the 100% directionless thread

DesertMedic66 said:
It could save 30 minutes or it could save several hours if you get hit on bed delay. But it should also reduce the amount of times these patients are seen in the ED. There are other systems built in to have the patient referred to services that are better able to help them such as mental health or public nursing/community paramedicine
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Bed delay? Waiting in triage for a bed to open up?

Are these services widespread enough to be generally efficiently and available to the public that "It was the only way to be seen" isn't a valid excuse? I guess the county and MD thinks so

Peak said:
There is an EMTALA term for it: Was Refused Care.

If this was done in an ED it would be a blatant violation of EMTALA as a medical screening exam must be performed by an LIP.

Even if we discharged a completely BS complaint 20 minutes ago, if the patient checks in with a new complaint we are obligated to perform a medical screening exam before we can tell them to leave.
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Ah. My third guess was going to be CRR. Crew Refused Care.

LIP?

Does a worsening complaint count as new? "It's hard to breathe" vs "I can't breathe" count?
 
Licensed Independent Practitioner. Physicians, sometimes NPs depending on the state.

That becomes a sticky question, and depends on their evaluation. It is something physicians have certainly been on the wrong side of the gray area before and either had to settle out of court or have lost lawsuits.

The hard thing is that subjective dyspnea may still be life threatening even with normal vital signs and a normal physical exam. A patient could for example have pulmonary hypertension and right sided failure but have a normal respiratory exam, but this still presents an acute life threatening situation.

Even a complaint of nausea and mild abdominal pain can be a tricky presentation. I took care of a young lady that we diagnosed with stage 4 gastric cancer only because she had so many bounce backs at another ED for dyspepsia and we decided to CT her. If we hadn't done that she probably would have been dead within days to weeks and we could have been liable for missing a life threatening condition.

Refusals sound great until you remember how litigious the united states is.
 
Peak said:
Licensed Independent Practitioner. Physicians, sometimes NPs depending on the state.

That becomes a sticky question, and depends on their evaluation. It is something physicians have certainly been on the wrong side of the gray area before and either had to settle out of court or have lost lawsuits.

The hard thing is that subjective dyspnea may still be life threatening even with normal vital signs and a normal physical exam. A patient could for example have pulmonary hypertension and right sided failure but have a normal respiratory exam, but this still presents an acute life threatening situation.

Even a complaint of nausea and mild abdominal pain can be a tricky presentation. I took care of a young lady that we diagnosed with stage 4 gastric cancer only because she had so many bounce backs at another ED for dyspepsia and we decided to CT her. If we hadn't done that she probably would have been dead within days to weeks and we could have been liable for missing a life threatening condition.

Refusals sound great until you remember how litigious the united states is.
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I was about to ask a question you literally spelled out. I dunno what's up with my comprehension tonight.

Am I the only one who finds random bruises? Found one on my head today among other places. ...

That reminds me of a teacher I had. Her son was getting sick. He was 12 ish? First it was just a cold. Then it was something else. They told her not to worry. He kept getting sicker. It got to the point she refused to leave until they found the problem. Stage 4 cancer. He lived though. But it was tough. He's better now.

And if you couldn't tell, that's the play-dead opossum I was poking with this here stick. One of them. Liability Schmiability.
 
Peak said:
There is an EMTALA term for it: Was Refused Care.

If this was done in an ED it would be a blatant violation of EMTALA as a medical screening exam must be performed by an LIP.

Even if we discharged a completely BS complaint 20 minutes ago, if the patient checks in with a new complaint we are obligated to perform a medical screening exam before we can tell them to leave.
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Yep. EMTALA is a double-edged sword. It allows for abuse of the ED and it can also create delays in getting a patient to the appropriate level of care because the ED is obligated to perform a medical screening exam and any necessary labs/imaging to accomplish this. Once we know the patient needs care we can't provide, we're obligated to transfer to a facility that can provide that necessary emergent care. Sometimes it's waiting for transport that delays things... though 911 and sending appropriate staff is an option.
DragonClaw said:
Bed delay? Waiting in triage for a bed to open up?
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Or holding a wall until a bed opens up. The cause of a bed delay can be that the ED is actually full and they're waiting on patients to be discharged or transferred to a floor/unit and then the room/bed to be cleaned for the next patient. Sometimes there are physical beds available and not enough staff to provide care, the effect is the same: ED is full. Closing the ED (diversion) to ambulance traffic isn't done in my area very often now, but it's still done and they absolutely hate doing it. I have, in years past, "suggested" that a patient I had on board would be appropriate for lobby triage and not necessarily triage at the ambulance entrance... and I've rarely been wrong on that.
 
Peak said:
Refusals sound great until you remember how litigious the united states is.
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So true, and even more so in California.
 
In LA at least, it was an every day, every shift occurrence to have ambulance crews waiting with patients on their gurneys for hours because the ED was full, and hospitals were unwilling to offload those patients into the waiting room. It wasn't uncommon for multiple ambulance crews each waiting 2-3 hours.

While individually we didn't see toooo many 911 abusers, we all knew people that called practically everyday, that we all could fill out the history/allergies/meds/etc from memory. And not because they had chronic medical conditions...
 
Jim37F said:
In LA at least, it was an every day, every shift occurrence to have ambulance crews waiting with patients on their gurneys for hours because the ED was full, and hospitals were unwilling to offload those patients into the waiting room. It wasn't uncommon for multiple ambulance crews each waiting 2-3 hours.

While individually we didn't see toooo many 911 abusers, we all knew people that called practically everyday, that we all could fill out the history/allergies/meds/etc from memory. And not because they had chronic medical conditions...
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Were they all allergic to acetaminophen, ibuprofen, ketorolac, and haldol?
 
May or may not have used my tax returns and some OT as a down payment for a (new to me) diesel truck...
 
StCEMT said:
The temptation to get a new truck started getting me the other day, but the whole no car payment thing is pretty sweet.
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Yeah... it kinda hurts paying the bank again to borrow the truck month to month. My other truck has been paid off for a while now, liability insurance, cheap as hell to drive, just gas and preventative maintenance.

But my payment is $540 a month, with insurance for both trucks at $214. So pretty much a new truck for under $800 a month.
 
CALEMT said:
Yeah... it kinda hurts paying the bank again to borrow the truck month to month. My other truck has been paid off for a while now, liability insurance, cheap as hell to drive, just gas and preventative maintenance.

But my payment is $540 a month, with insurance for both trucks at $214. So pretty much a new truck for under $800 a month.
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Yea but $800/month is a significant portion of my discretionary income. I'd be pretty tapped out with that.
 
Partner and I want to go on a skiing/hiking trip. Can you ski all year long? Without going too far north like Maine, NY, ND etc where are good spots? Do people ski in the Appalachian and Smokies or just really the rockies? Suggestions?
 
An extra 30 hours of PTO appeared on this pay stub. I like this number a lot more. 😂
 
Theres nothing like the feel of a fresh haircut.
 
CALEMT said:
Theres nothing like the feel of a fresh haircut.
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Yerp. #FauxHawk...
 
Rano Pano said:
Preach. First cut recently since shaving my head during this pandemic and it felt great.
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I got a haircut in November. I had it above my jawline. Now it's getting down my back. Because my hair grows fast (at least an inch a month) I can't cut it during a pandemic. It was pretty uncommon to wear an N95 before, so if I get a pixie cut or anything short it will quickly grow to the point I can't put it in a ponytail but it's long enough to constantly get in my face and under a mask seal.
 
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