# Holding someones hand



## Guardian (Aug 3, 2006)

Lately, many of my pts have been asking me to hold their hand because they're scared, upset, crazy, etc.  From now on, I'm starting a no hand holding rule in the back of my ambulance.  What do yall think about this?


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## Chimpie (Aug 3, 2006)

Are you talking about 911 transports or regular transports?


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## Stevo (Aug 3, 2006)

is there something wrong about being a compassionate ems'er?


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## MedicPrincess (Aug 3, 2006)

I think it is a TERRIBLE idea.  Your there to provide for their medical needs.  Making them feel safe and comfortable is part of taking care of your patient.  

It doesn't matter if it is a 911 call or taking Grandma back to the nursing home.  Sometimes holding their hand is exactly what they need from you.  

Its not going to hurt anything.  And you never know, you may be the only person to show them that much compassion all day.

I sure hope when I need an ambulance for my daughter who has a heart condition, that Medic in the back doesn't refuse to hold her hand if she asks.  I will come unglued!

Compassion.  Empathy.  Just general give a crap about your patients is all part of your job.


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## rescuecpt (Aug 3, 2006)

Wear gloves.  Hold hands.  If it interferes with your ability to treat the patient, say "excuse me", do what you need to do, then hold their hand.  There is something called "psychological first aid" that I practice a lot on my ambulance.  Usually if you can calm a patient down a bit, some of their symptoms subside - and it provides a better, more well rounded course of care for your patient.

If you have a probie, have them hold hands, so you don't have to.


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## Jon (Aug 3, 2006)

I've got no problem holding the hand of a patient, if it dosen't interfere with my other responsbilities at hand.

I've had problems with elderly women (and men) with dementia grab my leg and start trying to feel me up... but holding someone's hand is sometimes the BEST treatment we can provide for them.


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## gradygirl (Aug 3, 2006)

Holding someone's hand is so simple, yet so effective. Words can only do so much; humans thrive on touch and contact.

This has been proven to me over and over again, but was first proven to me when my partner and I held a little boy's hands who had been abused and abandoned by his parents.


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## Stevo (Aug 3, 2006)

I've had quite a few patients open up with critical info on holding their hand, or what is simple eye contact and calm friendly nature

nobody cares how much you know, until they know how much you care

~S~


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## rescuecpt (Aug 3, 2006)

Stevo said:
			
		

> nobody cares how much you know, until they know how much you care



Wow Stevo - very deep.    Good line to remember.


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## Guardian (Aug 4, 2006)

Thanks for the responses everyone.  Hand holding has become way to cliché and everyone expects it now.  If someone wants me to hold their hand while they're dying, that's one thing.  In reality, people who are dying rarely care about holding someones hand.  More commonly people want me to hold their hand just because they think that's what we do.  For example, some people want me to hold their hand while my partner starts an IV.  You wouldn't see this being done at the hospital would you?


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## gradygirl (Aug 4, 2006)

I dunno Guardian. I hate having IVs started on me and wouldn't hesitate one moment to have someone hold my hand while getting one. I've also held friends's hands during blood drives and people's hands in the ED while doing rotations in hospital. I've always worn gloves, but these people were scared half to death, and if they were going to cooperate more by having me hold their hand, then, by all means, I was going to.


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## lfsvr0114 (Aug 4, 2006)

If by holding someones hand while they were scared for any reason helped them be calmer, then what did it hurt?  A calmer pt is a better pt.  I've held many a hand while procedures were being done to a pt.  It keeps them occupied with you and your conversation and the procedure is less traumatic for them.  Sometimes the patient only wants to have their fear acknowledged since some people forget that the patient has feelings, too.


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## c-spine (Aug 4, 2006)

Don't pick on the probies! -giggle- But yeah, like most of ya'll said... if it makes them feel better, I'll do it. -shrug-


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## rescuecpt (Aug 4, 2006)

c-spine said:
			
		

> Don't pick on the probies! -giggle- But yeah, like most of ya'll said... if it makes them feel better, I'll do it. -shrug-



I like my probies.  For example, last night, when the cable died in the crew lounge, my probies went to get the cable box from one of the bunk rooms to swap it out - and proceeded to have the entire wall mount with tv and cable box fall on his face.  Umm, yeah.  Note to all, don't do that.


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## MariaCatEMT (Aug 4, 2006)

Guardian said:
			
		

> Lately, many of my pts have been asking me to hold their hand because they're scared, upset, crazy, etc.  From now on, I'm starting a no hand holding rule in the back of my ambulance.  What do yall think about this?



*Do you have a personal issue with touching a patient outside of necessary medical care?*


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## Guardian (Aug 4, 2006)

I don't know what you mean by "personal" but yes, I want to keep touching to a minimum and have a problem with unnecessary handholding.


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## MariaCatEMT (Aug 4, 2006)

Guardian said:
			
		

> I don't know what you mean by "personal" but yes, I want to keep touching to a minimum and have a problem with unnecessary handholding.



*Personal issue.....as in.....personal preference.....and....I was just asking. Meow!*


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## Rangat (Aug 4, 2006)

I find holding someone's hand very useful.

coz, it helps a lot if the pt is in pain and moving & grabbing around messing up ur work, and if the pt gets combative and tries to undo your stuff, etc.

But i'll let go if i have to do other things... 

Except if it's a pretty girl, then she has no choice. And she'll get a T.U.B.E.

then again, i've had thousands of rotten foot, stinky pts, and like 2 girls.:sad:


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## Guardian (Aug 4, 2006)

Rangat said:
			
		

> I find holding someone's hand very useful.
> 
> coz, it helps a lot if the pt is in pain and moving & grabbing around messing up ur work, and if the pt gets combative and tries to undo your stuff, etc.
> 
> ...



T.U.B.E. as in Totally unnecessary breast examination?.....wow, that will get you in some trouble.


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## gradygirl (Aug 4, 2006)

Guardian said:
			
		

> T.U.B.E. as in Totally unnecessary breast examination?.....wow, that will get you in some trouble.



Good call. My medic friends all threaten me with being "examined" if they ever have to pick me up. I just smile and tell them to go ahead, see where that will get them.


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## Rangat (Aug 5, 2006)

Ah, but... Now did you know that Medazolam affects your short term memory???


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## gradygirl (Aug 5, 2006)

Hey, have you seen the thread by Ignac? He's from S. Africa as well.


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## aline (Aug 6, 2006)

This is a job where you violate other peoples personal space every call/day, and our patients violate ours. Holding a hand is something I do. It's called theraputic touch. Sometimes just holding their hand or a gentle hand on an arm or shoulder lets the patient know that he/she isn't just a number to you. It can be calming and reassuring to them. Now, do I do this with every Pt...No. But, if my medical care is done and I'm sitting there waiting for the next set of vitals, I see no issue with holding someones hand and a little converstation.
   I don't know how long you've been in the field but, if you have an serious issue with touching or being touched then maybe this isn't the profession for you.

**Off my soapbox**


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## Ridryder911 (Aug 6, 2006)

Guardian said:
			
		

> Lately, many of my pts have been asking me to hold their hand because they're scared, upset, crazy, etc.  From now on, I'm starting a no hand holding rule in the back of my ambulance.  What do yall think about this?


I think who in the hell you think you are & what you are doing in a health profession? I think you need to get out ASAP!. If you fill you are above giving compassionate care, and only are there for the pleasures of yourself, EMS does not need representation such as this. There are way too many .. "I am better than this" in EMS. Get over yourself. This is why, EMS has such a poor rating among those surveyed of patients, of those they trust in health care. 

Being a human, providing comfort (physical and emotional) is our job..yes, there are times when one is busy with an essential procedure to perform such.. but that is VERY RARE and as well can be done prior or after procedure. 

If you are above giving "personal care" then obviously, you should evaluate your priorities. As well, if I seen you avoiding touching my daughter, family, while they were in pain, grief, etc.. I definitely would take action... There is no room for holier than thou people in this profession.. 

R/r 911


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## MariaCatEMT (Aug 6, 2006)

Ridryder911 said:
			
		

> I think who in the hell you think you are & what you are doing in a health profession? I think you need to get out ASAP!. If you fill you are above giving compassionate care, and only are there for the pleasures of yourself, EMS does not need representation such as this. There are way too many .. "I am better than this" in EMS. Get over yourself. This is why, EMS has such a poor rating among those surveyed of patients, of those they trust in health care.
> 
> Being a human, providing comfort (physical and emotional) is our job..yes, there are times when one is busy with an essential procedure to perform such.. but that is VERY RARE and as well can be done prior or after procedure.
> 
> ...



*It just occured to me that you have been here a very long time, and don't post too frequently. When you do, it is definitely food for thought. Thank you for having the ability to get to the heart of matters....*


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## SwissEMT (Aug 7, 2006)

Rid get's my post of the year vote.

FACE IT: It's part of your job. 75% of EMS is comforting the patient, being there for them as a compassionate human being in a time of need.


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## ffmedic (Aug 12, 2006)

I see it as more like 90% but who's counting. Hold their hands. If it doesn't make you feel better too you might not be in the right profession. 

TUBE BTW maybe better stated as "tactile fremitus". Hey, its a medical procedure madam.


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## SwissEMT (Aug 12, 2006)

You're forgetting the 10% paper work section ^_^


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## Guardian (Aug 13, 2006)

Ridryder911 said:
			
		

> I think who in the hell you think you are & what you are doing in a health profession? I think you need to get out ASAP!. If you fill you are above giving compassionate care, and only are there for the pleasures of yourself, EMS does not need representation such as this. There are way too many .. "I am better than this" in EMS. Get over yourself. This is why, EMS has such a poor rating among those surveyed of patients, of those they trust in health care.
> 
> Being a human, providing comfort (physical and emotional) is our job..yes, there are times when one is busy with an essential procedure to perform such.. but that is VERY RARE and as well can be done prior or after procedure.
> 
> ...




Wow, this is a passionate post.  I respect your opinion.  I do think there are times when people need to grow up and stop expecting us to give them the attention they never got from mommy and daddy.  I also think we should stop encouraging this behavior which is what we do every time we gratuitously hold their hands.

As for holding your daughters hand, of course I would, I'm not Hitler.

As for wanting me out of EMS, join the club...lol


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## Firechic (Aug 14, 2006)

> I also think we should stop encouraging this behavior which is what we do every time we gratuitously hold their hands.


This, to me, is an odd thought. I don't think that EMS people are big pushers of the hand holding issue. I also don't think it is performed gratuitously. My patient care during a transport doesn't include, "well, I finished my assessment, all of the necessary procedures were performed (IV, meds, etc), okay then....cripes - given me your freaking hand until I have to retake your BP."  
THAT is gratuitous - unwarranted - perfunctory - mechanical.

I don't want this to be misconstrued as an attack or as condescending....
Think for a moment, why do people reach out for a person's hand when in an EMS situation or in the back of an ambulance? 
Fear? Loss of control? The unknown? Is something wrong with me? Am I dying? What will happen to my family? What are they doing to me? Why am I hurting? etc, etc, etc.    
You are in the back of that MICU every shift - God only knows how much time you have logged there. This may be the very first time the patient is there, it is unfamiliar and strange.
It's called empathy - identifying with what the patient is experiencing. If you cannot experience compassion for the patient perhaps empathize with them, try to imagine it. I will guarantee that one day, someday in your life you WILL experience something similar to those patients you write about. I pray that you will have someone there to help you who is empathetic and merciful to your suffering and fear and will even hold your hand.


