Medic Madness - Latest Comments

Re: Air Ambulance – Vital and Overused

Beverly colasanti — Thu, 07 Aug 2014 01:20:58 -0000

My son was air lifted after rolling his truck 3-5 times and being ejected. Luckily he had no broken bones or enternal injuries thank God. Our bill was 33,225.32 for 28 miles he didn't even stay the night in the hospital. I'm not complaining just in shock that the bill was so much.

Re: Product Review: CPR RsQ Assist

Dave Rusch — Mon, 04 Aug 2014 08:09:15 -0000

Can also be purchased from Cardio-start, www.cardio-start.com, 414-418-7760. Free shipping.

Re: Air Ambulance – Vital and Overused

R. Kinney — Thu, 31 Jul 2014 14:29:02 -0000

I was airlifted to the nearest hospital that could do a heart catherization. That hospital released me the next week and the catherization was NOT done.
That was a bad call
The trip to the hospital was 26 miles.
The bill was 48,490.00
Almost $50,000.00.

Unreal!

Blue Cross paid most of the bill leaving me with 4,500.00 balance
I refused to pay
I contacted Attorney General office in my state, the dept of insurance and was ready to send a letter to the Better Business Bureau when Rocky Mountain Holdings called and said they would settle for 1,000.00
Today is Aug 1, 2014. My air lift was March 12, 2014. They said last week that my bill was being sent to collections and it would ruin my credit if I didn't pay
I left a message with RMH just now with a counter offer 500.00

I don't think I should pay any of it. NOBODY gets full retail for medical procedures.
A 10% discount would have put us as even.; no balance
These people have driven me crazy. Phone calls, sometimes twice a day , letters,
i couldn't sleep.
Their business practices are questionable. They should be looked at by the federal government.
From what I have read in these blogs, this company and ruined many people's lives
Their greed is monumental. They have become the largest air lift company in the US
They made their money by legally stealing money from those who can least afford it.
It's wrong. Just wrong.
RK North Carolina

Re: Product Review: Leatherman Raptor Trauma Shears

Josh — Wed, 30 Jul 2014 18:50:49 -0000

we had a guy that broke his ankle in a 4 wheeler accident. I was cutting his cowboy boot off with my local hems service donated trauma shears. I got about halfway down his boot and my shears just ran out of steam. They were a brand new pair and they dulled very quickly trying to cut those boots. My (part time) partner pulled out a pair of these and told me to try them. They not only cut the rest of the boot off (very quickly), but also cut his pants afterwards with no apparent dulling. I was very impressed. Just my $.02

Re: EMS – Bad for Relationships?

Joe — Thu, 17 Jul 2014 18:46:24 -0000

My wife enjoys me gone. Gives her a chance to sleep sideways across the bed.

Re: The Dual Medic Dilemma

MedicMomSI — Tue, 01 Jul 2014 14:06:19 -0000

I would have to hold the opposing conclusion that you do. I spent 32 years in a 2 paramedic, dual tier, high volume municipal service, and then the past 8 years in a single medic, single tier county high volume system. I feel the reason I have survived the last 8 is the skills and judgement obtained in my first career.

I feel many of the paramedics in my current system would have have benefited greatly and grown more as a medic had they worked longer with more experienced practitioners, particularly those with experience from other systems. They would have had a much broader view of how other systems handle call triage, MCI response, equipment and vehicle design issues as well as difficult calls. As it stands now, paramedics here gets perhaps a year with another medic and are then on their own for the rest of their careers.This exposure would have permeated into system leadership, many of them brought up with only exposure to "we've always done it this way". They appear blind to many of the problems that their decisions create.

How many of us have benefited from learning some little trick or had the thought process of their partner, teach them something that makes care more efficient or successful? Truly successful paramedics- the ones that make the job easy and more often error free, are the ones that put together all the great things they have seen in their partners, and dropped all the methods that did not serve them well.

As a single medic in a 1 tier system, I feel very frustrated that the majority of assignments I respond to are BLS level calls, with a significantly greater proportion that do not even warrant an ambulance.. Where I might have seen 3 or 4 ALS patients a shift, I now only see 1 or 2 in a longer shift. I used to see at least 1 arrest a week, and now 1 every 2 months. It takes a toll on physical skills, critical thinking, as well as less used protocol memorization.

