Re: article from HoustonChronicle.com (RN triaging ems calls)

June 6, 2008

found the quote:

Those who do not learn from the mistakes of history are doomed to repeat

them. â€“ Santayana

this, of course, is in reference to the dallas, texas nurse triaging EMS 9-1-1

calls incident

jim davis

paramedic

Subject: phillipsdo@... has sent you an article from

HoustonChronicle.com

To: texasems-l

Date: Friday, June 6, 2008, 5:13 AM

Sound familiar to the north Teaxs people

http://www.chron. com/disp/ story.mpl/ metropolitan/ 5819858.html

Houston to hire 'tele-nurses' as alternative to ambulances

By CAROLYN FEIBEL

Should you call an ambulance for a sprained wrist or child's fever? A

spider bite?

The medical consensus is no, but every year thousands of people in the

Houston area dial 911 for non-emergencies.

Hoping to cut back on the number of ambulances responding to

non-emergency calls, the City Council voted Wednesday to hire

round-the-clock " tele-nurses " to work with 911 dispatchers.

For callers who do not have a true emergency, a nurse will offer

first-aid advice over the phone, or help them find a clinic or doctor.

The Houston Fire Department responds to about 750 emergency medical

calls a day.

" In a large percentage of cases, when we get there, the patient didn't

even want to go to the hospital, " said Dr. Persse, the city's

director of Emergency Medical Services. " Maybe they just wanted some

advice, get their blood pressure taken. "

Some people call 911 because they have no health insurance or no

transportation to the hospital. Others have insurance but do not know

how to get after-hours care or cannot judge how serious a problem may

be.

Until now, the default solution has been to send an ambulance. That

costs taxpayers and also can cost the patient: An ambulance ride to the

ER costs $415, plus $7.50 per mile. That's before the hospital bill.

" That's a waste of resources, and it also could endanger somebody who

really does need an emergency response, " Mayor Bill White said.

The city will spend $6.8 million over five years on a contract with the

County Healthcare Alliance. The nonprofit group has

subcontracted with San -based CareNet, which will provide at

least two nurses around the clock.

If primary care is needed, the nurses can refer callers to

health-access " navigators " at the nonprofit Gateway to Care. The

navigators will help 911 callers make an appointment at clinics in

Houston and can help arrange transportation.

Treated like a cab ride

Houston is among the first cities to try tele-nurses for 911 calls.

Richmond, Va., has a similar program, Persse said.

Capt. Alan Nollkamper, who worked for more than 12 years as a Houston

paramedic, said flu season is the worst for unnecessary runs.

" It comes in as a 'breathing difficulty' call, " Nollkamper said. " We

get there and realize the patient has a low-grade fever or congestion.

Maybe they need antibiotics, but they don't need our services. "

Nollkamper said people call ambulances for minor cuts, sunburns or even

because they need prescriptions refilled.

" It's a 911 ambulance, but it's treated like a taxicab, " said Sebastian

Chavez, a paramedic in the Sunnyside and South Park neighborhoods.

" You'll get told many times on the street, 'just do your job and take

me to the hospital.'

" They're taking away a paramedic unit from somebody who may need a

paramedic unit. "

City officials did not provide an estimate but said they were certain

the program will save money in the long run.

At first, the nurses will handle about 20 calls a day, but that could

grow to 75 or 100 calls a day.

More than half of emergency-room visits by County residents in

2006 were for problems that could have been treated in a doctor's

office, according to a study by UT's School of Public Health. The

estimated cost was $50 million, the study said.

Only 32 percent of those ER visitors had no health insurance. The rest

had private or federal coverage but may not have known how to use it

efficiently, said Love, executive director of the County

Health Care Alliance.

" The whole idea is to educate people, help them get self-care when

appropriate, " Love said. " It's just about getting these folks to

connect to what we call a 'medical home,' a regular source of care

where someone has your medical records there. "

There is little danger that a true emergency will get diverted to a

phone nurse, officials said.

" If, at any time during the call, the nurse feels the call has shifted

and is of an emergency nature, then the call is immediately directed

back to (Houston Emergency Center) and an ambulance is dispatched, "

said HFD Capt. Dupont.

She added that working with the nurse will be voluntary. If at any time

a caller wants an ambulance, it will be dispatched, she said.

Fully insured

The alliance is purchasing additional liability insurance, and CareNet,

the company providing the nurses, also carries insurance of $3 million

per claim, Love said.

More than 30 percent of County residents are uninsured, compared

with 24 percent in Texas and 15 percent nationwide.

The reasons are manifold, Love said. Texas has strict income limits for

Medicaid eligibility. A high proportion of Texans work for small

businesses, which are less likely to offer insurance. Undocumented

residents also contribute to the uninsured rates.

carolyn.feibel@ chron.com

Brought to you by the HoustonChronicle. com

June 6, 2008

Definition of â€œTriage Tragedyâ€: When the nursing student triages a ruptured

abdominal aneurysm to OB as a term pregnancy.