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## Guardian (Aug 14, 2006)

I love that you call your trucks MICUs.  Ambulances ambulate, which is what we do but thats not what sets us apart.  What sets us apart from the average taxicab is the fact we bring intensive care to the pt.  Kudos to you for using MICU instead of the outdated term ambulance.

I meant the pts are being gratuitous by requesting we hold their hands and we are telling them it's acceptable behavior by agreeing to do so.


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## gradygirl (Aug 14, 2006)

Guardian said:
			
		

> I do think there are times when people need to grow up and stop expecting us to give them the attention they never got from mommy and daddy.



I agree to this when it comes to people making stupid choices, going overboard with them, and then realizing "hey, that was really stupid." I agree to this when it comes to being called at 5am to a sick 22 y.o. who doesn't have a thermometer and wants to know if you can take their temperature. I agree to this when it comes to neighbors 3-4 years your senior getting drunk and walking around your dorm hall yelling and screaming, stripping, hitting on every person that walks by, and then forgetting the code to their door, all at 3am the day of your National Exam. I agree to this when it comes to people being generally being immature and stupid. BUT, I do not agree that this is a legitimate excuse to not hold a person's hand.



			
				Guardian said:
			
		

> As for holding your daughters hand, of course I would, I'm not Hitler.



While this might have been to appease Rid's comments, double standards are NOT acceptable.



			
				Guardian said:
			
		

> As for wanting me out of EMS, join the club...



As to this, three words: GET OUT NOW. All of us in EMS have enough issues to deal with, uncompassionate EMTs are not burdens that the rest of us need.


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## joemt (Aug 14, 2006)

I don't know that I would push you out the door so easily or quickly Guardian, but I would ask you to take a step back and re-evaluate why you got into EMS in the first place... I would nearly guarantee that it was NOT for the $$$.. and if it was, boy did someone surely lie to YOU!

Holding a hand, regardless of the arm, shoulder or body attached is the very LEAST that we can do as Health Care Providers / Professionals.  I have worked with patients in which that one minor gesture made all the difference in the world.  I'm glad that you brought the topic up, but saddened in regards to your feelings about therapeutic touch.


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## Guardian (Aug 15, 2006)

tcert, are you saying if I don't treat kids and adults the same, it's a double standard?  Here on planet earth, we have to treat them differently because they're different.  I usually let pediatric pts get away with just about anything because they're immature.  Adults on the other hand should be held to a higher standard.  Why are you appeasing our adult pts who act inappropriately.  You are doing a disservice by reinforcing bad behavior and helping to guarantee they will do it again and again and again.  Example: Some belligerent SOB gets into a fight and has his face smashed.  Helpless bystanders are scared for their safety when the fight breaks out.  Police, Fire and EMS are called in to control the situation which ties up resources so gramps down the block has to wait an extra 15 mins for EMS MI treatment and subsequently dies.  Meanwhile, tcert gets on scene and holds this SOBs hand doing everything he can to appease him.  The SOB then thinks to himself, hey, this was a lot of fun.  I wreaked havoc, acted like a complete jerk and everybody loves me because they're holding my hand.  I'm going to have to do this more often, I love the attention!

I think ems needs to take an active role in helping to fix problems in our society because we're on the front lines.  We need to start treating people like adults.  How can we expect them to act like adults when we don't treat them like adults?


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## Guardian (Aug 15, 2006)

joemt said:
			
		

> I don't know that I would push you out the door so easily or quickly Guardian, but I would ask you to take a step back and re-evaluate why you got into EMS in the first place... I would nearly guarantee that it was NOT for the $$$.. and if it was, boy did someone surely lie to YOU!
> 
> Holding a hand, regardless of the arm, shoulder or body attached is the very LEAST that we can do as Health Care Providers / Professionals.  I have worked with patients in which that one minor gesture made all the difference in the world.  I'm glad that you brought the topic up, but saddened in regards to your feelings about therapeutic touch.



Reasons I got into EMS

1) Help people.
2) Leave the world a better place than I found it.
3) Help people.

I volunteer, that should tell you where money falls on my list.

The only reason I post topics like this one here, is because I want people to think outside the box every now and again.  Handholding in ems has become a knee-jerk requirement.  Back in the 1970's, handholding was important to gain the publics trust and comfort seriously injured or dieing pts.  Now, to a large extent, it's outdated and gratuitously overdone but we still do it because it's ingrained into our minds and anything else would be unholy.


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## gradygirl (Aug 15, 2006)

Guardian said:
			
		

> Meanwhile, tcert gets on scene and holds this SOBs hand doing everything he can to appease him.



1. That's not even funny.
2. I'm a girl.
3. Please don't lecture me about immature patients, I deal with them every day. I live, eat, learn, and work where my patients are. We don't hold their hands because none of those morons ask us to. This past year as a freshman, I was the youngest person on my dorm hall and I was taking care of people 4 years older than me who were to frickin drunk to be able to tell me how old they were.
4. The only time I won't hold a person's hand is if they pose a threat to me. It's pretty obvious that SOB is one, so no hand holding for him.
5. I will only hold someone's hand if they ask. The last thing I'm going to do is shove my hand into theirs.
6. I don't run ambulances. I work campus EMS; I don't deal with you run of the mill dirt bags, just a bunch of stupid kids with too much time and money. And, I'm still young and compassionate, so yeah, I'm probably more inclined to hold someone's hand.
7. I appreciate that you do EMS. You got into it for the right reasons. I can understand that you want everyone to grow up and act mature. The truth is, they won't. Sorry.
8. I realize that my post sounded much harsher than I intended; I had just had to euthanize my dog and wasn't feeling too hot.


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## Guardian (Aug 15, 2006)

TCERT1987 said:
			
		

> 1. That's not even funny.
> 2. I'm a girl.
> 3. Please don't lecture me about immature patients, I deal with them every day. I live, eat, learn, and work where my patients are. We don't hold their hands because none of those morons ask us to. This past year as a freshman, I was the youngest person on my dorm hall and I was taking care of people 4 years older than me who were to frickin drunk to be able to tell me how old they were.
> 4. The only time I won't hold a person's hand is if they pose a threat to me. It's pretty obvious that SOB is one, so no hand holding for him.
> ...





I see you're a woman now, and I apologize.

I was a paramedic at 18 with pts of ALL ages, so I know how hard that can be.

I love my dogs like family and I'm sorry for your loss.


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## randyb (Aug 23, 2006)

I think the compassion of human touch is crucial to good patient care.  We have to remember we treat the patient, not just the injury.


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## MariaCatEMT (Aug 23, 2006)

*Why do any of us have to explain....anything....to anyone on here? :sad: *


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## HFD EMS (Aug 23, 2006)

Sorry but i think that if it helps the patient get ahold of themselves and makes them feel safe and calm.  Then so be it.  Espescially if it drops their heart rate.  They are scared to death when they see a bunch of people working over the top of them while sittin on a rough stiff backboard with a c-collar and straps all around them.  So if all they want is to know that someone is caring about them then i am completely for it because i know that if i was a trauma pt. i would probably want the same care.  Thats my Oppinion.


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## Ridryder911 (Aug 24, 2006)

Ironically, I had a partner the other day, explain he never wants a patient to touch him or for that goes even his partner or "anyone".. I asked why would someone ever consider ever entering the health field, not wanting to touch or be touched by anyone? 

He described he does not mind touching people only and if only he has gloves on.. and he touches them, not the opposite. 

I informed him, I could understand those with blood, fluid, etc.. but, not those for example, that have just lost their loved one, or apparently has no contact problems.. and I felt that he has a phobia.. that he needs to address. 

He really is a smart Paramedic, but I find this behavior very odd and actually rude, when someone needs compassion, or even the humanistic touch. 

I agree there are definitely times, their are people that seek behavior to get or gain attention, but there are those that need it and it is our JOB to give it. We are in the people business, and part of healing is psychological as much as it is physical. 

R/r 911


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## MedicPrincess (Aug 24, 2006)

Guardian said:
			
		

> Lately, many of my pts have been asking me to hold their hand because they're scared, upset, crazy, etc. From now on, I'm starting a no hand holding rule in the back of my ambulance. What do yall think about this?


 
In your very first post you state no hand hold.  You even mention the scared and upset patient.

Yet here...



> Adults on the other hand should be held to a higher standard. Why are you appeasing our adult pts who act inappropriately. You are doing a disservice by reinforcing bad behavior and helping to guarantee they will do it again and again and again.


 
you are talking about adults who act inappropriate.

So since you won't hold anybodies hand anymore because it reinforces inappropriate behavior, how do you deal with the little old lady who has fallen down and broken her hip, scared and in pain?  Or how about the adult patient who has just been in a MVC and now they are the patient strapped down to the backboard, scared and in pain?  Or the female patient who has been beaten up and raped, scared and in pain?  

Are you somehow implying these types of patients are acting inappropriatley because they have had terrible events happen to them and now they need YOU to help them to feel better for just the few minutes in your life you are there? 

ABSOLUTLEY! there are some patients who won't touch me, gloved hand or not.  Most of our calls to the pain phone at the BP gas station are those patient.  Those guys call, and will tell you they did, because they know its me and my partner on that day and we are the nicest/prettiest/blah blah make me puke.  They will call for mosquito bites and want transport.  They sit on the bench seat, and get very little interaction from me.  Because that is behavior not to be encourage.

Holding someones hand isn't going to be the be all end all reason for someone call you.  However, because you showed that LOL that easiest bit of empathy, it may be the part of that terrible day when she lost her mobility she reflects back on.


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## Guardian (Aug 25, 2006)

My first comment was hasty because I was angry at all the BS handholding requests I've been getting.  Plus, unconsciously, I like to be abrasive sometimes to stir up debate.  When I wrote about not wanting to hold the hands of scared pts, I was talking about pts who are scared for BS reasons.  Ex. Wanting to hold my hand and scream out loudy because my partner is starting a small IV.  Quit being a baby, I'm not here to hold the hands of 42 y/o babies.:angry:  I'm not your hand :censored::censored::censored::censored::censored:.

Anyway, ultimately, I'd like to see more ems providers treat these people how they deserve to be treated.  If you got some big crybaby, don't sympathize with them.  Don't try to assuage their not existent pain.  Tell them the truth (ex. "I think you're full of crap" or "Grow the F up").

I'm seriously thinking about quitting inner city ems.  I am fed up with the BS.  Anyone else feel the same way I do?


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## Sineath02 (Aug 25, 2006)

I think human contact is a form of healing. I would want someone to hold my hand. It's a way of letting the patient know you care


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## fm_emt (Aug 25, 2006)

*paranoid people*

Has anyone brought up the fact that in many aspects of our society, simply putting your hand on someones shoulder can wind up getting you sued? Imagine.. some female patient is upset, so you put your hand on her shoulder. Next thing you know you're being added to a sexual harrassment suit. Stranger things have happened.

Maybe I've been watching too many Human Resource videos, but it's certainly something to think about. I've known a few (non-EMS) people that wound up walking around at work in a paranoid haze because of similar issues.


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## Stevo (Aug 26, 2006)

> I like to be abrasive sometimes to stir up debate.



good, then lets have at it Guardian , i so love people with a firey tude like mine...

so let's say that we apply being _real_, and doling out our contempt along with out compassion shall we?

after all, they are two sides of the same human coin, and i'm not afraid to express either vs. being a cold dry participant in ems

it's been said that the majority of our calls are no more than taxi rides, and we all know that a certain % have no chief complaint, other than wishing to get _checked out_ for insurance reasons, evading the cops,etc

so why can't we call them on it? heck, most mothers (especially those who've raised multiple boys) would downplay , if not ridicule such behavior wouldn't they?

