Prime Example of Why LA County EMS is a Broken System

[JPINFV]

Haha, believe me I would love to do something like that, and I agree if they don't understand the way the system works they have no business answering calls. The problem is, I don't think much is done in the way of MICN training to include direction of IFT units, and after having sat in and observed a Prehospital Advisory Committee meeting at LACoEMSA it doesn't seem like it's very high on the priority list.

Forgive my ignorance, but is there anything substantially different between 911 scene response and emergency IFTs between the decision to continue to the accepting facility or reroute?

Again, this wasn't my call. I was on another call at that facility when this happened, and am just relating my experiences with making base contact as a private IFT medic.

It might not have been your call, but it sounds like you've had to deal with consistently with MICNs who were unable to do their job. Random acts of stupidity are one thing, systematic ignorance is another.

 

[MrBrown]

See this is why I don't plan to get sick in Los Angeles.

 

[thegreypilgrim]

Forgive my ignorance, but is there anything substantially different between 911 scene response and emergency IFTs between the decision to continue to the accepting facility or reroute?

Certainly nothing worth noting. I really can't give you anything more than guesswork as explanation for why this problem exists. Honestly I just think that MICNs are still RNs and in most RNs' minds here private ambulance = BLS. Therefore, when they have one calling their med control line they just get confused.

It might not have been your call, but it sounds like you've had to deal with consistently with MICNs who were unable to do their job. Random acts of stupidity are one thing, systematic ignorance is another.

Systematic ignorance is probably the best description of it. Myself and other medics I work with consistently have orders denied when not readily warranted. Fortunately for me at least such orders have been limited to morphine for pain management (which is still bad) but nothing critically necessary.

 

[John E]

so....

after all that, what happened to the patient?

Just curious.

John E

 

[Shishkabob]

How about be proactive and assume the guy with the MD after his name might know a little more then the box with the squiggly lines.

Eh, I had a doc refuse to give a patent aspirin, yet gave nitro, and when asked why gave no further explanation than "waiting for you (a paramedic) to arrive".

 

[usafmedic45]

Eh, I had a doc refuse to give a patent aspirin, yet gave nitro, and when asked why gave no further explanation than "waiting for you (a paramedic) to arrive".

Better than the primary care doc I work with who fancies himself a critical care doc. h34r: I actually have signed (by a judge friend of mine), notarized paperwork in my locker and on file (along with my advance directives and demands that I be transferred elsewhere) with my boss that this doctor is allowed in the room with me if I get hurt or sick at work. I call them my "Do Not *doctor's name*" forms. Several of my colleagues have followed suit and have their own copies of the paperwork now.

 

[CAOX3]

Call me crazy but middle age male presenting with substernal chest pain, back pain and ST elevation seems we would errr on the side of caution and transport him to a hospital with interventional cath lab.

Geeez I dont even have a monitor but here he would have went to a hospital with a cath lab based soley on age, presentation and I bet if we dug a little we would find some history or risk factors present.

I mean its LA right, not familiar with this area but how much further could the cath lab be from where he went?

 

[JPINFV]

I mean its LA right, not familiar with this area but how much further could the cath lab be from where he went?

I believe a better question would be, "How much further from the recliner would it take the fire fighters?"

 

[MrBrown]

... and how much closer to providing some form of patient care would those fire fighters come?

 

[Aidey]

If the provider can't actually interpret an EKG and make a transportation decision based on their judgement does anyone really think getting them to efficently use 21st century data transfer devices is going to be easier?

Fair enough. I was thinking that if they aren't going to trust them to interpret an EKG and make an appropriate transport decision they might want a way to give the people making that decision the necessary information.

Maybe if they put pictures on the buttons it would work? ^_^

 

[terrible one]

was it LAco or city?
not surprised either way.

 

[thegreypilgrim]

was it LAco or city?
not surprised either way.

Actually it was neither one, but one of the several other municipal departments. I'd rather not publicly ID them though.

 

[jgmedic]

Actually it was neither one, but one of the several other municipal departments. I'd rather not publicly ID them though.

This has so much to do as well with the epic fail that is paramedic education in LACo(or most of SoCal), I mean doesn't PTI require a fire academy for admission into the medic program? Freeman used to be legit, but from what I've heard they have been run aground by FD interference. Over here in Riverside County, we just lost the ability for discretionary transport to STEMI centers without an AMI suspected on the 12L. Fortunately, as long as you call the STEMI center as your base and not the county hospital, the doctors there will often tell you just to come there.