From: texasems-l [mailto:texasems-l ] On Behalf

Of james davis

Sent: Friday, June 06, 2008 11:03 AM

To: texasems-l

Subject: Re: article from HoustonChronicle.com (RN triaging ems

calls)

found the quote:

Those who do not learn from the mistakes of history are doomed to repeat

them. â€“ Santayana

this, of course, is in reference to the dallas, texas nurse triaging EMS 9-1-1

calls incident

jim davis

paramedic

From: phillipsdo@... <mailto:phillipsdo%40yahoo.com>

<phillipsdo@... <mailto:phillipsdo%40yahoo.com> >

Subject: phillipsdo@... <mailto:phillipsdo%40yahoo.com> has

sent you an article from HoustonChronicle.com

To: texasems-l <mailto:texasems-l%40yahoogroups.com>

Date: Friday, June 6, 2008, 5:13 AM

Sound familiar to the north Teaxs people

http://www.chron. com/disp/ story.mpl/ metropolitan/ 5819858.html

Houston to hire 'tele-nurses' as alternative to ambulances

By CAROLYN FEIBEL

Should you call an ambulance for a sprained wrist or child's fever? A

spider bite?

The medical consensus is no, but every year thousands of people in the

Houston area dial 911 for non-emergencies.

Hoping to cut back on the number of ambulances responding to

non-emergency calls, the City Council voted Wednesday to hire

round-the-clock " tele-nurses " to work with 911 dispatchers.

For callers who do not have a true emergency, a nurse will offer

first-aid advice over the phone, or help them find a clinic or doctor.

The Houston Fire Department responds to about 750 emergency medical

calls a day.

" In a large percentage of cases, when we get there, the patient didn't

even want to go to the hospital, " said Dr. Persse, the city's

director of Emergency Medical Services. " Maybe they just wanted some

advice, get their blood pressure taken. "

Some people call 911 because they have no health insurance or no

transportation to the hospital. Others have insurance but do not know

how to get after-hours care or cannot judge how serious a problem may

be.

Until now, the default solution has been to send an ambulance. That

costs taxpayers and also can cost the patient: An ambulance ride to the

ER costs $415, plus $7.50 per mile. That's before the hospital bill.

" That's a waste of resources, and it also could endanger somebody who

really does need an emergency response, " Mayor Bill White said.

The city will spend $6.8 million over five years on a contract with the

County Healthcare Alliance. The nonprofit group has

subcontracted with San -based CareNet, which will provide at

least two nurses around the clock.

If primary care is needed, the nurses can refer callers to

health-access " navigators " at the nonprofit Gateway to Care. The

navigators will help 911 callers make an appointment at clinics in

Houston and can help arrange transportation.

Treated like a cab ride

Houston is among the first cities to try tele-nurses for 911 calls.

Richmond, Va., has a similar program, Persse said.

Capt. Alan Nollkamper, who worked for more than 12 years as a Houston

paramedic, said flu season is the worst for unnecessary runs.

" It comes in as a 'breathing difficulty' call, " Nollkamper said. " We

get there and realize the patient has a low-grade fever or congestion.

Maybe they need antibiotics, but they don't need our services. "

Nollkamper said people call ambulances for minor cuts, sunburns or even

because they need prescriptions refilled.

" It's a 911 ambulance, but it's treated like a taxicab, " said Sebastian

Chavez, a paramedic in the Sunnyside and South Park neighborhoods.

" You'll get told many times on the street, 'just do your job and take

me to the hospital.'

" They're taking away a paramedic unit from somebody who may need a

paramedic unit. "

City officials did not provide an estimate but said they were certain

the program will save money in the long run.

At first, the nurses will handle about 20 calls a day, but that could

grow to 75 or 100 calls a day.

More than half of emergency-room visits by County residents in

2006 were for problems that could have been treated in a doctor's

office, according to a study by UT's School of Public Health. The

estimated cost was $50 million, the study said.

Only 32 percent of those ER visitors had no health insurance. The rest

had private or federal coverage but may not have known how to use it

efficiently, said Love, executive director of the County

Health Care Alliance.

" The whole idea is to educate people, help them get self-care when

appropriate, " Love said. " It's just about getting these folks to

connect to what we call a 'medical home,' a regular source of care

where someone has your medical records there. "

There is little danger that a true emergency will get diverted to a

phone nurse, officials said.

" If, at any time during the call, the nurse feels the call has shifted

and is of an emergency nature, then the call is immediately directed

back to (Houston Emergency Center) and an ambulance is dispatched, "

said HFD Capt. Dupont.

She added that working with the nurse will be voluntary. If at any time

a caller wants an ambulance, it will be dispatched, she said.

Fully insured

The alliance is purchasing additional liability insurance, and CareNet,

the company providing the nurses, also carries insurance of $3 million

per claim, Love said.

More than 30 percent of County residents are uninsured, compared

with 24 percent in Texas and 15 percent nationwide.