Too bad telling a patient to _'go to your room'_ could be construed as malfecant, that's what my brothers and i usually recieved short of an arterial bleed or exposed bone....

~S~


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## ffemt8978 (Aug 26, 2006)

Stevo said:
			
		

> so why can't we call them on it? heck, most mothers (especially those who've raised multiple boys) would downplay , if not ridicule such behavior wouldn't they?
> ~S~



We kind of do this.  We have what's called a "Medical Necessity" form that we can use if we feel there is no valid reason for the patient to go by ambulance.  It basically says since we can't determine that you have a valid need for transport by ambulance, your insurance will not pay for the ride meaning you get stuck for the whole bill.  In addition, we will send you to collections if you fail to pay it.

It's not perfect, and we don't get all of our money back but about half the time, the patient reads that form and decides that yeah, they can go by POV.


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## Stevo (Aug 26, 2006)

> We have what's called a "Medical Necessity" form



i would like to learn more about this FF, seems we could use this (listen to me wishing for more paperwork, gawd...)


~S~


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## Guardian (Aug 26, 2006)

Stevo said:
			
		

> good, then lets have at it Guardian , i so love people with a firey tude like mine...
> 
> so let's say that we apply being _real_, and doling out our contempt along with out compassion shall we?
> 
> ...



So you're all for letting lawyers decide how you should provide care?

It won't be easy but we have to do something.  The system here is broken.

I'm asking that we be truthful with pts.  If someone comes up and spits into your face, you don't smile and say thank you.  That would be a dishonest reaction.  An honest reaction would be to voice your concerns.  If they spit into your face again, you take them out DT4EMS style.  These people are spitting in our face every time they take advantage of us.  

The most we are looking at is nonfeasance, not malfeasance.

I personally don't like the idea of taxi vouchers because I think people should pay their own way if they can and I don't want to pay (taxes) for these slugs.

Medical Necessity forms may work for your system ffemt8978, but it wouldn't work for ours.  The people we pick up would gladly sign the form.  Then when we tried to bill them, they wouldn't pay.  It's as simple as that.  They know we can't touch their medicaid or welfare checks.  They know we can't kick them out of public housing.  If we took them to court, we wouldn't get anything because they don't have anything of major value so it would be a waste of time and money for EMS agencies.  And, in our state, they wouldn't even think of putting these deadbeats in prison.

Keep the ideas coming.  We need to figure out something and fast.  We are no longer an EMS service but instead a cabulance service that is forced to transport deadbeats.  In my opinion, tolerating these people and allowing them to tie up our resources because we are afraid of being sued is misfeasance against the people who really need our care.


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## fm_emt (Aug 27, 2006)

Guardian said:
			
		

> SIn my opinion, tolerating these people and allowing them to tie up our resources because we are afraid of being sued is misfeasance against the people who really need our care.



We need more lawyers on our side, eh?


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## ffmedic (Aug 27, 2006)

edited post


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## ffmedic (Aug 27, 2006)

Gosh! I guess systems are really different all over. I have for the last 25 years been able to decide if someone even gets in my rig. Originally we contacted Med Control and they OK'ed it As recently as 7 years ago the Doc's just got tired of hearing from us. They told us to stop calling. Only call if its a "value added" question. So, if I decide you don't get a ride, you don't get a ride. It would be difficult to do it any other way now for me. 

Lucky I guess to have grown up with a really great system. Seriously though, it doesn't come up that often. Most just take the suggestion to POV. A very few are told "sorry, it aint happening". That's not to say losers don't get transported, just losers with a better story.


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## Guardian (Aug 27, 2006)

ffmedic said:
			
		

> Gosh! I guess systems are really different all over. I have for the last 25 years been able to decide if someone even gets in my rig. Originally we contacted Med Control and they OK'ed it As recently as 7 years ago the Doc's just got tired of hearing from us. They told us to stop calling. Only call if its a "value added" question. So, if I decide you don't get a ride, you don't get a ride. It would be difficult to do it any other way now for me.
> 
> Lucky I guess to have grown up with a really great system.




Cool.  Do you work for public or private company.  Affiliated with a fire dept?  

Here, if people request to be transported, we take them.  I would be really nervous refusing to take someone.  Ex. pt complains of N/V since yesterday.  I say, no sir, you can't ride to the hospital with us because this isn't an emergency.  You just have a stomach virus.  With my luck, the SOB would die because of massive GI bleed.  I would rather find a way to discourage the people from calling in the first place.  I want them to drive to a primary care doc like everyone else.


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## Guardian (Aug 27, 2006)

Also, what are the demographics.  Do you see a lot of poor inner city pts, lower middle class, middle class, or rich?


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## FF894 (Sep 5, 2006)

Guardian said:


> For example, some people want me to hold their hand while my partner starts an IV.  You wouldn't see this being done at the hospital would you?



haha, yeah I have seen it and been asked to do it in the ED before....


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## FF894 (Sep 5, 2006)

Guardian said:


> I also think we should stop encouraging this behavior which is what we do every time we gratuitously hold their hands.




Sorry to go back to this one, but heres what I dont understand about this, and I teach this to veterans all time.  You say this as if all of your patients have a forum like this that they can talk about how they are treated.  Your patients dont talk to each other.  They have no idea what you did for the last guy.  You need to single out every single call as if it was your only call of the day.  If you go into a call thinking its just the next call then thats exactly the kind of treatment you will provide.  Sure, there are frequent flyers that have been in the ambulance who knows how many times, but for most people going in the ambulance is A BAD DAY for them.  Who wants to call 911 for an ambulance ride to the hospital?  Some people are really scared of just the site of the ambulance let alone riding in one, not to mention whatever is going on with them.  You have seen so many sick people, you become numb to the fact that if someone can't breath or they feel like they have an elephant on their chest, they need you for help.  Its up to you to control the situation.  And if a simple hand holding is part of what makes them feel better, than give them your damn hand.  They didnt know the last guy wanted to, too.  They just want you to look at them, hold their hand, and let them know that you are there now, and you are goign to help them.


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## joemt (Sep 5, 2006)

I could not have said it better...good job ff894!


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## ffemt8978 (Sep 5, 2006)

FF894 said:


> You need to single out every single call as if it was your only call of the day.



I think this point bears repeating.


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## Guardian (Sep 5, 2006)

FF894 said:


> haha, yeah I have seen it and been asked to do it in the ED before....



haha, yeah, sometimes I have to go back and spell it out for people.  I write in general and not in absolutes.  Of course there have been times throughout recorded history that people have asked someone in the ED to hold their hand but *IN GENERAL* this doesn't happen


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## Guardian (Sep 5, 2006)

FF894 said:


> Sorry to go back to this one, but heres what I dont understand about this, and I teach this to veterans all time.  You say this as if all of your patients have a forum like this that they can talk about how they are treated.  Your patients dont talk to each other.  They have no idea what you did for the last guy.  You need to single out every single call as if it was your only call of the day.  If you go into a call thinking its just the next call then thats exactly the kind of treatment you will provide.  Sure, there are frequent flyers that have been in the ambulance who knows how many times, but for most people going in the ambulance is A BAD DAY for them.  Who wants to call 911 for an ambulance ride to the hospital?  Some people are really scared of just the site of the ambulance let alone riding in one, not to mention whatever is going on with them.  You have seen so many sick people, you become numb to the fact that if someone can't breath or they feel like they have an elephant on their chest, they need you for help.  Its up to you to control the situation.  And if a simple hand holding is part of what makes them feel better, than give them your damn hand.  They didnt know the last guy wanted to, too.  They just want you to look at them, hold their hand, and let them know that you are there now, and you are goign to help them.




You are underestimating people.  People do come to expect certain things and there is a word for this, it's called culture.  People see things on TV.  People talk to aunt sally about her experience riding in the ambulance.  People talk to each other.  When we go and pick someone up, you can bet the family will be talking about and picking apart our visit for days to come.

I strive for perfection on every call even though I never achieve it.

Who wants to call 911 for a ride to the hospital? (BS)  About 60,000 people a year where I work.

Here is the problem with your attitude.  You are encouraging the misuse of EMS.  You are catching little Johny with his hand in the cookie jar and you are saying thats OK, what you did was fine and here are some pointers on how not to get caught next time.  I am starting to think some of you think EMS is a routine house call with a nice ride to the hospital.  EMS is for EMERGENCIES ONLY! hence the name EMERGENCY medical service.  I wish someone told me the truth early on, I wish someone said "being a paramedic is taking care of minor medical problems 99% of the time because people are to lazy and inconsiderate to take care of themselves."


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## joemt (Sep 5, 2006)

*The straw that broke THIS camel's back....*

Guardian,
   With all due respect, the very people that you are complaining about are the very people who put food on your table... if you don't like 99% of your job then get the heck out!  You are a HEALTHCARE PROVIDER that happens to work on an AMBULANCE (a transport vehicle, no?) that just happens to be a part of EMS.  Without the patients there's no job for us.  I am going to go against my grain here, and be rude (something I try desperately not to do in open forums).... It's providers like you that I beg my students not to become.  I'm not saying that you're a bad person, I'm saying that the viewpoints that you have expressed here are disappointing to me, and that if you think that your job is a joke, that you are being mistreated and put out by doing what you were hired to do (taking care of people), then it's time for you to find something else. Do you get paid by the hour, or by the number of Emergency Patients that you bring in?  I think that if it was due to true emergency patient numbers that you would have found a different career long ago.  So, by staying in EMS you are agreeing to running mediocre calls, don't :censored::censored::censored::censored::censored: to me about having to do your job!  Geez..... 

Ok, sorry all.. I had to get that out.
Peace Guardian,
Jo  

Jo


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## gradygirl (Sep 5, 2006)

I bet you've seen this before...







Here's the truth: if this job is getting to you so much that you're going to stop treating your patients 100%, then it really is time to hang up your boots. Yes, it sucks that so many of EMS calls are not emergencies, but it sounds like you've gotten past a point where you can accept that. 

You asked for our opinions, we've given them to you. It's apparent that few to none are the agreements you were looking for. Our opinions are what they are, our opininons. Your opinions are yours. Period. I hope you can once again find yourself in a position where you can deal with all of the cons of the job.


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## ffemt8978 (Sep 5, 2006)

I think the point that Guardian was trying to make is that we are supposed to be EMERGENCY Medical Technicians, not ROUTINE Medical Technicians.  There is a difference here.

Yes, the routine calls are 99% of our call volume, but why is this?  Does anyone remember why EMS came to be?  What the original focus of EMS was?  Anyone remember the name of the paper that recommended creating a standarized EMS system?

EMS was never originally conceived to handle the routine calls.  It was meant to be for emergencies only.

How did we go from there to here?  Simple, we (as a healthcare system as a whole) have allowed non-emergent situations to continue to tie up our precious few resources.  Why is this allowed?  

1.  Because 911 is a lot easier to remember and dial than your personal physician.  
2.  We're here 24/7/365, unlike your doc.  
3.  We have to provide you service even if you don't pay for it, unlike your doc.  

I agree that the ability to pay should not factor in patient care for critical calls, but it aboslutely should factor in on the non-emergent / non-life threatening, I need a ride because I don't have a car calls.


