at so and so hospital" oh is he meeting you im the er? No? Then the other hospital will be just fine.
> 
> Sent from LuLu using Tapatalk




...and now the ED has to transfer the patient to their home hospital upon admission so that the patients insurance and physician can treat them, which then leads to the ED not being able to turn over beds as fast as they could, which leads to ambulance crews holding the wall and complaining about how stupid their patient is for wanting to go to the hospital 10 minutes further away and how stupid the hospital is for not being able to get them a bed in an hour because of the patients who they are waiting to transfer to their home hospital because the ambulance crews only want to transport to the closest hospital, where they get to hold the wall.

/run-on sentence.


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## Shishkabob (Jul 30, 2011)

JPINFV said:


> ...and now the ED has to transfer the patient to their home hospital upon admission so that the patients insurance and physician can treat them, which then leads to the ED not being able to turn over beds as fast as they could, which leads to ambulance crews holding the wall and complaining about how stupid their patient is for wanting to go to the hospital 10 minutes further away and how stupid the hospital is for not being able to get them a bed in an hour because of the patients who they are waiting to transfer to their home hospital because the ambulance crews only want to transport to the closest hospital, where they get to hold the wall.
> 
> /run-on sentence.



If it's a medically necessary transport, then they need to go to the closest appropriate hospital, and the insurance company will pay.

If it's not a medically necessary transport, they don't need to be taking an ambulance in the first place.


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## JPINFV (Jul 30, 2011)

Linuss said:


> If it's a medically necessary transport, then they need to go to the closest appropriate hospital, and the insurance company will pay.
> 
> If it's not a medically necessary transport, they don't need to be taking an ambulance in the first place.



I'm not talking about the ambulance company getting paid, and just because the insurance company will pay part of the hospital bill doesn't mean that they pay all of the bill, or even as much as they would for an in-network hospital. This is especially true when the ED patient becomes an in-patient. Besides, if the transport is medically necessary, then the patient is an in-patient. Since the home hospital is the patient's most appropriate hospital, it is now the closest appropriate hospital unless other issues are present. It's hard to justify that an extra 10 minutes is going to matter either for the patient's condition or for the ambulance crew.


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## Sasha (Jul 30, 2011)

JPINFV said:


> I'm not talking about the ambulance company getting paid, and just because the insurance company will pay part of the hospital bill doesn't mean that they pay all of the bill, or even as much as they would for an in-network hospital. This is especially true when the ED patient becomes an in-patient. Besides, if the transport is medically necessary, then the patient is an in-patient. Since the home hospital is the patient's most appropriate hospital, it is now the closest appropriate hospital unless other issues are present. It's hard to justify that an extra 10 minutes is going to matter either for the patient's condition or for the ambulance crew.



So you would rather take an ambulance out of service for an hour or more to transfer a stable patient to a facility when transfering them to a closer facility would be adequate?

Sent from LuLu using Tapatalk


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## Shishkabob (Jul 30, 2011)

You're confusing financially appropriate for medically appropriate.


A patients insurance might be accepted at hospital A and not hospital B, but if hospital B is a cath lab and the hospital A is not, then going to hospital A is not smart OR appropriate when the patient needs a cath lab.



Plus you keep saying 10 minutes.  10 minutes is a non-issue.  We're speaking of the ones that want a 1+ hour transport when another appropriate facility is much closer.  Another truck in our county had a patient the other day request to be taken to a hospital 1.5 hours away.  That's retarded.


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## Sasha (Jul 30, 2011)

We are not even talking about ten minutes further, thats fine... but half an hour? Where do you draw the line? "oh i live in gains

Sent from LuLu using Tapatalk


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## Sasha (Jul 30, 2011)

Sasha said:


> We are not even talking about ten minutes further, thats fine... but half an hour? Where do you draw the line? "oh i live in gainsville but i was visitimg here, i want to go to my hospital in gainsville two hours away"
> 
> Sent from LuLu using Tapatalk





Sent from LuLu using Tapatalk


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## fafinaf (Jul 30, 2011)

-- - -


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## exodus (Jul 30, 2011)

Linuss said:


> You're confusing financially appropriate for medically appropriate.
> 
> 
> A patients insurance might be accepted at hospital A and not hospital B, but if hospital B is a cath lab and the hospital A is not, then going to hospital A is not smart OR appropriate.



Totally true. And in those instances the insurance will pay back their full amount of their normal reimbursement, as well as the transfer costs. But if someone goes to the ER for 'flu like symptoms' which get's dx'd as PNA so the DR keeps them over night for IV meds. Especially if it's Kaiser, they will want to get them to their own hospital. Thankfully kaiser will pay for everything. But many ER's will require a transport to a direct admit to the insurances hospital.

Edit: Maybe we should venture into a new thread? I have a feeling I've seen EMS: Healthcare Vs. Customer Service before somewhere around here ... Hm.


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## Sasha (Jul 30, 2011)

fafinaf said:


> the ambulance company i work for has more than enough ambulances to cover the area while i take the patient to his home hospital. and yes, ems is customer service at the company i work for.



Yeah you have worked for ONE company. You have a small snapshot of ems and you do not speak for the system as a whole. Some places have one truck for their entire county

Sent from LuLu using Tapatalk


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## fma08 (Jul 30, 2011)

Sasha said:


> Yeah you have worked for ONE company. You have a small snapshot of ems and you do not speak for the system as a whole. Some places have one truck for their entire county
> 
> Sent from LuLu using Tapatalk



We're lucky enough to have two


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## Shishkabob (Jul 30, 2011)

Not to mention seeing his location my money is on his agency doesn't do 911, therefor it's a non-issue to be level zero for hours on end as no one has the potential of having a bad outcome because of a delayed response.


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## Sasha (Jul 30, 2011)

Linuss said:


> Not to mention seeing his location my money is on his agency doesn't do 911, therefor it's a non-issue to be level zero for hours on end as no one has the potential of having a bad outcome because of a delayed response.



Not true. We often have emergent cath lab txf

Sent from LuLu using Tapatalk


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## Shishkabob (Jul 30, 2011)

Sasha said:


> Not true. We often have emergent cath lab txf
> 
> Sent from LuLu using Tapatalk



While true, are there also not other transfer agencies in the area?


When I worked at AMR and a time sensitive call came in to which we couldn't make it in reasonable time, dispatch would call another transfer company to take the call.



Plus the patient is already receiving medical care, as opposed to a 911 response where they most likely aren't.


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## JPINFV (Jul 30, 2011)

Sasha said:


> So you would rather take an ambulance out of service for an hour or more to transfer a stable patient to a facility when transfering them to a closer facility would be adequate?
> 
> Sent from LuLu using Tapatalk



Not all hospitals are 30 minutes or further away. Heck, I grew up within 5 minutes of 3 separate hospitals.


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## Shishkabob (Jul 30, 2011)

JPINFV said:


> Not all hospitals are 30 minutes or further away. Heck, I grew up within 5 minutes of 3 separate hospitals.



Again, which is why this is a non-issue for urban providers.



I have 30ish minute transports to a couple of hospitals that can handle most complaints.


Most patients want to go to hospitals over an hour away... even though they are affiliated with the hospitals that are closer.  If we transport to Dallas or Tyler, you're taking a truck out of service for a minimum for 3 hours... 3 hours for a single call that is non-critical and could have taken a POV.


I will run calls all day without issue, it's not a problem of 'being lazy'.  However, asking resources to be taken out of service for that length of time for no change in benefit for the patient is ridiculous.


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## JPINFV (Jul 30, 2011)

Linuss said:


> You're confusing financially appropriate for medically appropriate.


Once the medical screening exam is complete and no "emergent" condition exists, then those are one in the same.



> A patients insurance might be accepted at hospital A and not hospital B, but if hospital B is a cath lab and the hospital A is not, then going to hospital A is not smart OR appropriate when the patient needs a cath lab.


...and what about the vast majority of patients who do not need a specialty center?





> Plus you keep saying 10 minutes.  10 minutes is a non-issue.  We're speaking of the ones that want a 1+ hour transport when another appropriate facility is much closer.  Another truck in our county had a patient the other day request to be taken to a hospital 1.5 hours away.  That's retarded.


