Is It Time?

[MackTheKnife]

Going back a few fears, so to speak, our EMS was under the Dept of General Services (Norfolk, VA). Our ambulances were in firehouses with the exception of one at a hospital. FF response were for unconscious calls or Code Reds. There was some animosity between us. A large portion of the griping was the fact that Fire didn't "own" EMS and we weren't unionized. There was an attitude as well that we should just strap the patient on the guerney and transport so Fire could get back to the house and work on lunch, watch the Playboy channel, etc. Not all of FF held these attitudes. After awhile FF and EMS merged. The good thing was the new advancement opportunities. Previously, there were none. We had four supervisors and three command personnel who were in their jobs until they died or retired. What's ironic is that in VA we had five levels of EMTs and for a long time none of the supervisors could pass the boards for paramedic. So you had lesser qualified people in charge. And after the sup' s were given a deadline to get qualified as PMs, or get demoted, two never made it while I was there. And you could be paid as an EMT even if you were a PM or Cardiac-EMT. The merge with the FF eliminated most of this. I'm not saying everything was peaches and cream, but there were positive aspects. Some PMs went to the dark side and became captains in charge of a house. I think EMS should be separate, but I don't think it'll ever go back. Then again, I have been out of the game for quite awhile, so I'm not up with the current state of affairs. And BTW, our EMS HMFIC, eventually became the Fire Chief.

 

[vcuemt]

I haven't thought this out properly and just came up with it for this thread, so bear with me. But how about we drop the E from EMS? The vast majority of what I do (I can't speak for anyone else) has nothing to do with an emergency. It's running the elderly to the hospital for a chronic problem, or transporting someone who could have easily POV'd to the hospital. Actual medical emergencies constitute a tiny percentage of the calls that we go on in the county I run in.

If we became Medical Services instead of EMERGENCY Medical Services, I think it would raise the level of respect given to us. But this would have to go hand-in-hand with everyone running on an ambulance being given the level of training needed to actually deal with medical problems. We wouldn't be taxi drivers, we'd be practitioners. I know there's a movement towards home health care provided by medics, but we'd extend the scope of practice of everyone, including basics, so that common medical problems - the kind of stuff that keeps 911 in business - can be handled by a skilled medical crew who are, handily enough, driving around in a mobile medical unit.

Given the ACA's reliance on cost-cutting measures, including preventative medicine and keeping folks out of the emergency room, I think the arc of medicine bends towards medical practitioners with less training than doctors but more than the current basic fresh out of high school will have being the primary care providers for many people.

Perhaps you'd even let fire handle the trueblue medical emergencies and ambulances would become mobile care units (like we already are, in practice, but with a vastly expanded scope).

Again, this is entirely off the cuff and we'd need a better acronym than MS (that one's taken), but it's an idea I had.

 

[Drax]

Deleted.

 

[Angel]

JPINFV, I think youre reaching and should perhaps change your name to contrarian. but i want to stick to the topic at hand.

i agree with sandpit in that fire should probably be relegated to code 3 dispatches only (cardiac arrests, lift assists ect) where they can be useful. Otherwise we can call them if we need them. too many medics on an ALS engine leads to skill dilution, we know this. like sandpit said, literally on EVERY call during my internship an engine, or tiller responded. they mostly just stood there and maybe took vitals while the captain gathered basic patient information. nice to have, but not necessary.

i agree about Paramedicine needing to be ATLEAST an AA degree. lots of people love to whine about this but its not that hard! my program was something like 40 units, add in some basic math, english, social sciences, and BAM degree. if you cant muster through that, do I really want you taking care of my sick love one? (no)

ideally higher education=higher wages, like RNs and RRTs.

but like was said, itll be hard if not impossible to get EMS away from fire. Ill try to find the article but the community medicine program in Corpus Cristi Texas was pretty much shut down because fire (their union) said NO. its taking away jobs from their firefighters and they couldn't have that!

meanwhile they get paid 80K a year (or more) to run maybe 1 true structure fire a month. the rest of the time spent at the station is spent, napping, working out, cooking or watching TV.

this post is all over the place but something has to change.

http://www.kristv.com/news/union-grievance-forces-city-to-decline-grant-program/

"The 3-year $860,000 grant would have funded the hiring of four people, made up of two nurses and two paramedics, but the paramedics were not going to be Corpus Christi Fire Department paramedics, and the Corpus Christi Firefighters Association believe using non-association paramedics violates its agreement with the City."

