# Anyone been running into this lately?



## Buzz (Feb 19, 2009)

Nursing Homes (or even a few hospitals) refusing to hand over a patients' chart to you when you arrive to pick up the patient...

Ran into this last night at a nursing home. Patient had dementia and we were taking him to a sleep study. I asked nicely to see the patient's chart so I could copy down his medications, allergies, history and whatnot and the nurse refused citing HIPAA as her reason... 

Also ran into it recently while on an emergency run. Had to rely solely on the report and a sloppy handwritten med list she gave me when we arrived. Granted, those are things you might not even have when responding to a residence, but still is there any reason for them to deny information that they have about the patient's condition?


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## PapaBear434 (Feb 19, 2009)

I have only had one or two good experiences with nursing homes.  Most of the time, I see some of the lowest level nurses doing such a horrible job...  It's like they haven't done a proper assessment in years, and seem to have no interest in doing so.

Always "lose" the paperwork, "forget" to get a set of vitals before we show up (or they are obviously made up), and if either one of these is done they are likely to be wrong.

Maybe I'm just in a bad area for nursing homes or something.


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## redcrossemt (Feb 19, 2009)

Buzz said:


> I asked nicely to see the patient's chart so I could copy down his medications, allergies, history and whatnot and the nurse refused citing HIPAA as her reason...



I assume someone at that facility got word of the changes to HIPAA and ran around telling all of the staff to not say anything to anyone.

If you weren't aware yet, there have been some changes to HIPAA that were enacted as part of the Stimulus Bill. Most of the changes related to how covered entities share information with their business partners. There's also new wording that bans the sale of PHI, requires additional accounting on electronic health records, and notification of patients when their PHI is accidentally released.

Page, Wolfberg, and Wirth has a page on the changes at http://www.pwwemslaw.com/content.aspx?id=396. I have no ulterior motives or undisclosed interests, but if you are a privacy officer, you should consider signing up for the PWW webinar on that page for an update.

Note that that law was never designed to prevent transfer of information between healthcare providers, and still allows the sharing of things like medical history, medications, drug allergies, and other information you need to know to provide the best care to the patient.


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## Sasha (Feb 19, 2009)

It's frustrating when they refuse to hand you the chart, but hey.. some EMTs and Medics give them a reason.

Only health care professionals look at the charts. There is a lot of unprofessional EMTs, especially IFT. Not knocking IFT companies. I loved working IFT but a lot of people don't take it seriously enough because it's "just transport" and don't care or on the flip side, they blow smoke up their butt because no one takes them seriously enough, are rude and mean to nurses and staff and leave a sour taste in their mouth.

I've found that politely reminding the nurse that you are an EMT, not just a "transporter" and they are transferring care of the patient to you sometimes helps.

If they still wont give it up, most of the information on the chart can be found in the patient's packet you just gotta look through it. The only reason I ever looked at the chart is if the paperwork was incomplete, the nurse was still working on the packet when we got there, and to to swipe an ID sticker.


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## Ridryder911 (Feb 19, 2009)

Here is how I handle that, inform them either to have proper (with needed information) and to be legible, or please go get the person in charge. If it is the LPN/LVN that is discussing this with you; then ask for the Director of Nurses name to make a call later. 

Personally, I have never asked to see the chart as it has too much B.S. within it  to decipher what is needed. I do though ask for a complete transfer sheet w/med list. 

As a person whom is responsible for administering care, HIPAA is not involved at this level. 

R/r 911


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## Buzz (Feb 19, 2009)

redcrossemt said:


> I assume someone at that facility got word of the changes to HIPAA and ran around telling all of the staff to not say anything to anyone.
> 
> If you weren't aware yet, there have been some changes to HIPAA that were enacted as part of the Stimulus Bill. Most of the changes related to how covered entities share information with their business partners. There's also new wording that bans the sale of PHI, requires additional accounting on electronic health records, and notification of patients when their PHI is accidentally released.



Ah, that probably is the reason for their refusal. I've never had an issue at most of these places before.


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## karaya (Feb 19, 2009)

redcrossemt said:


> I assume someone at that facility got word of the changes to HIPAA and ran around telling all of the staff to not say anything to anyone.
> 
> If you weren't aware yet, there have been some changes to HIPAA that were enacted as part of the Stimulus Bill. Most of the changes related to how covered entities share information with their business partners. There's also new wording that bans the sale of PHI, requires additional accounting on electronic health records, and notification of patients when their PHI is accidentally released.
> 
> ...


 
The changes in the stimulus bill chiefly focus on Business Associates, which EMS provider would usually not be considered a BA since they too are a covered entity.  And the new changes don't go into effect until this time in 2010.


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## JPINFV (Feb 19, 2009)

The only two problems I've ever encountered was them sealing the envelope and telling me that it's "for the hospital," and them not providing a copy of the MAR (which I ask for since the ER usually wants a copy of it). The first is easily handled once the doors to my ambulance close.


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## Ridryder911 (Feb 19, 2009)

karaya said:


> The changes in the stimulus bill chiefly focus on Business Associates, which EMS provider would usually not be considered a BA since they too are a covered entity.  And the new changes don't go into effect until this time in 2010.



Yeah, I just read the new amend to the HIPAA reg. It has very little to do with the street medic, but may affect billing services and contract review services for insurane payors. Again, alike discussed will not be effective for a while. 

R/r 911


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## firecoins (Feb 19, 2009)

At my IFT company we are run by a health network that is owned by the 4 hospitals we serve.  They have sheet that informs them what we need ahead of time. This way we don't run into such problems.  Usually if there is a problem it is because the person preparing the file is new.  This is easily fixed.  

I have befriended many of the techs, RNs and MDs who work at the facilities I frequently attend.  Therefore they recognize me and will often give me a full verbal report even on the most routine of trips.


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## medicdan (Feb 19, 2009)

I run into this fairly often, I take daily tours of some of the worst nursing homes in the area. I keep insisting that I need the chart in order to take the patient off their hands-- as soon as I say "take this patient away" they tend to comply. This really is not a HIPAA issue-- we are medical professionals (well some are), and we need this information in order to take care of our patients. 

Some EMTs at my company have gotten into the habit of calling and confirming their patient's appointments before transporting, because these nursing homes screw up appointments so often. 

Once I get the chart, I look for a face sheet (towards the front, because it is guaranteed to have correct name, address, SSN, etc), recent hospital discharge paperwork (more legible and trustworthy then SNF paperwork, used to get PMH, meds, allergies).