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## FF894 (Sep 5, 2006)

Guardian said:


> You are underestimating people.  People do come to expect certain things and there is a word for this, it's called culture.  People see things on TV.  People talk to aunt sally about her experience riding in the ambulance.  People talk to each other.  When we go and pick someone up, you can bet the family will be talking about and picking apart our visit for days to come.
> 
> I strive for perfection on every call even though I never achieve it.
> 
> ...



Alright, don't get me wrong here.  I agree partly with what you are saying.  We touched on this in the "taxi" thread somewhere on here.  If I determine that it is a frequent flyer abusing our system we do not transport.  I call in a private company to handle the transport and I make it clear to the pt that in the future they should call the private company if they need a transport and call us if its an emergency.  I think it sounds like you are burnt out :wacko:   It happens.  This is a tough job and it takes a toll on you after doing it for a while.  Some people get burnt out sooner than others.  The fact is though if you get in the mind set that are in when you post like you did here, you are treating your patients like they are just the next lazy and inconsiderate person who cant take care of themselves.  There needs to be a balance.  You need to be mindful or these people but dont expect every call you respond to is going to be these people.  Respond with the benefit of doubt that your pt's well-being is at stake and you are the one thats going to make a difference.


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## Guardian (Sep 6, 2006)

joemt said:


> Guardian,
> With all due respect, the very people that you are complaining about are the very people who put food on your table... if you don't like 99% of your job then get the heck out!  You are a HEALTHCARE PROVIDER that happens to work on an AMBULANCE (a transport vehicle, no?) that just happens to be a part of EMS.  Without the patients there's no job for us.  I am going to go against my grain here, and be rude (something I try desperately not to do in open forums).... It's providers like you that I beg my students not to become.  I'm not saying that you're a bad person, I'm saying that the viewpoints that you have expressed here are disappointing to me, and that if you think that your job is a joke, that you are being mistreated and put out by doing what you were hired to do (taking care of people), then it's time for you to find something else. Do you get paid by the hour, or by the number of Emergency Patients that you bring in?  I think that if it was due to true emergency patient numbers that you would have found a different career long ago.  So, by staying in EMS you are agreeing to running mediocre calls, don't :censored::censored::censored::censored::censored: to me about having to do your job!  Geez.....
> 
> Ok, sorry all.. I had to get that out.
> ...





I dont even know where to start.  I disagree with almost every sentence in your post...lol.

These people are taking food off my table (taxes).  They don't pay for our services.

I don't plan on quitting anytime soon.

EMS should not be providing routine health care to people.

It sounds like you might work for a private transport company (taxi with bed and flashing lights), in which case, a lot of what you say is true. We cannot continue to operate publicly funded EMS this way.

If my hunch is correct, you should come to a poor city and transport primary illness calls all day without getting payed like we do and your view point may change.  Oh, and your company would probably go out of business the first week.

I do think my current job is a joke.

So what your saying is, if i don't like my job, i should quit.  Sorry, i'm not a quitter.  I'm one of those pesky think-for-yourselfers that wants to make a change in ems.  It's obvious to me now that I have a long way to go.  Not only do I have to convince the public of what a joke ems has become, but i also have to convince my fellow ems providers. 

On a side note, medicaid and medicare is up to about 52% of the national budget (i think).  This dwarfs defense and other spending.  We have serious issues in this county with health care.


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## Guardian (Sep 6, 2006)

ffemt8978 said:


> I think the point that Guardian was trying to make is that we are supposed to be EMERGENCY Medical Technicians, not ROUTINE Medical Technicians.  There is a difference here.
> 
> Yes, the routine calls are 99% of our call volume, but why is this?  Does anyone remember why EMS came to be?  What the original focus of EMS was?  Anyone remember the name of the paper that recommended creating a standarized EMS system?
> 
> ...




Great post.  To tie this back into hand holding, I feel like we are holding to many peoples hands both metaphorically and physically.  It pisses me off that they call for some BS reason and then expect me to hold their hand too.

This is a hard problem to fix.  We are not doctors with x-rays and blood labs and therefore we can't rule out major issues.  Someone could call for a stomach ache and we would have to take them.  In my system, we can't call for a private transport truck because they don't want to come anywhere near us (violence and 0% chance of getting paid).  The only way to fix the problem as I see it is to change the public perception of EMS and stop encouraging them to take advantage of us.


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## Guardian (Sep 6, 2006)

TCERT1987 said:


> I bet you've seen this before...
> 
> 
> 
> ...




lol, I already got screamed at by my supervisor for putting something similar on my ambulance.  To my credit, I only drove it around our headquarter parking lot and not out in public.  I am very conscious about public image.  In my mind, I do treat all of my pts 100%.


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## gradygirl (Sep 6, 2006)

Guardian said:


> Someone could call for a stomach ache and we would have to take them.  In my system, we can't call for a private transport truck because they don't want to come anywhere near us (violence and 0% chance of getting paid).  The only way to fix the problem as I see it is to change the public perception of EMS and stop encouraging them to take advantage of us.


Excellent point. Wouldn't it be heavenly if someone could figure out how to set up a definitive dispatching system so that emergency calls could get screened out of the BS that constantly comes through? Haha, and all of the "issue" EMT/medics could be stuck on the BS calls while the quality EMT/medics could be used on the good calls...

It's amazing how under-informed most (esp. minority immigrant) populations can be. So many are told to call 911 for anything and do not understand that 911=emergency. Hartford's got HUGE issues with this, as most of the population is made up of differing generations of immigrant families. But heck, even you're average Joe will try to explain to you how them not having their meds at 3a (and the drug store opens at 9a) is an emergency. -shakes head-



			
				Guardian said:
			
		

> In my mind, I do treat all of my pts 100%.


Good enough.


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## Firechic (Sep 7, 2006)

guardian said:
			
		

> I'm one of those pesky think-for-yourselfers that wants to make a change in ems. It's obvious to me now that I have a long way to go. Not only do I have to convince the public of what a joke ems has become, but i also have to convince my fellow ems providers.



So, what is your game plan??


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## MMiz (Sep 7, 2006)

I hate to jump in late in the game, but here goes...

I think it's just plain ignorant to blame the current state of EMS on any one race, population group, or socioeconomic level.  While it may be the immigrants in one region, the poor people in another, and the wussified folks in yet another region, the truth is that as a whole our EMS system is broken, and it would be wrong to blame just one group.

I work for a private service, so I can expect that crap calls that the public services don't want.  I respond RLS when needed, pick up my patient, and treat them with 100% respect.  I know that the ambulance service will never see a dime for the transport, and I do my job.  I once had a hospital in a rough area call my unit back 5 times during a midnight shift to transport their poor non-insurance patients while their local favorite private ambulance service waited outside all night for a paying call.  It sucked, but I did it.

But the truth is, how long can a person be expected to respond to BS calls and provide amazing patient care.  The truth is, even I believe that one's compassion is truly limited, and after x many BS calls, EMS just isn't the same anymore.

I'm not going to call anyone out of the forum, but I am going to say that it's more than funny that some of us are accusing others of not having compassion, when our idea of EMS is far different than someone elses.  I worked one shift a week, and I loved that shift.  But when I worked five shifts a week doing the daily BLS transfers, I couldn't stand my job by the end of the week.  Hm.

Some of you work for public services, in wealthy neighborhoods, or even for college EMS systems.  How you or I can get mad at someone for disliking the BS crap of an abused private or urban EMS system?

The problem with EMS isn't the immigrants, poor, or pissed off EMTs, but frustration with a system that has come to serve populations that should be seeking care elsewhere.


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## Guardian (Sep 7, 2006)

Firechic said:


> So, what is your game plan??




My game plan is to open your eyes to this problem.  Hopefully, if all of my fellow emsers get upset and demand a change, then maybe someone with political skills and power can make a change and bring us back to doing what we are supposed to be doing.  I think I read somewhere you were a RN, maybe not, but in any case, I know how pissed off nurses get when we bring in the bs pts.  I also know that nurses as a whole are more powerful than god (yes people, nurses do run hospitals) and I think they would back us up on this issue, then again maybe not, they are pretty egotistical.  Anyway, I'm not sure what my game plan is but anythings better than what we have now.


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## Guardian (Sep 7, 2006)

great post MMiz although I would add that when it comes time to fix the problem, we shouldn't be afraid to identify areas that abuse ems systems more than others.  I warn you, these areas tend to be high minority areas, low socioeconomic areas, and wussy areas.  We can't be afraid to shed light on these areas because of political correctness.  Facts are facts.  When all the money left new orleans during katrina, america got a good look at what I deal with every day (poor people).  We should not be afraid to shed some light on these problem areas if we are truly going to make a change.


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## joemt (Sep 7, 2006)

One of the Great things about America is that everyone is allowed a right to their opinion... I respect your right to have an opionion, that doesn't mean that I have to agree with it.

I DO agree that there has to be a change in EMS....but I think that we need to be thinking of starting at the base of the problems, and working our way up from there.  Just MY opinion, which I'm sure that you respect as well.

Take care my friend!
Jo


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## Ridryder911 (Sep 7, 2006)

Wow.. what a bunch of whiners!.. Geez, like every patient seen in ER is a true emergency. Just think, if medicare or medicaid, did not pay.. would you have job? Each person that calls you is a consumer. Payer or not.. your boss gets to right off a portion, and reimburse. Want to know something, it is the emergency calls that usually does not pay.. people who get shot or stabbed, usually do not carry blue cross and blue shield. I had a bumper sticker once made that said...." medicare bought this car"...

True, there is an abuse .. and yet who's fault is it really? Does your EMS have public service announcements in print, t.v., radio on when it is is proper to notify 911 and how to call for EMS?.. Do you speak at civic organizations and groups routinely? Do you teach CPR and first-aid to the public, and when to call EMS as well? Do you participate in policy and protocol development, to develop protocols to not transport non injured and ill patients. If you don't then you are just as much as part of the problem.

Yes, I hate it when there are b.s. calls, and even more so when they are informed and knowledgeable of what an true emergency is and then abuse it Who doesn't ... every job has its' down-point. 

But, this has nothing to do with compassion and "hand holding" of patients..90% of this job has nothing to do with performing emergency procedures and calls, never has and guess what never will. Nationally, medical care is only needed 18-20% of the time in EMS, ALS is only needed in 10% of the time and that even may be greatly exaggerated. If you didn't realize that when you were in school, then and clinicals, then you were the foolish one...it didn't change, because you entered the  workforce.If emergency care was needed all the time on every call, the population would be 10% lower... 

Now, do you actually think they call EMS for medical care.. or more because they don't know what to do in that predicament..? Trust me, general population does not consider an ambulance an health care facility. 

If one think they are above "hand holding" or giving compassionate care really needs to get a reality check.. so you attended a couple of nights a week for a year training program and few hundred hour clinicals, and you are above this? really, who do or what do you think you are?... Give me a break! Even surgeons should not be above this.. and if they are, they to need to get the hell out as well.. that is part of the job, don't like it, there are many other professions out there, may I suggest a non-health care profession.

This is a "human" business, with physical, psychological and emotional needs..can't perform to treat these.. leave.. you won't be missed, trust me there is always someone to fill your shoes.


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## joemt (Sep 7, 2006)

My point(s) exactly Rid.. thanks for watching my back!


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## ResTech (Sep 8, 2006)

I just caught this thread and really cant believe a provider would have a no hand holding policy. Thatz really mind blowing. 



> I also think we should stop encouraging this behavior which is what we do every time we gratuitously hold their hands.