 

[jrm818]

JPINFV, I think youre reaching and should perhaps change your name to contrarian. but i want to stick to the topic at hand.

I guess I'm another contrarian - JPINFV just beat me to it.

Though you may not like dealing with patients with mental illness, much of the value of the EMS system lies in the fact that it serves all who call for help. If they're not a) on fire b) needing a jail cell for the night or c) already dead, EMS is the "department" of 911 that is responsible for dealing with the problem.

This is not the EMS of the 60s and 70s...highway trauma is no longer the focus of the system.

Yes mental illness can be frustrating, no many of the problems can't be fixed acutely (although some certainly can be improved), and no you didn't get enough training in emergency psych. That doesn't make the back of a police car (with hard edges, hard restraints, no attendant immediately available, no room to work, and no way to resuscitate someone) the right place for somebody in crisis.

 

[SandpitMedic]

Dr. House... AKA medical resident JPINFV. I am going to address the points you made. You undoubtedly will have another off the wall rebuttal, and I will undoubtedly defend my passionate views. In the spirit of keeping the general topic as opposed to the specificity of this particular issue, I beg your leave.

You and I will clearly not agree, and we clearly come from different systems and have different outlooks on life in general, given your exuberant compassion and dare to dream that a homeless regular may one day be suffering a tragic frontal lobe tumor or that it may not be his chronic alcoholism which I have witnessed for years after extending a helping hand and watching him waste away due to his inability to make decent choices and exert personal responsibility. No, I should assume he is altered not because of the empty Steel Reserve/Bud Ice/211 tall cans next to him. I should assume his sodium levels are dangerously low, or perhaps he is having a CVA/TIA... I mean... After all, his speech is slurred and his gait unsteady. Maybe a it's an acute anticholinergic syndrome, I mean it is hot as hell out side, but this guy is certainly blind as a bat, red as a beet, hot as a hare, dry as a bone, dang it he's as mad as a hatter... Tachy too... Dysrhythmia alert?!?! Better do a 12 lead too!

While you may take that approach, your position may allow you to. Unfortunately.... I say again.... UNFORTUNATELY, that just is not the way it works in most urban centers. I have worked EMS in 3, each one similar in essence. If I came at everyone like they were dying not only would I look like a fool, but I would crash my career into smithereens faster than a speeding bullet.

You must look at the whole picture... The whole picture. Is it easy to dismiss that guy? Certainly is. Perhaps he should have not have cried wolf 365 times last year, and more of us would take his precarious situation more seriously. That's the system I work in. I can encounter a drunk in the morning, haul him in to the ER where he can sleep it off. And then low and behold get called out again to the same guy, behind the convenience store drunk as a skunk again in the afternoon, and haul him back. (They all have Medicaid too, but I'll get to that later.) "Psych" patients too.

That said, before you accuse me of lacking compassion and caring for those I am supposed to help.... I can do a thorough assessment on everyone if I deemed it appropriate. I can also use my common sense and critical thinking skills to guide me. And one more thing before you say one day someone is going to die due to my cavalier attitude; everything I do while on the clock for my patients, is in their best interests. Do what is in you patients best interests at the time, and you'll never go wrong, and never question your morals.

Educating the public is also part of my job. Therefore, I don't see a problem with advising someone of alternatives to transport in my emergency service vehicle. The mantra that "you called 911 so it must be an emergency" is out dated.

Early on while posting I said..... This is the way my system works. This is what I think would better EMS, in my area. If you want to play Doctor House then... Go ahead. We're all going to be laughing at you behind your back.

Is it too much to train EMS to do this? Heck, being able to deescalate is useful for non-psych patients who may be uppity.

