It's That Time, KCM1 Now Hiring

medichopeful

Flight nurse, ground paramedic
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Wow, you couldn't be more incorrect on this.. I have zero issues with people who are critical of my system. As I have and will continue to say, we are not perfect. But what is truly LAME is your incessant need to make negative statements with little to no bases. If you have a question, or are unsure about something ask! I have made it more then clear that I am happy to clarify anything to anyone to the best of my ability. But your disparaging comments are not only unwanted they are are unwarranted.

I'm legitimately curious. Can you walk me through how a call would go for a patient who broke their ankle, and is hemodynamically stable? I'm talking about just a brief overview, including treatment before medcon, talking to medcon, after medcon, etc.
 

EpiEMS

Forum Deputy Chief
3,469
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Can you walk me through how a call would go for a patient who broke their ankle, and is hemodynamically stable?

Based on what I've heard, they'd BLS that :p

But yeah, this is a valid question - medics are on scene, no BLS unit available, how do they handle this? Do they really have to call medical direction?
 

DrParasite

The fire extinguisher is not just for show
5,486
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Wow, you couldn't be more incorrect on this.. I have zero issues with people who are critical of my system. As I have and will continue to say, we are not perfect. But what is truly LAME is your incessant need to make negative statements with little to no bases.
IDK.... providing documentation from the website from the University of Washington's Department of Emergency Medicine that clearly provides information about Seattle/King County Paramedics from the doctor's point of view is a pretty strong support for a claim.....

It's like me saying Medic One paramedics have to call for everything; that's a baseless statement. But if I show the protocol from Medic one, or from their medical director's training program, which clearly say medics need to call a doc to give a drug, than it's not so baseless.

If anything, I think your response saying that his claim (which may or may not be true) is incorrect is pretty baseless..... Can you provide any support to your (currently) baseless claim, such as by posting a link of the MedicOne protocols that state when a paramedic is supposed to call the doc? something like this (http://www.emsonline.net/assets/EMTPatientCareProtocols2012.pdf), but preferably from the paramedic level and more recent than 2012
 
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FLMedic311

FLMedic311

Forum Lieutenant
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Well, that's from Medic One...what is the real standard?

That is from Seattle Medic One. If you don't understand the difference, there are plenty of other posts explaining this..

IDK.... providing documentation from the website from the University of Washington's Department of Emergency Medicine that clearly provides information about Seattle/King County Paramedics from the doctor's point of view is a pretty strong base.....

It's like me saying Medic One paramedics have to call for everything; that's a baseless statement. But if I show the protocol from Medic one, or from their medical director's training program, which clearly say medics need to call a doc to give a drug, than it's not so baseless.

If anything, I think your response saying that his claim (which may or may not be true) is incorrect is pretty baseless..... Can you provide any support to your (currently) baseless claim, such as by posting a link of the MedicOne protocols that state when a paramedic is supposed to call the doc? something like this (http://www.emsonline.net/assets/EMTPatientCareProtocols2012.pdf), but preferably from the paramedic level and more recent than 2012

No it is not. It is out of context.
I work here, I take time out of my personal life to try clarify what it means to be a part of this organization from the eyes of someone who has done it and recently for that matter. I would say that is the definition of bases.


Based on what I've heard, they'd BLS that :p

But yeah, this is a valid question - medics are on scene, no BLS unit available, how do they handle this? Do they really have to call medical direction?

@medichopeful @EpiEMS Yes, we would likely BLS that.. There is always a BLS unit available, whether it would be FD, AMR or Trimed. That is not to say there is no circumstances in which that person could/would be transported by a medic, Most situations that require a MD contact prior to Tx are Conscious sedation and the use of anti-arrhythmic in a otherwise stable arrhythmia i.e. Diltiazem to Afib RVR with stable vitals.
 

medichopeful

Flight nurse, ground paramedic
1,848
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Thanks for the response. Would discomfort/pain be one of the reason that it would be ALS? In other words, how does pain management play into these calls?

I have zero interest in working for KCMO for a variety of reasons, but I'm curious how the system handles some things.
 

RocketMedic

Californian, Lost in Texas
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Is symptom relief and pain management not a thing in King County? Kidney stones, etc?
 