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## amberdt03 (Feb 19, 2009)

PapaBear434 said:


> I have only had one or two good experiences with nursing homes.  Most of the time, I see some of the lowest level nurses doing such a horrible job...  It's like they haven't done a proper assessment in years, and seem to have no interest in doing so.
> 
> Always "lose" the paperwork, "forget" to get a set of vitals before we show up (or they are obviously made up), and if either one of these is done they are likely to be wrong.
> 
> Maybe I'm just in a bad area for nursing homes or something.




almost everytime i go to a nh for a call, the nurse always says, " i just came on" or "this is normally my patient" and i'm like does nobody talk to each other here. anybody else get that?


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## Veneficus (Feb 19, 2009)

amberdt03 said:


> almost everytime i go to a nh for a call, the nurse always says, " i just came on" or "this is normally my patient" and i'm like does nobody talk to each other here. anybody else get that?



The better question would be: "does anybody not get that line?"

I better stop now before I really post what I think of nursing homes.


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## CAOX3 (Feb 19, 2009)

How would HIPPA apply to this?  The pt is now in your care, which makes their information lawfully available to you.


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## Aidey (Feb 19, 2009)

emt.dan said:


> Some EMTs at my company have gotten into the habit of calling and confirming their patient's appointments before transporting, because these nursing homes screw up appointments so often.



TBH that is a good idea, and I might start doing that myself. The other day we picked up a 400lb+ woman who was "scheduled" to get a PICC line placed. After loading her into the ambulance the hospital we were taking her to went on divert. We called to make sure they would still take our patient, and they had no record of her being scheduled so they told us we were SOL. We ended up parking the rig and calling all the local hospitals to find someone who could do the procedure so we didn't have to take her back since she did geniunely need the PICC line.


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## sir.shocksalot (Feb 19, 2009)

amberdt03 said:


> almost everytime i go to a nh for a call, the nurse always says, " i just came on" or "this is normally my patient" and i'm like does nobody talk to each other here. anybody else get that?


All the time. I'm pretty sure thats just nursese for "The reason why I know nothing about this patient is because, in spite of the patient having been here for a week, I have not once seen this patient while s/he was conscious." My favorite is being called to a dementia facility for ALOC and the nurse just says the patient is confused and walks off to do other things.


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## TransportJockey (Feb 19, 2009)

One SNF tried that when I was working IFT. It stopped real quick when I said that the pt was NOT going to the hospital (friday night of a 3 day weekend, where it looked like that LPN just had this one pt... pt didn't seem to need to go to the ED for a consult, and that came from my medic partner) unless I could see the information I was asking for IE face sheet, meds, allergies, pmhx, hpi... The LPN didn't seem to know anything I asked.


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## amberdt03 (Feb 19, 2009)

sir.shocksalot said:


> All the time. I'm pretty sure thats just nursese for "The reason why I know nothing about this patient is because, in spite of the patient having been here for a week, I have not once seen this patient while s/he was conscious." My favorite is being called to a dementia facility for ALOC and the nurse just says the patient is confused and walks off to do other things.



yes i love that one too. i like telling the RN in my report that we are coming in with an altered LOC and saying with a Hx of Dementia. I always ask the nursing home nurse How do you know they are altered?


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## Hockey (Feb 19, 2009)

While I was in dispatch, I had one nursing facility call and say the patient had a stroke "last night  and either someone didn't notice it or they forgot to call but this patient is going to need to go to the hospital whenever you can get here. "  I go "OK I'll get them there right away"

She comes back with "No no no there is no need to run lights and sirens on this I think he had a stroke thats all"

I smacked my hand on my head and just said "OK Goodbye"

I wouldn't even send my worst enemy to this facility.  They play IMHO "depressing death music" on the floor.  For those who have heard it, you understand...


As for the OP, we run into this problem quite often.  Not as much lately, but we do.  I usually have learned to not ASK but to TELL the person you need such and such information.  Seems when you ask they tell you no or throw a fit.  When you TELL the person, it seems they just bend over and do it and gripe.  But it gets done immediately.


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## ffemt8978 (Feb 19, 2009)

I had a problem one time with the SNF nurse saying that she had already called report to the hospital, and that I didn't need it from her.  I asked her for it again, and when she refused I stated, "Well, you will need to call somebody to pick you up from the hospital, because we don't transport employees back to their work."

She stopped for a moment, and then asked me what I meant by that.  I replied, "Either I get a report and accept patient care from you, or you come with us and keep patient care during the transport.  Doesn't matter to me either way."

I got my report and a phone call from my boss asking me why I refused to accept patient care for a patient.  Once I explained what happened, my boss called the SNF and gave them an "attitude adjustment".


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## PapaBear434 (Feb 19, 2009)

ffemt8978 said:


> I had a problem one time with the SNF nurse saying that she had already called report to the hospital, and that I didn't need it from her.  I asked her for it again, and when she refused I stated, "Well, you will need to call somebody to pick you up from the hospital, because we don't transport employees back to their work."
> 
> She stopped for a moment, and then asked me what I meant by that.  I replied, "Either I get a report and accept patient care from you, or you come with us and keep patient care during the transport.  Doesn't matter to me either way."
> 
> I got my report and a phone call from my boss asking me why I refused to accept patient care for a patient.  Once I explained what happened, my boss called the SNF and gave them an "attitude adjustment".



That, sir, is AWESOME and will be remembered next time these slacker do-nothings give me this line of crap.

Luckily, I only work rescue, so with the emergent situations they are usually pretty good about just turning over information.  But it HAS happened a time or two, people not understanding what HIPPA is actual meant to protect.


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## Outbac1 (Feb 19, 2009)

If I go to a home and the staff have no papers for me I tell them what I need and wait for them to get it. I tell them I am responsible for the pt and as such I need to know certain info. If they give me a sealed envelope I open it in front of them and check the contents to see if it is what I need. If they object they get the responsible speech. I've educated a few and some have even learned.


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## PapaBear434 (Feb 20, 2009)

Outbac1 said:


> If I go to a home and the staff have no papers for me I tell them what I need and wait for them to get it. I tell them I am responsible for the pt and as such I need to know certain info. If they give me a sealed envelope I open it in front of them and check the contents to see if it is what I need. If they object they get the responsible speech. I've educated a few and *some have even learned.*



I'm throwing the BS flag on this!  Liar!


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## Jon (Feb 20, 2009)

PapaBear434 said:


> That, sir, is AWESOME and will be remembered next time these slacker do-nothings give me this line of crap.
> 
> Luckily, I only work rescue, so with the emergent situations they are usually pretty good about just turning over information.  But it HAS happened a time or two, people not understanding what HIPPA is actual meant to protect.


Yep.

I work full-time 911 in a community with too many SNF's. That said, I have VERY little issues with our facilities, as I'm on the 911 squad that they called... Hearing these stories brings back the memories of working Transport, and how much that could suck. At some places, it was pulling teeth to get access to even a face sheet, let alone a medication record or H&P. I always tried to re-educate about HIPAA... but that fell on many deaf ears.