No, it is not too much to train us better. We have "a lot of holes" in our education as you put already though, so....
Also be sure you incorporate some self defense training and maybe an arm bar or take down techniques.

Point being: police are better suited to handle that. In a manner least likely to cause undue injury to themselves or to the patient.

Which is safer... chemical restraints or physical restraints?

Physical. By far. The way it has for centuries. Why risk getting a dirty needle stick or infecting a patient by breaking the skin when you don't need to. For that matter why inject a medication into a person who is so out of wack that they can't tell you if they are allergic to it. What if they go into anaphylaxis?

Point being: less invasive to most invasive. Is it prudent at times? Absolutely, and it is for those "true" psych emergencies.

...and it's relatively stupid that EMS can't make a medico-legal decision. (side note: In California, physicians can write the same hold and individuals designated by the county health department can also write holds... i.e. RNs on psychiatric evaluation teams).

Irrelevant. Those folks aren't responding lights and sirens to everyone who is feeling sad or depressed today. Perhaps they should.. ::lightbulb:: Excellent suggestion Dr! Why, that might get us to meet in the middle and satisfy us both.

...yet all of them are going to be evaluated by a psychiatrist...

Not true. Some, a "mental health tech" or simply an ER doctor who will assess as I have and likely come to the same conclusions. Maybe run a test, for liability's sake. Don't worry, it won't cost the patient a thing.

So your system's dispatch protocols suck. That doesn't change the fact that it's a medical problem, not a law enforcement problem.

Already addressed. I'm taking about a growing subvert of patients... That are not EMS requiring patients either. They need policing, not a babysitter or a free meal.
Et. Al. As I've been saying includes the cited examples and other similar manner of nonsense.

By "this person" do you mean acute psych breaks or people playing the system?

If I use the term person instead of the term patient in this discussion in this context, I am referring to a person who is not a patient or should not be a patient in the traditional sense.

What does your opinion "as a tax payer" have to do with this? Do you think that emergency medical care should be provided based off of insurance or presumed value?

My opinion as a tax payer is relevant. And you are using the term "emergency" very loosely again. While I agree that care should not be refused based on ability to pay... EMTALA... And that's my limit. Stabilizing care. Therefore, if already stable... Sorry.

Where I disagree is this for example, a call I had the other day. Called out for a Delta Chest Pain/SOB. AOS to a residential neighborhood on a clear warm day. Two females are standing outside in the roadway in front of the address I was dispatched to chatting it up with the 4 firefighters in front of the engine. There is an SUV parked a few feet in front of it. We pull up along the curb in front of the SUV. As I get out an walk towards the scene one of the females approaches, "That's my cousin over there, she needs the help." Initially I had seen that these two are in no apparent distress, without grimace or guarding, ambulatory without difficulty, appearing to be under no duress with ABC's intact. The first female says "I'm going to follow you to the emergency room." I acknowledge and continue to the "patient." Fire says all V/S stable WNL, c/o abd pain, we're out of here, and have a good day fellas. I instruct the patient to walk with me; she does so without difficulty and without appearing in pain/distress.{everything between the stars can be skipped unless you want to see exactly how I arrived at my conclusion that this person is not having a true emergency and is a waste of time, resources, money, and oxygen}

********As I assess and gather history this patient tells me she has had ongoing (chronic) GI issues for about 3 years including Chrohns, UTIs, cholecystectomy, appendectomy, uterine fibroids. Some of which she has been seen for in the Emergency Room more than 10+ times since the beginning of this year. She states she is "tired of those doctors not knowing whats wrong with me." Her most recent issue has been a bout of Giardia. She was seen in the emergency room 6 days ago, diagnosed, and prescribed a 5 day Z pack (antibiotics.) Today is the 4th day of her regiment, her cramping has not subsided, and therefore she would like to go to the ER. Pain is as it has been the last time: cramping in the lower quadrants, 10/10 (clearly, as she is texting her friends and fidgeting through her purse on the way in) non radiating, increasing on exertion or palp. She is physically unremarkable. Abd is soft/nondistended, bowel sounds normal (yes I actually listened.) No difficulty with voiding and bowels PRN. Diahrrea of course as you'd expect with Giardia. No other complaints whatsoever including pertinent negatives that I'm not listing. Diet: soda and fried foods/fast food, and some social ETOH recently. ******

