# Your system's "occupational health"?



## OnceAnEMT (Oct 1, 2014)

I am curious to hear about what the process is for your individual systems in managing an on-duty injury. For instance, you sustain a hand injury during an MVC extrication. Assuming the system will care for you, what is the process of obtaining evaluation, treatment, and rehabilitation? Are you sent to the ED? Are you referred to the system's medical director? Is there a mid-level or other healthcare professional that provides an initial evaluation? Is rehabilitation handled by in-house therapists, or is it billed out?

As an athletic training student I am looking ahead at future careers, and have started to deviate from the classic high school or college AT positions and more towards working in the ED or with EMS/Fire directly. Specifically, one of my ideas is to operate under the medical director as sort of a "middle man" between the initial injury and the potential for a full ED work up. I have not heard much of such a position, but I believe that it would save money for the employee and the employer, in addition to keeping everything simpler by remaining in-house. With EBP the way it is today in sports medicine, special tests and palpations are allowing for greater true positive results, and thus less reliance on expensive imagery, let alone a visit to the ED as a whole. An AT (or similar profession) could cut down on referrals, provide in-house legitimate treatment (even at the station), provide a rehab program, all while saving money and time, In-House CHP. 

Does anyone have any insight on their system's management of on-duty injuries, or of the position I am describing? I am holding off on contacting system administrators directly as I am still 2 years away from licensure as an AT, but once that time nears and the job search begins I hope to get my ducks in a row and attempt to create such a position within a city's EMS system. 

Thanks for any input!


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## Underoath87 (Oct 19, 2014)

I've never heard of any such thing.  Pretty sure most agencies will just place you on disability and have you seek treatment through traditional channels.


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## NomadicMedic (Oct 19, 2014)

My last system had an extensive OcHealth policy. Work injuries were well documented and initial evaluation at the local ed or occupational health clinic through follow up and, if needed, PT was covered by the department. Also part of the infection control plan for the department.


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## Anjel (Oct 19, 2014)

I have recently become very familiar with our on the job injury procedure.

On Monday at 2000 I totaled an ambulance. Hurt my partners and my back. Since it was after hours we were taken to the designated hospital and the supervisor met us there. 

After discharge I was given appointment with the Occ Health clinic for the next day. I was evaluated by a PA and kept off work till I go back tomorrow. 

The company pays for everything until I am off work for 8 days. It then gets turned into workman's comp. 

That's generally how things work around here. A designated hospital for after hours and then the clinic for follow up.


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## Chimpie (Oct 19, 2014)

@Anjel Just out of curiosity, were you drug tested at the hospital?


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## Anjel (Oct 19, 2014)

Chimpie said:


> @Anjel Just out of curiosity, were you drug tested at the hospital?



No but I was at the Clinic.

The other company I work for wont do drug testing. Because if the driver tests positive the insurance company won't pay for the damages. That's what I was told anyway.


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## OnceAnEMT (Oct 20, 2014)

Anjel said:


> No but I was at the Clinic.
> 
> The other company I work for wont do drug testing. Because if the driver tests positive the insurance company won't pay for the damages. That's what I was told anyway.



That is a disgusting loophole.

At my hospital they seem to want to drug test even before an evaluation. Can't blame them I suppose.

Thank you all for the replies, I hope to get some more. It seems that initial evaluation and treatment is planned, but there is no in-house rehabilitation and/or minimal prevention education.


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## NomadicMedic (Oct 20, 2014)

SCEMS has a contract with a PT group and have a physical therapist available once a week for anyone who wants/needs one. They also do frequent fitness/injury prevention training   (which nobody cares about)


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## OnceAnEMT (Oct 20, 2014)

DEmedic said:


> SCEMS has a contract with a PT group and have a physical therapist available once a week for anyone who wants/needs one. They also do frequent fitness/injury prevention training   (which nobody cares about)



This is kind of what I am talking about. What does the SC stand for? I'm seeing a few options come up on Google. Sizeable system? Wealthy area?


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## NomadicMedic (Oct 20, 2014)

Sussex County DE. About 90 medics. All ALS. NOT a particularly wealthy area. Mostly rural/ag.


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## chaz90 (Oct 20, 2014)

Grimes said:


> This is kind of what I am talking about. What does the SC stand for? I'm seeing a few options come up on Google. Sizeable system? Wealthy area?


