Re: [texasems-L]BS reasons for EMS call (was Liens for EMS bills)

[Guest guest]

These [people are still human even if they don't measure up to our social

standards and deserve all the care that the local socialite queen would get .

Re: BS reasons for EMS call (was Liens for EMS bills)

The " EMS " run I have to grasp the seriousness of is the " OB

emergency " type run. Granted, situations arise that necessitate EMS

being called but how about the 9 OB, BOWI, contractions infrequent,

due 2 days ago, and needs a ride to the hospital because " my baby's

daddy ain't here " ? The words " emergency " and " childbirth " RARELY

belong in the same sentence (or paragraph for that matter). One

paramedic that I work with is particularly verbal with these

folks... " look here playa... I betcha if someone had a bag of weed

waitin' for you over in XXX you'd find a way to get there "

and " betcha if your baby's daddy had a 40 ounce where he stays you'd

find a ride " ...

Pretty harsh but funny and true.

DFW

[Guest guest]

These [people are still human even if they don't measure up to our social

standards and deserve all the care that the local socialite queen would get .

Re: BS reasons for EMS call (was Liens for EMS bills)

The " EMS " run I have to grasp the seriousness of is the " OB

emergency " type run. Granted, situations arise that necessitate EMS

being called but how about the 9 OB, BOWI, contractions infrequent,

due 2 days ago, and needs a ride to the hospital because " my baby's

daddy ain't here " ? The words " emergency " and " childbirth " RARELY

belong in the same sentence (or paragraph for that matter). One

paramedic that I work with is particularly verbal with these

folks... " look here playa... I betcha if someone had a bag of weed

waitin' for you over in XXX you'd find a way to get there "

and " betcha if your baby's daddy had a 40 ounce where he stays you'd

find a ride " ...

Pretty harsh but funny and true.

DFW

[Guest guest]

Yes print it all and maybe tdh will read it and give you some advise on how to

deal with your problem.

Ps. Good shot there Andy

Re: BS reasons for EMS call (was Liens for EMS bills)

In a message dated 1/14/2004 4:05:18 PM Central Standard Time,

dfw_firefighter@... writes:

and " betcha if your baby's daddy had a 40 ounce for you where he

stays you'd find a ride " ...

Pretty harsh but funny and true.

DFW

Not only is it pretty harsh, but it is very racial also. Please be careful

that you don't print everything your uneducated brain tells you too.

Andy Foote

EMS Manager

[Guest guest]

I agree . Our local hospitals understand my FD's plight

of " you call, we HAVE to haul " and understand the corner the

paramedics are " backed into " . That is the primary reason that a

traige patient goes to traige and a medical emergency or injury goes

to the ER. Its good business for us all - the patient (i.e the

reason we have a job) gets definitive medical care when its needs

regardless of mode of transport and the jobless 24 year old who

needed a ride to the hospital to get his ingown hair removed from a

pimple waits in the ER with the rest of the masses.

DFW

[Guest guest]

There's absolutely nothing funny about it. It's stupid, pathetic,

unprofessional, and would get you fired at my service or any other that has a

modicum

of QA/QI. Does yours? It's exactly this sort of conduct that helps keep us

at the bottom of the heap of medical providers both pay-wise and

professionally. There are better ways to address the problems this type of

patient causes.

Also, this is the sort of conduct that gets you sued and inflames juries to

award zillions in damages. Sooner of later this jerk will make a mistake and

talk that way to a patient who bites back. It's only a matter of time.

Gene Gandy, JD, LP

In a message dated 1/14/2004 3:26:09 PM Central Standard Time,

dfw_firefighter@... writes:

Joby,

My initials are DFW (as ironic as that is) and I do not condone that

paramedic's statements. I did think it was funny though.

DFW

[Guest guest]

Danny,

Go back and read the confidentiality sections of H & SC Chapter 773; also

HIPAA. The information in the " glass in the coke " scenario does not fall within

any of the permitted disclosures that we can make to law enforcement without a

subpoena.

I know that many of us have a " cop fetish " and wish we could be the police as

well as the medical caregiver, thereby curing the world's social ills as well

as its medical ills. But that's not the way things are.

