True, no argument about that....everything must be documented.
Shady Companies In LA City
- Thread starter MusicMedic
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True, no argument about that....everything must be documented.
You forgot about West Coast Ambulance, the shadiest of them all!
or work with CARE Ambulance. They are legit and well respected.
justforfun1795
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Just cause someone tells you to do something, does not mean you should do it. If the call is shady, just say no!
I worked for Care years ago, and while with them, I was never once sent to a call as a BLS IFT that had any remote possibility of needing ALS. I assume part of that was because Care had 911 contracts, so they had a lot to lose if they got auditing and that they got many 911 in their jurisdiction anyway.
I've also worked, for a very short time, for an IFT only, BLS company in LA (County first then later they got LA City DOT permit). That company pulled many "shady" acts. It wasn't that the owners didn't care, it was that they cared more about money and the consequences to them were nill. County did not care and they could always just blame the EMTs.
I was repeatedly sent to calls that were illegal for me to have taken, so quess what I DID NOT TRANSPORT! When I arrived on scene and the chief complain was chest pain. I told the nurse at the snf she HAD to call 911 PER LA COUNTY POLICY (that's the policy I was taught anyway). When I was told to PICK-up a patient but that location was Los Robles hospital, I knew that was Ventura County and that Ventura EMS REQUIRED ambulance to be licensed in Ventura and EMT's running in Ventura to have County cards, so I REFUSED THE CALL! The onus is on me in these case to know better. If I had taken these calls, I would be just as guilty as the company. I refused a couple more cardiac patients, demanding 911 ALS. Every time, I was backed up by Fire when they arrived on scene who told the snf nurse we (BLF IFT) are not allowed to take a chest pain patient.
If your boss tells you to mark every patient as non-ambulatory, but you do not agree, then DO NOT mark it!
I was never mean to the nurse or my boss, I politely and quickly explain the situation and what needed to be done. The nurse and my company always argued with me, but I stood my ground.
Any EMT that participates in these shady calls are at fault too! Don't think these companies would not hang you out to dry if they ever did get in hot water. It is your job to assess the patient. Your supervisor will claim they were not on scene, so how could they really know what was going on. The nurse is likely to also claim that you should know what patients you can take, not her. Don't expect that "my boss told me to do it" is going to stand up in court! Your certification is proof that you know better.
If you are sent to a call you know you shouldn't be taking, then DON'T TAKE THE PATIENT. Use your personal cell phone to call 911 if the nurse will not! And do not leave until 911 gets there to take over!
Do not allow these companies to do this. Do not allow yourself to be just as shady as these companies you condemn. If every EMT grew a backbone and learned to just say no, this would not be a problem.
Remember, the EMT takes ALL THE RISK (you are responsible for assessment and determination of additional resources, ie ALS and rapid transport=911) and the company gets ALL THE MONEY.
I worked for Care years ago, and while with them, I was never once sent to a call as a BLS IFT that had any remote possibility of needing ALS. I assume part of that was because Care had 911 contracts, so they had a lot to lose if they got auditing and that they got many 911 in their jurisdiction anyway.
I've also worked, for a very short time, for an IFT only, BLS company in LA (County first then later they got LA City DOT permit). That company pulled many "shady" acts. It wasn't that the owners didn't care, it was that they cared more about money and the consequences to them were nill. County did not care and they could always just blame the EMTs.
I was repeatedly sent to calls that were illegal for me to have taken, so quess what I DID NOT TRANSPORT! When I arrived on scene and the chief complain was chest pain. I told the nurse at the snf she HAD to call 911 PER LA COUNTY POLICY (that's the policy I was taught anyway). When I was told to PICK-up a patient but that location was Los Robles hospital, I knew that was Ventura County and that Ventura EMS REQUIRED ambulance to be licensed in Ventura and EMT's running in Ventura to have County cards, so I REFUSED THE CALL! The onus is on me in these case to know better. If I had taken these calls, I would be just as guilty as the company. I refused a couple more cardiac patients, demanding 911 ALS. Every time, I was backed up by Fire when they arrived on scene who told the snf nurse we (BLF IFT) are not allowed to take a chest pain patient.