The patient requests to go to a hospital that is pretty far away, about half way across town. Noting also that we would be passing 4 other closer ERs, the closest about a mile away. She is adamant about it, even as I suggest the closer hospitals. We can't refuse, so okay... I also ask "why can't your cousin take you." Her reply, "oh I'm going to the emergency room; I need the ambulance." I tell her there is a fair chance she is going to have to wait in the lobby regardless, and that I can't do little more for her other than sit next to her on the way in. She replies, "that's fine, but I need the ambulance, I have insurance." I ask for her ID & insurance card. She proceeds to hand me her out of state drivers license and her State of Nevada Medicaid card. (We're in Nevada) and her cousin followed closely, all the way to the ER as I monitored her V/S Q15 without any abnormalities or deviations.............

And with that you and I, along with everyone reading this were forced to pay for this unnecessary transport and subsequent ER evaluation. So yes sir, I should be allowed to say no. No I am not taking to the ER AGAIN. Finish up your antibiotics as previously instructed, and follow up with a primary care physician. If you have new symptoms manifest or your current symptoms progress or worsen, I will take you the NEAREST capable facility. Period. I should not have to acquiesce to her requests and sit there with a smile on my face with the "that's what I'm here for" mantra when I am paying for this and am being taken out of service when I could be actually helping someone else. No Dr. No!
Take note that I said I could be actually helping someone else; I did not say running an "OMG STEMI" or "OMG TRAUMA."

How do you think I feel about my taxes paying for her ride? And the 10,000 others with the same nonemergent needs that will do the exact same thing today accross the country with govt assistance. Can you surmise my attitude? I'm a tax payer too. And that person need to start taking better care of themselves.

You actually just judged your patients a few paragraphs up...

We all do. It's called a scene size up and general impression. Use it in your "whole picture" assessment as I stated above.

Are every patient who calls 911 having a real emergency? No.

We agree!?!?! It's a cold day in ......

Are the etiology of every patient always obvious? No. It's relatively easy to dismiss the obvious meth psychosis until you get the elevated T4 indicating that the psychosis could easily be thyrotoxicosis. It's relatively easy to dismiss the patient with chronic schizophrenia... and then realize that his old records shows 2 large meningiomas putting mass effect on the frontal lobes that the patient was refusing surgery for the year before.

You're all hung ho! What you're suggesting is like the police showing up in full SWAT gear to every petty noise compliant and pointing guns at everyone in the area.
Thoroughly addressed above in the first few paragraphs. If you want to be Dr. House and treat everyone as a medical mystery then go for it. 99.9% you'll be overdoing it though. In addition, the guy with the frontal lobe tumors; someone on scene should be able to indicate some suspicion of that, or perhaps through the investigative techniques of LEOs and medical providers perhaps a medical pendant or other indicator. Like a business card in his wallet for the brain cancer treatment center up the road. Without everyone assuming he's actually having that issue. Also, at psych intake facilities they should have a doctor there and the capabilities to do a few basic labs and procedures.... To find that and refer them to more appropriate care (calling 911 or transporting to ER, etc.)

You say that you're not a psychiatrist, yet you're in a field that, by it's very nature, involves dealing with emergencies in all fields... including psychiatry. You can't pick and choose which fields you want to treat emergencies from.

Again, I addressed this in the first few paragraphs of this reply. A true psych emergency is an emergency. We should do our jobs. Although, you're looking at a very low percentile of patients who are actually having a treatable acute psych episode with a medical cause.

Except FF isn't medicine. Psychiatry is medicine. Some psychiatry is emergency medicine.

