At the same time, the family/pt may sometimes know the pts pmhx better. Using that pulmonary fibrosis example, i can see why the pt or family care providers might have an issue, expecially if it was a very 'cookbook' medic or emtb performing care. Its 2013 and we still cling onto the oxygen dogma of 'if a little's good, then more is better' - dogma that has been known to cause harm since the 1980's (by the rt's and pulmonary docs).
Pt w a Dr for a wife??
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abandonallhope
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A horrible job? Judgmental much.....first of all why do we hammer closest facility over and over to our new techs if our Pt. complains of CO,SOB etc. if were only going to criticize them for following their protocols and education?
What interaction did he engage in that warrants termination?
Why does he need to attend ANY reeducation ? How is he responsible for the MVA when he was not driving
We ( MANAGERS ) need to be empowering our crews not allowing them to be ordered around by every turkey that claims to be MD/DO.
I can already see it...had this tech decided to follow Pt's spouses instructions you would be arguing that he failed to exercise control over his scene.
Come on folks... We need to be supporting our fellow medics not chastising them. You don't see this type of internal discourse and open berating in the fire service or among fellow LEO's.
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DrankTheKoolaid
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No, when they screw up they need to be called out on it.
We don't need coddled providers who have poor decision making capabilities. That is exactly why EMS in a lot of areas is the way it is. The Medical Directors have no faith in the technicians it has to allow to work in the system.
We don't need coddled providers who have poor decision making capabilities. That is exactly why EMS in a lot of areas is the way it is. The Medical Directors have no faith in the technicians it has to allow to work in the system.
abandonallhope
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I'm not advocating coddling however if you see anything in the post that I critiqued that could be construed to be constructive by all means feel free to point it out.
Secondly with almost 2 decades in EMS I feel confident in stating that our M.D.'s lack of faith or reluctance to permit more relaxed permission is firmly rooted in technician arrogance and overconfidence in practicing already approved modalities.
We all to often earn our "paragod" titles with our overly critical comments again like the ones I highlighted. It is just not reasonable to believe that anyone can glean the type of insight from the OP's post to support the type of remarks that were given.
We need to be encouraging constructive criticism and skill building to our younger FTO's and mentors not supporting the type of comments we saw.
Many of these newer technicians are volunteers and are already making sacrifices to better themselves and their communities while so many other young folks are only interested in their own benefit.
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DrankTheKoolaid
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That was a blanket statement not directed solely at you.
There were many errors in the scenario as given. First is knowledge of protocols. Every EMS system I have worked has the same solution for MD at a scene. They can back off, assist or assume all patient care. Allowing this now irritated spouse to assume all care would have squashed the issue right then and there. Unless this was a STEMI/CVA/trauma where the intended receiving facility was the ONLY specialize ED to cover it. Then maybe you can justify diverting to it after advising the spouse or have the spouse sign AMA against using that facility and document the hell out of it.
The second was allowing financial greed to dictate medicine when it may not have been in the patients best interest (not an OP problem) but piss poor unethical management problem.
I won't even touch on the hit and run issue.
The end result is the same when care providers F up they need to receive constructive criticism as you put it ( just a PC way of saying being called on it) and education.
There were many errors in the scenario as given. First is knowledge of protocols. Every EMS system I have worked has the same solution for MD at a scene. They can back off, assist or assume all patient care. Allowing this now irritated spouse to assume all care would have squashed the issue right then and there. Unless this was a STEMI/CVA/trauma where the intended receiving facility was the ONLY specialize ED to cover it. Then maybe you can justify diverting to it after advising the spouse or have the spouse sign AMA against using that facility and document the hell out of it.
The second was allowing financial greed to dictate medicine when it may not have been in the patients best interest (not an OP problem) but piss poor unethical management problem.
I won't even touch on the hit and run issue.
The end result is the same when care providers F up they need to receive constructive criticism as you put it ( just a PC way of saying being called on it) and education.
deftdrummer1
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Where I work, you wouldn't have turned a wheel toward any hospital until that ALS unit showed up at scene.
End of story.
End of story.
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How does that help the patient at all? If the hospital is closer than an ALS unit, the hospital is your "ALS."
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Seems like wherever you work needs a policy adjustment. If the hospital is closer than ALS, why wait for a paramedic unit just to transport to the same hospital?
TheLocalMedic
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Deft is a dispatcher, so be gentle… they don't know what it's like in the real world, lol.
deftdrummer1
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The "real world" lol and you know nothing about dispatch I suppose, safe to say right? Obviously the pretentiousness of the "real" EMS world is alive and well here.
Hey what EMS service couldn't use a policy adjustment or two?
Reason they wouldn't turn a wheel is because BLS units don't transport ALS patients with my agency. Simple as that. If the patient codes in the rig whose fault is it then that the proper equipment is not on board?
Hey what EMS service couldn't use a policy adjustment or two?
Reason they wouldn't turn a wheel is because BLS units don't transport ALS patients with my agency. Simple as that. If the patient codes in the rig whose fault is it then that the proper equipment is not on board?
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So if the patient codes while waiting on scene that is somehow better?
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If BLS finds themselves alone on scene with an unstable patient, the decision needs to be made if an ALS intercept or the hospital itself is closer. If the patient is found in cardiac arrest I can understand waiting for ALS while performing high quality CPR and defibrillation on scene. Otherwise, what good is the BLS unit doing holding the hand of a critical patient while time to hospital<time to ALS?
deftdrummer1
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No good, and I understand what you're saying. Like others have said generally it's bets to just get the patient in the rig and get going if a facility that offers the services required is within a reasonable distance.
I don't make policy I just follow it until it's changed
I don't make policy I just follow it until it's changed
TheLocalMedic
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Ah, don't be so quick to make assumptions. I DID work in a fire/EMS 911 dispatch center in the not too distant past! And having experienced both sides of the radio, I often advocate for our dispatchers. It's a tough job, no doubt about it. But now that I'm in the field, I can say with absolute authority that dispatchers simply don't know what it's like to be out here in the glorious fresh air, lol.
One of the big things that dispatchers tend to forget is that those numbers in the computer are attached to real people, and those people get to be the ones to decide what needs to be done on the ground. If I were an EMT and a dispatcher told me to wait for ALS instead of transporting to the ED (if ALS was not in the immediate vicinity), then I'd tell them to take it up with me later and just hit the road. Y'all can't make me sit and wait if I don't want to!
deftdrummer1
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I agree LocalMedic, but at the same time there's many in the field that think all dispatch does is sit around and watch movies and are only able to do what the computer tells us and not think critically. If it's not fair to make assumptions please don't make them about me and how I perform my job.
I don't want to thread-jack, but I'd be willing to bet we see more eye to eye than you might think LocalMedic - and likely work for the same company.
I don't want to thread-jack, but I'd be willing to bet we see more eye to eye than you might think LocalMedic - and likely work for the same company.
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TheLocalMedic
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Down boy! Easy! I didn't say any of that, in fact I noted that dispatching is a lot tougher than field crews think it is. But, as I also mentioned, having worked both sides of the fence, I can appreciate the differences between the two sides. Dispatchers, sitting in their little tower, often have delusions of grandeur. They imagine that they're making all the decisions and making those units move about. They forget that the boots on the ground are the ones actually piloting those units.
Again, I used to be a dispatcher, so I feel that I can say this with a fair measure of authority.