Re: (unknown)

April 12, 2000

:

As far as I know, there isn't one. Unless TCJ has one simmering on the back

burner that Jeff isn't talking about, there isn't even one in the works.

Tyler will be the nearest when they get theirs up and running

Dave

(unknown)

> Does anyone know of any paramedic to rn bridge programs in the Ft.

> Worth/Dallas area?

>

> Lindsey EMT-P

>

> ------------------------------------------------------------------------

> Chocolate eggs, tulips, bunnies and more...

> Click Here

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>

April 21, 2000

Marble Falls Area EMS, Inc.

PO Box 296

Marble Falls, Texas 78654

(830) 693 - 7277

Paid / Volunteer service

20 miles west of Lago Vista on RR 1431

J.

(unknown)

> does any one know about ems services in or around lago

> vista (its around austin) looking to move there and

> can't seem to find anything out.

> thanks

>

> __________________________________________________

>

April 21, 2000

Lago Vista is in County. All of the 911 service in County is

provided by a cooperative effort between County and the City of

Austin. Basically, the 911 provider is Austin EMS. All of the Austin EMS

providers are full-time paid paramedics. The Lago Vista Fire Department

provides First Responder services for the area. They have volunteer

providers/firefighters and I think they also have some paid

providers/firefighters.

I am happy to answer any questions that you have regarding Austin EMS. YOu

can also contact the main office for Austin EMS at . If you are

interested in employement, you can contact the recruiter, Rob Curr at

448-8380. I know that Austin EMS is planning on hiring quite a few medics

over the ext year. I do not have any contact information for the Lago

Vista Fire Department. I'm pretty sure you could just show up at their

station and get info.

There are some private services in the area. They do not provide 911 within

County. They may do 911 outside of County, but I am not

really sure. I think the majority of their calls are transfers and event

stand-bys. The two services that I know of are Guardian and AMR. You can

get their numbers through information for the 512 area code.

on County EMS is another 911 provider relatively close to Lago

Vista. I know that there are quite a few on County providers on the

list. If you just post a message asking about them, I'm sure they will come

forward and give you a hand.

(unknown)

does any one know about ems services in or around lago

vista (its around austin) looking to move there and

can't seem to find anything out.

thanks

__________________________________________________

June 18, 2000

Medics are few and far between...anyone who says they never made a mistake

doesn't know much. keep your chin up..never say quit...go forward into the

night and be the best you can...hows that...we all have bad days...and

calls.

>From: c-tfish@...

>Reply-To: egroups

>To: egroups

>Subject: Re: (unknown)

>Date: Sun, 18 Jun 2000 10:03:22 -0500 (CDT)

>

>I'm using my husbands e-mail, so when I read your post I thought that I

>would reply. The advise I would give my husband in this situation would

>be this: Understand that you are going to make mistakes. The amount of

>time you've been a Medic has no relection on your abilittes. Although

>you will only get better as time prgresses. I don't know the

>concequences for this, however I strongly feel that you shouldn't give

>up your career because of an oversite, no matter how serious. Learn

>from this!! Pay close attention to details. To give up will only leave

>you where you are... feeling shame and being defeated. Take the

>experience for what it is...a learning experience. Go easy on yourself.

>Once you except the fact that mistakes will happen, you'll learn to be

>more careful. Hang in there!!! Don't give up!!

>Take care...

>A Medic's Wife

>

________________________________________________________________________

Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com

June 18, 2000

And what if the medic was *right*? What if the woman really did have a BP

(although I hate this quote, I'll use it) " well within normal limits " (which

doesn't tell me a THING, because what I consider normal, based on history,

may be completely different than what the author intended...)?

We're assuming the medic messed up. But in reality, he delivered the

patient to the medical facility without a critical incident. There's very

obviously a history, she's most likely dehydrated (both from history and

assessment), but even so, there's not a lot that *I* would be likely to do

two miles out from a facility on a case like this, especially with the

" obvious blood draw/IV attempts " . Why not verify stability, load, transport

and let the staff at the hospital, who will be providing her continued care,

initiate necessary treatments? While dehydration is certainly a significant

problem, is it enough of an emergency for me (as an EMERGNECY medical

provider) to treat just minutes from a facility that can do the same in a

much more reserved, sane environment than either this woman's nursing home

room, or the back of my ambulance? Remember, she's been not eating for DAYS

(another problem I have, though this seems to be a staff at the nursing home

issue, DAYS is *much* too long for something like this, and the nursing home

needs to be reported to DHS/APS). 5 minutes enroute is NOT going to make a

difference.

