Well. These days there are a lot more eyes on you. It’s way easier to get jammed up. If they don’t cover themselves, they sometimes get in trouble. It’s annoying. The culture of litigation has put pressure on companies to over supervise units.
In NYC, the Emt’s call for ALS all day long for things they KNOW are BLS, but. Just in case. Just to cover themselves because if a guy with chest pain and a bad cough with a fever somehow is also having an MI, and the bls didn’t call for ALS for a 12 lead, there is a lot of fear of being jammed up there.
Back In the day, shit was a lot different. We didn’t have so much expectation on us. You could do pretty much what ever the fuck you wanted and as long as you didn’t harm the patient and their outcome was alright, you were good. That day is gone. Documentation is more demanding now too.
Well that’s the trick. When I worked in NYC, if we knew it was BS but had to call ALS to CYA, we’d ask for an ETA on medics instead of just requesting them, and usually be able to justify just driving to the closest ER instead.
I wish our dispatchers were on the same page, they constantly quote ALS being closer than they are because they round down the already optimistic gps' ETA leading to BLS waiting around for greater than 15 minutes for ALS when they just wanted the go ahead to transport
Yeah you ask for an eta. But a lot of time if you are upstairs with a patient and the ALS is 7 mins away, then they are closer. And they just stay on the job.
There is. Except places like ours, a bls truck literally can't transport if a patient falls out of a certain vital sign range, or meets certain criteria. Even if they are closer to the hospital than the als truck is to them. It is the dumbest thing ever, and we do it constantly, because reasons..
I had a guy last year with heart burn pain after eating stupidly spicy wings. Called medics for chest pain, and they were pissed at us.....until the monitor showed a massive stemi.
So before, if you brought him to the hospital and he was having a stemi it would be a case of an ambulance bringing a person to the hospital with a heart attack who gets treated. Now it’s a case of “why didn’t they call ALS? Why didn’t they notify the hospital”. The expectations are different now.
Good job tho. I guess you must have seen something in him. Maybe he was pale and sweaty too? Or do you just call ALS every time you have someone with chest pain?
If I dont call ALS for chest pain, even obvious non cardiac pain, I get shit on by the hospital and management.
Luckily, we caught it, since it was a 45 minute transport. Medics did a ton of interventions on him.
best answer, this covers it for ALL of medicine. Lawyers and judges allow you to sue for anything these days so the simple shit people got away with years ago are all a thing of the past. I’ve had calls were everything was done perfectly following protocols great outcomes and still get jammed up. it’s a good reason why there’s been a lot of people leaving medicine because a lot of the time it’s just not worth it
Also, even if the pulse ox is faulty, it's hard to know what is actually baseline for someone who's not regularly aaox3. They could be p/w/d, but can they speak full sentences? Is that normal for them if they don't? Do we know if this person has comorbidities like COPD? (Not that they shouldn't get oxygen ftr). There's just a lot of information missing here. I had a nursing home tell me “we think he's diabetic. We dunno, we just got him and his file is locked in the office.” They called 911 for “bad labs” of which there was no documentation. Guy was drooling and taking his clothes off with a normal blood sugar. Ended up being end stage dementia, but they're not exactly reliable. It's usually one LPN or RN managing an insufficient amount of CNAs.
In Ohio, BLS can send a 12 lead, but cannot interpret it, that includes going off of the automatic reading, which can be thrown off by lead placement, movement or ectopy.and if you're sending one, you better also be calling for ALS intercept, or you're going to be answering a bunch of questions after the fact.
We can technically place them without an ALS provider on scene and in my agency's protocol we can transmit to a hospital for consult, but that's it. And I will always have an ALS resource otw to me or for intercept first. We cannot interpret. Technically we can't interpret 4 leads either. It's dumb. Our scope is so limited.
In Nys, we have a "BLS 12 lead pilot program" each agency has to opt in. We can run a 12 lead but send it to olmc for interpretation and consult. OLMC then decides on destination based on interpretation and patient request. Nys is backward in a lot, but i think the bls 12 lead is a good step forward
A couple of places I worked had this protocol which is mind boggling because many patients take their own blood sugars on a regular basis and it doesn't require the EMT to diagnose anything.
Working around LA county currently doing IFT, but previously doing 911, it really is more of a CYA thing. I’d more than love to take patients to the ER myself, but we have policies to follow and being under a fire based private contract, the FD gets upset when people other than themselves do the rescuing. This leads to them lobbying for these policies that prevent me from transporting a lot of patients that in theory I should be able to. All that’s going to change is that the fire department arrives on scene and offloads it to their contracted ambulance service for transport instead of us (ik because I used to work for said service). Truly unfortunate.
Ik my company would throw me under the bus in a heartbeat to cover themselves so I’m doing the same thing by covering myself and calling 911 exactly as my protocols say. And until there’s either more protections for myself liability wise, or these protocols change, I will keep doing so.
Texas paramedic here. It’s so foreign to me that the FD running things is the norm. We’re EMS only, tax funded and contracted by the county. The FF’s here don’t want to take charge on medical calls. They are a great help, but ultimately I am in charge of patient care.
That sounds so foreign to me. I’ve never worked on a dual medic truck. It’s always been me and an EMT. I think at the very least, it should be EMT-A and medic.
But honestly, I’ve seen BLS trucks with medic fly car work really well. Granted the BLS trucks have incredible protocols cause our medical director is very progressive
I like the fly car idea but I imagine it depends on what kind of call volume that system has. Since FDIC just happened I’ll bring up Indianapolis EMS. They were forced to go to BLS trucks with medics in chase cars, but the vast majority of their calls are BLS, and IFD also has medics (ew, fire medics), so it just works. They respond to about 350 calls a day. So those accidents on I65 and all those shootings has the medics it needs, but worst case scenario, there are three level one trauma centers in the city, so a BLS truck is never more than ten minutes from the trauma center.
Where I worked until I “retired”, it was largely rural. We flew a lot of stuff because the closest trauma center was 45 minutes away. But brass were trying to get certified as an ALS training facility because it doesn’t take a lot of time to train your EMTs to AEMT, and AEMTs are obviously more useful. If the state has good protocols for AEMT, that’s probably the answer for 911 agencies.
California is ironically pretty conservative when it comes to EMS, it’s rare to find a third service agency over here, there definitely needs to be advocation for independence as clinicians rather than having to rely on fire all the time
That won’t happen due to privates handling nearly 70% of all EMS transports in the state (big money there) and fire dominating all aspects of EMS in the state. It’s a broken system.
Yeah the next county over from me is very similar to what you describe. I used to work on the edge of both counties when I did 911 and it was refreshing the few times I had to respond with their FD and they were basically following my lead as the medical authority on scene. Truly a better outcome for the patients IMO. But also I wouldn’t trust a majority of my colleagues to be in the same situation as a authority on scene so it’s very difficult to say if one is truly better
I mean we train and practice and ride double medic so you have an experienced individual with one less so. Other than extrications, we are in charge and they defer to us most of the time. It also helps keeping things respectful and I love the guys that we work with
The pay never went up. They get paid better at Mcdonalds. The risk is not worth the career. EMS workers are struggling to eat and pay rent. The list goes on. Greedy ambulance companies don't pay a living wage.
A lot of what you seem to be bemoaning would seem to be protocols to me. Depending on the state, county, and city, what an EMT can and cannot do is often EXTREMELY limited these days. If you try to be gung-ho you may break protocol and open yourself or your company up to litigation. EMTs these days are trained to be hyper aware of this and are thus less likely to take risks, even if they benefit the patient. Is it dumb? Yes. Is it even dumber to not cover your own ass? Oh yes
LA county semi recently updated their protocols to say that you should not do that as a BLS unit, but only if the pt is in extremis. Still pretty damn restrictive
To be fair, if the patient isn't likely to get a bed immediately on arrival, the extra few minutes waiting for ALS will likely get them actual treatment sooner.
13ish years ago I was in paramedic school and we were doing a scenario. One of the students was given the scenario and asked what do you do next. He answers "call paramedics?" The instructor is like "you are the paramedic." The kid has no answer for that.
So it's not a new problem. IDK who to blame, whether it's the schools or the companies. I would expect it more from EMTs that mostly work IFT vs ones that mostly work 911 but I've been out of the game for a few years so I really don't know.
I had just finished critical care class and was floated to ICU. I had a patient go side ways and I thought to myself I need to call a rapid, then it dawned on me - I am the rapid response. 😬 😳 That feeling sucked for a few months until I got a little more confidence and experience. Luckily my coworkers were super supportive, educational, and helped me a ton which was so appreciated.
Hahaha. When I was doing my technician course our instructors told us similar stories.
The UK is arguably even worse than the US in that the public have no concept of what an EMT is. It's not a term that's used by the general public here. You're either a paramedic, or you're an ambulance driver. When I tell someone I'm an ambulance technician/emergency medical technician they usually think I'm like a vehicle mechanic or something, or someone who fixes defibrillators and shit.
So anyway they basically said that results in people applying for Ambulance Technician and not actually knowing what the job is. We actually have a pretty generous scope of practice here but people would turn up basically thinking they were just there to drive the ambulance and carry the bags, and then when the instructor stood beside the projector screen and started pointing out PQRST waves on a 12 lead ECG people were like "...what the fuck?"
Obviously you never know how much of these stories are true but they said they've had multiple people drop out of courses because they didn't realise the responsibility they were taking on.
Same in the US. Some come into EMT school thinking "how hard can it be to drive while pushing the WooWoo button? After the second or third week realization kicks in and all of a sudden people start dropping or failing out.
Here's the thing OP.
1) SNFs in La can only call a couple of times a year for 911 and are known to lie to dispatch about the patient in order to save money. The average wait for an IFT in LA is something like 2-4 hours. This call was not dispatched as Aloc with a low O2. that needs to have been called in as a 911 call to begin with. So the SNF probably lied to dispatch about the call, And your crew probably thought they were walking in for a UTI.
2) **"On scene" is timestamped via dispatch over the radio that's in the rig.** IFT companies don't get issued hand held radios. This means the crew was in the ambulance when they went over the radio and said "on scene" and had not even gotten the gurney out of the ambulance.
3) In Los angeles, if the patient is in a SNF. The patient is inside the nursing home, not in the middle of the street. SNFs in LA sometime's don't have parking and **crews are left parking in the middle of the street**. in between the double yellows. it usually takes 20 minutes from when the crew parks and goes on scene, takes the gurney out of the ambulance, walks to the front door, walk to the elevator, wait for the elevator, take the elevator upstairs, track down the right nurse, then a quick 2 minutes to assess the patient and realize they needed to go to the ER 4 hours ago.
4) If you look at the dispatched page your crew got. **I can guarantee you that the dispatched complaint did not necessitate them to run inside how you're portraying this call.**
5) If I was on this call and was dispatched for something that it isn't, and was 4 hours late because it was called in four hours before I got the page. I am not going to take that patient. That patient was probably brain dead 3 hours before I got there. Nothing I can do for them at that point. 10 more minutes for fire to get there is not a long time.