The reasons are manifold, Love said. Texas has strict income limits for

Medicaid eligibility. A high proportion of Texans work for small

businesses, which are less likely to offer insurance. Undocumented

residents also contribute to the uninsured rates.

carolyn.feibel@ chron.com

Brought to you by the HoustonChronicle. com

June 6, 2008

OK so I guess I dont know what the Dallas Incident was but it must have been a

good one and if the response that Doc here is saying is apart of it then OMG.

I am not sure what to think about this plan we all know that there have been

plenty of calls that came in as BS and turned into a bad call on patient

contact, just like the CPR in progress calls that end up actually being someone

that was asleep.

I do however find it interesting to know that nurses are once againg moving

into what is our sandbox while steadily pushing hard to keep us from thiers.

When in actuality<at least in our minds, we will allways be better at triage

(wonder how many nurses I have just shook up LOL )

I dont know if we are better or not but...

For what its worth

Terrell EMT-P CC...,...,...,.,....( all the other things that still mean

I am a paramedic)

June 6, 2008

Agree about nurses elbowing themselves into our field while prohibiting us

from theirs. I would hope Dr. Persse and Houston would reconsider and use

paramedics.

GG

>

> OK so I guess I dont know what the Dallas Incident was but it must have been

> a good one and if the response that Doc here is saying is apart of it then

> OMG.

>

> I am not sure what to think about this plan we all know that there have been

> plenty of calls that came in as BS and turned into a bad call on patient

> contact, just like the CPR in progress calls that end up actually being

someone

> that was asleep.

>

> I do however find it interesting to know that nurses are once againg moving

> into what is our sandbox while steadily pushing hard to keep us from thiers.

> When in actuality<at least in our minds, we will allways be better at triage

> (wonder how many nurses I have just shook up LOL )

> I dont know if we are better or not but...

>

> For what its worth

> Terrell EMT-P CC...,...,.. Terrell EMT-P CC...,...,..

> .,.,....( all the other t

>

June 6, 2008

In a message dated 06/06/2008 16:22:42 Central Daylight Time,

tmartin_emtp@... writes:

I do however find it interesting to know that nurses are once againg moving

into what is our sandbox while steadily pushing hard to keep us from thiers.

When in actuality<at least in our minds, we will allways be better at triage

(wonder how many nurses I have just shook up LOL )

I dont know if we are better or not but...

For what it's worth, both the Military and Disaster Life Support paradigms

recommend the use of medics for the initial and ongoing triage of patients up

to the arrival of the victims at definitive care.

ck

S. Krin, DO FAAFP

**************Get trade secrets for amazing burgers. Watch " Cooking with

Tyler Florence " on AOL Food.

(http://food.aol.com/tyler-florence?video=4? & NCID=aolfod00030000000002)

June 6, 2008

The reason EMS wants to do this is not because of lack of resources but

misuse of resources. PD categorizes calls and some it never responds to. For

example, if you have a simple theft report, you do it over the phone. For

other calls, the wait may be long--hours in fact.

In EMS we can't do that. But we could use the call sorting methods we have

better than we do and send alternative units to those calls that obviously do

not need an emergency response.

Tucson has recently implemented an " Alpha Unit " program. An alpha unit

responds to calls for " invalid assist " and other calls that need a response but

not a full Bring-On-The-Cavalry response.

That sort of program would be far better than allowing some nurse sitting in

the comm center to try to diagnose over the phone somebody on the other end.

And diagnosis is just what they will be doing, regardless of what they want

to call it. There will inevitably be a disaster.

I recall several instances where the caller stated that her husband " needed

to go to the hospital. " We responded, expecting to find a stable patient

needing a ride and arrived to find a patient in extreme shock from a GI bleed or

in cardiac arrest. (Notice I did not say full cardiac arrest. What's half

cardiac arrest? LOL.).

No matter how many questions one asks over the phone, one will not get a

picture of the patient until one sees him. Many patients do not understand the

questions being asked and will give misleading answers. Many are unable to

self-assess well enough to answer questions correctly.

This scheme of Houston's is BAD, BAD, BAD, and they and their patients will

pay a high price for it. In the end it won't save anything.

Put some Alpha units on the street and respond to all calls.

GG

**************

Get trade secrets for amazing burgers. Watch " Cooking with

Tyler Florence " on AOL Food.

(http://food.aol.com/tyler-florence?video=4? & amp;

NCID=aolfod00030000000002)

June 6, 2008

Regardless of who is doing it...why is it that we continually try to find other

things to do with 911 EMS calls other than send someone to them?? FD and PD

would never consider not-sending to a 911 call...yet EMS always seems to want to

try it.?

Try this...go pick up the phone, call 911, wait for them to answer and then hang

up...make sure you don't answer the phone when it rings back...does PD just

assume you don't need anything?? I will bet, if you actually wait for the phone

to be answered (and you are calling from a phone that actually works with

enhanced 911...not vonage, etc) that within a few minutes someone wearing a

badge and gun will be knocking on your door.