As for envelopes:
There was one facility (psych emergency) that insisted on sealing most of the patient's records in an envelope, and would raise a s**tstorm if the reciving facility called because the envelope was opened. They were concerned about their psychiatric evaluations and committment paperwork going missing... becuase there were times when the transport EMT's would lose/misplace the transfer paperwork.
After going back and forth on this, they eventually settled on giving us a sealed envelope with all the documentation, including commitment warrants, as well as a seperate copy of the face sheet, PMH, and medication information. This was adequate for 99% of the patients, so we kept it at that. If I had to open the envelope, I could... I would just have to explain it to a bunch of folks - I never needed to.


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## ffemt8978 (Feb 20, 2009)

I should probably add that the one time I said that, it was for a non-emergent transport for a test procedure.

I certainly understand that all information may not be immediately available for an emergent problem.


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## emtfarva (Feb 20, 2009)

I have. Not at a SNF, but a large Hosp group. There was a one floor that would literally yell at you if you even requested a report, let alone a signature. They would tape the envelope shut with a whole roll of tape. Of course we opened it in the truck. Now, they let us see whatever we want. They sometimes won't sign though. I also had this attitude at a psych facility.


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## CAOX3 (Feb 20, 2009)

Why would you make a scene in the hospital about seeing someones information.  If you need to open in the truck.

Your taking them home for gods sake, do you really need to know the pts whole medical history. Why do you care?  The informations there if you need it enroute open it.

This field is really in trouble.  If these posts are any sign.  All I hear is, Im better then him, Im better then her, give me respect, I deserve respect.  Im an EMT, IM a medic.

My God. 

How about what ever level you are, you do your job competently, proffesionaly and respectfuly.  Stop worrying about what everyone thinks of you and concentrate on doing your job to the best of your ability. 

There is a role for everyone, handle your business, people will respect you for it.

Do you need to be showered in praise, constantly told that your an asset to this field, if it wasnt for you I dont know where EMS would be.  The constant sesrching for respect and acceptance, its getting really old.


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## PapaBear434 (Feb 20, 2009)

CAOX3 said:


> Why would you make a scene in the hospital about seeing someones information.  If you need to open in the truck.
> 
> Your taking them home for gods sake, do you really need to know the pts whole medical history. Why do you care?  The informations there if you need it enroute open it.
> 
> ...



Did you just hear a loud whizzing noise flying over your head?  Because I think that was the point, and you completely missed it.

I don't think people are really complaining about lack of respect, or even not knowing every little detail about someone when you ship them HOME.  It's when it's an emergent (or semi-emergent) situation, or even just taking custody of a patient, which requires you know a base level about the patient you are taking.  If they are allergic to something, and the nurse just hands you a sealed envelope and don't tell you a thing about them, something very bad could very well happen.

If we didn't need to know this stuff, they wouldn't teach you to ask for a SAMPLE in basic class.


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## CAOX3 (Feb 20, 2009)

Oh no not something very bad.  

Sorry when I do calls I dont have the ability to just check the paperwork.  I have to use assessmnet.  Signs and symptoms should lead you in the direction you need to go in.  Sure your paperwork could be helpful. I wouldnt rely on it.    

I also dont use acronyms.  They were brought about to dumb down the EMT class.  I learned pt assessment, do they even still teach that.


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## amberdt03 (Feb 20, 2009)

CAOX3 said:


> I also dont use acronyms.  They were brought about to dumb down the EMT class.  I learned pt assessment, do they even still teach that.



they only teach enough of patient assessment to pass national registry. they rest you have to learn on the job.


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## John Legg (Feb 20, 2009)

There seems to be a common denominator in this thread. Lack of education. Locally, we were experiencing the same issues. However, once a representative visited each Nursing Home and Hospital, educated them on what was needed and why, we saw a dramatic change. Now, we receive two envelopes, one for the hospital, one for the crew, with the same documents.

The hospitals now have a discharge transport checklist that must be followed. If applicable, even the Medical Necessity Form is usually completed before we arrive, along with HPI, PMHx and Meds/Allergies. What a change!

Took a little time, cost a little money but ultimately it decreases the head aches and has improved our relationships with those facilities.

John Legg
National EMS Association


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## PapaBear434 (Feb 20, 2009)

CAOX3 said:


> Oh no not something very bad.
> 
> Sorry when I do calls I dont have the ability to just check the paperwork.  I have to use assessmnet.  Signs and symptoms should lead you in the direction you need to go in.  Sure your paperwork could be helpful. I wouldnt rely on it.
> 
> I also dont use acronyms.  They were brought about to dumb down the EMT class.  I learned pt assessment, do they even still teach that.



Your "Holier-Than-Thou" nature aside, you are supposed to receive a turnover whenever you take a patient from another medical professional.  Yes, you still do an assessment of your own.  But in a lot of cases, particularly in the nursing home cases, your patient is unconscious or unable to tell you anything.  Knowing his/her allergies to meds, usual condition, and past medical history is kind of important.  Yeah, you can do without those things if you need to, like in emergent cases where you don't have anyone to tell you these things and they are unable to tell you themselves.  But if that information is available, and it is perfectly within your scope of practice to know, you should damn well know it.

Do you give a turn over when you turn someone over to an ER nurse, or do you just drop them off in a room and figure the ER assessment is enough?  I mean, they have to do it ANYWAY, right?


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## CAOX3 (Feb 20, 2009)

amberdt03 said:


> they only teach enough of patient assessment to pass national registry. they rest you have to learn on the job.



Actually experience helps but education is the key.

Her are some good books Ive read.

*Principle of PT assessmnet in EMS*
not sure who wrote this one I let someone borrow it.

*Sick not sick*
-AAOS

*Pt assessmnet handbook*
-Richard Cherry

Just because you didnt learn it or werent taught it isnt an excuse, prepare yourself.  Even at the BLS level if you cant treat it.  It will help everyone involved if you can recognise it.


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## amberdt03 (Feb 20, 2009)

CAOX3 said:


> Just because you didn't learn it or weren't taught it isn't an excuse, prepare yourself.  Even at the BLS level if you cant treat it.  It will help everyone involved if you can recognize it.



i totally agree. i'm doing just about everything i can to further my education. granted i can't really treat much but i can recognize it and give the er a heads up.


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## JPINFV (Feb 20, 2009)

CAOX3 said:


> Sorry when I do calls I dont have the ability to just check the paperwork.  I have to use assessmnet.  Signs and symptoms should lead you in the direction you need to go in.  Sure your paperwork could be helpful. I wouldnt rely on it.




You're right. All that history, allergies, and medications that are normally documented in the paperwork and fairly easy to find if you know what you're looking for is completely useless in front of the all mighty exam.