Yes, the few I have conceited and offer solutions for or agreed that it is in the EMS realm.
On that note. Are there podiatrists in the ER? Are there Dermatologists in the ER? Podiatry and dermatology are medicine; some are emergency medicine.
I'm tired of typing and beating this dead horse.

 

[JPINFV]

You and I will clearly not agree, and we clearly come from different systems and have different outlooks on life in general, given your exuberant compassion and dare to dream that a homeless regular may one day be suffering a tragic frontal lobe tumor or that it may not be his chronic alcoholism which I have witnessed for years after extending a helping hand and watching him waste away due to his inability to make decent choices and exert personal responsibility. No, I should assume he is altered not because of the empty Steel Reserve/Bud Ice/211 tall cans next to him. I should assume his sodium levels are dangerously low, or perhaps he is having a CVA/TIA... I mean... After all, his speech is slurred and his gait unsteady. Maybe a it's an acute anticholinergic syndrome, I mean it is hot as hell out side, but this guy is certainly blind as a bat, red as a beet, hot as a hare, dry as a bone, dang it he's as mad as a hatter... Tachy too... Dysrhythmia alert?!?! Better do a 12 lead too!

Of course the drunk dude with unilateral deficits is going to get his head irradiated.

Also, when I talk about the schizo with the menigioma and mass effect, it wasn't a hypothetical situation (neither was the meth psychosis with thyrotoxicosis). Those were actual patients of mine while in med school. It isn't touchy feely when you suddenly have those patients.

Similarly, your likely EtOH with dehydration patient? What if you get your liter or 3 in and he's still tachying away? Oh, wait, I bet you're going to get that 12 lead now, right?

While you may take that approach, your position may allow you to. Unfortunately.... I say again.... UNFORTUNATELY, that just is not the way it works in most urban centers. I have worked EMS in 3, each one similar in essence. If I came at everyone like they were dying not only would I look like a fool, but I would crash my career into smithereens faster than a speeding bullet.

You must look at the whole picture... The whole picture. Is it easy to dismiss that guy? Certainly is. Perhaps he should have not have cried wolf 365 times last year, and more of us would take his precarious situation more seriously. That's the system I work in. I can encounter a drunk in the morning, haul him in to the ER where he can sleep it off. And then low and behold get called out again to the same guy, behind the convenience store drunk as a skunk again in the afternoon, and haul him back. (They all have Medicaid too, but I'll get to that later.) "Psych" patients too.

I'll definitely grant that my position may be colored by the fact that the county hospital where I did most of my medical school rotations and am now doing residency has both a high census and high pathology. When you're at a hospital where patients on med/surg would be in the ICU at any community hospital and you've seen multiple patients with diseases best described as extremely rare (seriously... the hospital gets multiple Fournier gangrene patients every year), it becomes a bit harder to justify not at least entertaining more severe, yet rarer, differentials. I get that hoof beats equal horses, not zebras, but I've seen enough zebras in my short career that I know that they exist, and the last thing you want to do is miss a zebra.

That said, before you accuse me of lacking compassion and caring for those I am supposed to help.... I can do a thorough assessment on everyone if I deemed it appropriate. I can also use my common sense and critical thinking skills to guide me. And one more thing before you say one day someone is going to die due to my cavalier attitude; everything I do while on the clock for my patients, is in their best interests. Do what is in you patients best interests at the time, and you'll never go wrong, and never question your morals.

Don't look at me for pointing out that you basically said anyone on public assistance shouldn't call 911.

Educating the public is also part of my job. Therefore, I don't see a problem with advising someone of alternatives to transport in my emergency service vehicle. The mantra that "you called 911 so it must be an emergency" is out dated.

Are there alternatives? Sure. I have no problem with not everyone receiving a fire engine (actually I think that fire engines shouldn't be responding at all to pure EMS calls). I have no problem with not everyone receiving a code 3 response. I have no problem with patients being diverted from EDs following an appropriate evaluation. I'm also not going to shame a patient for calling 911 because their child swallowed a silicon gel packet or their loved one is altered (even if he has a history of pseudoseizures). It's a lot easier to tell what is and isn't an emergency when you're educated in emergency medicine.