Yet....someone calls 911, stays on the line, states they have a medical problem

and needs help...and EMS will try to determine if we need to send anyone out

there at all.? I just don't get this...

But wait, you work in?a small jurisdiction...you can't possibly understand...and

your right...but I have worked and ran a system that ran over 120,000 requests a

year...and I will tell you, I often wished for a way to do this, but I would

never try and actually NOT send someone to a 911 call for medical assistance.?

The PR, liability, ethical issues are all too great in my mind.?

I am a believer in EMD and other triage methods...but, unless I am mistaken,

these guidelines are built to determine WHO should go and HOW they should

respond.? They are not designed to determine IF someone should go.? I hear of

jurisdiction after jurisdiction trying to find a way to address this...yet they

almost always choose the " easy on the surface " answer of " we just won't send an

ambulance to those people who don't need one " .?

I believe there are answers out there, but it will take great creative minds to

explore and come up with these ideas.? To exclude the easy, first to come up

answers, and to dig deeper into causes and effects...to seek a solution that not

only works for the EMS agency looking to save resources...but ALSO works for our

customers/patients who are calling 911 because they perceive they have a need

that they can not handle on their own any longer.

Dudley

RE: article from HoustonChronicle.com (RN triaging ems

calls)

OK so I guess I dont know what the Dallas Incident was but it must have been a

good one and if the response that Doc here is saying is apart of it then OMG.

I am not sure what to think about this plan we all know that there have been

plenty of calls that came in as BS and turned into a bad call on patient

contact, just like the CPR in progress calls that end up actually being someone

that was asleep.

I do however find it interesting to know that nurses are once againg moving into

what is our sandbox while steadily pushing hard to keep us from thiers. When in

actuality<at least in our minds, we will allways be better at triage (wonder how

many nurses I have just shook up LOL )

I dont know if we are better or not but...

For what its worth

Terrell EMT-P CC...,...,...,.,....( all the other things that still mean

I am a paramedic)

June 6, 2008

Amen, brother...........

,

Sent via BlackBerry by AT & T

RE: article from HoustonChronicle.com (RN triaging ems

calls)

OK so I guess I dont know what the Dallas Incident was but it must have been a

good one and if the response that Doc here is saying is apart of it then OMG.

I am not sure what to think about this plan we all know that there have been

plenty of calls that came in as BS and turned into a bad call on patient

contact, just like the CPR in progress calls that end up actually being someone

that was asleep.

I do however find it interesting to know that nurses are once againg moving

into what is our sandbox while steadily pushing hard to keep us from thiers.

When in actuality<at least in our minds, we will allways be better at triage

(wonder how many nurses I have just shook up LOL )

I dont know if we are better or not but...

For what its worth

Terrell EMT-P CC...,...,...,.,....( all the other things that still mean

I am a paramedic)

June 7, 2008

Dare I say this but since I'm in London I'm safe.

Why not contract with private ambulances to do as Gene terms is " Alpha Unit

calls " based on a city set scheme? (Asked as a rhetorical ? Btw)

LNM

Sent via BlackBerry by AT & T

Re: article from HoustonChronicle.com (RN triaging ems

calls)

The reason EMS wants to do this is not because of lack of resources but

misuse of resources. PD categorizes calls and some it never responds to. For

example, if you have a simple theft report, you do it over the phone. For

other calls, the wait may be long--hours in fact.

In EMS we can't do that. But we could use the call sorting methods we have

better than we do and send alternative units to those calls that obviously do

not need an emergency response.

Tucson has recently implemented an " Alpha Unit " program. An alpha unit

responds to calls for " invalid assist " and other calls that need a response but

not a full Bring-On-The-Cavalry response.

That sort of program would be far better than allowing some nurse sitting in

the comm center to try to diagnose over the phone somebody on the other end.

And diagnosis is just what they will be doing, regardless of what they want

to call it. There will inevitably be a disaster.

I recall several instances where the caller stated that her husband " needed

to go to the hospital. " We responded, expecting to find a stable patient

needing a ride and arrived to find a patient in extreme shock from a GI bleed or

in cardiac arrest. (Notice I did not say full cardiac arrest. What's half

cardiac arrest? LOL.).

No matter how many questions one asks over the phone, one will not get a

picture of the patient until one sees him. Many patients do not understand the

questions being asked and will give misleading answers. Many are unable to

self-assess well enough to answer questions correctly.

This scheme of Houston's is BAD, BAD, BAD, and they and their patients will

pay a high price for it. In the end it won't save anything.

Put some Alpha units on the street and respond to all calls.

GG

**************

Get trade secrets for amazing burgers. Watch " Cooking with

Tyler Florence " on AOL Food.

(http://food.aol.com/tyler-florence?video=4? &

NCID=aolfod00030000000002)

June 7, 2008

Gene,

If call triage is so bad with RN's what makes a Medic better? I sat on the end

of the " pre " 9-1-1 call center for a large northeastern County the better part

of 20 years ago in my first real " 9-1-1 " job and the first thing I was taught

was " when in doubt send everything " some of that was County attorneys scared of

being seen as the deeper pockets but most of it came from the guys that had been

doing this for 10 years and learning hard earned lessons like the Dallas thing.