...and you keep on saying 1 hour plus, which is not always the case either.


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## JPINFV (Jul 30, 2011)

Sasha said:


> We are not even talking about ten minutes further, thats fine... but half an hour? Where do you draw the line? "oh i live in gains
> 
> Sent from LuLu using Tapatalk




That's an issue (maximum time one way) that needs to be set up by the system administrators or 911 contract and not something decided on an ad hoc basis by field providers.


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## fafinaf (Jul 30, 2011)

I'm not trying to come across as a jerk and I can see how I did. I see all of your points and I understand that not every company is the same. I think we can all agree that there needs to be a time when you draw the line where we try our best to meet the expectations of the patient, and make the best judgement based on availability of ambulances and higher priority calls in the area.

I do believe that EMS is a customer based service, that is my opinion. I feel that meeting and exceeding the expectations of patients not only makes a happy patient, but also generates positive reviews and attitudes towards the company you work for. Can you satisfy every request that a patient has? No. Can you try to do everything you can to make your patient happy while doing what's best for your co-workers and city? Yes. 

Some ambulance companies have more ambulances than others, some have less. Some ambulance companies have contracts with fire and some don't. It's a situation to situation based thing. There are many factors that would play into what hospital you would take a patient to. A patient showing signs and symptoms of an MI is not going to go to a hospital further than the closest one. Sorry to everyone for sounding ignorant. Must have been having a bad day!

Peace & Love


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## Sasha (Jul 30, 2011)

Not sure where you work but i dont have customers, i have patients.

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## JPINFV (Jul 30, 2011)

Linuss said:


> When I worked at AMR and a time sensitive call came in to which we couldn't make it in reasonable time, dispatch would call another transfer company to take the call.



However not all companies are going to do that nor are they going to do that for all calls that have potentials to be an "emergency." Additionally, using that logic, provided all of the calls holding are low grade calls under EMD, what's the problem with being at level 0 under the same reasoning?


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## JPINFV (Jul 30, 2011)

Sasha said:


> Not sure where you work but i dont have customers, i have patients.
> 
> Sent from LuLu using Tapatalk



Sure you do, who ever your company is contracted with is your customer. If it's a 911 company, than the citizens in your jurisdiction (especially if your company receives any tax substitutes) is your customer. If it's private pay, then that patient is your customer. If it's out of a health care facility, then the health care facility is your customer. If it's event standby, then the event organizers are your customers. I'm assuming that your service gets money from somewhere, after all.


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## fafinaf (Jul 30, 2011)

I treat my patients as patients, not customers. And secondly, they ARE customers..


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## Sasha (Jul 30, 2011)

JPINFV said:


> Sure you do, who ever your company is contracted with is your customer. If it's a 911 company, than the citizens in your jurisdiction (especially if your company receives any tax substitutes) is your customer. If it's private pay, then that patient is your customer. If it's out of a health care facility, then the health care facility is your customer. If it's event standby, then the event organizers are your customers. I'm assuming that your service gets money from somewhere, after all.


The only customers are the hospitals/nursing homes. Patients are patients, not customers.


Sent from LuLu using Tapatalk


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## JPINFV (Jul 30, 2011)

Sasha said:


> The only customers are the hospitals/nursing homes. Patients are patients, not customers.
> 
> 
> Sent from LuLu using Tapatalk




If I'm paying out of pocket for care, then I'm both a patient and a customer, and if I don't like the care I received from a transport I set up, I'm free to take my business elsewhere in the future. Similarly, if, as a tax paying citizen, I'm unhappy with the service provided by the contracted ambulance provider, I'm free to work towards the city (the customer) finding a different provider.


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## Sasha (Jul 30, 2011)

JPINFV said:


> If I'm paying out of pocket for care, then I'm both a patient and a customer, and if I don't like the care I received from a transport I set up, I'm free to take my business elsewhere in the future. Similarly, if, as a tax paying citizen, I'm unhappy with the service provided by the contracted ambulance provider, I'm free to work towards the city (the customer) finding a different provider.



I dont work for the city, you are free to refuse care as is someone who isnt paying for care. You can campaign against hospitals contracts if you want but they come down to who does it cheaper and how happy their staff is. A patient is a patient and not a customer.

I dont do billing and dont differentiate between who is paying how and who isnt. So theyre all treated equally.

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## JPINFV (Jul 30, 2011)

Sasha said:


> I dont work for the city,


So you're not running 911 calls? (Honest question, just checking, NTTTAWWT)


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## Sasha (Jul 30, 2011)

Nope. My company if ift, nursing home to er(which is emergency lots of times because nursing homes cant find the 11 key), and critical care transports.

Sent from LuLu using Tapatalk


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## jgmedic (Jul 30, 2011)

fafinaf said:


> I'm not trying to come across as a jerk and I can see how I did. I see all of your points and I understand that not every company is the same. I think we can all agree that there needs to be a time when you draw the line where we try our best to meet the expectations of the patient, and make the best judgement based on availability of ambulances and higher priority calls in the area.
> 
> I do believe that EMS is a customer based service, that is my opinion. I feel that meeting and exceeding the expectations of patients not only makes a happy patient, but also generates positive reviews and attitudes towards the company you work for. Can you satisfy every request that a patient has? No. Can you try to do everything you can to make your patient happy while doing what's best for your co-workers and city? Yes.
> 
> ...



You work for CARE, right? Their contracts are not with Fire, but rather the cities they contract with. Also, c'mon man, a patient with signs and symptoms of an MI is almost always going to a further hospital. I will give you an example from CARE, a patient in Buena Park is having an MI, they are not going to the closest(WAMC or AGH) but rather to Los Alamitos(the closest STEMI center). OTOH, I do agree that EMS, especially at a for-profit agency is seen as customer service.


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## JPINFV (Jul 30, 2011)

jgmedic said:


> You work for CARE, right? Their contracts are not with Fire, but rather the cities they contract with.


Let's be honest here. Yes, the transport contract is with the city itself and approved by the city council, but do you honestly think that the city council cares enough to go against the fire department's recommendation and vetting?



> Also, c'mon man, a patient with signs and symptoms of an MI is almost always going to a further hospital. I will give you an example from CARE, a patient in Buena Park is having an MI, they are not going to the closest(WAMC or AGH) but rather to Los Alamitos(the closest STEMI center).



To be nit picky, I don't think Anaheim General has been approved as a paramedic receiving center after regaining their accreditation earlier this year.


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## jgmedic (Jul 30, 2011)

JPINFV said:


> Let's be honest here. Yes, the transport contract is with the city itself and approved by the city council, but do you honestly think that the city council cares enough to go against the fire department's recommendation and vetting?
> 
> 
> 
> To be nit picky, I don't think Anaheim General has been approved as a paramedic receiving center after regaining their accreditation earlier this year.



Fair enough, I think it depends on the city though, I know when I worked in OC, OCFA had apparently wanted to use CARE as their exclusive ambo provider but got shot down by the contract cities using other providers, I know it's different due to it being a county issue, but it happens. I hadn't heard about AGH, but when I worked in that area, we had an agreement that if one of us coded at work, we were to immediately bypass AGH, even if we were in their parking lot(i'm being facetious, a little) and go to WAMC.


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## JPINFV (Jul 30, 2011)

Well, it's pretty much Doctors and Care now running the show. Costa Mesa (which is looking at contracting to OCFA or going to civilian paramedics) replaced Schaffer with Care and Medix lost all of their contracts but Mission Viejo to Doctors (except Seal Beach, which went to Care). Basically everything North of the 55 is Care and South is Doctors with MV and a few cities using Emergency as exceptions.


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## fafinaf (Jul 30, 2011)

jgmedic said:


> You work for CARE, right? Their contracts are not with Fire, but rather the cities they contract with. Also, c'mon man, a patient with signs and symptoms of an MI is almost always going to a further hospital. I will give you an example from CARE, a patient in Buena Park is having an MI, they are not going to the closest(WAMC or AGH) but rather to Los Alamitos(the closest STEMI center). OTOH, I do agree that EMS, especially at a for-profit agency is seen as customer service.