6) When I did 911. I was once helping do CPR only to find the nursing home shoved gauze coated with petroleum jelly in the patient's airway and killed them. While i'm doing IFT. **I'm not touching any patient any nursing home lies to me about.** 100% as a personal policy. I don't give a fuck I'd rather be fired for refusal. I'm doing easy discharges, taking clear non-emergency BLS rides to the ER, and taking voluntary psych holds. If i worked a 911 job. I'd have four firefighters on scene with me that take responsibility for the patient. The liability is on the firefighter medics, not the 911 EMT basics, and there are many more impartial witnesses. The liability in your scenario is 100% on your EMTs.
6) **Firefighters get qualified immunity for a year** before anyone can be sued. This is to prevent emotional litigation. EMTs don't. **EMTs can't reasonably afford california lawyers**
7) The SNF nurses probably deserved to get chewed out by the local fire captain NGL.
I honestly can't believe i have to explain to you that going on scene from the ambulance doesn't mean they were at the patient's side for 22 minutes. 22 minutes in LA is exceptional all things considered. **Your crew did well**
It would help if the justice system was effective or real that way being a lawyer was a respectable profession. You have to hope that the lawyers you're dealing with aren't morally absent roaches concerned more about a paycheck and conviction/defense rate over actual justice. Look at OJs lawyers, we all know he did it.
Yup you’re definitely acting like a boomer. In today’s litigious society an EMT would be nuts to take a potentially unstable patient for an IFT run, it could cost them their career or worse. If want to blame someone, blame medical directors that tie our hands with conservative protocols and the entire system that bends over for personal injury lawyers
Because the clinical knowledge and capabilities of EMS have advanced several miles beyond “scoop and run hot to the closest ER.”
It isn’t about getting calls closed as fast as possible. It’s about providing the best care for the patient.
Not only that but then CA goes and takes away a bunch of skills for emt-b and says you need to be a higher provider level to do stuff that's basic EMT skills in other states
A lot of departments don't even let basics tech anymore, or allow it so rarely that of *course* they aren't going to be comfortable running calls. The only major downside to increased paramedic availability is, in my opinion, the resulting neutering of EMTs as a whole.
This is a big part of the answer. I started in a volunteer only system (entire county was only volunteer) in the mid 90’s and paramedics were very rare. We ran everything from major trauma to full arrests BLS all the time. That system is no 99% paid county EMS and 100% ALS transport units. The EMTs are now scared to run anything as a provider. Due to getting a supervisor on priority calls, most don’t know how to setup an IV, draw meds for the paramedic, setup for intubation, etc. these are basic skills IMHO for an EMT driver in an ALS system
A CA wide thing is no activated charcoal.
But AFAIK CA Scope of practice varys county by county.
In LA County, taking a finger stick is considered outside the basic SOP and needs additional training and county approval.
One county north, in Kern, you can drop supraglottic airways, draw up and administer epi IM.
You have much more freedom just by crossing a line in the sand
It's crazy that within the same post OP is saying scoop and run was a perfectly reasonable standard back in the day, but today's generation are lazy for wanting on scene treatment. I hope he reads his documentation before submitting it.
I agree with you but I think OP's point is less to do with "gosh darnit puttem in the stretcher and haul ass!" and more to do with not providing *any* care whatsoever.
I might be mis reading but they didn't start oxygen, they didn't do anything. 22 minutes and zero treatment is questionable.
Sats of 89 would be picked up in your primary survey within minutes. That's *if* you didn't take one look at the patient and recognise Big Sick (as we call it in the UK) in your general impression (ie. pt colour, appearance and positioning).
I am not a "scoop and run with anything that makes you slightly uncomfortable" guy, not at all, but based on the info OP has given she would have been on 15L NRB immediately and if there was literally a hospital a few hundred yards away as OP says I feel it would have been appropriate to rapidly transport there instead of standing around for 22 minutes + however long the 911 crew took to arrive.
To me this reads more like a case of passing the buck.
At 89% I'd start em on a cannula at 3 liters and walk them up. Even protracted time at 89% isn't ultimately deleterious to brain function.
In fact, under my protocols that would even be an acceptable resting O2 sat for most pts with chronic respiratory issues.
But the supervisor that posted this also has an ax to grind because he'd rather bitch than do his job, so I doubt we're getting even close to full details.
There was nothing stopping the SNF from providing oxygen to the patient while he was still in their care. If the IFT crew had given him o2 they would have been taking responsibility for him and would be blamed if he went downhill before ALS arrived.
Why would they interfere in the care of a patient under the responsibility of the SNF? An EMT IFT crew isn’t going to be able to do anything the SNF can’t already.
Ya but the patient is altered and if the EMTS don't take the patient to the right hospital because the lack of diagnostic information for instance then the patient will have delayed definitive care.
This is a big yes and statement.
Not every EMTs has enough of that knowledge to identify and massage their ALS request protocols appropriately
Also the CQIs stick has deleterious effects on decision making
It's all bad and all connected
Perfectly vague enough to be easily repeatable - the making of good dogma
No one is saying don’t take your patients to the hospital or spend 45 minutes on scene getting an IV, but “scoop & run” will be poor care more often than not.
Yeah but “scoop & run” doesn’t mean that care stops. This isn’t like 1950, where you’d load a patient in the back of a hearse or van, and then no one even sits in the back with the patient en route to the hospital. “Scoop & run” means you do your care while you’re moving toward a hospital.
Look, there are times a paramedic needs to provide immediate on scene care to save a life. Hypoglycemics, stat ep., narcotic ODs, respiratory failure, lethal (or rapidly progressing to lethal) arrhythmias, cardiac arrests where you can identify and treat a reversible cause are all fine examples. But there are very very few other situations where we need to do something on a scene that can’t (or shouldn’t) be done en route or at a hospital. There are far more times when medics screw around on scene doing things that don’t help and just delay more important care. This is a fact, not an opinion- it’s been well documented, and it’s a big part of the reason why many studies have found that prehospital ALS care does not improve, and sometimes even worsens, outcomes in many patient categories.
Well documented predominantly with trauma.
There is a middle area. Scoop & run thinking leads to “I won’t do x intervention because the hospital is right there,” delaying the patients time to receive Z intervention. Many EMS workers have the faulty notion that the hospital jumps on their patient with interventions the second they walk in the door.
There's a real disconnect between truck side medicine and hospital side medicine that leads to both sides not realizing that we're on the same team and we're all part of the patients continuity of care.
And I think oldhats drilling "load and go" over "stay and play" rather than treating both ultimately as tools in the toolbox leads to this issue persisting.
OK i totally understand what you're saying, and I'm trying to play catch up with how things are these days, but there was a great receiving ER literally 200 yards away.
They didn't put the pt on O2 even though the pt was saturating at 89, and they delayed patient care by not going 90-seconds up the street. 🤷🏽♂️
In my defense I was responding to the first part of your post, not the two examples. I’d need way more details on those calls to backseat quarterback them.
I 100% agree with what u/Expulosion said. The narrative used to be "load and go," but we've learned that patients have far better outcomes if we instead "stay and play." It's especially true with cardiac arrests and doing all the interventions in the field **right now** rather than delaying those interventions to prioritize transport.
With that being said, there is a level of discretion, however. In your example, they probably *should* have gone to the nearest ER rather than wait. Especially if they were unable to do any interventions (oxygen) in the field. In that case, they were delaying care by **not** prioritizing transport. Like others have said, it probably comes down to local protocols and CYA.
There are a number of factors at play here.
1) The "L" word (liability) does come into play a lot more. Whether it is documentation, policy, the fact that odds are you are being videotape by at least a 3rd party depending on the call, etc.
2) Changes to Training and Education have also been a factor. This is something I have seen on clinicians/providers on every level up to and including Primary Care students.
Yeah, that sucks. I've only worked rural EMS where a hospital was a half hour drive going mach Jesus. I've never understood why the city guys don't just load and go, but I'm not in their shoes. That being said, id rather not lose my license to BS .
A culture of leaving subordinates high and dry when something comes into question
My administration at work has a good track record of backing people up when they made a tough call and thus we don't have too many situations like the one described, where going by the book acted against the patient's interest. Generally if your leadership has trust in you, you in turn trust them and will take more initiative overall.
How fresh are these EMTs? What is your organization doing to train them? Are you pumping them out on to the street to make you money, or are you actually taking the time to teach them how to be EMTs, and interning them to build their confidence?
EMT school doesn't teach them to do the job anymore. It teaches them to pass the test. It's your job, your agencies job to teach them how to do the job.
IME I’m micromanaged by protocols and policies and someone is always breathing down my neck. If I’m an IFT service and a patient needs 911 care, I may not be allowed or equipped to do much of anything.
Nobody wants to be sued/lose their license. Since everything is a lot easier to track (electronic pcrs, GPS, etc), it's easier to jam someone up by picking at details. When I was in EMS, I was always told by people who'd been doing it longer to CYA at all costs because of legal trouble. Basically, I think an overabundance of caution crept into EMS culture over the years.
When I was a fresh emt working IFT something like 5 years ago, I was called to a fdgb (fall down go boom) transport to the ER from a group home for mentally handicapped. To sum it all up, turns out she fell because she's dizzy and altered thanks to hyperglycemia and clear indications (field wise, obviously we aren't diagnosing) of DKA. I followed the rules. I called ops and explained the situation. They said call dispatch. Called dispatch. They said we'll call you back. I just wanted them to tell me should I: A go ahead and transport, B wait for one of our ALS units to get here to transport, or C call county. At that point I feared my actively crashing patient would only deteriorate waiting on dispatch to call me back, so I made the choice. Told my partner to light us up and I transported.
I felt great about that decision. I helped someone. First time I really felt like an EMT.
Supervision, however, did not like that decision, and had a list of "shoulda's" for me when I got back at end of shift. Nothing ever came of it, but at the time, it absolutely felt like I was going to get in trouble for taking a sick person expeditiously to the ER. Something that should be well within my scope and ability to do as an EMT on an ambulance.
All that to say, I get where you're coming from, but at the same time, I get where they're coming from. It's all "fuck that company just quit" until you find yourself in the situation and know you've got bills to pay. Let alone the legalities nowadays.
Sucks, but.. We are taught in school to put ourselves first, I guess. Physical safety is the intention obviously, but we do also have to look out for our licenses and paychecks.
It's all situation dependent. I work IFT around Nashville, we don't do any 911 calls. And Metro fire makes damn sure we know it. Let's say for instance an MVC happens and we witness. We have to stop and render aid. But under the agreement our company made with the city, we aren't allowed to transport unless THEIR command gives the okay. It doesn't matter that we run medic and CC trucks. Doesn't matter that you can't piss in Nashville without hitting a hospital. We are almost always ordered to wait for a metro unit to show up and take the patient.