Plus with a savvy urban population they will soon learn " I can't breathe " and

other key phrases will get them what they want. When the Clawsen book and EMD

came out many of those old timers said many of the same things that others say

today about the whole idea of telephonic triage.

I can't see Medics being any better or worse than RN's as in ways it's still

playing Magic 8 ball with the call.

LNM

Sent via BlackBerry by AT & T

Re: article from HoustonChronicle.com (RN triaging ems

calls)

Agree about nurses elbowing themselves into our field while prohibiting us

from theirs. I would hope Dr. Persse and Houston would reconsider and use

paramedics.

GG

>

> OK so I guess I dont know what the Dallas Incident was but it must have been

> a good one and if the response that Doc here is saying is apart of it then

> OMG.

>

> I am not sure what to think about this plan we all know that there have been

> plenty of calls that came in as BS and turned into a bad call on patient

> contact, just like the CPR in progress calls that end up actually being

someone

> that was asleep.

>

> I do however find it interesting to know that nurses are once againg moving

> into what is our sandbox while steadily pushing hard to keep us from thiers.

> When in actuality<at least in our minds, we will allways be better at triage

> (wonder how many nurses I have just shook up LOL )

> I dont know if we are better or not but...

>

> For what its worth

> Terrell EMT-P CC...,...,.. Terrell EMT-P CC...,...,..

> .,.,....( all the other t

>

June 7, 2008

The whole issues revolves around who can pay and who cannot. & nbsp; This is the

society we live in now as the insurance or lack there of and how it pays

determines how the systems works for them. & nbsp; Look at the medical system as a

whole. & nbsp; Even if you have insurance you must be able to pay your

copay & nbsp;at the ER or go find someone else to help like your regular MD,

urgent care facility (but even they are getting the same attitude pay or

go). & nbsp; This is the reason for the concern not truly what is wrong & nbsp; with

the patient. & nbsp; I can remember being taught that we should treat the patient

not the equipment we lug around. & nbsp;

From: THEDUDMAN@... & lt;THEDUDMAN@... & gt;

Subject: Re: article from HoustonChronicle.com (RN triaging ems

calls)

To: texasems-l

Date: Friday, June 6, 2008, 10:47 PM

Regardless of who is doing it...why is it that we continually try to find other

things to do with 911 EMS calls other than send someone to them?? FD and PD

would never consider not-sending to a 911 call...yet EMS always seems to want to

try it.?

Try this...go pick up the phone, call 911, wait for them to answer and then hang

up...make sure you don't answer the phone when it rings back...does PD just

assume you don't need anything?? I will bet, if you actually wait for the phone

to be answered (and you are calling from a phone that actually works with

enhanced 911...not vonage, etc) that within a few minutes someone wearing a

badge and gun will be knocking on your door.

Yet....someone calls 911, stays on the line, states they have a medical problem

and needs help...and EMS will try to determine if we need to send anyone out

there at all.? I just don't get this...

But wait, you work in?a small jurisdiction. ..you can't possibly understand..

..and your right...but I have worked and ran a system that ran over 120,000

requests a year...and I will tell you, I often wished for a way to do this, but

I would never try and actually NOT send someone to a 911 call for medical

assistance.? The PR, liability, ethical issues are all too great in my mind.?

I am a believer in EMD and other triage methods...but, unless I am mistaken,

these guidelines are built to determine WHO should go and HOW they should

respond.? They are not designed to determine IF someone should go.? I hear of

jurisdiction after jurisdiction trying to find a way to address this...yet they

almost always choose the " easy on the surface " answer of " we just won't send an

ambulance to those people who don't need one " .?

I believe there are answers out there, but it will take great creative minds to

explore and come up with these ideas.? To exclude the easy, first to come up

answers, and to dig deeper into causes and effects...to seek a solution that not

only works for the EMS agency looking to save resources... but ALSO works for

our customers/patients who are calling 911 because they perceive they have a

need that they can not handle on their own any longer.

Dudley

RE: article from HoustonChronicle. com (RN triaging ems

calls)

OK so I guess I dont know what the Dallas Incident was but it must have been a

good one and if the response that Doc here is saying is apart of it then OMG.

I am not sure what to think about this plan we all know that there have been

plenty of calls that came in as BS and turned into a bad call on patient

contact, just like the CPR in progress calls that end up actually being someone

that was asleep.

I do however find it interesting to know that nurses are once againg moving into

what is our sandbox while steadily pushing hard to keep us from thiers. When in

actuality & lt;at least in our minds, we will allways be better at triage (wonder

how many nurses I have just shook up LOL )

I dont know if we are better or not but...