So, back to the point... what if the woman really was stable (okay, most

likely NOT, but what if?)? What if the medic was right, and what if she

experienced some sort of vagal episode from being lifted in, around, up and

down and in and out of the ambulance, bed, etc.? Point is, we don't know,

and unless this medic has a history (can anyone say QA and education?) of

missing something like this, or worse yet, falsely documenting patient

information (guessing on a BP, etc.), there's not a pattern, it's a " medic "

vs " other medical staff " scenario.

Mike

>

>Reply-To: egroups

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>Subject: Re: (unknown)

>Date: Sun, 18 Jun 2000 08:50:31 -0700

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>

>The skill of auscultating or palpating a BP is one of the most basic

>assessments in EMS. It sounds as though the medic did not perform an

>adequate patient assessment or recognize the other signs/symptoms of

>hemodynamic instability.

>

>The medics supervisors should research past run tickets for critical errors

>in treatment, interview the medics most recent co-workers for problem area

>in patient treatment, and interview the medic who made this call about

>their

>competence level. The call should be documented very well and disciplinary

>action should definitely be carried out even if it is minor. The medic

>should be monitored very closely for continuing problems. The medic should

>be remediated on the skill of BP assessment and patient assessment. The

>medical director should provide some input as to a course of action toward

>the medic in question. It would be a good idea to schedule this medic to

>work with a supervisor such as a field training officer for several weeks,

>then be re-evaluated.

>

>Tony

>EMS Educator

> (unknown)

>

> > Hello everyone,

> >

> > I need some input. I do choose to stay anonymous.

> >

> > Let me tell you a little about myself,- I am a paramedic.

> > - I have been a paramedic for two years come July.

> > - I have only been practicing as a medic for under 6

> > months, due too extenuating circumstances.

> >

> > What should I due, or what should be the punishment for the following:

> > - I had the following patient, from a nursing home.

> > approx. 2 miles, from the nearest hospital of which we

> > had been directed to transport the patient for a direct admit.

> > - approx. 80 yr old

> > - intial report to us was altered lab values and

> > refusing to eat for 5 to 7 days.

> > - skin turgor of just over 1sec.

> > - my partner took a blood presure in the room and got a

> > BP of which lets say fell will within the normal limits of some one

> > of this persons age, my partner also got a BP at tne hospital

> > which was also well within the normal limits for a person of this

> > patient.

> > - this patient had several spots of which it appeared

> > that attemps had been made to withdraw blood.

> > - we got the patient to the hospital, and into their

> > room, the nurse came into take the patients intial

> > V/S and got a BP of 44/30.

> > - as you could expect the medical control doctor was

> > broght made aware of the case, and the out come you can imaging.

> > - the medic didn't read the patient as badly as it turns

> > out that the patient really was.

> > - a fact unkown to the medic at the time, patient had

> > not eaten for approx. 11 days.

> >

> > My qestion is what should happened to the medic in this case, and what

> > should the medic do now. The medic knows he made a mistake that could

> > have cost the patient their life. Should the medic stay in the business,

> > just what should they do.

> >

> > Thanks for any input.

> >

> > anonymous medic.

> >

> > ------------------------------------------------------------------------

> > Find out your risk for Diabetes and win one of 40 cash prizes.

> > For every test taken, we'll donate a $1 for research.

> > http://click./1/5600/7/_/4981/_/961312450/

> > ------------------------------------------------------------------------

> >

>

>------------------------------------------------------------------------

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June 18, 2000

I'm using my husbands e-mail, so when I read your post I thought that I

would reply. The advise I would give my husband in this situation would

be this: Understand that you are going to make mistakes. The amount of

time you've been a Medic has no relection on your abilittes. Although

you will only get better as time prgresses. I don't know the

concequences for this, however I strongly feel that you shouldn't give

up your career because of an oversite, no matter how serious. Learn

from this!! Pay close attention to details. To give up will only leave

you where you are... feeling shame and being defeated. Take the

experience for what it is...a learning experience. Go easy on yourself.

Once you except the fact that mistakes will happen, you'll learn to be

more careful. Hang in there!!! Don't give up!!

Take care...

A Medic's Wife

June 18, 2000

The skill of auscultating or palpating a BP is one of the most basic

assessments in EMS. It sounds as though the medic did not perform an

adequate patient assessment or recognize the other signs/symptoms of

hemodynamic instability.

