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.
Holding someones hand
- Thread starter Guardian
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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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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."
Ridryder911
EMS Guru
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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
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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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.
You all made good points.
Rid - I can't wait to see pre-hospital care turn into that. I know it is coming, eventually.
rescuecpt
Community Leader Emeritus
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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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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.
rescuecpt
Community Leader Emeritus
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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.
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.
rescuecpt
Community Leader Emeritus
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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?
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.
this thread has evolved and you have some reading to catch up on but look at post #66 for a quick reference.
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.
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.
firetender
Community Leader Emeritus
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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,
Stevo
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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~
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~
Easy
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Hold hands. It works. Keep them calm and comfortable.
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
Forum Asst. Chief
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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....
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~
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....
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~
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."
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."
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.