LA County Fire.....

[terrible one]

My advice, move far far away from LA county (CA as a whole really).

In all seriousness I witnessed much of the same in LA county for several years. Most fire depts are delusional in the fact that they perform poor care. They'll never admit it and I highly doubt it'll ever change. Obviously this problem is not a fire only issue, but I've seen privates much more proactive in either training or disciplining poor patient care paramedics / EMTs.

 

[socalmedic]

My advice, move far far away from LA county (CA as a whole really).

In all seriousness I witnessed much of the same in LA county for several years. Most fire depts are delusional in the fact that they perform poor care. They'll never admit it and I highly doubt it'll ever change. Obviously this problem is not a fire only issue, but I've seen privates much more proactive in either training or disciplining poor patient care paramedics / EMTs.

Much of this also has to do with Sovereign Immunity, municipalities cannot be held liable in civil court for negligence so there is no motivation for the county to ensure their paramedics are competent. however the private companies do not have this protection and can be sued for lots of money if their paramedic commits a negligent act, there is a lot of financial motivation for the privates to ensure their paramedics are competent and following the rules.

 

[Christopher]

Well thats what happens when you have fire medics, most of them hate the ems side of the job but they have to do it because theyre required. The sad part is that in the end the ones that suffer are the patients.

Yes, us Fire Medics are certainly the problem facing EMS Just because California is backwards/backwater when it comes to EMS doesn't mean the rest of us are.

 

[terrible one]

Yes, us Fire Medics are certainly the problem facing EMS Just because California is backwards/backwater when it comes to EMS doesn't mean the rest of us are.

I agree. Even in CA there are great FDs with amazing employees. However, this is not the norm and I've worked in 5 different counties with close to over 30 different fire depts.
The apathy towards EMS is palpable. Good to know there are some FDs out there that do actually care though.

 

[Christopher]

I agree. Even in CA there are great FDs with amazing employees. However, this is not the norm and I've worked in 5 different counties with close to over 30 different fire depts.
The apathy towards EMS is palpable. Good to know there are some FDs out there that do actually care though.

The system is what matters. Strong QA/QI, quality education, with empowered providers given the responsibility to provide high quality care; the keys to success are not dependent on the delivery model.

 

[Tigger]

I agree with documenting the lack of appropriate care in the PCR. As an EMS provider in the field, that is the only protection you have against erroneous claims or lawsuits. What do you think the first thing a lawyer is going to say in court when he is suing you for malpractice? "If you had thoughts that this patient did not need to go BLS, why is there no record of this? Are you now lying or were you negligent in the care of this patent." If you're getting screwed over, you do what you need to do save your butt. If that means you document what has happened/did not happen in the PCR, then you do so. At the end of the day, it is your license to practice on the line.

Document it elsewhere than a medical record, that's pretty much exactly what an incident report is for.

If the system is so broken that this isn't adequate, well I don't know what to say then. Maybe this is the only way you deal with that, though it doesn't make it the right way. Socal's post highlighting how messed up the record keeping is disconcerting at best.

 

[avdrummerboy]

Funny how LACo was the first county to have paramedics and it has changed (or even gone backwards) the least. Anyone who has seen the ALS protocols knows how ridiculous they are, anyone who's worked BLS there knows how stupid it can be, the best you can do is document. Not just PCR'r, IR's as well. Also, there is nothing wrong with documenting what mandatory things didn't happen on scene. I don't know of any ALS system that doesn't require a 12 lead on chest pain calls, if it's not done (especially if someone calls it in saying that it was) make damn sure that you document that. It doesn't matter that you're BLS, what did or did not happen in your presence is important to document.

 

[gonefishing]

Funny how LACo was the first county to have paramedics and it has changed (or even gone backwards) the least. Anyone who has seen the ALS protocols knows how ridiculous they are, anyone who's worked BLS there knows how stupid it can be, the best you can do is document. Not just PCR'r, IR's as well. Also, there is nothing wrong with documenting what mandatory things didn't happen on scene. I don't know of any ALS system that doesn't require a 12 lead on chest pain calls, if it's not done (especially if someone calls it in saying that it was) make damn sure that you document that. It doesn't matter that you're BLS, what did or did not happen in your presence is important to document.