The medics supervisors should research past run tickets for critical errors

in treatment, interview the medics most recent co-workers for problem area

in patient treatment, and interview the medic who made this call about their

competence level. The call should be documented very well and disciplinary

action should definitely be carried out even if it is minor. The medic

should be monitored very closely for continuing problems. The medic should

be remediated on the skill of BP assessment and patient assessment. The

medical director should provide some input as to a course of action toward

the medic in question. It would be a good idea to schedule this medic to

work with a supervisor such as a field training officer for several weeks,

then be re-evaluated.

Tony

EMS Educator

(unknown)

> Hello everyone,

>

> I need some input. I do choose to stay anonymous.

>

> Let me tell you a little about myself,- I am a paramedic.

> - I have been a paramedic for two years come July.

> - I have only been practicing as a medic for under 6

> months, due too extenuating circumstances.

>

> What should I due, or what should be the punishment for the following:

> - I had the following patient, from a nursing home.

> approx. 2 miles, from the nearest hospital of which we

> had been directed to transport the patient for a direct admit.

> - approx. 80 yr old

> - intial report to us was altered lab values and

> refusing to eat for 5 to 7 days.

> - skin turgor of just over 1sec.

> - my partner took a blood presure in the room and got a

> BP of which lets say fell will within the normal limits of some one

> of this persons age, my partner also got a BP at tne hospital

> which was also well within the normal limits for a person of this

> patient.

> - this patient had several spots of which it appeared

> that attemps had been made to withdraw blood.

> - we got the patient to the hospital, and into their

> room, the nurse came into take the patients intial

> V/S and got a BP of 44/30.

> - as you could expect the medical control doctor was

> broght made aware of the case, and the out come you can imaging.

> - the medic didn't read the patient as badly as it turns

> out that the patient really was.

> - a fact unkown to the medic at the time, patient had

> not eaten for approx. 11 days.

>

> My qestion is what should happened to the medic in this case, and what

> should the medic do now. The medic knows he made a mistake that could

> have cost the patient their life. Should the medic stay in the business,

> just what should they do.

>

> Thanks for any input.

>

> anonymous medic.

>

> ------------------------------------------------------------------------

> Find out your risk for Diabetes and win one of 40 cash prizes.

> For every test taken, we'll donate a $1 for research.

> http://click./1/5600/7/_/4981/_/961312450/

> ------------------------------------------------------------------------

>

June 18, 2000

I will go with Mike that is so right on.... what a way to put it .....

Matt on EMT-P

June 18, 2000

BP's are a basic skill that we should feel the most comfortable with. This

is a key tool with patient assesment. Granted I have had times when my

vitals on scene, enroute and at back door of ER where exactly what I got

and the nurses in ER are just totaly " WACKED OUT " and different or right on

the money with mine.. Plus they are using machines to to their vitals in

most cases, and machines are foulable too, were we are doing it the old

fashion way. I guess the bottom line is that each patient is different

and can change sometimes without warnings. Patients can go south for no

reason, who knows this might have been the case. I wasnt there. What I

would suggest is maybe trying a BP clinic, get more time on the cuff if you

need it. With a free clinic its not only PR for the company it gives you a

chance to hear different BP's cause not all are the same. Punishment, well

did you follow protocols, did you do harm to the patient by this. Did you

actually hear what you did, and when you got to the hospital the patient go

south due to her condition? Dont beat yourself up, we all make mistakes,

but be willing if you did " screw up " to take the consequences for that

action and admit to it. Try a case review and Q & A the run, figure out what

can be done to make this go smoother next time. As for how long youve been

doing this....well with time comes experience. Remember as a paramedic your

a basic first and then a medic second. I wouldnt call it quits over this...

Something else to remember what is " text book " for one patient isnt for the

next. What is normal for a 80 yr woman by " text book " may not actually be

that for the one your transporting right now. Her for example: vitals using

" text book values " might be way off, but for this patient might be " normal "

for her, and off for someone else. Does this make sense to you?? Use the

numbers, your patients past Hx and etc..to see what might be " normal " for

that particular patient. If you remember to do no harm, follow protocols,

and when in doubt to ask, then you should do well. Take this as a learn

experience and build upon it. I wish you luck in this learning experience.

Take care and continue to try and grow in this ever changing field that we

all work in.

randy, emtp

emt@...

(unknown)

> Hello everyone,

>

> I need some input. I do choose to stay anonymous.