DrParasite

The fire extinguisher is not just for show
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No it is not. It is out of context.
I work here, I take time out of my personal life to try clarify what it means to be a part of this organization from the eyes of someone who has done it and recently for that matter. I would say that is the definition of bases.
1) please explain how it's taken out of context.

2) we have only your word that you actually work there. I would say I work there too, and both claims have the same validity. it's the nature of the online forum. Your claim that you have done it and done it recently has the similar amount of validity. Did you do it? maybe? maybe not? I wasn't looking over your shoulder, so I can't say for sure (and no one else can too).

3) the definition of base is typically an objective statement that is verifiable by a third party. I can verify that the document provided is legitimate. I can verify that it is, indeed, on an authentic server from UW. Based on this, I have no reason to doubt it's accuracy. Your claim that the document is inaccurate, without any supporting documentation, based solely on your opinion, has no base, because it isn't verifiable by a third party.

4) I did ask for a copy of some KCM1 protocols (feel free to thank Chief Tait for me). It looks like they operate similar to NJ; paramedics can do a whole of of standing order stuff, and then call the doc, who might say to do more, or might just say monitor and transport.. Although I was surprised to see you guys still put certain meds down the tube in a cardiac arrest...... Since I'm attaching the actual patient care guidelines, it's now no longer a baseless claim.

I hope clearing up baseless vs solid base for you.
 

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RocketMedic

Californian, Lost in Texas
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That's a surprisingly narrow band of standing orders.
 

NomadicMedic

Pot or Kettle? Unsure.
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That's a surprisingly narrow band of standing orders.

So, the way it works is like this. The medic sees a patient, makes a field diagnosis, decides on a treatment plan and then calls the doc to present the patient and proposed treatment. The doc usually agrees, the medic treats the patient and transports to the hospital.

@FLMedic311, am I right on this? There are few standing orders because the medic is expected to make contact, present the patient with proposed treatment and get approval. It's not exactly a "mother may i" system ... It's more like a "This is what I've got Doc. Do you agree?"
 
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FLMedic311

FLMedic311

Forum Lieutenant
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Thanks for the response. Would discomfort/pain be one of the reason that it would be ALS? In other words, how does pain management play into these calls?

I have zero interest in working for KCMO for a variety of reasons, but I'm curious how the system handles some things.

Is symptom relief and pain management not a thing in King County? Kidney stones, etc?


No problem, Yes it can be, but it is at the discretion of the crew as to whether or not they are going to Tx for pain management. Because ALS is treated as a limited resource, there are other considerations that have to be taken into account before making this decision. We unfortunately do not have the ability to Tx for pain and allow BLS transport subsequent to that.
 

RocketMedic

Californian, Lost in Texas
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So, the way it works is like this. The medic sees a patient, makes a field diagnosis, decides on a treatment plan and then calls the doc to present the patient and proposed treatment. The doc usually agrees, the medic treats the patient and transports to the hospital.

@FLMedic311, am I right on this? There are few standing orders because the medic is expected to make contact, present the patient with proposed treatment and get approval. It's not exactly a "mother may i" system ... It's more like a "This is what I've got Doc. Do you agree?"

But where is the vast majority of treatment in a system that is tiered and sends most people off BLS, if they ever see a medic?
 

RocketMedic

Californian, Lost in Texas
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No problem, Yes it can be, but it is at the discretion of the crew as to whether or not they are going to Tx for pain management. Because ALS is treated as a limited resource, there are other considerations that have to be taken into account before making this decision. We unfortunately do not have the ability to Tx for pain and allow BLS transport subsequent to that.
So basically, the quality of care provided is primarily determined not by the patients needs or wants, but by EMD and how compassionate the crew feels if they are actually assigned?

Like, in our system, every truck has a medic, so you're not actually saving time if you don't want to ALS something, and although discretion remains, you can't handwave "resources" to defend not doing something. There's really no reason not to manage pain if it can be done safely and effectively.
 
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Bullets

Forum Knucklehead
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4) I did ask for a copy of some KCM1 protocols (feel free to thank Chief Tait for me). It looks like they operate similar to NJ; paramedics can do a whole of of standing order stuff, and then call the doc, who might say to do more, or might just say monitor and transport.. Although I was surprised to see you guys still put certain meds down the tube in a cardiac arrest...... Since I'm attaching the actual patient care guidelines, it's now no longer a baseless claim.

