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Old 03-09-2009, 09:30 AM   #21
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not quite right Tom if you are sued for over treatment it is harder to win and if won you pay a small amount. If you are sued because of bad outcome it is easier to win even if everything was done correctly and the amount of pay out is massive.
I didn't say it was an easy win, but it does happen more than you think. A lot of providers are having to retrain and rewrite protocols in order to keep this from happening. Once again, litigation rules the roost. And I wouldn't mention it if I didn't know about it first hand, I'm sure you guys see it in the ER and don't even realize it has happened.

One of the biggest thing to make those changes come about is when hospitals decided to actually get their levels designated. That tosses out the argument that "there's no level hospital near here, therefore we have to fly them..." Now, services are mandating that their personnel transport locally due the designation and to mitigate any legal action.

Just sayin'.

EMS could be so much better than it is. The days of actual good medics in the field are slowly dieing out in lieu of medics who are good test takers. I personally find it appalling. I'm not saying there aren't "new" good ones out there, but they are few and far between. Street smarts have totally been replaced with "book smarts".

Common sense ain't so common.
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Old 03-09-2009, 09:33 AM   #22
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I didn't say it was an easy win, but it does happen more than you think. A lot of providers are having to retrain and rewrite protocols in order to keep this from happening. Once again, litigation rules the roost. And I wouldn't mention it if I didn't know about it first hand, I'm sure you guys see it in the ER and don't even realize it has happened.

One of the biggest thing to make those changes come about is when hospitals decided to actually get their levels designated. That tosses out the argument that "there's no level hospital near here, therefore we have to fly them..." Now, services are mandating that their personnel transport locally due the designation and to mitigate any legal action.

Just sayin'.

EMS could be so much better than it is. The days of actual good medics in the field are slowly dieing out in lieu of medics who are good test takers. I personally find it appalling. I'm not saying there aren't "new" good ones out there, but they are few and far between. Street smarts have totally been replaced with "book smarts".

Common sense ain't so common.
I agree 100%!
now days it should be called un-common sense.
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Old 03-09-2009, 10:01 AM   #23
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actually it is quite relevant. that kind of information is needed for the quality improvement process. Being able to determine if protocol needs to change or if protocol is even being followed is important for future training and education of emergency care providers. It is not a matter of punishing individuals, it is a matter of improving the system. Protocol requires that you err on the side of caution, on the side of the patient.

EMS protocols also identify certain mechanisms of injury as significant, and require immediate and rapid transport. Motorcycle crashes in excess of 20mph or with separation of the rider from the bike are considered significant. There are other indicators of a significant injury as well as what is considered a critical injury. For example a broken femur is considered a critical injury, and the injured party can lose as much as 1.5 liters of blood due to a femur fracture.

So in other words the injury assessment done in the field as compared to what is diagnosed in the hospital can make a huge difference. If a guy in the field assesses repeatedly is WAY off then he should not be hired if you ask me. The other thing is what does protocol require, it may be that protocol is not clear, nor specific, or leaves too much in the hands of minimally trained people.

Regardless it sounds to me that protocol needs to be revisited as well as the skills of the EMT's being hired.
I think I was either misunderstood or perhaps I wasn't clear about what I was saying.

I wasn't meaning that you were making irrelevant statements, I meant that your application of that information was more applicable to the service providing care and NOT the general public. It's all part of the QA/ QC process that goes ignored all too often by private services. I've worked for plenty of them unfortunately over the years, and I know from first hand experience that what drives the privates is not good care, but good dollars. Patient care takes the "way back" seat as we used to call the very back of my Mom's '71 suburban.

It's not the protocols either- as JP mentioned, the protocols never vary too much or at all from the accepted standard of care. It's the training and QA/QC process that needs attention, and that's up to the provider/ service. It's also the mechanism that can get them in a whole lot of trouble. No matter to them though, they go out of business and start another get-rich-quick endeavor.

Regarding personnel, as mentioned, they're allowed to be a paramedic or EMT-B by the State and NR. There's no gauge there that says whether they can actually apply those skills, that's something that's acquired with time and experience. Show me a new paramedic and I'll show you a person who can pass a test. Show me a good paramedic, and I'll show you a person who has street skills, experience with assessment, can apply treatment based on those skills/ experience, and a person who doesn't crater under pressure- and can pass a test.

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I do believe that all tracks,venues or rereational facilities that have either large groups or risky/dangerous activities should have "on staff" a Paramedic at least with a Medical Director(doctor) on call during operation. It is very unfortunate that they don't and cite the reason of "cost" most of the time. The other thing they do too much of is have a nurse on staff, and nurses have absolultly NO prehospital standing under either the medical paractice act or the EMS act, so the care rendered is substandard, but it continues to the present time.
While this may be the most prudent thing to do, you have to realize that having an MD on call is out of the question financially. It's much easier and cost effective to have protocols and good personnel. Unfortunately, I think some of these tracks may believe that "one's just as good as another" in regard to EMS. Why should they believe differently?