Its much more mentally draining, despite having great confidence in the majority of the EMTs I work with. You are responsible for every decision, every EKG interpretation, and when things do not go well on an arrest( and we all have had these) trying to set the priorities and pull it all together very very quickly.Unless the question rises to the level of a medical control consult, there is not that ability to ask a peer for another opinion. All the paperwork is yours, whether you write it or have to review it before submission.

Many of the EMTs lack the leadership and critical skill and decision making experiences I saw in the system that ran BLS 911 units. The EMTs now are essentially "paramedic helpers" - waiting for their medic to direct them. They are not accustomed or experienced in running a call from start to finish. This system design fails to give them either a training or financial incentive to do so, and unless you have a longstanding team of Medic and EMT, its not often possible on a personal level to foster that experience growth.

On critical calls I'm frustrated we could have done more in less time. The fact that we no longer have that second medic has driven services away from practitioners who have high experience and high success levels with intubation. Granted, airways like the King and Combitube are vastly better than the older alternatives, we now require EMT use of blind devices like the King Airway to make up for the lack of second medic and lack of intubation skill. On occasions where the King is not appropriate, you are asking medics with even less experience at intubation to take on the most challenging tubes.

I remain strongly in favor of the dual medic design, as both better for the critically ill patient, multiple patient incidents, as well as system and personal growth incentive, and job satisfaction.

Re: The Dual Medic Dilemma

Sean Eddy — Mon, 30 Jun 2014 20:39:58 -0000

Skill depletion is a real problem when it comes multi-medic deployments. That's one of the main reasons I have advocated for single-medic systems throughout my career. Where I work, we don't have an unbearable call volume. Actually, we have it quite easy. I was worried about moving to an area with a lower call volume and dual medics, but I haven't found that I perform the skills any less. I still practice on the manikins every week and I still do my best to stay current on my knowledge. I support either system as long as it's done right.

Thanks for your input!

Re: The Dual Medic Dilemma

Omnimedic — Mon, 30 Jun 2014 15:19:41 -0000

I cut my teeth in EMS as an EMT working for a 911-only
service in an urban setting. 99% of the time I had a medic partner, although I
was one of the few EMTs who was granted “in-charge” consideration and allowed
to run calls with an EMT partner and the ability to request a paramedic
supervisor as needed. My partner and I had a great relationship: he ran the
first call of the day, and we usually alternated from there, with him taking
all the ALS calls and me taking all the BLS calls. We regularly ran 12-15 calls
per shift with 5-6 CPRs a month, an intubation or two every other shift and 5-6
patients a month that NEEDED a helicopter. Our record was landing a helicopter
3 times within 12 hours. I saw that time in my life as critical to contributing
to my success and it went a long way towards my education and helping me become
the medic I am today. It was that time in my life that I developed my love for
patient care which turned into my drive to go to medical school. I learned as
much about patient care in that time as an EMT than I have in the rest of my
career, and those four years made my next 18 months in paramedic school an
absolute breeze.

I can see both sides of the argument, but overall, I am a
proponent of running a crew configuration of one EMT and one Paramedic. Unless
you’re running VERY high call volume of high-acuity patients, the ability to
maintain skills of two medics on the same truck leaves quickly. The
muscle-memory that comes with intubating a patient fades fast, and unless you’re
supplementing call volume with OR time, the skill goes out the window. In
addition, the critical thinking skills that come with diagnosing critical
patients simply isn’t developed, and you end up with this situation: think
about a 5-gallon cooler of Kool-Aid. You have 5 gallons of Kool-Aid, and
throughout the course of the afternoon, you drink half of it. The next morning,
you add more water to the jug to give you another 5 gallons to use, but without
adding more powdered drink mix, you are watering down the mix. Do that for a
few days, and you are left with little more than a bit of color in the water.
That’s what we are doing by putting two medics together from the get-go in the
absence of a strong training department to help them supplement their education
and skills.