You know the average emt makes what Johnny and Roy were making lol. I caught their pay in one of the episodes I think it was $8.25 an hour as a parmadeic fire fighter. Average emt is $9 an hour lol sad but true.

 

[Bullets]

Question regarding LA

When ALS arrived, you give a report and legally transfer care to them. When they decide it is a BLS patient, can you refuse to accept the patients care? I dont know if this is how they look at it in LA, and i dont know if you want to makes waves of this size, but if you really feel that this patient needs advanced levels of care, then just refuse to accept the patient from them

 

[Jim37F]

Question regarding LA

When ALS arrived, you give a report and legally transfer care to them. When they decide it is a BLS patient, can you refuse to accept the patients care? I dont know if this is how they look at it in LA, and i dont know if you want to makes waves of this size, but if you really feel that this patient needs advanced levels of care, then just refuse to accept the patient from them

Ideally that's the case. When I worked for Gerber Ambulance in Torrance, TFD responded to medicals using the same model as LACoFD, and when they sent a couple medics to our Gerber new hire orientation class they maintained that we were able to do that....fortunately I never had to do that out in the field, but I got the sense that some medics would've ALS'd no problem in that case, and others would have made a big fuss the way the OP describes...seems very individual personality based.

Hopefully (and I say this wanting to become an LACo FF, but then again I want to be a medic who occasionally gets to put out a fire or cut apart a car as a perk lol) the advent of ePCR's will make QA/QI easier and calls more transparent (at Glendale our ePCR software wont close out the form and let you upload it if you don't have a 12 lead attached to your chest pain run form, so you better get one, or explain why you have a picture of nothing attached instead).

 

[gonefishing]

Ideally that's the case. When I worked for Gerber Ambulance in Torrance, TFD responded to medicals using the same model as LACoFD, and when they sent a couple medics to our Gerber new hire orientation class they maintained that we were able to do that....fortunately I never had to do that out in the field, but I got the sense that some medics would've ALS'd no problem in that case, and others would have made a big fuss the way the OP describes...seems very individual personality based.

Hopefully (and I say this wanting to become an LACo FF, but then again I want to be a medic who occasionally gets to put out a fire or cut apart a car as a perk lol) the advent of ePCR's will make QA/QI easier and calls more transparent (at Glendale our ePCR software wont close out the form and let you upload it if you don't have a 12 lead attached to your chest pain run form, so you better get one, or explain why you have a picture of nothing attached instead).

Sorry couldn't help it.....lol

 

[Jim37F]

Sorry couldn't help it.....lol

Doesn't help that the ambulances are the same color scheme, blue and yellow "Blellow!"

 

[OG EMT]

Question regarding LA

When ALS arrived, you give a report and legally transfer care to them. When they decide it is a BLS patient, can you refuse to accept the patients care? I dont know if this is how they look at it in LA, and i dont know if you want to makes waves of this size, but if you really feel that this patient needs advanced levels of care, then just refuse to accept the patient from them

Question regarding LA

When ALS arrived, you give a report and legally transfer care to them. When they decide it is a BLS patient, can you refuse to accept the patients care? I dont know if this is how they look at it in LA, and i dont know if you want to makes waves of this size, but if you really feel that this patient needs advanced levels of care, then just refuse to accept the patient from them

In L.A. County Protocol for one pre-hospital team handing a patient off to another, i.e. County Fire Squad handing patient off to EMT Unit for BLS transport, the receiving team must agree to accept patient care. Now if you're going to insist that they follow up with patient they feel only needs BLS you better have a good reason, and stick to your guns. I have never had a County Fire Squad refuse, some took it in good heart some went into door slamming mode. Document everything.