Early on while posting I said..... This is the way my system works. This is what I think would better EMS, in my area. If you want to play Doctor House then... Go ahead. We're all going to be laughing at you behind your back.

Don't worry, when you bring in the "obvious drunk" and miss the 13 findings that leads suspicion to not drunk (or drunk + ____), we won't be laughing.

No, it is not too much to train us better. We have "a lot of holes" in our education as you put already though, so....
Also be sure you incorporate some self defense training and maybe an arm bar or take down techniques.

Point being: police are better suited to handle that. In a manner least likely to cause undue injury to themselves or to the patient.

1. So... fix the education.
2. Restraints are, in the end, a medical intervention. There's a reason why restraints placed in the hospital requires a license physician, even if the restraints are being placed by security.

Physical. By far. The way it has for centuries. Why risk getting a dirty needle stick or infecting a patient by breaking the skin when you don't need to. For that matter why inject a medication into a person who is so out of wack that they can't tell you if they are allergic to it. What if they go into anaphylaxis?

Wait... so people strugling against hard restraints aren't at risk for skin damage? People bashing their head against windows and cages (police cars aren't padded, gurneys are) is safe? ...and people get medications all the time who are altered and can't say their whether they're allergic to it or not. The fact is that violent patients are brought into emergency departments and psychiatric hospitals everyday who end up getting a needle with sleepy juice because it's safer for both them and the providers.

If we're talking about non-violent psych patients... well, why are they in restraints anyways, regardless of legal status.

Irrelevant. Those folks aren't responding lights and sirens to everyone who is feeling sad or depressed today. Perhaps they should.. ::lightbulb:: Excellent suggestion Dr! Why, that might get us to meet in the middle and satisfy us both.

Or perhaps EMS shouldn't be responding lights and sirens to every call.

Not true. Some, a "mental health tech" or simply an ER doctor who will assess as I have and likely come to the same conclusions. Maybe run a test, for liability's sake. Don't worry, it won't cost the patient a thing.

I don't know a single system that allows mental health techs to break holds, and I don't know a single emergency physician who will break anything but the most egregiously stupid hold.

My opinion as a tax payer is relevant. And you are using the term "emergency" very loosely again. While I agree that care should not be refused based on ability to pay... EMTALA... And that's my limit. Stabilizing care. Therefore, if already stable... Sorry.

Should society decide that some antibiotics are too expensive? Chemo is too expensive?

[patient who could have drove themselves]

...and I have to balance that with the patient I had today who has mental issues possibly secondary to alcohol abuse whose mother took her from a board and care (group home) to the hospital because she wasn't acting normal. Her BGL was 36 (mumble mumble... friggin PMD and polypharm). So while there are plenty of stories that are essentially, "WTF are you doing, drive your own damn butt to the hospital," there are plenty of the opposite of "WTF are you doing... call 911 next time."

And with that you and I, along with everyone reading this were forced to pay for this unnecessary transport and subsequent ER evaluation. So yes sir, I should be allowed to say no. No I am not taking to the ER AGAIN. Finish up your antibiotics as previously instructed, and follow up with a primary care physician. If you have new symptoms manifest or your current symptoms progress or worsen, I will take you the NEAREST capable facility. Period. I should not have to acquiesce to her requests and sit there with a smile on my face with the "that's what I'm here for" mantra when I am paying for this and am being taken out of service when I could be actually helping someone else. No Dr. No!

I'll agree that paramedics can say no when they can predict hospital admission and ICU vs med-surg at a greater rate than essentially a coin flip. When the positive predictive value of admission is only 59% and ICU is 50%, that's a pretty big sign that no... paramedics shouldn't be determining transport decisions.
http://www.ncbi.nlm.nih.gov/pubmed/16798145

Yes, the few I have conceited and offer solutions for or agreed that it is in the EMS realm.
On that note. Are there podiatrists in the ER? Are there Dermatologists in the ER? Podiatry and dermatology are medicine; some are emergency medicine.
I'm tired of typing and beating this dead horse.