I hope clearing up baseless vs solid base for you.
So where are the standing orders for like, every other thing a medic might come in contact with?
 

VentMonkey

Family Guy
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@FLMedic311 this is yours...
06FA7260-8AAD-44D6-875E-19B450BA7B83.jpeg

And so my post doesn’t get deleted, here’s to hoping the thread can stay moderately relevant until 03/31, cheers.
 

Ensihoitaja

Forum Captain
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So, the way it works is like this. The medic sees a patient, makes a field diagnosis, decides on a treatment plan and then calls the doc to present the patient and proposed treatment. The doc usually agrees, the medic treats the patient and transports to the hospital.

@FLMedic311, am I right on this? There are few standing orders because the medic is expected to make contact, present the patient with proposed treatment and get approval. It's not exactly a "mother may i" system ... It's more like a "This is what I've got Doc. Do you agree?"

I have a friend that works for Seattle Fire and that's exactly how he described it to me.
 

chriscemt

Forum Lieutenant
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The county medical director, who is the over all medical director, is fine with it as they are the kcmo medical director. The AMR or xyz ambulance medical director has to play by the county medical directors rules. And honestly they are just there to catch a paycheck and don't really provide over site.

Being in the Kansas City area, each reference to KC and KCMO is terribly confusing. Carry on.
 

RocketMedic

Californian, Lost in Texas
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I'm still wondering how world-class prehospital medical care is consistently provided for most patients in a system where most calls don't even see a provider capable of providing meaningful interventions for their complaints, much less get transported by them.

@FLMedic311 , here's a few questions. What sort of response, treatment and transport should these patients expect from the KCM1 system? (Assume all vitals are stable)

A) 65 y/o hemodynamically-stable hip fracture, complaints of 10/10 pain and fracture, uncomplicated.
B) 25 y/o GSW to the hand, complaints of 10/10 pain, uncomplicated.
C) Adult asthma exacerbation, expiratory wheezing only, some relief from MDI, "I can't breathe well and I feel bad"
D) 70 y/o near-syncope
E) "Grandma's a little lethargic today"
F) 60 y/o chest pain with cough.
G) 70 y/o with chest pain.

Broadly, who gets medics, and who gets rides?
 

PotatoMedic

Has no idea what I'm doing.
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I'm still wondering how world-class prehospital medical care is consistently provided for most patients in a system where most calls don't even see a provider capable of providing meaningful interventions for their complaints, much less get transported by them.

@FLMedic311 , here's a few questions. What sort of response, treatment and transport should these patients expect from the KCM1 system? (Assume all vitals are stable)

A) 65 y/o hemodynamically-stable hip fracture, complaints of 10/10 pain and fracture, uncomplicated.
B) 25 y/o GSW to the hand, complaints of 10/10 pain, uncomplicated.
C) Adult asthma exacerbation, expiratory wheezing only, some relief from MDI, "I can't breathe well and I feel bad"
D) 70 y/o near-syncope
E) "Grandma's a little lethargic today"
F) 60 y/o chest pain with cough.
G) 70 y/o with chest pain.

Broadly, who gets medics, and who gets rides?

Besides the gsw I can say I have transported all those patients as a bls provider in the kcmo system.

To also be honest I have seen medics transport and treat all of those patients as well. And to note just because I have transported a chest pain as a bls provider does not mean that the medics don't do it regularly. The kcmo protocols are well... Lacking because they are trained and educated well. They have a trauma protocol. A cardiac arrest protocol and a do what you want just call the doc to clear it by them protocol. They literally don't have a set protocol because they are trusted to diagnose and treat. Yes they call the doc but honestly half the time they just do and then let the doc know what they did. Honestly I don't like that a lot of patients that would benefit from ALS care go bls. In fact a lot of patients that would mandate Als care in a lot of places go bls in king county. But the providers are very knowledgeable and most do care. They also are put in a limited resources situation. And they will split crews to take two different ALS calls. I remember a few times being at one scene with a medic unit when bad trauma came in. I left my partner with one medic and the other medic grabbed the kits and told me to drive to the other call to take the second patient. In the end both got ALS transports. No system is perfect. And I know kcmo is not perfect. But it is also evolving. I know with the new medical director some things are changing for the better. But it takes time to change a culture.
 

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