Re: Paramedics Cannot Determine Which Patients Require Transport

[Guest guest]

As a person in favor of denying transport I do feel that we should not deny

chest, abd, or head related calls. Even Doctors with all their equipment have

trouble making accurate diagnosis. The calls that would be allowed denial would

be the minor trauma such as stubbed toe, the sneezed once and want to make sure

its not swine flu, the I just need a ride to the hospital so I can get to my

doctors appointment, the I really just need someone to talk to to help cope (

this one only if you have resources that can come there while you wait ).

The denial process would also involve as much if not more effort than just load

and go so would discourage abuse by that one lazy Paramedic that everyone seems

to know since he is mentioned often.

I would like to see a study on EMS denials based on a system as described above.

If allowed denial of the items even Doctors have trouble with then it is doomed

to show we can not do it. It would also need a better criteria for mistake than

admission to the hospital. For example the stubbed toe might end up needing

surgery, yet nothing about the call required EMS, so admission was not a failure

in this case.

Well just my worthless idealistic thoughts.

Renny Spencer

The Idealistic Paramedic

> > > > >

> > > > > Abstract

> > > > > Introduction. Reducing unnecessary ambulance transports may have

> > > > operational

> > > > > and economic benefits for emergency medical services (EMS)

> > agencies and

> > > > > receiving emergency departments. However, no consensus exists on

> > the

> > > > ability

> > > > > of paramedics to accurately and safely identify patients who do not

> > > > require

> > > > > ambulance transport. Objective. This systematic review and

> > meta-analysis

> > > > > evaluated studies reporting U.S. paramedics' ability to determine

> > > > medical

> > > > > necessity of ambulance transport. Methods. PubMed, Cumulative

> > Index to

> > > > > Nursing and Allied Health Literature (CINAHL), and Cochrane Library

> > > > > databases were searched using Cochrane Prehospital and Emergency

> > Care

> > > > Field

> > > > > search terms combined with the Medical Subject Headings (MeSH) terms

> > > > > D*$¢®triageD*$¢®; D*$¢®utilization reviewD*$¢®; D*$¢®health

> > services misuseD*$¢®; D*$¢®

> > > > severity of

> > > > > illness index,D*$¢® and D*$¢®trauma severity indices.D*$¢® Two

> > reviewers

> > > > independently

> > > > > evaluated each title to identify relevant studies; each abstract

> > then

> > > > > underwent independent review to identify studies requiring full

> > > > appraisal.

> > > > > Inclusion criteria were original research; emergency responses;

> > > > > determinations of medical=2

> > > > 0necessity by U.S. paramedics; and a reference

> > > > > standard comparison. The primary outcome measure of interest was the

> > > > > negative predictive value (NPV) of paramedic determinations. For

> > studies

> > > > > 20reporting sufficient data, agreement between paramedic and

> > reference

> > > > > standard determinations was measured using kappa; sensitivity,

> > > > specificity,

> > > > > and positive predictive value (PPV) were also calculated.

> > Results. From

> > > > > 9,752 identified titles, 214 abstracts were evaluated, with 61

> > studies

> > > > > selected for full review. Five studies met the inclusion criteria

> > > > > (interrater reliability, kappa = 0.75). Reference standards included

> > > > > physician opinion (n = 3), hospital admission (n = 1), and a

> > composite

> > > > of

> > > > > physician opinion and patient clinical circumstances (n = 1).

> > The NPV

> > > > ranged

> > > > > from 0.610 to 0.997. Results lacked homogeneity across studies;

> > > > > meta-analysis using a random-effects model produced an aggregate

> > NPV of

> > > > > 0.912 (95% confidence interval: 0.707-0.978) 0.912 (95%

> > confidence inte

> > > > > complete 2 2 data: kappa was 0.105 and 0.427; sensitivity was

> > 0.992 and

> > > > > 0.841; specificity was 0.356 and 0.581; and PPV was 0.158 and 0.823.

> > > > > Conclusion. The results of the few studies evaluating U.S. paramedic

> > > > > determinations of medical necessity for ambulance transport vary

> > > > > considerably, and only two studies report complete data. The

> > aggregate

> > > > NPV

> > > > > of the paramedic determinations is 0.91, with a lower confidence

> > limit

> > > > of

> > > > > 0.71. These data do not support the practice of paramedics'

> > determining

> > > > > whether patients require ambulance transport. These

> > > > findings have

> > > > > implications for EMS systems, emergency departments, and

> > third-party

> > > > payers.

> > > > >

> > > > > Prehospital Emergency Care 2009, Volume 13, Issue 4 pages 516 - 527

> > > > >

> > > > >

> > > > > [Non-text portions of this mess

> > > > > age have been removed]

> > > > >

> > > > >

> > > > >

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

> > > > >

[Guest guest]

As a person in favor of denying transport I do feel that we should not deny

chest, abd, or head related calls. Even Doctors with all their equipment have

trouble making accurate diagnosis. The calls that would be allowed denial would

be the minor trauma such as stubbed toe, the sneezed once and want to make sure

its not swine flu, the I just need a ride to the hospital so I can get to my

doctors appointment, the I really just need someone to talk to to help cope (

this one only if you have resources that can come there while you wait ).

The denial process would also involve as much if not more effort than just load

and go so would discourage abuse by that one lazy Paramedic that everyone seems

to know since he is mentioned often.

I would like to see a study on EMS denials based on a system as described above.

If allowed denial of the items even Doctors have trouble with then it is doomed

to show we can not do it. It would also need a better criteria for mistake than

admission to the hospital. For example the stubbed toe might end up needing

surgery, yet nothing about the call required EMS, so admission was not a failure

in this case.

Well just my worthless idealistic thoughts.

Renny Spencer

The Idealistic Paramedic

> > > > >

> > > > > Abstract

> > > > > Introduction. Reducing unnecessary ambulance transports may have

> > > > operational

> > > > > and economic benefits for emergency medical services (EMS)

> > agencies and

> > > > > receiving emergency departments. However, no consensus exists on

> > the

> > > > ability

> > > > > of paramedics to accurately and safely identify patients who do not

> > > > require

> > > > > ambulance transport. Objective. This systematic review and

> > meta-analysis

> > > > > evaluated studies reporting U.S. paramedics' ability to determine

> > > > medical

> > > > > necessity of ambulance transport. Methods. PubMed, Cumulative

> > Index to

> > > > > Nursing and Allied Health Literature (CINAHL), and Cochrane Library

> > > > > databases were searched using Cochrane Prehospital and Emergency

> > Care

> > > > Field

> > > > > search terms combined with the Medical Subject Headings (MeSH) terms

> > > > > D*$¢®triageD*$¢®; D*$¢®utilization reviewD*$¢®; D*$¢®health

> > services misuseD*$¢®; D*$¢®

> > > > severity of

> > > > > illness index,D*$¢® and D*$¢®trauma severity indices.D*$¢® Two

> > reviewers

> > > > independently

> > > > > evaluated each title to identify relevant studies; each abstract

> > then

> > > > > underwent independent review to identify studies requiring full

> > > > appraisal.

> > > > > Inclusion criteria were original research; emergency responses;

> > > > > determinations of medical=2

> > > > 0necessity by U.S. paramedics; and a reference

> > > > > standard comparison. The primary outcome measure of interest was the

> > > > > negative predictive value (NPV) of paramedic determinations. For

> > studies

> > > > > 20reporting sufficient data, agreement between paramedic and

> > reference

> > > > > standard determinations was measured using kappa; sensitivity,

> > > > specificity,

> > > > > and positive predictive value (PPV) were also calculated.

> > Results. From

> > > > > 9,752 identified titles, 214 abstracts were evaluated, with 61

> > studies

> > > > > selected for full review. Five studies met the inclusion criteria

> > > > > (interrater reliability, kappa = 0.75). Reference standards included

> > > > > physician opinion (n = 3), hospital admission (n = 1), and a

> > composite

> > > > of

> > > > > physician opinion and patient clinical circumstances (n = 1).

> > The NPV

> > > > ranged

> > > > > from 0.610 to 0.997. Results lacked homogeneity across studies;

> > > > > meta-analysis using a random-effects model produced an aggregate

> > NPV of

> > > > > 0.912 (95% confidence interval: 0.707-0.978) 0.912 (95%

> > confidence inte

> > > > > complete 2 2 data: kappa was 0.105 and 0.427; sensitivity was

> > 0.992 and

> > > > > 0.841; specificity was 0.356 and 0.581; and PPV was 0.158 and 0.823.

> > > > > Conclusion. The results of the few studies evaluating U.S. paramedic

> > > > > determinations of medical necessity for ambulance transport vary

> > > > > considerably, and only two studies report complete data. The

> > aggregate

> > > > NPV

> > > > > of the paramedic determinations is 0.91, with a lower confidence

> > limit

> > > > of

> > > > > 0.71. These data do not support the practice of paramedics'

> > determining

> > > > > whether patients require ambulance transport. These

> > > > findings have

> > > > > implications for EMS systems, emergency departments, and

> > third-party

> > > > payers.

> > > > >

> > > > > Prehospital Emergency Care 2009, Volume 13, Issue 4 pages 516 - 527

> > > > >

> > > > >

> > > > > [Non-text portions of this mess

> > > > > age have been removed]

> > > > >

> > > > >

> > > > >

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

> > > > >

[Guest guest]

The one thing I find the longer I have my paramedic patch is that I know less

than I thought I did. 

At this point, EMS has a hard enough time mastering our core skills, as the Wang

study and several others have indicated.  I'm not sure that we're anywhere near

ready to assume a role as the gatekeepers to the healthcare system, determining

who is worthy of our time. That to me is the height of arrogance, especially

considering that we want to be considered a profession.  It smacks of hubris at

the least.

I realize that we've come a long ways from high-top Cadillac hearse/ambulances,

but the reality is that we're still in the business of medical transportation. 

Ultimately, that means we give people rides to the hospital.  Having said that,

though, part of informed consent means giving patients a realistic expectation

of our capabilities and treatment.  I have told a patient with minor complaints

that it's unlikely that I could provide any treatment beyond assessment and

transport.  If I've informed the patient as to their options and they still

choose to ride in an ambulance, I'm not in a position to deny them that option.

And can we please kill this damned thread?

-Wes Ogilvie, MPA, JD, Lic.P./NREMT-P

-Attorney at Law/Licensed Paramedic/EMS Instructor

-Austin, Texas

Re: Paramedics Cannot Determine Wh

ich Patients Require Transport

As a person in favor of denying transport I do feel that we should not deny

chest, abd, or head related calls. Even Doctors with all their equipment have

trouble making accurate diagnosis. The calls that would be allowed denial would

be the minor trauma such as stubbed toe, the sneezed once and want to make sure

its not swine flu, the I just need a ride to the hospital so I can get to my

doctors appointment, the I really just need someone to talk to to help cope (

this one only if you have resources that can come there while you wait ).

The denial process would also involve as much if not more effort than just load

and go so would discourage abuse by that one lazy Paramedic that everyone seems

to know since he is mentioned often.

I would like to see a study on EMS denials based on a system as described above.

If allowed denial of the items even Doctors have trouble with then it is doomed

to show we can not do it. It would also need a better criteria for mistake than

admission to the hospital. For example the stubbed toe might end up needing

surgery, yet nothing about the call required EMS, so admission was not a failure

in this case.

Well just my worthless idealistic thoughts.

Renny Spencer

The Idealistic Paramedic

> > > > >

> > > > > Abstract

> > > > > Introduction. Reducing unnecessary ambulance transports may have

> > > > operational

> > > > > and economic benefits for emergency medical services (EMS)

> > agencies and

> > > > > receiving emergency departments. However, no consensus exists on

> > the

> > > > ability

> > > > > of paramedics to accurately and safely identify patients who do not

> > > > require

> > > > > ambulance transport. Objective. This systematic review and

> > meta-analysis

> > > > > evaluated studies reporting U.S. paramedics' ability to determine

> > > > medical

> > > > > necessity of ambulance transport. Methods. PubMed, Cumulative

> > Index to=0

A> > > > > Nursing and Allied Health Literature (CINAHL), and Cochrane Library

> > > > > databases were searched using Cochrane Prehospital and Emergency

> > Care

> > > > Field

> > > > > search terms combined with the Medical Subject Headings (MeSH) terms

> > > > > D*$¢®triageD*$¢®; D*$¢®utilization reviewD*$¢®; D*$¢®health

> > services misuseD*$¢®; D*$¢®

> > > > severity of

> > > > > illness index,D*$¢® and D*$¢®trauma severity indices.D*$¢® Two

> > reviewers

> > > > independently

> > > > > evaluated each title to identify relevant studies; each abstract

> > then

> > > > > underwent independent review to identify studies requiring full

> > > > appraisal.

> > > > > Inclusion criteria were original research; emergency responses;

> > > > > determinations of medical=2

> > > > 0necessity by U.S. paramedics; and a reference

> > > > > standard comparison. The primary outcome measure of interest was the

> > > > > negative predictive value (NPV) of paramedic determinations. For

> > studies

> > > > > 20reporting sufficient data, agreement between paramedic and

> > reference

> > > > > standard determinations was measured using kappa; sensitivity,

> > > > specificity,

> > > > > and positive predictive value (PPV) were also calculated.

> > Results. From

> > > > > 9,752 identified titles, 214 abstracts were evaluated, with 61

> > studies

> > > > > selected for full review. Five studies

met the inclusion criteria

> > > > > (interrater reliability, kappa = 0.75). Reference standards included

> > > > > physician opinion (n = 3), hospital admission (n = 1), and a

> > composite

> > > > of

> > > > > physician opinion and patient clinical circumstances (n = 1).

> > The NPV

> > > > ranged

> > > > > from 0.610 to 0.997. Results lacked homogeneity across studies;

> > > > > meta-analysis using a random-effects model produced an aggregate

> > NPV of

> > > > > 0.912 (95% confidence interval: 0.707-0.978) 0.912 (95%

> > confidence inte

> > > > > complete 2 2 data: kappa was 0.105 and 0.427; sensitivity was

> > 0.992 and

> > > > > 0.841; specificity was 0.356 and 0.581; and PPV was 0.158 and 0.823.

> > > > > Conclusion. The results of the few studies evaluating U.S. paramedic

> > > > > determinations of medical necessity for ambulance transport vary

> > > > > considerably, and only two studies report complete data. The

> > aggregate

> > > > NPV

> > > > > of the paramedic determinations is 0.91, with a lower confidence

> > limit

> > > > of

> > > > > 0.71. These data do not support the practice of paramedics'

> > determining

> > > > > whether patients require ambulance transport. These

> > > > findings have

> > > > > implications for EMS systems, emergency departments, and

> > third-party

> > > > payers.

> > > > >

> > > > > Prehospital Emergency Care 2009, Volume 13, Issue 4 pages 516 - 5

27

> > > > >

> > > > >

> > > > > [Non-text portions of this mess

> > > > > age have been removed]

> > > > >

> > > > >

> > > > >

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

> > > > >

[Guest guest]

The one thing I find the longer I have my paramedic patch is that I know less

than I thought I did. 

At this point, EMS has a hard enough time mastering our core skills, as the Wang

study and several others have indicated.  I'm not sure that we're anywhere near

ready to assume a role as the gatekeepers to the healthcare system, determining

who is worthy of our time. That to me is the height of arrogance, especially

considering that we want to be considered a profession.  It smacks of hubris at

the least.

I realize that we've come a long ways from high-top Cadillac hearse/ambulances,

but the reality is that we're still in the business of medical transportation. 

Ultimately, that means we give people rides to the hospital.  Having said that,

though, part of informed consent means giving patients a realistic expectation

of our capabilities and treatment.  I have told a patient with minor complaints

that it's unlikely that I could provide any treatment beyond assessment and

transport.  If I've informed the patient as to their options and they still

choose to ride in an ambulance, I'm not in a position to deny them that option.

And can we please kill this damned thread?

-Wes Ogilvie, MPA, JD, Lic.P./NREMT-P

-Attorney at Law/Licensed Paramedic/EMS Instructor

-Austin, Texas

Re: Paramedics Cannot Determine Wh

ich Patients Require Transport

As a person in favor of denying transport I do feel that we should not deny

chest, abd, or head related calls. Even Doctors with all their equipment have

trouble making accurate diagnosis. The calls that would be allowed denial would

be the minor trauma such as stubbed toe, the sneezed once and want to make sure

its not swine flu, the I just need a ride to the hospital so I can get to my

doctors appointment, the I really just need someone to talk to to help cope (

this one only if you have resources that can come there while you wait ).

The denial process would also involve as much if not more effort than just load

and go so would discourage abuse by that one lazy Paramedic that everyone seems

to know since he is mentioned often.

I would like to see a study on EMS denials based on a system as described above.