The other issue is that if a track did find an MD to be on-call or on-site for events, can you imagine what kind of doctor that would be? Personally, I'd want one that was an actual ER or better yet Trauma doc so that they would actually know what they're doing! I've seen too many doc in a box types or docs that specialize in podiatry who think they know what's up and are complete idiots. Goes back to the "I can pass a test" thing...

We (LSTD) happen to have medically trained personnel (Paramedic and EMTs) on staff, but that was just a coincidence with staffing that has worked out rather well.

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These "protocols/standing orders" control and specify what an EMT is to do in a situation, no they are not all inclusive and many times the judgement of the EMT/Paramedic is used, however many services especially those using Houston Med Con have given facilities that a given injury or mechanism of injury is to be transported to or method of transport to be used. These portocols are to be followed to the letter and if deviated from there MUST be documented valid reasons as to why the deviation occured.
I'm with you here, I was raised on Standing Orders Delegation and I believe that is the most effective way for paramedics to render care. The problem is that services get out of paying for med-con (or similar) by having standing orders and then don't provide a QA/ QC process to back them up. They end up dieing off as a business, but that doesn't help the people they've treated during their existance.
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Like Tom said it is my opinion that the people who are being certified currently are being taught how to pass the NR test and the NR is considered the end all in certification, the Private transfer services do NOT invest in the people who staff the ambulance, the main reason this is, is that when a person has more experience and knowldge they want more money. The private transfer services opinion is generally " why should I pay you more when there are a hundred just like you waiting to take your place?" its a sad state of affairs when the person holding your life in his/her hands is paid between 7 and 16 an hour, with no benefits, and the pay doesn't apply to just private transfer services it also applies to many of the small regional 911 services.
Amen. The other issue is that often the private services pay more than the 911 services so people flock there. They also pick up bad habits, become lax, and gain no real experience imho in some cases. Then they wake up, realize that there's no stability in private services, try to get hired at a 911 provider, and then think that because they've got years as a paramedic, they're "good".

Another gem for yall that applies here- "training is good, good training is better." Most of these folks get no training, let alone any training.

Private transport EMS is a stick in my craw, at least the problem services are. The gubment focuses more on if these companies are trying to bilk the system instead of looking at if they're actually providing a worth-while and safe care service.
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Old 03-09-2009, 11:05 AM   #24
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Old 03-09-2009, 11:16 AM   #25
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Fixed it for you!
I was really out of it until I got to the hospital! I still dont remember a whole lot
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Old 03-09-2009, 11:45 AM   #26
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Tom, if you guys have need of another medic let me know, I'll come out depending on where at and sit round watchin bikes run.and this makes 21 years as a texas certified medic for me, geez I'm gettin old
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Old 03-09-2009, 11:49 AM   #27
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Tom, if you guys have need of another medic let me know, I'll come out depending on where at and sit round watchin bikes run.and this makes 21 years as a texas certified medic for me, geez I'm gettin old
BE AN ENTREPRENUER.... buy a box, label it up, get the appropriate licenses, etc....call it Lonestar State Trackside Medic Service. at $800 (I think that's a rough cost estimate) per event, you could make a living doing this...pending your ability to drive from track to track.
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Old 03-09-2009, 11:56 AM   #28
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BE AN ENTREPRENUER.... buy a box, label it up, get the appropriate licenses, etc....call it Lonestar State Trackside Medic Service. at $800 (I think that's a rough cost estimate) per event, you could make a living doing this...pending your ability to drive from track to track.

LMAO If I did that I'd have to go to everyone just to break even(not just LSTD), the insurance, medical director,malpractice and state license fee's are out of the realm of reality. like tom said the fee's they charge us haven't changed but the DSHS don't do squat anymore, they don't do enforcement on the trucks anymore they sit around not doing a thing drinking coffee, like at the employment office. and its 800 a day not per weekend. I have been recently involved in special events for a service here in houston that does that stuff and it costs
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Old 03-09-2009, 01:02 PM   #29
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Tom, if you guys have need of another medic let me know, I'll come out depending on where at and sit round watchin bikes run.and this makes 21 years as a texas certified medic for me, geez I'm gettin old
Dang, I got my EMT in '88... fire cert in '86... I guess that puts me in the same boat! (old)

Like I mentioned though, we pay the contract people to do that job so our staff doesn't interfere with it, just offer friendly advice and help when needed. Sometimes some of the weaker medics just need to know someone is there to help and they don't flounder as bad. Some need more persuasion... most of the time there are no issues though.

You're welcome to come on out and cornerwork if you want to get involved- , that's how Pam got a job with us!