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## CAOX3 (Feb 20, 2009)

PapaBear434 said:


> Your "Holier-Than-Thou" nature aside, you are supposed to receive a turnover whenever you take a patient from another medical professional.  Yes, you still do an assessment of your own.  But in a lot of cases, particularly in the nursing home cases, your patient is unconscious or unable to tell you anything.  Knowing his/her allergies to meds, usual condition, and past medical history is kind of important.  Yeah, you can do without those things if you need to, like in emergent cases where you don't have anyone to tell you these things and they are unable to tell you themselves.  But if that information is available, and it is perfectly within your scope of practice to know, you should damn well know it.
> 
> Do you give a turn over when you turn someone over to an ER nurse, or do you just drop them off in a room and figure the ER assessment is enough?  I mean, they have to do it ANYWAY, right?



Holier than thou.  You hurt my feelings.  Actually its confidence in my ability, through experience and education.

I dont have the luxury of recieving a printed manuscript.  I have to create it myself.  That is done by assessment.  Therfore in a case where I would recieve one, no I dont rely on it.  Does it have helpful/useful information?  Im sure it does.  
When a pt has a medical hx as long as my arm, isnt much use if I cant recognise one from another.  CHF or pneumonia?  CHF or COPD Left sided or right sided failure.  I could go on and on.


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## CAOX3 (Feb 20, 2009)

JPINFV said:


> You're right. All that history, allergies, and medications that are normally documented in the paperwork and fairly easy to find if you know what you're looking for is completely useless in front of the all mighty exam.



Yes well when they have a hx of everything, and our on every medication under the sun. Thier allergies look the Physicians desk refrence.

Then where are you?  Square one.  I didnt say it wasnt helpful, I stated I dont rely on it.

Fairly easy to find, Ok well I dont know where you work or with who, but when I recieve these, I would probably have a better chance if it was written by a fifth grader.


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## RESQ_5_1 (Feb 20, 2009)

What if your pt is MRSA positive? Which part of your assessment leads you to that discovery? Yesterday, transported an 80 y/o F back to her sending facility after an ORIF on her right humerus (for anyone that doesn't know that would be; Open Reduction/Internal Fixation). Turns out, after she got to the hospital where the procedure was performed, they found she had chronic A-Fib. This was after being seen by nurses, at least one doctor, and at minimum 2 EMS crews. She had an irregular pule at around 120. Generally a good indicator of A-Fib. It was actually caught by the Anesthesiologist who stated he wouldn't sedate her until her HR came below 120.

We do E-PCRs, so I need all that info. Sure, the pt could tell me, but what if my pt is unconcious or doesn't communicate? What if my pt is altered? It's good information to have. I still do my own assessment, but it's a little more focused because I already have information form the sending facility. 

Luckily, we don't do transfers from NHs. All of our LTC facilities are located at the hospitals.


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## PapaBear434 (Feb 20, 2009)

CAOX3 said:


> Holier than thou.  You hurt my feelings.  Actually its confidence in my ability, through experience and education.
> 
> I dont have the luxury of recieving a printed manuscript.  I have to create it myself.  That is done by assessment.  Therfore in a case where I would recieve one, no I dont rely on it.  Does it have helpful/useful information?  Im sure it does.
> When a pt has a medical hx as long as my arm, isnt much use if I cant recognise one from another.  CHF or pneumonia?  CHF or COPD Left sided or right sided failure.  I could go on and on.



Again, you miss the point.  The thread conversation had changed from just denial to seeing the chart to nursing home nursing staff not wanting to tell you any pertinent info about the patient.  Just take them, here's the envelope, have a good time.  

I'm sorry, but a turnover needs to be more than pointing to a body laying in a bed.


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## JPINFV (Feb 20, 2009)

CAOX3 said:


> Yes well when they have a hx of everything, and our on every medication under the sun. Thier allergies look the Physicians desk refrence.


How often do you really transport someone with a "history of everything?" Sure, some Dxs are more common than others, but that's just a tad hyperbole. 



CAOX3 said:


> Fairly easy to find, Ok well I dont know where you work or with who, but when I recieve these, I would probably have a better chance if it was written by a fifth grader.



Primary medical history in H/Ps are generally found in the introduction area, the part labeled "past medical history" or at the "assessment" section at the ending. You don't have to read the entire H/P if you know where to look.


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## Sasha (Feb 20, 2009)

> What if your pt is MRSA positive?



Sorry to jump off topic a bit, but that point is kind of moot if you take standard BSI with all patients. Now for something air/droplet borne I see getting upset at not knowing, but if I find out someone's got MRSA after I've transported. Ehh. No big. I wore gloves. And we all have MRSA crawling around on our skin anyway.


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## JPINFV (Feb 20, 2009)

Sasha said:


> Now for something air/droplet borne I see getting upset at not knowing, but if I find out someone's got MRSA after I've transported. Ehh. No big. I wore gloves. And we all have MRSA crawling around on our skin anyway.


MRSA in the nares requires droplet protection. I'll also generally gown up if transporting a patient under contact isolation. Ambulances don't have the room or stability of a hospital room, so you can't generally be sure what part of the patient you will/won't be touching.


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## Sasha (Feb 20, 2009)

> I'll also generally gown up if transporting a patient under contact isolation.



Ah. I never did. I probably should have. And yes, you're right about MRSA in the nares.


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## Veneficus (Feb 20, 2009)

CAOX3 said:


> Oh no not something very bad.
> 
> Sorry when I do calls I dont have the ability to just check the paperwork.  I have to use assessmnet.  Signs and symptoms should lead you in the direction you need to go in.  Sure your paperwork could be helpful. I wouldnt rely on it.
> 
> I also dont use acronyms.  They were brought about to dumb down the EMT class.  I learned pt assessment, do they even still teach that.



Not that I have seen.


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## CAOX3 (Feb 20, 2009)

What about TB in the field, meningitis.  What about MRSA, VRE, CDIFF.  I dont usually see a note hanging on the fridge for any of these.  Just because they are at home does not eliminate the possibility. 

Do you gown up on every 911 call? 

I stated The paperwork is helpful, relying on it soley is a mistake, as is basing your treatment on it.


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## BossyCow (Feb 20, 2009)

CAOX3 said:


> How would HIPPA apply to this?  The pt is now in your care, which makes their information lawfully available to you.



That would be HIPAA. 
Your comments about Pt Assessment puzzled me. Part of doing an effective Pt Assessment includes collecting pertinent past history on the pt. If the pt is in a facility, and often in those cases suffering from dementia, you must receive that information from their current caregiver. An existing condition may not be the primary concern during a transport but can be a contributing factor to why things go south in the rig.