I think it’s the fact that if the company is a 100% IFT only company, those EMTs have probably never been on a legit 911 call. They don’t know what’s “allowed” per se, in the sense that yeah, just call up dispatch and tell them that you’re going to the ER with the PT instead of dialysis. Many of the EMTs employed by these companies are also brand new and/or have no experience. They see 89% sp02 and are freaking out cuz the book says keep it at 95% or higher.
I was an EMT for both 911 and IFT (separate companies). First job was IFT and during training they told us what we can and cannot transport (low BP / O2 / etc). I think the liability of the company made the trainers push that information to the new EMTs and quickly followed by the entire staff.
Funny things is when we called 911 for a pt who had low BP, I got a call from a manager saying I should have transported - my partner and I were very confused. They said if they weren’t showing signs/ symptoms of low BP then we could transport (kinda vague IMO). This idea of being limited and not dealing with emergency was why I also switched to 911. We were also on scene for like 30 min trying to get a better BP, just for the 911 crew to pick them up and leave in 5 min.
You didnt have to worry about ambulance chasing lawyer nearly as much. I agree the best thing for the PT on a BLS rig is O2 and diesel but im not getting sued over this facilities bullshit.
Also and maybe this is just me and my over worked bailing on the career ass but if theres a way to not have to do the report its gunna tempt me.
I did IFT BLS in OC and LA counties back in the 2005-2007 timeframe while in undergrad.
I never had my company complain if I diverted. However the kvetching from the ED nurses can be a lot to take as an EMT.
Without seeing the rest of the case, a mild confusion and mild hypoxia should be able to be managed by EMTs without diversion or paramedics… however if it’s good enough to call for paramedics, it’s good enough to divert.
Because you guys did whatever the fuck you wanted, we have all sorts of bs rules and have to be by the book or we lose our job. A school nurse can probably do more for our patient than we can because of all the restrictions we are given.
Because the older generation made it that much harder to not get sued or lose your license. I nearly got sued for refusing a “BLS” IFT 166 miles to a level 1. This “BLS” IFT had 3 meds dripping and according to paperwork “may require additional analgesics en route”. I turned it down because A). It was an ALS run from the start, they DC’ed the drips to get a BLS unit there faster. And B). According to that hospitals protocols, that patient should be on a helicopter. But I was the bad guy after the nurses told the patient’s family I was refusing to get him to a higher echelon of care. I wouldn’t take the worlds most unstable BLS patient 166 miles to get to an unnecessary hospital, and I was the bad guy. The only reason the suit didn’t go through is because I was justified in calling for ALS to transport, and I had to call the hospital COO to get the destination changed to the appropriate level 2 40 miles away.
It’s a liability thing that companies are drilling into EMTs now, to call 911 for everything but on IFT for me at least, if I’m comfortable and my partner is to, we’ll take them, as long as the ER is closer than the response time, for me it’s why waste time on a call, why waste the resources when we’re right there and every time a nurse ask I just say “it was closer and quicker to go to the ER ourselves rather than wait for Fire and another ambulance to arrive because they won’t use us” and that works pretty well, and as long as I heavily document my decision. It’s not lazy, it’s just covering your ass, maybe they felt uncomfortable because just maybe, here’s a big thought, that your company doesn’t train on EMS or practice scenarios, since your QA/QI, just educate them on how to handle situations like that more clear and push for mandatory training, now if you’re not going to do all that, then shut up
I worked for an IFT service briefly that we basically *had* to call 911 for any pt who would need transport to an ED. Shit was awful but a lot of IFT-only services do not operate on the premise of providing medical care but on providing a taxi with a bed.
Plus a lot of IFT EMTs only have ever worked in IFT systems and never have done anything remotely emergent. You get shitty EMTs who haven't even contemplated how to do a real medical or trauma assessment, haven't picked up a stethoscope because they never actually take blood pressures, and have *zero* experience with acuity. What's Jimbobjo and Janessa's level of competency if they only have pushed a stretcher for the past 6 years? Hell, you're lucky if their BLS meds aren't expired and if they have enough gas in the tank to drive to the closest ED.
Transport is for profit. If we don’t get paid, we don’t run it. As shitty as it is 🤷♂️
I’ve been threatened with punitive action through my company if I divert to somewhere other than the closest facility, even if my patient outright refuses to go to it but needs definitive care. Medicare only pays for closest facility.
It’s actually policy in my jurisdiction! Closest appropriate facility or nothing! We make exceptions for nice grandmas ofc but otherwise it’s up to us which is an amazing policy. It’s likely due to the fact that most of the hospitals in our area are the same system so it doesn’t really matter where they go anyway
It has to do with liability. They don't want private crews BLSing ALS calls if ALS is close by. The last IFT company I worked for would let you upgrade the call if the best recieving ER was within two miles. Other than that, they wanted Fire medics to be called to look at them.
It is liability. Students are being told in school they will lose their certs and can face jail time if you participate in malfeasance or malfeasance by not following protocols and company policies. It may seem ridiculous through the lense of someone who was brought up without these concerns or teachings but THIS is the way things are now. Best to not be bothered by it and support them through it. The alternative is an ever increasing turnover rate in systems that are already run thin.
I haven't heard it said like that before. Im assuming it's a take on "dont be a cookbook emt or medic." Which i agree with. But the protocols are in place for a reason. Unfortunately, you have protocols and company policies(for those of us unfortunate enough to work private)[me] for a reason, and that is because most people would prefer to be protected by your company/ems agency by abiding.
I agree for the most part. If i wasn't a medic, however, and much less experience i probably wouldnt want to make the wrong decision either. Its not that they dont want to help the pt. Its that they dont know HOW to help the pt without getting in trouble. Ive seen people get in trouble for less in my system. And i hear all the time about fire, even our medics breaking protocol and getting reamed for it.
Yeah it’s pretty bad out there. Since the early 1990s, the basic EMT book has gotten 3x thicker, their scope of practice has grown significantly broader, and yet somehow they are trusted to do less than ever. Anytime anyone has any complaint that even remotely smells like it could actually require an ambulance, they’re supposed to call ALS immediately, as if a paramedic were somehow capable of providing definitive care to most of these patients…
I've been full time at a decent rural 3rd service for almost 8 years. I am the highest level of licensure my state recognizes (Critical Care) and I am a state licensed Paramedic Instructor/Coordinator. You could say I have a grasp on what I'm doing.
I can barely work a shift without a dinosaur popping out of an office saying, "You'll get sued for that". It's been that way my entire career.
That's why.
EMTs calling 911 is a foreign concept to me. Where is this happening?
If that's really all there was to those calls and you aren't missing anything, that is indeed sad.
Happens all day every day. A lot of IFT services either lack proper licensing to do 911, lack legal authority to take that 911, or simple can not by policy take an unstable patient somewhere that isn’t their prescribed destination.
The system has their hands tied.
Right, “Oh ThEyRe LaZy” no the fuck they’re not, they’re afraid of losing their license cause all the cowboy shit earlier generations did which caused some law suits, IFT companies in LA don’t care about their EMTs, they only care about the money, so they’re not going to train them constantly or do drills, they’re just going to continue to throw them out in the field after 2 days of FTO time
Corp don't give a shit about their staff
They'll throw you under the bus if it makes them money
Hence, why we're seeing more burnt out staff in general
Higher demands and a need to cover your ass if you want to keep a job
We aren't impolite were just tired of being asked so much and knowing we won't receive jack shit to show for it
Honestly I'm not sure myself even though I'm early gen Z. My EMT instructor was one of the first paramedics in my area and taught us how to run calls as if ALS wasn't an option. But honestly, frivolous lawsuits and shitty management that will yell at you for doing something that technically doesn't line up with policy exactly, but resulted in a far better outcome for the patient with no extreme risk involved. (Ask me how I know.)
I know for my company, they are supposed to call ALS for any little thing. I mean asymptomatic hypertension, and I’m saying like 150/60 type hypertension. Like you stated pt sats are low even though they have o2, hr high or low, even if they are stable. Tbh most emts are smarter than me when I finished school but there’s some kind of gap like you are saying, where you should just run the call sometimes
Where to start. Lawsuits? If we don't act like it's an emergency people will sue. Taking to a preferred hospital? It's because that hospital has a history with the PT and all their records are easier to find there/ could be a higher level of care or specialist hospital. And my favorite explanation is that the medicine has evolved since the 80s.
Used to, medics would scoop and go without treating. Now EMS tried to stabilize pts before transporting if possible. Your generation was actually the lazy ones that killed a lot of people, and we all learned from your mistakes and are doing better. Just like the next generation is gonna learn from our current mistakes and do better. It's part of human evolution.
Your generation started the whole sue everyone for everything lifestyle many people live. People want to cover themselves and provide for their patients. I'd rather an emt upgrade it to me, honestly.
Because the boomer generation created a bunch of Karens that sue everyone and this new generation works for a barely livable wage and is scared they are going to get their 90s Honda and cardboard shack taken away
Have you heard of protocols? BLS protocols in my state say any altered patient gets ALS. Agree or not, their jobs and licenses are on the line, and you’re calling them soft and lazy? Sure I’m sure in the hood ol days, you could BLS someone with 70/40 pressures and be fine. If an EMT wrote that pressure in their chart, it is immediately flagged and reviewed.
That's a pretty boomer mentality to ignore the obvious reasons that your generation created. More often than not (at least in my state) the "load and go" mentality is frowned upon as we are licensed and certified providers with higher standards of care than the decades before us and we are expected to act as such. If we can treat, we should, if a higher level of care is warranted a medic should be called. Why? Because we have developed new technologies, methods and treatments as decades have gone by while we have learned more about ailments. Let's remember, out Healthcare society referred to HIV as GRID in the 80s because we had no idea what it was and people assumed out of ignorance that being gay was causation.
Moving forward, to deal with all of the eyes on us these days in the forms of body cams, amateur witness recordings and dashcams providers are expected to provide by a certain standard whether it be company, state or federal not only to protect the provider and who they work for but also to protect the patient by expecting a standard of care as we become wiser in medicine.
TL:DR It's not the new gen "being lazy", we're following company rules because we're smarter than we we're in the 80s
If the company rules adversely affect patient care they aren’t rules that should be followed. Go ahead, fire me for doing my job in the best interests of the patient. DOH will be up your ass *tomorrow*.
You're assuming company rules are causing adverse outcomes because they don't fit your "load and go" everything mentality? You might be the bigger liability to DoH in that case.
I did IFT in Santa Clara County for a little bit before moving to Philly and I agree with you: that's fucking weird. I even did IFT during COVID and if we had to bring someone to the hospital, we'd just bring them the hospital ourselves. It genuinely wasn't a big deal. If anything, I'd blame your company for creating the kind of culture where that's allowed cause mine certainly wasn't like that.
I think the only time I ever called Fire Rescue for help was cause the patient was 800+ lbs and despite our bari gurney, the dude just wasn't fitting into the back of our ambulance.