If allowed denial of the items even Doctors have trouble with then it is doomed

to show we can not do it. It would also need a better criteria for mistake than

admission to the hospital. For example the stubbed toe might end up needing

surgery, yet nothing about the call required EMS, so admission was not a failure

in this case.

Well just my worthless idealistic thoughts.

Renny Spencer

The Idealistic Paramedic

> > > > >

> > > > > Abstract

> > > > > Introduction. Reducing unnecessary ambulance transports may have

> > > > operational

> > > > > and economic benefits for emergency medical services (EMS)

> > agencies and

> > > > > receiving emergency departments. However, no consensus exists on

> > the

> > > > ability

> > > > > of paramedics to accurately and safely identify patients who do not

> > > > require

> > > > > ambulance transport. Objective. This systematic review and

> > meta-analysis

> > > > > evaluated studies reporting U.S. paramedics' ability to determine

> > > > medical

> > > > > necessity of ambulance transport. Methods. PubMed, Cumulative

> > Index to=0

A> > > > > Nursing and Allied Health Literature (CINAHL), and Cochrane Library

> > > > > databases were searched using Cochrane Prehospital and Emergency

> > Care

> > > > Field

> > > > > search terms combined with the Medical Subject Headings (MeSH) terms

> > > > > D*$¢®triageD*$¢®; D*$¢®utilization reviewD*$¢®; D*$¢®health

> > services misuseD*$¢®; D*$¢®

> > > > severity of

> > > > > illness index,D*$¢® and D*$¢®trauma severity indices.D*$¢® Two

> > reviewers

> > > > independently

> > > > > evaluated each title to identify relevant studies; each abstract

> > then

> > > > > underwent independent review to identify studies requiring full

> > > > appraisal.

> > > > > Inclusion criteria were original research; emergency responses;

> > > > > determinations of medical=2

> > > > 0necessity by U.S. paramedics; and a reference

> > > > > standard comparison. The primary outcome measure of interest was the

> > > > > negative predictive value (NPV) of paramedic determinations. For

> > studies

> > > > > 20reporting sufficient data, agreement between paramedic and

> > reference

> > > > > standard determinations was measured using kappa; sensitivity,

> > > > specificity,

> > > > > and positive predictive value (PPV) were also calculated.

> > Results. From

> > > > > 9,752 identified titles, 214 abstracts were evaluated, with 61

> > studies

> > > > > selected for full review. Five studies

met the inclusion criteria

> > > > > (interrater reliability, kappa = 0.75). Reference standards included

> > > > > physician opinion (n = 3), hospital admission (n = 1), and a

> > composite

> > > > of

> > > > > physician opinion and patient clinical circumstances (n = 1).

> > The NPV

> > > > ranged

> > > > > from 0.610 to 0.997. Results lacked homogeneity across studies;

> > > > > meta-analysis using a random-effects model produced an aggregate

> > NPV of

> > > > > 0.912 (95% confidence interval: 0.707-0.978) 0.912 (95%

> > confidence inte

> > > > > complete 2 2 data: kappa was 0.105 and 0.427; sensitivity was

> > 0.992 and

> > > > > 0.841; specificity was 0.356 and 0.581; and PPV was 0.158 and 0.823.

> > > > > Conclusion. The results of the few studies evaluating U.S. paramedic

> > > > > determinations of medical necessity for ambulance transport vary

> > > > > considerably, and only two studies report complete data. The

> > aggregate

> > > > NPV

> > > > > of the paramedic determinations is 0.91, with a lower confidence

> > limit

> > > > of

> > > > > 0.71. These data do not support the practice of paramedics'

> > determining

> > > > > whether patients require ambulance transport. These

> > > > findings have

> > > > > implications for EMS systems, emergency departments, and

> > third-party

> > > > payers.

> > > > >

> > > > > Prehospital Emergency Care 2009, Volume 13, Issue 4 pages 516 - 5

27

> > > > >

> > > > >

> > > > > [Non-text portions of this mess

> > > > > age have been removed]

> > > > >

> > > > >

> > > > >

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

> > > > >

[Guest guest]

The one thing I find the longer I have my paramedic patch is that I know less

than I thought I did. 

At this point, EMS has a hard enough time mastering our core skills, as the Wang

study and several others have indicated.  I'm not sure that we're anywhere near

ready to assume a role as the gatekeepers to the healthcare system, determining

who is worthy of our time. That to me is the height of arrogance, especially

considering that we want to be considered a profession.  It smacks of hubris at

the least.

I realize that we've come a long ways from high-top Cadillac hearse/ambulances,

but the reality is that we're still in the business of medical transportation. 

Ultimately, that means we give people rides to the hospital.  Having said that,

though, part of informed consent means giving patients a realistic expectation

of our capabilities and treatment.  I have told a patient with minor complaints

that it's unlikely that I could provide any treatment beyond assessment and

transport.  If I've informed the patient as to their options and they still

choose to ride in an ambulance, I'm not in a position to deny them that option.

And can we please kill this damned thread?

-Wes Ogilvie, MPA, JD, Lic.P./NREMT-P

-Attorney at Law/Licensed Paramedic/EMS Instructor

-Austin, Texas

Re: Paramedics Cannot Determine Wh

ich Patients Require Transport

As a person in favor of denying transport I do feel that we should not deny

chest, abd, or head related calls. Even Doctors with all their equipment have

trouble making accurate diagnosis. The calls that would be allowed denial would

be the minor trauma such as stubbed toe, the sneezed once and want to make sure

its not swine flu, the I just need a ride to the hospital so I can get to my

doctors appointment, the I really just need someone to talk to to help cope (

this one only if you have resources that can come there while you wait ).

The denial process would also involve as much if not more effort than just load

and go so would discourage abuse by that one lazy Paramedic that everyone seems

to know since he is mentioned often.

I would like to see a study on EMS denials based on a system as described above.

If allowed denial of the items even Doctors have trouble with then it is doomed

to show we can not do it. It would also need a better criteria for mistake than

admission to the hospital. For example the stubbed toe might end up needing

surgery, yet nothing about the call required EMS, so admission was not a failure

in this case.

Well just my worthless idealistic thoughts.

Renny Spencer

The Idealistic Paramedic

> > > > >

> > > > > Abstract

> > > > > Introduction. Reducing unnecessary ambulance transports may have

> > > > operational

> > > > > and economic benefits for emergency medical services (EMS)

> > agencies and

> > > > > receiving emergency departments. However, no consensus exists on

> > the

> > > > ability

> > > > > of paramedics to accurately and safely identify patients who do not

> > > > require

> > > > > ambulance transport. Objective. This systematic review and

> > meta-analysis

> > > > > evaluated studies reporting U.S. paramedics' ability to determine

> > > > medical

> > > > > necessity of ambulance transport. Methods. PubMed, Cumulative

> > Index to=0

A> > > > > Nursing and Allied Health Literature (CINAHL), and Cochrane Library

> > > > > databases were searched using Cochrane Prehospital and Emergency

> > Care

> > > > Field

> > > > > search terms combined with the Medical Subject Headings (MeSH) terms

> > > > > D*$¢®triageD*$¢®; D*$¢®utilization reviewD*$¢®; D*$¢®health

> > services misuseD*$¢®; D*$¢®

> > > > severity of

> > > > > illness index,D*$¢® and D*$¢®trauma severity indices.D*$¢® Two

> > reviewers

> > > > independently

> > > > > evaluated each title to identify relevant studies; each abstract

> > then

> > > > > underwent independent review to identify studies requiring full

> > > > appraisal.

> > > > > Inclusion criteria were original research; emergency responses;

> > > > > determinations of medical=2

> > > > 0necessity by U.S. paramedics; and a reference

> > > > > standard comparison. The primary outcome measure of interest was the

> > > > > negative predictive value (NPV) of paramedic determinations. For

> > studies

> > > > > 20reporting sufficient data, agreement between paramedic and

> > reference

> > > > > standard determinations was measured using kappa; sensitivity,

> > > > specificity,

> > > > > and positive predictive value (PPV) were also calculated.

> > Results. From

> > > > > 9,752 identified titles, 214 abstracts were evaluated, with 61

> > studies

> > > > > selected for full review. Five studies

met the inclusion criteria

> > > > > (interrater reliability, kappa = 0.75). Reference standards included

> > > > > physician opinion (n = 3), hospital admission (n = 1), and a

> > composite

> > > > of

> > > > > physician opinion and patient clinical circumstances (n = 1).

> > The NPV

> > > > ranged

> > > > > from 0.610 to 0.997. Results lacked homogeneity across studies;

> > > > > meta-analysis using a random-effects model produced an aggregate

> > NPV of

> > > > > 0.912 (95% confidence interval: 0.707-0.978) 0.912 (95%

> > confidence inte

> > > > > complete 2 2 data: kappa was 0.105 and 0.427; sensitivity was

> > 0.992 and

> > > > > 0.841; specificity was 0.356 and 0.581; and PPV was 0.158 and 0.823.

> > > > > Conclusion. The results of the few studies evaluating U.S. paramedic

> > > > > determinations of medical necessity for ambulance transport vary

> > > > > considerably, and only two studies report complete data. The

> > aggregate

> > > > NPV

> > > > > of the paramedic determinations is 0.91, with a lower confidence

> > limit

> > > > of

> > > > > 0.71. These data do not support the practice of paramedics'

> > determining

> > > > > whether patients require ambulance transport. These

> > > > findings have

> > > > > implications for EMS systems, emergency departments, and

> > third-party

> > > > payers.

> > > > >

> > > > > Prehospital Emergency Care 2009, Volume 13, Issue 4 pages 516 - 5

27

> > > > >

> > > > >

> > > > > [Non-text portions of this mess

> > > > > age have been removed]

> > > > >

> > > > >

> > > > >

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

> > > > >

[Guest guest]

Why is it arrogant to actually try and get the patient the care they need while

saving them money? Honestly it seems much more professional to get patients the

help they need rather than just treating them as not worthy of our time which is

what is being said by just transporting them all if better options of help are

available. And even in the way under educated state we find ourselves being in

we should still strive for what is best for our patients rather than to just be

a taxi service.

Renny Spencer

The Idealistic Paramedic

>

>

> The one thing I find the longer I have my paramedic patch is that I know less

than I thought I did. 

>

>

>

> At this point, EMS has a hard enough time mastering our core skills, as the

Wang study and several others have indicated.  I'm not sure that we're anywhere

near ready to assume a role as the gatekeepers to the healthcare system,

determining who is worthy of our time. That to me is the height of arrogance,

especially considering that we want to be considered a profession.  It smacks

of hubris at the least.

>

>

>

> I realize that we've come a long ways from high-top Cadillac

hearse/ambulances, but the reality is that we're still in the business of

medical transportation.  Ultimately, that means we give people rides to the

hospital.  Having said that, though, part of informed consent means giving

patients a realistic expectation of our capabilities and treatment.  I have

told a patient with minor complaints that it's unlikely that I could provide any

treatment beyond assessment and transport.  If I've informed the patient as to

their options and they still choose to ride in an ambulance, I'm not in a

position to deny them that option.

>

>

>

> And can we please kill this damned thread?

>

>

>

> -Wes Ogilvie, MPA, JD, Lic.P./NREMT-P

>

> -Attorney at Law/Licensed Paramedic/EMS Instructor

>

> -Austin, Texas

>

>

>

>

>

>

> Re: Paramedics Cannot Determine Wh

> ich Patients Require Transport

>

>

>

>

>

>

> As a person in favor of denying transport I do feel that we should not deny

chest, abd, or head related calls. Even Doctors with all their equipment have

trouble making accurate diagnosis. The calls that would be allowed denial would

be the minor trauma such as stubbed toe, the sneezed once and want to make sure

its not swine flu, the I just need a ride to the hospital so I can get to my

doctors appointment, the I really just need someone to talk to to help cope (

this one only if you have resources that can come there while you wait ).

>

> The denial process would also involve as much if not more effort than just

load and go so would discourage abuse by that one lazy Paramedic that everyone

seems to know since he is mentioned often.

>

> I would like to see a study on EMS denials based on a system as described

above. If allowed denial of the items even Doctors have trouble with then it is

doomed to show we can not do it. It would also need a better criteria for

mistake than admission to the hospital. For example the stubbed toe might end up

needing surgery, yet nothing about the call required EMS, so admission was not a

failure in this case.

>

> Well just my worthless idealistic thoughts.

>

> Renny Spencer

> The Idealistic Paramedic

[Guest guest]

Why is it arrogant to actually try and get the patient the care they need while

saving them money? Honestly it seems much more professional to get patients the

help they need rather than just treating them as not worthy of our time which is

what is being said by just transporting them all if better options of help are

available. And even in the way under educated state we find ourselves being in

we should still strive for what is best for our patients rather than to just be

a taxi service.

Renny Spencer

The Idealistic Paramedic

>

>

> The one thing I find the longer I have my paramedic patch is that I know less

than I thought I did. 

>

>

>

> At this point, EMS has a hard enough time mastering our core skills, as the

Wang study and several others have indicated.  I'm not sure that we're anywhere

near ready to assume a role as the gatekeepers to the healthcare system,

determining who is worthy of our time. That to me is the height of arrogance,

especially considering that we want to be considered a profession.  It smacks

of hubris at the least.

>

>

>

> I realize that we've come a long ways from high-top Cadillac

hearse/ambulances, but the reality is that we're still in the business of

medical transportation.  Ultimately, that means we give people rides to the

hospital.  Having said that, though, part of informed consent means giving

patients a realistic expectation of our capabilities and treatment.  I have

told a patient with minor complaints that it's unlikely that I could provide any

treatment beyond assessment and transport.  If I've informed the patient as to

their options and they still choose to ride in an ambulance, I'm not in a

position to deny them that option.

>

>

>

> And can we please kill this damned thread?

>

>

>

> -Wes Ogilvie, MPA, JD, Lic.P./NREMT-P

>

> -Attorney at Law/Licensed Paramedic/EMS Instructor

>

> -Austin, Texas

>

>

>

>

>

>

> Re: Paramedics Cannot Determine Wh

> ich Patients Require Transport

>

>

>

>

>

>

> As a person in favor of denying transport I do feel that we should not deny

chest, abd, or head related calls. Even Doctors with all their equipment have

trouble making accurate diagnosis. The calls that would be allowed denial would

be the minor trauma such as stubbed toe, the sneezed once and want to make sure

its not swine flu, the I just need a ride to the hospital so I can get to my

doctors appointment, the I really just need someone to talk to to help cope (

this one only if you have resources that can come there while you wait ).

>

> The denial process would also involve as much if not more effort than just

load and go so would discourage abuse by that one lazy Paramedic that everyone

seems to know since he is mentioned often.

>

> I would like to see a study on EMS denials based on a system as described

above. If allowed denial of the items even Doctors have trouble with then it is

doomed to show we can not do it. It would also need a better criteria for

mistake than admission to the hospital. For example the stubbed toe might end up

needing surgery, yet nothing about the call required EMS, so admission was not a

failure in this case.

>

> Well just my worthless idealistic thoughts.

>

> Renny Spencer

> The Idealistic Paramedic

[Guest guest]

Why is it arrogant to actually try and get the patient the care they need while

saving them money? Honestly it seems much more professional to get patients the

help they need rather than just treating them as not worthy of our time which is

what is being said by just transporting them all if better options of help are

available. And even in the way under educated state we find ourselves being in

we should still strive for what is best for our patients rather than to just be

a taxi service.

Renny Spencer

The Idealistic Paramedic

>

>

> The one thing I find the longer I have my paramedic patch is that I know less

than I thought I did. 

>

>

>

> At this point, EMS has a hard enough time mastering our core skills, as the

Wang study and several others have indicated.  I'm not sure that we're anywhere

near ready to assume a role as the gatekeepers to the healthcare system,

determining who is worthy of our time. That to me is the height of arrogance,

especially considering that we want to be considered a profession.  It smacks

of hubris at the least.

>

>

>

> I realize that we've come a long ways from high-top Cadillac

hearse/ambulances, but the reality is that we're still in the business of

medical transportation.  Ultimately, that means we give people rides to the

hospital.  Having said that, though, part of informed consent means giving

patients a realistic expectation of our capabilities and treatment.  I have

told a patient with minor complaints that it's unlikely that I could provide any

treatment beyond assessment and transport.  If I've informed the patient as to

their options and they still choose to ride in an ambulance, I'm not in a

position to deny them that option.

>

>

>

> And can we please kill this damned thread?

>

>

>

> -Wes Ogilvie, MPA, JD, Lic.P./NREMT-P

>

> -Attorney at Law/Licensed Paramedic/EMS Instructor

>

> -Austin, Texas

>

>

>

>

>

>

> Re: Paramedics Cannot Determine Wh

> ich Patients Require Transport

>

>

>

>

>

>

> As a person in favor of denying transport I do feel that we should not deny

chest, abd, or head related calls. Even Doctors with all their equipment have

trouble making accurate diagnosis. The calls that would be allowed denial would

be the minor trauma such as stubbed toe, the sneezed once and want to make sure

its not swine flu, the I just need a ride to the hospital so I can get to my

doctors appointment, the I really just need someone to talk to to help cope (

this one only if you have resources that can come there while you wait ).