Yet the ED will treat foot emergencies and dermatological emergencies. Ever see Steven-Johnson syndrome?

 

[Angel]

Can we get back on topic? I feel like we're just feeding a troll :wacko:

 

[JPINFV]

Can we get back on topic? I feel like we're just feeding a troll :wacko:

In other words, "Good sir, I strongly disagree with your stated position, therefore you must be trolling because no one can underestimate how awesome I am."

 

[epipusher]

Based on what ive just read it appears to me that you are absolutely judging your patients. Beyond your 'general impression. ' Regardless if this is the first time they have called 911 or the 361st, in their eyes what they are feeling or seeing may be a true medical emergency. It would have been interesting to be a fly on the wall in your rig when you are `educating´ your patient about her antibiotic use.

 

[SandpitMedic]

When I say vital signs WNL.... I include pupillary response and BGL and 3L EKG and CSM and SpO2. So there goes half of your zebra hunt.

You're a troll because you are not in EMS. You are not a Paramedic. I am now questioning your credentials. Have you been a certified EMT or EMT-I or EMT-P? If so, how many years experience do you have in a patient care position. If so, where? What city? And where is your hospital? We all know where I am, so tell me where this mythical town is where everyone has a rare disease and not enough ICU beds. If you were, how long have you been "out of the game?" (Off of the streets.)

Basically you are Med-Surg doctor (resident) and not a street medic. Street medicine is different than Med-Surg and ICU. And it's a whole lot different than the books teach.

Zebras?! Sounds like you're hunting unicorns.

Chemo and antibiotics are not EMERGENCIES that require an ambulance.

The guy bashing his head against the window in the cop car??? Yeah he sounds like he should be a candidate for an EMERGENCY ambulance also (sarcasm.) Perhaps once he splits his wig, sure. Find me a true blue incident where a person suffering a brain tumor was beat up by police for being violent, and then dies because he didn't receive medical treatment in a timely manner.

Public assistance is a necessity born with good intentions. Unfortunately, it has morphed into a free for all which allows people to disregard personal responsibility and self-reliance.

Ever seen Magic Johnson? If you had a billion dollars in your checking account you can practically cure yourself of AIDS. You're reaching, man. I am talking big picture. My clinical skills are on point, and I can tell what is sick and what is not sick. It is something we should all be able to do, regurgitated through years of time on the job and training. Will you miss a unicorn once or twice?.. Sure. I am not perfect, and neither are you Dr. House. None of us are. Guess who else misses unicorns? Everyone. Some people just are not going to make it. Not due to neglect, but just because we are all human, that's why medicine is a practice.


Oh, and fly on the wall guy... You already have been, because I just told you what it's like. I smile and say okay- as I suggest alternatives- and suck it up and do the job. I don't "shame" everyone who calls 911. I am a Darwin interventionist after all.

There are always the "one time I had this call where....." And there then 100 other calls between those calls.

As far as your post saying we better be greater than 50% etc.??? Are you suggesting we aren't good at what we do? Sounds like you should be out there with your retroviral kit and I-STATs and your iPad charting system so you can save everyone from the paramedics.

Like I said friend, we're on two different fields of understanding. So be it, keep up the good work. Maybe you can cure all these Ebola problems, I'll pay for your flight to Liberia. Hit me up whenever.

 

[SandpitMedic]

Anyone else feel free to chime in on how we can evolve?

Not particularly who should be handling recurrent psych patients and 911 abusers.

I'm a realist. Not in fantasy land, but if I'm out of line the mods can freely tell me to let it go.

 

[NomadicMedic]

Let it go.

 

[MrJones]

Can we get back on topic?

Yes, please. While the points raised in the discussion between SandPitMedic and JPINFV are interesting and worthy of discussion, they have evolved beyond the intent and scope of this thread. So as the initiator of this thread I'll ask that please, guys, "get a room" so to speak and let's get this thread back on track.

 

[vcuemt]

Anyone else feel free to chime in on how we can evolve?

Folks chimed in in between various walls of text, but they were drowned out.