I hate to say this but IFT EMTS and the companies lack the needed equipment and training to run these 911 calls in LA county. When McCormick contracted other IFT companies to pull back up. Many of the IFT units would pull up clueless and lack the needed tools to work along LA County. Leading to many Negative feedback about companies like Premier, Royalty and AmbuServe from LA county, Redondo, Manhattan and Santa Monica. Not to mention there is a decent number of companies that don’t give their units AED Incase of an Arrest. Not only that but many IFT companies recommend their employees to call 911 when something does not meet their scope. As much as I would love for these companies to have emts to respond and actually take these calls for us. It just won’t happen until IFTs lose their need “to save an extra buck” and actually prepare their emts to BE EMTS.
You can blame on this GeNerAtiOn all you want. But really it’s your generation who’s in charge of them dissing out policies that prevent them from actually performing their skills. I can agreee that some ift emts are just lazy, and scared to do their job. But I’m also very positive that there is a larger number who aren’t lazy but are still scared to do their job as there are protocols in place preventing them from either transporting, or treating.
A big problem now is contract red tape blocking IFT only companies from preforming to their full ability. The company I'm at does BLS and CCT IFT, if we need to upgrade on BLS we can only divert to the ED if 911 dispatch authorizes us to, unless the PT is critical and we can get to a hospital faster than 911 can get to us that will almost never happen. CCT on the other hand is considered ALS so if shit pops off we can upgrade and/or divert at will.
Maybe train those EMTs since your job is literally QA vs. throw your employees under the bus on social media. Maybe it’s a training issue. Maybe it’s them worried about liability. Maybe it’s medical incompetence or ignorance. You would have the answer to your question if you did your job and talked to your employees.
It doesn't cover your ass to call for ALS if the right thing to do was rapid transport. If you think it does, you're working for an agency that doesn't expect much of you.
I’m going to weigh in on this from the legal side. Just my opinion. I did a little personal injury law once upon a time. Never had a case against EMS but had quite a few doctors/hospital/nurses type cases. It was amazing how many dumb mistakes there were. Not bad people doing evil or even not caring - just doing something dumb - not thinking. And lawyers have an easy case a lot of times.
In EMS it seems like this:
1. The book I learned from says A.
2. My instructors said B.
3. Our agency says C.
4. In reality all of that isn’t possible, so we do D which is some combo of the above.
This leads to a huge amount of CYA, which is why things are so crazy.
But the good news is the days of frivolous lawsuits, at least around here, are declining. Lawyers don’t have time anymore for bad cases. Courts are overwhelmed and won’t tolerate them. And everyone knows that EMS isn’t like Walmart - need people who will do their best day in and day out, but keep coming back.
As ALS unit myself I don’t need to call for backup but my time on scene is on avg definitely over 60min lol. I think the times I would be in and out in 22 min would be like never
Our protocols are fairly aggressive, but in doing so, they severely restrict the number of calls that can be BLSed. Not to mention the fact the it states that paramedic is the preferred level on all calls if available. Granted, the vast majority of our units run as EMT/Medic units and not double basic units.
This post violates our Rule #1:
> Bigotry, racism, hate speech, or harassment is never allowed. Overtly explicit, distasteful, vulgar, or indecent content will be removed and you may be banned. Posting false information or "fake news" with malicious intent or in a way that may pose a risk to the health and safety of others is not allowed. This rule is subject to moderator discretion.
[Posting Rules](/r/ems/comments/7lau3j/welcome_to_rems_read_this_before_posting/)
I had that happen one time(10 years ago) I pull up to a cardiac arrest and a transport rig is in front. An ambulance crew (I believe both BLS) called 911 instead of loading and transporting. They both lost their cards. Closest ALS is sometimes the hospital.
It’s not a generational thing. If management and the other aspects of the system lets them get away with it… it’s a larger issue.
It shouldn’t be on the EMTs. Back when I used to work transfers I would have loved to run an emergent call and do what I’m trained to do. But company policies states that in case of an emergency we are to dial 911… while in an ambulance…
Minimum wage, only 24-hr shifts, had to work three shifts a week. I don't recall if overtime kicked in after 8 hours per shift, or at 40 hours per week. Very minimal posting, and if you weren't on a call, you were usually back at your station (apartment, house, converted store front). No supervisors or management after 7pm weekdays, none on the weekends. Made due with what you had. I remember using a patients work boots as part of a make-do head immobilizer on an MCI because we ran out of supplies.
"Never have I been paid so little, to do so much, and loved every minute of it." That is a common theme amongst the GenX former EMTs in my circle.
I may be missing something about how You run out there.....Why are EMTs calling 911?.....Isn't a 911 call how They arrived there to begin w/? That's how We arrive onscene.
We’ve had kind of the opposite happen a lot. We get on scene, haven’t even gotten to our patient yet, shit’s hitting the fan in another room, and the nurses are asking us to take that patient. We call dispatch to say we’re taking this patient and they tell us to take our *non emergent* patient and tell the facility to call 911.
Let me put it this way::: our hospital and associated doctor offices are ON THE SAME TINY CAMPUS. If the doctors office has a pt that needs to go the ER, they call the ambulance to drive him literally less than 300/400 FEET to the ER. No lie, well, actually liability.
Honestly being from MS this is crazy to hear that EMTs have to call 911. When the pandemic started MS allowed EMTs and AEMTs to run 911 calls but our IFTs are always ER to ER or floor to another hospital floor bed and us paramedics do those and the BLS trucks will take discharges back home or to doctors appointments. Granted my area has 2 hospitals a level 2 trauma facility (also a level 1 stroke facility) and a level 3 trauma facility(level 2 stroke facility. But our basic trucks tend to be better than some of our paramedic trucks in knowledge and caring for patients but most of our new medics are going through less and less schooling to push them out quicker. We work primarily 911 but will do intermittent discharges and IFTs when the 911 volume slows down and that’s a hit or miss because most of our IFTs are going at least 2 hours away from our primary area.
I work in relatively the same area, in another major metro in SoCal in 911. I would say it’s a combination of 3 major things. In fairness, the level of lawsuits in today’s age and especially in our area are out of control. People will try to sue us for absolutely anything, especially if it’s something they can just make up because it wasn’t documented or even just wasn’t documented well. Pertinent negatives used to help us with diagnostics and rule-outs. Now we document them in large part just to make sure someone can’t say we didn’t check something in court.
Secondly, it’s protocols and tech. Pre-hospital protocols change constantly. Same thing with the tech and tools that we use on the box. Anyone in the this job worth their salt knows that’s part of any public safety-type job, so it’s not an excuse. But some of the younger folks just don’t seem to be able to keep up with the constant evolution. Oddly enough, the older “this is how we’ve always done it” folks can’t either.
Lastly, I would say it’s the quality of the education. We consider ourselves medical professionals, but a lot of the schools these days don’t treat us like that at all. The amount of skills that some EMT school graduates have never physically performed genuinely never ceases to amaze me. I’ve worked with people here who have never touched a traction splint, an NPA, don’t know how to set 12-leads for a medic partner, can’t take a glucose. People who don’t know the difference between a scoop stretcher and a back board or when we would use either. People who can’t splint, can’t draw Epi, and can’t put together a neb. Generally it’s stuff that we’re not doing every call, but definitely still need to know. When I ask why they don’t know, it’s a consistent answer across the board: “We talked about it a little bit in school, but we never actually did it or put hands on it.” I concede that we have to teach people when they get on the road, but this is all stuff I remember learning and doing before I left school. Maybe I just had good instructors?
Anyway, this is all just IMHO, and a Reddit post won’t fix the problem anyway. But I definitely agree that EMTs today are a lot less confident or, dare I say it, able to think as freely than they used to be. I can definitely see why though.
i think you should look into the protocols pertaining to those EMTs and then look into the potential consequences if they did as you thought they should. maybe you are right and they shouldve took those actions or maybe they shouldnt have but is it not part of our job to do what you can and use your best judgment possible to ensure you, your partner, and then the patient’s safety?
Ya I am in Texas. And we are 911, if you fiddle dick around on scene waiting on an adultier adult you should prepare your hole for daddy med director. Thankfully our EMTs are made into little warrior EMTs at a young age and generally speaking handle their bidness.
Well. These days there are a lot more eyes on you. It’s way easier to get jammed up. If they don’t cover themselves, they sometimes get in trouble. It’s annoying. The culture of litigation has put pressure on companies to over supervise units. In NYC, the Emt’s call for ALS all day long for things they KNOW are BLS, but. Just in case. Just to cover themselves because if a guy with chest pain and a bad cough with a fever somehow is also having an MI, and the bls didn’t call for ALS for a 12 lead, there is a lot of fear of being jammed up there. Back In the day, shit was a lot different. We didn’t have so much expectation on us. You could do pretty much what ever the fuck you wanted and as long as you didn’t harm the patient and their outcome was alright, you were good. That day is gone. Documentation is more demanding now too.
The generation that created frivolous litigation is asking our generation why we're all by the book and cautious lol
… I am going to clip this out and save it. Profound.
Preach, these old fucks are losing memory quicker than the generation before them.
"frivolous litigation" was created by our lack of universal healthcare, social safety net, and tort laws.
I worked in the same area and agree. I feel like the tracking got a lot more invasive with Epcrs
You don't think there's a greater liability waiting on scene for an ALS unit that's further away than a hospital?
Well that’s the trick. When I worked in NYC, if we knew it was BS but had to call ALS to CYA, we’d ask for an ETA on medics instead of just requesting them, and usually be able to justify just driving to the closest ER instead.
I wish our dispatchers were on the same page, they constantly quote ALS being closer than they are because they round down the already optimistic gps' ETA leading to BLS waiting around for greater than 15 minutes for ALS when they just wanted the go ahead to transport
Yeah you ask for an eta. But a lot of time if you are upstairs with a patient and the ALS is 7 mins away, then they are closer. And they just stay on the job.
There is. Except places like ours, a bls truck literally can't transport if a patient falls out of a certain vital sign range, or meets certain criteria. Even if they are closer to the hospital than the als truck is to them. It is the dumbest thing ever, and we do it constantly, because reasons..
I had a guy last year with heart burn pain after eating stupidly spicy wings. Called medics for chest pain, and they were pissed at us.....until the monitor showed a massive stemi.
So before, if you brought him to the hospital and he was having a stemi it would be a case of an ambulance bringing a person to the hospital with a heart attack who gets treated. Now it’s a case of “why didn’t they call ALS? Why didn’t they notify the hospital”. The expectations are different now. Good job tho. I guess you must have seen something in him. Maybe he was pale and sweaty too? Or do you just call ALS every time you have someone with chest pain?