I see your point


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## Tigger (Jul 31, 2011)

JPINFV said:


> That's an issue (maximum time one way) that needs to be set up by the system administrators or 911 contract and not something decided on an ad hoc basis by field providers.



Exactly. The operations staff should be responsible for these sorts of things. It is not the field providers job to plan out operational and deployment contingencies. The field providers job is to treat their patient(s). Worrying about what will happen to the rest of the system while you are treating/transporting is not the providers responsibility.

If you work at a service with a small number of ambulances that cover a large area, then hopefully your SOPs reflect that and do not typically allow for long distance transports. Clearly, no blanket solution will fit all agencies.

I'm happy I don't have that problem where I. We have four adult Level 1s and two Level 2s in my service area, along with three pediatric Level 1s and a Level 2. Usually the big question is which one the patient or family wants to go to, which is usually the one that is the farthest one away during rush hour.


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## DesertMedic66 (Jul 31, 2011)

jgmedic said:


> You work for CARE, right? Their contracts are not with Fire, but rather the cities they contract with. Also, c'mon man, a patient with signs and symptoms of an MI is almost always going to a further hospital. I will give you an example from CARE, a patient in Buena Park is having an MI, they are not going to the closest(WAMC or AGH) but rather to Los Alamitos(the closest STEMI center). OTOH, I do agree that EMS, especially at a for-profit agency is seen as customer service.



As of tomorrow all of the hospitals in my response area are now a STEMI center. So no more bypassing hospitals for STEMIs.


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## Shishkabob (Aug 1, 2011)

Tigger said:


> I'm happy I don't have that problem where I. We have four adult Level 1s and two Level 2s in my service area, along with three pediatric Level 1s and a Level 2. Usually the big question is which one the patient or family wants to go to, which is usually the one that is the farthest one away during rush hour.



And AGAIN, this is a NON ISSUE for urban providers most of the time as you have a 5-10 minute transport MAX.


However, say you do have all those hospitals in your city, and the patient requests to go to a hospital 100 miles away.  Do you oblige?


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## usalsfyre (Aug 1, 2011)

firefite said:


> As of tomorrow all of the hospitals in my response area are now a STEMI center. So no more bypassing hospitals for STEMIs.



Considering one of the ideas behind STEMI centers was a high volume of procedures to minimize complications...isn't this kind of defeating the purpose? 

Gotta love Medicare dollar grabs...


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## katgrl2003 (Aug 1, 2011)

Linuss said:


> And AGAIN, this is a NON ISSUE for urban providers most of the time as you have a 5-10 minute transport MAX.
> 
> 
> However, say you do have all those hospitals in your city, and the patient requests to go to a hospital 100 miles away.  Do you oblige?



We have an ungodly number of hospitals in the city including 2 level 1 trauma centers, a level 1 pediatric trauma center, and a level 2 adult. That being said, we can transport to anywhere in the 9 county area, which is about 1800 sq. miles. (Someone from Indy correct me if my math is wrong, I had to go to googlemaps to figure out the area.)


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## JPINFV (Aug 1, 2011)

Linuss said:


> And AGAIN, this is a NON ISSUE for urban providers most of the time as you have a 5-10 minute transport MAX.
> 
> 
> However, say you do have all those hospitals in your city, and the patient requests to go to a hospital 100 miles away.  Do you oblige?




...and again, the decision of the limits to transport should be set by policy by the people involved with managing the system, not the providers themselves on an ad-hoc basis.

...and again, just because you're rural doesn't mean everybody else is, so in a properly designed system, it's a non-issue for rural agencies as well.


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## Shishkabob (Aug 1, 2011)

What makes an administrative decision to refuse silly (lets be honest, they are silly) transport destinations any more viable or "correct" than a field providers?  Is not a field providers very job TO make decisions ad hoc and not stick to some concrete plan? 



Yesterday, called for a sliver stuck in someone, no bleeding, no true reason to transport, but they asked if we could take them to a hospital 1.5 hours away, closer to their home.  You know what I said?  "You are more than welcome to go by personal car if you want.  There's nothing that I can do for you inside the ambulance.  I'll take you if you want us to, but I'm giving you some options to think about"

You know what I SHOULD be legally able to say?  "You don't need an ambulance, you need to find alternate travel arrangements, have a better day"


We aren't taxis, and the sooner we quit acting as such the better.


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## JPINFV (Aug 1, 2011)

Linuss said:


> What makes an administrative decision to refuse silly (lets be honest, they are silly) transport destinations any more viable or "correct" than a field providers?  Is not a field providers very job TO make decisions ad hoc and not stick to some concrete plan?



There's a difference between justifying refusing a patient's request regarding their own medical care (including which hospital to go to) because of medical necessity (specialty hospital or closest, which even then should be able to be overridden akin to any other specific procedure) and refusing a destination because of some amorphous system design concerns. 

Furthermore, the patient is not going to see increased out-of-pocket expense for going to an out of network hospital (especially when they are either admitted or required to pay for an ultimately unnecessary interfacility transport) as "silly." Neither is their physician going to see such a request as "silly" when they find themselves unable to provide inpatient care because the patient isn't at a hospital where the physician has practice rights because the ambulance crew threw a fit because of a 10 minute greater transport time. 




> You know what I SHOULD be legally able to say?  "You don't need an ambulance, you need to find alternate travel arrangements, have a better day"


I agree, provided the average paramedic has formal education in determining who needs additional care and has more training than 150 or so at the EMT level and a year or so (total, post secondary) for paramedic. I think the entire concept that EMS has shown themselves unable to determine even when a helicopter is medically necessary (what's the number for the amount of people who are discharged directly from the ED within 24 hours of their helicopter flight again?) how shown that they, as a whole, are incapable of determining which patients need a hospital and which don't.

Furthermore, as long as there are legitimate concerns that providers are going to refuse care so that they can get back to watching Emergency! on their iPad, it's not going to happen, and it's up to EMS providers to clean their own house for this concern.


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## MrBrown (Aug 1, 2011)

Is there anywhere in the US that is leaving people at home?


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## Shishkabob (Aug 1, 2011)

JPINFV said:


> Furthermore, the patient is not going to see increased out-of-pocket expense for going to an out of network hospital (especially when they are either admitted or required to pay for an ultimately unnecessary interfacility transport) as "silly." Neither is their physician going to see such a request as "silly" when they find themselves unable to provide inpatient care because the patient isn't at a hospital where the physician has practice rights because the ambulance crew threw a fit because of a 10 minute greater transport time.



So, because the patient has an issue with their insurance agency, they get to demand wherever they go for a non-emergency when they are more than capable to find alternate forms of transportation?  How is that not an abuse of the system?  Yes... asking an ambulance to make a transport to a far away hospital for something that doesn't need to be transported by an ambulance IS silly.




> I agree, provided the average paramedic has formal education in determining who needs additional care and has more training than 150 or so at the EMT level and a year or so (total, post secondary) for paramedic. I think the entire concept that EMS has shown themselves unable to determine even when a helicopter is medically necessary (what's the number for the amount of people who are discharged directly from the ED within 24 hours of their helicopter flight again?) how shown that they, as a whole, are incapable of determining which patients need a hospital and which don't.




We'll go to the call I had yesterday.

Can you honestly say you can't trust 99.9% of providers to go "Hmm.. isolated foreign body stuck in soft tissue with no possible chance of an emergent condition.... they need a taxi not an ambulance"?  If they cannot be trusted with something as simple as that, they don't need to be trusted with anything considered 'ALS'.

(PS.. please don't go off some hypothetical thing like an embolus...)


Emergency care is a right... palliative care is not.


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## Sasha (Aug 1, 2011)

Jp you are the ONLY one talking about a ten minute difference. Linuss and i were referring to 30 minute differences

Sent from LuLu using Tapatalk


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## JPINFV (Aug 1, 2011)

Sasha said:


> Jp you are the ONLY one talking about a ten minute difference. Linuss and i were referring to 30 minute differences
> 
> Sent from LuLu using Tapatalk




Ok, 30 minutes. What about 25? 20? 10? Where is the line, or does every crew get to decide what their own line is?


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## Shishkabob (Aug 1, 2011)

JPINFV said:


> Ok, 30 minutes. What about 25? 20? 10? Where is the line, or does every crew get to decide what their own line is?