If your boss tells you to mark every patient as non-ambulatory, but you do not agree, then DO NOT mark it!
I was never mean to the nurse or my boss, I politely and quickly explain the situation and what needed to be done. The nurse and my company always argued with me, but I stood my ground.
Any EMT that participates in these shady calls are at fault too! Don't think these companies would not hang you out to dry if they ever did get in hot water. It is your job to assess the patient. Your supervisor will claim they were not on scene, so how could they really know what was going on. The nurse is likely to also claim that you should know what patients you can take, not her. Don't expect that "my boss told me to do it" is going to stand up in court! Your certification is proof that you know better.
If you are sent to a call you know you shouldn't be taking, then DON'T TAKE THE PATIENT. Use your personal cell phone to call 911 if the nurse will not! And do not leave until 911 gets there to take over!
Do not allow these companies to do this. Do not allow yourself to be just as shady as these companies you condemn. If every EMT grew a backbone and learned to just say no, this would not be a problem.
Remember, the EMT takes ALL THE RISK (you are responsible for assessment and determination of additional resources, ie ALS and rapid transport=911) and the company gets ALL THE MONEY.
JPINFV
Gadfly
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Yes. It is against protocol for an IFT unit to be dispatched to a 911 call (Principal 1). That's where the righteous indignation over protocol ends, though (and trust me, I know a thing or two about righteous indignation). However, when a patient is suffering from a medical emergency, and in your good judgement, the patient is better off being transported BLS rather than waiting for paramedics (based off of ETA of paramedics and estimated transport time), then protocol dictates transport (Principal 7).
As an EMT and not a dispatcher, I can not imagine any way you can violate the protocol dictating IFT units not being dispatched to 911 calls. It's simply not your responsibility. In contrast, I can't see how, "Well, they should have called 911 in the first place, so we're going to sit on scene for 7 minutes waiting for paramedics instead of transporting to the hospital 5 minutes away" is showing "good clinical judgement" required under the transport protocol.
When I was told to PICK-up a patient but that location was Los Robles hospital, I knew that was Ventura County and that Ventura EMS REQUIRED ambulance to be licensed in Ventura and EMT's running in Ventura to have County cards, so I REFUSED THE CALL! The onus is on me in these case to know better. If I had taken these calls, I would be just as guilty as the company. I refused a couple more cardiac patients, demanding 911 ALS. Every time, I was backed up by Fire when they arrived on scene who told the snf nurse we (BLF IFT) are not allowed to take a chest pain patient.
Finally, if you want to play the righteous indignation game (nothing wrong with being a gad fly), have your ducks in a row. All of LACo's protocols are online. Go off of them and not what some random person says (and don't go off what I say, go off of what I -linked.-)
It's not that simple, and to claim it's that simple completely moves you off of any high ground you have. You treat the patient in front of you, regardless of how much of a mistake the dispatch office made in accepting and dispatching that call.
thegreypilgrim
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Every last one of them (and yes, I work for one) should have their licenses revoked, be subjected to a scornful investigation from LADHS, USHHS, and possibly even the LA County District Attorney's Office. Beyond that legislation should be passed prohibiting such organizations from incorporating unless they are operated on a not-for-profit basis or as some other highly regulated public utility.
They're a bottom-feeding, blood-sucking scourge upon the earth barely above the status of a racketeering syndicate. And as evinced by our resident poster, looker, they are bereft of even a modicum of professional ethics or scrupulous business practices. It's a deplorable situation that should not be permitted to continue to exist.