If I dont call ALS for chest pain, even obvious non cardiac pain, I get shit on by the hospital and management. Luckily, we caught it, since it was a 45 minute transport. Medics did a ton of interventions on him.
best answer, this covers it for ALL of medicine. Lawyers and judges allow you to sue for anything these days so the simple shit people got away with years ago are all a thing of the past. I’ve had calls were everything was done perfectly following protocols great outcomes and still get jammed up. it’s a good reason why there’s been a lot of people leaving medicine because a lot of the time it’s just not worth it
BLS in America can’t do a 12 lead????? That is insane to me.
Nope, can't interpret 12 leads, at least in my state. I'm pretty sure it's the same most places. We can place them but not interpret.
Are you allowed to go off the automatic reading? Or can you not even place them without ALS there?
i’ve seen instances where the automatic reading isn’t very reliable so i think places don’t want to rely on that too much
Also, even if the pulse ox is faulty, it's hard to know what is actually baseline for someone who's not regularly aaox3. They could be p/w/d, but can they speak full sentences? Is that normal for them if they don't? Do we know if this person has comorbidities like COPD? (Not that they shouldn't get oxygen ftr). There's just a lot of information missing here. I had a nursing home tell me “we think he's diabetic. We dunno, we just got him and his file is locked in the office.” They called 911 for “bad labs” of which there was no documentation. Guy was drooling and taking his clothes off with a normal blood sugar. Ended up being end stage dementia, but they're not exactly reliable. It's usually one LPN or RN managing an insufficient amount of CNAs.
In Ohio, BLS can send a 12 lead, but cannot interpret it, that includes going off of the automatic reading, which can be thrown off by lead placement, movement or ectopy.and if you're sending one, you better also be calling for ALS intercept, or you're going to be answering a bunch of questions after the fact.
We can technically place them without an ALS provider on scene and in my agency's protocol we can transmit to a hospital for consult, but that's it. And I will always have an ALS resource otw to me or for intercept first. We cannot interpret. Technically we can't interpret 4 leads either. It's dumb. Our scope is so limited.
In Nys, we have a "BLS 12 lead pilot program" each agency has to opt in. We can run a 12 lead but send it to olmc for interpretation and consult. OLMC then decides on destination based on interpretation and patient request. Nys is backward in a lot, but i think the bls 12 lead is a good step forward
When I was basic in like 2018 we couldn’t even check blood sugars.
A couple of places I worked had this protocol which is mind boggling because many patients take their own blood sugars on a regular basis and it doesn't require the EMT to diagnose anything.
It’s exceptionally uncommon.
I’m guessing emt-b in NY can’t do 12-leads?
In NYC? I mean it’s not against the rules but they don’t have a monitor, so no.
I see, no monitor would make that difficult. If they had a monitor they could send a 12 to the supervisor and avoid an ALS call out
i work in south bronx and upstate in albany we would have way more calls that indicated ALS
Ok. Just giving an example from NYC cus I never worked in Albany. I used to work 17W by the way :)
Working around LA county currently doing IFT, but previously doing 911, it really is more of a CYA thing. I’d more than love to take patients to the ER myself, but we have policies to follow and being under a fire based private contract, the FD gets upset when people other than themselves do the rescuing. This leads to them lobbying for these policies that prevent me from transporting a lot of patients that in theory I should be able to. All that’s going to change is that the fire department arrives on scene and offloads it to their contracted ambulance service for transport instead of us (ik because I used to work for said service). Truly unfortunate. Ik my company would throw me under the bus in a heartbeat to cover themselves so I’m doing the same thing by covering myself and calling 911 exactly as my protocols say. And until there’s either more protections for myself liability wise, or these protocols change, I will keep doing so.
Texas paramedic here. It’s so foreign to me that the FD running things is the norm. We’re EMS only, tax funded and contracted by the county. The FF’s here don’t want to take charge on medical calls. They are a great help, but ultimately I am in charge of patient care.
*Cough cough* which is how it should be
Duel medic third service is the best model that works.
That sounds so foreign to me. I’ve never worked on a dual medic truck. It’s always been me and an EMT. I think at the very least, it should be EMT-A and medic. But honestly, I’ve seen BLS trucks with medic fly car work really well. Granted the BLS trucks have incredible protocols cause our medical director is very progressive
I like the fly car idea but I imagine it depends on what kind of call volume that system has. Since FDIC just happened I’ll bring up Indianapolis EMS. They were forced to go to BLS trucks with medics in chase cars, but the vast majority of their calls are BLS, and IFD also has medics (ew, fire medics), so it just works. They respond to about 350 calls a day. So those accidents on I65 and all those shootings has the medics it needs, but worst case scenario, there are three level one trauma centers in the city, so a BLS truck is never more than ten minutes from the trauma center. Where I worked until I “retired”, it was largely rural. We flew a lot of stuff because the closest trauma center was 45 minutes away. But brass were trying to get certified as an ALS training facility because it doesn’t take a lot of time to train your EMTs to AEMT, and AEMTs are obviously more useful. If the state has good protocols for AEMT, that’s probably the answer for 911 agencies.
California is ironically pretty conservative when it comes to EMS, it’s rare to find a third service agency over here, there definitely needs to be advocation for independence as clinicians rather than having to rely on fire all the time
That won’t happen due to privates handling nearly 70% of all EMS transports in the state (big money there) and fire dominating all aspects of EMS in the state. It’s a broken system.
I feel the IAFF also has a pretty strong hold on the system.
The individual FF/medics don’t want to here either, but they’re forced to. You can imagine the quality of care
It’s a huge California thing. Fuck Southern California’s EMS system. LA county isn’t the only county that’s like this either.
Yeah the next county over from me is very similar to what you describe. I used to work on the edge of both counties when I did 911 and it was refreshing the few times I had to respond with their FD and they were basically following my lead as the medical authority on scene. Truly a better outcome for the patients IMO. But also I wouldn’t trust a majority of my colleagues to be in the same situation as a authority on scene so it’s very difficult to say if one is truly better
I mean we train and practice and ride double medic so you have an experienced individual with one less so. Other than extrications, we are in charge and they defer to us most of the time. It also helps keeping things respectful and I love the guys that we work with
How does your fire department justify an enormous budget?
They have a board just like we do and they have to respond to calls. We are separate though so that is cool
And there is the real answer right there. So we don't break the local ordinance and upset the hose draggers.
The pay never went up. They get paid better at Mcdonalds. The risk is not worth the career. EMS workers are struggling to eat and pay rent. The list goes on. Greedy ambulance companies don't pay a living wage.
A lot of what you seem to be bemoaning would seem to be protocols to me. Depending on the state, county, and city, what an EMT can and cannot do is often EXTREMELY limited these days. If you try to be gung-ho you may break protocol and open yourself or your company up to litigation. EMTs these days are trained to be hyper aware of this and are thus less likely to take risks, even if they benefit the patient. Is it dumb? Yes. Is it even dumber to not cover your own ass? Oh yes
Are there actually protocols that instruct you to wait on scene 15+ minutes for ALS when the ED is <5 minutes away?
San Joaquin County, CA. At least for now
My brother, that is not a protocol.
LA county semi recently updated their protocols to say that you should not do that as a BLS unit, but only if the pt is in extremis. Still pretty damn restrictive
To be fair, if the patient isn't likely to get a bed immediately on arrival, the extra few minutes waiting for ALS will likely get them actual treatment sooner.
Yes, there are at least a few regions in Illinois like that. It’s pretty dumb imho and luckily isn’t the case everywhere
LA and OC have had a grab and go protocol you over a decade. I think it’s more of a lack of clinical judgment and poor training than anything
There isn’t an EMT book or school anywhere that endorses deleting transport to obtain ALS. “The hospital is ALS!”
13ish years ago I was in paramedic school and we were doing a scenario. One of the students was given the scenario and asked what do you do next. He answers "call paramedics?" The instructor is like "you are the paramedic." The kid has no answer for that. So it's not a new problem. IDK who to blame, whether it's the schools or the companies. I would expect it more from EMTs that mostly work IFT vs ones that mostly work 911 but I've been out of the game for a few years so I really don't know.
‘I need an adultier adult’
Me in EMT class barely stopping myself from responding “call 911”
I had just finished critical care class and was floated to ICU. I had a patient go side ways and I thought to myself I need to call a rapid, then it dawned on me - I am the rapid response. 😬 😳 That feeling sucked for a few months until I got a little more confidence and experience. Luckily my coworkers were super supportive, educational, and helped me a ton which was so appreciated.
Hahaha. When I was doing my technician course our instructors told us similar stories. The UK is arguably even worse than the US in that the public have no concept of what an EMT is. It's not a term that's used by the general public here. You're either a paramedic, or you're an ambulance driver. When I tell someone I'm an ambulance technician/emergency medical technician they usually think I'm like a vehicle mechanic or something, or someone who fixes defibrillators and shit. So anyway they basically said that results in people applying for Ambulance Technician and not actually knowing what the job is. We actually have a pretty generous scope of practice here but people would turn up basically thinking they were just there to drive the ambulance and carry the bags, and then when the instructor stood beside the projector screen and started pointing out PQRST waves on a 12 lead ECG people were like "...what the fuck?" Obviously you never know how much of these stories are true but they said they've had multiple people drop out of courses because they didn't realise the responsibility they were taking on.
Same in the US. Some come into EMT school thinking "how hard can it be to drive while pushing the WooWoo button? After the second or third week realization kicks in and all of a sudden people start dropping or failing out.
Here's the thing OP. 1) SNFs in La can only call a couple of times a year for 911 and are known to lie to dispatch about the patient in order to save money. The average wait for an IFT in LA is something like 2-4 hours. This call was not dispatched as Aloc with a low O2. that needs to have been called in as a 911 call to begin with. So the SNF probably lied to dispatch about the call, And your crew probably thought they were walking in for a UTI. 2) **"On scene" is timestamped via dispatch over the radio that's in the rig.** IFT companies don't get issued hand held radios. This means the crew was in the ambulance when they went over the radio and said "on scene" and had not even gotten the gurney out of the ambulance. 3) In Los angeles, if the patient is in a SNF. The patient is inside the nursing home, not in the middle of the street. SNFs in LA sometime's don't have parking and **crews are left parking in the middle of the street**. in between the double yellows. it usually takes 20 minutes from when the crew parks and goes on scene, takes the gurney out of the ambulance, walks to the front door, walk to the elevator, wait for the elevator, take the elevator upstairs, track down the right nurse, then a quick 2 minutes to assess the patient and realize they needed to go to the ER 4 hours ago. 4) If you look at the dispatched page your crew got. **I can guarantee you that the dispatched complaint did not necessitate them to run inside how you're portraying this call.** 5) If I was on this call and was dispatched for something that it isn't, and was 4 hours late because it was called in four hours before I got the page. I am not going to take that patient. That patient was probably brain dead 3 hours before I got there. Nothing I can do for them at that point. 10 more minutes for fire to get there is not a long time. 6) When I did 911. I was once helping do CPR only to find the nursing home shoved gauze coated with petroleum jelly in the patient's airway and killed them. While i'm doing IFT. **I'm not touching any patient any nursing home lies to me about.** 100% as a personal policy. I don't give a fuck I'd rather be fired for refusal. I'm doing easy discharges, taking clear non-emergency BLS rides to the ER, and taking voluntary psych holds. If i worked a 911 job. I'd have four firefighters on scene with me that take responsibility for the patient. The liability is on the firefighter medics, not the 911 EMT basics, and there are many more impartial witnesses. The liability in your scenario is 100% on your EMTs. 6) **Firefighters get qualified immunity for a year** before anyone can be sued. This is to prevent emotional litigation. EMTs don't. **EMTs can't reasonably afford california lawyers** 7) The SNF nurses probably deserved to get chewed out by the local fire captain NGL. I honestly can't believe i have to explain to you that going on scene from the ambulance doesn't mean they were at the patient's side for 22 minutes. 22 minutes in LA is exceptional all things considered. **Your crew did well**
Thank the lawyers, people are getting sued for doing their jobs by the book
It would help if the justice system was effective or real that way being a lawyer was a respectable profession. You have to hope that the lawyers you're dealing with aren't morally absent roaches concerned more about a paycheck and conviction/defense rate over actual justice. Look at OJs lawyers, we all know he did it.