I get the impression Guardian that you think pt's. that are treated by EMS get together for group meetings and tell each other about how they got to hold their providers hand and conspire to start a hand holding epidemic. Thatz crazy. Holding someones hand doesnt encourage someones future desire to want to hold a hand when they are scared or want comforting. This is called HUMAN NATURE! Its instinctive to reach out to other human beings when we are hurt to find our comfort when we arent in control to comfort ourselves. And when in the back of the ambulance, laying flat on your back on a stretcher, holding your caregivers hand is the best way to obtain some comfort and reassurance that everything is going to be ok. 

With that said, I guess its really important to point out that some people while although human, are lacking the most important human characteristics of compassion and empathy. I dont know you, but sense you are lacking these and that you can be a very cold and selfish person. Putting your own desire over your pt's. is clearly selfish. 

They're isnt much else to say as every other point has pretty much been made here. You have some serious issues if you feel holding a pt's. hand isnt providing CARE to your pt. Hopefully you will reevaluate yor "hand holding policy" for your pt's. sake.


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## Guardian (Sep 9, 2006)

Ridryder911 said:


> Wow.. what a bunch of whiners!.. Geez, like every patient seen in ER is a true emergency. Just think, if medicare or medicaid, did not pay.. would you have job? Each person that calls you is a consumer. Payer or not.. your boss gets to right off a portion, and reimburse. Want to know something, it is the emergency calls that usually does not pay.. people who get shot or stabbed, usually do not carry blue cross and blue shield. I had a bumper sticker once made that said...." medicare bought this car"...
> 
> True, there is an abuse .. and yet who's fault is it really? Does your EMS have public service announcements in print, t.v., radio on when it is is proper to notify 911 and how to call for EMS?.. Do you speak at civic organizations and groups routinely? Do you teach CPR and first-aid to the public, and when to call EMS as well? Do you participate in policy and protocol development, to develop protocols to not transport non injured and ill patients. If you don't then you are just as much as part of the problem.
> 
> ...



Q. If medicare or medicaid didn't pay, would I have a job?  A. I sure hope so, I would hope that someone would see the importance of having EMS and see that it got funded.  Look at the bigger picture and try to stay with me on this.  If Bush came on tv and said he was starting a new government program to transport lazy and poor people to the hospital for free and was going to raise taxes to do it, there would be widespread outrage.  People would say, let these bums get a job and take care of themselves.  Politically it would never work because this is a democracy.  To get around this, we are lying to the public.  We say we provide EMS when all we really provide is ROUTINE MEDICAL CARE >90% of the time.  Tell me what is cheaper, having 20 ambulances responding to 25 ems calls/day funded by _____ or having 48 ambulances in the same city responding to 130 routine calls funded by medi___.  When EMS is transformed into a routine medical system (RMS), the quality of care goes down (quality of provider, equipment, training, response time, resources in general).  We were not created to be mobile free clinics.

You are right, routine calls pay and ems calls don't.  This is the fundamental difference in our beliefs.  You think ems is a routine medical service much like the hospitals you've worked in while I equate EMS to critical public services like the fire service, police department, and military.  I have seen very successful private (for profit) ems agencies so I'm not against that idea if done honestly and providing good care.  I am against stretching our resources to the limit to run routine calls and lying to the public about the services we provide for money.  Cities have done this for years but now rural ems agencies are having to cope with the ever growing number of BS calls that are turning their ems system into a rms system and ruining ems as a whole.

You say "90% of this job has nothing to do with performing emergency procedures and calls".....funny, I thought that was exactly what ems was originally set up to do.  This is clear evidence to me that we've lost focus on our true mission.  Go back and watch an episode of the tv show emergency!, that is what we are supposed to be doing.  Now, we are nothing but a bunch of hand holders who provide a free shuttle service and justify charging the public ridiculous amounts of money by calling ourselves paramedics.

Every person on earth should be in the "human business" and we as ems providers are no exception.  We should be polite and nice and warm and fuzzy to other human beings, emergency or no emergency.  The exception is when someone tries to take advantage of you.  Then you have to stick up for yourself and not be so warm and fuzzy.  When someone comes up and punches me in the head, I don't hold their hand and go skipping off into the sunset.  When someone comes up and demands my services for bs and takes resources away from those who actually need it, I don't feel like holding their hand, get over it!

If my dream ever comes true and ems is really EMERGENCY medical services, our profession will change drastically.  We will downsize.  Unwanted deadweight will be cut off.  We wont need all these extra ambulances running routine crap.  Instead, we will be a lean, mean, life saving machine.  Only the best paramedics will get hired.  Volunteers will again be able to staff their stations.  When paramedics walk into a hospital, everyone will stop and take note because chances are good there has been a real emergency and they will want to hear this true professional give his/her report.

You say "Now, do you actually think they call EMS for medical care.. or more because they don't know what to do in that predicament..?"  

Yea, they have a major predicament, they can't scrape together the 10 bucks for a cab, but you know its funny, they all seem to have cable tv.  You know, if they didn't all have cable tv, I might be a little more understanding...give me a break! 

I can understand some of the newer people on this site disagreeing with me for various reasons.  Rid, you however have worked in systems like mine.  You know the kind of bs we have to put up with.  I remember you wrote in an earlier post that you went back to working in the field instead of the ED because you got tired of babysitting and routine abuse of the ED.  I would think you of all people should be able to understand my views.

Whose fault is ems abuse?  It is everyones fault.  Keep in mind that EMS is still a relatively new concept and we should make sure it is kept on the right path.  We should protect it.


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## Flight-LP (Sep 9, 2006)

Guardian said:


> Go back and watch an episode of the tv show emergency!, that is what we are supposed to be doing.  Now, we are nothing but a bunch of hand holders who provide a free shuttle service and justify charging the public ridiculous amounts of money by calling ourselves paramedics.



OMG, did you actually just compare our career field with a television show??

I applaud your efforts and beliefs, but the bottom line in todays society and tomorrows future, IT ISN'T GOING TO CHANGE! In fact I believe it will even get worse. We can educate the public all day long, we can require payment up front, we can flat out refuse to transport people, but it is not going to change and will only cause further headaches. To me the choice is simple, I CHOOSE to perform in this career realizing the limited need and use of my scope of practice. If the BS calls are too much for you, then you need to make a choice. Ranting an 8 page thread isn't going to do it for you......

And please, if you are going to compare us to a TV show, find one with better looking (and younger) women and one that has an up to date plot, thanks..........


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## Ridryder911 (Sep 9, 2006)

I do understand Guardian of you feelings, however let's look at the true EMS, not one fictionalized as on television, magazines, or Rickey Rangers Gall Magazines. I do understand there is a far abuse of the system, again these need to be addressed by the service and set protocols in place for dealing with such abusers. (in JEMS, this month has such article). Fortunately, my system has had protocols to give permission to determine value if transport by stretcher is needed or not. After discussion with medical director, other options of transport can be explored... cab, van, wheel chair transport, etc.. 

But to assume the public will continue paying for EMS as it is unrealistic.

A brief history of EMS, was developed by accident, not purpose in 1965 during the re-development of issues during LBJ presidency. I believe it was #46, on things to do "reduce mortality and morbidity, in automobile accidents" thus emergency medical services was born, the initial idea was to place surgeons in ambulances.. of course this never caught on, so the next thing was to train ambulance attendants (usually funeral home) and fireman, on rescue squads, cardiac and medical was never thought of at that time.. until about 1968, when some pre-hospital treatment was done by various hospitals and FD's. Then the medical portion caught on. 

I grew up watching "emergency" and yes, was a Paramedic product from it, like so many other veterans. Sure life would be nice, if it was like on t.v. were grandma and the single girls would thank-you and bring cookies responding to nothing but emergencies.. but, alas that is what script writers are for, that is television. Sorry, if that was your perception, but you should had known that during your research of a career, or at least exposure on clinicals, reality versus television. 

So how much are you worth? $20k, 30K, 50k, uh.. 75k a year? Wow, that's a lot for someone to respond to only "true" emergencies, that occur very rarely.. if ever. So you spent a couple of nights a week for what 6 months, maybe a year.. with a few hundred hours of clinical.. Now, compare that with the beautician, that spent longer in training in comparison. But, that is right.. you are special and are only capable of providing one service.

Medicine is changing.. do you think ER doc's that spent 8 years, + 3-5 years in residency trained to be in fast track? Guess what that is part of the business now.. You think they like it as well? private doc's don't want to see medicaid, non-payers, or even take call.. bump to ER. We have not yet seen anything yet.. the baby boomers which turned 60 this year, will increase call volumes almost 2-3 fold.. so, yes, we will be responding more and more to non-emergencies. 

The days of "checker board" and sitting around and awaiting for the emergencies in EMS and Fire Departments are OVER! The public, consumer, client, whatever you call patients.. want and demand more and will get more for their money. Medicare. (which will dictate insurance companies payment) are at this time reviewing optional payment regimes for EMS. Managers, will follow whatever will bring them money. Medicare and other insurance companies, do not and will not continue to pay $800 or more for a glorified taxi ride to a hospital. Don't believe me check the American Ambulance Association web site.. 

Therefore, more and more medical care will be performed (similar to homecare) in the field, by EMS to justify its' means. 
This will help in several ways:

1) Triage to those, that truly need an ER visit (triage) due to the large numbers of ER patients, and lack of hospital beds. 

2) Expansion of the Paramedic role as a health care provider.. really, we are medical not a public service utility. The term EMS is really changing and about dead, have you not heard of "mobile health care systems"?. This will allow those that are really serious about medical care to expand their role and secure a comfortable position to make the appropriate salary, and those that will not have to work 2 jobs, or work horrible shift hours and still provide emergency care, when and if needed. 

3) Emergencies will always be a part of the system, but only part of the system; like ER.. not the general rule. ......"That is part of the problem, we are still trying to manage ER and EMS, like it was in the 70's (when Emergency t.v. show was on) and it is not like that anymore.. . and never will be, our patients are different now"..... (paraphrase mine). This comment was made by the director of San Francisco General ER, when discussing managing failing emergency departments and emergency services and the delay in care.... 

Generally, wake up ... the days of sitting around for the "good one" are dead. and gone. EMS, is no longer and can no longer be a system feeding off the people for the "what if theory".. I suggest to research programs such as.. "shots across Texas program" where Paramedics were providing immunizations on their downtime...again, multitasking and thinking outside the box. 

Again, finances will dictate the way EMS will go. Cities are cutting back and as they should, people are tired of paying for things and they expect more for their money. As well, it is foolish to pay large amounts of salaries for those that can only provide one type of service, when they can provide more. 

So to summarize it, EMS is a health care industry. It is going to have to expand and provide more to keep itself alive. The days of "emergencies and only emergencies" are gone (and actually never were there). The industry is looking to expand in any form they can to provide services to keep this business alive itself..albeit to be a municipal, county, or private system. Money, and resources have to come in to have it go out....

The choices are simple ..... 

p.s. I am a full time Paramedic, part time RN. I have worked several EMS systems from hospital, private, muncipal, air..even as a consultant on many State, and municipal systems, so my experience is varied. 

R/r 911


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## rescuecpt (Sep 9, 2006)

Guardian - In my area, the whole doing "EMS" rather than social work is alive and well, however, there is a certain amount of social work/transport work involved with any 911 system.  Last night I was hanging out at the squad and a woman crossed the street from the ER and told us she just got kicked out of the ER but is homeless.  We called the County and got her into a shelter for the night (the ER told her the shelters were closed and she was out of luck - this was 11pm)... the shelter sent a taxi for her.  If they didn't, we were totally prepared to give her a lift.  No, it's not exactly in our job description - but she had a need, and we are there to help.  None of us could just let this 60 year old woman spend the night sleeping on the corner when she came to us asking for help.