What the patient tells you in the course of treatment is privileged by virtue

of Chapter 773. Period. Privileged information is that information that you

learn solely because of the special relationship that you have with the

patient, that of a medical professional.

This patient's admissions do not form the basis for a disclosure to law

enforcement because they do not signal a threat to others. If, however, she had

said that she inhaled a bunch of smoke from her meth lab, that's another story,

because there is a clear and present danger to the public there, and you can

disclose that.

There are fine nuances that come to bear in disclosure decisions, but a

basically self-incriminating statement generally cannot be disclosed without

court

process.

Best,

Gene

In a message dated 1/14/2004 5:58:33 PM Central Standard Time,

petsardlj@... writes:

For information HIPPA relates to information not related to medical treatment

purposes, not for violations of law. I don't think this has been tried in

court yet but I can see it being done. Of course if I am incorrect I am sure

there will be an attorney comment somewhere. The argument can be made that

drug

abuse is a form of self mutilation.

I am not joking about the Medical Professional statement. We don't feel

sometimes as part of the medical profession but we are. We may even be

informed

by our counterparts in the ER that we are not medical professionals. They

are

jealous because they know we are quickly being put into this realm.

Danny L.

Owner/NREMT-P

Panhandle Emergency Training Services And Response

(PETSAR)

Office

FAX

[Guest guest]

>LETS END THIS ONE NOW!!!!!

[Guest guest]

Mike,

You make some valid points as far as EMS professionalism is concerned,

and are points that I've wrestled with sometime in my short career as

a paramedic. However, look at it from another perspective. If a

patient drives himself/herself over to a local ER and asks to be seen,

even if the cheif complaint is something that clearly is not an

emergency, the nurses/doctors still have to treat this person under

EMTALA. Sure, they might wait in triage for a LONG time, but does

anyone question the nurse's and/or doctor's professionalism? The

simple fact of the matter is in the majority of municipalities, if one

dials 911 and requests an ambulance and his/her chief complaint might

not necessarily warrant it, we're still obligated to treat them. What

makes us professional is our dedication to the theory and applied

science of pre-hospital emergency medicine.

Regards,

Alfonso R. Ochoa, NREMT-P

>

> Danny,

>

> OK, I'll give some latitude on this, explain to me, how transporting

each

> and every person regardless of medical neccessity, lack of injury or

illness

> etc, makes us more professional?

>

> Seems to me that this would actually lend credence to the theory

that we

> have no idea what we are doing, as we are unable to distinguish

between thos

> injuries and illnesses that ARE life threatening, and those that

AREN'T.

>

> If I took a patient with a stubbed tow to our trauma facility, and

told the

> nurse there, " I brought him because he called, and since he called,

it must

> be a cry for help, he isn't able to fend for himself, and needs

society's

> humanitarian assistance " , I would have to have her foot surgically

removed

> from my a** because she kicked me out of the ER so hard it stuck

somewhere

> near the ascending colon.

>

> I appreciate the fact that you are a humanitarian, believe it or

not, I

> really do, but at some point you have to be reaslistic as well, not

every

> patient that calls 911, needs 911.

>

> Mike

[Guest guest]

Alphonso,

I agree for the most part with your post. I still, however, see no

correlation between professionalism and length of time one waits to

be seen in a ER. I agree that our measure of professionalism is the

committment one makes to do his job. I still see no way of

measuring our professionalism with whether our patient is admitted

to an ER or unloaded from the stretcher in the triage/waiting room.

DFW

[Guest guest]

" Cause after you drop me off at the hospital, I am only 2 blocks from the

mall, and I can't aford a taxi in both directions "

Only heard that once......

> I can beat that.

> " I'm thirsty "

> " I'm hungry "

> " I can't sleep "

> " I think there is a force in my walls that makes my TV come on "

> " I took some sleeping pills, now I feel like I want to pass out "

> " I smoked some weed, now I feel all dizzy and kind of like I'm drunk "

>

> Pt: " Where am I going to get this prescription filled at 3 AM? "

> Paramedic: " Eckerds? "

> Pt: " For real? "

> Paramedic: " Yes ma'am....for real "

>

> sigh......