By running the configuration of one EMT and one paramedic (with
the ability of up-and-coming EMTs to ride BLS calls in), we are watering-down
our paramedics, and preventing them from reaching their potential. In addition,
with a BLS/ALS partner combination, I have been on both ends of the following
scenario: when treating a critical patient, the paramedic is focused on
intubating, IVs, medications, pacing, etc, while the EMT is holding up the BVM
saying “hey, you want me to start using this while you’re doing your stuff?” While
some may disagree, I like the “sink-or-swim” model of throwing a new paramedic
into the deep end. By allowing them to be forged by fire, we develop their
skills and critical thinking abilities. The cream rises to the top and the rest
are filtered out. Harsh? Maybe so, but my family knows most of my co-workers by
name and stories, and they have instructions on which of my coworkers are
allowed to treat me and when to sign a refusal in favor of driving like hell to
the nearest ED. I currently work in two very different systems: one is an
urban, fire-based system in which every provider is a paramedic, and the other
is a rural, private system which runs an EMT and a Paramedic. I would put most of the private paramedics up against the fire-based medics any day of the week and feel comfortable with the outcome, although it seems that almost everyone wants to get on the fire truck….

Every system is different. Some high-volume systems operate
better with a double-medic configuration, while others do better with the
combination of EMT and Paramedic. Overall, it depends on the system you are
working in, and that decision must be evaluated by the administration WITH
CONSIDERATION for crew input, the design of the overall system, call volume, and
educational factors. There’s no right or wrong answer… it all depends on the
system.

Re: The Dual Medic Dilemma

Sean Eddy — Mon, 30 Jun 2014 14:27:15 -0000

Having spent 4+ years as a field supervisor and several more as a field training officer, I can certainly relate to what you are saying. It is the responsibility of the service to make sure new paramedics are paired up with people that can help guide them, or at least function with little-to-no guidance.

Where I might slightly disagree with you is the emphasis on placing somebody with seniority with the new hires. You did point out that having a "reliable senior guy" is key. I would say that we really need someone who is knowledgeable, trustworthy, patient and willing to take the time to mentor and help hone the skills of the new paramedic. While that person needs to have some experience under their belt, I wouldn't put so much emphasis on the actual years of experience.

You make some very valid arguments and I appreciate your feedback!

Re: The Dual Medic Dilemma

Sean Eddy — Mon, 30 Jun 2014 12:44:19 -0000

I love the point you make in regards to the more experienced medic mentoring the new one. That is one of the hidden gems of a dual-medic system. I've been a paramedic now for nearly 10 years and I learn from my partner every day.

I do feel that the single-medic system does have a built-in mechanism for either producing strong medics or weeding out the bad. Yes, I agree that tossing new medics to the wolves isn't benefiting the patients, but at some point the eagle has to fly on his own. As they say, the eagle that doesn't fly is a turkey :-)

I think we can agree that it does ultimately come down to the provider. A paramedic that seeks to expand their knowledge and has a desire to better themselves is going to thrive in any system.

Thanks for taking the time to read my article and share your opinion!

-Sean Eddy

Re: The Dual Medic Dilemma

ryan D — Sun, 29 Jun 2014 23:39:24 -0000

I agree with skip. now I am only a basic with 5yrs exp. 3 of which I have been a field training officer and supervisor. while at one end of the spectrum we need bodies to fill the ambulances, however, pairing an experienced medic/emt with a less experienced medic/emt is vital to the success and future careers of the less experienced one on the truck as well as the lives of our patients.
not everyone wants to be the trainer for many reasons be it money, liability, stress, whatever it may be, you need to have good reliable senior medics that are willing to train and pass on the knowledge and communicate why they do, what they do, and when they do it; before, during and after every call. the FNG, definitely has a key role in the right circumstances though. two schools of thought are better than one, the fresh out of school by the book, book smart guy is just as valuable as the seasoned vet that's seen a lot and knows the right parameters to operate within.
I've heard of some systems placing a brand new medics fresh off pre-cepting, into a single medic role and I think that's an enormous liability. and now with medics going straight to medic school and right onto a truck without ever even working on any type of truck a day in their life, having a reliable senior guy on every truck is key!! I hate that this is even allowed. I really think that because lives are at stake in some instances that there should be a law or at least very defined regulations to prevent that from ever happening. maybe a 6 month bls minimum or something to that effect.
I can say that in my system, we are fortunate that the brass recognizes this and works hard to make sure 2 new guys don't end up together but sometimes you just cant avoid it. but at least they limit when it happens or it if happens, they might stick the 2 new guys on a transfer truck rather than a town truck or they may stick them on the town truck in the "quiet" district.
all in all, I think that its all about the people and that a lot of it is circumstantial.
be safe!