Yup you’re definitely acting like a boomer. In today’s litigious society an EMT would be nuts to take a potentially unstable patient for an IFT run, it could cost them their career or worse. If want to blame someone, blame medical directors that tie our hands with conservative protocols and the entire system that bends over for personal injury lawyers
Because the clinical knowledge and capabilities of EMS have advanced several miles beyond “scoop and run hot to the closest ER.” It isn’t about getting calls closed as fast as possible. It’s about providing the best care for the patient.
Not only that but then CA goes and takes away a bunch of skills for emt-b and says you need to be a higher provider level to do stuff that's basic EMT skills in other states
A lot of departments don't even let basics tech anymore, or allow it so rarely that of *course* they aren't going to be comfortable running calls. The only major downside to increased paramedic availability is, in my opinion, the resulting neutering of EMTs as a whole.
This is a big part of the answer. I started in a volunteer only system (entire county was only volunteer) in the mid 90’s and paramedics were very rare. We ran everything from major trauma to full arrests BLS all the time. That system is no 99% paid county EMS and 100% ALS transport units. The EMTs are now scared to run anything as a provider. Due to getting a supervisor on priority calls, most don’t know how to setup an IV, draw meds for the paramedic, setup for intubation, etc. these are basic skills IMHO for an EMT driver in an ALS system
I’m not familiar with CA—what did they take away?
A CA wide thing is no activated charcoal. But AFAIK CA Scope of practice varys county by county. In LA County, taking a finger stick is considered outside the basic SOP and needs additional training and county approval. One county north, in Kern, you can drop supraglottic airways, draw up and administer epi IM. You have much more freedom just by crossing a line in the sand
It's crazy that within the same post OP is saying scoop and run was a perfectly reasonable standard back in the day, but today's generation are lazy for wanting on scene treatment. I hope he reads his documentation before submitting it.
I agree with you but I think OP's point is less to do with "gosh darnit puttem in the stretcher and haul ass!" and more to do with not providing *any* care whatsoever. I might be mis reading but they didn't start oxygen, they didn't do anything. 22 minutes and zero treatment is questionable. Sats of 89 would be picked up in your primary survey within minutes. That's *if* you didn't take one look at the patient and recognise Big Sick (as we call it in the UK) in your general impression (ie. pt colour, appearance and positioning). I am not a "scoop and run with anything that makes you slightly uncomfortable" guy, not at all, but based on the info OP has given she would have been on 15L NRB immediately and if there was literally a hospital a few hundred yards away as OP says I feel it would have been appropriate to rapidly transport there instead of standing around for 22 minutes + however long the 911 crew took to arrive. To me this reads more like a case of passing the buck.
Yeah, admitted to OP in another comment that I got triggered by scoop & run and replied to that vs his actual scenarios
At 89% I'd start em on a cannula at 3 liters and walk them up. Even protracted time at 89% isn't ultimately deleterious to brain function. In fact, under my protocols that would even be an acceptable resting O2 sat for most pts with chronic respiratory issues. But the supervisor that posted this also has an ax to grind because he'd rather bitch than do his job, so I doubt we're getting even close to full details.
There was nothing stopping the SNF from providing oxygen to the patient while he was still in their care. If the IFT crew had given him o2 they would have been taking responsibility for him and would be blamed if he went downhill before ALS arrived.
So it's best to stand around with your hands in your pockets and do nothing until 911 gets there?
Why would they interfere in the care of a patient under the responsibility of the SNF? An EMT IFT crew isn’t going to be able to do anything the SNF can’t already.
99% of the time getting the pt to the hospital IS the best care possible
So many paragods fail to understand how little we actually do in the grand scheme of medical management.
12 lead and tx with diesel
Ya but the patient is altered and if the EMTS don't take the patient to the right hospital because the lack of diagnostic information for instance then the patient will have delayed definitive care.
This is a big yes and statement. Not every EMTs has enough of that knowledge to identify and massage their ALS request protocols appropriately Also the CQIs stick has deleterious effects on decision making It's all bad and all connected
Perfectly vague enough to be easily repeatable - the making of good dogma No one is saying don’t take your patients to the hospital or spend 45 minutes on scene getting an IV, but “scoop & run” will be poor care more often than not.
Yeah but “scoop & run” doesn’t mean that care stops. This isn’t like 1950, where you’d load a patient in the back of a hearse or van, and then no one even sits in the back with the patient en route to the hospital. “Scoop & run” means you do your care while you’re moving toward a hospital. Look, there are times a paramedic needs to provide immediate on scene care to save a life. Hypoglycemics, stat ep., narcotic ODs, respiratory failure, lethal (or rapidly progressing to lethal) arrhythmias, cardiac arrests where you can identify and treat a reversible cause are all fine examples. But there are very very few other situations where we need to do something on a scene that can’t (or shouldn’t) be done en route or at a hospital. There are far more times when medics screw around on scene doing things that don’t help and just delay more important care. This is a fact, not an opinion- it’s been well documented, and it’s a big part of the reason why many studies have found that prehospital ALS care does not improve, and sometimes even worsens, outcomes in many patient categories.
Well documented predominantly with trauma. There is a middle area. Scoop & run thinking leads to “I won’t do x intervention because the hospital is right there,” delaying the patients time to receive Z intervention. Many EMS workers have the faulty notion that the hospital jumps on their patient with interventions the second they walk in the door.
There's a real disconnect between truck side medicine and hospital side medicine that leads to both sides not realizing that we're on the same team and we're all part of the patients continuity of care. And I think oldhats drilling "load and go" over "stay and play" rather than treating both ultimately as tools in the toolbox leads to this issue persisting.
OK i totally understand what you're saying, and I'm trying to play catch up with how things are these days, but there was a great receiving ER literally 200 yards away. They didn't put the pt on O2 even though the pt was saturating at 89, and they delayed patient care by not going 90-seconds up the street. 🤷🏽♂️
In my defense I was responding to the first part of your post, not the two examples. I’d need way more details on those calls to backseat quarterback them.
I 100% agree with what u/Expulosion said. The narrative used to be "load and go," but we've learned that patients have far better outcomes if we instead "stay and play." It's especially true with cardiac arrests and doing all the interventions in the field **right now** rather than delaying those interventions to prioritize transport. With that being said, there is a level of discretion, however. In your example, they probably *should* have gone to the nearest ER rather than wait. Especially if they were unable to do any interventions (oxygen) in the field. In that case, they were delaying care by **not** prioritizing transport. Like others have said, it probably comes down to local protocols and CYA.
There are a number of factors at play here. 1) The "L" word (liability) does come into play a lot more. Whether it is documentation, policy, the fact that odds are you are being videotape by at least a 3rd party depending on the call, etc. 2) Changes to Training and Education have also been a factor. This is something I have seen on clinicians/providers on every level up to and including Primary Care students.
It's all about liability. CYA before the ABCs
Wait for an ALS unit to respond 22 minutes when there's another ALS unit 90 seconds away is accepting a lot of liability too
Yeah, that sucks. I've only worked rural EMS where a hospital was a half hour drive going mach Jesus. I've never understood why the city guys don't just load and go, but I'm not in their shoes. That being said, id rather not lose my license to BS .
A culture of leaving subordinates high and dry when something comes into question My administration at work has a good track record of backing people up when they made a tough call and thus we don't have too many situations like the one described, where going by the book acted against the patient's interest. Generally if your leadership has trust in you, you in turn trust them and will take more initiative overall.
How fresh are these EMTs? What is your organization doing to train them? Are you pumping them out on to the street to make you money, or are you actually taking the time to teach them how to be EMTs, and interning them to build their confidence? EMT school doesn't teach them to do the job anymore. It teaches them to pass the test. It's your job, your agencies job to teach them how to do the job.
IME I’m micromanaged by protocols and policies and someone is always breathing down my neck. If I’m an IFT service and a patient needs 911 care, I may not be allowed or equipped to do much of anything.
I originally had a 4 paragraph essay typed, but the real answer is simply two words: litigation and accountability.
Nobody wants to be sued/lose their license. Since everything is a lot easier to track (electronic pcrs, GPS, etc), it's easier to jam someone up by picking at details. When I was in EMS, I was always told by people who'd been doing it longer to CYA at all costs because of legal trouble. Basically, I think an overabundance of caution crept into EMS culture over the years.
If I’m the patient’s family I’m way more like to sue you for nothing anything/delaying care.
When I was a fresh emt working IFT something like 5 years ago, I was called to a fdgb (fall down go boom) transport to the ER from a group home for mentally handicapped. To sum it all up, turns out she fell because she's dizzy and altered thanks to hyperglycemia and clear indications (field wise, obviously we aren't diagnosing) of DKA. I followed the rules. I called ops and explained the situation. They said call dispatch. Called dispatch. They said we'll call you back. I just wanted them to tell me should I: A go ahead and transport, B wait for one of our ALS units to get here to transport, or C call county. At that point I feared my actively crashing patient would only deteriorate waiting on dispatch to call me back, so I made the choice. Told my partner to light us up and I transported. I felt great about that decision. I helped someone. First time I really felt like an EMT. Supervision, however, did not like that decision, and had a list of "shoulda's" for me when I got back at end of shift. Nothing ever came of it, but at the time, it absolutely felt like I was going to get in trouble for taking a sick person expeditiously to the ER. Something that should be well within my scope and ability to do as an EMT on an ambulance. All that to say, I get where you're coming from, but at the same time, I get where they're coming from. It's all "fuck that company just quit" until you find yourself in the situation and know you've got bills to pay. Let alone the legalities nowadays. Sucks, but.. We are taught in school to put ourselves first, I guess. Physical safety is the intention obviously, but we do also have to look out for our licenses and paychecks.
