Shady als calls given to bls. How do you deal?

[Anjel]

What they probably need is 911, not a private company though.

We are 911 and a private company.

 

[leoemt]

What they probably need is 911, not a private company though.

Why? What is a 911 call going to do that a private can't? I work for AMR and we run both fire calls and private calls to SNF's. We have the same skills as the engine and aid crews that show up on scene as well as the same equipment.

The SNF has RN's which are a higher level of care than paramedics. They can provide interventions as well. When I show up on scene I treat the call the same as any other call and make the decisions I have to make. If I need ALS they get ALS.

 

[NYMedic828]

Why? What is a 911 call going to do that a private can't? I work for AMR and we run both fire calls and private calls to SNF's. We have the same skills as the engine and aid crews that show up on scene as well as the same equipment.

The SNF has RN's which are a higher level of care than paramedics. They can provide interventions as well. When I show up on scene I treat the call the same as any other call and make the decisions I have to make. If I need ALS they get ALS.

Not 100% on this but I believe an RN at a SNF (which are usually not BSNs) can only provide interventions as far as basic CPR and medication administration of prescribed patient meds.

They can't decide to start an IV for example, on a patient without the orders of the overseeing doctor, who in my experience with SNFs, is never present.

I recognize that technically a paramedic is equally overseen I am not looking to start that debate, it isn't the point im making.



I don't quite understand why private vs 911 is an issue though. A paramedic is a paramedic doesn't matter who they work for. Their experience in treating may vary but thats everywhere...


I am a bit biased in this matter as my opinion of SNF nurses is nowhere near good.

 

[TRSpeed]

Why? What is a 911 call going to do that a private can't? I work for AMR and we run both fire calls and private calls to SNF's. We have the same skills as the engine and aid crews that show up on scene as well as the same equipment.

The SNF has RN's which are a higher level of care than paramedics. They can provide interventions as well. When I show up on scene I treat the call the same as any other call and make the decisions I have to make. If I need ALS they get ALS.

I believe what he means is that they need an immediate 911 unit to transfer the pt not a IFT unit that will have a longer ETA. But you must work where AMR provides the same level of care for 911 and IFT(I.e. BLS 911). HEre our transfer units are BLS and 911 are ALS. Also AMR btw. So they are different.

 

[leoemt]

Not 100% on this but I believe an RN at a SNF (which are usually not BSNs) can only provide interventions as far as basic CPR and medication administration of prescribed patient meds.

They can't decide to start an IV for example, on a patient without the orders of the overseeing doctor, who in my experience with SNFs, is never present.

I recognize that technically a paramedic is equally overseen I am not looking to start that debate, it isn't the point im making.


I am a bit biased in this matter as my opinion of SNF nurses is nowhere near good.

I agree with you about your opinion. However, some of the SNF's we go into are extremely good and have RN's that can do some pretty advanced stuff. However, this is usually because the patient has known needs that require the advanced procedures and doctors have signed off on it.

I have seen SNF's start IV's and administer meds in the past. I have also seen them contact doctors to get permission.

That is far and few though and when I arrive I am usually talking to a CNA that is giving me the 1000 yard stare because they understand less than I do.

 

[leoemt]

I believe what he means is that they need an immediate 911 unit to transfer the pt not a IFT unit that will have a longer ETA. But you must work where AMR provides the same level of care for 911 and IFT(I.e. BLS 911). HEre our transfer units are BLS and 911 are ALS. Also AMR btw. So they are different.

Your right...here in Seattle AMR provides equal level of care. We are on scene in less than 5 minutes most of the time whether it is a fire call, 911 call or SNF call. Our dispatchers are trained the same as 911 dispatchers and have the same certifications. They triage the calls the same as if you called 911 directly and will send the appropriate units and resources.

 

[JPINFV]

CVA's are BLS here unless they have airway compromise. Nothing ALS is going to do for a CVA - they need a Stroke center ASAP. ALS is going to delay the time it takes patient to get to definitive care.

Hypoglycemia is a stroke mimic.

Paramedics can rule out or treat hypoglycemia.

Moral of the story is that there's no such thing as a "CVA" until a glucose level has been obtained.

 

[Aidey]

Remember JP, this is King County.... Anything that can remotely be turfed to BLS is.

 

[usalsfyre]

The one problem with all this is that I've often found EMTs are poorly equipped to decide what's "in the best interest" of the average SNF patient.

 

[NorthCalEMT]

Welcome to BLS IFT. It happens. Learn to adapt to it, err on the side of caution, and above all have the patient's best interest be your main priority. It wastes time, like JP said, to sit around arguing with the nurses. Most of them think you're just a on call taxi service that will obey all commands because that's what your company's marketers/management promised them. Nothing will change that belief, trust me. They'll sit there and pull the "Well the Doctor said pt needs to go to this hospital 40 miles away BLS blah blah blah. Bottom line, limit your on scene time.

