Why private industry has no business in EMS

[VentMedic]

Elective cosmetic surgery.

That could affect alot of our soldiers where their insurance have now agreed to surgeries that can restore them to a better appearance although they may not be medically necessary. The same for some prosthetics.

Diseases that are unambiguously the fault of bad decisions by the person.

There are many decisions made by people every day including driving a car that could also be considered "bad" if it was not for some absolute necessity. Also, should a child be denied because of the bad decisions of the parents? Maybe the babies born with the severe birth defects be euthanized or have medical care withheld since their parents did drugs and alcohol. Look at the enormous cost for a Specialty team to transport one of these babies knowing they will never become productive citizens and will require millions of dollars in care during their lifetime.

 

[JPINFV]

That could affect alot of our soldiers where their insurance have now agreed to surgeries that can restore them to a better appearance although they may not be medically necessary. The same for some prosthetics.

Ok... what ever the terms that need to be used to differentiate between reconstructive surgery and a breast enhancement surgery or face lift.

There are many decisions made by people every day including driving a car that could also be considered "bad" if it was not for some absolute necessity. Also, should a child be denied because of the bad decisions of the parents? Maybe the babies born with the severe birth defects be euthanized or have medical care withheld since their parents did drugs and alcohol. Look at the enormous cost for a Specialty team to transport one of these babies knowing they will never become productive citizens and will require millions of dollars in care during their lifetime.

There comes a point, though, where personal responsibility needs to come in to play. People shouldn't be able to get a free ride when there was things that they could have done to prevent injury and disease. Yes, things happen, but drunk drivers, for example, should be liable at the very least in part for the cost of the injuries they cause.

 

[VentMedic]

Ok... what ever the terms that need to be used to differentiate between reconstructive surgery and a breast enhancement surgery or face lift.

So it is okay for a male soldier to have a little work done to make whatever was damaged but if it is a female it is wrong even if it is done post accident or defect? The reconstruction to some function has been done at military hospitals but the question is do we leave them disfigured which would then fall into the catagory of comestic surgery by privately contracted specialists? I guess since you would call that cosmetic, these soldiers should just do without.

There comes a point, though, where personal responsibility needs to come in to play. People shouldn't be able to get a free ride when there was things that they could have done to prevent injury and disease. Yes, things happen, but drunk drivers, for example, should be liable at the very least in part for the cost of the injuries they cause.

Who is to be the judge on right or wrong? Marijuana may soon be legalized and where does that place those who you consider wrong the day before and the day after legalization? Drunk drivers can be held liable for the cost of injuries they cause but once they are in jail, their ability to pay is rather limited. Anybody can be held liable by a court judgement for just about anything.

If I work with an EMS partner who smokes and develop some airway disorder like Asthma or COPD, who is responsible? Should I requested he stop smoking when working on the truck and at the station even if it is his right to smoke? (Yes, in some areas you can still smoke even when driving the ambulance.) We all know we don't want to impinge upon the rights of the smoker. If you over eat and are overweight should you pay the full costs of your medical bills for your MI and should the ambulance have the right to refuse to treat your chest pain because you are fat? Who will be the judge and jury?

For the hospitals, private companies and FDs that have banned smokers and have instituted fitness programs, there will always be those to criticize and justify their "rights" to do whatever.

 

[rescue99]

That could affect alot of our soldiers where their insurance have now agreed to surgeries that can restore them to a better appearance although they may not be medically necessary. The same for some prosthetics.



There are many decisions made by people every day including driving a car that could also be considered "bad" if it was not for some absolute necessity. Also, should a child be denied because of the bad decisions of the parents? Maybe the babies born with the severe birth defects be euthanized or have medical care withheld since their parents did drugs and alcohol. Look at the enormous cost for a Specialty team to transport one of these babies knowing they will never become productive citizens and will require millions of dollars in care during their lifetime.

Now you're being silly. War injuries and children are victims of events. Drunks who falll down go boom is not an plausable excuse to get a new nose! Choosing to be a welfare queen is not a plausable excuse to stay that way. Fields need picking and streets need cleaning....earn the medical coverage!

I'll am happy to pay my share of taxes to bridge those who cannot help themselves due to significant illness, injury, age, accident or unavoidable circumstance. I would be more than happy to bridge those who help themselves. Paying for drunks, druggies and those who won't help themselves is not what our programs were ever meant to support.

