Santa Monica Fd

[mike1390]

http://abclocal.go.com/kabc/video?id=9127794&pid=9127766

I'll just leave this here....

maybe things will change at least in one part of LA?

 

[Chris07]

I have a feeling that after about 1 or 2 good screw ups and a lawsuit or two later...then the whole things would go out the window.

Even if it all works out, you do realize that it'd take the county YEARS to implement this. LACo EMSA is hardly known for getting things done quickly....for goodness sake look how long it's taking them to decide on the 1+1 staffing of ALS 911 units. I think this would be an even bigger change than that.

I hope it works out but, in a county where transports are automatically code 3 if a medic jumps on board...I'm not holding my breath.

 

[Amberlamps916]

I like how the video shows LAFD in the ER, no sign on Santa Monica FD. Oh wait, that's right, Americare is used for transport by them. I've never seen Santa Monica wait in the ER with a patient because almost everything is BLSed. What is their motivation behind this?

 

[Achilles]

There was a shooting in the city and they talk about this.
I'm in agreement w/ Chris, if it was implemented (which it shouldn't)
You're just opening yourself up for a lawsuit.
In addition, what would the criteria be?

 

[JPINFV]

What is their motivation behind this?

That La-Z-Boy recliner doesn't rock itself.

 

[All Ryle Dup]

I'm on board.
It could work with strict criteria and protocol for chronic callers/abusers/transients/etc.

In Las Vegas we have a chronic public inebriate protocol in which we decide based on PT presentation and vitals whether we take them somewhere other than the ED. And works just fine.
I could see this being implemented or contoured to fit specific other criteria including weak sauce medical claims (ie toe pain, chronic X pain, isolated injury, etc) as well as transport/destination discretion by the provider.

 

[All Ryle Dup]

(I stress minor and repetitve non emergent incidents when I say this)
Additionally, it would minimize liability and lawsuits due to having an approved protocol and confirmation with on line medical control if it were implemented that way. Is it going to prevent all lazy bumble :censored::censored::censored::censored:s from using the protocol when maybe they shouldn't- no. But those are the same type of medics who are giving NTG to pts with R sided MI among other things which lead to law suits and poor PT outcomes. There are enough responsible professionals out there to make something like this work. We have the training and know how -- at least we should -- to be taken as true emergency medical providers. As paramedics, should be able to determine what is and is not a true emergency with proper assessment and diagnostic techniques in MOST cases.
Sick or not sick!?

Nothing is without flaws, but something certainly needs to be done now that this epidemic is finally being addressed by the masses. Of course it took a fire dept to push for it (obviously no private is gonna say this publicly as it may hurt there pocketbook) but I for one am pleasantly surprised its being addressed as an issue of abuse on the system, taxing the systems, and taxing the providers as well... Who we all know are worth more than what we earn. I think some discretion by those with the most experience should be able to make the judgement whether a pts condition warrants being on bed delay for 1,2,3 hours or whether they should go to urgent care, have a friend take them via POV, or flat out suck it up....

Sign here please....

 

[DrParasite]

Based on the report, the driving force for this is the lack of staff in the ER, causing the paramedics to hold a wall, sometimes 4 at a time.

So instead of having more staff in the hospital (which would solve the underlying problem with the existing system even more than a first responder engine or more ambulances), the city is implementing a pilot program (which is in violation of the state laws and protocols), where the existing paramedics can tell people they don't need an ER? what additional training will they receive? as one of the commenters said, if the patient wants to go to the ER, but the paramedics doesn't think it's needed, can they deny transport? they get paid to take people to the ER.

Nice idea in theory, but I can see plenty of issues.

Lets give the paramedics more education, and a high level of QA, and do it to better help the patients, not to relieve the back log in the ER.

 

[Amberlamps916]

Ok folks, Santa Monica almost never holds the wall because they utilize Americare, a BLS ambulance company for transport. Seriously, it's always the EMTs holding the wall, not the medics.....this is going to be done to free up the ambulances that end up transporting Mr. Shtinkelson for his gout because Americare is not big enough to devote 50 ambulances to the city.....

 

[zzyzx]

This is a great idea as long as they do so only very selectively and as long as they have to call in all their denial of transports to medical control.

Baby boomers are retiring, healthcare keeps getting more expensive...we need to try some common sense ways of reducing healthcare expenditures.