 

[JPINFV]

You're a troll because you are not in EMS. You are not a Paramedic. I am now questioning your credentials. Have you been a certified EMT or EMT-I or EMT-P? If so, how many years experience do you have in a patient care position. If so, where? What city? And where is your hospital? We all know where I am, so tell me where this mythical town is where everyone has a rare disease and not enough ICU beds. If you were, how long have you been "out of the game?" (Off of the streets.)

First off, I find it hilarious how you seem to automatically judge me that because I'm now a physician I must have never been in EMS... nope, never... not even during undergrad (yea... sorry about that, but yep, I did spend time on the ambulance). While I'm not going to sit here and ID myself to some complete stranger, there's plenty of people on this board who work in So Cal and know which hospital I work at. It's one of the busiest hospitals in California (over 100k/year ED census) in one of the largest counties in the US. ...and yes, there have been patients on ventilators chilling in the ED for days because, hey, there's no room upstairs. Also, when your catchment area for higher level of care measured in square miles is in the 5 digit range, you tend to get a lot of things shipped in.

Basically you are Med-Surg doctor (resident) and not a street medic. Street medicine is different than Med-Surg and ICU. And it's a whole lot different than the books teach.

So... apparently you have no clue how residency works, do you.

Chemo and antibiotics are not EMERGENCIES that require an ambulance.

No, but they cost a hell of a lot more than you and your ambulance... but hey, bothering your sleep is really the problem, not the cost that irritate your tax payer senses.

The guy bashing his head against the window in the cop car??? Yeah he sounds like he should be a candidate for an EMERGENCY ambulance also (sarcasm.) Perhaps once he splits his wig, sure. Find me a true blue incident where a person suffering a brain tumor was beat up by police for being violent, and then dies because he didn't receive medical treatment in a timely manner.

No, he sounds like the perfect candidate for some chemical sedation... something police don't offer.

Also, can we go with police beat man with hypoglycemia? http://abcnews.go.com/blogs/headlin...n-diabetic-shock-and-nevada-city-pays-for-it/

Ever seen Magic Johnson? If you had a billion dollars in your checking account you can practically cure yourself of AIDS. You're reaching, man. I am talking big picture. My clinical skills are on point, and I can tell what is sick and what is not sick. It is something we should all be able to do, regurgitated through years of time on the job and training. Will you miss a unicorn once or twice?.. Sure. I am not perfect, and neither are you Dr. House. None of us are. Guess who else misses unicorns? Everyone. Some people just are not going to make it. Not due to neglect, but just because we are all human, that's why medicine is a practice.

A positive predictive value of 50% and 59% is hardly "missing once or twice." It's a coin flip, and the protocols are written for what the most brain dead paramedic can handle, not Sandpit Medic, Superstar. Regardless, when the PPV is that low, the problems are hardly limited to just the medics who have trouble picking their nose and breathing at the same time.

As far as your post saying we better be greater than 50% etc.??? Are you suggesting we aren't good at what we do? Sounds like you should be out there with your retroviral kit and I-STATs and your iPad charting system so you can save everyone from the paramedics.

If you're saying that EMS can start refusing transport to patients, you better be able to predict admissions better than a coin flip. If dispatch was allowed to refuse ambulance response and got it wrong almost half the time, you'd be talking about how wrong it was for dispatch to be refusing to dispatch ambulances.

 

[JPINFV]

Let it go.

I'm a little confused about your meme reference here... but ok...

 

[NomadicMedic]

I'm a realist. Not in fantasy land, but if I'm out of line the mods can freely tell me to let it go.

Just to clarify my "let it go" reference.

Now, let's go build a snowman.

 

[Chimpie]

Get back on topic or the thread will be closed.

Just as parents hope to give their children the best possible start in life before watching them take what they've learned and head out to make it on their own, is it time for EMS to thank Fire for getting us through our formative years and then take what we've learned and strike out on our own, so to speak?

Discuss.

 

[karaya]

I tried to read this whole thread, but I gave up. My head hurts. Next topic??