For what its worth

Terrell EMT-P CC...,...,.. .,.,....( all the other things that still mean

I am a paramedic)

June 7, 2008

Ah but therein lies the rub. Those toys (and tools) cost mega bucks and EMS is a

money maker (I've been told so anyway). Not all that long ago two guys with a

station wagon and a first aid class (maybe) would get Ya to the ED for pizza

money. *t times I wonder how the survival rates for the patients of Manny, Moe

and, Jack would compare to the " standard " in some places today.

LNM

Sent via BlackBerry by AT & T

RE: article from HoustonChronicle. com (RN triaging ems

calls)

OK so I guess I dont know what the Dallas Incident was but it must have been a

good one and if the response that Doc here is saying is apart of it then OMG.

I am not sure what to think about this plan we all know that there have been

plenty of calls that came in as BS and turned into a bad call on patient

contact, just like the CPR in progress calls that end up actually being someone

that was asleep.

I do however find it interesting to know that nurses are once againg moving into

what is our sandbox while steadily pushing hard to keep us from thiers. When in

actuality<at least in our minds, we will allways be better at triage (wonder how

many nurses I have just shook up LOL )

I dont know if we are better or not but...

For what its worth

Terrell EMT-P CC...,...,.. .,.,....( all the other things that still mean

I am a paramedic)

June 7, 2008

What I was really saying is that when it comes to prehospital care, nurses

lack the necessary training and perspective, just as a paramedic would be poorly

suited to work in the med-surg unit of a hospital without further training.

IF one were going to implement a telephone triage system, then paramedics

would be better than nurses.

However, I am not in favor of such a system under any circumstances. It is

impossible to rule out a medical emergency over the phone.

Sorry if I gave the wrong impression.

Gene Gandy

>

> Gene,

>

> If call triage is so bad with RN's what makes a Medic better? I sat on the

> end of the " pre " 9-1-1 call center for a large northeastern County the better

> part of 20 years ago in my first real " 9-1-1 " job and the first thing I was

> taught was " when in doubt send everything " some of that was County attorneys

> scared of being seen as the deeper pockets but most of it came from the guys

> that had been doing this for 10 years and learning hard earned lessons like

> the Dallas thing. Plus with a savvy urban population they will soon learn " I

> can't breathe " and other key phrases will get them what they want. When the

> Clawsen book and EMD came out many of those old timers said many of the same

> things that others say today about the whole idea of telephonic triage.

> I can't see Medics being any better or worse than RN's as in ways it's still

> playing Magic 8 ball with the call.

>

> LNM

>

> Sent via BlackBerry by AT & T

>

> Re:

> a

>

> Agree about nurses elbowing themselves into our field while prohibiting us

> from theirs. I would hope Dr. Persse and Houston would reconsider and use

> paramedics.

>

> GG

> In a message dated 6/6/08 2:22:43 PM, tmartin_emtp@tmartin_e writes:

>

> >

> > OK so I guess I dont know what the Dallas Incident was but it must have

> been

> > a good one and if the response that Doc here is saying is apart of it then

> > OMG.

> >

> > I am not sure what to think about this plan we all know that there have

> been

> > plenty of calls that came in as BS and turned into a bad call on patient

> > contact, just like the CPR in progress calls that end up actually being

> someone

> > that was asleep.

> >

> > I do however find it interesting to know that nurses are once againg

> moving

> > into what is our sandbox while steadily pushing hard to keep us from

> thiers.

> > When in actuality<at least in our minds, we will allways be better at

> triage

> > (wonder how many nurses I have just shook up LOL )

> > I dont know if we are better or not but...

> >

> > For what its worth

> > Terrell EMT-P CC...,...,.. Terrell EMT-P CC...,...,..

> > .,.,....( all the other t

> >

June 7, 2008

>>> OK so I guess I dont know what the Dallas Incident was but it must

have been a good one . . . <<<<

Terrell,

It happened a quarter of a century ago. If you have not heard of the

incident, just stay tuned. Someone will bring it up again regardless

of whether it is relevant.

Kenny Navarro

UT Southwestern Medical Center

June 7, 2008

Does the name Doff mean anything to you????????>............

Kenny Navarro wrote: >>> OK so I

guess I dont know what the Dallas Incident was but it must

have been a good one . . . <<<<

Terrell,

It happened a quarter of a century ago. If you have not heard of the

incident, just stay tuned. Someone will bring it up again regardless

of whether it is relevant.

Kenny Navarro

UT Southwestern Medical Center

Larry Mc LP, NREMT-P

June 7, 2008

I've been in EMS for 34 years now; nothing has changed, same problems are

present. Looks like different people are trying the same things over and over

again thats all. Can't seem to learn from our mistakes. Just my 0.02 cents

worth/thats all.

Larry Mc wrote: Does the name Doff mean

anything to you????????>............

Kenny Navarro wrote: >>> OK so I guess I

dont know what the Dallas Incident was but it must

have been a good one . . . <<<<

Terrell,

It happened a quarter of a century ago. If you have not heard of the

incident, just stay tuned. Someone will bring it up again regardless

of whether it is relevant.