>

> The denial process would also involve as much if not more effort than just

load and go so would discourage abuse by that one lazy Paramedic that everyone

seems to know since he is mentioned often.

>

> I would like to see a study on EMS denials based on a system as described

above. If allowed denial of the items even Doctors have trouble with then it is

doomed to show we can not do it. It would also need a better criteria for

mistake than admission to the hospital. For example the stubbed toe might end up

needing surgery, yet nothing about the call required EMS, so admission was not a

failure in this case.

>

> Well just my worthless idealistic thoughts.

>

> Renny Spencer

> The Idealistic Paramedic

[Guest guest]

It is arrogance and hubris when paramedics argue in favor of

paramedic-initiated refusals with the *current* level of paramedic

education, Renny. Bottom line is, we simply aren't educated well enough

to make it work. And if we provide more education, the question then

becomes a matter of reimbursement. How will we pay those super-educated

paramedics in a manner commensurate to their education, when the current

reimbursement model is weighted heavily toward *transporting* patients,

and is in most runs, *less* than the cost of providing the current level

of EMS care.

There are a host of problems to solve before we can have paramedics

serve as gatekeepers, and education is the one that needs to be solved

first. As it stands now, Wes is right. All too many of us haven't even

mastered our *current* scope of practice, much less an expanded one.

spenair wrote:

>

>

> Why is it arrogant to actually try and get the patient the care they

> need while saving them money? Honestly it seems much more professional

> to get patients the help they need rather than just treating them as

> not worthy of our time which is what is being said by just

> transporting them all if better options of help are available. And

> even in the way under educated state we find ourselves being in we

> should still strive for what is best for our patients rather than to

> just be a taxi service.

>

> Renny Spencer

> The Idealistic Paramedic

>

>

> >

> >

> > The one thing I find the longer I have my paramedic patch is that I

> know less than I thought I did.Â

> >

> >

> >

> > At this point, EMS has a hard enough time mastering our core skills,

> as the Wang study and several others have indicated. I'm not sure

> that we're anywhere near ready to assume a role as the gatekeepers to

> the healthcare system, determining who is worthy of our time. That to

> me is the height of arrogance, especially considering that we want to

> be considered a profession. It smacks of hubris at the least.

> >

> >

> >

> > I realize that we've come a long ways from high-top Cadillac

> hearse/ambulances, but the reality is that we're still in the business

> of medical transportation. Ultimately, that means we give people

> rides to the hospital. Having said that, though, part of informed

> consent means giving patients a realistic expectation of our

> capabilities and treatment. I have told a patient with minor

> complaints that it's unlikely that I could provide any treatment

> beyond assessment and transport.  If I've informed the patient as to

> their options and they still choose to ride in an ambulance, I'm not

> in a position to deny them that option.

> >

> >

> >

> > And can we please kill this damned thread?

> >

> >

> >

> > -Wes Ogilvie, MPA, JD, Lic.P./NREMT-P

> >

> > -Attorney at Law/Licensed Paramedic/EMS Instructor

> >

> > -Austin, Texas

> >

> >

> >

> >

> >

> >

> > Re: Paramedics Cannot Determine Wh

> > ich Patients Require Transport

> >

> >

> >

> >

> >

> >

> > As a person in favor of denying transport I do feel that we should

> not deny chest, abd, or head related calls. Even Doctors with all

> their equipment have trouble making accurate diagnosis. The calls that

> would be allowed denial would be the minor trauma such as stubbed toe,

> the sneezed once and want to make sure its not swine flu, the I just

> need a ride to the hospital so I can get to my doctors appointment,

> the I really just need someone to talk to to help cope ( this one only

> if you have resources that can come there while you wait ).

> >

> > The denial process would also involve as much if not more effort

> than just load and go so would discourage abuse by that one lazy

> Paramedic that everyone seems to know since he is mentioned often.

> >

> > I would like to see a study on EMS denials based on a system as

> described above. If allowed denial of the items even Doctors have

> trouble with then it is doomed to show we can not do it. It would also

> need a better criteria for mistake than admission to the hospital. For

> example the stubbed toe might end up needing surgery, yet nothing

> about the call required EMS, so admission was not a failure in this case.

> >

> > Well just my worthless idealistic thoughts.

> >

> > Renny Spencer

> > The Idealistic Paramedic

>

>

--

Grayson

www.kellygrayson.com

[Guest guest]

It is arrogance and hubris when paramedics argue in favor of

paramedic-initiated refusals with the *current* level of paramedic

education, Renny. Bottom line is, we simply aren't educated well enough

to make it work. And if we provide more education, the question then

becomes a matter of reimbursement. How will we pay those super-educated

paramedics in a manner commensurate to their education, when the current

reimbursement model is weighted heavily toward *transporting* patients,

and is in most runs, *less* than the cost of providing the current level

of EMS care.

There are a host of problems to solve before we can have paramedics

serve as gatekeepers, and education is the one that needs to be solved

first. As it stands now, Wes is right. All too many of us haven't even

mastered our *current* scope of practice, much less an expanded one.

spenair wrote:

>

>

> Why is it arrogant to actually try and get the patient the care they

> need while saving them money? Honestly it seems much more professional

> to get patients the help they need rather than just treating them as

> not worthy of our time which is what is being said by just

> transporting them all if better options of help are available. And

> even in the way under educated state we find ourselves being in we

> should still strive for what is best for our patients rather than to

> just be a taxi service.

>

> Renny Spencer

> The Idealistic Paramedic

>

>

> >

> >

> > The one thing I find the longer I have my paramedic patch is that I

> know less than I thought I did.Â

> >

> >

> >

> > At this point, EMS has a hard enough time mastering our core skills,

> as the Wang study and several others have indicated. I'm not sure

> that we're anywhere near ready to assume a role as the gatekeepers to

> the healthcare system, determining who is worthy of our time. That to

> me is the height of arrogance, especially considering that we want to

> be considered a profession. It smacks of hubris at the least.

> >

> >

> >

> > I realize that we've come a long ways from high-top Cadillac

> hearse/ambulances, but the reality is that we're still in the business

> of medical transportation. Ultimately, that means we give people

> rides to the hospital. Having said that, though, part of informed

> consent means giving patients a realistic expectation of our

> capabilities and treatment. I have told a patient with minor

> complaints that it's unlikely that I could provide any treatment

> beyond assessment and transport.  If I've informed the patient as to

> their options and they still choose to ride in an ambulance, I'm not

> in a position to deny them that option.

> >

> >

> >

> > And can we please kill this damned thread?

> >

> >

> >

> > -Wes Ogilvie, MPA, JD, Lic.P./NREMT-P

> >

> > -Attorney at Law/Licensed Paramedic/EMS Instructor

> >

> > -Austin, Texas

> >

> >

> >

> >

> >

> >

> > Re: Paramedics Cannot Determine Wh

> > ich Patients Require Transport

> >

> >

> >

> >

> >

> >

> > As a person in favor of denying transport I do feel that we should

> not deny chest, abd, or head related calls. Even Doctors with all

> their equipment have trouble making accurate diagnosis. The calls that

> would be allowed denial would be the minor trauma such as stubbed toe,

> the sneezed once and want to make sure its not swine flu, the I just

> need a ride to the hospital so I can get to my doctors appointment,

> the I really just need someone to talk to to help cope ( this one only

> if you have resources that can come there while you wait ).

> >

> > The denial process would also involve as much if not more effort

> than just load and go so would discourage abuse by that one lazy

> Paramedic that everyone seems to know since he is mentioned often.

> >

> > I would like to see a study on EMS denials based on a system as

> described above. If allowed denial of the items even Doctors have

> trouble with then it is doomed to show we can not do it. It would also

> need a better criteria for mistake than admission to the hospital. For

> example the stubbed toe might end up needing surgery, yet nothing

> about the call required EMS, so admission was not a failure in this case.

> >

> > Well just my worthless idealistic thoughts.

> >

> > Renny Spencer

> > The Idealistic Paramedic

>

>

--

Grayson

www.kellygrayson.com

[Guest guest]

With all respect, Renny, how many services have you worked at and how long have

you been a paramedic?   The reality is that rural, frontier, suburban, and

urban/inner city EMS are all incredibly different -- and that's not even

considering the various methods of service delivery -- fire, private, PUM, third

service, health department, ESD, etc.

I've worked in a variety of settings and can guarantee you that what works in

City may well be sheer lunacy in inner city Houston.

-Wes Ogilvie, MPA, JD, Lic.P./NREMT-P

-Attorney at Law/Licensed Paramedic/EMS Instructor

-Austin, Texas

Re: P

aramedics Cannot Determine Wh

> ich Patients Require Transport

>

>

>

>

>

>

> As a person in favor of denying transport I do feel that we should not deny

chest, abd, or head related calls. Even Doctors with all their equipment have

trouble making accurate diagnosis. The calls that would be allowed denial would

be the minor trauma such as stubbed toe, the sneezed once and want to make sure

its not swine flu, the I just need a ride to the hospital so I can get to my

doctors appointment, the I really just need someone to talk to to help cope (

this one only if you have resources that can come there while you wait ).

>

> The denial process would also involve as much if not more effort than just

load and go so would discourage abuse by that one lazy Paramedic that everyone

seems to know since he is mentioned often.

>

> I would like to see a study on EMS denials based on a system as described

above. If allowed denial of the items even Doctors have trouble with then it is

doomed to show we can not do it. It would also need a better criteria for

mistake than admission to the hospital. For example the stubbed toe might end up

needing surgery, yet nothing about the call required EMS, so admission was not a

failure in this case.

>

> Well just my worthless idealistic thoughts.

>

> Renny Spencer

> The Idealistic Paramedic

[Guest guest]

There are a number of Catch 22s in this, as has pointed out.

I suppose I should urge more paramedic initiated refusals since I make

pretty good money as an expert witness in cases that result from that, but in

reality I don't wish that on anybody.

As Wes said, the more we know, the more we realize we don't know. Was

talking to a long-time flight medic today about atypical presentations of MI

and other conditions where the true condition only came to light after lab

tests and radiological examination, none of which we can do. Even the docs

were surprised at the results. If you belong to the EMED-L list, which is

mainly populated by ER docs from around the world, you'll see them discussing

problems of diagnosis all the time, and these are board certified

physicians. I can't begin to compete with them in knowledge and experience

even

though I've been at this game for 30+ years.

For those who want to do paramedic initiated refusals, I have only one

thing to say: Buy individual malpractice insurance and as much of it as you

can afford, but remember that it won't pay for loss of your certificate.

Start planning another career, since sooner or later you'll need one. Like it

or not, our motto is still, " You call, we haul. "

Further Affiant Sayeth Not on this subject.

GG

>  

> It is arrogance and hubris when paramedics argue in favor of

> paramedic-initiated refusals with the *current* level of paramedic

> education, Renny. Bottom line is, we simply aren't educated well enough

> to make it work. And if we provide more education, the question then

> becomes a matter of reimbursement. How will we pay those super-educated

> paramedics in a manner commensurate to their education, when the current

> reimbursement model is weighted heavily toward *transporting* patients,

> and is in most runs, *less* than the cost of providing the current level

> of EMS care.

>

> There are a host of problems to solve before we can have paramedics

> serve as gatekeepers, and education is the one that needs to be solved

> first. As it stands now, Wes is right. All too many of us haven't even

> mastered our *current* scope of practice, much less an expanded one.

>

> spenair wrote:

> >

> >

> > Why is it arrogant to actually try and get the patient the care they

> > need while saving them money? Honestly it seems much more professional

> > to get patients the help they need rather than just treating them as

> > not worthy of our time which is what is being said by just

> > transporting them all if better options of help are available. And

> > even in the way under educated state we find ourselves being in we

> > should still strive for what is best for our patients rather than to

> > just be a taxi service.

> >

> > Renny Spencer

> > The Idealistic Paramedic

> >

> >

> > >

> > >

> > > The one thing I find the longer I have my paramedic patch is that I

> > know less than I thought I did.Â

> > >

> > >

> > >

> > > At this point, EMS has a hard enough time mastering our core skills,

> > as the Wang study and several others have indicated. I'm not sure

> > that we're anywhere near ready to assume a role as the gatekeepers to

> > the healthcare system, determining who is worthy of our time. That to

> > me is the height of arrogance, especially considering that we want to

> > be considered a profession. It smacks of hubris at the least.

> > >

> > >

> > >

> > > I realize that we've come a long ways from high-top Cadillac

> > hearse/ambulances, but the reality is that we're still in the business

> > of medical transportation. Ultimately, that means we give people

> > rides to the hospital. Having said that, though, part of informed

> > consent means giving patients a realistic expectation of our

> > capabilities and treatment. I have told a patient with minor

> > complaints that it's unlikely that I could provide any treatment

> > beyond assessment and transport.  If I've informed the patient as to

> > their options and they still choose to ride in an ambulance, I'm not

> > in a position to deny them that option.

> > >

> > >

> > >

> > > And can we please kill this damned thread?

> > >

> > >

> > >

> > > -Wes Ogilvie, MPA, JD, Lic.P./NREMT-

> > >

> > > -Attorney at Law/Licensed Paramedic/EMS Instructor

> > >

> > > -Austin, Texas

> > >

> > >

> > >

> > >

> > >

> > >

> > > Re: Paramedics Cannot Determine Wh

> > > ich Patients Require Transport

> > >

> > >

> > >

> > >

> > >

> > >

> > > As a person in favor of denying transport I do feel that we should

> > not deny chest, abd, or head related calls. Even Doctors with all

> > their equipment have trouble making accurate diagnosis. The calls that

> > would be allowed denial would be the minor trauma such as stubbed toe,

> > the sneezed once and want to make sure its not swine flu, the I just

> > need a ride to the hospital so I can get to my doctors appointment,

> > the I really just need someone to talk to to help cope ( this one only

> > if you have resources that can come there while you wait ).

> > >

> > > The denial process would also involve as much if not more effort

> > than just load and go so would discourage abuse by that one lazy

> > Paramedic that everyone seems to know since he is mentioned often.

> > >

> > > I would like to see a study on EMS denials based on a system as

> > described above. If allowed denial of the items even Doctors have

> > trouble with then it is doomed to show we can not do it. It would also

> > need a better criteria for mistake than admission to the hospital. For

> > example the stubbed toe might end up needing surgery, yet nothing

> > about the call required EMS, so admission was not a failure in this

> case.

> > >

> > > Well just my worthless idealistic thoughts.

> > >

> > > Renny Spencer

> > > The Idealistic Paramedic

> >

> >

>

> --

> Grayson

> www.kellygrayson. ww

>

>

>

>

[Guest guest]

Danny, I am with you. But it's going to take some real wrenching changes

before things will be where you and I would like them to be.

500 hour paramedic courses won't cut it. And unless we somehow get

funding for services other than transport, we'll never be able to pay people for

doing a bachelor's degree in EMS. Which comes first? The chicken or the

egg?

And bachelor degreed medics won't cut it either without extensive clinical

experience and improved diagnostic tools available in the ambulance. Even

then, we're rolling the dice when we try to make field determinations about

who needs a ride and who doesn't. It's not simple. It cannot be made

simple. We are nowhere close to being able to do that reliably, and I see no

prospects for change in an upward direction. I see lots of factors that

indicate going to a lessor level of care and decision making.

We have so much potential power. If we had ONE VOICE in this country as

medics, from EMT-B to Paramedic, we could do great things. But we have NO

VOICE because we cannot even muster 1% of the Texas certificants to join the

one organization that's dedicated to their interests. NAEMT only has less

percent than that of the medics in the country. We have no voice, no

presence, no political clout, and we have nobody to blame but ourselves.

The fire service medics are typically IAFF or some other union members, but

their interests are in their fire service jobs, not in EMS. So they

typically do not involve themselves in lists like this and the others, do not

come to conferences, and are not interested in improving EMS as a whole in

terms of what you are talking about. I realize that's a broad generalization,

and I recognize that there are exceptions, but they are few and far between.

The man who we honored last week on the 5th anniversary of his death, Jim

Page, knew that better than anybody. The facts are that fire service

medics see themselves as public safety and fire professionals, not medical

professionals. We have had discussions here about whether or not one can serve

two masters. Can one be both a crackerjack fire suppression expert and a

prehospital medicine expert? I don't think so. Some will disagree, and

there are always exceptions, but that's my take. And will fire service

medics make any more than their non-medic coworkers if they are required to have

bachelors degrees? Of course not.

How do we come together as medics and promote improved education standards

and scope of practice? As long as fire chiefs and private service

managers veto any effort to improve standards, we'll never see improvement.