 

[VentMedic]

Now you're being silly. War injuries and children are victims of events. Drunks who falll down go boom is not an plausable excuse to get a new nose! Choosing to be a welfare queen is not a plausable excuse to stay that way. Fields need picking and streets need cleaning....earn the medical coverage!

I'll am happy to pay my share of taxes to bridge those who cannot help themselves due to significant illness, injury, age, accident or unavoidable circumstance. I would be more than happy to bridge those who help themselves. Paying for drunks, druggies and those who won't help themselves is not what our programs were ever meant to support.

I am ABSOLUTELY NOT being silly.

These are ethical questions discussed everyday in every NICU in this country as well as others. What do we or should we consider viable? We also discuss these everyday when trying to approach end of life issue for the very young, the very old and the very ill. This is NOT a laughing matter just because YOU don't always see the bigger picture.

And, as for as the soldiers, that again is a very big issue. We will fix the injuries to a better appearance and function of our enemies because their countries will pay for a specialty here but will not always give our own soldiers the same opportunity because a specialist may not be covered.

EMS education is so very limiting and some do not do enough reading to see the bigger picture of medicine. The only few situations that some look at are their "worst BS" patient but yet few may actually know the extent of their diseases. How about those in EMS and the FDs that suck up benefits for being over weight or just fat and then claiming "on the job injury" but yet probably aren't fit to even be do the job? For some, they should be held at a higher standard and be responsible for their own blunders since they should know better.

 

[JPINFV]

So it is okay for a male soldier to have a little work done to make whatever was damaged but if it is a female it is wrong even if it is done post accident or defect? The reconstruction to some function has been done at military hospitals but the question is do we leave them disfigured which would then fall into the catagory of comestic surgery by privately contracted specialists? I guess since you would call that cosmetic, these soldiers should just do without.

There's a difference between reconstructive/plastic surgery secondary to injury or disability and there's a difference between a similar surgery because someone is unhappy with their looks. I almost can't believe that you would compare reconstructive surgery secondary to burns on the same level as going from a 34AA to 34C.

Who is to be the judge on right or wrong? Marijuana may soon be legalized and where does that place those who you consider wrong the day before and the day after legalization? Drunk drivers can be held liable for the cost of injuries they cause but once they are in jail, their ability to pay is rather limited. Anybody can be held liable by a court judgement for just about anything.

What's the alternative then? On demand healthcare at the expense of the tax payers? Oh, sorry you were a complete idiot and was a drunk driver. The government (read: taxpayers) will pay for you until you get back on your feet. Never mind not drunk driving in the first place.

...and yes. As long as marijuana is illegal, people need to not smoke. Now, yes, this becomes a problem in medical marijuana states with the current issues between local laws, federal laws, and just how far the commerce clause can be stretched. However, it's the duty of citizens to follow the law outside of egregious miscarriages of justice. Civil disobedience is one thing for civil rights and a completely different issue for things like which mind altering substances the government will let citizens use.

If I work with an EMS partner who smokes and develop some airway disorder like Asthma or COPD, who is responsible? Should I requested he stop smoking when working on the truck and at the station even if it is his right to smoke? (Yes, in some areas you can still smoke even when driving the ambulance.) We all know we don't want to impinge upon the rights of the smoker. If you over eat and are overweight should you pay the full costs of your medical bills for your MI and should the ambulance have the right to refuse to treat your chest pain because you are fat? Who will be the judge and jury?

For the hospitals, private companies and FDs that have banned smokers and have instituted fitness programs, there will always be those to criticize and justify their "rights" to do whatever.

Since when is smoking a right? The smoker should be able to abide by simple requests, such as limiting smoking to outside, including not in the vehicle.

Who's to decide what is medical necessary then? Should I be able to demand and receive any medical procedure that I want at the expense of the tax payers? If I want a third ear grafted onto my chest, why shouldn't I get it at no direct cost to me if all medical procedures are considered a right?

 

[VentMedic]

There's a difference between reconstructive/plastic surgery secondary to injury or disability and there's a difference between a similar surgery because someone is unhappy with their looks. I almost can't believe that you would compare reconstructive surgery secondary to burns on the same level as going from a 34AA to 34C.

Most "true cosmetic surgeries" are self pay. I have yet to know of an insurance that pays for one. However, injuries can also be discriminated against because of the "cosmetic" surgery misunderstanding such as what you are failing to see. For many decades, many vets have not be able to have any form of this surgery by a specialist and have had to live with some pretty disfiguring injuries because they couldn't afford to pay cash.