> magnetass sends

> RE: Liens for EMS bills

>

>

> > It hasn't changed since 1974. I have transported " I got a bad ingrown

> > toenail " , " I need my Dilantin refilled " , " I haven't had a bowel movement

> in

> > two days " , " I think my man done gave me the clap "

[Guest guest]

From: Alfonso R. ochoa

>> Mike,

>>The simple fact of the matter is in the majority of municipalities, if

one

>>dials 911 and requests an ambulance and his/her chief complaint might

>>not necessarily warrant it, we're still obligated to treat them. What

>>makes us professional is our dedication to the theory and applied

>>science of pre-hospital emergency medicine.

Alfonso,

One of the many things that make us professionals is our ability to do

field level triage and understand the difference between life

threatening and non-life threatening illnesses and injuries, and make

decisions regarding patient care accordingly.

I assess my patients and help them make an informed decision, after 14

years, I have yet to be sued (looking for wood to knock on), for the

most part because if I have any personal doubt, I convince them to go.

That informed decision may or may not be, " you could be seen, but it

does not require an ambulance " . Paramedic initiated refusals are OK,

they really are, as long as they are done by competent paramedics. If

you have someone working for you that you don't trust enough to make

that decision, then they shouldn't be working for you, or, remedial

training is in order.

There is no feasible or reasonable correlation between transporting a

toothache at 3 am via our over burdened, under staffed, overworked and

under budgeted EMS to an over burdened, under staffed, overworked and

under budgeted ER; and our level of professionalism.

Where does the applied science and theory of pre-hospital emergency care

tell us that *all* patients require MICU transport to a hospital?

Mike

[Guest guest]

Q: Where does the applied science and theory of pre-hospital emergency care

tell us that *all* patients require MICU transport to a hospital?

A: The same applied science and theory of pre-hospital emergency care book

that said all transport vehicles have to be MICU's.

If we don't want to tie up the MICU boxes on BLS calls, then should we look

at resurrecting (please forgive me for saying this) the old, or maybe a

modified, tiered model for EMS? Cost more for more trucks but certainly can

provide an alternative to keeping paramedics busy on toothaches.

Also, about 10 years ago the head-honchos at MedStar in Fort Worth were

tauting a new advanced paramedic program that would allow medics to respond

to non-emergency calls in order to do advanced patient assessment with some

clinical testing and then coordinate non-emergency transport via van with

the patient's doc or emergency room. This unit (a converted bus if I

remember right) was to be called out by the 911-MICU medics when they were

called to a patient that was obviously a non-emergency call but still needed

some type of treatment/assessment but not necessarily MICU and Level 1

Trauma Center. What ever happened to this plan? It was presented as being in

the development stages back when the conference was being held in Fort

Worth.

Barry

[Guest guest]

> I can say with absolutely no doubt that that person would not work as my

> partner the first time that came out to a patient or a patients family.

This

> is one example why EMS has the reputation that it has.

> No wonder you are not signing your name, I would be embarrassed too.

>

> Joby Berkley

Sheesh, remind me to never tell you some of the things I have told my

patients in the past, there was a day when I had a LOT less patience, and

therefore, less BS patients, I think old age has mellowed me some. Those

that know me may argue.

MWH

[Guest guest]

> I can say with absolutely no doubt that that person would not work as my

> partner the first time that came out to a patient or a patients family.

This

> is one example why EMS has the reputation that it has.

> No wonder you are not signing your name, I would be embarrassed too.

>

> Joby Berkley

Sheesh, remind me to never tell you some of the things I have told my

patients in the past, there was a day when I had a LOT less patience, and

therefore, less BS patients, I think old age has mellowed me some. Those

that know me may argue.

MWH

[Guest guest]

From: Barry Sharp

>>This unit (a converted bus if I

>>remember right) was to be called out by the 911-MICU medics when they

were

>>called to a patient that was obviously a non-emergency call but still

>>needed some type of treatment/assessment but not necessarily MICU and

>>Level 1 Trauma Center.

A metro area I worked for some years back also planned on implementing

the same plan, when I left, they had already purchased two vans, which

would have been staffed by EMT-B's and would have been called only after

the Paramedic arrived and did an assessment on the patient. Every

patient refusal that was associated with alternative transportation was

to be reviewed by the medical director.

Allows the MICU to remain in service, while providing low expense

transportation to the 'appropriate' facility according to the patients

needs.