They're a bottom-feeding, blood-sucking scourge upon the earth barely above the status of a racketeering syndicate. And as evinced by our resident poster, looker, they are bereft of even a modicum of professional ethics or scrupulous business practices. It's a deplorable situation that should not be permitted to continue to exist.
justforfun1795
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Yes it that simple! Two wrongs do not make a right. Just cause dispatch sent you to a call does not make it right or legal. If ALS is needed, don't just go, "well dispatch sent me, I just take them anyway" That's wrong and it really is that simple!
It's rare that an EMT ETA to hospital is less that fire's arrival time. And this certain was not the case in my experience. People are citing it like it is the get out of jail free card that applies every time! It is very rare that is the case, especially in LA city! Maybe in a rural area where Fire is an hour away, but we are talking about LA here. The LA 911 system is designed that response is 10 minutes or less from when DISPATCH gets the call.
You are clearly just trying to justify your own shady behavior and no one is buying it, hence why that vast majority of people here think of companies as shady!
I'm sure many have stood up to them, but too many others are all talk and no action.
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JPINFV
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Does it apply every time? No. Does it apply often? Yes. Yea, the response time is short, but how long is your average transport time to the closest facility? While I'm more familiar with Orange County than LA County, both have a rather high number of emergency departments for geographical area. For a lot of LA County, you aren't going to be too terribly far from a hospital.
justforfun1795
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LA county scope of practice for EMT does clearly list scenarios that require ALS and rapid transport, which is NOT BLS IFT! See if for yourself. LA does have very clear protocols, but very few bother to read them thoroughly.
Go to the county website and read everything carefully that is part of the prehospital care policy manual. It explains how if BLS arrives before ALS, then ALS must NOT be canceled and if ALS has not been request it must be. Contacting them is the only sure way to know what their arrival time is at that very moment in question! If you don't, when you stand up in court and try to say, "our ETA was faster than arrival time" the lawyer suing you will ask "How did you know what paramedic's arrival time was? Did you contact 911 dispatch to find out?"
LA county clearly spells out what meats "base contact" (direct hospital contact) criteria. BLS companies do NOT even have base hospitals. In order to contact base, you must be a paramedic, thus it requires ALS. This includes (taken from LA county prehosiptal care manual, which is available online and I highly suggest everyone look it up for themselves! It is readily available on the LA County DHS EMS website)
BASE HOSPITAL CONTACT (EMT-I/PARAMEDIC/MICN) AND TRANSPORT CRITERIA REFERENCE NO. 808
Signs or symptoms of shock
B. Cardiopulmonary arrest (excluding patients defined in Ref. Nos. 814 and 815)
C. Chest pain or discomfort
D. Shortness of breath and/or tachypnea
E. Pediatric Medical Care (PMC) guidelines as defined in Ref. No. 510
F. Situations involving five or more patients who require transport (Contacting the Medical Alert Center constitutes base hospital contact)
G. Altered level of consciousness as defined in the Medical Control Guidelines H. Suspected ingestion of potentially poisonous substances I. Exposure to hazardous materials with a medical complaint J. Abdominal pain in a pregnant or in a suspected pregnant patient
K. Childbirth or signs of labor L. Suspected fractures of the pelvis or femur M. Facial, neck, electrical, or extensive burns:
1. 2. 3.
20% or greater BSA in adults 15% or greater BSA in children 10% or greater BSA in infants
N. Trauma Triage Criteria and Guidelines as defined in Ref. No. 506.
O. Traumatic Crush Syndrome
P. Syncope or loss of consciousness, or acute neurological symptoms (i.e., blurred vision, weak and dizzy, numbness, etc) prior to or upon EMS personnel arrival.
Q. A patient meeting any criteria in Section I who refuses transport against medical advice (AMA). Base contact is required prior to the patient leaving the scene.
You DO NOT get out of this base contact requirement by using the ETA less that arrival time! That policy also dictates that EMTs must contact the MAR when they do transport before ALS arrival under that policy. How many EMTs actually try to do that? How many even knew they had to?