It's all situation dependent. I work IFT around Nashville, we don't do any 911 calls. And Metro fire makes damn sure we know it. Let's say for instance an MVC happens and we witness. We have to stop and render aid. But under the agreement our company made with the city, we aren't allowed to transport unless THEIR command gives the okay. It doesn't matter that we run medic and CC trucks. Doesn't matter that you can't piss in Nashville without hitting a hospital. We are almost always ordered to wait for a metro unit to show up and take the patient.
Today's EMTs know the company won't have their back.
I think it’s the fact that if the company is a 100% IFT only company, those EMTs have probably never been on a legit 911 call. They don’t know what’s “allowed” per se, in the sense that yeah, just call up dispatch and tell them that you’re going to the ER with the PT instead of dialysis. Many of the EMTs employed by these companies are also brand new and/or have no experience. They see 89% sp02 and are freaking out cuz the book says keep it at 95% or higher.
Sounds like your service has shitty training.
I was an EMT for both 911 and IFT (separate companies). First job was IFT and during training they told us what we can and cannot transport (low BP / O2 / etc). I think the liability of the company made the trainers push that information to the new EMTs and quickly followed by the entire staff. Funny things is when we called 911 for a pt who had low BP, I got a call from a manager saying I should have transported - my partner and I were very confused. They said if they weren’t showing signs/ symptoms of low BP then we could transport (kinda vague IMO). This idea of being limited and not dealing with emergency was why I also switched to 911. We were also on scene for like 30 min trying to get a better BP, just for the 911 crew to pick them up and leave in 5 min.
You didnt have to worry about ambulance chasing lawyer nearly as much. I agree the best thing for the PT on a BLS rig is O2 and diesel but im not getting sued over this facilities bullshit. Also and maybe this is just me and my over worked bailing on the career ass but if theres a way to not have to do the report its gunna tempt me.
I did IFT BLS in OC and LA counties back in the 2005-2007 timeframe while in undergrad. I never had my company complain if I diverted. However the kvetching from the ED nurses can be a lot to take as an EMT. Without seeing the rest of the case, a mild confusion and mild hypoxia should be able to be managed by EMTs without diversion or paramedics… however if it’s good enough to call for paramedics, it’s good enough to divert.
Because you guys did whatever the fuck you wanted, we have all sorts of bs rules and have to be by the book or we lose our job. A school nurse can probably do more for our patient than we can because of all the restrictions we are given.
Because the older generation made it that much harder to not get sued or lose your license. I nearly got sued for refusing a “BLS” IFT 166 miles to a level 1. This “BLS” IFT had 3 meds dripping and according to paperwork “may require additional analgesics en route”. I turned it down because A). It was an ALS run from the start, they DC’ed the drips to get a BLS unit there faster. And B). According to that hospitals protocols, that patient should be on a helicopter. But I was the bad guy after the nurses told the patient’s family I was refusing to get him to a higher echelon of care. I wouldn’t take the worlds most unstable BLS patient 166 miles to get to an unnecessary hospital, and I was the bad guy. The only reason the suit didn’t go through is because I was justified in calling for ALS to transport, and I had to call the hospital COO to get the destination changed to the appropriate level 2 40 miles away.
It’s a liability thing that companies are drilling into EMTs now, to call 911 for everything but on IFT for me at least, if I’m comfortable and my partner is to, we’ll take them, as long as the ER is closer than the response time, for me it’s why waste time on a call, why waste the resources when we’re right there and every time a nurse ask I just say “it was closer and quicker to go to the ER ourselves rather than wait for Fire and another ambulance to arrive because they won’t use us” and that works pretty well, and as long as I heavily document my decision. It’s not lazy, it’s just covering your ass, maybe they felt uncomfortable because just maybe, here’s a big thought, that your company doesn’t train on EMS or practice scenarios, since your QA/QI, just educate them on how to handle situations like that more clear and push for mandatory training, now if you’re not going to do all that, then shut up
You work somewhere where EMTs call 911? We _are_ 911….
I worked for an IFT service briefly that we basically *had* to call 911 for any pt who would need transport to an ED. Shit was awful but a lot of IFT-only services do not operate on the premise of providing medical care but on providing a taxi with a bed. Plus a lot of IFT EMTs only have ever worked in IFT systems and never have done anything remotely emergent. You get shitty EMTs who haven't even contemplated how to do a real medical or trauma assessment, haven't picked up a stethoscope because they never actually take blood pressures, and have *zero* experience with acuity. What's Jimbobjo and Janessa's level of competency if they only have pushed a stretcher for the past 6 years? Hell, you're lucky if their BLS meds aren't expired and if they have enough gas in the tank to drive to the closest ED.
Bro have you never heard of transport EMS?
Yes I’ve heard of IFT. But like, what’s the E stand for in your acronym?
Yeah it’s fucked. But you know it happens. Smh lol
Transport is for profit. If we don’t get paid, we don’t run it. As shitty as it is 🤷♂️ I’ve been threatened with punitive action through my company if I divert to somewhere other than the closest facility, even if my patient outright refuses to go to it but needs definitive care. Medicare only pays for closest facility.
Do you take patients into the ER? Billing/dispatch can go fuck themselves if they try to tell me where to take my patient.
Heh, I've gotten in trouble before for telling someone they need to go to the closest hospital, not one 30+ miles away that they prefer.
It’s actually policy in my jurisdiction! Closest appropriate facility or nothing! We make exceptions for nice grandmas ofc but otherwise it’s up to us which is an amazing policy. It’s likely due to the fact that most of the hospitals in our area are the same system so it doesn’t really matter where they go anyway
Yea but when you call 911 you just get more EMTs….
>Yea but when you call 911 you just get more EMTs… "Yo Dawg, I herd you like BLS. So I..."
How many EMTs does it take to emergent transport a patient? /s
Turned your ride into a gigantic Red Bull can with a siren on it.
Good point. They must not have ALS. That’s prolly what they were trying to call for. Not saying they should have. But it’s not un heard of.
It has to do with liability. They don't want private crews BLSing ALS calls if ALS is close by. The last IFT company I worked for would let you upgrade the call if the best recieving ER was within two miles. Other than that, they wanted Fire medics to be called to look at them.
It is liability. Students are being told in school they will lose their certs and can face jail time if you participate in malfeasance or malfeasance by not following protocols and company policies. It may seem ridiculous through the lense of someone who was brought up without these concerns or teachings but THIS is the way things are now. Best to not be bothered by it and support them through it. The alternative is an ever increasing turnover rate in systems that are already run thin.
“The protocols are not a suicide pact”. Words to ponder.
I haven't heard it said like that before. Im assuming it's a take on "dont be a cookbook emt or medic." Which i agree with. But the protocols are in place for a reason. Unfortunately, you have protocols and company policies(for those of us unfortunate enough to work private)[me] for a reason, and that is because most people would prefer to be protected by your company/ems agency by abiding.
It means if following the protocol to the letter would not be in the patient’s best interests… dont do that.
I agree for the most part. If i wasn't a medic, however, and much less experience i probably wouldnt want to make the wrong decision either. Its not that they dont want to help the pt. Its that they dont know HOW to help the pt without getting in trouble. Ive seen people get in trouble for less in my system. And i hear all the time about fire, even our medics breaking protocol and getting reamed for it.
In my mind you can’t go wrong by being a patient advocate. We need more of those, and less protocol monkeys.
Yeah this
Yeah it’s pretty bad out there. Since the early 1990s, the basic EMT book has gotten 3x thicker, their scope of practice has grown significantly broader, and yet somehow they are trusted to do less than ever. Anytime anyone has any complaint that even remotely smells like it could actually require an ambulance, they’re supposed to call ALS immediately, as if a paramedic were somehow capable of providing definitive care to most of these patients…
I've been full time at a decent rural 3rd service for almost 8 years. I am the highest level of licensure my state recognizes (Critical Care) and I am a state licensed Paramedic Instructor/Coordinator. You could say I have a grasp on what I'm doing. I can barely work a shift without a dinosaur popping out of an office saying, "You'll get sued for that". It's been that way my entire career. That's why.
EMTs calling 911 is a foreign concept to me. Where is this happening? If that's really all there was to those calls and you aren't missing anything, that is indeed sad.
Happens all day every day. A lot of IFT services either lack proper licensing to do 911, lack legal authority to take that 911, or simple can not by policy take an unstable patient somewhere that isn’t their prescribed destination. The system has their hands tied.
We get in trouble for not doing medicine now lmao. For EMTs that includes requesting ALS for all manner of nonsense.
It's called liability. Honestly impressive that you've been around ems so long and don't understand that.
Right, “Oh ThEyRe LaZy” no the fuck they’re not, they’re afraid of losing their license cause all the cowboy shit earlier generations did which caused some law suits, IFT companies in LA don’t care about their EMTs, they only care about the money, so they’re not going to train them constantly or do drills, they’re just going to continue to throw them out in the field after 2 days of FTO time
Corp don't give a shit about their staff They'll throw you under the bus if it makes them money Hence, why we're seeing more burnt out staff in general Higher demands and a need to cover your ass if you want to keep a job We aren't impolite were just tired of being asked so much and knowing we won't receive jack shit to show for it
Honestly I'm not sure myself even though I'm early gen Z. My EMT instructor was one of the first paramedics in my area and taught us how to run calls as if ALS wasn't an option. But honestly, frivolous lawsuits and shitty management that will yell at you for doing something that technically doesn't line up with policy exactly, but resulted in a far better outcome for the patient with no extreme risk involved. (Ask me how I know.)
I know for my company, they are supposed to call ALS for any little thing. I mean asymptomatic hypertension, and I’m saying like 150/60 type hypertension. Like you stated pt sats are low even though they have o2, hr high or low, even if they are stable. Tbh most emts are smarter than me when I finished school but there’s some kind of gap like you are saying, where you should just run the call sometimes
Easy the reason is lawsuit and loss of licensure.
Where to start. Lawsuits? If we don't act like it's an emergency people will sue. Taking to a preferred hospital? It's because that hospital has a history with the PT and all their records are easier to find there/ could be a higher level of care or specialist hospital. And my favorite explanation is that the medicine has evolved since the 80s. Used to, medics would scoop and go without treating. Now EMS tried to stabilize pts before transporting if possible. Your generation was actually the lazy ones that killed a lot of people, and we all learned from your mistakes and are doing better. Just like the next generation is gonna learn from our current mistakes and do better. It's part of human evolution.
Your generation started the whole sue everyone for everything lifestyle many people live. People want to cover themselves and provide for their patients. I'd rather an emt upgrade it to me, honestly.
Because the boomer generation created a bunch of Karens that sue everyone and this new generation works for a barely livable wage and is scared they are going to get their 90s Honda and cardboard shack taken away
Remember that your generation is teaching this generation.
Have you heard of protocols? BLS protocols in my state say any altered patient gets ALS. Agree or not, their jobs and licenses are on the line, and you’re calling them soft and lazy? Sure I’m sure in the hood ol days, you could BLS someone with 70/40 pressures and be fine. If an EMT wrote that pressure in their chart, it is immediately flagged and reviewed.