Re: The Dual Medic Dilemma

Skip Kirkwood — Sat, 28 Jun 2014 11:02:15 -0000

It's not about the design of the system, it's about the people in the system. I've been in one-medic systems where there were good and bad medics. The good ones did good, the bad ones were tolerated because higher-ups were concerned with "meat in the seat."

I've also been in two-medic systems where half the medics couldn't function on their own. In one of those, the system changed and the medics were split up and moved to a single-medic environment. Guess what - half of them had been hiding behind their competent partners for years.

In a good two-medic system with good people, the new medics will be mentored by their partners and developed so that if the time comes, they will function fine in an independent mode. In a good single-medic system, there will either be a long field training program (in effect, two medics), or the patients get to pay the price for the new medics' "learning" experiences.

Re: If the Food Industry Was Treated Like Health Care

Sean Eddy — Mon, 23 Jun 2014 13:17:23 -0000

Thanks, Ron. I've been trying to find the right words to write this article for a while now.

Re: If the Food Industry Was Treated Like Health Care

Ron King — Mon, 23 Jun 2014 10:36:26 -0000

Great explanation!

Re: Ed Searfoss

Shawna Tazioli Monroe — Wed, 18 Jun 2014 00:46:45 -0000

What happened to him??

Re: Perception

Sean Eddy — Mon, 16 Jun 2014 11:59:32 -0000

I'm all for whatever level of service the community wants, as long as they are willing to pay for it. The issue I had was the expectation that the entire county should front the bill. I can certainly see the benefit to having paramedic service in the rural communities, where the problem usually lies is cost and demand. Private and public agencies have a long standing history of not playing well with each other, and the specific communities that we are speaking of are obviously not an exception. We face a lot of the same problems where I currently work. We don't train together, we have separate missions and in the end, the patient care suffers. I have the utmost respect for you and the majority of the people with the fire department. The truth is, if the 2 agencies could figure out a way to bridge the gaps and work together, that system could be one of the best in the country.

Thanks for taking the time to read and respond. I'm always happy to see another perspective.

P.S. Tell everyone around the fire station and at my other, other former employer that I said hi. :-)

Re: Perception

Kevin — Mon, 16 Jun 2014 11:26:39 -0000

If follows the same pattern that those who believe they are entitled to things. I understand where the folks in that community were coming from though. Most had history in an even richer county just south of the one you were operating in. The perceived tax base was the same, the truth of the true dollars collected per square mile are very different. Of course the more southern agency has run all ALS for many years. The bashing of your employer , I believe, was and is warranted as he has specifically fought ALS fire service in the county. I currently work at the north end of the county in a remote station and routinely wait for an hour for an ALS ambulance to respond from the metro area. My hands are tied by policy that prevent me from practicing paramedicine as a first responder. Frustrating to say the least. The locals here are different though. They have no expectation of metro type responses. They have never (I say that generally) experienced that kind of coverage. It's refreshing to arrive on a call after a 30 minute response and hear "man you guys are fast!", which I never hear in metro stations. I know in the community you speak of there is and was some very hurt feelings due to a few response incidents where ALS couldn't get to the call but bls fire did. To single out crews obviously not right but I did see some corporate shenanigans occur that I would have been embarrassed to be seen in the same uniform as those folks. Sadly the "competition" between private ambulance service and tax based fire service continues even though the end goal of quality patient care is and should be the priority.

Kevin

Re: Ed Searfoss

Patty Montoya — Sat, 14 Jun 2014 11:18:14 -0000

Thank you for this post. I'm Ed's "former" mother-in-law, but have always stayed close to Eddy. My husband and I always told Ed he was like a son and would always be. Eddy frequently sought advice from my husband. He would go to all of Elizabeth's activities and save seats for all of us. When my daughter remarried, he checked out the new stepdad and the two of them played t-ball with Elizabeth. His first concern was for his daughter. He was a super dad. I will save a copy of this post for Elizabeth so that she will be able to know what kind of man he was and will always be in her memory. Ed, we love you and miss you.