[Guest guest]

Comments inline (including sarcastic humor, so take no offense)

> Hate to bring this up, but; How about the humanitarian side of our job.

The

> same addict that " snorts glass " is in a world where they need help, they

can't

> do it for themselves so they turn to us for the help.

No, some of them turn to us for a ride, nothing more nothing less. I don't

have a problem with the humaniitarian side of my job, I do it and I do it

well. But your blanket statement means that the person who calls us 3 times

a week for the flu, can't do anything for themselves?

You can't generalize everyone as needing EMS anymore than I or anyone else

can generalize all patients as being an ignoranus (ignoranus is defined as

someone who is ignorant AND an a**hole)

> Think about it.

> Cocaine use is against the law, why state that they are taking it in the

first

> place?

Less than average intelligence. Plus the fact that according to HIPPA, we

can't tell the police anyway.

> Although these patients also irritate me, we are there to help.

We do, we take them to the hospital so we can share our amazement at their

less than average intelligence with everyone else.

> If we

> forget what we are there for we need to find another line of work. EMS is

> changing. People regard us as, dare I say it; " Medical Professionals " .

That means

> those outside the realm of EMS and the medical profession regard us in the

same

> light as the Emergency Room Nurse.

You're joking right?

> Stupid but true.

Ok, we agree on something

[Guest guest]

Comments inline (including sarcastic humor, so take no offense)

> Hate to bring this up, but; How about the humanitarian side of our job.

The

> same addict that " snorts glass " is in a world where they need help, they

can't

> do it for themselves so they turn to us for the help.

No, some of them turn to us for a ride, nothing more nothing less. I don't

have a problem with the humaniitarian side of my job, I do it and I do it

well. But your blanket statement means that the person who calls us 3 times

a week for the flu, can't do anything for themselves?

You can't generalize everyone as needing EMS anymore than I or anyone else

can generalize all patients as being an ignoranus (ignoranus is defined as

someone who is ignorant AND an a**hole)

> Think about it.

> Cocaine use is against the law, why state that they are taking it in the

first

> place?

Less than average intelligence. Plus the fact that according to HIPPA, we

can't tell the police anyway.

> Although these patients also irritate me, we are there to help.

We do, we take them to the hospital so we can share our amazement at their

less than average intelligence with everyone else.

> If we

> forget what we are there for we need to find another line of work. EMS is

> changing. People regard us as, dare I say it; " Medical Professionals " .

That means

> those outside the realm of EMS and the medical profession regard us in the

same

> light as the Emergency Room Nurse.

You're joking right?

> Stupid but true.

Ok, we agree on something

[Guest guest]

It's a minor point, but actually EMTALA does not necessarily mandate

treatment. From emtala.com:

" Any patient who " comes to the emergency department " requesting

" examination or treatment for a medical condition " must be provided with

" an appropriate medical screening examination " to determine if he is

suffering from an " emergency medical condition " . If he is, then the

hospital is obligated to either provide him with treatment until he is

stable or to transfer him to another hospital in conformance with the

statute's directives. "

EMTALA also does not apply to all hospitals. Again, from emtala.com:

" EMTALA applies only to " participating hospitals " -- i.e., to hospitals

which have entered into " provider agreements " under which they will

accept payment from the Department of Health and Human Services, Centers

for Medicare and Medicaid Services (CMS) under the Medicare program for

services provided to beneficiaries of that program. In practical terms,

this means that it applies to virtually all hospitals in the U.S., with

the exception of the Shriners' Hospital for Crippled Children and many

military hospitals. "

Also VA's, as far as I understand.

Food for thought.

R

Re: BS reasons for EMS call (was Liens for EMS

bills)

Mike,

You make some valid points as far as EMS professionalism is concerned,

and are points that I've wrestled with sometime in my short career as

a paramedic. However, look at it from another perspective. If a

patient drives himself/herself over to a local ER and asks to be seen,

even if the cheif complaint is something that clearly is not an

emergency, the nurses/doctors still have to treat this person under

EMTALA. Sure, they might wait in triage for a LONG time, but does

anyone question the nurse's and/or doctor's professionalism? The

simple fact of the matter is in the majority of municipalities, if one

dials 911 and requests an ambulance and his/her chief complaint might

not necessarily warrant it, we're still obligated to treat them. What

makes us professional is our dedication to the theory and applied

science of pre-hospital emergency medicine.