On a side note, today I found out some interesting information about the recently shut down Medlife ambulance is being investigated for. Apparently, a BLS unit was dispatched from VAN NUYS to a snf in PASADENA for, get this, "POSSIBLE CVA (Ok to go BLS). You would assume that even though they decided to make this call BLS, at least they would have the EMTs transport the patient to the designated stroke center exactly 1 Mile away from the snf. But no, patient was to be transported to an URGENT CARE 14 miles away.
Upon arrival of the EMTs, they told the facility prior to patient contact that they would be going to the stroke center, regardless of what the doctor who hadn't even seen the patient's presentation said. The nurse told them they can't do that and called the charge nurse. And can you guess what the patient presented as? Left sided facial droop with weak grips and pulls with inability to speak. After getting the patient on the gurney, the charge nurse came with the operations manager of MEDLIFE AMBULANCE on the phone telling the EMTs that if they didn't transport the patient to the URGENT CARE, they would be out of a job. They told him he couldn't do that and transported the patient to the stroke center. They didn't get fired but got written up for "spending too long on scene".

Apparently both those EMTs reported MEDLIFE AMBULANCE and the snf. Is it any coincidence that the company was shut down soon after? My point is that if you do the right thing, have all your bases covered and be a patient advocate, you can help in getting the companies and facilities that try to pull this kind of crap into the spotlight!
Good job for being a concerned EMT. We need more of those out there! Keep your head up.

Good reply! Your right about on-scene time. That story about MEDLIFE is nuts! SNF's might think they're sly, but when my certifications are on the line with certain calls - it's just not worth it. As an EMT-1 going to medic school, any sort of investigation is too risky... not to mention the fact that getting paid about $9/hr (again) isn't worth risking my career.

Besides that, my partner doesn't handle pressure very well and is a passive, unobservant person by nature. For example, we get a call to pick up an 84 y/o female for a fractured arm and take her about 2 or maybe 3 miles away. We show up, my partner splits to get some vitals while I get the usual info from the nurse. Now, this is where it becomes shady... I ask how she fractured her arm. Response given was "she fell". Next, I asked, when did she fall? only to receive the most suspicious answer(s) I have encountered in a while... "two days ago." I then ask the nurse her history and as I do I notice the patient has Alzheimer's and of course - general weakness. Then I ask if she's been given any medication... answered with a snappy "No! the file is right in front of you with all the answers you need." and as I'm looking through this file I notice norco given for shoulder pain so naturally I point it out and ask if she was given anything today. Anyway, I began suspecting something wasn't right from about 3 minutes into speaking with the nurses, the answer I received and shared here (as well as others I don't wanna bore any of you with), and the fact that the patient was hypertensive (without a history of it). Anyway we bring her to the ER, I give them the facts and relay the information I was given and told by the SNF nurses and long behold... as the cut off her shirt because of the edema was so bad in her right arm (again, no history of any health problems or edema), the RN and the tech gasp. Typically, IMO when ER nurses show an extreme interest in what I'm telling them, and request that I leave the run report (always do anyways) something isn't right. So, the hospital RN asked me again about where we picked her up from and the details of the call... I tell him and he motions me over to look at her shoulder as he's saying how she has a dislocated shoulder and the amount of bruising as well as the edema from the supposed fall couldn't have happened when the SNF said but, must have happened 4 or 5 days ago. Wrapping it up, he said he was calling social services and when I returned about an hour or so later with another patient he was still talking about it with another ER nurse.

Simply amazing what these SNF's get away with and the one with that call... apparently they have a reputation with that hospital for sending their residents with outrages injuries to...

I get that there's a fine line working in IFT with regards to your duty to act, as well as report but, at the same time to take the patient so they get paid. However, $9/hr ...not worth an indefinite ban for a B.S. ALS call passed off to BLS.

 

[NorthCalEMT]

Not sure. The guy who told me about it didn't say where it was. Is that on convalescent row off Fair Oaks? Lol

El encanito or something like that in whittier

 

[NorthCalEMT]

What happens to my patient is my responsibility and my choices. Dispatch doesn't dictate what happens on my truck.

100% agree. And it may be time for me to look elsewhere for work until medic school starts since I had an interesting conversation with my supervisor today. He basically said: you're new with this company and need to earn the right to rush code 3. followed with: You don't call ALS or report anyone unless going through me first.

That right there my friends... is what I like to say: 'the writing is on the wall'

 

[usalsfyre]

100% agree. And it may be time for me to look elsewhere for work until medic school starts since I had an interesting conversation with my supervisor today. He basically said: you're new with this company and need to earn the right to rush code 3. followed with: You don't call ALS or report anyone unless going through me first.

That right there my friends... is what I like to say: 'the writing is on the wall'

We actually have a similar policy. The reason? A huge problem with inappropriate reporting, diversions and utilization by self-rightous inexperienced EMTs....

 

[Aidey]

... He basically said: you're new with this company and need to earn the right to rush code 3. followed with: You don't call ALS or report anyone unless going through me first.

That right there my friends... is what I like to say: 'the writing is on the wall'

I'm failing to see the problem with any of this. You're new and the company has policies. What is the problem?