And

where is the groundswell of support for a more strict education and training

system? It's just not there. Right now, paramedicine is the best deal

imaginable. Where else can you spend as little time in class as we do and

earn the kind of salaries and benefits that most fire service medics do?

What percentage of EMS is run by fire departments? Figure it out for

yourselves. What percentage of all certified medics work for private services?

What do you get for having an associate's degree or a bachelor's degree in

either of them? Maybe a little, but not enough to pay for a 4 year

bachelor's degree when you can be a nurse and make at least three to four times

what

a medic does. A respiratory therapist makes twice what a paramedic does.

A radiology tech the same. Who will pay us for the expanded education?

Some services do pay a premium for a degree, but out of all the medics

working in the U.S., I'll wager that most of them have minimum education and

would be paid no more if they had a college degree in EMS. Prove me wrong. I

hope you can.

Certainly the rank and file have never demonstrated that as a group they're

in favor of anything other than less CE and maintaining the status quo.

Sorry if I offend, but that's my experience.

And unless the folks who pay for care recognize us as doing something

that's reimbursable and decide to pay us for non-transport care, nothing will

happen. That means primarily that Medicare and Medicaid must change their

reimbursement rules. Anybody think that's going to happen?

I do not see that happening. In all the discussion about " Healthcare

Reform " there is not one word that I have heard about EMS. It's as though we

didn't exist.

There are many more forces arguing for the status quo or less than there

are for improvements. Start talking about making a bachelor degree

requirement for paramedics and you'll see some fire chiefs and private service

managers with their hair on fire.

And when there is no medical evidence to support much of what we do now,

where would the evidence be for an expanded scope of practice and

responsibility? Doesn't exist. And it's damn near impossible to construct

research

studies that will prove that anything we do actually helps, because you

cannot do a double blind study because of ethics.

I wish it were otherwise, but it's not. It seems that we're stuck in a

niche that we'll always have, but it won't expand or improve because the

politics and the economics are just not there.

GG

>  

> But that is the point, If you do a proper assessment things like an

> atypical chest pain or even a typical chest pain would not be an issue. There

> are several things that diagonses do not do.  I believe that as a profession

> the Standard of Care for the future can include refusals and other avenues

> of treatment not currently offered today. I do not see us that far off from

> this picture.

>   I do see many at the top of our ranks and even within the ranks that

> would rather not see it get that far. Why?  God only knows. We are tasked

with

> doing the best for our patients from point A to point B and anywhere

> in-between. Education has come up from what it was even 4 years ago. What do

we

> need to continue to do that will make this discussion history in the

> making?  

>   I for one am in it for the long haul. Who's with me?

>  

>  

>  

>  

>  

>

> Danny L.

> Owner/NREMT-

> PETSAR INC.

> (Panhandle Emergency Training Services And Response)

> Office

> Fax

>

>

> > >

> > >

> > > Why is it arrogant to actually try and get the patient the care they

> > > need while saving them money? Honestly it seems much more professional

> > > to get patients the help they need rather than just treating them as

> > > not worthy of our time which is what is being said by just

> > > transporting them all if better options of help are available. And

> > > even in the way under educated state we find ourselves being in we

> > > should still strive for what is best for our patients rather than to

> > > just be a taxi service.

> > >

> > > Renny Spencer

> > > The Idealistic Paramedic

> > >

> > >

> > > >

> > > >

> > > > The one thing I find the longer I have my paramedic patch is that I

> > > know less than I thought I did.Â

> > > >

> > > >

> > > >

> > > > At this point, EMS has a hard enough time mastering our core skills,

> > > as the Wang study and several others have indicated. I'm not sure

> > > that we're anywhere near ready to assume a role as the gatekeepers to

> > > the healthcare system, determining who is worthy of our time. That to

> > > me is the height of arrogance, especially considering that we want to

> > > be considered a profession. It smacks of hubris at the least.

> > > >

> > > >

> > > >

> > > > I realize that we've come a long ways from high-top Cadillac

> > > hearse/ambulances, but the reality is that we're still in the business

> > > of medical transportation. Ultimately, that means we give people

> > > rides to the hospital. Having said that, though, part of informed

> > > consent means giving patients a realistic expectation of our

> > > capabilities and treatment. I have told a patient with minor

> > > complaints that it's unlikely that I could provide any treatment

> > > beyond assessment and transport.  If I've informed the patient as to

> > > their options and they still choose to ride in an ambulance, I'm not

> > > in a position to deny them that option.

> > > >

> > > >

> > > >

> > > > And can we please kill this damned thread?

> > > >

> > > >

> > > >

> > > > -Wes Ogilvie, MPA, JD, Lic.P./NREMT-

> > > >

> > > > -Attorney at Law/Licensed Paramedic/EMS Instructor

> > > >

> > > > -Austin, Texas

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > > Re: Paramedics Cannot Determine Wh

> > > > ich Patients Require Transport

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > > As a person in favor of denying transport I do feel that we should

> > > not deny chest, abd, or head related calls. Even Doctors with all

> > > their equipment have trouble making accurate diagnosis. The calls that

> > > would be allowed denial would be the minor trauma such as stubbed toe,

> > > the sneezed once and want to make sure its not swine flu, the I just

> > > need a ride to the hospital so I can get to my doctors appointment,

> > > the I really just need someone to talk to to help cope ( this one only

> > > if you have resources that can come there while you wait ).

> > > >

> > > > The denial process would also involve as much if not more effort

> > > than just load and go so would discourage abuse by that one lazy

> > > Paramedic that everyone seems to know since he is mentioned often.

> > > >

> > > > I would like to see a study on EMS denials based on a system as

> > > described above. If allowed denial of the items even Doctors have

> > > trouble with then it is doomed to show we can not do it. It would also

> > > need a better criteria for mistake than admission to the hospital. For

> > > example the stubbed toe might end up needing surgery, yet nothing

> > > about the call required EMS, so admission was not a failure in this

> > case.

> > > >

> > > > Well just my worthless idealistic thoughts.

> > > >

> > > > Renny Spencer

> > > > The Idealistic Paramedic

> > >

> > >

> >

> > --

> > Grayson

> > www.kellygrayson. ww

> >

> >

> >

> >

>

>

[Guest guest]

But that is the point, If you do a proper assessment things like an atypical

chest pain or even a typical chest pain would not be an issue. There are several

things that diagonses do not do.  I believe that as a profession the Standard of

Care for the future can include refusals and other avenues of treatment not

currently offered today. I do not see us that far off from this picture.

  I do see many at the top of our ranks and even within the ranks that would

rather not see it get that far. Why?  God only knows. We are tasked with doing

the best for our patients from point A to point B and anywhere in-between.

Education has come up from what it was even 4 years ago. What do we need to

continue to do that will make this discussion history in the making?  

  I for one am in it for the long haul. Who's with me?

 

 

 

 

 

Danny L.

Owner/NREMT-P

PETSAR INC.

(Panhandle Emergency Training Services And Response)

Office

Fax

> >

> >

> > Why is it arrogant to actually try and get the patient the care they

> > need while saving them money? Honestly it seems much more professional

> > to get patients the help they need rather than just treating them as

> > not worthy of our time which is what is being said by just

> > transporting them all if better options of help are available. And

> > even in the way under educated state we find ourselves being in we

> > should still strive for what is best for our patients rather than to

> > just be a taxi service.

> >

> > Renny Spencer

> > The Idealistic Paramedic

> >

> >

> > >

> > >

> > > The one thing I find the longer I have my paramedic patch is that I

> > know less than I thought I did.Â

> > >

> > >

> > >

> > > At this point, EMS has a hard enough time mastering our core skills,

> > as the Wang study and several others have indicated. I'm not sure

> > that we're anywhere near ready to assume a role as the gatekeepers to

> > the healthcare system, determining who is worthy of our time. That to

> > me is the height of arrogance, especially considering that we want to

> > be considered a profession. It smacks of hubris at the least.

> > >

> > >

> > >

> > > I realize that we've come a long ways from high-top Cadillac

> > hearse/ambulances, but the reality is that we're still in the business

> > of medical transportation. Ultimately, that means we give people

> > rides to the hospital. Having said that, though, part of informed

> > consent means giving patients a realistic expectation of our

> > capabilities and treatment. I have told a patient with minor

> > complaints that it's unlikely that I could provide any treatment

> > beyond assessment and transport.  If I've informed the patient as to

> > their options and they still choose to ride in an ambulance, I'm not

> > in a position to deny them that option.

> > >

> > >

> > >

> > > And can we please kill this damned thread?

> > >

> > >

> > >

> > > -Wes Ogilvie, MPA, JD, Lic.P./NREMT-

> > >

> > > -Attorney at Law/Licensed Paramedic/EMS Instructor

> > >

> > > -Austin, Texas

> > >

> > >

> > >

> > >

> > >

> > >

> > > Re: Paramedics Cannot Determine Wh

> > > ich Patients Require Transport

> > >

> > >

> > >

> > >

> > >

> > >

> > > As a person in favor of denying transport I do feel that we should

> > not deny chest, abd, or head related calls. Even Doctors with all

> > their equipment have trouble making accurate diagnosis. The calls that

> > would be allowed denial would be the minor trauma such as stubbed toe,

> > the sneezed once and want to make sure its not swine flu, the I just

> > need a ride to the hospital so I can get to my doctors appointment,

> > the I really just need someone to talk to to help cope ( this one only

> > if you have resources that can come there while you wait ).

> > >

> > > The denial process would also involve as much if not more effort

> > than just load and go so would discourage abuse by that one lazy

> > Paramedic that everyone seems to know since he is mentioned often.

> > >

> > > I would like to see a study on EMS denials based on a system as

> > described above. If allowed denial of the items even Doctors have

> > trouble with then it is doomed to show we can not do it. It would also

> > need a better criteria for mistake than admission to the hospital. For

> > example the stubbed toe might end up needing surgery, yet nothing

> > about the call required EMS, so admission was not a failure in this

> case.

> > >

> > > Well just my worthless idealistic thoughts.

> > >

> > > Renny Spencer

> > > The Idealistic Paramedic

> >

> >

>

> --

> Grayson

> www.kellygrayson. ww

>

>

>

>

[Guest guest]

Okay, I will get off my soap box now, but I would like to see your data to

support the statement:

The fire service medics are typically IAFF or some other union members, but

their interests are in their fire service jobs, not in EMS. So they

typically do not involve themselves in lists like this and the others, do not

come to conferences, and are not interested in improving EMS as a whole in

terms of what you are talking about. I realize that's a broad generalization,

and I recognize that there are exceptions, but they are few and far between.

The man who we honored last week on the 5th anniversary of his death, Jim

Page, knew that better than anybody. The facts are that fire service

medics see themselves as public safety and fire professionals, not medical

professionals. We have had discussions here about whether or not one can serve

two masters. Can one be both a crackerjack fire suppression expert and a

prehospital medicine expert? I don't think so. Some will disagree, and

there are always exceptions, but that's my take. And will fire service

medics make any more than their non-medic coworkers if they are required to have

bachelors degrees? Of course not.

For fire service agencies providing EMS, EMS is just as important as fire

suppression, as just as important as fire AND injury prevention...etc...I cannot

comment on your personal experiences, but remember there is a broader view.

Generalizations such as this contribute to lack of unity and distance the fire

service from other providers. I am a fire service professional active in EMS

since 1981. I have also worked for private EMS providers for a number of years.

Maxie Bishop came from Dallas Fire Rescue. I can think of fire based EMS

providers from all across this great State who would argue with you about your

comments. Have you vetted this group list to know there are few fire based

medics included? Have you reviewed the attendee lists from the Texas EMS

conference or others to quantify your statements?

There are good fire based EMS providers, good third City providers, and good

private providers. There are also bad in each category. I find it incredibly

frustrating when generalizations are made without supporting evidence. This

debate has been going on since I joined the profession in 1981.

Your arguments perpetuate the separation. How about we put differences aside and

work together?

I agree with several of your comments on education. Gradual change rather than

radical will likely gain wider support.

Danny Kistner

________________________________

From: texasems-l on behalf of wegandy1938@...

Sent: Wed 9/9/2009 1:11 AM

To: texasems-l

Subject: Re: Re: Paramedics Cannot Determine Which Patients Require

Transport

Danny, I am with you. But it's going to take some real wrenching changes

before things will be where you and I would like them to be.

500 hour paramedic courses won't cut it. And unless we somehow get

funding for services other than transport, we'll never be able to pay people for

doing a bachelor's degree in EMS. Which comes first? The chicken or the

egg?

And bachelor degreed medics won't cut it either without extensive clinical

experience and improved diagnostic tools available in the ambulance. Even

then, we're rolling the dice when we try to make field determinations about

who needs a ride and who doesn't. It's not simple. It cannot be made

simple. We are nowhere close to being able to do that reliably, and I see no

prospects for change in an upward direction. I see lots of factors that

indicate going to a lessor level of care and decision making.

We have so much potential power. If we had ONE VOICE in this country as

medics, from EMT-B to Paramedic, we could do great things. But we have NO

VOICE because we cannot even muster 1% of the Texas certificants to join the

one organization that's dedicated to their interests. NAEMT only has less

percent than that of the medics in the country. We have no voice, no

presence, no political clout, and we have nobody to blame but ourselves.

The fire service medics are typically IAFF or some other union members, but

their interests are in their fire service jobs, not in EMS. So they

typically do not involve themselves in lists like this and the others, do not

come to conferences, and are not interested in improving EMS as a whole in

terms of what you are talking about. I realize that's a broad generalization,

and I recognize that there are exceptions, but they are few and far between.

The man who we honored last week on the 5th anniversary of his death, Jim

Page, knew that better than anybody. The facts are that fire service

medics see themselves as public safety and fire professionals, not medical

professionals. We have had discussions here about whether or not one can serve

two masters. Can one be both a crackerjack fire suppression expert and a

prehospital medicine expert? I don't think so. Some will disagree, and

there are always exceptions, but that's my take. And will fire service

medics make any more than their non-medic coworkers if they are required to have

bachelors degrees? Of course not.

How do we come together as medics and promote improved education standards

and scope of practice? As long as fire chiefs and private service

managers veto any effort to improve standards, we'll never see improvement. And

where is the groundswell of support for a more strict education and training

system? It's just not there. Right now, paramedicine is the best deal

imaginable. Where else can you spend as little time in class as we do and

earn the kind of salaries and benefits that most fire service medics do?

What percentage of EMS is run by fire departments? Figure it out for

yourselves. What percentage of all certified medics work for private services?

What do you get for having an associate's degree or a bachelor's degree in

either of them? Maybe a little, but not enough to pay for a 4 year

bachelor's degree when you can be a nurse and make at least three to four times

what

a medic does. A respiratory therapist makes twice what a paramedic does.

A radiology tech the same. Who will pay us for the expanded education?

Some services do pay a premium for a degree, but out of all the medics

working in the U.S., I'll wager that most of them have minimum education and

would be paid no more if they had a college degree in EMS. Prove me wrong. I

hope you can.

Certainly the rank and file have never demonstrated that as a group they're

in favor of anything other than less CE and maintaining the status quo.

Sorry if I offend, but that's my experience.

And unless the folks who pay for care recognize us as doing something

that's reimbursable and decide to pay us for non-transport care, nothing will

happen. That means primarily that Medicare and Medicaid must change their

reimbursement rules. Anybody think that's going to happen?

I do not see that happening. In all the discussion about " Healthcare

Reform " there is not one word that I have heard about EMS. It's as though we

didn't exist.

There are many more forces arguing for the status quo or less than there

are for improvements. Start talking about making a bachelor degree

requirement for paramedics and you'll see some fire chiefs and private service

managers with their hair on fire.

And when there is no medical evidence to support much of what we do now,

where would the evidence be for an expanded scope of practice and

responsibility? Doesn't exist. And it's damn near impossible to construct

research

studies that will prove that anything we do actually helps, because you

cannot do a double blind study because of ethics.

I wish it were otherwise, but it's not. It seems that we're stuck in a

niche that we'll always have, but it won't expand or improve because the

politics and the economics are just not there.

GG

In a message dated 9/8/09 10:34:33 PM, petsardlj@...

writes:

>

> But that is the point, If you do a proper assessment things like an

> atypical chest pain or even a typical chest pain would not be an issue. There

> are several things that diagonses do not do. I believe that as a profession

> the Standard of Care for the future can include refusals and other avenues

> of treatment not currently offered today. I do not see us that far off from

> this picture.

> I do see many at the top of our ranks and even within the ranks that

> would rather not see it get that far. Why? God only knows. We are tasked with

> doing the best for our patients from point A to point B and anywhere

> in-between. Education has come up from what it was even 4 years ago. What do

we

> need to continue to do that will make this discussion history in the

> making?

> I for one am in it for the long haul. Who's with me?

>

>

>

>

>

>

> Danny L.

> Owner/NREMT-

> PETSAR INC.