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## Sasha (Feb 20, 2009)

CAOX3 said:


> Do you gown up on every 911 call?
> .



You mean you don't put yourself in a protective bubble before you touch patients?


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## JPINFV (Feb 20, 2009)

CAOX3 said:


> Do you gown up on every 911 call?


Are you suggesting that providers ignore all isolation precautions besides standard precautions even when you know that the patient has a transmittable disease?


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## CAOX3 (Feb 20, 2009)

BossyCow said:


> That would be HIPAA.
> Your comments about Pt Assessment puzzled me. Part of doing an effective Pt Assessment includes collecting pertinent past history on the pt. If the pt is in a facility, and often in those cases suffering from dementia, you must receive that information from their current caregiver. An existing condition may not be the primary concern during a transport but can be a contributing factor to why things go south in the rig.



First, I dont work in or on a rig. I work in an ambulance.  Second I have little experience dealing with pts in SNF.  Maybe I dont have the experience to comment on this topic.

If I did this is how I would handle it.

I wouldnt get in pissing matches with a nurse, because she does not feel I need to see it.  I cant be bothered.  

If  I need it taking grandma home.  Then its there.  If I dont, I dont go tearing through it, because Im under the impression that I have a right to look at it, pissing everyone off in the process, delaying pt care, and arguing with everyone that wont give me the respect I deserve because Im an EMT.

I would package my pt, assess the pt deliver treatment as needed, drop off the pt at the hospital with report.  Continue on my way.


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## PapaBear434 (Feb 20, 2009)

Veneficus said:


> Not that I have seen.



I have been taught how to do a full assessment the entire time, every step of the way from basic to my current ALS classes.  Every level, you have to basically requal BLS assessment and care skills.


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## Veneficus (Feb 20, 2009)

PapaBear434 said:


> I have been taught how to do a full assessment the entire time, every step of the way from basic to my current ALS classes.  Every level, you have to basically requal BLS assessment and care skills.



That is actually good to hear. I am so used to assessment being mindlessly repeating the NREMT sheets without thought or consideration. My favorite are people who know all kinds of acronyms but not the significance of the findings.


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## PapaBear434 (Feb 20, 2009)

Veneficus said:


> That is actually good to hear. I am so used to assessment being mindlessly repeating the NREMT sheets without thought or consideration. My favorite are people who know all kinds of acronyms but not the significance of the findings.



Well, that isn't to say that there isn't a lot of that either.  They are ultimately teaching so that you can pass the exam.  But yeah, they have taught us how to properly examine both trauma and medical patients, what these findings mean, and in most cases what is done to treat said patient once we get them to the hospital.  

I imagine it all depends on the teacher you get.  My BLS instructor was great, in depth, and made sure to tell us "This is what you do to pass the test, but in real life you are more likely to do this or this..."  My first ALS instructor, on the other hand, sucked.  Missed information, didn't teach things until after she tested us on them, and it led to a failure rate to the tune of 27 of the 32 that took the class.


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## Veneficus (Feb 20, 2009)

PapaBear434 said:


> Well, that isn't to say that there isn't a lot of that either.  They are ultimately teaching so that you can pass the exam.  But yeah, they have taught us how to properly examine both trauma and medical patients, what these findings mean, and in most cases what is done to treat said patient once we get them to the hospital.
> 
> I imagine it all depends on the teacher you get.  My BLS instructor was great, in depth, and made sure to tell us "This is what you do to pass the test, but in real life you are more likely to do this or this..."  My first ALS instructor, on the other hand, sucked.  Missed information, didn't teach things until after she tested us on them, and it led to a failure rate to the tune of 27 of the 32 that took the class.



We have been seeing a lot of massive failure. (4 or 5 out of 20-30 or so passing the last few semesters) We attribute a lot of it to poor study habits.
Many of the people who go to medic class right after basic under estimate the demands. Some even think the only material you need is presented in lectures despite the fact we tell them you need to read the chapter before class and there is too much material to cover in class. A certain subset of students who like to think they are just attending class so they can file an application for a different job always find themselves hopelessly behind thinking they are just learning a few new skills to supplement that covered in Basic.

I think they are taught “proficiency testing” strategies when they are younger, which simply do not work after EMT class. A failure of “no child left behind.” Even my friends who teach other classes in college outside of medical say they are facing the same issues. It is hard to fix years of poor study habits, low demands, and little effort while maintaining college standards and still have everyone pass.

Any solutions?


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## CAOX3 (Feb 20, 2009)

Yes, but since I type about fifteen words a minute, Ill pass.


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## Outbac1 (Feb 20, 2009)

PapaBear434 said:


> I'm throwing the BS flag on this!  Liar!


I'm not taking this personally. It's a fair comment BUT I know it is hard to believe but yes, some have learned. When they are treated professionally and it is explained why it is important, some do learn. Not all staff at Nursing/residential care facilities are morons. However it does seem that way sometimes. 

 "Why would you make a scene in the hospital about seeing someones information. If you need to open in the truck.  

Your taking them home for gods sake, do you really need to know the pts whole medical history. Why do you care? The informations there if you need it enroute open it. CAOX3"

I don't open sealed paperwork to piss people off. I do it to ensure the info I need is there. I don't need to read every page top to bottom. A good scan will do. If a pt arrests on you half way into a  transport. It is not the time to root through their paperwork to find out their DNR is not there.

 No matter how thorough the assessment on an incommunicative pt. there will still be unanswered questions. If you are assuming care for a person you have a right and an obligation to the paperwork and knowledge of the pts condition so you may provide proper care.


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## PapaBear434 (Feb 20, 2009)

Veneficus said:


> We have been seeing a lot of massive failure. (4 or 5 out of 20-30 or so passing the last few semesters) We attribute a lot of it to poor study habits.
> Many of the people who go to medic class right after basic under estimate the demands. Some even think the only material you need is presented in lectures despite the fact we tell them you need to read the chapter before class and there is too much material to cover in class. A certain subset of students who like to think they are just attending class so they can file an application for a different job always find themselves hopelessly behind thinking they are just learning a few new skills to supplement that covered in Basic.
> 
> I think they are taught “proficiency testing” strategies when they are younger, which simply do not work after EMT class. A failure of “no child left behind.” Even my friends who teach other classes in college outside of medical say they are facing the same issues. It is hard to fix years of poor study habits, low demands, and little effort while maintaining college standards and still have everyone pass.
> ...



In our case, it was so bad that the college tossed out the grades and told us to take it again with their apologies.  It was partially the fault of the state of Virginia, however, who forces EMT-Enhanced class into what is suppose to be "Intro to ALS."  Essentially, the intro class gets turned into a EMT-E class with state mandated tests, and she was teaching it as if it was still based as a basic intro class.