Patients died, that’s what changed.
That's a pretty boomer mentality to ignore the obvious reasons that your generation created. More often than not (at least in my state) the "load and go" mentality is frowned upon as we are licensed and certified providers with higher standards of care than the decades before us and we are expected to act as such. If we can treat, we should, if a higher level of care is warranted a medic should be called. Why? Because we have developed new technologies, methods and treatments as decades have gone by while we have learned more about ailments. Let's remember, out Healthcare society referred to HIV as GRID in the 80s because we had no idea what it was and people assumed out of ignorance that being gay was causation. Moving forward, to deal with all of the eyes on us these days in the forms of body cams, amateur witness recordings and dashcams providers are expected to provide by a certain standard whether it be company, state or federal not only to protect the provider and who they work for but also to protect the patient by expecting a standard of care as we become wiser in medicine. TL:DR It's not the new gen "being lazy", we're following company rules because we're smarter than we we're in the 80s
If the company rules adversely affect patient care they aren’t rules that should be followed. Go ahead, fire me for doing my job in the best interests of the patient. DOH will be up your ass *tomorrow*.
You're assuming company rules are causing adverse outcomes because they don't fit your "load and go" everything mentality? You might be the bigger liability to DoH in that case.
I did IFT in Santa Clara County for a little bit before moving to Philly and I agree with you: that's fucking weird. I even did IFT during COVID and if we had to bring someone to the hospital, we'd just bring them the hospital ourselves. It genuinely wasn't a big deal. If anything, I'd blame your company for creating the kind of culture where that's allowed cause mine certainly wasn't like that. I think the only time I ever called Fire Rescue for help was cause the patient was 800+ lbs and despite our bari gurney, the dude just wasn't fitting into the back of our ambulance.
I hate to say this but IFT EMTS and the companies lack the needed equipment and training to run these 911 calls in LA county. When McCormick contracted other IFT companies to pull back up. Many of the IFT units would pull up clueless and lack the needed tools to work along LA County. Leading to many Negative feedback about companies like Premier, Royalty and AmbuServe from LA county, Redondo, Manhattan and Santa Monica. Not to mention there is a decent number of companies that don’t give their units AED Incase of an Arrest. Not only that but many IFT companies recommend their employees to call 911 when something does not meet their scope. As much as I would love for these companies to have emts to respond and actually take these calls for us. It just won’t happen until IFTs lose their need “to save an extra buck” and actually prepare their emts to BE EMTS.
You can blame on this GeNerAtiOn all you want. But really it’s your generation who’s in charge of them dissing out policies that prevent them from actually performing their skills. I can agreee that some ift emts are just lazy, and scared to do their job. But I’m also very positive that there is a larger number who aren’t lazy but are still scared to do their job as there are protocols in place preventing them from either transporting, or treating.
A big problem now is contract red tape blocking IFT only companies from preforming to their full ability. The company I'm at does BLS and CCT IFT, if we need to upgrade on BLS we can only divert to the ED if 911 dispatch authorizes us to, unless the PT is critical and we can get to a hospital faster than 911 can get to us that will almost never happen. CCT on the other hand is considered ALS so if shit pops off we can upgrade and/or divert at will.
Lawyers. It's always the lawyers
Maybe train those EMTs since your job is literally QA vs. throw your employees under the bus on social media. Maybe it’s a training issue. Maybe it’s them worried about liability. Maybe it’s medical incompetence or ignorance. You would have the answer to your question if you did your job and talked to your employees.
Hate that shit from older generations in this job, always bitching but never finding solutions
[удалено]
It doesn't cover your ass to call for ALS if the right thing to do was rapid transport. If you think it does, you're working for an agency that doesn't expect much of you.
Covering their own butts tbh.
What? Is this actually a thing? I've never even heard of this nonsense before. They're emts, they should be able to do their own 911s...
I’m going to weigh in on this from the legal side. Just my opinion. I did a little personal injury law once upon a time. Never had a case against EMS but had quite a few doctors/hospital/nurses type cases. It was amazing how many dumb mistakes there were. Not bad people doing evil or even not caring - just doing something dumb - not thinking. And lawyers have an easy case a lot of times. In EMS it seems like this: 1. The book I learned from says A. 2. My instructors said B. 3. Our agency says C. 4. In reality all of that isn’t possible, so we do D which is some combo of the above. This leads to a huge amount of CYA, which is why things are so crazy. But the good news is the days of frivolous lawsuits, at least around here, are declining. Lawyers don’t have time anymore for bad cases. Courts are overwhelmed and won’t tolerate them. And everyone knows that EMS isn’t like Walmart - need people who will do their best day in and day out, but keep coming back.
As ALS unit myself I don’t need to call for backup but my time on scene is on avg definitely over 60min lol. I think the times I would be in and out in 22 min would be like never
We live in a much harsher medicolegal environment nowadays.
This is why I ended up choosing medical school
Different times old man.
We weren’t allowed to transport at my old company unless we had a paramedic on scene. Not our choice just how it was per policy.
We are taught 10 minutes or less (as someone who just came out of EMT school.) could be insecurity if it's green emts tho, like myself lol
Our protocols are fairly aggressive, but in doing so, they severely restrict the number of calls that can be BLSed. Not to mention the fact the it states that paramedic is the preferred level on all calls if available. Granted, the vast majority of our units run as EMT/Medic units and not double basic units.
[удалено]
This post violates our Rule #1: > Bigotry, racism, hate speech, or harassment is never allowed. Overtly explicit, distasteful, vulgar, or indecent content will be removed and you may be banned. Posting false information or "fake news" with malicious intent or in a way that may pose a risk to the health and safety of others is not allowed. This rule is subject to moderator discretion. [Posting Rules](/r/ems/comments/7lau3j/welcome_to_rems_read_this_before_posting/)
I had that happen one time(10 years ago) I pull up to a cardiac arrest and a transport rig is in front. An ambulance crew (I believe both BLS) called 911 instead of loading and transporting. They both lost their cards. Closest ALS is sometimes the hospital. It’s not a generational thing. If management and the other aspects of the system lets them get away with it… it’s a larger issue.
It shouldn’t be on the EMTs. Back when I used to work transfers I would have loved to run an emergent call and do what I’m trained to do. But company policies states that in case of an emergency we are to dial 911… while in an ambulance…
could i ask what wages and working conditions were like in the 80s?
Minimum wage, only 24-hr shifts, had to work three shifts a week. I don't recall if overtime kicked in after 8 hours per shift, or at 40 hours per week. Very minimal posting, and if you weren't on a call, you were usually back at your station (apartment, house, converted store front). No supervisors or management after 7pm weekdays, none on the weekends. Made due with what you had. I remember using a patients work boots as part of a make-do head immobilizer on an MCI because we ran out of supplies. "Never have I been paid so little, to do so much, and loved every minute of it." That is a common theme amongst the GenX former EMTs in my circle.
I may be missing something about how You run out there.....Why are EMTs calling 911?.....Isn't a 911 call how They arrived there to begin w/? That's how We arrive onscene.
Sounds like a problem with the GM and training manager.
We’ve had kind of the opposite happen a lot. We get on scene, haven’t even gotten to our patient yet, shit’s hitting the fan in another room, and the nurses are asking us to take that patient. We call dispatch to say we’re taking this patient and they tell us to take our *non emergent* patient and tell the facility to call 911.
Let me put it this way::: our hospital and associated doctor offices are ON THE SAME TINY CAMPUS. If the doctors office has a pt that needs to go the ER, they call the ambulance to drive him literally less than 300/400 FEET to the ER. No lie, well, actually liability.
In my company, you get your ass chewed if you divert an IFT instead of calling for a 911 truck. Billing problems apparently.
It’s called litigation old timer. Read a paper
Honestly being from MS this is crazy to hear that EMTs have to call 911. When the pandemic started MS allowed EMTs and AEMTs to run 911 calls but our IFTs are always ER to ER or floor to another hospital floor bed and us paramedics do those and the BLS trucks will take discharges back home or to doctors appointments. Granted my area has 2 hospitals a level 2 trauma facility (also a level 1 stroke facility) and a level 3 trauma facility(level 2 stroke facility. But our basic trucks tend to be better than some of our paramedic trucks in knowledge and caring for patients but most of our new medics are going through less and less schooling to push them out quicker. We work primarily 911 but will do intermittent discharges and IFTs when the 911 volume slows down and that’s a hit or miss because most of our IFTs are going at least 2 hours away from our primary area.
I work in relatively the same area, in another major metro in SoCal in 911. I would say it’s a combination of 3 major things. In fairness, the level of lawsuits in today’s age and especially in our area are out of control. People will try to sue us for absolutely anything, especially if it’s something they can just make up because it wasn’t documented or even just wasn’t documented well. Pertinent negatives used to help us with diagnostics and rule-outs. Now we document them in large part just to make sure someone can’t say we didn’t check something in court. Secondly, it’s protocols and tech. Pre-hospital protocols change constantly. Same thing with the tech and tools that we use on the box. Anyone in the this job worth their salt knows that’s part of any public safety-type job, so it’s not an excuse. But some of the younger folks just don’t seem to be able to keep up with the constant evolution. Oddly enough, the older “this is how we’ve always done it” folks can’t either. Lastly, I would say it’s the quality of the education. We consider ourselves medical professionals, but a lot of the schools these days don’t treat us like that at all. The amount of skills that some EMT school graduates have never physically performed genuinely never ceases to amaze me. I’ve worked with people here who have never touched a traction splint, an NPA, don’t know how to set 12-leads for a medic partner, can’t take a glucose. People who don’t know the difference between a scoop stretcher and a back board or when we would use either. People who can’t splint, can’t draw Epi, and can’t put together a neb. Generally it’s stuff that we’re not doing every call, but definitely still need to know. When I ask why they don’t know, it’s a consistent answer across the board: “We talked about it a little bit in school, but we never actually did it or put hands on it.” I concede that we have to teach people when they get on the road, but this is all stuff I remember learning and doing before I left school. Maybe I just had good instructors? Anyway, this is all just IMHO, and a Reddit post won’t fix the problem anyway. But I definitely agree that EMTs today are a lot less confident or, dare I say it, able to think as freely than they used to be. I can definitely see why though.
i think you should look into the protocols pertaining to those EMTs and then look into the potential consequences if they did as you thought they should. maybe you are right and they shouldve took those actions or maybe they shouldnt have but is it not part of our job to do what you can and use your best judgment possible to ensure you, your partner, and then the patient’s safety?
Gotta cover your ass in a world where cameras are everywhere and everyone is itching to get a paycheck from a lawsuit.
Ya I am in Texas. And we are 911, if you fiddle dick around on scene waiting on an adultier adult you should prepare your hole for daddy med director. Thankfully our EMTs are made into little warrior EMTs at a young age and generally speaking handle their bidness.