> (Panhandle Emergency Training Services And Response)

> Office

> Fax

>

>

> > >

> > >

> > > Why is it arrogant to actually try and get the patient the care they

> > > need while saving them money? Honestly it seems much more professional

> > > to get patients the help they need rather than just treating them as

> > > not worthy of our time which is what is being said by just

> > > transporting them all if better options of help are available. And

> > > even in the way under educated state we find ourselves being in we

> > > should still strive for what is best for our patients rather than to

> > > just be a taxi service.

> > >

> > > Renny Spencer

> > > The Idealistic Paramedic

> > >

> > >

> > > >

> > > >

> > > > The one thing I find the longer I have my paramedic patch is that I

> > > know less than I thought I did.Â

> > > >

> > > >

> > > >

> > > > At this point, EMS has a hard enough time mastering our core skills,

> > > as the Wang study and several others have indicated. I'm not sure

> > > that we're anywhere near ready to assume a role as the gatekeepers to

> > > the healthcare system, determining who is worthy of our time. That to

> > > me is the height of arrogance, especially considering that we want to

> > > be considered a profession. It smacks of hubris at the least.

> > > >

> > > >

> > > >

> > > > I realize that we've come a long ways from high-top Cadillac

> > > hearse/ambulances, but the reality is that we're still in the business

> > > of medical transportation. Ultimately, that means we give people

> > > rides to the hospital. Having said that, though, part of informed

> > > consent means giving patients a realistic expectation of our

> > > capabilities and treatment. I have told a patient with minor

> > > complaints that it's unlikely that I could provide any treatment

> > > beyond assessment and transport.  If I've informed the patient as to

> > > their options and they still choose to ride in an ambulance, I'm not

> > > in a position to deny them that option.

> > > >

> > > >

> > > >

> > > > And can we please kill this damned thread?

> > > >

> > > >

> > > >

> > > > -Wes Ogilvie, MPA, JD, Lic.P./NREMT-

> > > >

> > > > -Attorney at Law/Licensed Paramedic/EMS Instructor

> > > >

> > > > -Austin, Texas

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > > Re: Paramedics Cannot Determine Wh

> > > > ich Patients Require Transport

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > > As a person in favor of denying transport I do feel that we should

> > > not deny chest, abd, or head related calls. Even Doctors with all

> > > their equipment have trouble making accurate diagnosis. The calls that

> > > would be allowed denial would be the minor trauma such as stubbed toe,

> > > the sneezed once and want to make sure its not swine flu, the I just

> > > need a ride to the hospital so I can get to my doctors appointment,

> > > the I really just need someone to talk to to help cope ( this one only

> > > if you have resources that can come there while you wait ).

> > > >

> > > > The denial process would also involve as much if not more effort

> > > than just load and go so would discourage abuse by that one lazy

> > > Paramedic that everyone seems to know since he is mentioned often.

> > > >

> > > > I would like to see a study on EMS denials based on a system as

> > > described above. If allowed denial of the items even Doctors have

> > > trouble with then it is doomed to show we can not do it. It would also

> > > need a better criteria for mistake than admission to the hospital. For

> > > example the stubbed toe might end up needing surgery, yet nothing

> > > about the call required EMS, so admission was not a failure in this

> > case.

> > > >

> > > > Well just my worthless idealistic thoughts.

> > > >

> > > > Renny Spencer

> > > > The Idealistic Paramedic

> > >

> > >

> >

> > --

> > Grayson

> > www.kellygrayson. ww

> >

> >

> >

> >

>

>

[Guest guest]

Okay, I will get off my soap box now, but I would like to see your data to

support the statement:

The fire service medics are typically IAFF or some other union members, but

their interests are in their fire service jobs, not in EMS. So they

typically do not involve themselves in lists like this and the others, do not

come to conferences, and are not interested in improving EMS as a whole in

terms of what you are talking about. I realize that's a broad generalization,

and I recognize that there are exceptions, but they are few and far between.

The man who we honored last week on the 5th anniversary of his death, Jim

Page, knew that better than anybody. The facts are that fire service

medics see themselves as public safety and fire professionals, not medical

professionals. We have had discussions here about whether or not one can serve

two masters. Can one be both a crackerjack fire suppression expert and a

prehospital medicine expert? I don't think so. Some will disagree, and

there are always exceptions, but that's my take. And will fire service

medics make any more than their non-medic coworkers if they are required to have

bachelors degrees? Of course not.

For fire service agencies providing EMS, EMS is just as important as fire

suppression, as just as important as fire AND injury prevention...etc...I cannot

comment on your personal experiences, but remember there is a broader view.

Generalizations such as this contribute to lack of unity and distance the fire

service from other providers. I am a fire service professional active in EMS

since 1981. I have also worked for private EMS providers for a number of years.

Maxie Bishop came from Dallas Fire Rescue. I can think of fire based EMS

providers from all across this great State who would argue with you about your

comments. Have you vetted this group list to know there are few fire based

medics included? Have you reviewed the attendee lists from the Texas EMS

conference or others to quantify your statements?

There are good fire based EMS providers, good third City providers, and good

private providers. There are also bad in each category. I find it incredibly

frustrating when generalizations are made without supporting evidence. This

debate has been going on since I joined the profession in 1981.

Your arguments perpetuate the separation. How about we put differences aside and

work together?

I agree with several of your comments on education. Gradual change rather than

radical will likely gain wider support.

Danny Kistner

________________________________

From: texasems-l on behalf of wegandy1938@...

Sent: Wed 9/9/2009 1:11 AM

To: texasems-l

Subject: Re: Re: Paramedics Cannot Determine Which Patients Require

Transport

Danny, I am with you. But it's going to take some real wrenching changes

before things will be where you and I would like them to be.

500 hour paramedic courses won't cut it. And unless we somehow get

funding for services other than transport, we'll never be able to pay people for

doing a bachelor's degree in EMS. Which comes first? The chicken or the

egg?

And bachelor degreed medics won't cut it either without extensive clinical

experience and improved diagnostic tools available in the ambulance. Even

then, we're rolling the dice when we try to make field determinations about

who needs a ride and who doesn't. It's not simple. It cannot be made

simple. We are nowhere close to being able to do that reliably, and I see no

prospects for change in an upward direction. I see lots of factors that

indicate going to a lessor level of care and decision making.

We have so much potential power. If we had ONE VOICE in this country as

medics, from EMT-B to Paramedic, we could do great things. But we have NO

VOICE because we cannot even muster 1% of the Texas certificants to join the

one organization that's dedicated to their interests. NAEMT only has less

percent than that of the medics in the country. We have no voice, no

presence, no political clout, and we have nobody to blame but ourselves.

The fire service medics are typically IAFF or some other union members, but

their interests are in their fire service jobs, not in EMS. So they

typically do not involve themselves in lists like this and the others, do not

come to conferences, and are not interested in improving EMS as a whole in

terms of what you are talking about. I realize that's a broad generalization,

and I recognize that there are exceptions, but they are few and far between.

The man who we honored last week on the 5th anniversary of his death, Jim

Page, knew that better than anybody. The facts are that fire service

medics see themselves as public safety and fire professionals, not medical

professionals. We have had discussions here about whether or not one can serve

two masters. Can one be both a crackerjack fire suppression expert and a

prehospital medicine expert? I don't think so. Some will disagree, and

there are always exceptions, but that's my take. And will fire service

medics make any more than their non-medic coworkers if they are required to have

bachelors degrees? Of course not.

How do we come together as medics and promote improved education standards

and scope of practice? As long as fire chiefs and private service

managers veto any effort to improve standards, we'll never see improvement. And

where is the groundswell of support for a more strict education and training

system? It's just not there. Right now, paramedicine is the best deal

imaginable. Where else can you spend as little time in class as we do and

earn the kind of salaries and benefits that most fire service medics do?

What percentage of EMS is run by fire departments? Figure it out for

yourselves. What percentage of all certified medics work for private services?

What do you get for having an associate's degree or a bachelor's degree in

either of them? Maybe a little, but not enough to pay for a 4 year

bachelor's degree when you can be a nurse and make at least three to four times

what

a medic does. A respiratory therapist makes twice what a paramedic does.

A radiology tech the same. Who will pay us for the expanded education?

Some services do pay a premium for a degree, but out of all the medics

working in the U.S., I'll wager that most of them have minimum education and

would be paid no more if they had a college degree in EMS. Prove me wrong. I

hope you can.

Certainly the rank and file have never demonstrated that as a group they're

in favor of anything other than less CE and maintaining the status quo.

Sorry if I offend, but that's my experience.

And unless the folks who pay for care recognize us as doing something

that's reimbursable and decide to pay us for non-transport care, nothing will

happen. That means primarily that Medicare and Medicaid must change their

reimbursement rules. Anybody think that's going to happen?

I do not see that happening. In all the discussion about " Healthcare

Reform " there is not one word that I have heard about EMS. It's as though we

didn't exist.

There are many more forces arguing for the status quo or less than there

are for improvements. Start talking about making a bachelor degree

requirement for paramedics and you'll see some fire chiefs and private service

managers with their hair on fire.

And when there is no medical evidence to support much of what we do now,

where would the evidence be for an expanded scope of practice and

responsibility? Doesn't exist. And it's damn near impossible to construct

research

studies that will prove that anything we do actually helps, because you

cannot do a double blind study because of ethics.

I wish it were otherwise, but it's not. It seems that we're stuck in a

niche that we'll always have, but it won't expand or improve because the

politics and the economics are just not there.

GG

In a message dated 9/8/09 10:34:33 PM, petsardlj@...

writes:

>

> But that is the point, If you do a proper assessment things like an

> atypical chest pain or even a typical chest pain would not be an issue. There

> are several things that diagonses do not do. I believe that as a profession

> the Standard of Care for the future can include refusals and other avenues

> of treatment not currently offered today. I do not see us that far off from

> this picture.

> I do see many at the top of our ranks and even within the ranks that

> would rather not see it get that far. Why? God only knows. We are tasked with

> doing the best for our patients from point A to point B and anywhere

> in-between. Education has come up from what it was even 4 years ago. What do

we

> need to continue to do that will make this discussion history in the

> making?

> I for one am in it for the long haul. Who's with me?

>

>

>

>

>

>

> Danny L.

> Owner/NREMT-

> PETSAR INC.

> (Panhandle Emergency Training Services And Response)

> Office

> Fax

>

>

> > >

> > >

> > > Why is it arrogant to actually try and get the patient the care they

> > > need while saving them money? Honestly it seems much more professional

> > > to get patients the help they need rather than just treating them as

> > > not worthy of our time which is what is being said by just

> > > transporting them all if better options of help are available. And

> > > even in the way under educated state we find ourselves being in we

> > > should still strive for what is best for our patients rather than to

> > > just be a taxi service.

> > >

> > > Renny Spencer

> > > The Idealistic Paramedic

> > >

> > >

> > > >

> > > >

> > > > The one thing I find the longer I have my paramedic patch is that I

> > > know less than I thought I did.Â

> > > >

> > > >

> > > >

> > > > At this point, EMS has a hard enough time mastering our core skills,

> > > as the Wang study and several others have indicated. I'm not sure

> > > that we're anywhere near ready to assume a role as the gatekeepers to

> > > the healthcare system, determining who is worthy of our time. That to

> > > me is the height of arrogance, especially considering that we want to

> > > be considered a profession. It smacks of hubris at the least.

> > > >

> > > >

> > > >

> > > > I realize that we've come a long ways from high-top Cadillac

> > > hearse/ambulances, but the reality is that we're still in the business

> > > of medical transportation. Ultimately, that means we give people

> > > rides to the hospital. Having said that, though, part of informed

> > > consent means giving patients a realistic expectation of our

> > > capabilities and treatment. I have told a patient with minor

> > > complaints that it's unlikely that I could provide any treatment

> > > beyond assessment and transport.  If I've informed the patient as to

> > > their options and they still choose to ride in an ambulance, I'm not

> > > in a position to deny them that option.

> > > >

> > > >

> > > >

> > > > And can we please kill this damned thread?

> > > >

> > > >

> > > >

> > > > -Wes Ogilvie, MPA, JD, Lic.P./NREMT-

> > > >

> > > > -Attorney at Law/Licensed Paramedic/EMS Instructor

> > > >

> > > > -Austin, Texas

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > > Re: Paramedics Cannot Determine Wh

> > > > ich Patients Require Transport

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > > As a person in favor of denying transport I do feel that we should

> > > not deny chest, abd, or head related calls. Even Doctors with all

> > > their equipment have trouble making accurate diagnosis. The calls that

> > > would be allowed denial would be the minor trauma such as stubbed toe,

> > > the sneezed once and want to make sure its not swine flu, the I just

> > > need a ride to the hospital so I can get to my doctors appointment,

> > > the I really just need someone to talk to to help cope ( this one only

> > > if you have resources that can come there while you wait ).

> > > >

> > > > The denial process would also involve as much if not more effort

> > > than just load and go so would discourage abuse by that one lazy

> > > Paramedic that everyone seems to know since he is mentioned often.

> > > >

> > > > I would like to see a study on EMS denials based on a system as

> > > described above. If allowed denial of the items even Doctors have

> > > trouble with then it is doomed to show we can not do it. It would also

> > > need a better criteria for mistake than admission to the hospital. For

> > > example the stubbed toe might end up needing surgery, yet nothing

> > > about the call required EMS, so admission was not a failure in this

> > case.

> > > >

> > > > Well just my worthless idealistic thoughts.

> > > >

> > > > Renny Spencer

> > > > The Idealistic Paramedic

> > >

> > >

> >

> > --

> > Grayson

> > www.kellygrayson. ww

> >

> >

> >

> >

>

>

[Guest guest]

Okay, I will get off my soap box now, but I would like to see your data to

support the statement:

The fire service medics are typically IAFF or some other union members, but

their interests are in their fire service jobs, not in EMS. So they

typically do not involve themselves in lists like this and the others, do not

come to conferences, and are not interested in improving EMS as a whole in

terms of what you are talking about. I realize that's a broad generalization,

and I recognize that there are exceptions, but they are few and far between.

The man who we honored last week on the 5th anniversary of his death, Jim

Page, knew that better than anybody. The facts are that fire service

medics see themselves as public safety and fire professionals, not medical

professionals. We have had discussions here about whether or not one can serve

two masters. Can one be both a crackerjack fire suppression expert and a

prehospital medicine expert? I don't think so. Some will disagree, and

there are always exceptions, but that's my take. And will fire service

medics make any more than their non-medic coworkers if they are required to have

bachelors degrees? Of course not.

For fire service agencies providing EMS, EMS is just as important as fire

suppression, as just as important as fire AND injury prevention...etc...I cannot

comment on your personal experiences, but remember there is a broader view.

Generalizations such as this contribute to lack of unity and distance the fire

service from other providers. I am a fire service professional active in EMS

since 1981. I have also worked for private EMS providers for a number of years.

Maxie Bishop came from Dallas Fire Rescue. I can think of fire based EMS

providers from all across this great State who would argue with you about your

comments. Have you vetted this group list to know there are few fire based

medics included? Have you reviewed the attendee lists from the Texas EMS

conference or others to quantify your statements?

There are good fire based EMS providers, good third City providers, and good

private providers. There are also bad in each category. I find it incredibly

frustrating when generalizations are made without supporting evidence. This

debate has been going on since I joined the profession in 1981.

Your arguments perpetuate the separation. How about we put differences aside and

work together?

I agree with several of your comments on education. Gradual change rather than

radical will likely gain wider support.

Danny Kistner

________________________________

From: texasems-l on behalf of wegandy1938@...

Sent: Wed 9/9/2009 1:11 AM

To: texasems-l

Subject: Re: Re: Paramedics Cannot Determine Which Patients Require

Transport

Danny, I am with you. But it's going to take some real wrenching changes

before things will be where you and I would like them to be.

500 hour paramedic courses won't cut it. And unless we somehow get

funding for services other than transport, we'll never be able to pay people for

doing a bachelor's degree in EMS. Which comes first? The chicken or the

egg?

And bachelor degreed medics won't cut it either without extensive clinical

experience and improved diagnostic tools available in the ambulance. Even

then, we're rolling the dice when we try to make field determinations about

who needs a ride and who doesn't. It's not simple. It cannot be made

simple. We are nowhere close to being able to do that reliably, and I see no

prospects for change in an upward direction. I see lots of factors that

indicate going to a lessor level of care and decision making.

We have so much potential power. If we had ONE VOICE in this country as

medics, from EMT-B to Paramedic, we could do great things. But we have NO

VOICE because we cannot even muster 1% of the Texas certificants to join the

one organization that's dedicated to their interests. NAEMT only has less

percent than that of the medics in the country. We have no voice, no

presence, no political clout, and we have nobody to blame but ourselves.

The fire service medics are typically IAFF or some other union members, but

their interests are in their fire service jobs, not in EMS. So they

typically do not involve themselves in lists like this and the others, do not

come to conferences, and are not interested in improving EMS as a whole in

terms of what you are talking about. I realize that's a broad generalization,

and I recognize that there are exceptions, but they are few and far between.