Re: 6 Signs You’ve Been Working System Status Management Too Long

Sean Eddy — Thu, 12 Jun 2014 10:56:50 -0000

I used to look at long distance transfers as a vacation! I also used to get Christmas cards for all the regular store clerks. Thanks for sharing!

Re: 6 Signs You’ve Been Working System Status Management Too Long

mr.fix-it — Thu, 12 Jun 2014 08:50:03 -0000

You purposely transport patients to the farthest hospital just to keep out of the system longer.
or
you're on a first name basis with all the store clerks at your post locations
or
you go to order food at a post location and you tell the clerk "I'll have the usual in a to go bag"

Re: Air Ambulance – Vital and Overused

arizonaian — Tue, 03 Jun 2014 10:01:16 -0000

Hi readers. After viewing some other articles on this site and after what I'm going through with this rocky mtn holdings company and there shady business practices something definitely needs to be done. My daughter was airvac on the recommendations of her doctor for a common cold 40 min flight nonlife threating no treatments where given for the flight not even oxygen. Later I received a bill for 50,000, sounds affordable and rightttt.I have been negotiating with them for months now they really dig deep to see how much they can get out of you, i was told that they take on a case by case basis. Meaning if you make more then they charge more sounds abit dishonest to me shouldn't be a mileage thing or services rendered or a flat rate. Sense negotiating I've gotten down to 9832. 00 crazy rightt. Has anyone gotten any lower what's the trick, these guys are flat out lyers.

Re: The Scene Is Not Safe

Pondering this — Tue, 20 May 2014 10:28:30 -0000

There are a few times when this would become a problem and I'm sure there are more
1 responding to jails and other high security areas
2 in firefighter/emt/paramedic when it comes time to put on bunks and fight fire where is the gun left?

Re: Praying With Patients

Barefoot in MN — Thu, 17 Apr 2014 19:09:26 -0000

Don, if it was you praying - yes, it'd be a waste of time. Like pushing the accelerator in a car that doesn't have the engine turned on; ain't nothin' gonna happen. So what? be tolerant! Maybe the reason you haven't been asked, is that perhaps people sense this in you? just sayin'. Your post comes across to me as a sneer, more than anything else,& yet you must be a nice guy with a caring heart or you wouldn't be in this field. As a devout person of faith (never mind which faith), I agree we shouldn't assume the patient follows the same god we do...BUT what is wrong with appealing to our own god on their behalf? especially when the patient requests it. So, you don't believe in any god - so what? if they asked you to call Aunt Mary & leave a message about the ER trip, you'd do it, right? even though you can't SEE Aunt Mary & have no idea if she really listens to the answering machine. So -- cut some slack to people of faith. Cut lotsa slack. To you prayer is a placebo, to them it's the ultimate cure-all; administering prayer won't hurt them. But yes do be honest about your own walk (without putting them down for theirs!); admit "sorry, I don't pray; but I'll stay with you as long as you need me here, & I'll try to find tangible help too if you can think of anyone you want me to call." or something like that. :-) okay? :-)

Re: In Defense of the LUCAS

TooOldToWork — Sun, 13 Apr 2014 20:52:01 -0000

I don't think it's a matter of whether or not the system cares about saving those lives. A lot of rural systems, especially volunteer systems have a hard time finding even TWO people to go to a call. The volunteer system was built on the premise of their members living in working in the response area. That doesn't happen any longer as many people live in small towns and commute to their jobs.

Even smaller paid departments have staffing issues. Some of the agencies I work with would lose most of their on duty crew if they sent 3 or 4 firefighters on every cardiac arrest transport. Since they can't have one guy doing compressions all the way to the hospital and remain within their compression quality requirements, they opt to use a LUCAS.

It may or may not make ROSC or survival to discharge rates better in the studies, but in real life, there might be substantial benefit to having that device. Especially in systems that don't allow field termination (of which there are many) and thus transport just about every patient.

Sometimes the real world is much different than the studies would suggest.

Re: Holding the Wall

Josh — Tue, 25 Feb 2014 11:02:27 -0000

Here in Ontario Canada we can have similar problems, mostly because beds are blocked with admitted patients waiting for available beds upstairs, in turn blocked by patients needing LTC placement. Services here are municipally run 3rd service, so our solution is that the region bills the hospitals for staffing/unit time on offloads greater than 30 minutes. Doesn't fix the problem, but hospitals can't ignore the issue.