 

[AnthonyM83]

So instead of having more staff in the hospital (which would solve the underlying problem with the existing system even more than a first responder engine or more ambulances), the city is implementing a pilot program (which is in violation of the state laws and protocols), where the existing paramedics can tell people they don't need an ER? what additional training will they receive? as one of the commenters said, if the patient wants to go to the ER, but the paramedics doesn't think it's needed, can they deny transport? they get paid to take people to the ER.

Nice idea in theory, but I can see plenty of issues.

Lets give the paramedics more education, and a high level of QA, and do it to better help the patients, not to relieve the back log in the ER.

How can it be in violation of state law if it was an approved study? The state has a procedures on getting a study approved so it won't be in violation. Otherwise one could never ever test out new protocols before implementing system-wide. I don't get it....

 

[DesertMedic66]

I can see this being both good and bad.

There will probably be some medic who deny transport on things that should definatly be transported.

On the other hand there are patient who do not need to go to the hospital (ouch I stubbed my toe, minor MVC with no damage to either cars, etc)

 

[Uclabruin103]

I hate the local news so much. Do we really care what Joe from Palms says or random lady from Riverside. I commend them for trying to change the system. Santa Monica UCLA makes everyone hold the wall. ALS or not. That's just how they operate. Now Regan is a lot better and trying to get people beds. And UCLA SM isn't even a base station!

Anyone have that law that mandates all 911 response gets a transport.

 

[Clipper1]

Anyone have that law that mandates all 911 response gets a transport.

According to the Massachusetts Emergency Medical Services System Regulations, 105 CMR 170.355(A), Responsibility to Dispatch, Treat and Transport:

No ambulance service or agent thereof shall refuse, in the case of an emergency, to dispatch an available ambulance, to provide life support at the scene or to transport a patient to an appropriate healthcare facility...


If the ambulance is owned by a hospital and operates for 911 calls, they are considered and extension of the hospital which is then bound by EMTALA.

 

[DesertMedic66]

According to the Massachusetts Emergency Medical Services System Regulations, 105 CMR 170.355(A), Responsibility to Dispatch, Treat and Transport:

No ambulance service or agent thereof shall refuse, in the case of an emergency, to dispatch an available ambulance, to provide life support at the scene or to transport a patient to an appropriate healthcare facility...


If the ambulance is owned by a hospital and operates for 911 calls, they are considered and extension of the hospital which is then bound by EMTALA.

The words "in an emergency" can mean many different things. Does someone calling 911 automatically mean it is an emergency or is it up to the providers to determine if it is an emergency?

 

[Farmer2DO]

I like how the doctor they chose to interview referred to the crews as "paramedics slash EMTs".

Which is it? Are paramedics AND EMTs going to be doing this? Or are paramedics only going to be doing this?

My guess is he doesn't even know the functional difference.

Just another medical provider that doesn't even represent us to the public correctly.

:angry:

 

[JPINFV]

According to the Massachusetts Emergency Medical Services System Regulations, 105 CMR 170.355(A), Responsibility to Dispatch, Treat and Transport:

No ambulance service or agent thereof shall refuse, in the case of an emergency, to dispatch an available ambulance, to provide life support at the scene or to transport a patient to an appropriate healthcare facility...


If the ambulance is owned by a hospital and operates for 911 calls, they are considered and extension of the hospital which is then bound by EMTALA.

Arguably not everyone who calls 911 is suffering from an emergency.

 

[Clipper1]

Arguably not everyone who calls 911 is suffering from an emergency.

Depending on how your local and state laws are written, not everyone with an EMT title is able to make that determination. this is why EMTALA still applies if the ambulance is hospital based.

 

[Clipper1]

The words "in an emergency" can mean many different things. Does someone calling 911 automatically mean it is an emergency or is it up to the providers to determine if it is an emergency?

If you as an EMT-B was allowed to say it is not an emergency and no transport was needed you would not be coaxing the patient to sign an RMA. In court that is also essentially useless if you do not have adequate documentation and approval of someone with MD behind their name to back you up.

 

[Clipper1]

I hate the local news so much. Do we really care what Joe from Palms says or random lady from Riverside. .

When a news team takes public opinions they might actually interview several hundred people. Time might only allow for a couple to be used. When some amendment debates on the voters ballots come down to a narrow margin, you might want a few more people on your side rather than making a statement like yours to piss off voters.