 

[NorthCalEMT]

We actually have a similar policy. The reason? A huge problem with inappropriate reporting, diversions and utilization by self-rightous inexperienced EMTs....

The problem I have with what was said wasn't as much with the code 3 (although that added to it), but the main issue was when my supervisor said, "you go through me before you report anyone. You only suspected them, you didn't see gross negligence or abuse (i.e. the staff throwing a resident to the floor)".

So I looked it up because I knew he was wrong. Sure enough ---> I forget the exact wording (and don't want to look it up as this is my last post before I hit the sack) but the law states specified anyone who witnesses or SUSPECTS negligence, or abuse must report it. however, if one person of the party files a written, the other may file via the phone.

That's essentially what I read earlier today again minus certain elaborations.

Long story short... I don't think anyone has the right to infringe on a confidential process like reporting to social services. Worst case scenario... someone unintentionally abuses the system. well, the employer should consider a training regarding form of abuse, etc. Or let's say someone reports frequently and nothing comes from most but, others yield some abuse. I'd say that was well worth it. Besides if SNF's are doing what they're suppose to do especially with our nations most easily victimized and rapidly growing population than who cares if a social worker drops in unannounced to audit or inspect them. who know.... maybe the word might get around to the shadier SNF's that social services has been auditing... I'm sure some of the Shady in those places might get somewhat cleaned up. I view it as a win-win in my above explanation.

I could be completely wrong with my opinion or what I suggest may be illegal. If it is, I welcome the corrections.


P.S. never thought my question would get such a huge response!

 

[NorthCalEMT]

I'm failing to see the problem with any of this. You're new and the company has policies. What is the problem?

Code 3 (not too worried)

Reporting- if he was imposing this regarding inexperienced self-righteous emt's I'd understand, would I agree no... however, I'm arguing against that policy on the basis of: the law states witnessed or suspected abuse should be reported. all of which is confidential and my supervisor is attempting to remove the confidential aspect of it.

I know they're a lot of questionable emt's out there and by no means am I the best, but when someone walks like a duck and quacks like a duck it's usually a duck. Being new in this field has nothing to do with being observant and being able to realize when a nurse keeps changing the date of the patients fall. I don't roll to every call hoping to find abuse going on, but when somethings not right + shifty RN answers... not to mention the documentation for the pt was incomplete and didn't add up. For example: pt had no hx of edema however, she had edema in her right arm. RN tried to debate that she had a hx of edema and couldn't tell me why it wasn't in the pt. file going with us to the er.

 

[NorthCalEMT]

I'm failing to see the problem with any of this. You're new and the company has policies. What is the problem?

Company policy does not override law. I may be new to this company but I'm not new to knowing when something isn't right especially when it's as obvious as it was with the elder abuse. I cant remember, but If I didn't drop that story in this thread I'll type it up tomorrow for anyone and everyone who is interested to draw their own conclusions. I welcome constructive criticism, advice, and or suggestions.

 

[JPINFV]

We actually have a similar policy. The reason? A huge problem with inappropriate reporting, diversions and utilization by self-rightous inexperienced EMTs....

The problem with reporting is that if I suspect abuse, then my hands are tied. I. DON'T. HAVE. A. CHOICE. I'm required, by law, to report it. EMTs (at least in California) are specifically mentioned in the mandated reporter law, so this isn't an "including, but not limited to" argument. I don't have a choice to either not report it, or run it through a supervisor. The supervisor isn't mandated to report it, I am.

/Yes, I've played that game once... unfortunately.

 

[JPINFV]

So I looked it up because I knew he was wrong. Sure enough ---> I forget the exact wording (and don't want to look it up as this is my last post before I hit the sack) but the law states specified anyone who witnesses or SUSPECTS negligence, or abuse must report it. however, if one person of the party files a written, the other may file via the phone.

In California if it's a team, one report can be made for the entire team. In general, there's supposed to be a phone report made within 24 hours and, if I remember correctly, a written submitted within 72 hours. I carried a kit with me with my county's mandated reporter policy (which included how to make reports), a company incident report form, the mandated reporter form, an a preaddressed stamped envelope so that I could complete the process before I even cleared the hospital.

Long story short... I don't think anyone has the right to infringe on a confidential process like reporting to social services.

Oh, you think it's a confidential process? How many other crews were treating John Doe at ABC SNF on 12/1/12 at 1300? Heck, how many crews were at ABC SNF on 12/1/12 at 1300?

 

[NorthCalEMT]

The problem with reporting is that if I suspect abuse, then my hands are tied. I. DON'T. HAVE. A. CHOICE. I'm required, by law, to report it. EMTs (at least in California) are specifically mentioned in the mandated reporter law, so this isn't an "including, but not limited to" argument. I don't have a choice to either not report it, or run it through a supervisor. The supervisor isn't mandated to report it, I am.

/Yes, I've played that game once... unfortunately.

Mandated reporter was the word I was looking for early this morning... and this post of yours states exactly what I was attempting to say in the previous post. Spot on JPINFV