Exactly... where IS the line?  Because as of right now, you'd advocate transporting a 911 patient from San Diego to New York because their insurance pays for the NY hospital.  Or for a more realistic one... from Houston to Dallas, a 250mi, 4 hour one way trip.  That's not responsible.  





The line is whatever hospital is able to treat the patients complaint that they called 911 for.  If it's emergent enough to call 911, and emergent enough to go by ambulance, it's emergent enough to go to the closest appropriate facility.

If not, they can set up an IFT from their house to wherever they choose.


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## DesertMedic66 (Aug 1, 2011)

Linuss said:


> Exactly... where IS the line?  Because as of right now, you'd advocate transporting a 911 patient from San Diego to New York because their insurance pays for the NY hospital.  Or for a more realistic one... from Houston to Dallas, a 250mi, 4 hour one way trip.  That's not responsible.
> 
> 
> 
> ...



If our patient gets to be able to chose the hospital (assuming they are not trauma, burn, stroke etc) they only get the choice of the 3 hospitals in our response area. They are free to schedule an IFT transfer from that hospital.


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## JPINFV (Aug 1, 2011)

Linuss said:


> So, because the patient has an issue with their insurance agency, they get to demand wherever they go for a non-emergency when they are more than capable to find alternate forms of transportation?  How is that not an abuse of the system?  Yes... asking an ambulance to make a transport to a far away hospital for something that doesn't need to be transported by an ambulance IS silly.


Is abuse of the 911 system not against the law in Texas? I'm not saying it doesn't happen, but if you're so big on being able to unilaterally set policy, call the police yourself. Have the person charged with abuse if they're calling for non-emergencies. 

Yes, within reason (and, again, I think that what is "reasonable" should be set at the system level, not at an individual ambulance level) patients have the right to direct their own care, which includes destination. 

This is an insurance issue. 

This is a continuity of care issue (what happens when your patient is admitted?). 

This is an EMS system issue (again, don't complain when you're holding the wall because the ED is waiting for an IFT to transfer out patients that shouldn't be at that specific hospital in the first place).

This is a health care cost issue (IFTs aren't free, nor is uncompensated care).

This is not -just- an insurance issue. 






> We'll go to the call I had yesterday.
> 
> Can you honestly say you can't trust 99.9% of providers to go "Hmm.. isolated foreign body stuck in soft tissue with no possible chance of an emergent condition.... they need a taxi not an ambulance"?  If they cannot be trusted with something as simple as that, they don't need to be trusted with anything considered 'ALS'.
> 
> ...



What if a bit broke off and he had an emboli? (I couldn't help myself, thanks for the idea!)

Seriously, though, the issue isn't the patently emergent or the patently non-emergent. Where's the line? Does that non-traumatic abdominal pain patient really need an ambulance? Does the leg pain patient really need an ambulance (wasn't there a story posted today about a video gamer who developed DVT and died?)? Saying "Does a patient with a splinter need an ambulance?" is as obvious as "Does the chest pain patient need an ambulance?" (...and no, I'm not trying to reference the infamous DC case here). The obvious answer is no and yes respectively. The problem is that there are plenty of cases that are not so obvious, and no, I don't think I'd trust a lot of providers in making those decisions in the non-obvious cases.


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## JPINFV (Aug 1, 2011)

Linuss said:


> Exactly... where IS the line?  Because as of right now, you'd advocate transporting a 911 patient from San Diego to New York because their insurance pays for the NY hospital.  Or for a more realistic one... from Houston to Dallas, a 250mi, 4 hour one way trip.  That's not responsible.



Ah, except that's not what I've been saying, but thanks for playing. Should I post a link back a few pages where I clearly stated that the time limit should be set at the system level? ...and yes, if your system wants you to transport all the way from Houston to Seattle, then yes, the appropriate thing is to transport the patient to Seattle, and then either quit, grin and bear it, *or work towards changing the policy. Intentionally ignoring a policy such as the patient's ability to choose their destination is not an option.* 





> The line is whatever hospital is able to treat the patients complaint that they called 911 for.  If it's emergent enough to call 911, and emergent enough to go by ambulance, it's emergent enough to go to the closest appropriate facility.
> 
> If not, they can set up an IFT from their house to wherever they choose.



Then call the police for every patient who does not meet your definition of time sensitive emergent. Every patient, every time.


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## firecoins (Aug 1, 2011)

-long internet threads

-EMT-B/Medic trucks

-IFT companies that make you purchase equipment that they should be supplying like O2 regulators. 

-People who like long walks on the beach.  

-People who expect you to speak their language.:rofl:  

-partners who speak over you to patients.


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## Epi-do (Aug 1, 2011)

katgrl2003 said:


> We have an ungodly number of hospitals in the city including 2 level 1 trauma centers, a level 1 pediatric trauma center, and a level 2 adult. That being said, we can transport to anywhere in the 9 county area, which is about 1800 sq. miles. (Someone from Indy correct me if my math is wrong, I had to go to googlemaps to figure out the area.)



That is department specific, kat.  I can tell you that if someone wanted me to take them across the entire county and into Hendricks or Morgan Co, the answer would be no.  For the most part, when it comes to transporting to the west, we really don't go much past all the stuff downtown.  It would take us forever to go from the east county line to Hendricks Co.


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## sirengirl (Aug 1, 2011)

firecoins said:


> -People who expect you to speak their language.:rofl:



people who dont speak your language then have the audacity to snap their fingers at you repeatedly and go "ey, ey, ey" and point and beckon you like a dog :glare: gtfo.


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## Hunter (Aug 1, 2011)

sirengirl said:


> people who dont speak your language then have the audacity to snap their fingers at you repeatedly and go "ey, ey, ey" and point and beckon you like a dog :glare: gtfo.



Lol! This is specially true in florida.


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## the_negro_puppy (Aug 1, 2011)

When people call 000 (911) and due to their low AMPDS triage, wait an hour or two for an Ambulance in the middle of the night. When you arrive they are sleeping in bed.


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## katgrl2003 (Aug 1, 2011)

Epi-do said:


> That is department specific, kat.  I can tell you that if someone wanted me to take them across the entire county and into Hendricks or Morgan Co, the answer would be no.  For the most part, when it comes to transporting to the west, we really don't go much past all the stuff downtown.  It would take us forever to go from the east county line to Hendricks Co.



Oops, forgot about that. My company has the rule that we can go anywhere in the 9 county area. In saying that, there are several other 911 providers in the city that say different.

Oh, Epi? I sometimes wish they didnt have that rule. We had to transport one from the west side to CHN the other day.... looooong transport.


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## MrBrown (Aug 1, 2011)

the_negro_puppy said:


> When people call 000 (911) and due to their low AMPDS triage, wait an hour or two for an Ambulance in the middle of the night. When you arrive they are sleeping in bed.



super mega hella gangsta big afro styles ROFPMSLMAO


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## HotelCo (Aug 1, 2011)

MrBrown said:


> super mega hella gangsta big afro styles ROFPMSLMAO



Don't make fun of my hair. That's not cool, dude... 


Sent from my iPhone using Tapatalk


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## Hunter (Aug 1, 2011)

HotelCo said:


> Don't make fun of my hair. That's not cool, dude...
> 
> 
> Sent from my iPhone using Tapatalk




I'd take that as a compliment


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## Tigger (Aug 1, 2011)

Linuss said:


> And AGAIN, this is a NON ISSUE for urban providers most of the time as you have a 5-10 minute transport MAX.
> 
> 
> However, say you do have all those hospitals in your city, and the patient requests to go to a hospital 100 miles away.  Do you oblige?



How about reading all of my post next time instead of just taking one part out of context? Did you just skip over the first part because it doesn't align perfectly with your stance?

Notice that I said I am personally glad to not have the problem of long distance transports, but I did offer an idea to those that do. 

To rehash:

Clearly it is not in the best interest of your service to transport people to a hospital an hour away. There's nothing wrong with that. All the administration has to due is write a policy that states all but specialty patients will be transported to hospitals within x amount of minutes. That way, you don't have to make that choice in the field, your choice to take them to closest appropriate facility has already been justified. I guess I don't see what the problem is with putting such a policy in writing is, it doesn't seem like something you would even want to go against anyway.