That's the nature of what we do.  If you don't have compassion for everyone that needs your help, whether because they were in an MVA or because they don't have anyone else to care for them, then you probably don't belong.  The best technical provider is worth nothing if he forgets that he is caring for people, with feelings, fears, and needs.


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## Guardian (Sep 10, 2006)

rescuecpt said:


> Guardian - In my area, the whole doing "EMS" rather than social work is alive and well, however, there is a certain amount of social work/transport work involved with any 911 system.  Last night I was hanging out at the squad and a woman crossed the street from the ER and told us she just got kicked out of the ER but is homeless.  We called the County and got her into a shelter for the night (the ER told her the shelters were closed and she was out of luck - this was 11pm)... the shelter sent a taxi for her.  If they didn't, we were totally prepared to give her a lift.  No, it's not exactly in our job description - but she had a need, and we are there to help.  None of us could just let this 60 year old woman spend the night sleeping on the corner when she came to us asking for help.
> 
> That's the nature of what we do.  If you don't have compassion for everyone that needs your help, whether because they were in an MVA or because they don't have anyone else to care for them, then you probably don't belong.  The best technical provider is worth nothing if he forgets that he is caring for people, with feelings, fears, and needs.





I don't know why I even respond to this type of post but here goes...I'm a pt advocate.  I'm an advocate for the man who is going to have a heart attack but doesn't know it yet.  I'm his advocate because I want to reserve my resources so that I can properly respond to his emergency and not be dealing with some bs at the time.


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## Guardian (Sep 10, 2006)

I could continue to argue every one of rids points but I think we have both laid out our vision for the future of ems adequately.  He wants mobile health care and I want EMS.


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## ffemt8978 (Sep 10, 2006)

rescuecpt said:


> That's the nature of what we do.  If you don't have compassion for everyone that needs your help, whether because they were in an MVA or because they don't have anyone else to care for them, then you probably don't belong.  The best technical provider is worth nothing if he forgets that he is caring for people, with feelings, fears, and needs.



And the most empathatic, compassionate, caring, hand-holding person isn't worth anything if they can't seperate their emotions from their skills and realize that there is more to this job than being a social worker.

Compassion, empathy, and caring are important factors in what we do.  However, they are not the most important part.  Will compassion stop the arterial bleeding?  Will empathy provide traction to the broken femur?  Skills, technique, and the ability to be emotionally distant are critical factors as well.  

I signed up to be an emergency responder.  If I wanted to be a "Routine" medical technician, I'd be a tech in the hospital or some clinic somewhere.

  Our system is broke...we all know it.  We will never be able to fix it if everyone says, "That's the way it's always going to be." or "If you don't like it, you shouldn't be here."


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## Ridryder911 (Sep 10, 2006)

Guardian, It is so not much I want mobile health care... I want to maintain a job and be paid adequately as a professional. The way EMS is currently ran, the people that use and utilize EMS, the percentage of reimbursement, and no community, city, etc. is going to afford it. We (EMS) are not a required service that the community receives any benefit such as F.D. (ISO rating),  Police (insurance decrease because of crime deterrence) etc.. so the public does not see the benefits of having one, until an EMS is needed.

It is not I don't agree with100%, it is just unrealistic though to expect and demand the public to pay for strictly an EMS services, for only emergency reasons. The buck can only go so far...people and communities demand more for their money. Study, some health care economics of EMS, look at how many EMS has closed in the past 10 years, and the financial costs of operating. Wanting and having are two opposite things. 

Actually, like I have described, I don't disagree, just I think we are going to have to justify our existence more than running on a few emergencies.
Be safe,

R/r 911


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## Jon (Sep 10, 2006)

Holy cow... I'm speechless...

You all made good points.

Rid - I can't wait to see pre-hospital care turn into that. I know it is coming, eventually.


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## rescuecpt (Sep 11, 2006)

ffemt8978 said:


> And the most empathatic, compassionate, caring, hand-holding person isn't worth anything if they can't seperate their emotions from their skills and realize that there is more to this job than being a social worker.
> 
> Compassion, empathy, and caring are important factors in what we do.  However, they are not the most important part.  Will compassion stop the arterial bleeding?  Will empathy provide traction to the broken femur?  Skills, technique, and the ability to be emotionally distant are critical factors as well.
> 
> ...



Hey, I'm a great provider (or so I've been told)... I know many technically skilled people who have no compassion whatsoever... and their patients and other providers perceive them as crappy providers because of this.  Weren't we arguing about PERCEPTION on the Saved thread too?  There needs to be a balance.  I'm not a bleeding heart by any means (I happen to be a conservative, lol, the two don't go together) but I do believe in helping people, that's why I'm doing this in the first place.  If one person's need is more mental than another persons, regardless, they are still having a crisis at that moment and we can help with that.


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## ffemt8978 (Sep 11, 2006)

rescuecpt said:


> I know many technically skilled people who have no compassion whatsoever... and their patients and other providers perceive them as crappy providers because of this. {snip}
> 
> There needs to be a balance.



Absolutely there must be a balance between emotions and skills.  There must also be a balance between the provider and the patient.  Just because the patient feels they "need" something doesn't mean the patient should get what they want.


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## rescuecpt (Sep 11, 2006)

ffemt8978 said:


> Absolutely there must be a balance between emotions and skills.  There must also be a balance between the provider and the patient.  Just because the patient feels they "need" something doesn't mean the patient should get what they want.



Exactly.  If the guy having a massive MI wants to drive through McDonalds on the way to the ER, no way!  But if he's scared and wants some comfort, I'll try to give it to him.


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## Guardian (Sep 11, 2006)

Ridryder911 said:


> It is not I don't agree with100%, it is just unrealistic though to expect and demand the public to pay for strictly an EMS services, for only emergency reasons. The buck can only go so far...people and communities demand more for their money. Study, some health care economics of EMS, look at how many EMS has closed in the past 10 years, and the financial costs of operating. Wanting and having are two opposite things.



I was going to end it but after reading this, I'm going to add something.  The public is going to pay a heck of a lot more for your system of mobile care and would pay a heck of a lot less for a strictly ems system.  My system makes the people pay for routine ambulance rides the same way they would pay for a taxi.  Note also, this would be done with private ambulances.  EMS would be handled by EMS and would be free to those who couldn't pay.  You could make a lot of arguments for your type of system but saying it is more bang for your buck is just foolish.  As far as baby boomers go, I've got a noble idea.  Let them take care of themselves with their own retirement money!  Granny needs to see the doctor 3 times a week because she's on 400 different medications.  Your solution, turn ems into mobile health care because it will be cheaper (are you kidding me?).  My solution, have nursing homes set up their own shuttle services.  Call up a local taxi company and get a discount.  Bottom line, let granny pay for it because she is not having an emergency and doesn't need ems, she needs a taxi ride.  And for those who would want to totally pay for grannies transportation, would you rather pay for a taxi ride or a fully staffed and equipped paramedic unit with all the latest and greatest ems equipment.


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## rescuecpt (Sep 11, 2006)

I'm usually pretty smart, but I don't see what your definition of mobile health care has to do with hand holding... and isn't that the topic here?


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## Guardian (Sep 11, 2006)

Ridryder911 said:


> Guardian, It is so not much I want mobile health care... I want to maintain a job and be paid adequately as a professional. The way EMS is currently ran, the people that use and utilize EMS, the percentage of reimbursement, and no community, city, etc. is going to afford it. We (EMS) are not a required service that the community receives any benefit such as F.D. (ISO rating),  Police (insurance decrease because of crime deterrence) etc.. so the public does not see the benefits of having one, until an EMS is needed.



I think we should change the way ems is currently ran, we should change the way people utilize ems (nice way of saying abuse), we should change percentage of reimbursement so that all communities, cities,etc. can afford it.  The one thing we shouldn't do is change ems into mobile health care.  I think ems is a required service because people now expect us to be there in case of emergency.  The ISO and insurance benefits of police and fire are negligible.


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## Guardian (Sep 11, 2006)

rescuecpt said:


> I'm usually pretty smart, but I don't see what your definition of mobile health care has to do with hand holding... and isn't that the topic here?



this thread has evolved and you have some reading to catch up on but look at post #66 for a quick reference.


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## ffmedic (Sep 28, 2006)

Sorry for getting back to Guardians questions for me so late  (post #52).  Its been a rough month. Also had my laptop  (total $5500) stolen from my vehicle in Portland. Fortunatly I had backed up everything it just pisses me off that some crack head in Portland has my stuff.

1: I work for a Fire Dept. 

2: Demographics.: We cover the entire county for EMS. Seventeen county fire districts provide volunteers and a few paid/vol depts. for first response.  Population approx. 120k in the county, half that in the city. Many years ago I got enough seniority to pick my station in the county. Rarely work in the city and won’t even take any OT’s there. Mostly because  the fire side is hard to work with. The Volunteers on the other hand treat you like gods and are practically under foot to help. 13k calls last year, 10k so far this year and thats after the Vol started doing our BLS xports ( what a great deal for me).

In the city, we have way too big of a retired population. Seems someone put out the word we are a good place to retire to. Also a college population. My area of “protection”, consists of a long stretch of an Interstate and the NW section of the county. I tend to get more trauma and I like it that way. The county has a large farm population and those old buggers never want to see a Dr. ( been living this long w/o one sonny, don’t see no reason to start now).  A substantial migrant population which for the most part avoids us if they can. The city is generally middle class but we have our skid row. 

Background is that in the early days we had no communication with the hospital. The mountainous area meant radios were sketchy at best. Protocals let us do everything without them until we got into range. As I said later this evolved  into “ hey don’t even call us unless you “really” need us”. This also let us decide if the Pt. even got a ride. 

So, I guess after reading a lot of posts here I really feel lucky to have been in a really great system for so long. As to the hand holding issue, I think you have to look at the pt and the situation. Everything and everyone is different. I have had pts who do not get hand holding. Most do if they need it.  I have met the worst in the county and (what keeps me going), also some of the most interesting and cool people in the world.  That’s another post.


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## firetender (May 19, 2007)

ffemt8978 said:


> I think the point that Guardian was trying to make is that we are supposed to be EMERGENCY Medical Technicians, not ROUTINE Medical Technicians. There is a difference here.
> 
> Yes, the routine calls are 99% of our call volume, but why is this? Does anyone remember why EMS came to be? What the original focus of EMS was? Anyone remember the name of the paper that recommended creating a standarized EMS system?
> 
> ...


 
The progression of EMS is a direct reflection of the continuing (and accelerating) breakdown of the social structures that we once depended on to take care of our own.

Before what we call modern medicine, which has only been around a couple hundred years, the community handled its own. Various people held various roles within the community but, as a whole, the responsibility for the care of the ill and injured was more equally spread out and shared. Medicine was nutrition, herbs, art, theatre, ritual, ceremony, music...things that had to do with connection between people.

Even what we'd term Modern Medicine was once personal, if you can believe it. In the absence of all these bells and whistles of today's health care, we pretty much were still our own first lines of defense. Back in the 1950's when I was growing up, in Brooklyn, someone would get sick and there'd be a house full of Aunts, taking care of things and offering folk remedies. If things got bad, the Dr. - who knew everyone in the family for a generation or two and was able to work WITH the family system - would come to the house. If that failed, then you'd go to the hospital to die. Simple.