Basically what DEmedic said. Not  wealthy overall, but there are some expensive areas near the beach. Mostly, it's an oddly progressive EMS service with some good ideas in an unanticipated locale.

Non transporting, all ALS service covering close to 1000 square miles and a year round population of ~200k. Summer has a huge surge.


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## OnceAnEMT (Oct 20, 2014)

Thank y'all for the info. Once that time comes I may ask them a few questions and see if I can't use your system as an example. Like I said, I get a feeling that this will be a position that will need a sturdy presentation.


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## NomadicMedic (Oct 21, 2014)

I would think that a PT/AT position for a department would simply be "additional duties". You'd probably be compensated, but I can't see a department adding a full-time athletic trainer/occupational health position when there are plenty of avenues to outsource that as needed.


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## DrParasite (Oct 21, 2014)

Anjel said:


> I have recently become very familiar with our on the job injury procedure.
> 
> On Monday at 2000 I totaled an ambulance. Hurt my partners and my back. Since it was after hours we were taken to the designated hospital and the supervisor met us there.
> 
> ...


That's pretty much how it was at my old service, with one annoying exception....

if you get hurt when Occupational health is open, go there, otherwise, go to the ER.  Once the ER finishes us, all your follow ups will be at occupational health.  If you need PT, they send you, but occupational health has to send you for everything.

As for the annoying thing, if you are out for less than 8 days on a work related injury, any time off is charged to your individual sick time.  more than 8 days is turned over to workman's comp, and IIRC, they cover the entire time out of work.  What makes it annoying is if you pull a muscle or strain something (back, ankle, shoulder, which are all too common), and you rest, recover, take your meds, and feel better after 5 days, you can come back early, and all that time off comes out of your earned sick time.  Really made me want to spend at least 8 days out of work for every on the job injury I sustained.... not that I would, but.....


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## OnceAnEMT (Oct 22, 2014)

DrParasite said:


> As for the annoying thing, if you are out for less than 8 days on a work related injury, any time off is charged to your individual sick time.  more than 8 days is turned over to workman's comp, and IIRC, they cover the entire time out of work.  What makes it annoying is if you pull a muscle or strain something (back, ankle, shoulder, which are all too common), and you rest, recover, take your meds, and feel better after 5 days, you can come back early, and all that time off comes out of your earned sick time.  Really made me want to spend at least 8 days out of work for every on the job injury I sustained.... not that I would, but.....



And that sir is what I am trying to effect. No matter which way it is spun, somebody (really both parties) are losing money, be it directly or through productivity statistics. Not to mention man hours and even stress/mental health accompanying injury. I want to take the athletic training approach to medicine and apply it to the world of First Responders. For example, when my athletes are injured, it is a chronic or an acute injury. If it is chronic, they almost always still play, though with the additions of treatment, rehab, and possibly the use of taping or bracing techniques during or out of activity. They will be out for over a week or not out at all. "Rest" to an athlete is a relative term, and unless it is an extreme chronic injury or a severe acute injury (anything from grade 3 sprains and strains, fractures, dislocations, brain-related trauma, etc.), that athlete will still participate. 

I believe that through e-mail, phone, and personal contact at the station, an AT would have the ability to commit themselves to a system just as they would a sports team in order to offer everything from prevention workshops/information to post-evaluation, personalized treatment and rehabilitation. Dedication on the patient's part (in this case, first responders) to getting back to pain-free and full strength function when participating in treatment and rehab often allows them to continue to participate through the injury. At minimum, this effectively turns that 5-7 days off work (that turn into no pay or sick pay) into normal paid hours, while the system still receives normal productivity (not paying for a sick provider and their substitute). 

To give some examples of success, the military has somewhat recently started contracting and even employing ATs for their services during IET/BCT. Whenever a soldier is injured during training, they often end up washing out due to a non-sports-minded HCP's "6 months of full rest" (fine, that's extreme, but you hear me). ATs were brought it and turned the retention numbers around when they began providing an opportunity for treatment and rehabilitation of injured soldiers, effectively returning them back to full participation. Saves the soldiers money, saves Uncle Sam money.

As well, though this is more specific, I have a colleague who works at a Toyota plant here in Texas as an AT providing occupational health services. He has saved the company and employees costs and time by providing treatment and rehabilitative services to employees who work on the floor doing the same repetitive motions after car/car parts are swung by at a constant speed. 

Thoughts on this concept? Suggestions on approach? Thanks again for the replies.


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