>

> Let me tell you a little about myself,- I am a paramedic.

> - I have been a paramedic for two years come July.

> - I have only been practicing as a medic for under 6

> months, due too extenuating circumstances.

>

> What should I due, or what should be the punishment for the following:

> - I had the following patient, from a nursing home.

> approx. 2 miles, from the nearest hospital of which we

> had been directed to transport the patient for a direct admit.

> - approx. 80 yr old

> - intial report to us was altered lab values and

> refusing to eat for 5 to 7 days.

> - skin turgor of just over 1sec.

> - my partner took a blood presure in the room and got a

> BP of which lets say fell will within the normal limits of some one

> of this persons age, my partner also got a BP at tne hospital

> which was also well within the normal limits for a person of this

> patient.

> - this patient had several spots of which it appeared

> that attemps had been made to withdraw blood.

> - we got the patient to the hospital, and into their

> room, the nurse came into take the patients intial

> V/S and got a BP of 44/30.

> - as you could expect the medical control doctor was

> broght made aware of the case, and the out come you can imaging.

> - the medic didn't read the patient as badly as it turns

> out that the patient really was.

> - a fact unkown to the medic at the time, patient had

> not eaten for approx. 11 days.

>

> My qestion is what should happened to the medic in this case, and what

> should the medic do now. The medic knows he made a mistake that could

> have cost the patient their life. Should the medic stay in the business,

> just what should they do.

>

> Thanks for any input.

>

> anonymous medic.

>

> ------------------------------------------------------------------------

> Find out your risk for Diabetes and win one of 40 cash prizes.

> For every test taken, we'll donate a $1 for research.

> http://click./1/5600/7/_/4981/_/961312450/

> ------------------------------------------------------------------------

>

June 18, 2000

I'll go with Matt and Mike on this one. There has been a nuber of times I can

remember that I picked up a " stable " patient just 2 minutes from the hospital

and the patient " crash " upon arrival or just shortly after. Keep your head up.

This may have just been a coincidence. I've seen it happen.

Eddie on, EMT-P

Re: (unknown)

> I will go with Mike that is so right on.... what a way to put it .....

> Matt on EMT-P

>

> ------------------------------------------------------------------------

> Make new friends, find the old at Classmates.com:

> http://click./1/5530/7/_/4981/_/961349111/

> ------------------------------------------------------------------------

>

June 18, 2000

I am curious, was the nurse taking a B/P with an Automatic B/P machine, and

like someone else said, it is harder for people to auscultate a B/P when a

patient is dehydrated. I cannot tell you how many times, the nurse comes up

with a different set of V/S, simply because they pay more attention to the

conveniences of a machine. The machine, if this is the case, will hardly ever

give a proper reading, simply because the machine cannot pick up the faint

feeling.

June 18, 2000

A few questions, rhetorical or not:

First, the patient assessment-

Were the first VS in the hospital done with an automated BP machine? Was

the cuff appropriate to the patient's arm size? With automated BP

machines, I always ignore the first and generally accept the next two,

while watching the trend.

Did the patient have a radial pulse? What was the LOC? If there was a

radial, and the patient's LOC wasn't diminished, then I certainly

wouldn't believe the initial in-hospital BP. Vital signs are not gold or

platinum; what are the trends and what is the patient doing? Take the two

together to determine the patient's condition and trend.

Next, the sending facility-

IF this Nursing Home was known for negligent care, why accept the word of

someone you know/suspect of being incompetent? I sometimes would work a

patient from some (ok, most) nursing homes as a " unconscious/unknown/no

one there " rather than listen to the erroneous (read negligent/ " butt

covering " ) report that I have had the misfortune of having to endure.

Next, the receiving facility-

What is the relationship with the receiving hospital? Might there be a

reason for the receiving facility to " gun down " the medic or the

transporting service in general? Stories, once told only get bigger and

better.

Next, the medics-

Was either of them a rookie, or close to burn out? Did either have a

history of deficient/negligent care? How often had they worked together?

Was there any Crew Resource Management training and utilization?

Most importantly-

What was the outcome of the patient? THAT is what this is ALL about.

" Leadership is action, not position "

Larry RN CFRN LEMT-P

....and some other stuff

________________________________________________________________

YOU'RE PAYING TOO MUCH FOR THE INTERNET!