To answer your other question, I will take a patient to whatever hospital they want, provided it is inside my EMS region. If not, I can contact my supervisor to see if I can take a patient out of area, though I am yet to do that. Incidentally, a lot of my transports are still over a half hour due to traffic, but we have contingency plans in place for when a unit is going out of service for a significant period of time.


Sent from my out of area communications device.


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## Farmer2DO (Aug 2, 2011)

I'm lucky not to have to deal with this, most of the time.

Almost everyone goes to one of the 4 local hospitals.  The exceptions are Veterans (we have 3 VA Medical Centers; 60, 70, and 90 miles) and a major hospital that does cancer only about 70 miles.  There have also been a few exceptions for post-surgical complications, which need to go back to their surgeon and the facility where they had the surgery.

I personally think that we SHOULD be able to make these decisions.  It's called judgement; we're supposed to exercise it all the time.  If you want the person to make the case to a supervisor or medical control, fine.  But if we can't decide things like this, how can we ever expect to get any respect as a profession?  

I'm more than happy to take someone on the 90 mile trip when there's a hospital across the road *when there's a reason*.  Going out of town because all the hospitals here know your game and won't give you a script for 120 percocets is not enough of a reason.


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## Farmer2DO (Aug 2, 2011)

firecoins said:


> -EMT-B/Medic trucks
> 
> -People who expect you to speak their language.



People who not only expect you to speak their language, but wave their benefits card at you like they own you.

Nurses that get up in the middle of triage and walk away to go do something else.

Medical personnel that work in areas that routinely deal with EMS and have NO idea what our role is, in any way, shape or form, and then think they need to tell us how to do our job.

BTW, what's wrong with EMT-B/paramedic trucks?  From what I can see, it's the rule, not the exception, and my place of employment makes it work quite well every day.


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## JPINFV (Aug 2, 2011)

Farmer2DO said:


> The exceptions are Veterans (we have 3 VA Medical Centers; 60, 70, and 90 miles)


Devils advocate time:

Why are veterans an exception? If you're going to transport them 60 miles because of their insurance (VA access), why shouldn't everyone else get the same benefit (transport to their home hospital if within 60 miles)?


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## Farmer2DO (Aug 2, 2011)

Because in reality, 90-95% of our patients are Medicaid, who doesn't care where they go.  

We have an outpatient VA clinic in town that authorizes local hospital ED visits all the time, so it's rarely an issue.  I'm talking about someone who's stable enough to make the trip, is going to be admitted, will likely be transferred if we go local, and has some benefit to be gained from making said trip.

But if you aren't a Veteran, and had your leg surgery 70 miles away, and now it's infected, and you aren't ambulatory, and are here staying with your daughter while you recover (a real scenario) then you deserve to go back where you had your surgery.

I think as a paramedic, these are decisions that I should be able to make.  I don't actually think they're that difficult.


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## Aidey (Aug 2, 2011)

Actually Medicaid (and Medicare) does care. They only pay mileage for the patient to go to the closest appropriate hospital.


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## Farmer2DO (Aug 2, 2011)

Medicare, perhaps.  Medicaid is administered by the state, and only has to meet certain minimum requirements as set forth by the federal gov't (as I understand it).  New York is a VERY liberal state, and Medicaid here pays for everything.  I've never heard of any Medicaid patients ever having "preferred hospital" issues here.


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## Leafmealone (Aug 2, 2011)

Farmer2DO said:


> Medicare, perhaps.  Medicaid is administered by the state, and only has to meet certain minimum requirements as set forth by the federal gov't (as I understand it).  New York is a VERY liberal state, and Medicaid here pays for everything.  I've never heard of any Medicaid patients ever having "preferred hospital" issues here.



Medicare/Medicaid makes you jump through a lot of hoops also when it comes to transporting. Not only do they do the whole closest facility thing, but they also require EMS to state why an emergency transport was needed, and why they couldn't have driven themselves. I've taken to placing all my Medicare/Medicaid patients on 2lpm O2 just so I can justify billing.


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## Sasha (Aug 2, 2011)

Leafmealone said:


> Medicare/Medicaid makes you jump through a lot of hoops also when it comes to transporting. Not only do they do the whole closest facility thing, but they also require EMS to state why an emergency transport was needed, and why they couldn't have driven themselves. I've taken to placing all my Medicare/Medicaid patients on 2lpm O2 just so I can justify billing.



Thats fraud.

Sent from LuLu using Tapatalk


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## Leafmealone (Aug 2, 2011)

Sasha said:


> Thats fraud.
> 
> Sent from LuLu using Tapatalk



I didn't mean it as so, Please, don't get me wrong. When I say taken to giving them O2, I meant that most of the time their sat is low, and I justify it by giving them O2. I wouldn't needlessly give treatment to a person who doesn't need it. Almost all of my patients get oxygen, because it is really a wonder drug. I'm just stating that most if not all of my medicare/medicaid patients get oxygen for one reason or another. It covers everything from SoB to nausea and even with the fall victims. Please don't think that I would knowingly falsify information for a payment, its not like I am the one collecting on the bills.


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## JPINFV (Aug 2, 2011)

Leafmealone said:


> I meant that most of the time their sat is low, and I justify it by giving them O2.


Just curious, what do you define as a low stat?



> its not like I am the one collecting on the bills.



Note, this is not directed at Leaf as it's a wide spread feeling in EMS.

While I don't condone giving even a false appearance of fraud, I think this completely the wrong attitude. I don't get why EMS providers aren't concerned over billing when the money their company receives from billing is what they use to reimburse their employees. The money for pay has to come somewhere.


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## Sasha (Aug 2, 2011)

Leafmealone said:


> I didn't mean it as so, Please, don't get me wrong. When I say taken to giving them O2, I meant that most of the time their sat is low, and I justify it by giving them O2. I wouldn't needlessly give treatment to a person who doesn't need it. Almost all of my patients get oxygen, because it is really a wonder drug. I'm just stating that most if not all of my medicare/medicaid patients get oxygen for one reason or another. It covers everything from SoB to nausea and even with the fall victims. Please don't think that I would knowingly falsify information for a payment, its not like I am the one collecting on the bills.



Thats not what your post said, it specifically stated you put all your patients on o2 JUST TO JUSTIFY BILLING.

Sent from LuLu using Tapatalk


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## socalmedic (Aug 2, 2011)

JPINFV said:


> yes, if your system wants you to transport all the way from Houston to Seattle, then yes, the appropriate thing is to transport the patient to Seattle, and then either quit, grin and bear it, *or work towards changing the policy. Intentionally ignoring a policy such as the patient's ability to choose their destination is not an option.*



the one thing California has going for it right now is that we transport all patients the the "*Closest most appropriate facility*" that is unless I as the paramedic feel that the patient is justified in requesting a different hospital i can bypass with base hospital approval.


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## Aprz (Aug 2, 2011)

People who think oxygen is a wonder drug. :\


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## JPINFV (Aug 2, 2011)

socalmedic said:


> the one thing California has going for it right now is that we transport all patients the the "*Closest most appropriate facility*" that is unless I as the paramedic feel that the patient is justified in requesting a different hospital i can bypass with base hospital approval.


It's a local thing as I know OC's protocol states patient preference if with in a 20 minute transport, unless a medically valid reason is present or no preference is expressed. 

Besides, within a reasonable transport time and provided no need for a specialty center, isn't the patients home hospital more appropriate than non-home hospitals?


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## MrBrown (Aug 2, 2011)

JPINFV said:


> Besides, within a reasonable transport time and provided no need for a specialty center, isn't the patients home hospital more appropriate than non-home hospitals?



Stop speaking sense!  

You know common sense and rational clinical judgement is not planned for in the 100 hour cirriculae


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## Epi-do (Aug 2, 2011)

"Why can't I pass NR?!?!?!?" posts.  Seriously, the test isn't all that difficult.  If you haven't taken a computer based test before, I'll grudgingly give you one fail for being freaked out by the format.  However, the second time around you know exactly what to expect from the format, and the style in which the questions are written.  At that point, is there really any excuse for not passing, except you just don't know the material?  And since EMS in the US isn't rocket science, if you can't pass on the second attempt, do you really think this is a good fit for you?