Kenny Navarro

UT Southwestern Medical Center

Larry Mc LP, NREMT-P

June 7, 2008

I agree with ya Gene. You know medical professionals have difficulty with

medical issues every day, especially triage issues in a hospital. What makes us

think that a non-medical person in a highly stressful situation would be able to

make such decisions, with check boxes and computer programs?????!!!!

Louis N. Molino, Sr. wrote: Dare I say this but

since I'm in London I'm safe.

Why not contract with private ambulances to do as Gene terms is " Alpha Unit

calls " based on a city set scheme? (Asked as a rhetorical ? Btw)

LNM

Sent via BlackBerry by AT & T

Re: article from HoustonChronicle.com (RN triaging ems

calls)

The reason EMS wants to do this is not because of lack of resources but

misuse of resources. PD categorizes calls and some it never responds to. For

example, if you have a simple theft report, you do it over the phone. For

other calls, the wait may be long--hours in fact.

In EMS we can't do that. But we could use the call sorting methods we have

better than we do and send alternative units to those calls that obviously do

not need an emergency response.

Tucson has recently implemented an " Alpha Unit " program. An alpha unit

responds to calls for " invalid assist " and other calls that need a response but

not a full Bring-On-The-Cavalry response.

That sort of program would be far better than allowing some nurse sitting in

the comm center to try to diagnose over the phone somebody on the other end.

And diagnosis is just what they will be doing, regardless of what they want

to call it. There will inevitably be a disaster.

I recall several instances where the caller stated that her husband " needed

to go to the hospital. " We responded, expecting to find a stable patient

needing a ride and arrived to find a patient in extreme shock from a GI bleed or

in cardiac arrest. (Notice I did not say full cardiac arrest. What's half

cardiac arrest? LOL.).

No matter how many questions one asks over the phone, one will not get a

picture of the patient until one sees him. Many patients do not understand the

questions being asked and will give misleading answers. Many are unable to

self-assess well enough to answer questions correctly.

This scheme of Houston's is BAD, BAD, BAD, and they and their patients will

pay a high price for it. In the end it won't save anything.

Put some Alpha units on the street and respond to all calls.

GG

**************

Get trade secrets for amazing burgers. Watch " Cooking with

Tyler Florence " on AOL Food.

(http://food.aol.com/tyler-florence?video=4? &

NCID=aolfod00030000000002)

June 7, 2008

Hmmm, it seems like to me from what I gathered by reading that article

is that the call will initially go to the 911 Dispatcher who asks the

typical questions and if it seems like it's not a true emergency, they

transfer them to the nurse where they ask their questions and if the

nurse feels that it really is a true emergency, than she will transfer

the call back to the Dispatcher to send an ambulance.

To me there is nothing wrong with that it's just a utilization of

resources. It's kind've like some ER's that have a policy where

someone walks into the ER cause they have had a sore throat for 2 days

and a torn hang nail on their " greeting finger " , they are quickly seen

by a PA and if it's not deemed a medical emergency, they ask for let's

say $500 up front and they wait in line like everybody else or they

can leave. Plus, that article said that the nurse will also transfer

them to that non profit group to get them the needed medical care.

Nothing has really worked and the healthcare system is in crisis so

why not try something new or tweak an idea that someone has tried in

the past and make it better. It's worth a shot, what else do we have

to lose. Sometimes change is tough and a new idea will be tough, but

that's why they call it practicing medicine, cause it's changing. Be

safe.

>

> What I was really saying is that when it comes to prehospital care,

nurses

> lack the necessary training and perspective, just as a paramedic

would be poorly

> suited to work in the med-surg unit of a hospital without further

training.

> IF one were going to implement a telephone triage system, then

paramedics

> would be better than nurses.

>

> However, I am not in favor of such a system under any circumstances.

It is

> impossible to rule out a medical emergency over the phone.

>

> Sorry if I gave the wrong impression.

>

> Gene Gandy

>

> >

> > Gene,

> >

> > If call triage is so bad with RN's what makes a Medic better? I

sat on the

> > end of the " pre " 9-1-1 call center for a large northeastern County

the better

> > part of 20 years ago in my first real " 9-1-1 " job and the first

thing I was

> > taught was " when in doubt send everything " some of that was County

attorneys

> > scared of being seen as the deeper pockets but most of it came

from the guys

> > that had been doing this for 10 years and learning hard earned

lessons like

> > the Dallas thing. Plus with a savvy urban population they will

soon learn " I

> > can't breathe " and other key phrases will get them what they want.

When the

> > Clawsen book and EMD came out many of those old timers said many

of the same

> > things that others say today about the whole idea of telephonic

triage.

> > I can't see Medics being any better or worse than RN's as in ways

it's still

> > playing Magic 8 ball with the call.

> >

> > LNM

> >

> > Sent via BlackBerry by AT & T

> >

> > Re:

> > a

> >

> > Agree about nurses elbowing themselves into our field while

prohibiting us

> > from theirs. I would hope Dr. Persse and Houston would reconsider

and use

> > paramedics.