What's the alternative then? On demand healthcare at the expense of the tax payers? Oh, sorry you were a complete idiot and was a drunk driver. The government (read: taxpayers) will pay for you until you get back on your feet. Never mind not drunk driving in the first place.

Do you not understand the criminal and civil law alternatives in this country? The person is tried, convicted and can be held liable for their actions. If we don't imprison the person then the system is being too easy and if we do they don't earn money to pay.

...and yes. As long as marijuana is illegal, people need to not smoke. Now, yes, this becomes a problem in medical marijuana states with the current issues between local laws, federal laws, and just how far the commerce clause can be stretched. However, it's the duty of citizens to follow the law outside of egregious miscarriages of justice. Civil disobedience is one thing for civil rights and a completely different issue for things like which mind altering substances the government will let citizens use.

So why did you move to California?

Since when is smoking a right? The smoker should be able to abide by simple requests, such as limiting smoking to outside, including not in the vehicle.

How many have argued this on this forum already? You should very well know where I stand on the issue. As long as it is legal in an area, they DO NOT have to put out that cigarette just because you are present and some will take that to test.

Who's to decide what is medical necessary then? Should I be able to demand and receive any medical procedure that I want at the expense of the tax payers? If I want a third ear grafted onto my chest, why shouldn't I get it at no direct cost to me if all medical procedures are considered a right?

Now who is being ridiculous? Again, cosmetic surgery is largely self pay...that means the person pays cash and no insurance. However, even for events of war and "accidents", the insurance may only have to pay to get you to functioning and NO MORE. You can still find work if your face is scarred. However, what some would like is to see our soldiers do get the benefit of being the best they can still be after being severely disfigured but again, for decades out country has not felt that way. Now, they are become somewhat more lenient and referring out. However, if some like yourself have a say these soldiers should just be happy with what they got already and go away.

 

[rescue99]

I am ABSOLUTELY NOT being silly.

These are ethical questions discussed everyday in every NICU in this country as well as others. What do we or should we consider viable? We also discuss these everyday when trying to approach end of life issue for the very young, the very old and the very ill. This is NOT a laughing matter just because YOU don't always see the bigger picture.

And, as for as the soldiers, that again is a very big issue. We will fix the injuries to a better appearance and function of our enemies because their countries will pay for a specialty here but will not always give our own soldiers the same opportunity because a specialist may not be covered.

EMS education is so very limiting and some do not do enough reading to see the bigger picture of medicine. The only few situations that some look at are their "worst BS" patient but yet few may actually know the extent of their diseases. How about those in EMS and the FDs that suck up benefits for being over weight or just fat and then claiming "on the job injury" but yet probably aren't fit to even be do the job? For some, they should be held at a higher standard and be responsible for their own blunders since they should know better.

Number 1 Vent, we (hubby and me) are the parents 2 of the sort of ill children you mention, not just a unit worker. We've made decisions no parent should ever have to make more than once. We've let God's will be done and we've chosen to risk the odds. My view would never be the same as your's nor could a mere worker even come close to saying he/she comprehends what it's like unless he/she too, has walked the same mile. I've taken my voice to Lansing and spoken to our leaders, pushed for more education on life planning for multiply impaired children. THAT...is seeing the bigger picture!

Secondly, soldiers are covered by VA benefits, which is not what we're talking about. VA has their own set of rules and those are improving each and everyday finally. It's been a long time coming. Our nation is getting better, making improvements. Thanks to huge public demands, our soldiers are starting to receive better treatment. I've been in D.C. attending Veteran's Day rallies..I see what the voices can do. Just wish it didn't take so many rallies to be heard though. At least we are being heard eventually.

What about EMS, Fire and PD? That's private insurance, which is employer provided. Those rules are negotiated and set by the employer, insurance provider and employee representatives. Citizens have every oportunity to attend meetings when municipale matters are being discussed. 2nd and 4th Tuesday (here) of every month 7 P.M.!! Be there or be square! Voice an opinion! Some policies are set in provider's stone while others are settled in talks. Citizens have a voice..use it or lose it.

 

[VentMedic]

Number 1 Vent, we (hubby and me) are the parents 2 of the sort of ill children you mention, not just a unit worker. We've made decisions no parent should ever have to make more than once. We've let God's will be done and we've chosen to risk the odds. My view would never be the same as your's nor could a mere worker even come close to saying he/she comprehends what it's like unless he/she too, has walked the same mile. I've taken my voice to Lansing and spoken to our leaders, pushed for more education on life planning for multiply impaired children. THAT...is seeing the bigger picture!