Regards,

Alfonso R. Ochoa, NREMT-P

>

> Danny,

>

> OK, I'll give some latitude on this, explain to me, how transporting

each

> and every person regardless of medical neccessity, lack of injury or

illness

> etc, makes us more professional?

>

> Seems to me that this would actually lend credence to the theory

that we

> have no idea what we are doing, as we are unable to distinguish

between thos

> injuries and illnesses that ARE life threatening, and those that

AREN'T.

>

> If I took a patient with a stubbed tow to our trauma facility, and

told the

> nurse there, " I brought him because he called, and since he called,

it must

> be a cry for help, he isn't able to fend for himself, and needs

society's

> humanitarian assistance " , I would have to have her foot surgically

removed

> from my a** because she kicked me out of the ER so hard it stuck

somewhere

> near the ascending colon.

>

> I appreciate the fact that you are a humanitarian, believe it or

not, I

> really do, but at some point you have to be reaslistic as well, not

every

> patient that calls 911, needs 911.

>

> Mike

_____

[Guest guest]

DFW,

The point I was trying to make by using the long wait times in triage

is this: just as paramedics have to deal with being taxi cab drivers

at times with people calling for chief complaints that are obvious not

emergencies, other members of the healthcare team face the same

situation, ie doctor's/nurse's having to deal with problems that could

better be dealt with in a night clinic. Given the amount of people

that abuse the system, we can still be thought of as professional by

treating everyone to the best of our knowledge/ability.

Alfonso R. Ochoa, NREMT-P

> Alphonso,

>

> I agree for the most part with your post. I still, however, see no

> correlation between professionalism and length of time one waits to

> be seen in a ER. I agree that our measure of professionalism is the

> committment one makes to do his job. I still see no way of

> measuring our professionalism with whether our patient is admitted

> to an ER or unloaded from the stretcher in the triage/waiting room.

>

> DFW

[Guest guest]

> I am not joking about the Medical Professional statement. We don't feel

> sometimes as part of the medical profession but we are. We may even be

informed

> by our counterparts in the ER that we are not medical professionals. They

are

> jealous because they know we are quickly being put into this realm.

Danny,

OK, I'll give some latitude on this, explain to me, how transporting each

and every person regardless of medical neccessity, lack of injury or illness

etc, makes us more professional?

Seems to me that this would actually lend credence to the theory that we

have no idea what we are doing, as we are unable to distinguish between thos

injuries and illnesses that ARE life threatening, and those that AREN'T.

If I took a patient with a stubbed tow to our trauma facility, and told the

nurse there, " I brought him because he called, and since he called, it must

be a cry for help, he isn't able to fend for himself, and needs society's

humanitarian assistance " , I would have to have her foot surgically removed

from my a** because she kicked me out of the ER so hard it stuck somewhere

near the ascending colon.

I appreciate the fact that you are a humanitarian, believe it or not, I

really do, but at some point you have to be reaslistic as well, not every

patient that calls 911, needs 911.

Mike

[Guest guest]

> These [people are still human even if they don't measure up to our social

standards and deserve all the care that the local socialite queen would get

..

>

You are absolutely correct, the care is the same, the communication, and

the verbiage that you use is vastly different.

[Guest guest]

Alphonso,

I still see no comparison with whether our patient is admitted to an

ER or unloaded from the stretcher in the triage/waiting room and

professionalism.

If I am missing something please tell me what it is.

DFW

[Guest guest]

You are absolutely correct, they still go to the ER, they still go through

triage, they just don't tie up an MICU doing it.

I still fail to see the correlation between the stubbed toe getting to the

ER, and our level of professionalism.

Re: BS reasons for EMS call (was Liens for EMS bills)

> The same patients you don't see still go to the ER. The same stubbed toe

> still gets evaluated even when they walk in or taken by a family member.

The

> epistaxis walks into the ER and gets evaluated. The tooth ache still gets

> evaluated. This seems to be a part of the problem. We want to be medical

> professionals but we still have a problem believing it.

>

> Danny L.

> Owner/NREMT-P

> Panhandle Emergency Training Services And Response

> (PETSAR)

> Office

> FAX

>

>

>