> >

> > GG

> > In a message dated 6/6/08 2:22:43 PM, tmartin_emtp@tmartin_e writes:

> >

> > >

> > > OK so I guess I dont know what the Dallas Incident was but it

must have

> > been

> > > a good one and if the response that Doc here is saying is apart

of it then

> > > OMG.

> > >

> > > I am not sure what to think about this plan we all know that

there have

> > been

> > > plenty of calls that came in as BS and turned into a bad call on

patient

> > > contact, just like the CPR in progress calls that end up

actually being

> > someone

> > > that was asleep.

> > >

> > > I do however find it interesting to know that nurses are once

againg

> > moving

> > > into what is our sandbox while steadily pushing hard to keep us

from

> > thiers.

> > > When in actuality<at least in our minds, we will allways be

better at

> > triage

> > > (wonder how many nurses I have just shook up LOL )

> > > I dont know if we are better or not but...

> > >

> > > For what its worth

> > > Terrell EMT-P CC...,...,.. Terrell EMT-P

CC...,...,..

> > > .,.,....( all the other t

> > >

June 7, 2008

I pretty much figured you point of view. You do however need to open up and be

more excessive. As do I.

LNM

Sent via BlackBerry by AT & T

Re:

> a

>

> Agree about nurses elbowing themselves into our field while prohibiting us

> from theirs. I would hope Dr. Persse and Houston would reconsider and use

> paramedics.

>

> GG

> In a message dated 6/6/08 2:22:43 PM, tmartin_emtp@tmartin_e writes:

>

> >

> > OK so I guess I dont know what the Dallas Incident was but it must have

> been

> > a good one and if the response that Doc here is saying is apart of it then

> > OMG.

> >

> > I am not sure what to think about this plan we all know that there have

> been

> > plenty of calls that came in as BS and turned into a bad call on patient

> > contact, just like the CPR in progress calls that end up actually being

> someone

> > that was asleep.

> >

> > I do however find it interesting to know that nurses are once againg

> moving

> > into what is our sandbox while steadily pushing hard to keep us from

> thiers.

> > When in actuality<at least in our minds, we will allways be better at

> triage

> > (wonder how many nurses I have just shook up LOL )

> > I dont know if we are better or not but...

> >

> > For what its worth

> > Terrell EMT-P CC...,...,.. Terrell EMT-P CC...,...,..

> > .,.,....( all the other t

> >

June 7, 2008

Larry with inflation your 2 cent buys a gallon of gas! 27 years here and I am

with Ya.

Lnm

Sent via BlackBerry by AT & T

Re: Re: article from HoustonChronicle.com (RN triaging ems

calls)

I've been in EMS for 34 years now; nothing has changed, same problems are

present. Looks like different people are trying the same things over and over

again thats all. Can't seem to learn from our mistakes. Just my 0.02 cents

worth/thats all.

Larry Mc wrote: Does the name Doff mean

anything to you????????>............

Kenny Navarro wrote: >>> OK so I guess I

dont know what the Dallas Incident was but it must

have been a good one . . . <<<<

Terrell,

It happened a quarter of a century ago. If you have not heard of the

incident, just stay tuned. Someone will bring it up again regardless

of whether it is relevant.

Kenny Navarro

UT Southwestern Medical Center

Larry Mc LP, NREMT-P

June 7, 2008

Come on Kenny be fair it IS relevant or does history goof bad or ugly not

matter?

I watched Charlie 's War on the plane to London. While its not some peer

reviewed documentary it's not a bad way to kill 2 hours. The last quote from the

Congressman at the end just before the credits is priceless and in some warped

way relevant to this discussion topic.

Nope I ain't giving it to Ya.

LNM

Sent via BlackBerry by AT & T

Re: Re: article from HoustonChronicle.com (RN triaging ems

calls)

Does the name Doff mean anything to you????????>............

Kenny Navarro wrote: >>> OK so I

guess I dont know what the Dallas Incident was but it must

have been a good one . . . <<<<

Terrell,

It happened a quarter of a century ago. If you have not heard of the

incident, just stay tuned. Someone will bring it up again regardless

of whether it is relevant.

Kenny Navarro

UT Southwestern Medical Center

Larry Mc LP, NREMT-P

June 7, 2008

What happens when it is an elderly pt, let's even throw female pt in there

for fun, who complains of lower back pain and flu like symptoms for the last

couple of days. Non-emergent right? Or is it atypical signs of a heart

attack that would only be seen with a physical exam and EKG. I do not think

you can make a safe " diagnosis " over the phone. I have run plenty of BS

calls that frustrate me, but how many times have we been on what seems like

a BS call that turns into something more. This idea just seems like such a

liability for the pt and for the person on the other end of the call.

Segner

Program Director

Blinn College EMS Program

jsegner@...

_____

From: texasems-l [mailto:texasems-l ] On

Behalf Of paramedic352a

Sent: Saturday, June 07, 2008 7:08 PM