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## Sasha (Aug 2, 2011)

They don't pass because the NR is a money stealing scam!!!!


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## Epi-do (Aug 2, 2011)

Sasha said:


> They don't pass because the NR is a money stealing scam!!!!



So all of us that passed the first time around either just got lucky or figured out how to scam the scammers?  :rofl:


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## Shishkabob (Aug 2, 2011)

Sasha said:


> They don't pass because the NR is a money stealing scam!!!!



Well, it IS, but that's not why people don't pass


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## Leafmealone (Aug 3, 2011)

JPINFV said:


> Just curious, what do you define as a low stat?



Anything under patients norm/ roughly 96 or less. even if its a couple of points, a minor improvement is still an improvement, IMO.


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## usalsfyre (Aug 3, 2011)

Leafmealone said:


> Anything under patients norm/ roughly 96 or less. even if its a couple of points, a minor improvement is still an improvement, IMO.



Your just trying to make numbers look pretty. Physiologically pulseox is a poor indicator of hypoxia, albeit the only objective measure we have.  Your not really hypoxic till 90-92% assuming a normal H&H and even then it's often a relatively mild hypoxemia. Trying to manipulate numbers with supraphysiologic levels of O2 isn't productive.


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## JPINFV (Aug 3, 2011)

Leafmealone said:


> Anything under patients norm/ roughly 96 or less. even if its a couple of points, a minor improvement is still an improvement, IMO.



Ah, the problem is that while 96 is "normal," the normal range is actually anything above 92. Starting a patient on supplemental oxygen because the SpO2 is 94/95 (baring other issues, least a certain other poster starts whining) is like a paramedic giving a fluid bolus because a patient's systolic blood pressue is 110 and not 120.


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## Hunter (Aug 3, 2011)

Epi-do said:


> Sasha said:
> 
> 
> > They don't pass because the NR is a money stealing scam!!!!
> ...



I passed the first time, I don't believe in luck I figured out how to scam the scammers myself 

No I actually studied my *** off, had no trace of a social life for at least 2 weeks, and made sure to minimize distractions, facebook, IM services, Cellphone, EMT Forums about the things that bother us... <.< last ones a biggy :lol:


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## Hunter (Aug 3, 2011)

Sasha said:


> Thats not what your post said, it specifically stated you put all your patients on o2 JUST TO JUSTIFY BILLING.
> 
> Sent from LuLu using Tapatalk



Actually... *vvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvv
*


Leafmealone said:


> Medicare/Medicaid makes you jump through a lot  of hoops also when it comes to transporting. Not only do they do the  whole closest facility thing, but they also require EMS to state why an  emergency transport was needed, and why they couldn't have driven  themselves. I've taken to placing all my *Medicare/Medicaid* patients on  2lpm O2 just so I can justify billing.



wich technically is fraud...


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## Farmer2DO (Aug 3, 2011)

Leafmealone said:


> Anything under patients norm/ roughly 96 or less. even if its a couple of points, a minor improvement is still an improvement, IMO.



Since I work in the same system as you, at our elevation above sea level, 92% and above on room air is considered normal.


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## Leafmealone (Aug 3, 2011)

Fair enough, I have stated in other posts that I am still relatively new. Good to have this information, and I will adjust accordingly.


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## firecoins (Aug 3, 2011)

-Supervisors with lower certification than yourself.:rofl:

-IFT dispatchers who call you while providing patient care on the SNF emergency they sent you too wondering why its taking so long.

-People who enjoy long walks on the beach.  Can't you find something else you enjoy less cliche?


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## sirengirl (Aug 3, 2011)

firecoins said:


> -IFT dispatchers who call you while providing patient care on the SNF emergency they sent you too wondering why its taking so long.



hospitals that call me for a gurney transport back to a nursing home and when I show up they are just serving the patient lunch, or there are still IVs/lines/random machines still hooked up to the pt :glare:


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## mycrofft (Aug 3, 2011)

*Annoying excited "partner" trick.*

You get the litter folded out and raised, whether or not there is a pt on it, and your co-worker starts trying to make you go faster, especially by pushing or pulling it faster, than the situation warrants.
Only time (so far) I've actually threatened to knock somone on their arse.


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## Sasha (Aug 3, 2011)

sirengirl said:


> hospitals that call me for a gurney transport back to a nursing home and when I show up they are just serving the patient lunch, or there are still IVs/lines/random machines still hooked up to the pt :glare:



"Ohh no I only have a few more minutes of paperwork done, no need to push the call back. <30 minutes later> I'm almost done!!!"


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## Sasha (Aug 3, 2011)

mycrofft said:


> You get the litter folded out and raised, whether or not there is a pt on it, and your co-worker starts trying to make you go faster, especially by pushing or pulling it faster, than the situation warrants.
> Only time (so far) I've actually threatened to knock somone on their arse.



I solve that fairly easily. I am usually in the front of the stretcher because I'm short. They start pushing faster, I let go of the stretcher and let them keep going. When I get a puzzled look I smile and go "I figured I'd let you go since you're in such a rush. I've got short legs!" they usually get it and adjust accordingly. 

If they don't, they start pushing faster, and I start pushing back against them.


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## Dr.NREMT-B (Aug 3, 2011)

Lifeguards For Life said:


> - How bad is your pain?
> 
> - 10/10.....it's getting worse....OH GOD!
> 
> ...



HAHA...  Here is one I had just like that!

ME: "How bad is your pain?"
PT: "10/10 in my right wrist.  I have been unable to use it for days."
ME: "The same right wrist in which you are holding your baby carrier?"
PT: "That's the one."
ME: "How many children do you have?"
PT: "4"
NURSE AT THE CHARGE DESK: "10/10 my @$$. She must have been under epidural!"
PT clearly overheard.


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## ITBITB13 (Aug 4, 2011)

-When you show up to an ER, and the security guard thinks she owns the place, bossing around everyone she can.

-Nurses that treat their patients badly.

-Nurses that make you wonder how the hell they managed to pull off getting a nursing license.

-Nurses that give bad reports.

-When your rig breaks down on the side of the freeway, and you have to wait 3+ hours for a damn tow truck, in the heat w/no AC.


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## Shishkabob (Aug 4, 2011)

Ivan_13 said:


> -When you show up to an ER, and the security guard thinks she owns the place, bossing around everyone she can.



I have this problem at a local hospital ALL the time.  

They have a long avenue for ambulances... you could easily fit 20 ambulances on it.  We could have JUST pulled in, or be walking back to the truck, and the same security guard will always tell us to hurry up and move the truck... even though it's never blocking anyone.


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## adamjh3 (Aug 4, 2011)

This little convo happened between a nurse and me yesterday

Me: "So why are we taking her to the hospital today?"
N: "So she can get treatment"
Me: "What treatment, what does she need done?"
N: "_The_ treatment"

I swear it must have been easier to find Osama than it was to find out why our patient needed to go to the hospital.


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## adamjh3 (Aug 4, 2011)

Double-tap, my bad.


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## Epi-do (Aug 4, 2011)

In the ambulance bay, prior to removing the pt & cot from the back of the truck:

Pt (said dead serious and with no humor whatsoever):  I don't know if it was you or the roads, but that was a horrible trip.

Me:  It's the roads.  They're terrible.

Pt:  Well, I certainly hope so, because that was really bad.  I've never had a ride that bad before.

(All with a smile on my face, while thinking, next time get in your caddy and drive yourself!)

Yep, I hate old biddies!


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## Shishkabob (Aug 7, 2011)

Patients who think that just because they have something means they know everything about it... such as a diabetic I ran on once a shift for a few weeks.  He got angry when I told his family to keep an eye on him and make sure he eats some real food and watch out for when he takes his insulin.  His BGL was 160 after some D50 (20 before) and he kept saying 


Him:  "That's too high, I need to take some insulin"  (baseline BGL is 140...)

Me  "No sir, you just need to eat some real food.  The D50 is what made it that high and that will wear off really fast and you'll crash without some real food and we'll be back to where we were 15 minutes ago"

Him  "Who knows more about this, me that's had it for 30 years or you?!"