Slam, bam, failed.  We'd test on something, and in two weeks later she'd actually teach it in class.  Very painful experience.


----------



## Veneficus (Feb 20, 2009)

PapaBear434 said:


> In our case, it was so bad that the college tossed out the grades and told us to take it again with their apologies.  It was partially the fault of the state of Virginia, however, who forces EMT-Enhanced class into what is suppose to be "Intro to ALS."  Essentially, the intro class gets turned into a EMT-E class with state mandated tests, and she was teaching it as if it was still based as a basic intro class.
> 
> Slam, bam, failed.  We'd test on something, and in two weeks later she'd actually teach it in class.  Very painful experience.



I think the simple solution to that is get rid of "enhanced" providers and make them get their medic. Not trying to be offensive and not attacking any individual, but I think that it is these nonstandard levels that hold EMS back as an industry.


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## amberdt03 (Feb 20, 2009)

PapaBear434 said:


> In our case, it was so bad that the college tossed out the grades and told us to take it again with their apologies.  It was partially the fault of the state of Virginia, however, who forces EMT-Enhanced class into what is suppose to be "Intro to ALS."  Essentially, the intro class gets turned into a EMT-E class with state mandated tests, and she was teaching it as if it was still based as a basic intro class.
> 
> Slam, bam, failed.  We'd test on something, and in two weeks later she'd actually teach it in class.  Very painful experience.



is the emt-enhanced the same thing a and intermediate? just curious never heard that term before.


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## medic417 (Feb 20, 2009)

amberdt03 said:


> is the emt-enhanced the same thing a and intermediate? just curious never heard that term before.



No.  Not nearly as much education for it as EMT-I.


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## amberdt03 (Feb 20, 2009)

medic417 said:


> No.  Not nearly as much education for it as EMT-I.



so its the same as a basic? or whats the difference?


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## PapaBear434 (Feb 20, 2009)

amberdt03 said:


> so its the same as a basic? or whats the difference?



Essentially a basic with a couple things added.  Some places call them "Shock Trauma."  You can start IV's, administer about ten different meds (aspirin, Benadryl, D50, glucogon, epi...  simple stuff like that), give a neb treatment with albuterol, and in some jurisdictions they let you intubate (they teach it in the class as required, but my city doesn't allow it).

It's basically a gap-filler rate.  Let's face it, guys, most ALS calls don't need a full blown medic most of the time.  Someone with an asthma attack, someone having a diabetic episode...  The Enhanced lets them take care of it, letting the medics not get tied up if something important happens.  And with the big gap between basic and intermediate, some states (only two that I've heard of with Enhanced is Virginia and Minnesota, though) like to fill that hole with something.  

It's not really meant as a rate to sit at.  Just something to let you start getting the basic ALS stuff mastered before you start doing the more complex stuff, like EKG's and the like.  The class is about a semester long, if that, with a clinical attachment.  Then, of course, comes the field release program of whatever agency you're running with...  But yeah, not much ed-u-ma-cation involved with it.



> I think the simple solution to that is get rid of "enhanced" providers and make them get their medic. Not trying to be offensive and not attacking any individual, but I think that it is these nonstandard levels that hold EMS back as an industry.



I won't disagree that they shouldn't go and try to get their medic, or at least make it a standard nationwide.  The NREMT newsletter they just sent out was pretty much dedicated to that, with almost every article talking about how the field needs to standardize to a universal qualifications and require academic achievements to start being taken more seriously.

But having SOMETHING between B and I should be included in there somewhere.  It's not THAT hard to start an IV, just something you need a lot of practice at to get good with, and some times all the person needs is fluids and/or some sugar.  And if you are first on scene to a major trauma before any medics get there, having someone on hand who can drop a tube, stick a large bore or two, and start pumping in fluids before the medic shows can only be a good thing.  Hell, just the ability to start an IV before the medic shows so that time isn't wasted, and the medic can get right to the epi and atropine rounds and have a better chance at saving the person.

So, I guess I agree with you about 60% is what I'm saying.


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## medic417 (Feb 20, 2009)

PapaBear434 said:


> But having SOMETHING between B and I should be included in there somewhere.



I disagree.  There is not that much more education required to get EMT-I and honestly it is not needed.  Have first responder basics and Paramedics only on the ambulance.  All the in between stuff is what confuses the public.  They see an ambulance and think they are safe but fail to realize that ambulance with basics or evn EMT-I's can not do much for them in a real emergency.


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## AJ Hidell (Feb 20, 2009)

PapaBear434 said:


> But having SOMETHING between B and I should be included in there somewhere.  It's not THAT hard to start an IV...


It's also not that necessary.  Nobody is saved by an IV alone.  So then you are left arguing that you should start an IV only "because I can", or else that you need to be able to give more drugs.  Either way, it's a slippery slope to nowhere.

No... there should not be anything between B and P, except for paramedic school, and a full two years of it.  There is no medical justification for it, and it holds back the profession.


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## PapaBear434 (Feb 20, 2009)

medic417 said:


> I disagree.  There is not that much more education required to get EMT-I and honestly it is not needed.  Have first responder basics and Paramedics only on the ambulance.  All the in between stuff is what confuses the public.  They see an ambulance and think they are safe but fail to realize that ambulance with basics or evn EMT-I's can not do much for them in a real emergency.



I guess this is just something they need to hammer out above our heads.  I can see your point of view, and kind of agree with it, but I have seen so many times a medic being called out for a BS call for someone having a panic attack and having to call another from WAY out of first call area to cover the cardiac arrest that just happened in Medic #1's area.  And my favorite, getting a medic called to a Doc-in-the-Box because they already have an IV in place via the Doctor on hand, and thus BLS cannot take them alone.

What I would LOVE to see is your vision, but expanded.  Basically make medics have a licensed position, and make them trauma nurses on wheels.  Or the level of a nurse practitioner, even.  They could have treat-and-release powers for the people who just need a little fluid boost or a band-aid, and be a lot more educated and ready for the big stuff.  Plus, they could actually get paid a decent amount and have the respect of the rest of the medical community.  

Not going to happen in the near future, of course, as no city will want to front up the money to pay for these mobile med centers.  But I think it would save money in the long run, prevent unnecessary patients clogging up the ER, and ultimately save more lives when all is said and done.  

Pipe dreams, of course.  Fevered imaginings of a madman.


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## PapaBear434 (Feb 20, 2009)

AJ Hidell said:


> It's also not that necessary.  Nobody is saved by an IV alone.  So then you are left arguing that you should start an IV only "because I can", or else that you need to be able to give more drugs.  Either way, it's a slippery slope to nowhere.
> 
> No... there should not be anything between B and P, except for paramedic school, and a full two years of it.  There is no medical justification for it, and it holds back the profession.