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Try it today - there's no risk! For your FREE software, visit:

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June 18, 2000

medicwebster@... wrote:

> I am curious, was the nurse taking a B/P with an Automatic B/P machine, and

> like someone else said, it is harder for people to auscultate a B/P when a

> patient is dehydrated. I cannot tell you how many times, the nurse comes up

> with a different set of V/S, simply because they pay more attention to the

> conveniences of a machine. The machine, if this is the case, will hardly ever

> give a proper reading, simply because the machine cannot pick up the faint

> feeling.

I had such a patient this past week, the machine wouldn't read the patients BP

at

all and they asked us where did we get our BP numbers from. I actually had to

point out where we could feel a pulse and everything. So the machines have many

problems. That is why most EMS departments don't use the automatic machines.

Dwayne

_____________________________________________

NetZero - Defenders of the Free World

Click here for FREE Internet Access and Email

http://www.netzero.net/download/index.html

June 18, 2000

Tony Write...you are a bit harsh in you judgement of

this call I think. Nothing critical happened to the

patient, and the patient was delivered to the hospital

safely. They were only 2 minutes from the hospital

and any treatment done would have only delayed

transport of this person to the hospital. Also,

everyone knows that IV's are diffucult enough on

elderly people, and even harder on those who are

dehydrated. Why risk blowing the only GOOD vein/s the

person has when they can be delivered, in less then 5

minutes, without incident and be turned over to the

hospital staff that has people to do the IV's on such

people? I am not saying to delay treatment if the

patient is in need of treatment, but the medic was

sure of his decision.

The medic checked the BP and was obviously satisfied

with what he read. He checked it twice and was still

satisfied. Why question him?

And did you ever stop to think that the " All Mighty

Nurse " COULD have been wrong???? It has been known to

happen!

Just a though...and no one is perfect....

Traci

=====

Traci Drozeski

Paramedic

Voice Mail Account#

1-

Extention#

__________________________________________________

June 18, 2000

I have been sitting here reading all these replies and tend to agree about

the machine. The last I knew, you could not feel a radial pulse with a

blood pressure under 80/P and you could not feel a jugular pulse under 60/P

(roughly), so was there REALLY a blood pressure of 44/whatever? I have a

major problem with that part of the whole scenario.

Support of your partner is also very important here. Have you talked to

him/her? And we also dont know the whole story. What I saw was that the

nursing home seemed to be the one who made the biggest errors and

jeapordized the patient way more than any one else. Take some time and talk

to your partner....

________________________________________________________________________

Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com

June 18, 2000

I find it very hard to trust the machines alot of the time.

Eddie

Re: (unknown)

> I am curious, was the nurse taking a B/P with an Automatic B/P machine, and

> like someone else said, it is harder for people to auscultate a B/P when a

> patient is dehydrated. I cannot tell you how many times, the nurse comes up

> with a different set of V/S, simply because they pay more attention to the

> conveniences of a machine. The machine, if this is the case, will hardly ever

> give a proper reading, simply because the machine cannot pick up the faint

> feeling.

>

> ------------------------------------------------------------------------

> Missing old school friends? Find them here:

> http://click./1/5534/7/_/4981/_/961376182/

> ------------------------------------------------------------------------

>

June 18, 2000

<GRIN> Boy you must have to have a HIGH pressure to have a jugular pulse.

<GRIN> :-)

Rodney

I have been sitting here reading all these replies and tend to agree about

the machine. The last I knew, you could not feel a radial pulse with a

blood pressure under 80/P and you could not feel a jugular pulse under 60/P

(roughly), so was there REALLY a blood pressure of 44/whatever? I have a

major problem with that part of the whole scenario.

June 19, 2000

Jugular pulse?! Hmmmmmm

>

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><GRIN> Boy you must have to have a HIGH pressure to have a jugular pulse.

><GRIN> :-)

>

>Rodney

>

>I have been sitting here reading all these replies and tend to agree about

>the machine. The last I knew, you could not feel a radial pulse with a

>blood pressure under 80/P and you could not feel a jugular pulse under 60/P

>(roughly), so was there REALLY a blood pressure of 44/whatever? I have a

>major problem with that part of the whole scenario.

>

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June 19, 2000

I'm sure that the person meant to type carotid pulse but, since you brought

it up, everybody has a jugular venous pulse and it can be easily measured in

the prehospital setting without any expensive equipment. It's a nice way to

help confirm a diagnosis of right-sided heart failure. If you want to know

how to do it, both Mosby's and Bates' s guides to physical exam have good

illustrations. I'd highly recommend either of these books to any medic, as

you can learn an immense ammount of physical diagnosis methods. I do know

that Mosby's comes with a CDROM disk, though I'm not sure about Bates's.