Go to the county website and read everything carefully that is part of the prehospital care policy manual. It explains how if BLS arrives before ALS, then ALS must NOT be canceled and if ALS has not been request it must be. Contacting them is the only sure way to know what their arrival time is at that very moment in question! If you don't, when you stand up in court and try to say, "our ETA was faster than arrival time" the lawyer suing you will ask "How did you know what paramedic's arrival time was? Did you contact 911 dispatch to find out?"
LA county clearly spells out what meats "base contact" (direct hospital contact) criteria. BLS companies do NOT even have base hospitals. In order to contact base, you must be a paramedic, thus it requires ALS. This includes (taken from LA county prehosiptal care manual, which is available online and I highly suggest everyone look it up for themselves! It is readily available on the LA County DHS EMS website)
BASE HOSPITAL CONTACT (EMT-I/PARAMEDIC/MICN) AND TRANSPORT CRITERIA REFERENCE NO. 808
Signs or symptoms of shock
B. Cardiopulmonary arrest (excluding patients defined in Ref. Nos. 814 and 815)
C. Chest pain or discomfort
D. Shortness of breath and/or tachypnea
E. Pediatric Medical Care (PMC) guidelines as defined in Ref. No. 510
F. Situations involving five or more patients who require transport (Contacting the Medical Alert Center constitutes base hospital contact)
G. Altered level of consciousness as defined in the Medical Control Guidelines H. Suspected ingestion of potentially poisonous substances I. Exposure to hazardous materials with a medical complaint J. Abdominal pain in a pregnant or in a suspected pregnant patient
K. Childbirth or signs of labor L. Suspected fractures of the pelvis or femur M. Facial, neck, electrical, or extensive burns:
1. 2. 3.
20% or greater BSA in adults 15% or greater BSA in children 10% or greater BSA in infants
N. Trauma Triage Criteria and Guidelines as defined in Ref. No. 506.
O. Traumatic Crush Syndrome
P. Syncope or loss of consciousness, or acute neurological symptoms (i.e., blurred vision, weak and dizzy, numbness, etc) prior to or upon EMS personnel arrival.
Q. A patient meeting any criteria in Section I who refuses transport against medical advice (AMA). Base contact is required prior to the patient leaving the scene.
You DO NOT get out of this base contact requirement by using the ETA less that arrival time! That policy also dictates that EMTs must contact the MAR when they do transport before ALS arrival under that policy. How many EMTs actually try to do that? How many even knew they had to?
justforfun1795
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you know you spend waaayyy too much time online when you can't even bother to use real words. Clearly you don't like real life. Feel free to continue arguing your "points" or posting pictures when you don't have one.
The rest of us all clearly agree and can see the situation for what it really is and can rise above it.
The rest of us all clearly agree and can see the situation for what it really is and can rise above it.
JPINFV
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1. How many people do you personally know have been successfully sued for a 5 minute transport time for not calling paramedics? Not "I've heard through the grapevine." Not "but but but it could happen." First hand knowledge?
2. "7. In life-threatening situations in which the estiamted time of arrival (ETA) of the paramedics exceeds the ETA of the most accessible receiving facility (MAR), EMT-Is [EMT-1s aka EMTs. EMT-I is now antiquated nomenclature] should exercise their clinical judgement as to whether it is in the patient's best interest to be transported prior to the arrival of paramedics. EMT-Is shall make every effort to notify the MAR via the Hospital emergency Administrative Radio Radio (HEAR), telephone, dispatch, or other appropriate means of communication when exercising this principle."
-http://ems.dhs.lacounty.gov/policies/Ref800/808.pdf
Gee, a few things pop out. First, this protocol puts no requirement for EMT-Is to contact a base hospital. Second, it includes telephone or dispatch as appropriate methods of communication. Third, it requires "every effort" for the EMT. If the company is so shady as to not provide a way, including through dispatch, to contact the receiving facility, then the issue is with the company, not with the EMT. The EMT has made every effort available, but the company choose not to provide proper methods. Fourth, the protocol calls for use of clinical judgement. Estimated ETA is just that. Based on the closest fire station, what is the ETA? Similarly, call 911 and request an ETA. It can be done. If you want to make an argument that EMTs are incapable of making judgement calls, then I'm all ears. Also, please stay off of any and every ambulance until you can do so.