The man who we honored last week on the 5th anniversary of his death, Jim

Page, knew that better than anybody. The facts are that fire service

medics see themselves as public safety and fire professionals, not medical

professionals. We have had discussions here about whether or not one can serve

two masters. Can one be both a crackerjack fire suppression expert and a

prehospital medicine expert? I don't think so. Some will disagree, and

there are always exceptions, but that's my take. And will fire service

medics make any more than their non-medic coworkers if they are required to have

bachelors degrees? Of course not.

How do we come together as medics and promote improved education standards

and scope of practice? As long as fire chiefs and private service

managers veto any effort to improve standards, we'll never see improvement. And

where is the groundswell of support for a more strict education and training

system? It's just not there. Right now, paramedicine is the best deal

imaginable. Where else can you spend as little time in class as we do and

earn the kind of salaries and benefits that most fire service medics do?

What percentage of EMS is run by fire departments? Figure it out for

yourselves. What percentage of all certified medics work for private services?

What do you get for having an associate's degree or a bachelor's degree in

either of them? Maybe a little, but not enough to pay for a 4 year

bachelor's degree when you can be a nurse and make at least three to four times

what

a medic does. A respiratory therapist makes twice what a paramedic does.

A radiology tech the same. Who will pay us for the expanded education?

Some services do pay a premium for a degree, but out of all the medics

working in the U.S., I'll wager that most of them have minimum education and

would be paid no more if they had a college degree in EMS. Prove me wrong. I

hope you can.

Certainly the rank and file have never demonstrated that as a group they're

in favor of anything other than less CE and maintaining the status quo.

Sorry if I offend, but that's my experience.

And unless the folks who pay for care recognize us as doing something

that's reimbursable and decide to pay us for non-transport care, nothing will

happen. That means primarily that Medicare and Medicaid must change their

reimbursement rules. Anybody think that's going to happen?

I do not see that happening. In all the discussion about " Healthcare

Reform " there is not one word that I have heard about EMS. It's as though we

didn't exist.

There are many more forces arguing for the status quo or less than there

are for improvements. Start talking about making a bachelor degree

requirement for paramedics and you'll see some fire chiefs and private service

managers with their hair on fire.

And when there is no medical evidence to support much of what we do now,

where would the evidence be for an expanded scope of practice and

responsibility? Doesn't exist. And it's damn near impossible to construct

research

studies that will prove that anything we do actually helps, because you

cannot do a double blind study because of ethics.

I wish it were otherwise, but it's not. It seems that we're stuck in a

niche that we'll always have, but it won't expand or improve because the

politics and the economics are just not there.

GG

In a message dated 9/8/09 10:34:33 PM, petsardlj@...

writes:

>

> But that is the point, If you do a proper assessment things like an

> atypical chest pain or even a typical chest pain would not be an issue. There

> are several things that diagonses do not do. I believe that as a profession

> the Standard of Care for the future can include refusals and other avenues

> of treatment not currently offered today. I do not see us that far off from

> this picture.

> I do see many at the top of our ranks and even within the ranks that

> would rather not see it get that far. Why? God only knows. We are tasked with

> doing the best for our patients from point A to point B and anywhere

> in-between. Education has come up from what it was even 4 years ago. What do

we

> need to continue to do that will make this discussion history in the

> making?

> I for one am in it for the long haul. Who's with me?

>

>

>

>

>

>

> Danny L.

> Owner/NREMT-

> PETSAR INC.

> (Panhandle Emergency Training Services And Response)

> Office

> Fax

>

>

> > >

> > >

> > > Why is it arrogant to actually try and get the patient the care they

> > > need while saving them money? Honestly it seems much more professional

> > > to get patients the help they need rather than just treating them as

> > > not worthy of our time which is what is being said by just

> > > transporting them all if better options of help are available. And

> > > even in the way under educated state we find ourselves being in we

> > > should still strive for what is best for our patients rather than to

> > > just be a taxi service.

> > >

> > > Renny Spencer

> > > The Idealistic Paramedic

> > >

> > >

> > > >

> > > >

> > > > The one thing I find the longer I have my paramedic patch is that I

> > > know less than I thought I did.Â

> > > >

> > > >

> > > >

> > > > At this point, EMS has a hard enough time mastering our core skills,

> > > as the Wang study and several others have indicated. I'm not sure

> > > that we're anywhere near ready to assume a role as the gatekeepers to

> > > the healthcare system, determining who is worthy of our time. That to

> > > me is the height of arrogance, especially considering that we want to

> > > be considered a profession. It smacks of hubris at the least.

> > > >

> > > >

> > > >

> > > > I realize that we've come a long ways from high-top Cadillac

> > > hearse/ambulances, but the reality is that we're still in the business

> > > of medical transportation. Ultimately, that means we give people

> > > rides to the hospital. Having said that, though, part of informed

> > > consent means giving patients a realistic expectation of our

> > > capabilities and treatment. I have told a patient with minor

> > > complaints that it's unlikely that I could provide any treatment

> > > beyond assessment and transport.  If I've informed the patient as to

> > > their options and they still choose to ride in an ambulance, I'm not

> > > in a position to deny them that option.

> > > >

> > > >

> > > >

> > > > And can we please kill this damned thread?

> > > >

> > > >

> > > >

> > > > -Wes Ogilvie, MPA, JD, Lic.P./NREMT-

> > > >

> > > > -Attorney at Law/Licensed Paramedic/EMS Instructor

> > > >

> > > > -Austin, Texas

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > > Re: Paramedics Cannot Determine Wh

> > > > ich Patients Require Transport

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > > As a person in favor of denying transport I do feel that we should

> > > not deny chest, abd, or head related calls. Even Doctors with all

> > > their equipment have trouble making accurate diagnosis. The calls that

> > > would be allowed denial would be the minor trauma such as stubbed toe,

> > > the sneezed once and want to make sure its not swine flu, the I just

> > > need a ride to the hospital so I can get to my doctors appointment,

> > > the I really just need someone to talk to to help cope ( this one only

> > > if you have resources that can come there while you wait ).

> > > >

> > > > The denial process would also involve as much if not more effort

> > > than just load and go so would discourage abuse by that one lazy

> > > Paramedic that everyone seems to know since he is mentioned often.

> > > >

> > > > I would like to see a study on EMS denials based on a system as

> > > described above. If allowed denial of the items even Doctors have

> > > trouble with then it is doomed to show we can not do it. It would also

> > > need a better criteria for mistake than admission to the hospital. For

> > > example the stubbed toe might end up needing surgery, yet nothing

> > > about the call required EMS, so admission was not a failure in this

> > case.

> > > >

> > > > Well just my worthless idealistic thoughts.

> > > >

> > > > Renny Spencer

> > > > The Idealistic Paramedic

> > >

> > >

> >

> > --

> > Grayson

> > www.kellygrayson. ww

> >

> >

> >

> >

>

>

[Guest guest]

Are you a good attorney or a good paramedic, Gene? You can't be good

at two things, right?

The implication is just as insulting to a fire/medic as it would be to

you, I'd assume. I understand -why- you'd feel that way, but you're

just wrong. The problem isn't that you CAN'T be good at more then one

thing, it's that many people don't WANT to, particularly when it comes

to a firefighter being told that he's going to be required to get his

EMT or 'Medic.

Austin

> Danny, I am with you. But it's going to take some real wrenching

> changes

> before things will be where you and I would like them to be.

>

> 500 hour paramedic courses won't cut it. And unless we somehow get

> funding for services other than transport, we'll never be able to

> pay people for

> doing a bachelor's degree in EMS. Which comes first? The chicken

> or the

> egg?

>

> And bachelor degreed medics won't cut it either without extensive

> clinical

> experience and improved diagnostic tools available in the

> ambulance. Even

> then, we're rolling the dice when we try to make field

> determinations about

> who needs a ride and who doesn't. It's not simple. It cannot be

> made

> simple. We are nowhere close to being able to do that reliably,

> and I see no

> prospects for change in an upward direction. I see lots of factors

> that

> indicate going to a lessor level of care and decision making.

>

> We have so much potential power. If we had ONE VOICE in this

> country as

> medics, from EMT-B to Paramedic, we could do great things. But we

> have NO

> VOICE because we cannot even muster 1% of the Texas certificants to

> join the

> one organization that's dedicated to their interests. NAEMT only

> has less

> percent than that of the medics in the country. We have no voice, no

> presence, no political clout, and we have nobody to blame but

> ourselves.

>

> The fire service medics are typically IAFF or some other union

> members, but

> their interests are in their fire service jobs, not in EMS. So they

> typically do not involve themselves in lists like this and the

> others, do not

> come to conferences, and are not interested in improving EMS as a

> whole in

> terms of what you are talking about. I realize that's a broad

> generalization,

> and I recognize that there are exceptions, but they are few and far

> between.

> The man who we honored last week on the 5th anniversary of his

> death, Jim

> Page, knew that better than anybody. The facts are that fire service

> medics see themselves as public safety and fire professionals, not

> medical

> professionals. We have had discussions here about whether or not

> one can serve

> two masters. Can one be both a crackerjack fire suppression expert

> and a

> prehospital medicine expert? I don't think so. Some will

> disagree, and

> there are always exceptions, but that's my take. And will fire

> service

> medics make any more than their non-medic coworkers if they are

> required to have

> bachelors degrees? Of course not.

>

> How do we come together as medics and promote improved education

> standards

> and scope of practice? As long as fire chiefs and private service

> managers veto any effort to improve standards, we'll never see

> improvement. And

> where is the groundswell of support for a more strict education and

> training

> system? It's just not there. Right now, paramedicine is the best

> deal

> imaginable. Where else can you spend as little time in class as we

> do and

> earn the kind of salaries and benefits that most fire service medics

> do?

> What percentage of EMS is run by fire departments? Figure it out for

> yourselves. What percentage of all certified medics work for

> private services?

> What do you get for having an associate's degree or a bachelor's

> degree in

> either of them? Maybe a little, but not enough to pay for a 4 year

> bachelor's degree when you can be a nurse and make at least three to

> four times what

> a medic does. A respiratory therapist makes twice what a paramedic

> does.

> A radiology tech the same. Who will pay us for the expanded

> education?

> Some services do pay a premium for a degree, but out of all the medics

> working in the U.S., I'll wager that most of them have minimum

> education and

> would be paid no more if they had a college degree in EMS. Prove

> me wrong. I

> hope you can.

>

> Certainly the rank and file have never demonstrated that as a group

> they're

> in favor of anything other than less CE and maintaining the status

> quo.

> Sorry if I offend, but that's my experience.

>

> And unless the folks who pay for care recognize us as doing something

> that's reimbursable and decide to pay us for non-transport care,

> nothing will

> happen. That means primarily that Medicare and Medicaid must

> change their

> reimbursement rules. Anybody think that's going to happen?

>

> I do not see that happening. In all the discussion about " Healthcare

> Reform " there is not one word that I have heard about EMS. It's as

> though we

> didn't exist.

>

> There are many more forces arguing for the status quo or less than

> there

> are for improvements. Start talking about making a bachelor degree

> requirement for paramedics and you'll see some fire chiefs and

> private service

> managers with their hair on fire.

>

> And when there is no medical evidence to support much of what we do

> now,

> where would the evidence be for an expanded scope of practice and

> responsibility? Doesn't exist. And it's damn near impossible to

> construct research

> studies that will prove that anything we do actually helps, because

> you

> cannot do a double blind study because of ethics.

>

> I wish it were otherwise, but it's not. It seems that we're stuck

> in a

> niche that we'll always have, but it won't expand or improve because

> the

> politics and the economics are just not there.

>

> GG

>

>

>

>>

>> But that is the point, If you do a proper assessment things like an

>> atypical chest pain or even a typical chest pain would not be an

>> issue. There

>> are several things that diagonses do not do. I believe that as a

>> profession

>> the Standard of Care for the future can include refusals and other

>> avenues

>> of treatment not currently offered today. I do not see us that far

>> off from

>> this picture.

>> I do see many at the top of our ranks and even within the ranks

>> that

>> would rather not see it get that far. Why? God only knows. We are

>> tasked with

>> doing the best for our patients from point A to point B and anywhere

>> in-between. Education has come up from what it was even 4 years

>> ago. What do we

>> need to continue to do that will make this discussion history in the

>> making?

>> I for one am in it for the long haul. Who's with me?

>>

>>

>>

>>

>>

>>

>> Danny L.

>> Owner/NREMT-

>> PETSAR INC.

>> (Panhandle Emergency Training Services And Response)

>> Office

>> Fax

>>

>>

>>>>

>>>>

>>>> Why is it arrogant to actually try and get the patient the care

>>>> they

>>>> need while saving them money? Honestly it seems much more

>>>> professional

>>>> to get patients the help they need rather than just treating them

>>>> as

>>>> not worthy of our time which is what is being said by just

>>>> transporting them all if better options of help are available. And

>>>> even in the way under educated state we find ourselves being in we

>>>> should still strive for what is best for our patients rather than

>>>> to

>>>> just be a taxi service.

>>>>

>>>> Renny Spencer

>>>> The Idealistic Paramedic

>>>>

>>>>

>>>>>

>>>>>

>>>>> The one thing I find the longer I have my paramedic patch is

>>>>> that I

>>>> know less than I thought I did.Â

>>>>>

>>>>>

>>>>>

>>>>> At this point, EMS has a hard enough time mastering our core

>>>>> skills,

>>>> as the Wang study and several others have indicated. I'm not sure

>>>> that we're anywhere near ready to assume a role as the

>>>> gatekeepers to

>>>> the healthcare system, determining who is worthy of our time.

>>>> That to

>>>> me is the height of arrogance, especially considering that we

>>>> want to

>>>> be considered a profession. It smacks of hubris at the least.

>>>>>

>>>>>

>>>>>

>>>>> I realize that we've come a long ways from high-top Cadillac

>>>> hearse/ambulances, but the reality is that we're still in the

>>>> business

>>>> of medical transportation. Ultimately, that means we give people

>>>> rides to the hospital. Having said that, though, part of informed

>>>> consent means giving patients a realistic expectation of our

>>>> capabilities and treatment. I have told a patient with minor

>>>> complaints that it's unlikely that I could provide any treatment

>>>> beyond assessment and transport.  If I've informed the patient

>>>> as to

>>>> their options and they still choose to ride in an ambulance, I'm

>>>> not

>>>> in a position to deny them that option.

>>>>>

>>>>>

>>>>>

>>>>> And can we please kill this damned thread?

>>>>>

>>>>>

>>>>>

>>>>> -Wes Ogilvie, MPA, JD, Lic.P./NREMT-

>>>>>

>>>>> -Attorney at Law/Licensed Paramedic/EMS Instructor

>>>>>

>>>>> -Austin, Texas

>>>>>

>>>>>

>>>>>

>>>>>

>>>>>

>>>>>

>>>>> Re: Paramedics Cannot Determine Wh

>>>>> ich Patients Require Transport

>>>>>

>>>>>

>>>>>

>>>>>

>>>>>

>>>>>

>>>>> As a person in favor of denying transport I do feel that we should

>>>> not deny chest, abd, or head related calls. Even Doctors with all

>>>> their equipment have trouble making accurate diagnosis. The calls

>>>> that

>>>> would be allowed denial would be the minor trauma such as stubbed

>>>> toe,

>>>> the sneezed once and want to make sure its not swine flu, the I

>>>> just

>>>> need a ride to the hospital so I can get to my doctors appointment,

>>>> the I really just need someone to talk to to help cope ( this one

>>>> only

>>>> if you have resources that can come there while you wait ).

>>>>>

>>>>> The denial process would also involve as much if not more effort

>>>> than just load and go so would discourage abuse by that one lazy

>>>> Paramedic that everyone seems to know since he is mentioned

>>>> often.

>>>>>

>>>>> I would like to see a study on EMS denials based on a system as

>>>> described above. If allowed denial of the items even Doctors have

>>>> trouble with then it is doomed to show we can not do it. It would

>>>> also

>>>> need a better criteria for mistake than admission to the

>>>> hospital. For

>>>> example the stubbed toe might end up needing surgery, yet nothing

>>>> about the call required EMS, so admission was not a failure in this

>>> case.

>>>>>

>>>>> Well just my worthless idealistic thoughts.

>>>>>

>>>>> Renny Spencer

>>>>> The Idealistic Paramedic

>>>>

>>>>

>>>

>>> --

>>> Grayson

>>> www.kellygrayson. ww

>>>

>>>

>>>

>>>

>>

>>

[Guest guest]

Are you a good attorney or a good paramedic, Gene? You can't be good

at two things, right?

The implication is just as insulting to a fire/medic as it would be to

you, I'd assume. I understand -why- you'd feel that way, but you're

just wrong. The problem isn't that you CAN'T be good at more then one

thing, it's that many people don't WANT to, particularly when it comes

to a firefighter being told that he's going to be required to get his

EMT or 'Medic.