Just thought you'd like to know.

Blaine Rourke

June 19, 2000

Traci, I'm not so concerned about the treatment as I am the ability of the

medic in question to perform a thorough patient assessment. Too often I

hear the statement " We were just two minutes from the hospital, " whether it

be two or ten or thirty no matter what the case, the medic should treat all

patients the same it's called the standard of care. The sooner the patient

is treated the better off the patient will be. Also, about the IV's, if the

patient appears hemodynamically unstable then an IV is obviously needed

asap. With a BP that low and considering the age of the patient, I'm quite

sure the patient had some s/s of being hemodynamically unstable. As for the

nurse being wrong that is entirely possible and happens quite frequently in

most ER's. I was not there, but then the question was brought to the

server.

Tony

EMS Educator

Re: (unknown)

> Tony Write...you are a bit harsh in you judgement of

> this call I think. Nothing critical happened to the

> patient, and the patient was delivered to the hospital

> safely. They were only 2 minutes from the hospital

> and any treatment done would have only delayed

> transport of this person to the hospital. Also,

> everyone knows that IV's are diffucult enough on

> elderly people, and even harder on those who are

> dehydrated. Why risk blowing the only GOOD vein/s the

> person has when they can be delivered, in less then 5

> minutes, without incident and be turned over to the

> hospital staff that has people to do the IV's on such

> people? I am not saying to delay treatment if the

> patient is in need of treatment, but the medic was

> sure of his decision.

>

> The medic checked the BP and was obviously satisfied

> with what he read. He checked it twice and was still

> satisfied. Why question him?

>

> And did you ever stop to think that the " All Mighty

> Nurse " COULD have been wrong???? It has been known to

> happen!

>

> Just a though...and no one is perfect....

>

> Traci

>

> =====

> Traci Drozeski

> Paramedic

> Voice Mail Account#

> 1-

> Extention#

>

> __________________________________________________

>

June 19, 2000

Ok, I admit, I was thinking of EJ lines at the time. I was in the right

area and coulda gotten a pulse. Forgive me for being human.......

----Original Message Follows----

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To: egroups

Subject: RE: (unknown)

Date: Mon, 19 Jun 2000 15:26:41 PDT

Jugular pulse?! Hmmmmmm

>

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><GRIN> Boy you must have to have a HIGH pressure to have a jugular pulse.

><GRIN> :-)

>

>Rodney

>

>I have been sitting here reading all these replies and tend to agree about

>the machine. The last I knew, you could not feel a radial pulse with a

>blood pressure under 80/P and you could not feel a jugular pulse under

60/P

>(roughly), so was there REALLY a blood pressure of 44/whatever? I have a

>major problem with that part of the whole scenario.

>

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June 19, 2000

Tony really is speaking to the principle that critical thinking, problem

solving, and careplan/building/implementation skills are the basis for good

Paramedicine. These skills cannot be learned in a minimum number of hours.

Learning depends upon many, many dynamics which influence both the rapidity

and quality of learning. Notice, I've not used the terms " teaching " or

" taught. " Teaching (or preaching) takes place every time I lecture.

Learning may or may not, with the emphasis on " may not. "

A certain number of hours of " butt in chair " time does not a reasonably

competent paramedic make. That's why I favor simple adoption of the National

Standard Curriculum without any mention of hours, and a system of real

evaluation. We don't have a system of real evaluation. It may be that some

students can become reasonably competent paramedics in a 624 hour prgram.

Others might never be in 2000 hours of exposure.

It is time we made the providers and medical directors responsible for the

quality of their employees. This would probably be done best through a

system of rewards for good performance and fines for poor performance.

Reimbursement would be diminished for poor performance and increased good

performance.

Medical directors should also have immunity from suit for all except failures

of standard of care as set forth by the protocols, failure of CQI, and actual

verbal orders which amount to gross negligence.

State exams should test not only recall but critical thinking skills and

problem solving ability. Therein lies the rub: Nobody knows quite how to do

this efficiently and in an environment of agency downsizing and budget

constraints.

It seems that reimbursements are going to be headed in the direction of

emphasizing good performance, but of course, what's the definition of " good

performance " , who will make that determination and upon what criteria?

Nobody knows this either.

Or do you? How ought this be handled?

Gene Gandy

In a message dated 6/19/2000 10:22:57 Central Daylight Time,

paramedicwright@... writes: