Officially and politically correctly: Liars.

[VentMedic]

The Er's I transport have about 30 psychiatrists in them. Münchhausen syndrome, are you kidding me.

The Er's I transport have about 30 psychiatrists in them. Are these people falling through the cracks, everyone is mis diagnosing them? Admitted? Yeah they get admitted, the majority of the time to a padded room with a box of crayons with their name on it, or a timeout in the local drug program, which they weasel their way out of with a prescription of soboxin that they can sell to get something with a kick. They dont want treatment, they want to be high.

How much do you know about Münchhausen syndrome?

Usually even in the larger EDs only one may be in house or on call. EDs don't have 30 doctors or even nurses present. 30 psychiatrists? You do exaggerate a little.

How long have you worked in the profession? Do you know how many services that have been cut back on in cities?

I may only have a couple hundred our of training however I am no dummy, drug seekers dont call 911 with chest pain, they wont get pain meds for that, they know the protocols better then we do.

Do you know what MONA stands for? Ever hear of Fentanyl?

Do you know how street drugs damage the heart? Do you think they might even have a legitimate complaint?

Referral system? This people are connivers, liars and cheats. They have worked their way through every drug program in a hundred mile radius, they rob the system of countless man hours, they our responsible for making truly sick or injured people wait, they dont want to get clean they want to get high. Refferal? Sure to a jail cell. They dont want to get clean, force them to, they will dry up quick in the clink.

Do you know what I was even referring to by referral system or for what purpose was meant when I stated get them known in the system. You can not just throw someone in jail when many EMT(P)s are too lazy to document adequately and effectively.

As you stated, you only have a couple hundred hours of training. You do need more education. If these are you views as you have stated, you need to re-examine your position as a health care provider. Your attitude does little good for your patients and will eventually skew your assessment which could cause harm. Your lack of understanding of "the system" also makes you of little use to help others who can be of assitance to prevent these situations.

 

[VentMedic]

I have one more thing to add, the attitudes displayed by some here are the reasons why EMT(P)s are not allowed to refuse transport in many services. Some are making personal judgments for denying transport instead of basing it as a medical decision from an assessment with proper documentation.

And, if some services have to pay their employees to document properly when they do transport, what incentive must be used for proper "denial of transport" documentation? Once EMS realizes it is its own worst enemy when it comes to getting protocols and attitudes changed, things might start to move forward. If some continue to behave like belligerent taxi drivers making personal assessments rather than medical ones, then that is how the public and legislators will also view those in EMS.

 

[CAOX3]

How much do you know about Münchhausen syndrome?

Enough. Trust me.

Usually even in the larger EDs only one may be in house or on call. EDs don't have 30 doctors or even nurses present. 30 psychiatrists? You do exaggerate a little.

I meant combined.

How long have you worked in the profession? Do you know how many services that have been cut back on in cities?

Fifteen-years, thats not my problem. I work in EMS, not in psychology, this is an EMS forum, here is a site if you would like to debate Münchhausen and the effects of cost cutting at urban emergency rooms nationwide and its affect on the modern day dope head.http://psychcentral.com/news/

Do you know what MONA stands for? Ever hear of Fentanyl?

Actually I do, but I stated OUR protocols.

Do you know how street drugs damage the heart? Do you think they might even have a legitimate complaint?

Yes actually I do. However they dont call when they our high, they call when they want to get high. As I stated before drug seekers dont call with the complain of chest pain. Maybe I should have prefaced that with in my area. I apologies.

Do you know what I was even referring to by referral system or for what purpose was meant when I stated get them known in the system. You can not just throw someone in jail when many EMT(P)s are too lazy to document adequately and effectively.

Yes everyones lazy and its the EMS health provider issue that the common drug seeker cant get help.

They are well known in the system, they are looking for someone that doesn't know them when they call. We document the hell out of it, people who dont want help far out numbered the the ones that do, with resources being cut like you say, dont you think we should focus our energy there?

As you stated, you only have a couple hundred hours of training. You do need more education. If these are you views as you have stated, you need to re-examine your position as a health care provider. Your attitude does little good for your patients and will eventually skew your assessment which could cause harm. Your lack of understanding of "the system" also makes you of little use to help others who can be of assitance to prevent these situations.

Next time preface these comments with "In my opinion" Thank you.

I am educated and its a little more then an associates in respiratory therapy. (See thats an assumption on my part about you which I dont usually do) When education in EMS in mandated I will look into it. I dont need to re-examine anything. My position as a health care provider is solid and strong. Nothing skews my assessment, this was my opinion as the original poster asked. I thoroughly understand the "system" in which I work. "Little use to help of others" That again is your opinion, which means little to me.

I'm sure you are a fine provider, an a asset to your system. Dont throw around your politically correct opinions and speak down your nose to me with your sixty or so college credit (see why assumptions are bad, thats another one I made about you), you know nothing about me and your condescending attitude just proves that.

 

[VentMedic]

Enough. Trust me.


I meant combined.



Fifteen-years, thats not my problem. I work in EMS, not in psychology, this is an EMS forum, here is a site if you would like to debate Münchhausen and the effects of cost cutting at urban emergency rooms nationwide and its affect on the modern day dope head.http://psychcentral.com/news/


Actually I do, but I stated OUR protocols.

Yes actually I do. However they dont call when they our high, they call when they want to get high. As I stated before drug seekers dont call with the complain of chest pain. Maybe I should have prefaced that with in my area. I apologies.


Yes everyones lazy and its the EMS health provider issue that the common drug seeker cant get help.

They are well known in the system, they are looking for someone that doesn't know them when they call. We document the hell out of it, people who dont want help far out numbered the the ones that do, with resources being cut like you say, dont you think we should focus our energy there?



Next time preface these comments with "In my opinion" Thank you.

I am educated and its a little more then an associates in respiratory therapy. (See thats an assumption on my part about you which I dont usually do) When education in EMS in mandated I will look into it. I dont need to re-examine anything. My position as a health care provider is solid and strong. Nothing skews my assessment, this was my opinion as the original poster asked. I thoroughly understand the "system" in which I work. "Little use to help of others" That again is your opinion, which means little to me.

I'm sure you are a fine provider, an a asset to your system. Dont throw around your politically correct opinions and speak down your nose to me with your sixty or so college credit (see why assumptions are bad, thats another one I made about you), you know nothing about me and your condescending attitude just proves that.

Now you've resorted to bashing Paramedics with degrees? I did chosse to get a degree in EMS as well as a Bachelors in Cardiopulmonary Sciences so I could look at things as an educated medical professional.

I also choose to see how the system works and how I can get patients directed to the more appropriate resources.

What your CP protocols if they do not include pain management?

Do you know what type of patients end up getting admitted to the hospital? Often it is the drug seekers because some other problem is found as a result of their chosen lifestyle.

Educate yourself about medicine. Keep the personal judgements out of it.

 

[CAOX3]

I havent resorted to anything you make assumptions of me I made some about you. See why assumptions are bad?

One more thing Vent I have nothing against you personally I find your posts educational and insightful. You are an asset to this forum. I however have " out of work" opinions and when asked I dont put a politicaly correct spin on it.

 

[VentMedic]

Next time preface these comments with "In my opinion" Thank you.

That is not necessary since I provided the quote from you and was just reinterating your statement about yourself.

 

[Sasha]

Drug addicts can't have legitimate medical problems?? Does the cocaine ward off heart attacks??

I think with the way they destroy their bodies they're more apt to have a legitimate medical problems.

 

[VentMedic]

I however have " out of work" opinions and when asked I dont put a politicaly correct spin on it.

I do not discriminate or make personal judgements about patients in my daily "work" with patients. Everyone has their flaws and sometimes you have to look past that to get the patient the proper MEDICAL assessment and treatment. I do not judge my patients based on their race, neighborhood, language spoken, immigration status, economic status or the way they have chosen to lead their lives. Yes, there are those that abuse the system but there are alot more that need assistance and do fall through the cracks often when a system and its health care providers become jaded.

But, thank you for the other compliments. However, the way I treat my patients as a medical professional is what I believe is my best assest. It was something I learned 30 years ago in my Paramedic degree program.

 

[Mountain Res-Q]

I have one more thing to add, the attitudes displayed by some here are the reasons why EMT(P)s are not allowed to refuse transport in many services. Some are making personal judgments for denying transport instead of basing it as a medical decision from an assessment with proper documentation.

And, if some services have to pay their employees to document properly when they do transport, what incentive must be used for proper "denial of transport" documentation? Once EMS realizes it is its own worst enemy when it comes to getting protocols and attitudes changed, things might start to move forward. If some continue to behave like belligerent taxi drivers making personal assessments rather than medical ones, then that is how the public and legislators will also view those in EMS.

Once again, Amen!

 

[Mountain Res-Q]

Drug addicts can't have legitimate medical problems?? Does the cocaine ward off heart attacks??

I think with the way they destroy their bodies they're more apt to have a legitimate medical problems.

And again, Amen! Who are we to make those judgements on them? Unless a liberal EMS Systems Protocols have allowed you to refuse transport based on your belief that they patient is full of sh*t, then (at least at the BLS level) treat and transport like anything else. And if you have the authority to refuse transport in these cases: DOCUMENT everything so that the lawyers know who to sue for how much. ^_^

 

[CAOX3]

Now you've resorted to bashing Paramedics with degrees? I did chosse to get a degree in EMS as well as a Bachelors in Cardiopulmonary Sciences so I could look at things as an educated medical professional..

I haven't bashed anyone, I stated my opinion on the problem. I'm sorry if you have an problem with that. I am no way jaded, opinionated yes. Jaded? no.

I also choose to see how the system works and how I can get patients directed to the more appropriate resources..

Let me get this strait, you expect me as an educated EMT to direct my drug seeking patient to more appropriate services when he/her will come in contact no less then ten highly educated medical professionals at the hospital, and then blame it on me that he hasn't received the help he/she so greatly deserves? I agree we need to document it and we do, our reach only goes so far and so does are responsibility.

What your CP protocols if they do not include pain management?

My protocols are ASA, O2 if needed and assist with nitro.

Do you know what type of patients end up getting admitted to the hospital? Often it is the drug seekers because some other problem is found as a result of their chosen lifestyle.

I understand that and that problem is usually beyond the reach of any EMS provider especially an EMT.

Educate yourself about medicine. Keep the personal judgements out of it.

Again I am educated, and this touchy feely, let me give you a hug attitude is just what empowers these people. They need reality checks, they need to stop being coddled. They are offered help, and continually decline to remain in their current predicament, yes I believe they should be forced into treatment, if they dont go willingly. I know many recovering attics, I also no many that never recovered.

Drug addiction is an ugly ride and affects everyone they encounter it ruins lives and if their not treated whether voluntary or involuntary then most will end up dead beside some dumpster with a needle in their arm and I cant and dont want to recall the number of them I have found.

So call me jaded, opinionated with no compassion. Thats your opinion, you couldn't be further from the truth.

 

[firecoins]

So call me jaded, opinionated with no compassion. Thats your opinion, you couldn't be further from the truth.

well he could be in Ohio. I am sure that is further from the truth.

by the way I haven't read any posts in this thread since my first post.

 

[VentMedic]

Let me get this strait, you expect me as an educated EMT to direct my drug seeking patient to more appropriate services when he/her will come in contact no less then ten highly educated medical professionals at the hospital, and then blame it on me that he hasn't received the help he/she so greatly deserves? I agree we need to document it and we do, our reach only goes so far and so does are responsibility.

My protocols are ASA, O2 if needed and assist with nitro.

I understand that and that problem is usually beyond the reach of any EMS provider especially an EMT.

Again I am educated, and this touchy feely, let me give you a hug attitude is just what empowers these people. They need reality checks, they need to stop being coddled. They are offered help, and continually decline to remain in their current predicament, yes I believe they should be forced into treatment, if they dont go willingly. I know many recovering attics, I also no many that never recovered.

Drug addiction is an ugly ride and affects everyone they encounter it ruins lives and if their not treated whether voluntary or involuntary then most will end up dead beside some dumpster with a needle in their arm and I cant and dont want to recall the number of them I have found.