Austin

> Danny, I am with you. But it's going to take some real wrenching

> changes

> before things will be where you and I would like them to be.

>

> 500 hour paramedic courses won't cut it. And unless we somehow get

> funding for services other than transport, we'll never be able to

> pay people for

> doing a bachelor's degree in EMS. Which comes first? The chicken

> or the

> egg?

>

> And bachelor degreed medics won't cut it either without extensive

> clinical

> experience and improved diagnostic tools available in the

> ambulance. Even

> then, we're rolling the dice when we try to make field

> determinations about

> who needs a ride and who doesn't. It's not simple. It cannot be

> made

> simple. We are nowhere close to being able to do that reliably,

> and I see no

> prospects for change in an upward direction. I see lots of factors

> that

> indicate going to a lessor level of care and decision making.

>

> We have so much potential power. If we had ONE VOICE in this

> country as

> medics, from EMT-B to Paramedic, we could do great things. But we

> have NO

> VOICE because we cannot even muster 1% of the Texas certificants to

> join the

> one organization that's dedicated to their interests. NAEMT only

> has less

> percent than that of the medics in the country. We have no voice, no

> presence, no political clout, and we have nobody to blame but

> ourselves.

>

> The fire service medics are typically IAFF or some other union

> members, but

> their interests are in their fire service jobs, not in EMS. So they

> typically do not involve themselves in lists like this and the

> others, do not

> come to conferences, and are not interested in improving EMS as a

> whole in

> terms of what you are talking about. I realize that's a broad

> generalization,

> and I recognize that there are exceptions, but they are few and far

> between.

> The man who we honored last week on the 5th anniversary of his

> death, Jim

> Page, knew that better than anybody. The facts are that fire service

> medics see themselves as public safety and fire professionals, not

> medical

> professionals. We have had discussions here about whether or not

> one can serve

> two masters. Can one be both a crackerjack fire suppression expert

> and a

> prehospital medicine expert? I don't think so. Some will

> disagree, and

> there are always exceptions, but that's my take. And will fire

> service

> medics make any more than their non-medic coworkers if they are

> required to have

> bachelors degrees? Of course not.

>

> How do we come together as medics and promote improved education

> standards

> and scope of practice? As long as fire chiefs and private service

> managers veto any effort to improve standards, we'll never see

> improvement. And

> where is the groundswell of support for a more strict education and

> training

> system? It's just not there. Right now, paramedicine is the best

> deal

> imaginable. Where else can you spend as little time in class as we

> do and

> earn the kind of salaries and benefits that most fire service medics

> do?

> What percentage of EMS is run by fire departments? Figure it out for

> yourselves. What percentage of all certified medics work for

> private services?

> What do you get for having an associate's degree or a bachelor's

> degree in

> either of them? Maybe a little, but not enough to pay for a 4 year

> bachelor's degree when you can be a nurse and make at least three to

> four times what

> a medic does. A respiratory therapist makes twice what a paramedic

> does.

> A radiology tech the same. Who will pay us for the expanded

> education?

> Some services do pay a premium for a degree, but out of all the medics

> working in the U.S., I'll wager that most of them have minimum

> education and

> would be paid no more if they had a college degree in EMS. Prove

> me wrong. I

> hope you can.

>

> Certainly the rank and file have never demonstrated that as a group

> they're

> in favor of anything other than less CE and maintaining the status

> quo.

> Sorry if I offend, but that's my experience.

>

> And unless the folks who pay for care recognize us as doing something

> that's reimbursable and decide to pay us for non-transport care,

> nothing will

> happen. That means primarily that Medicare and Medicaid must

> change their

> reimbursement rules. Anybody think that's going to happen?

>

> I do not see that happening. In all the discussion about " Healthcare

> Reform " there is not one word that I have heard about EMS. It's as

> though we

> didn't exist.

>

> There are many more forces arguing for the status quo or less than

> there

> are for improvements. Start talking about making a bachelor degree

> requirement for paramedics and you'll see some fire chiefs and

> private service

> managers with their hair on fire.

>

> And when there is no medical evidence to support much of what we do

> now,

> where would the evidence be for an expanded scope of practice and

> responsibility? Doesn't exist. And it's damn near impossible to

> construct research

> studies that will prove that anything we do actually helps, because

> you

> cannot do a double blind study because of ethics.

>

> I wish it were otherwise, but it's not. It seems that we're stuck

> in a

> niche that we'll always have, but it won't expand or improve because

> the

> politics and the economics are just not there.

>

> GG

>

>

>

>>

>> But that is the point, If you do a proper assessment things like an

>> atypical chest pain or even a typical chest pain would not be an

>> issue. There

>> are several things that diagonses do not do. I believe that as a

>> profession

>> the Standard of Care for the future can include refusals and other

>> avenues

>> of treatment not currently offered today. I do not see us that far

>> off from

>> this picture.

>> I do see many at the top of our ranks and even within the ranks

>> that

>> would rather not see it get that far. Why? God only knows. We are

>> tasked with

>> doing the best for our patients from point A to point B and anywhere

>> in-between. Education has come up from what it was even 4 years

>> ago. What do we

>> need to continue to do that will make this discussion history in the

>> making?

>> I for one am in it for the long haul. Who's with me?

>>

>>

>>

>>

>>

>>

>> Danny L.

>> Owner/NREMT-

>> PETSAR INC.

>> (Panhandle Emergency Training Services And Response)

>> Office

>> Fax

>>

>>

>>>>

>>>>

>>>> Why is it arrogant to actually try and get the patient the care

>>>> they

>>>> need while saving them money? Honestly it seems much more

>>>> professional

>>>> to get patients the help they need rather than just treating them

>>>> as

>>>> not worthy of our time which is what is being said by just

>>>> transporting them all if better options of help are available. And

>>>> even in the way under educated state we find ourselves being in we

>>>> should still strive for what is best for our patients rather than

>>>> to

>>>> just be a taxi service.

>>>>

>>>> Renny Spencer

>>>> The Idealistic Paramedic

>>>>

>>>>

>>>>>

>>>>>

>>>>> The one thing I find the longer I have my paramedic patch is

>>>>> that I

>>>> know less than I thought I did.Â

>>>>>

>>>>>

>>>>>

>>>>> At this point, EMS has a hard enough time mastering our core

>>>>> skills,

>>>> as the Wang study and several others have indicated. I'm not sure

>>>> that we're anywhere near ready to assume a role as the

>>>> gatekeepers to

>>>> the healthcare system, determining who is worthy of our time.

>>>> That to

>>>> me is the height of arrogance, especially considering that we

>>>> want to

>>>> be considered a profession. It smacks of hubris at the least.

>>>>>

>>>>>

>>>>>

>>>>> I realize that we've come a long ways from high-top Cadillac

>>>> hearse/ambulances, but the reality is that we're still in the

>>>> business

>>>> of medical transportation. Ultimately, that means we give people

>>>> rides to the hospital. Having said that, though, part of informed

>>>> consent means giving patients a realistic expectation of our

>>>> capabilities and treatment. I have told a patient with minor

>>>> complaints that it's unlikely that I could provide any treatment

>>>> beyond assessment and transport.  If I've informed the patient

>>>> as to

>>>> their options and they still choose to ride in an ambulance, I'm

>>>> not

>>>> in a position to deny them that option.

>>>>>

>>>>>

>>>>>

>>>>> And can we please kill this damned thread?

>>>>>

>>>>>

>>>>>

>>>>> -Wes Ogilvie, MPA, JD, Lic.P./NREMT-

>>>>>

>>>>> -Attorney at Law/Licensed Paramedic/EMS Instructor

>>>>>

>>>>> -Austin, Texas

>>>>>

>>>>>

>>>>>

>>>>>

>>>>>

>>>>>

>>>>> Re: Paramedics Cannot Determine Wh

>>>>> ich Patients Require Transport

>>>>>

>>>>>

>>>>>

>>>>>

>>>>>

>>>>>

>>>>> As a person in favor of denying transport I do feel that we should

>>>> not deny chest, abd, or head related calls. Even Doctors with all

>>>> their equipment have trouble making accurate diagnosis. The calls

>>>> that

>>>> would be allowed denial would be the minor trauma such as stubbed

>>>> toe,

>>>> the sneezed once and want to make sure its not swine flu, the I

>>>> just

>>>> need a ride to the hospital so I can get to my doctors appointment,

>>>> the I really just need someone to talk to to help cope ( this one

>>>> only

>>>> if you have resources that can come there while you wait ).

>>>>>

>>>>> The denial process would also involve as much if not more effort

>>>> than just load and go so would discourage abuse by that one lazy

>>>> Paramedic that everyone seems to know since he is mentioned

>>>> often.

>>>>>

>>>>> I would like to see a study on EMS denials based on a system as

>>>> described above. If allowed denial of the items even Doctors have

>>>> trouble with then it is doomed to show we can not do it. It would

>>>> also

>>>> need a better criteria for mistake than admission to the

>>>> hospital. For

>>>> example the stubbed toe might end up needing surgery, yet nothing

>>>> about the call required EMS, so admission was not a failure in this

>>> case.

>>>>>

>>>>> Well just my worthless idealistic thoughts.

>>>>>

>>>>> Renny Spencer

>>>>> The Idealistic Paramedic

>>>>

>>>>

>>>

>>> --

>>> Grayson

>>> www.kellygrayson. ww

>>>

>>>

>>>

>>>

>>

>>

[Guest guest]

Are you a good attorney or a good paramedic, Gene? You can't be good

at two things, right?

The implication is just as insulting to a fire/medic as it would be to

you, I'd assume. I understand -why- you'd feel that way, but you're

just wrong. The problem isn't that you CAN'T be good at more then one

thing, it's that many people don't WANT to, particularly when it comes

to a firefighter being told that he's going to be required to get his

EMT or 'Medic.

Austin

> Danny, I am with you. But it's going to take some real wrenching

> changes

> before things will be where you and I would like them to be.

>

> 500 hour paramedic courses won't cut it. And unless we somehow get

> funding for services other than transport, we'll never be able to

> pay people for

> doing a bachelor's degree in EMS. Which comes first? The chicken

> or the

> egg?

>

> And bachelor degreed medics won't cut it either without extensive

> clinical

> experience and improved diagnostic tools available in the

> ambulance. Even

> then, we're rolling the dice when we try to make field

> determinations about

> who needs a ride and who doesn't. It's not simple. It cannot be

> made

> simple. We are nowhere close to being able to do that reliably,

> and I see no

> prospects for change in an upward direction. I see lots of factors

> that

> indicate going to a lessor level of care and decision making.

>

> We have so much potential power. If we had ONE VOICE in this

> country as

> medics, from EMT-B to Paramedic, we could do great things. But we

> have NO

> VOICE because we cannot even muster 1% of the Texas certificants to

> join the

> one organization that's dedicated to their interests. NAEMT only

> has less

> percent than that of the medics in the country. We have no voice, no

> presence, no political clout, and we have nobody to blame but

> ourselves.

>

> The fire service medics are typically IAFF or some other union

> members, but

> their interests are in their fire service jobs, not in EMS. So they

> typically do not involve themselves in lists like this and the

> others, do not

> come to conferences, and are not interested in improving EMS as a

> whole in

> terms of what you are talking about. I realize that's a broad

> generalization,

> and I recognize that there are exceptions, but they are few and far

> between.

> The man who we honored last week on the 5th anniversary of his

> death, Jim

> Page, knew that better than anybody. The facts are that fire service

> medics see themselves as public safety and fire professionals, not

> medical

> professionals. We have had discussions here about whether or not

> one can serve

> two masters. Can one be both a crackerjack fire suppression expert

> and a

> prehospital medicine expert? I don't think so. Some will

> disagree, and

> there are always exceptions, but that's my take. And will fire

> service

> medics make any more than their non-medic coworkers if they are

> required to have

> bachelors degrees? Of course not.

>

> How do we come together as medics and promote improved education

> standards

> and scope of practice? As long as fire chiefs and private service

> managers veto any effort to improve standards, we'll never see

> improvement. And

> where is the groundswell of support for a more strict education and

> training

> system? It's just not there. Right now, paramedicine is the best

> deal

> imaginable. Where else can you spend as little time in class as we

> do and

> earn the kind of salaries and benefits that most fire service medics

> do?

> What percentage of EMS is run by fire departments? Figure it out for

> yourselves. What percentage of all certified medics work for

> private services?

> What do you get for having an associate's degree or a bachelor's

> degree in

> either of them? Maybe a little, but not enough to pay for a 4 year

> bachelor's degree when you can be a nurse and make at least three to

> four times what

> a medic does. A respiratory therapist makes twice what a paramedic

> does.

> A radiology tech the same. Who will pay us for the expanded

> education?

> Some services do pay a premium for a degree, but out of all the medics

> working in the U.S., I'll wager that most of them have minimum

> education and

> would be paid no more if they had a college degree in EMS. Prove

> me wrong. I

> hope you can.

>

> Certainly the rank and file have never demonstrated that as a group

> they're

> in favor of anything other than less CE and maintaining the status

> quo.

> Sorry if I offend, but that's my experience.

>

> And unless the folks who pay for care recognize us as doing something

> that's reimbursable and decide to pay us for non-transport care,

> nothing will

> happen. That means primarily that Medicare and Medicaid must

> change their

> reimbursement rules. Anybody think that's going to happen?

>

> I do not see that happening. In all the discussion about " Healthcare

> Reform " there is not one word that I have heard about EMS. It's as

> though we

> didn't exist.

>

> There are many more forces arguing for the status quo or less than

> there

> are for improvements. Start talking about making a bachelor degree

> requirement for paramedics and you'll see some fire chiefs and

> private service

> managers with their hair on fire.

>

> And when there is no medical evidence to support much of what we do

> now,

> where would the evidence be for an expanded scope of practice and

> responsibility? Doesn't exist. And it's damn near impossible to

> construct research

> studies that will prove that anything we do actually helps, because

> you

> cannot do a double blind study because of ethics.

>

> I wish it were otherwise, but it's not. It seems that we're stuck

> in a

> niche that we'll always have, but it won't expand or improve because

> the

> politics and the economics are just not there.

>

> GG

>

>

>

>>

>> But that is the point, If you do a proper assessment things like an

>> atypical chest pain or even a typical chest pain would not be an

>> issue. There

>> are several things that diagonses do not do. I believe that as a

>> profession

>> the Standard of Care for the future can include refusals and other

>> avenues

>> of treatment not currently offered today. I do not see us that far

>> off from

>> this picture.

>> I do see many at the top of our ranks and even within the ranks

>> that

>> would rather not see it get that far. Why? God only knows. We are

>> tasked with

>> doing the best for our patients from point A to point B and anywhere

>> in-between. Education has come up from what it was even 4 years

>> ago. What do we

>> need to continue to do that will make this discussion history in the

>> making?

>> I for one am in it for the long haul. Who's with me?

>>

>>

>>

>>

>>

>>

>> Danny L.

>> Owner/NREMT-

>> PETSAR INC.

>> (Panhandle Emergency Training Services And Response)

>> Office

>> Fax

>>

>>

>>>>

>>>>

>>>> Why is it arrogant to actually try and get the patient the care

>>>> they

>>>> need while saving them money? Honestly it seems much more

>>>> professional

>>>> to get patients the help they need rather than just treating them

>>>> as

>>>> not worthy of our time which is what is being said by just

>>>> transporting them all if better options of help are available. And

>>>> even in the way under educated state we find ourselves being in we

>>>> should still strive for what is best for our patients rather than

>>>> to

>>>> just be a taxi service.

>>>>

>>>> Renny Spencer

>>>> The Idealistic Paramedic

>>>>

>>>>

>>>>>

>>>>>

>>>>> The one thing I find the longer I have my paramedic patch is

>>>>> that I

>>>> know less than I thought I did.Â

>>>>>

>>>>>

>>>>>

>>>>> At this point, EMS has a hard enough time mastering our core

>>>>> skills,

>>>> as the Wang study and several others have indicated. I'm not sure

>>>> that we're anywhere near ready to assume a role as the

>>>> gatekeepers to

>>>> the healthcare system, determining who is worthy of our time.

>>>> That to

>>>> me is the height of arrogance, especially considering that we

>>>> want to

>>>> be considered a profession. It smacks of hubris at the least.

>>>>>

>>>>>

>>>>>

>>>>> I realize that we've come a long ways from high-top Cadillac

>>>> hearse/ambulances, but the reality is that we're still in the

>>>> business

>>>> of medical transportation. Ultimately, that means we give people

>>>> rides to the hospital. Having said that, though, part of informed

>>>> consent means giving patients a realistic expectation of our

>>>> capabilities and treatment. I have told a patient with minor

>>>> complaints that it's unlikely that I could provide any treatment

>>>> beyond assessment and transport.  If I've informed the patient

>>>> as to

>>>> their options and they still choose to ride in an ambulance, I'm

>>>> not

>>>> in a position to deny them that option.