Me  "Clearly me sir, since I have to keep getting called out here to help you"



He hasn't needed D50 since ^_^


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## Cup of Joe (Sep 3, 2011)

When I offer someone some chips, and they reach their entire fist into the bag, push the sides of the bag down, and crush all the chips they don't take.


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## ArcticKat (Sep 21, 2011)

When I see a health professional of any type conduct a fluid bolus/challenge by turning the IV pump up to 999mls/hr.


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## usalsfyre (Sep 21, 2011)

ArcticKat said:


> When I see a health professional of any type conduct a fluid bolus/challenge by turning the IV pump up to 999mls/hr.


That's how you "titrate" Diprivan right?


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## jamesm (Sep 22, 2011)

This may be an Australian thing but my pet peev is "she'll be right mate" here is something that happened last week

We had an electrician that fall off a dragline when he was changing a light bulb, so we climbed on up set up our rigging system and I abseiled down and attached him to the rescue line and we both made it to the ground and cleared the fall zone. Anyways a little time go's by I worked out he needed to go to hospital.

Me: "alright, when your ready hop up into the ambulance and we will take you to the gate and let QAS (Queensland Ambulance Service) take you to the hospital"  

Electrician: "Nah it's ok, she'll be right mate" 

Me: "No.. it's not alright, you fell two stories, your harness saved you and now I'm quite sure your nuts are jammed between your two cerebral hemispheres" 

Electrician: "Alright, best we get going"

To be honest I had no idea why I said that and at the time it was pretty funny becuase the Mine Rescue Captain is like laughing his *** off.


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## the_negro_puppy (Sep 22, 2011)

- When a patient says they are 10/10 pain, then goes ballistic (NO NEEDLES!) when you tell them you need to put a needle in their hand/arm to start an IV

- Pt's whinging and moaning about waiting when they are on our stretcher/wheelchair waiting for a bed in the ED for their non-acute ailment, especially when we have spent hours already that day baby-sitting patients in hospital corridors

- Family members who 'follow you' up to hospital, almost tail-gaiting you with their car while their non-acute husband/sister/partner/whatever is in the back.

- Pts who are asleep and that you have to awake when you roll up at 3am, and they arent dead/ ALOC 

- The words shock/shocky. 'She's going into shock, i'm in shock' to describe nervous/emotional response to a situation.

- Pts who tell me they have no medical Hx, then list the 10 prescription only meds they are taking.


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## sdennislee (Sep 22, 2011)

phillybadboy said:


> how do i start A THREAD



Start here http://www.emtlife.com/index.php

Go to the forum that you want to post your thread in. Look toward the upper left and click the big NEW THREAD button.


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## VCEMT (Sep 22, 2011)

I hate whiners and pissy EMTs that are burnouts and think they are worth more than their title. I hate the burnout ER nurses that hate getting any pt. into their care.


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## Dpiner42 (Sep 22, 2011)

"Can i have your insurance card"
- Hands you a medicade Card.


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## usalsfyre (Sep 22, 2011)

Dpiner42 said:


> "Can i have your insurance card"
> - Hands you a medicade Card.



It is insurance.

Besides, who requires upfront insurance information?


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## Dpiner42 (Sep 22, 2011)

usalsfyre said:


> It is insurance.
> 
> Besides, who requires upfront insurance information?



We don't REQUIRE it, but we ask for it to make life interesting. It's just nice to see the people taxpayers pay for go to the hospital via an ambulance for that stubbed toe.


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## usalsfyre (Sep 22, 2011)

Dpiner42 said:


> We don't REQUIRE it, but we ask for it to make life interesting. It's just nice to see the people taxpayers pay for go to the hospital via an ambulance for that stubbed toe.



Ehhh, Medicaid will deny it meaning your not stuck with the bill as a taxpayer, rather you'll be stuck with it as someone who uses the ED for legit reasons and has health coverage.


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## Sasha (Sep 22, 2011)

I get annoyed when a patient tells me their pain is a ten. But theyre sitting there calm and happy as a clam... 

Sent from LuLu using Tapatalk


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## socalmedic (Sep 22, 2011)

Dpiner42 said:


> "Can i have your insurance card"
> - Hands you a medicade Card.



mastercaid, used more places than visa...


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## Joe (Nov 24, 2011)

Motion sickness while writing the epcr sitting in the airway seat on a third ride haha


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## icefog (Nov 25, 2011)

Patients who drink too much, but not enough that they need to be intubated. They always come just after we clean the rig, even if it's 7 am on a Wednesday.

The home nursing service calling an ALS crew to help raise the patient into her armchair.

The local drunk who learned by heart all the most nightmarishly specific symptoms and different specialized medical centers just to use the ambulance as a taxi to get to whichever part of the city he wants in under 7 minutes.


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## jh0n001flip (Nov 29, 2011)

stupid interview questions that dont relate to the job itself. one time an interviewer ask me if i knew a "round hole" in my mind i'm like no mother:censored::censored::censored::censored:er i dont know whats a round hole. then he goes and explain about it saying when a person gets stuck in a question or a situation blah blah..u gotta find ways to react blah blah..i'm like WTF I'm not getting the job am I..cuz of one little stupid question u made and i dont know how to respond to it.


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## BandageBrigade (Nov 29, 2011)

Sounds like someone blew an interview.. I can only guess why. If your last few posts are any indicator of the interview.. Then improve your attitude and try again.


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## Missedcue (Nov 29, 2011)

pet peev's

Arriving at a SNF, asking the CNA or LPN what's going on and hearing, "I don't know, I just started shift."

"How much is this going to cost?"
If you're healthy enough to worry about the price you could probably take yourself.

"Can I have some water?"
Why do people suddenly get dehydrated in the back of an ambulance?

"Why aren't we going faster? Why aren't the sirens on?"
Because this is the third tie I've seen you today for the same thing. You're not dying.

After getting a whole list of c/o having to ask, "okay what's the biggest problem", or, "Why did you call 911 TODAY?"


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## fast65 (Nov 29, 2011)

jh0n001flip said:


> stupid interview questions that dont relate to the job itself. one time an interviewer ask me if i knew a "round hole" in my mind i'm like no mother:censored::censored::censored::censored:er i dont know whats a round hole. then he goes and explain about it saying when a person gets stuck in a question or a situation blah blah..u gotta find ways to react blah blah..i'm like WTF I'm not getting the job am I..cuz of one little stupid question u made and i dont know how to respond to it.



Seriously? Again? This attitude is why you're not getting a job.


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## usalsfyre (Nov 29, 2011)

I've learned a new one.

Dialysis chairs that don't have weights written on them.


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## Sasha (Nov 29, 2011)

usalsfyre said:


> I've learned a new one.
> 
> Dialysis chairs that don't have weights written on them.



How about:

Arriving at a dialysis facility with a patient who has gone to that dialysis center at the same time three times a week for years to find that all the dialysis chairs that open on the side are taken by completely mobile patients and you are stuck offloading into one that doesn't open and your patient is 250lbs?


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## Meursault (Nov 30, 2011)

Missedcue said:


> "Can I have some water?"
> Why do people suddenly get dehydrated in the back of an ambulance?



Well, you've already gotten them a blanket and pillow, tucked them in, and picked up their luggage. It seems like the logical next step.

And on that note, one of my dialysis regulars went through a phase where he just had to have a glass* of ice water when we got him back to his SNF. One day, I was astonished to find that the staff, otherwise some of the laziest and least competent I know of, actually had a fresh cup of ice water waiting for him on his bedside table. I found this out as I was filling a cup with ice from their floor kitchen. Not sure which of us was more thoroughly conditioned at that point. 
*He would probably have finished off a 5-gallon bucket if we gave it to him in 8 oz. increments.


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## usalsfyre (Nov 30, 2011)

Sasha said:


> How about:
> 
> Arriving at a dialysis facility with a patient who has gone to that dialysis center at the same time three times a week for years to find that all the dialysis chairs that open on the side are taken by completely mobile patients and you are stuck offloading into one that doesn't open and your patient is 250lbs?