Actually, based on a strict reading of protocol 808, you do get out of base hospital if you are unable to do so. Additionally see the above. For the company I worked for in Orange County, unless you were looking at an insanely short (less than 1 minute) ETA, the ED was contacted for every patient going to the ED, every time, through dispatch. If your company is that screwed up that there is no method to contact the hospital at all, then quit.
JPINFV
Gadfly
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Next time you want to complain about the grammar is my posts, or more laughably the grammar in meme pictures, you might want to proof read your own post. I've taken the time to make some modification, which I've placed in bold.
1. Appeal to majority (which doesn't exist).
2. Ad hominem.
3. Pot meet kettle. Also, I love your (since you brought this up) confusion between "meat" and "meet" in your prior post.
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You do realize that every single provider does some form of IFT. The last time I checked doing ambulance transportation for those that needing is providing proper care. What do you suggest those that need ambulance use? A taxi?
I would love to know what is you definition of bottom-feeding? Not everyone can do 911 yet there are plenty of people that need ambulance service. I guess you feel those people should be out of luck?
thegreypilgrim
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If you read closely, you'll notice I'm not disparaging the utility of IFT as a patient care service. In fact, I recognize it as an important and necessary.
No, what I would like is a way of providing such services to these patients which does not insult their dignity as persons, which is essentially what the sort of organizations providing IFT services for-profit in the Greater Los Angeles County do. It's not IFTs in and of themselves, looker, it's the grossly unethical, inefficient, and counterproductive way it is handled that I take issue with.
I am bit confused being you're not going in to much detail. A crew let say comes to NFS and picks up a patient and transport(s) them to dialysis service, hospital etc. Once they are done an ambulance take them back. What is grossly unethical, inefficient, underproduction about this? During transport patient is monitored by emt/medic depending on lvl of ambulance.
thegreypilgrim
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Explain to me what is ethical or in accordance with proper business practice as any of the following:
(1) Accepting calls from SNFs or urgent care facilities which should have been 911 activations from the start without any caller interrogation - leaving the patient to suffer with whatever progressively worsening problem they've got and creating needless delays in care.
(2) Restricting access to supplies and forcing crews to go into service with defective/missing equipment.
(3) Ignoring service dates and/or mileage markers for vehicle maintenance.
(4) Creative billing practices.
(5) Holding crews accountable for the lackluster appearance of ambulances that should have been retired 200K miles ago and look as though were once used in some sort of crash derby event.
(6) Consistently and predictably making accounting errors on crew's paychecks which mysteriously always seem to work in the company's favor.
(7) Refusing to reimburse employees for expenses they incurred as means of employment (renewing certifications, etc.)
Should I go on? What sort of organizations in the world of EMS do the above remind one of without even having to think about it to any great extent?
1-3 and 5-6 no justification.
4) Depends if it legal or not. You can say same thing but using "creative way of saying" to get paid.
7) I do not see a problem with that. You need to have certificates to perform your work. Now if it's internal requirement that is totally different.
Care about what? Did you not do your homework before you decided to become emt?
obviously not well enough. i expected the low pay, education and respect. knew i wanted to medic and keep going further. but didnt find out about how easy it is to lose cert's, job through lawsuits and such until almost done with EMT school. however i didnt expect to hear about shady practices like fakeing calls or what not. i am not accusing anyone of anything here! like i said, im babyfresh in EMS. there's alot i gotta learn, see for myself, so on. just bummed. not gonna quit, i know better than to let others make up my mind for me. and real change happens from within, happens slowly.
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