So call me jaded, opinionated with no compassion. Thats your opinion, you couldn't be further from the truth.

This has nothing about being a "touchy feely big hug attitude". It is about doing a medical assessment regardless of the patient's life issues. However, these issues will enable one to look at a broader picture during the asssessment of a patient.

Without EMS getting involved to leave a paper trail of some sort with proper documentation, it does little good to keep complaining when you have done nothing but expect others to do what you also could be doing to support the whole system to do something about 911 abuse. It just takes one weak link in the system to make it stop or become inadequate. Unfortunately, EMS is often that weak link. There are systems that do have the appropriate attitude and do put their protocols in place if not to deny transport but to do the proper documentation so the ED can carry through with their end easier to get whatever assistance or law enforcement involved.

You are speaking as an EMT-B and may not know the resources available outside and inside the hospital. For this reason, I do not believe a "deny transport" protocol is acceptable especially when EMT-Bs who develop "opinionated" attitudes may eventually take the plunge and become Paramedics. If they have spent too much time working with someone a s"opinionated" as yourself or become jaded, they will not be able to effectively and objectively perform an adequate medical assessment to make the decision to deny transport.

 

[CAOX3]

We do not have a deny transport protocol and I agree with that.

I am not familiar all the programs available to these parties, I also not sure I agree with that being my responsability.

I am a professional I can remove personel feelings and opinions from the equation, I encounter plenty of things I dont agree with. I am still able to operate with the best interest of my patients in mind.

I dont have all the answers, I never claimed I do. I do my job to the best of my ability, I believe I do it well.

We could go round and round all night on this and similar issue.

You say Im jaded, thats your opinion and your certainly entitled to it,as I am entitled to mine.

Posted from my phone(now im blind thank you)

 

[mycrofft]

My thread got tangles.

The cruxes of my original post were that you definitely established the complaint as factitious, and from that platform, asked what if any policy was in place. We wind up with members telling each other what to do, denigrating their personal expertise, making blanket statements that you cannot rule out any complaint, etc etc. I guess this issue bothers some people as much as it does me.

Let me share my personal perspective. My organizaton exerts unwritten but steady pressure not to send our patients out or to circumvent the care regimen and schedule in our institution, but on the other hand will tell you to stop telling the patients "No" and give them what they want to avoid grievances. Once institutionalized patients find out the benefits of this approach, the numbers start to swell of people who can't get out of their bed due to pain (except to eat, get their meds and go to the bathroom), who are having grand mal seizures without postictal periods, and who fall down the stairs (except the new security cameras catch them staging these "falls"...what a LUXURY!).

If you will not rule out any complaint a pt makes and insists upon, the pt is practicing the medicine, not you. If you relinquish that control and a misadventure occurs, it's your arse, legally and ethically. BUT (but, but, but)...using the bases of commonality of training based on the lowest common denominator of student and the protocols safest for the organization, how CAN you refuse any request for an ambulance ride?

 

[BossyCow]

If you will not rule out any complaint a pt makes and insists upon, the pt is practicing the medicine, not you. If you relinquish that control and a misadventure occurs, it's your arse, legally and ethically. BUT (but, but, but)...using the bases of commonality of training based on the lowest common denominator of student and the protocols safest for the organization, how CAN you refuse any request for an ambulance ride?

We assess each pt by the same criteria. What are their vitals, how do they look, is there a visible MOI? As far as refusing to transport, each agency should have a protocol for refusal. Both when the pt refuses and when we refuse. The only person I have 'refused' to transport was the boyfriend of a 'pt' complaining of 10:10 belly pain with no visible tenderness or reaction to the palp of the ABD. Turns out she fakes kidney infections when her boyfriend misses the bus so the ambulance can take them both into town. When I said I was under no obligation to transport her boyfriend in the rig with us did her symptoms magically disappear.

 

[mycrofft]

Thanks BC, take care.

Longtime veterans will tell you it is always less likely to get you in trouble if you treat than if you don't. That's why we detox hundreds of prescription abusers each month.