>>>>>

>>>>>

>>>>>

>>>>> And can we please kill this damned thread?

>>>>>

>>>>>

>>>>>

>>>>> -Wes Ogilvie, MPA, JD, Lic.P./NREMT-

>>>>>

>>>>> -Attorney at Law/Licensed Paramedic/EMS Instructor

>>>>>

>>>>> -Austin, Texas

>>>>>

>>>>>

>>>>>

>>>>>

>>>>>

>>>>>

>>>>> Re: Paramedics Cannot Determine Wh

>>>>> ich Patients Require Transport

>>>>>

>>>>>

>>>>>

>>>>>

>>>>>

>>>>>

>>>>> As a person in favor of denying transport I do feel that we should

>>>> not deny chest, abd, or head related calls. Even Doctors with all

>>>> their equipment have trouble making accurate diagnosis. The calls

>>>> that

>>>> would be allowed denial would be the minor trauma such as stubbed

>>>> toe,

>>>> the sneezed once and want to make sure its not swine flu, the I

>>>> just

>>>> need a ride to the hospital so I can get to my doctors appointment,

>>>> the I really just need someone to talk to to help cope ( this one

>>>> only

>>>> if you have resources that can come there while you wait ).

>>>>>

>>>>> The denial process would also involve as much if not more effort

>>>> than just load and go so would discourage abuse by that one lazy

>>>> Paramedic that everyone seems to know since he is mentioned

>>>> often.

>>>>>

>>>>> I would like to see a study on EMS denials based on a system as

>>>> described above. If allowed denial of the items even Doctors have

>>>> trouble with then it is doomed to show we can not do it. It would

>>>> also

>>>> need a better criteria for mistake than admission to the

>>>> hospital. For

>>>> example the stubbed toe might end up needing surgery, yet nothing

>>>> about the call required EMS, so admission was not a failure in this

>>> case.

>>>>>

>>>>> Well just my worthless idealistic thoughts.

>>>>>

>>>>> Renny Spencer

>>>>> The Idealistic Paramedic

>>>>

>>>>

>>>

>>> --

>>> Grayson

>>> www.kellygrayson. ww

>>>

>>>

>>>

>>>

>>

>>

[Guest guest]

I am confused. My wanting to get a patient that tells you they need to talk to

someone actually turned over to the services they need is arrogant/hubris? How?

I do not see doing what is best for the patient is wrong. I have had many

patients tell me they asked for the ambulance because they did not know what

they need. If I am aware of a service that takes care of their need and get the

process started for them how is that wrong? If I take them to the ER is that a

benefit to them? No as they now have a huge transport bill, an even larger ER

bill and sadly may be discharged w/o ever being put in touch with the agency

they needed.

As I stated earlier I am not saying deny chest, abd, or head.

Oh and why have we chosen to use two words with the same meaning like they are

two separate things. Hubris basically means arrogant so using them in the same

sentence/question seems to be improper based on my uneducated understanding. But

maybe I misunderstand as I am not an English major.

As to reimbursement. I am sorry when did money start coming before being a

patient advocate? If I cause more harm by transporting a patient that does not

need transport should I justify it by saying oh well that will make sure the

service has enough money to keep an ambulance staffed so if there is ever a real

emergency? I am well aware it takes money to function but disagree with making

my patients suffer undue hardship because the current reimbursement system is

flawed. Based on Medicare/Medicaid rules I do not see how many of those that do

not need an ambulance transport are getting reimbursed anyway? Which means you

are transporting for free so why not just do whats right instead?

Again I know the medical education we as Paramedics get is seriously lacking. I

know even if we do add education w/o all sorts of lab, cat scans, etc that we

still would just have to transport the callers with chest, head, abd problems as

there are way to many variables.

I mean no disrespect but I just can not wrap my brain around what you and Wes

are saying.

Renny Spencer

The Idealistic Paramedic

> > >

> > >

> > > The one thing I find the longer I have my paramedic patch is that I

> > know less than I thought I did.Â

> > >

> > >

> > >

> > > At this point, EMS has a hard enough time mastering our core skills,

> > as the Wang study and several others have indicated. I'm not sure

> > that we're anywhere near ready to assume a role as the gatekeepers to

> > the healthcare system, determining who is worthy of our time. That to

> > me is the height of arrogance, especially considering that we want to

> > be considered a profession. It smacks of hubris at the least.

> > >

> > >

> > >

> > > I realize that we've come a long ways from high-top Cadillac

> > hearse/ambulances, but the reality is that we're still in the business

> > of medical transportation. Ultimately, that means we give people

> > rides to the hospital. Having said that, though, part of informed

> > consent means giving patients a realistic expectation of our

> > capabilities and treatment. I have told a patient with minor

> > complaints that it's unlikely that I could provide any treatment

> > beyond assessment and transport.  If I've informed the patient as to

> > their options and they still choose to ride in an ambulance, I'm not

> > in a position to deny them that option.

> > >

> > >

> > >

> > > And can we please kill this damned thread?

> > >

> > >

> > >

> > > -Wes Ogilvie, MPA, JD, Lic.P./NREMT-P

> > >

> > > -Attorney at Law/Licensed Paramedic/EMS Instructor

> > >

> > > -Austin, Texas

> > >

> > >

> > >

> > >

> > >

> > >

> > > Re: Paramedics Cannot Determine Wh

> > > ich Patients Require Transport

> > >

> > >

> > >

> > >

> > >

> > >

> > > As a person in favor of denying transport I do feel that we should

> > not deny chest, abd, or head related calls. Even Doctors with all

> > their equipment have trouble making accurate diagnosis. The calls that

> > would be allowed denial would be the minor trauma such as stubbed toe,

> > the sneezed once and want to make sure its not swine flu, the I just

> > need a ride to the hospital so I can get to my doctors appointment,

> > the I really just need someone to talk to to help cope ( this one only

> > if you have resources that can come there while you wait ).

> > >

> > > The denial process would also involve as much if not more effort

> > than just load and go so would discourage abuse by that one lazy

> > Paramedic that everyone seems to know since he is mentioned often.

> > >

> > > I would like to see a study on EMS denials based on a system as

> > described above. If allowed denial of the items even Doctors have

> > trouble with then it is doomed to show we can not do it. It would also

> > need a better criteria for mistake than admission to the hospital. For

> > example the stubbed toe might end up needing surgery, yet nothing

> > about the call required EMS, so admission was not a failure in this case.

> > >

> > > Well just my worthless idealistic thoughts.

> > >

> > > Renny Spencer

> > > The Idealistic Paramedic

> >

> >

>

>

> --

> Grayson

> www.kellygrayson.com

>

[Guest guest]

You can't wrap your head around it because you didn't listen to what was

said. No one is disputing your desire to get the patient the *right*

kind of care instead of just blithely transporting one and all to the

ER. What we're disputing is the assertion that such ideas are workable

within the current EMS educational and reimbursement models.

And if you think that paramedics are capable of acting as gatekeepers as

they are *currently* trained, then yes, that's arrogant. And believe me,

I know arrogant. I'm capable of being the most arrogant paragod bastard

you will ever meet.

But as arrogant as I can be about my skill and knowledge level, I don't

kid myself that I can accurately make decisions in the field that ER

physicians struggle over, with a wealth of diagnostic tools and

education at their disposal. To do so would be utter hubris.

You sign your emails as " The Idealistic Paramedic, " and that's good. We

need idealistic people. But don't let idealism blind you to reality. To

do what you propose would require a wholesale overhaul of how EMTs are

educated, and how EMS is delivered in this country. That's a big job,

and you'll likely be retired, and considerably less idealistic, by the

time if/when it happens.

spenair wrote:

>

>

> I am confused. My wanting to get a patient that tells you they need to

> talk to someone actually turned over to the services they need is

> arrogant/hubris? How? I do not see doing what is best for the patient

> is wrong. I have had many patients tell me they asked for the

> ambulance because they did not know what they need. If I am aware of a

> service that takes care of their need and get the process started for

> them how is that wrong? If I take them to the ER is that a benefit to

> them? No as they now have a huge transport bill, an even larger ER

> bill and sadly may be discharged w/o ever being put in touch with the

> agency they needed.

>

> As I stated earlier I am not saying deny chest, abd, or head.

>

> Oh and why have we chosen to use two words with the same meaning like

> they are two separate things. Hubris basically means arrogant so using

> them in the same sentence/question seems to be improper based on my

> uneducated understanding. But maybe I misunderstand as I am not an

> English major.

>

> As to reimbursement. I am sorry when did money start coming before

> being a patient advocate? If I cause more harm by transporting a

> patient that does not need transport should I justify it by saying oh

> well that will make sure the service has enough money to keep an

> ambulance staffed so if there is ever a real emergency? I am well

> aware it takes money to function but disagree with making my patients

> suffer undue hardship because the current reimbursement system is

> flawed. Based on Medicare/Medicaid rules I do not see how many of

> those that do not need an ambulance transport are getting reimbursed

> anyway? Which means you are transporting for free so why not just do

> whats right instead?

>

> Again I know the medical education we as Paramedics get is seriously

> lacking. I know even if we do add education w/o all sorts of lab, cat

> scans, etc that we still would just have to transport the callers with

> chest, head, abd problems as there are way to many variables.

>

> I mean no disrespect but I just can not wrap my brain around what you

> and Wes are saying.

>

> Renny Spencer

> The Idealistic Paramedic

>

>

> > > >

> > > >

> > > > The one thing I find the longer I have my paramedic patch is that I

> > > know less than I thought I did.Â

> > > >

> > > >

> > > >

> > > > At this point, EMS has a hard enough time mastering our core

> skills,

> > > as the Wang study and several others have indicated. I'm not sure

> > > that we're anywhere near ready to assume a role as the gatekeepers to

> > > the healthcare system, determining who is worthy of our time. That to

> > > me is the height of arrogance, especially considering that we want to

> > > be considered a profession. It smacks of hubris at the least.

> > > >

> > > >

> > > >

> > > > I realize that we've come a long ways from high-top Cadillac

> > > hearse/ambulances, but the reality is that we're still in the

> business

> > > of medical transportation. Ultimately, that means we give people

> > > rides to the hospital. Having said that, though, part of informed

> > > consent means giving patients a realistic expectation of our

> > > capabilities and treatment. I have told a patient with minor

> > > complaints that it's unlikely that I could provide any treatment

> > > beyond assessment and transport.  If I've informed the patient

> as to

> > > their options and they still choose to ride in an ambulance, I'm not

> > > in a position to deny them that option.

> > > >

> > > >

> > > >

> > > > And can we please kill this damned thread?

> > > >

> > > >

> > > >

> > > > -Wes Ogilvie, MPA, JD, Lic.P./NREMT-P

> > > >

> > > > -Attorney at Law/Licensed Paramedic/EMS Instructor

> > > >

> > > > -Austin, Texas

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > > Re: Paramedics Cannot Determine Wh

> > > > ich Patients Require Transport

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > > As a person in favor of denying transport I do feel that we should

> > > not deny chest, abd, or head related calls. Even Doctors with all

> > > their equipment have trouble making accurate diagnosis. The calls

> that

> > > would be allowed denial would be the minor trauma such as stubbed

> toe,

> > > the sneezed once and want to make sure its not swine flu, the I just

> > > need a ride to the hospital so I can get to my doctors appointment,

> > > the I really just need someone to talk to to help cope ( this one

> only

> > > if you have resources that can come there while you wait ).

> > > >

> > > > The denial process would also involve as much if not more effort

> > > than just load and go so would discourage abuse by that one lazy

> > > Paramedic that everyone seems to know since he is mentioned often.

> > > >

> > > > I would like to see a study on EMS denials based on a system as

> > > described above. If allowed denial of the items even Doctors have

> > > trouble with then it is doomed to show we can not do it. It would

> also

> > > need a better criteria for mistake than admission to the hospital.

> For

> > > example the stubbed toe might end up needing surgery, yet nothing

> > > about the call required EMS, so admission was not a failure in

> this case.

> > > >

> > > > Well just my worthless idealistic thoughts.

> > > >

> > > > Renny Spencer

> > > > The Idealistic Paramedic

> > >

> > >

> >

> >

> > --

> > Grayson

> > www.kellygrayson.com

> >

>

>

--

Grayson

www.kellygrayson.com

[Guest guest]

I for one am done with this discussion. Let's move on to another dead horse --

like the semi-regular fire versus other providers discussion or a rant about

Christmas.

-Wes

Re: Paramedics Cannot Determine Wh

> > > ich Patients Require Transport

> > >

> > >

> > >

> > >

> > >

> > >

> > > As a person in favor of denying transport I do feel that we should

> > not deny chest, abd, or head related calls. Even Doctors with all

> > their equipment have trouble making accurate diagnosis. The calls that

> > would be allowed denial would be the minor trauma such as stubbed toe,

> > the sneezed once and want to make sure its not swine flu, the I just

> > need a ride to the hospital so I can get to my doctors appointment,

> > the I really just need someone to talk to to help cope ( this one only

> > if you have resources that can come there while you wait ).

> > >

> > > The denial process would also involve as much if not more effort

> > than just load and go so would discourage abuse by that one lazy

> > Paramedic that everyone seems to know since he is mentioned often.

> > >

> > > I would like to see a study on EMS denials based on a system as

> > described above. If allowed denial of the items even Doctors have

> > trouble with then it is doomed to show we can not do it. It would also

> > need a better criteria for mistake than admission to the hospital. For

> > example the stubbed toe might end up needing surgery, yet nothing

> > about the call required EM

S, so admission was not a failure in this case.

> > >

> > > Well just my worthless idealistic thoughts.

> > >

> > > Renny Spencer

> > > The Idealistic Paramedic

> >

> >

>

>

> --

> Grayson

> www.kellygrayson.com

>

[Guest guest]

I for one am done with this discussion. Let's move on to another dead horse --

like the semi-regular fire versus other providers discussion or a rant about

Christmas.

-Wes

Re: Paramedics Cannot Determine Wh

> > > ich Patients Require Transport

> > >

> > >

> > >

> > >

> > >

> > >

> > > As a person in favor of denying transport I do feel that we should

> > not deny chest, abd, or head related calls. Even Doctors with all

> > their equipment have trouble making accurate diagnosis. The calls that

> > would be allowed denial would be the minor trauma such as stubbed toe,

> > the sneezed once and want to make sure its not swine flu, the I just

> > need a ride to the hospital so I can get to my doctors appointment,

> > the I really just need someone to talk to to help cope ( this one only

> > if you have resources that can come there while you wait ).

> > >

> > > The denial process would also involve as much if not more effort

> > than just load and go so would discourage abuse by that one lazy

> > Paramedic that everyone seems to know since he is mentioned often.

> > >

> > > I would like to see a study on EMS denials based on a system as

> > described above. If allowed denial of the items even Doctors have

> > trouble with then it is doomed to show we can not do it. It would also

> > need a better criteria for mistake than admission to the hospital. For

> > example the stubbed toe might end up needing surgery, yet nothing

> > about the call required EM

S, so admission was not a failure in this case.

> > >

> > > Well just my worthless idealistic thoughts.

> > >

> > > Renny Spencer

> > > The Idealistic Paramedic

> >

> >

>

>

> --

> Grayson

> www.kellygrayson.com

>

[Guest guest]

I for one am done with this discussion. Let's move on to another dead horse --

like the semi-regular fire versus other providers discussion or a rant about

Christmas.

-Wes

Re: Paramedics Cannot Determine Wh

> > > ich Patients Require Transport

> > >

> > >

> > >

> > >

> > >

> > >

> > > As a person in favor of denying transport I do feel that we should

> > not deny chest, abd, or head related calls. Even Doctors with all

> > their equipment have trouble making accurate diagnosis. The calls that

> > would be allowed denial would be the minor trauma such as stubbed toe,

> > the sneezed once and want to make sure its not swine flu, the I just

> > need a ride to the hospital so I can get to my doctors appointment,

> > the I really just need someone to talk to to help cope ( this one only

> > if you have resources that can come there while you wait ).

> > >

> > > The denial process would also involve as much if not more effort

> > than just load and go so would discourage abuse by that one lazy

> > Paramedic that everyone seems to know since he is mentioned often.

> > >

> > > I would like to see a study on EMS denials based on a system as

> > described above. If allowed denial of the items even Doctors have

> > trouble with then it is doomed to show we can not do it. It would also

> > need a better criteria for mistake than admission to the hospital. For

> > example the stubbed toe might end up needing surgery, yet nothing

> > about the call required EM

S, so admission was not a failure in this case.

> > >

> > > Well just my worthless idealistic thoughts.

> > >

> > > Renny Spencer

> > > The Idealistic Paramedic

> >

> >

>

>

> --

> Grayson

> www.kellygrayson.com

>