Our medical system today, driven by technology, has shoved the concept of our taking care of ourselves out the door. Most health care is not that damn complicated and, if done preventatively by a populace who takes part in their own health and well- being will significantly reduce the need to use the system. We all know that, but the AMA and drug companies and "technological innovators", unfortunately have banded together to reinforce the illusion that we are incapable of taking care of ourselves because we don't know how we work.

The Docs have the ju-ju provided by the drug companies and medical technology people. They are supported at every turn by a system that continually reinforces the illusion that only they can do the magic. But even that's an illusion.

It's about control and money. And it's not too hard to see what the source is and who pulls the puppet's strings. Look what's happening: All over the media are ads going directly FROM the drug companies TO the people urging the people to GO TO their Doctors so they can GET the drugs that the drug COMPANIES want to sell them. The Physician is no longer a resource for health and well-being, but a Distributor for a slew of corporations!

This is also about a populace that is wooed into such a deep sense of isolation from troubles that less and less people even grasp the idea of service and self-sacrifice so there are fewer and fewer practitioners to handle more and more patients. 

It's a numbers game, and the numbers are overwhelming. Do you understand that we are a profession that takes on the pain and suffering of others so that everyone else doesn't have to? Saving lives? Honestly...that's not what's needed. More equally sharing the burden of life, that's what's needed.

And then, there's the trickle-down theory. We're at the bottom of the food chain. Government doesn't want to deal with the people so they empower the corporations to make the drugs that are supplied to the doctors so that THEY don't have to deal with the people (as people), and, if they do, they "Buff and Turf" them down to the lower level of Flesh Mechanic and the societal service systems keep squeezing them down lower and lower (and further away from the Doc) until they're out on the street.

And who gets 'em?

On one hand, medicine has been institutionalized such that we must leave wherever we're at to go TO a practitioner. The reason we must go somewhere is that mechanization and specialization requires that all the machines and stuff can't be thrown into a "Doctor's Bag" (when was the last time you saw one of them?) and brought to the house.

On the other hand -- and this is a HUGE factor that ties in with the above -- back in the 1980's Mr. Reagan closed down the institutions that actually served as governmentally supported and regulated communities designed to shelter, feed and clothe -- and this is important -- provide space for contact and interaction and stimulation -- the people who could not function in the real world.

What do you think? 25% of your patients? 40%? Lots of them once lived together in these huge structures on spread out grounds. They had a bit of a sense of purpose. At the very least, they were not isolated.

Then with the drug explosion, there it was, you could sedate them and put them out into the streets.

And, yes, you are being called on to hold their hands, because no one else will.

I think it's important that those of us involved in EMS (and I still count myself because I still would like to have an effect!) take the time to understand the system of which we are part and the overall systems that define us. 

My purpose is not to dis what we have. The system is an incredibly complex, and in so many ways, efficient tool that affects the whole meaning of what it means to be alive! 

My sadness about the whole thing is that what I am seeing in my lifetime is that these systems, while making our lives longer, are driving us further and further away from each other.

And you know what, Gang? Y'all are in the perfect position to keep the spark of humanity alive. 

With love,


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## Stevo (May 19, 2007)

I'm impressed firetender.

i could easliy post a link to almost every paragraph you've written here.

the system is so broken, but we live in denial imho

~S~


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## Easy (May 19, 2007)

Hold hands.  It works.  Keep them calm and comfortable.


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## Guardian (May 20, 2007)

> On the other hand -- and this is a HUGE factor that ties in with the above -- back in the 1980's Mr. Reagan closed down the institutions that actually served as governmentally supported and regulated communities designed to shelter, feed and clothe -- and this is important -- provide space for contact and interaction and stimulation -- the people who could not function in the real world.
> 
> What do you think? 25% of your patients? 40%? Lots of them once lived together in these huge structures on spread out grounds. They had a bit of a sense of purpose. At the very least, they were not isolated.
> 
> ...



firetender, I agreed and/or thought a lot of what you wrote was interesting.  With that said, I disagree with the last part.  After the depression, we became a welfare nation.  But you can only go so far before it becomes a problem.  Before long, people start abusing the system.  All of a sudden, young healthy people start living off the government.  Reagan was tired of seeing this and helped to limit the problem by cutting government handouts.  Obviously, based on what I see at work, the problem wasn't fixed.  You say we are being called to hold hands because no one else will and I say no one should have to hold any hands.  More handouts will only encourage and facilitate more dependency and an expectation of hand holding.


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## Stevo (May 20, 2007)

Guardian,
it doesn't really matter which potus we blame, the two party oligarghy we exist in is simply a two headed hyra that instigates a fight among itself as a diversion

besides, beyond the hanout/handup argument, isn't the true measure of any governance how it's citizens fare? 

especially it's young and old?

i say our health care systems a shambles, a disgrace, a failure to all Americans _except_ that top echelon bleeding the life out of us

this part here Firetender, this is on mark here....



> It's about control and money. And it's not too hard to see what the source is and who pulls the puppet's strings. Look what's happening: All over the media are ads going directly FROM the drug companies TO the people urging the people to GO TO their Doctors so they can GET the drugs that the drug COMPANIES want to sell them. The Physician is no longer a resource for health and well-being, but a Distributor for a slew of corporations!



corporatism is the disease of unbridled capatalism firetender.  we actually have the Lamborghini or health care systems, but everyone i know drives a Chevy....

solutions? market based is the usual turn of such debates, but a capatalist system can only present a capatalistic rx, otherwise it'd be socialist ,would it not?

meet the new boss folks...







~S~


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## medic5740 (May 20, 2007)

*Hand Holding the real issue??*

Is the hand holding the real issue?  Is frustration with political institutions the issue?  If we got into EMS to help people, then we should do whatever it is that will help them??

"Integrity, compassion, accountability, respect, empathy", (icare.org) the components that my students must possess no matter how competent they are medically if they want to pass my class.  Yes, they can fake all of them, just like some practicing EMS providers can fake them, but at least they must appear to possess them or they don't pass.  

Patient care should start with caring for patients, not just providing them the medically necessary procedures to try to allow them to survive.  So if the patient reaches out to me or asks me to hold his/her hand, you can bet that I will do that--to demonstrate those five components of patient care that I believe are important.  

I'm sorry that some of us believe that touching a patient for other than medical reasons is improper.  I would love to hear your simple stories about how reaching out to a patient seemed to help them.

Send them to me at medic5740@yahoo.com.  I'll post them on my website:
http://ruralemsisdifferent.com

"Let's put the caring back in patient care."


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## jrm818 (May 20, 2007)

medic5740 said:


> I'm sorry that some of us believe that touching a patient for other than medical reasons is improper.



Heck you can look at it from a purely physiological perspective and still find that handholding is a good thing for patient care and overall outcome.  Even if its only a little bit, holding a fearful patient's hand can relieve stress, which is actually important for patient outcome in a meaningful way - the last thing you want for many patients is a physiological stress response, and if hand-holding works to calm the patient, any EMT/paremedic (or heck, the most senior MD) has no buisness taking a holier-than-thou attitude and claiming that hand-holding is beneath them or that thier patient doesnt deserve everything possible in terms of patient care.  I can't fathom what could lead guardian to treat hand-holding as if its crack-cocaine or something that EMS has gotten patients hooked on - anymore than you would say that you are going to try to stop the gratuitious use of band-aids that we've hooked people on.

Patient advocacy doensn't just mean you try to create a system where you can plug patients into as many electronic widgets as humanly possible to perform the most crazy bada$$ procedures possible in the field (with one hand tied behind your back!), but that you also that you show a deep concern for the human aspect of medical care, and try to make the deliverance of medical care as positive as possible for the human patient experiencing it.  Who died and made you king of deciding who deserves your care and who doesn't?

The issue of the overall use of EMS is a seperate issue, but the fact remains that anyone to whom you are called is your patient first and foremost - and your primary responsibility is to providing care to the patient in front of you - not lecturing the pt. as to why they are idiots for thinking they needed help from an ambulance.  You sure as heck aren't there to punish your patients for mis-using the system - thats about as far away as you can get from patient advocacy.  Education about appropriate times to call an ambulance is one thing, witholding something that could benefit your patient because you have deemed thier problem "BS" is another.  If you don't like the way the system of EMS is working, then go ahead and try to modify it, but when you're acutally on the job looking at a patient, be they on thier death bed or just scared because they have a really nasty cut on thier little finger, your responsibility is to them.

Sorry for hijacking the thread, I konw it's evolved into something on which I am not qualified to comment (system-wide analysis of EMS), but I literally couldn't believe the sentiment from guardian (as in I thought this was a joke at first) about the simple issue of hand-holding.


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## Ridryder911 (May 20, 2007)

I have to admit there are some times that I do not care for "certain" patients to grab, touch, or hug me. It is not the "personal" or even having feelings of apathy, rather some of the patients are not the best in " hygiene" and being clean. I know that sounds very egotistical and definitely non-Christian like, but again it is not the person rather ,I have had B.O. smell, perfume smells left on my uniform for my duration of my shift or until I can change. 

With that saying, I am seeing more and more medics entering the field that have no desire to touch the patient except in the care. I do find this odd since we are supposed to be the first medical care. This is where the debate begins.... does providing medical care require and encompass compassion and just how much does that encounter? 

Ironically, in nursing I believe it is naturally assumed that touching, intimate closeness other than the brief touch of procedure(s) is part of the job. I do find it ironic, many of these "non-touchy" medics are considering going into the nursing profession. When addressed they still remark, they do not feel comfortable touching or being touched. I do not believe they understand that the main emphasis of nursing is the "human touch". That it is usually the difference between physician and other medical care. That skills and texts places emphasis on touching the patient, be it in stroking the hair, washing the face or holding the hand of a patient. In fact this is one of the concerns that nurses have of "increased work load", that does not allow them to give the humanistic care needed while being ill and increasing psyche needed for resistance. 

Yes, it has been proven several times that "human touch" definitely has benefits in decreasing stress, increasing antibodies, resistance, and improving out come. Many are familiar with scientific studies performed several years ago, involving neonates where there was non-touched versus those that received stroking and touching. The results was over-whelming in those that received "touch" in comparison of that did not. 

Maybe, part of our curriculum should have to be increased "touching" on skills, or as I have emphasized screening of applicants on admission to any EMS program describing that part of requirements is "touching people". This is shameful, but does need to be addressed. 

I believe we are addressing a hidden problem that EMS applauds to ignore. Again, until we attempt to screen applicants based upon multiple points we will continue to have this increasing problem. 

R/r 911


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## Glorified (May 21, 2007)

I'm not gonna bother to read 10 more pages of this thread, but I see no problem in providing emotional support.  If someone's mind is at rest, their body can more easily compensate.


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## bstone (May 21, 2007)

I had a PT last summer who held my hand. She has horrible leg pain and we were BLS so no narcs. Just a ride to the ER and a scream every time we hit a bump in the road.

I sat in the back with her feeling helpless, but then she grabbed onto my hand and held it tight. I felt it was the LEAST I could have done for her and it turned out to be one of my most memorable patients.


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## Guardian (May 21, 2007)

Stevo said:


> Guardian,
> it doesn't really matter which potus we blame, the two party oligarghy we exist in is simply a two headed hyra that instigates a fight among itself as a diversion



  It's fun to think that big business is secretly controlling the world and use republicans and democrats as a diversion.  In reality, I think it's just a popular conspiracy theory.





