Anyone been running into this lately?

[Sasha]

What if your pt is MRSA positive?

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

 

[JPINFV]

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

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

 

[Sasha]

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

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

 

[Veneficus]

Oh no not something very bad.

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

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

Not that I have seen.

 

[CAOX3]

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

Do you gown up on every 911 call?

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

 

[BossyCow]

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

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

 

[Sasha]

Do you gown up on every 911 call?
.

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

 

[JPINFV]

Do you gown up on every 911 call?

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

 

[CAOX3]

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

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

If I did this is how I would handle it.

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

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

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

 

[PapaBear434]

Not that I have seen.

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

 

[Veneficus]

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

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

 

[PapaBear434]

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

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

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

 

[Veneficus]

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

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

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

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

Any solutions?

 

[CAOX3]

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

 

[Outbac1]

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

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

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

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

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

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

 

[PapaBear434]

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

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

Any solutions?

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

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

 

[Veneficus]

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

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

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

 

[amberdt03]

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

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

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

 

[medic417]

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

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

 

[amberdt03]

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

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