I disagree there.  I know medics NOW that start IV's "Because they can."  And no, IV's themselves have never saved lives.  But I have seen a lot of time being spent trying to drop on IV on an arrest patient after they have already been down for way too long, or an unconscious diabetic patient who's veins suck so they remain unconscious waiting for a D50 while the medic(s) try for a stick.

Having someone on hand that can do that while you wait for the medic can't hurt.  To me, it's like having a nurse do the blood draws so the Doctor can do the more important stuff.


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## medic417 (Feb 20, 2009)

PapaBear434 said:


> They could have treat-and-release powers for the people who just need a little fluid boost or a band-aid, .



We and several services do this.   Some already even keep antibiotcs, ointments, etc.  Yes more education for all will lead to our type of systems being the minimum rather than the max as it seems they are now.  We deny transport if after exam they do not need it, we inject for example toradol for muscle pain and release after confirming no adverse reaction, we perform many other field treatments and release.  So not the future as we have done this for decade or more here.  Hopefully the future brings much more and if education increases it will.


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## AJ Hidell (Feb 20, 2009)

PapaBear434 said:


> I guess this is just something they need to hammer out above our heads.


There is nothing above my head.  The buck stops with me.  I am responsible for the future of my profession, not some faceless "they" at some committee in Washington, D.C.  You can be a part of that process too, or you can sit back and be impotent in the control of your future.  The choice is yours.  You may not be able to change the world, but you can change you.  And one provider at a time, we can change the profession.



> I can see your point of view, and kind of agree with it, but I have seen so many times a medic being called out for a BS call for someone having a panic attack and having to call another from WAY out of first call area to cover the cardiac arrest that just happened in Medic #1's area.


An EMS system should be designed to provide for those that need us most, not those who need us least.  You do not dumb down an entire profession simply because a lot of your patients aren't really that sick.  That is leaving those who really need us to suffer.  We can hardly call ourselves EMERGENCY medical services -- much less healthcare professionals -- if our biggest concern is those who need us least, can we?

Regardless, every 911 patient needs a paramedic.  Period.  They may not need drugs or an invasive intervention, but paramedics are more than the sum of their skills and the content of their drug boxes.  Not everyone who goes to the doctor needs drugs either, but it takes a doctor to figure that out, doesn't it?  Same thing with EMS.  It takes a paramedic assessment to decide whether a patient needs a paramedic or not.  Lesser levels are not educated or trained to do so.

If you don't have enough paramedics, you don't just accept it and find stop-gap ways to work without them.  You get them!  It's really not that difficult. .  Where there is a will, there is a way.


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## PapaBear434 (Feb 20, 2009)

medic417 said:


> We and several services do this.   Some already even keep antibiotcs, ointments, etc.  Yes more education for all will lead to our type of systems being the minimum rather than the max as it seems they are now.  We deny transport if after exam they do not need it, we inject for example toradol for muscle pain and release after confirming no adverse reaction, we perform many other field treatments and release.  So not the future as we have done this for decade or more here.  Hopefully the future brings much more and if education increases it will.



Man I hope you're right.  I would love to see Medics get to the point they can actually write limited prescriptions for certain meds (antibiotics, antihistamines...) based on standing orders like a NP.  But the education needs to get there first, THEN the process of trying to convince the rest of the medical world that these folks are qualified and ready for a responsibility like that.  

And since a good number of the medical world views us as uneducated adrenaline junkies, I can only imagine how long that would take.  Which would mean that the initial folks, the first generation of these new medics, getting that level of education would very likely end up wasted and unused.  I mean, hell, it wasn't just that long ago that they still made Medics transmit three leads, and now they finally trust you guys with THAT they still make you transmit the twelves.  

One could only imagine how long it would take them to trust you to start handing out meds and medical advice.


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## PapaBear434 (Feb 20, 2009)

AJ Hidell said:


> *If you don't have enough paramedics, you don't just accept it and find stop-gap ways to work without them.  You get them!*  It's really not that difficult. Where there is a will, there is a way.



Easy to say.  But when the city budget gets strained, fire, police, and EMS are always the first to get cuts for some reason or another.  

Increasing education standards means actually having to pay someone a better wage.  And I think they'd rather cut off their own fingers with a paint scraper than do that.


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## AJ Hidell (Feb 20, 2009)

PapaBear434 said:


> And since a good number of the medical world views us as uneducated adrenaline junkies, I can only imagine how long that would take.


It's not how the medical community views us that is the problem.  We have serious allies in the medical community who are ready to move us forward.  Our problem is how we view ourselves.  And right now, the majority of the people in EMS believe it's just a temp job for undereducated adrenalin junkies, a part-time gig for firefighters, a stepping stone to med school or nursing school, and a hobby for people who want a thrill.  None of those people want to make a two to four year commitment just to play with the siren.  Those are the people holding us back, not the medical community, the politicians, or anyone else.  We are our own worst enemy.


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## JPINFV (Feb 20, 2009)

AJ Hidell said:


> And right now, the majority of the people in EMS believe it's just a temp job for undereducated adrenalin junkies, a part-time gig for firefighters, *a stepping stone to med school or nursing school*, and a hobby for people who want a thrill.  None of those people want to make a two to four year commitment just to play with the siren.  Those are the people holding us back, not the medical community, the politicians, or anyone else.  We are our own worst enemy.



How do you convince those of us that are looking to advance to other levels that EMS is going to improve anytime soon? Why should we become a martyr for EMS when a large enough number of providers are fighting to maintain the status quo or regress it? While I would love to be a paramedic, I just don't see a future in EMS at this time. Too many people do not want to do what it's going to take to move paramedicine from a tech job to a practitioner profession.


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## AJ Hidell (Feb 20, 2009)

Those people can't be convinced, and no effort should be wasted trying to do so.  The idea of uniting EMS together to move into the future is a pipe dream.  It'll never happen.  Those who are going to lead us into the future will do so against the will of the majority.  We will drag them kicking and screaming, and many will go away mad.  I'm okay with that.  That's the way that every other medical profession -- including physicians -- has had to do it, and we are certainly no better than them.


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## reaper (Feb 20, 2009)

JPINFV said:


> How do you convince those of us that are looking to advance to other levels that EMS is going to improve anytime soon? Why should we become a martyr for EMS when a large enough number of providers are fighting to maintain the status quo or regress it? While I would love to be a paramedic, I just don't see a future in EMS at this time. Too many people do not want to do what it's going to take to move paramedicine from a tech job to a practitioner profession.




That is the biggest problem with EMS!

Why not become a very educated Paramedic and work the job. All the while fighting for others to educate themselves as well.

How can you not see a future in EMS? If you want to be an educated Paramedic, then what is wrong with being just that?