Then you should know that this is not "silly stuff". We deal everyday in the NICU as to whether a 22 or 23 week baby should be resuscitated. The parents look to the doctor and not always God in a time of immediate crisis. There is often not time to wait for a sign for God since we must either begin resuscitation and put the baby on life support or back off. We do however know how much it will cost if that baby goes on life support.

Secondly, soldiers are covered by VA benefits, which is not what we're talking about. VA has their own set of rules and those are improving each and everyday finally. It's been a long time coming. Our nation is getting better, making improvements. Thanks to huge public demands, our soldiers are starting to receive better treatment. I've been in D.C. attending Veteran's Day rallies..I see what the voices can do. Just wish it didn't take so many rallies to be heard though. At least we are being heard eventually.

Why is it not what we are talking about? Aren't they entitled to specialists that are not always within the VA system? Rallies are great but there are veterans who would like to have their insurance reexamine their rights to go outside the system for some things and to recognize that some surgery should not be frowned upon because some think it is "cosmetic" or that they can get along fine with a WC so there is not need for any prosthetics.

Also, like post Vietnam, we will again see many of these young veterans on the street. They will be at the mercy of EMS providers who will consider them just some BS drunk or druggie or nut cases who are not worthy of any treatment or even the time of day from some in EMS.

What about EMS, Fire and PD? That's private insurance, which is employer provided. Those rules are negotiated and set by the employer, insurance provider and employee representatives. Citizens have every oportunity to attend meetings when municipale matters are being discussed. 2nd and 4th Tuesday (here) of every month 7 P.M.!! Be there or be square! Voice an opinion! Some policies are set in provider's stone while others are settled in talks. Citizens have a voice..use it or lose it.

But why are some in EMS wanting the public held to a different standard of health than what some themselves can not adhere to? Some EMS workers smoke, drink and are fat. They have habits that should be controlled but if JP is correct, they should not be allowed to suck up workmen's comp or raise insurance rates which is passed on to all either. There have been numerous times when we have done the cardiopulmonary testing for fitness, insurance and workmen's comp claims for EMS/FD providers and many should not be working but often do squeak by the low standards provided by some agencies. Others beg us to fail them so they can suck up a few more months of disability insurance.

 

[rescue99]

Then you should know that this is not "silly stuff". We deal everyday in the NICU as to whether a 22 or 23 week baby should be resuscitated. The parents look to the doctor and not always God in a time of immediate crisis. There is often not time to wait for a sign for God since we must either begin resuscitation and put the baby on life support or back off. We do however know how much it will cost if that baby goes on life support.




Why is it not what we are talking about? Aren't they entitled to specialists that are not always within the VA system? Rallies are great but there are veterans who would like to have their insurance reexamine their rights to go outside the system for some things and to recognize that some surgery should not be frowned upon because some think it is "cosmetic" or that they can get along fine with a WC so there is not need for any prosthetics.

Also, like post Vietnam, we will again see many of these young veterans on the street. They will be at the mercy of EMS providers who will consider them just some BS drunk or druggie or nut cases who are not worthy of any treatment or even the time of day from some in EMS.



But why are some in EMS wanting the public held to a different standard of health than what some themselves can not adhere to? Some EMS workers smoke, drink and are fat. They have habits that should be controlled but if JP is correct, they should not be allowed to suck up workmen's comp or raise insurance rates which is passed on to all either. There have been numerous times when we have done the cardiopulmonary testing for fitness, insurance and workmen's comp claims for EMS/FD providers and many should not be working but often do squeak by the low standards provided by some agencies. Others beg us to fail them so they can suck up a few more months of disability insurance.

I know for a fact VA sends people outside for services they cannot provide.
You're wrong about that. I have transported dozens and dozens myslef.

EMS, PD and Fire...again, provider, employer and employee negotiated.

You want change? Join your local civic organizations. Hack, be a volunteer! Get elected to your local board of trustees and start working on change. When yer done there..head to the state house then to D.C. Be active and help make a difference. ^_^

 

[wolfwyndd]

Sure it does! Don't bother voting then don't complain. Do not try to excersise a right you already blew off. That time has passed. Freedom of speech is already expressed loud and clear the moment any of us decide to walk away from our privalege to help decide on matters that affect each of us, our community, state and our country.

ANY of our Bill of Rights, including the right to freedom of speech, freedom of religion and our '5th amendment' rights can be exercised AT WILL. If you give up one in one circumstance, you can exercise that right 30 second from now. So despite the fact that you didn't vote, you still have the right to voice your opinion and go worship whereever and however you choose.

Given your argument once someone gives up that right ONCE then they can never decide to vote again. I know a lot of women who did not vote in the last presidential election, does that mean we should take away their right to vote? Let's just repeal the 19th amendment, it's only been around for 100 years. If they don't vote, they won't miss it, right? I skipped church, does that mean I give up my right to practice my religion? Come on now.

 

[VentMedic]

I know for a fact VA sends people outside for services they cannot provide.
You're wrong about that. I have transported dozens and dozens myslef.

EMS, PD and Fire...again, provider, employer and employee negotiated.

I have worked for both the VA and the hospitals that receive these patients. I have done the VA's 12 hours transports to another facility and often it is not for the reasons you think. Only a few make it through the system to be transferred and that is generally because of bed availability rather than need of the patient. A few TBIs are now going to the appropriate centers and we did get a couple of hand reconstructions but the wife's private insurance was listed as the primary and not the soldier's VA benefits.

The very few patients that you transport are not the only veterans in need of specialized care and frankly the VA system is overwhelmed right now. Chances are they were just shuffling the patients rather than determining appropriateness for a level of care. Not all rehabs centers are equal and not all plastic/reconstructive surgeons are equal.

You want change? Join your local civic organizations. Hack, be a volunteer! Get elected to your local board of trustees and start working on change. When yer done there..head to the state house then to D.C. Be active and help make a difference. ^_^

Been there and done that. Why do you think I have given out links to meetings and national organizations? I belong to various organizations and committees as do some of the other seniors on this forum (or no longer) who have sought change. But, it is those who refuse to see any problem with any health care system including EMS that are our own worst enemies when it comes to change. I seem to be wasting time even discussing these issues since some in EMS have made up their mind they are in a perfect world and even though belief in God is good, it isn't enough to change the health care system.

 

[eynonqrs]

Well here is some of my insight for what it's worth:

In my area where I am from there are 3 private services. A long time ago, the City of Scranton Fire used to run an ambulance service. Dunmore Fire Ran an ambulance. CMC and Mercy Hospital ran hospital based MICU's. There were volunteer ambulances that were part of fire companies. And guess what ? They are no longer. 911 calls do not make money, IFT's do. I work for a private service as a dispatcher. We do 911's for the city of Scranton, Dunmore, ALS intercepts with BLS paid and volunteer units. There are nights that we don't do hardly any 911, but we do alot of IFT's, and then it can be the reverse. How can a service that only does 911 survive when you know as well as I do that in some areas you get "self pay" or insurance that dosen't pay squat, therefore you need IFT's to pay the bills and salaries. Yes there are private companies that are greedy, there are those that good too. The grass sometimes is greener on the other side. People here are complaining that volunteers keep paid salaries down. That is not true. If you sat down and figured out how much it costs to run an ambulance service it would blow your mind + low insurance reimbursment + other factors. I agree 100% that the fire service should not have a hand in EMS. Like I stated before there were fire dept's in my area that had ambulances and dumped them. Now they want them back. Why ? Because they want to save their own jobs or to by shinny new toys.

 

[rescue99]

Well here is some of my insight for what it's worth:

In my area where I am from there are 3 private services. A long time ago, the City of Scranton Fire used to run an ambulance service. Dunmore Fire Ran an ambulance. CMC and Mercy Hospital ran hospital based MICU's. There were volunteer ambulances that were part of fire companies. And guess what ? They are no longer. 911 calls do not make money, IFT's do. I work for a private service as a dispatcher. We do 911's for the city of Scranton, Dunmore, ALS intercepts with BLS paid and volunteer units. There are nights that we don't do hardly any 911, but we do alot of IFT's, and then it can be the reverse. How can a service that only does 911 survive when you know as well as I do that in some areas you get "self pay" or insurance that dosen't pay squat, therefore you need IFT's to pay the bills and salaries. Yes there are private companies that are greedy, there are those that good too. The grass sometimes is greener on the other side. People here are complaining that volunteers keep paid salaries down. That is not true. If you sat down and figured out how much it costs to run an ambulance service it would blow your mind + low insurance reimbursment + other factors. I agree 100% that the fire service should not have a hand in EMS. Like I stated before there were fire dept's in my area that had ambulances and dumped them. Now they want them back. Why ? Because they want to save their own jobs or to by shinny new toys.

You are absolutely correct. ALS Fire is, and always has been about job security. Can't blame them for trying I suppose.