> besides, beyond the hanout/handup argument, isn't the true measure of any governance how it's citizens fare?
> 
> especially it's young and old?
> 
> i say our health care systems a shambles, a disgrace, a failure to all Americans _except_ that top echelon bleeding the life out of us



the "top echelon" is keeping it alive, it's all the rest of us who are bleeding the life out of it.  Ford motor company spends more on health care than it does on buying parts for its vehicles and we wonder why they scramble to leave our country and outsource.



> this part here Firetender, this is on mark here....
> 
> corporatism is the disease of unbridled capatalism firetender.  we actually have the Lamborghini or health care systems, but everyone i know drives a Chevy....
> 
> ...



Corporatism is a good thing in my opinion.  Why?...because we control corporations by choosing to either spend money or not spend money on their products.  We give them their power and we can take it away if they don't cater to our needs.  Is the alternative socialism or god forbid communism, yes, and that is power we would have no control over.


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## Guardian (May 21, 2007)

By itself, holding someones hand can be a good thing.  The real issue here is the shocking number of adults who are stupid, immature, whinny babies who can't take care of themselves.  After working in ems, i have realized how many of these people there are and it scares me.  To me, its un-American and is a cancer to our society.  A "pt" asking me to hold their hand for some B.S. reason represents the epitome of this cancerous culture.  Why?...because it shows they are so used to relying on "authority" to comfort them, they have no shame when it comes to seeking it.  They expect it.  More and more are growing up in this culture and it's becoming the norm to many people.  They're like drug addicts who become dependent on our system.  They become nothing more than leeches and stop contributing.  They become a cancer and what do we do?  We offer to hold their hands and pamper them.  This is only making it worse.  I guess it's all a matter of perspective though...I work in a city with a huge dependency problem that some of you have never and will never see.  And what do some want to do to fix the problem?  Increase government handouts...this makes no sense to me.


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## BossyCow (May 22, 2007)

Guardian said:


> I do think there are times when people need to grow up and stop expecting us to give them the attention they never got from mommy and daddy.  I also think we should stop encouraging this behavior which is what we do every time we gratuitously hold their hands.




Gratuitously?  I've found that holding a pt's hand can lower their anxiety level considerably.  Which lowers h/r, b/p, slows respirations and generally calms the pt.  A calm pt is better able to give me an accurate report of symptoms, hx, and makes my job so much easier.

I think we become so familiar with the back of our rigs that we don't realize what a scary place it can be. We treat people, not body systems and need to look at relating to the person in the emergency as part of giving care.  

I don't see holding a patient's hand as an unreasonable demand of me, nor beneath my skill level.  I do not see a pt's need to connect with me as a human being as a weakness or an attempt to take something from me.  

In unfamiliar surroundings, a smile, a handshake, and a shared joke can go a long way towards making the experience a positive one, instead of one that makes the pt want to call the agency supervisor or your lawyer.


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## firetender (May 22, 2007)

*In Hawaii, we say "Mahalo!" for thank you*

Y'ever seen the movie Sullivan's Travels, Guardian, my Braddah?

It's older than you because it's older than me.

A top-notch Hollywood director of high-falutin' comedies wants to make a serious movie, so he becomes a Hobo and hits the rails. It's the Depression. At first, he's followed everywhere by an absurd entourage of publicists and accountants and barbers and the like, but one day, he gets smacked by a cop, looses his memory and, homeless, turns into one of "them." The movie comes full circle when, after regaining his "senses" he goes back to Hollywood, but it's to make lowbrow comedies for the people, because that's what they need and want. He knows this now, for he has become one of them.

The point is, the guy got smacked in the head, lost all sense of who he was -- and whom he THOUGHT he was – and, responding to the world he lived in now, moment to moment, became one of the rabble that he wouldn't have spit on before he got knocked on the noggin.

But he started as a storyteller and the stories he once told were of the world he knew, from the POV of his experience within that world. He was a man in control in that world. But then, something got switched -- in an instant -- and he ended up learning that given the proper circumstances, he could become that which he despised.

*Given the proper circumstances, he could become that which he despised. In an instant. Who amongst us has even seen that happen as much as you?*

Is it possible that you have NOT had the experience of saying to yourself, "Lord, if I had to put up with the same kinds of circumstances that guy had to, I'd (fill-in-the-blank) too!"?

With your time in the field, I can't imagine it. It doesn’t have to happen too often before you get the sense, “Yeah, maybe this is part of being human, we ARE shaped by our environment as much as we shape it.” 

I’ll add to this that had I been your partner through all the calls you ran, in all the areas you covered, during all the times you were called on to act, I’d probably be tossing down a beer with you and ranting and laughing about the dopey wimp who reached his snot-encrusted hand to me for reassurance.

By all means, be who you are and I cannot deny you the validity of your experience, but if you look back in detail on your medic experience you will invariably find (challenge me on this, please!) that incident by incident you began shellacking yourself with a thin coat to insulate yourself from the trauma of living in the world you’ve chosen to live in. Today, you have such a thick, accumulated coat built on you, you can hardly bend! 

You, yourself Guardian are a lesson in compassion in action for everyone on this site. Because there’s few Rookies out there who picture themselves as unfeeling and uncaring as you sometimes appear to be, and fewer still that believe that they’ll end up like you. Yet, everyone who responds to this thread fears that “There but for fortune…” they will become you, because they know you’re speaking the truth about the profession they’ve entered.

I was just going to write, “But they haven’t lost the fight!” 

How arrogant and judgmental of ME! Because when I read your thread I can see that you’re still in there, like the rest of us, struggling with knowing some of these *******s DO weasel their ways into your heart, sometimes, you do reach out to a patient, and sometimes you do shed a tear over someone else’s pain, no matter how trivial it seems.

Why else would you start this thread by boldly announcing, “No more hand-holding!” and then following it with “What do you think?” Could you not project that that was the burp that would start the avalanche? You knew damn well!

You want to examine yourself, and be affected by others, and especially by your peers who live in the same world you do (albeit, probably less extreme.). You have NOT made up your mind because you DID reach out. And, no, that does NOT make you a wimp!

I would encourage you to put as much energy into working through your challenges with heartlessness as you spend trying to justify your stance with those of us who haven’t sat beside you in your ambulances. And then...teach us.

I can’t emphasize enough that there’s absolutely nothing wrong with you. You are so honestly reflecting a stream that truly exists and something that really does live in each and every one of us. But the opposite lives inside each and every one of us as well. Neither can exist without the other. 

This struggle is part and parcel of the territory of being a human being who chooses to live on the line between life and death, and I thank you for bringing it up!

What if, in this thread, you shared with us a moment that flipped you toward that shellac bucket, but because you saw a smidgen of yourself in the patient or the circumstances, chose to put down the brush? How is it that you can teach us about your struggles in retaining your own humanity? 

I hate to burst your bubble in public, Guardian, but you have managed to accomplish this.


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## mfrjason (May 22, 2007)

I did it all the time when I was in the back of the ambulance with a patient,it makes them feel more comfortable,especially after a traumatic event (i.e.-auto accident). There is nothing wrong with holding a patient's hand.


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## firetender (May 22, 2007)

*…and on the Societal Front…*

Guardian suggests that it is the poor that are causing the problems for the rest of us, somehow moving difficulties up and up until the Government gets hobbled by them.

Very cool. That’s the first time I’ve heard the “Trickle-UP” theory! 

Actually, I’m lying, because I used to watch Archie Bunker on ALL IN THE FAMILY. 

The history of innovation, creation, conquest and progress in our world is quite the opposite. There are a privileged few, at the top of the proverbial food chain, who live in a world fueled by the illusion that they are insulated from the troubles or inconveniences of life. Illusion is the operative word, and who knows that better than us?

But in order to reinforce that illusion, in fact, to make it stronger, they employ any one they can, in any way that they can get away with, to take on the burdens of life so that they don’t have to. It’s really not a conspiracy or a 666 mark or anything ill-concieved, it’s part of the animal that lives inside the human. 

Near the bottom of the food chain are us. What do you think we’re doing? We’re holding the hands of the people they won’t touch because those hands are too dirty from the work that’s being done to keep the privileged few on top of the food chain!

_*Problems, especially economic problems, trickle DOWN, not UP! The problems of society -- the breakdown of family structure, the costly institutionalization of medicine, the widening gap between rich and poor and the squeezing of the middle class - have their deepest impact on the poor and are generated by the moves that the privileged few take to further insulate themselves from pain and suffering.*_ 

Somebody’s got to experience the pain, there is no Yin without Yang, Heads without Tails, Dark without Light! 

It is not the poor whose behavior determines the health of the greater society; it is the health of the greater society that determines the behavior of the poor. That behavior happens in the extremes because the culture of the poor consists of living a life responding to doors closing, whereas the upper economic levels' lives are geared toward the exploitation of the doors that are opening.

...as long as there's someone on a lower level acting as a doorstop.


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## Guardian (May 22, 2007)

firetender said:


> Problems, especially economic problems, trickle DOWN, not UP! The problems of society -- the breakdown of family structure, the costly institutionalization of medicine, the widening gap between rich and poor and the squeezing of the middle class - have their deepest impact on the poor and are generated by the moves that the privileged few take to further insulate themselves from pain and suffering.




Can you expound this with some examples of how the rich elite are breaking family structure, institutionalizing medicine, etc.  I am genuinely curious how you came to this conclusion.

At the turn of the century, our standard of living went way up because of industrialization.  Our middle class exploded because of industrialization.  But now, big business (rich elite) are being blamed for the above social problems.  Why?  Wouldn't the rich elite stand to make more money from a stronger middle class?  Right now the rich elite are paying for the healthcare of the lower class.  Why would they want to do this?

As far as my humanity is concerned, it's really easy to make me out to be a heartless monster.  But am I really?  I want these people to be independent.  Feeding their dependency is not going to help them, it we only hurt them.  Maybe the hand holders of the world are creating this dependency.


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## BossyCow (May 23, 2007)

Guardian said:


> Feeding their dependency is not going to help them, it we only hurt them.  Maybe the hand holders of the world are creating this dependency.



There is a huge difference between 'feeding their dependency' and acknowledging that we are all humans together.  How is the simple act of holding someone's hand 'feeding their dependency'?  Allowing the pt to see us as human beings capable of compassion doesn't mean they have manipulated us into being their emotional IV's.  

We've all had the emotional black holes as patients, but this is not a valid reason in my perspective to withold all contact with all other pt's wanting some reassurance


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## mfrjason (May 24, 2007)

I was on this one call where this lady was involved in a PI and since there was 3 of us on the call I sat in back and held her hand all the way to the hospital just cuz it was the right thing to do,she was severly freaked out about what had happened that I think it made her feel better to hold onto my hand while my partner was treating her. We had her as a patient again a few days later cuz she had taken too much of her meds,she lived thank god.


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## firetender (May 25, 2007)

Guardian said:


> Can you expound this with some examples of how the rich elite are breaking family structure, institutionalizing medicine, etc. I am genuinely curious how you came to this conclusion.
> 
> ....
> 
> As far as my humanity is concerned, it's really easy to make me out to be a heartless monster. But am I really? I want these people to be independent. Feeding their dependency is not going to help them, it we only hurt them. Maybe the hand holders of the world are creating this dependency.


 
#1 I'm speaking in terms of overall flow pointing to the direction rather than the specifics. I'm mostly off-line for a week, but will see if I can illustrate this better. AND, it's not my desire to get in political debate, just supply food for thought...take as you will!

#2  Making you out to be a heartless monster is as counterproductive as writing anyone else off about anything. Face the real Guardian, I say, and you'll find lots of heart!


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