Not all want to be supervisors. Some do this job for the medicine and helping the pt's. They are not looking to climb a ladder to an easier job. If all these people leave the profession because they see no future, then there will never be a future.

Stay and fight for change, for better education, for better EMS as a whole in this country. 

That is the future that needs to be seen!


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## PapaBear434 (Feb 21, 2009)

AJ Hidell said:


> It's not how the medical community views us that is the problem.  We have serious allies in the medical community who are ready to move us forward.  Our problem is how we view ourselves.  And right now, the majority of the people in EMS believe it's just a temp job for undereducated adrenalin junkies, a part-time gig for firefighters, a stepping stone to med school or nursing school, and a hobby for people who want a thrill.  None of those people want to make a two to four year commitment just to play with the siren.  Those are the people holding us back, not the medical community, the politicians, or anyone else.  We are our own worst enemy.



Point taken.  I have seen both sides of it, but I agree that people inside the community are probably hurting it much more than those outside of it.


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## DevilDuckie (Feb 21, 2009)

We have a local federal government run facility for youths or young adults age 16-21, to give them skills and job training, after a hard life or bad choices screwed up their life. The ones 18+, we get no problem. But lately, they have been refusing to give (EMS) the patient history, forms, reports, stating it's a HIPAA violation.. and won't give it to the ER either.. They won't even give us the paper that gives us permission to treat them minor child. And their parents are anywhere from jail to 200 miles away.. No phone, no way to contact them.

It's been a real PITA! Kids have anything from BS problems to head injuries to drug OD's.. and they're dying.. 70 miles from the hospital.. and these people don't understand that it's okay to inform us, to treat the child, like they completely misunderstand HIPAA. They'll give the forms to the cops, but not the ambulance, wtf is up w/ that? Stupidity kills.


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## JPINFV (Feb 21, 2009)

reaper said:


> Why not become a very educated Paramedic and work the job. All the while fighting for others to educate themselves as well.
> 
> How can you not see a future in EMS? If you want to be an educated Paramedic, then what is wrong with being just that?
> 
> ...



Large swaths of the US are essentially shut out of professional EMS. How many places choose not to have paramedics because they love their volunteers? How many EMS based fire suppression services out there hire single function paramedics and pay them anything decent? What's left pay for and have protocols for what's left, which in large part isn't good. 

Unfortunately the current attitude in EMS is exactly what drives out the very people that I think EMS needs to advance. EMS tends to be anti-intellectual (ever see what happens to people who start to question traditional practices?), spineless (stock answer to any dilemma is "Call medical control." There's nothing wrong with asking for help, but there really is a point where we just have to say "I know what I'm doing, I know my protocols, and damn it, I'm going to make a decision!") and anti-education ("Let's see what I can get to do with the least amount of education and training"). As long as these attitudes (do X because I said so, call medical control if anything that doesn't fit the cook book, and we don't need no stinkin edumakation) remain and are taught in class, nothing will change and EMS will continue to drive away promising providers.


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## PapaBear434 (Feb 21, 2009)

reaper said:


> How can you not see a future in EMS? If you want to be an educated Paramedic, then what is wrong with being just that?



Simple answer?  People like to eat and actually make a decent wage for their considerable investment.  Better pay will lead to better incentives.


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## HasTy (Feb 21, 2009)

So I have been watching this thread...and while I have not directly ran into this problem my self I have been listening to the "war stories" while I am in HQ posting or waitign for shift to start and a few of the BLS cars are starting to say that they are having issues with Nurses or other parts of the staff are beginning to refuse the hand over of charts we get only the parts that they choose which is generally only the Med list and if applicable the DNR...


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## reaper (Feb 21, 2009)

If you are not out to make a million dollars, the pay in EMS is pretty decent. I survive just fine in big cities and try not to work a lot of OT.

Money is never the answer to making a better system, it is just a band aid over the major problems!


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## DevilDuckie (Feb 21, 2009)

What about taking patients from an SNF, and they don't keep the actual DNR on hand, only copies?

How do you handle that?


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## PapaBear434 (Feb 21, 2009)

DevilDuckie said:


> What about taking patients from an SNF, and they don't keep the actual DNR on hand, only copies?
> 
> How do you handle that?



Actually had to handle that the other day.  Told them sorry, I couldn't accept that, and I would have to try revive the patient if she crashed out.  

We have rules to follow.  Breaking them isn't exactly going to help our stature.


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## JPINFV (Feb 21, 2009)

DevilDuckie said:


> What about taking patients from an SNF, and they don't keep the actual DNR on hand, only copies?
> 
> How do you handle that?



Where I currently work a copy of the prehosptial DNR works fine. At my old location a copy of any physician signed DNR was acceptable as well as viewing the written order in the patient's medical chart (licensed health care facilities only for this one).


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## JPINFV (Feb 21, 2009)

reaper said:


> If you are not out to make a million dollars, the pay in EMS is pretty decent. I survive just fine in big cities and try not to work a lot of OT.
> 
> Money is never the answer to making a better system, it is just a band aid over the major problems!



Money is pretty important if you're trying to pay off 100k+ in education debt and want to have a life outside of EMS. I do agree that increasing only pay is just a band aid. Increased pay doesn't change the current culture of EMS and the culture does more damage than any amount of pay does.


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## HasTy (Feb 21, 2009)

DevilDuckie said:


> What about taking patients from an SNF, and they don't keep the actual DNR on hand, only copies?
> 
> How do you handle that?




You know what I never really thought about it...I will have to ask when I get back to work and I will let y'all know...or maybe I will ask in class tomorrow. Anyway stand by and we will figure otu the answer to that.


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## DevilDuckie (Feb 21, 2009)

That doesn't answer my question


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## TransportJockey (Feb 21, 2009)

DevilDuckie said:


> What about taking patients from an SNF, and they don't keep the actual DNR on hand, only copies?
> 
> How do you handle that?



My old companies policy at that was that copies of the EMS DNR worked fine, and sometimes originals of the facility DNR would work. Now if they didn't have a copy of anything for me, we worked em as a full code


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## medicdan (Feb 21, 2009)

in MA, a copy of the CC-DNR must travel with the patient in order to be valid.


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## PapaBear434 (Feb 21, 2009)

Yeah, like I said, we need the original copy.  Copies and reproductions don't count.  It's ticked off more than a couple people.


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## medic417 (Feb 21, 2009)

JPINFV said:


> Money is pretty important if you're trying to pay off 100k+ in education debt and want to have a life outside of EMS. I do agree that increasing only pay is just a band aid. Increased pay doesn't change the current culture of EMS and the culture does more damage than any amount of pay does.



Education and money will have to improve for EMS to move forward.  Which will have to come first?  Some argue the education will lead to the money others say that with our low pay we can never demand higher education.


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