 

[socalmedic]

Question regarding LA

When ALS arrived, you give a report and legally transfer care to them. When they decide it is a BLS patient, can you refuse to accept the patients care? I dont know if this is how they look at it in LA, and i dont know if you want to makes waves of this size, but if you really feel that this patient needs advanced levels of care, then just refuse to accept the patient from them

Technically they aren't transferring care to you, technically when they made base contact the base station MICN (radio nurse) accepted the patient until they arrive at the destination hospital. If they send you BLS the paramedic is no longer responsible because the MICN in on the hook, its kind of a limbo state gray area. It is important to note that once contact is made the paramedic is supposed to re-contact to get any treatment directions (patient went into V-Tach... hang on while I call the hospital...)

while I never met a Paramedic who wouldn't go with you if you asked, as stated above they will go into door slamming mode, I even had one ride in the front once, and you will probably get an earful from the captain and your supervisor for questioning a paragod.

 

[Jim37F]

Technically they aren't transferring care to you, technically when they made base contact the base station MICN (radio nurse) accepted the patient until they arrive at the destination hospital. If they send you BLS the paramedic is no longer responsible because the MICN in on the hook, its kind of a limbo state gray area. It is important to note that once contact is made the paramedic is supposed to re-contact to get any treatment directions (patient went into V-Tach... hang on while I call the hospital...)

while I never met a Paramedic who wouldn't go with you if you asked, as stated above they will go into door slamming mode, I even had one ride in the front once, and you will probably get an earful from the captain and your supervisor for questioning a paragod.

So what if they never made base contact? Not exactly the MICN's patient at that point...even if they call base and get permission to release to BLS, it's still my patient, I'm the attendant doing my reassessment with my patient physically in front of me not the nurse sitting in a radio room at a hospital I may not even be going to.

 

[socalmedic]

So what if they never made base contact? Not exactly the MICN's patient at that point...even if they call base and get permission to release to BLS, it's still my patient, I'm the attendant doing my reassessment with my patient physically in front of me not the nurse sitting in a radio room at a hospital I may not even be going to.

first question, if they never made base contact they are operating outside their scope of practice and cannot release to a lesser medical authority. second question, kind of that's why I said its a state of gray area limbo, yes you are the person with the patient but the MICN is still responsible until you arrive at the destination. think of a patient in the ER who is taken by the X-Ray tech for an X-ray. the patients nurse is still responsible for the condition of the patient even though the patient is in a different area of the hospital, but the tech is responsible to let the nurse know if there are any apparent changes in the patient condition or if the patient is not stable enough to go without the nurse.

 

[Angel]

Is this a socal thing? Where I work its not the nurses or even the hospitals patient until the patient is physically there and report is given. if thats the case why not just drop the pt off and leave? (its abandonment)
Also they have no choice but to accept the patient if they have the resources to treat him/her.

 

[Jim37F]

Really? They have to make base contact to send a patient BLS? Where in the County policy/protocol does it say that? I'm legitimately curious, I've never heard that, and I guess pretty much every medic I've worked with has been in violation for triaging to BLS with Base Contact Not Attempted checked off on the run form.

 

[gonefishing]

Really? They have to make base contact to send a patient BLS? Where in the County policy/protocol does it say that? I'm legitimately curious, I've never heard that, and I guess pretty much every medic I've worked with has been in violation for triaging to BLS with Base Contact Not Attempted checked off on the run form.

I second that.lol

 

[socalmedic]

Really? They have to make base contact to send a patient BLS? Where in the County policy/protocol does it say that? I'm legitimately curious, I've never heard that, and I guess pretty much every medic I've worked with has been in violation for triaging to BLS with Base Contact Not Attempted checked off on the run form.

I must make a public apology and redact my prior statement.

It seems that policy 808 has changed it appears in 2013, that there is now a list of patient complaints (albeit, most complaints) which require base contact. there are also Standing Field Treatment Protocols (SFTP), however LAcoFD is not authorized for SFTP (according to policy 401). my statement should say that on any patient where an ALS tool has been used in the assessment or a complaint listed in policy 808, or if the agency is authorized to use SFTP and the protocol indicates base contact the paramedic must make base contact and get authorization for BLS transport. or if the paramedic unit is assigned to an area utilizing the "Round Robin" or the call is within the former catchment of a closed MAR, the designated Base must be contacted for destination both ALS and BLS.

one other exception I found, if you are on Catalina island and the only helicopter the MAC could dispatch was the USCG who has only a rescue swimmer you are allowed to transfer care to them without calling the base...

I don't think I have read these policies in quite some, I apologize for the misinformation.