Perhaps the only "plus" of having a bariatric stretcher on our truck is we usually get a second truck for our morning dialysis run. But dialysis chairs that don't open suck period.


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## Anjel (Nov 30, 2011)

usalsfyre said:


> Perhaps the only "plus" of having a bariatric stretcher on our truck is we usually get a second truck for our morning dialysis run. But dialysis chairs that don't open suck period.



Hate them. Unless the pt is less than 150. Then i like to do end to end transfer


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## Sasha (Nov 30, 2011)

250 isn't bariatric for us. 

I do a head to foot slide for those. Line the head of the stretcher up with the end of the chair, and slide or lift/carry them up to the end of the chair. Easier than going up and over that stupid mother effing arm rest.


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## Anjel (Nov 30, 2011)

Sasha said:


> 250 isn't bariatric for us.
> 
> I do a head to foot slide for those. Line the head of the stretcher up with the end of the chair, and slide or lift/carry them up to the end of the chair. Easier than going up and over that stupid mother effing arm rest.



Yea agreed. 300 and up is bari for us


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## DesertMedic66 (Nov 30, 2011)

usalsfyre said:


> Perhaps the only "plus" of having a bariatric stretcher on our truck is we usually get a second truck for our morning dialysis run. But dialysis chairs that don't open suck period.



I've never seen a dialysis chair before so I have no clue what you guy are talking about haha


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## Tigger (Nov 30, 2011)

Sasha said:


> How about:
> 
> Arriving at a dialysis facility with a patient who has gone to that dialysis center at the same time three times a week for years to find that all the dialysis chairs that open on the side are taken by completely mobile patients and you are stuck offloading into one that doesn't open and your patient is 250lbs?



Or going to clinics that just don't have side loading chairs period and the patient is not interested in cooperating with you during the lift. "Please give yourself a hug...please...no don't grab the siderail...NO let go of that...stop spitting at me...no no seriously stop spitting at me...wait no don't roll back over onto the cot...can we get some help over here!"

The VA dialysis unit here is all beds that have scales built into them, oh the joy!


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## adamjh3 (Nov 30, 2011)

Partners with snoring respirations... while awake.

Partners who eat like five year olds (both in diet and table manners).

Posting all day without running a single call... until the last half hour of your shift.

350+ pound patients who blame others for their weight problem. 


Sent from my DROID X2 using Tapatalk


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## Sasha (Nov 30, 2011)

Tigger said:


> Or going to clinics that just don't have side loading chairs period and the patient is not interested in cooperating with you during the lift. "Please give yourself a hug...please...no don't grab the siderail...NO let go of that...stop spitting at me...no no seriously stop spitting at me...wait no don't roll back over onto the cot...can we get some help over here!"
> 
> The VA dialysis unit here is all beds that have scales built into them, oh the joy!



Hey! You've taken my patient before, haven't you?


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## STXmedic (Dec 2, 2011)

"O2 stats"


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## NomadicMedic (Dec 2, 2011)

PoeticInjustice said:


> "O2 stats"



+ 1million!


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## wlittle (Dec 2, 2011)

*My pet peeves*



PoeticInjustice said:


> "How long has this been going on?"
> "Ohhhh.... For *insert any time frame imaginable that could be chronic*"



My "favorites" calls are the 3:00 A.M. toothache, earache, sore throat responses. you ask them how long they had the problem . . . "oh, two or three days". I have to bite my tongue to keep from asking "why did you call us?":wacko:


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## Handsome Robb (Dec 2, 2011)

PoeticInjustice said:


> "O2 stats"



I'll have you know my O2 stats are awesome! 



wlittle said:


> My "favorites" calls are the 3:00 A.M. toothache, earache, sore throat responses. you ask them how long they had the problem . . . "oh, two or three days". I have to bite my tongue to keep from asking "why did you call us?":wacko:



Welcome to the job. Nothing like meeting PD at 0330 to make sure drunky mcdrunko is ok to go to jail.


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## epipusher (Dec 4, 2011)

wlittle said:


> My "favorites" calls are the 3:00 A.M. toothache, earache, sore throat responses. you ask them how long they had the problem . . . "oh, two or three days". I have to bite my tongue to keep from asking "why did you call us?":wacko:



I never have, and never will complain about these people. They are easy runs and job security. Hence the reason I love my frequent fliers. Its a break from a busy shift and relative job security.


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## STXmedic (Dec 12, 2011)

When you ask a student if they have any questions, or if there's anything they need to work on: "No, I think I'm good...."

......Really? Because I'm working in the field, have been doing this for a few years, and have more questions than I can ever remember! How is it that you're in class, but don't have even ONE question?! Maybe you should just go sit for the USMLEs...


Hmph.


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## Sasha (Dec 12, 2011)

PoeticInjustice said:


> When you ask a student if they have any questions, or if there's anything they need to work on: "No, I think I'm good...."
> 
> ......Really? Because I'm working in the field, have been doing this for a few years, and have more questions than I can ever remember! How is it that you're in class, but don't have even ONE question?! Maybe you should just go sit for the USMLEs...
> 
> ...



My pet peeves are students who try to fight with me when I tell them something.

Really? I've worked in EMS for three full years now you really wanna try and tell me I'm wrong? Shut up and listen. 

Sent from LuLu using Tapatalk


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## Missedcue (Dec 12, 2011)

Giving a radio report beginning with "we are 5 minutes out..." then the nurse telling me to stand by for 4 1/2 minutes and getting pissed when she comes back and I inform her that we are at the door.

Getting a patient to the ER after doing a good exam and suddenly they report all manor of symptoms that would have required a medic eval.

Having to stop a patient and ask, "Okay, so why did you call 911 THIS time."


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## Missedcue (Dec 12, 2011)

People who don't know what meds their on or what their meds are for. If I'm taking medication you bet I'm damn sure I know what I'm on and why I'm on it.


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## STXmedic (Dec 12, 2011)

There, their, and they're...


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## Missedcue (Dec 12, 2011)

Sasha said:


> You want to get a bunch of nurses at once, knock something heavy to the ground and go "OH CRAP!"right before the thud.



I am totally using this one! LOL


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## Missedcue (Dec 12, 2011)

Bullets said:


> I tell them you get seen based on what wrong with you, im always honest. Foot pain? im probably going to wheel you straight into the waiting room and put you in a chair with everyone else. and we are driving code 1 too



The nurses at our level 1 trauma center are awesome. Not only will they chair that patient but they will give them a lecture about not abusing the EMS system, and if it's a chronic abuser they might make the person sit for an extra few hours.


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## Sasha (Dec 12, 2011)

"what's the liter flow rate?"

"40 percent."

"........how many liters?" 

Sent from LuLu using Tapatalk


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## truetiger (Dec 12, 2011)

Students that don't know a dose/scale/exam etc on a call but then will come back to the station and not crack their book.


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## JPINFV (Dec 12, 2011)

Professors who don't understand the meaning of what they write in a primer.

Course directors who change the keyed answer from the correct answer to the wrong answer instead of double keying because the majority of the class got the question wrong.

Course directors and professors who decide test challenges based off the percent of the class who got the answer wrong instead of the merits of the challenge, especially when they can't actually come up with a reason why the challenge is bad.


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## exodus (Dec 12, 2011)

Sasha said:


> "what's the liter flow rate?"
> 
> "40 percent."
> 
> ...



5-12 h34r:


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## adamjh3 (Dec 13, 2011)

Providers with the same exact certs as you acting like they're better/treating you like dirt because they work for one of the local 911 services (but do mostly IFT...) while you work strictly IFT. 

Oh, I was going to tell you what you need to do to get in the locked facility, but you didn't even look at me when I said "what's up?" Fine, ****. Have fun looking like the rookie you are.


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## DesertMedic66 (Dec 13, 2011)

adamjh3 said:


> Providers with the same exact certs as you acting like they're better/treating you like dirt because they work for one of the local 911 services (but do mostly IFT...) while you work strictly IFT.
> 
> Oh, I was going to tell you what you need to do to get in the locked facility, but you didn't even look at me when I said "what's up?" Fine, ****. Have fun looking like the rookie you are.



For over here it's the opposite way. The IFT company's employees act like that.


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