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LMAO If I did that I'd have to go to everyone just to break even(not just LSTD), the insurance, medical director,malpractice and state license fee's are out of the realm of reality. like tom said the fee's they charge us haven't changed but the DSHS don't do squat anymore, they don't do enforcement on the trucks anymore they sit around not doing a thing drinking coffee, like at the employment office. and its 800 a day not per weekend. I have been recently involved in special events for a service here in houston that does that stuff and it costs
Funny thing is I get paid more for off-duty instruction at the academy than with paramedic instruction and side jobs. That's one of the reasons why I don't teach EMS any more, fire pays way better!

Personally though, I like doing side jobs that don't involve my regular job, but none of them pay as well as the academy.
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Old 03-09-2009, 03:32 PM   #30
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Tom you are right on point, as you know me over the last 3 decades I have needed major med assistance several times and had I refused the outcome would not have been good,and looking at life in my present state I really value all of it.Peace to all, Grumpy
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Old 03-09-2009, 04:31 PM   #31
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Tom you are right on point, as you know me over the last 3 decades I have needed major med assistance several times and had I refused the outcome would not have been good,and looking at life in my present state I really value all of it.Peace to all, Grumpy
Can't wait to see you on Saturday Grumpy! I'll try to give you a call during my boring drive up there Thursday if you're taking calls!
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Old 03-09-2009, 06:55 PM   #32
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I personally can understand why lifeflight is used, particularly at MSRH. For one, Angleton Danbury is not known for having a great trauma center... or a trauma center period, for that matter. And there are also liability reasons there for the track, and others involved. Granted I was pretty sure I was okay, but I knew I'd broken some stuff I was unconsciouss for a good amount of time and was relieved to know all my injuries were minor and I would be good to go asap. This sport is inherently dangerous, and hitting the ground at 100mph can cause all sorts of injuries that initially wouldn't be noticed... like what if you hit hard enough to tear an aorta or other large artery and you didn't know, and you moved wrong it your sleep and it was completely dislocated, this happened to a friend of mine and he died without even knowing he was too hurt. Always good to just get it checked out, and if you have to fly me to get it done properly, so be it.
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Old 03-09-2009, 07:35 PM   #33
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Tom, I am trying to be there sat morn to watch some of the endurance and go home, my daughters house is about 45min from track,come back for some sun sprints. Norm and sam are bring the motor home as I need a place to rest.my cell is918-916-3206,Peace be with you, grumpy
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Old 03-09-2009, 07:52 PM   #34
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Good thing for us(TTD) we have a doctor on staff this year!
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Old 03-09-2009, 08:40 PM   #35
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I personally can understand why lifeflight is used, particularly at MSRH. For one, Angleton Danbury is not known for having a great trauma center... or a trauma center period, for that matter. And there are also liability reasons there for the track, and others involved. Granted I was pretty sure I was okay, but I knew I'd broken some stuff I was unconsciouss for a good amount of time and was relieved to know all my injuries were minor and I would be good to go asap. This sport is inherently dangerous, and hitting the ground at 100mph can cause all sorts of injuries that initially wouldn't be noticed... like what if you hit hard enough to tear an aorta or other large artery and you didn't know, and you moved wrong it your sleep and it was completely dislocated, this happened to a friend of mine and he died without even knowing he was too hurt. Always good to just get it checked out, and if you have to fly me to get it done properly, so be it.
You're right, if you tear an aorta you wouldn't know it. You'd be dead. Even if you tear your aorta in the ER with a doctor standing next to you you'd probably die.

The advantage to air medical transport is to get definitive treatment to a patient whose life is ruled by the "golden hour". The secret to knowing if that is necessary is good patient care and knowing what your assessment tells you. This comes with time and experience.

I'm not sure what the big deal is with Angleton, but any hospital with an ER doctor and a CT scan can handle someone with a bell rung, concussion, and even a small bleed, as well as arterial/ venous injuries, pneumothorax, etc, etc, etc.

Since it seems some of yall aren't reading the whole posts, I'll say it again just as JP is saying, there is a time and place for air medical and you should be an active participant in your transport decision if it's prudent and you're capable of making decisions.
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Old 03-09-2009, 09:00 PM   #36
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Good thing for us(TTD) we have a doctor on staff this year!
You mean an anesthesiologist? Great if you want Jerran to put you to sleep. Ba ha ha ha.
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Old 03-09-2009, 09:21 PM   #37
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You mean an anesthesiologist? Great if you want Jerran to put you to sleep. Ba ha ha ha.
I am not trying to post up his life on here, but there is more to him than that.
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Old 03-09-2009, 09:32 PM   #38
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I am not trying to post up his life on here, but there is more to him than that.
True. He's probably the fastest anesthesiologist in the country. Woo hoo!!
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Old 03-09-2009, 09:42 PM   #39
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True. He's probably the fastest anesthesiologist in the country. Woo hoo!!
lol that too.
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Old 03-09-2009, 09:48 PM   #40
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You mean an anesthesiologist? Great if you want Jerran to put you to sleep. Ba ha ha ha.
Wow, good for TTD, that's good.

Question though, what can a doctor do that a paramedic can't? Just curious, LSTD may want to look in to that or something.
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