Social and Professional Network
Safety and Leadership in EMS??
Replies to This Discussion
-
Permalink Reply by Paula Miller on -
One of the issues that we have is that there is a home for troubled adolescents in our coverage area that has inadequate (OK, no) security and many out of control teenagers there. We are frequently called there for a variety of reasons, some medical and some behavioral. The staff there are poorly trained and have a rapid turnover rate. They do not wear name badges, and many are young (adolescent appearing) females, so it is often hard to tell who works there and who is a patient. The staff do not send the other kids to their rooms or anything when they call 911, so we are often dealing with other parties who would like to hurt the patient while we are trying to provide care. They often are misleading when they call 911, to the point where we responded for seizures and found a paranoid combative adolescent. One of our personnel was injured, and one had a bodily fluid exposure on this call. Just last week, one went out in 2 sets of cuffs and a police escort in our ambulance after injuring several staff there.
We have a policy that PD is to be dispatched there whenever we are, or we will stage until they arrive. This works with local PD (one officer at a time, some combination resulting in 80 hours of coverage a week). The other 98 hours, it is state police,who will not respond unless there is report of someone being violent. We have attempted to work with the home, contacted our attorney and our township supervisors, and gotten nowhere. Incidentally, this home is very reluctant to pay their bills as well and it is commonplace to receive payment a year later after much harrassment.
We still respond there, but what can we do when it is an emergency dispatch? Currently, we are refusing to go in until the patient is reportedly under control or the police arrive. If the police are not coming, our chief is getting on the phone and calling county control to tell them to say on the air that we will not be going in until PD is there.
I am giving information, also hoping for suggestions...
-
Permalink Reply by Skip Kirkwood on -
Difficult. Facilities like these are accountable to SOMEONE - you need to find out who, and start working with them. Perhaps it is their funding source?
If you go in, and you feel uncomfortable due to a reason that you can articulate, leave. Tell your dispatch center, whomever they are, that you can't safely proceed and will not be entering until you can safely do so.
This is an issue for your service chiefs to resolve, immediately, not one that you should be left to grapple with.
-
Permalink Reply by Warren E. Shaulis on -
Skip, This is such a topical question, it begs a response. I have been a flight paramedic/flight nurse for the last 15 plus years. I recently resigned my position over a concern I had regarding the safety of operations and the competency of a fixed wing pilot I was expected to fly with. I had concerns, which I voiced locally after some issues with this gentleman. Our local leadership agreed with me, however nothing was really done. I had a near mid air collision in july, which I wrote up and submitted, with no negative action against this pilot, shortly after (two weeks) he had another crew on board, flew into a storm with severe turbulance and caused significant injury to both medical crew members ( who were properly restrained according to company policy). They have been off work for 2 1/2 months based on injuriews sustained in this incident. The company repsone was to remove the pilot from duty for a couple days, remediate him and do a check ride, then return him to service. I refused to fly with him, and was told that I would experience disciplinary procedures if I continued to do so. I believe this is partly based on the company's profit motive and partly on the fact that the pilots are unionized and the medical crew is not. I am not a union advocate, however in this particular instance, it seems to play a part. The career that I have pursued for 15 years comes to an end, I am back working as a ground medic , and going to school for my masters in nursing, we do come full circle. But at least I am alive.
-
Permalink Reply by Paula Miller on
-
Sorry, failed to mention...I am the EMS officer...trying to figure out what to do so I can "resolve it immediately, instead of leaving others to grapple with it." LOL. It is an organization which owns multiple homes, so maybe I can find out who is the "big cheese" and deal with that person, instead of just the one in charge of this individual home. Thanks for your help.
Skip Kirkwood said:Difficult. Facilities like these are accountable to SOMEONE - you need to find out who, and start working with them. Perhaps it is their funding source?
If you go in, and you feel uncomfortable due to a reason that you can articulate, leave. Tell your dispatch center, whomever they are, that you can't safely proceed and will not be entering until you can safely do so.
This is an issue for your service chiefs to resolve, immediately, not one that you should be left to grapple with.
-
Permalink Reply by Bob Sullivan on -
In many ALS chase truck systems, paramedics have no control over who drives the ambulances they ride in the back of. The ambulance drivers (some of them are not EMTs) are only accountable to the chief of the volunteer organization that employs them. One of them got his picture in the paper a few years ago after getting his seventh (yes, seventh) DUI. Most paid EMTs and drivers work for multiple services, and often work consecutive 24 hour shifts. This is sited as a patient care and safety issue in the state EMS report every year, but nothing is done about it.
-
Permalink Reply by Paula Miller on
-
Pennsylvania has a regulation that you cannot drive an ambulance for 2 years after a DUI, however, I know someone who got ARD and escaped this a few years ago---drove as a PAID provider, no less.
-
Permalink Reply by Jeff on -
Every agency I have worked for has allowed the police to call us to "clear" people to go to jail. I have never been given any guidance or criteria on how to do this properly and I know it was not covered in the 1998 DOT Paramedic curiculum. I think this exposes the medic to an unreasonable amount of liability plus it isn't safe for the patient.
-
Permalink Reply by Justin P on -
Bob, time to involve your state's EMS office and if you get no where with them, your state legislator. The bureau of EMS in your state is responsible for dictating who can drive an ambulance, yes most states have exceptions that allow volunteer fire/ rescue folks to drive a unit if needed in an emergency but for routine practice, there should be standards/ qualifications to drive a unit.
Bob Sullivan said:In many ALS chase truck systems, paramedics have no control over who drives the ambulances they ride in the back of. The ambulance drivers (some of them are not EMTs) are only accountable to the chief of the volunteer organization that employs them. One of them got his picture in the paper a few years ago after getting his seventh (yes, seventh) DUI. Most paid EMTs and drivers work for multiple services, and often work consecutive 24 hour shifts. This is sited as a patient care and safety issue in the state EMS report every year, but nothing is done about it.
-
Permalink Reply by Skip Kirkwood on
-
Justin - coulda, shoulda, woulda --- there are more than a few states where there are no such requirements, particularly for volunteer personnel. Many are so concerned with "staying volunteer" that they will take anybody, no matter how under-qualified, just to have a body in a seat.
In those systems where paramedics from another organization have to ride in the back of somebody else's ambulance, they are often at risk from under-trained, under-supervised, and over-adrenalized drivers. And outside of legislation, there is little that a state EMS office or anyone else can do.
-
Permalink Reply by Justin P on
-
Jeff, I used to work in a corrections system as an EMT screener so I have a little background knowledge here. Each county has its own way of treating medical needs for inmates (or potential inmates) some provide intake medical screening from an EMT/LPN type some smaller areas don't have any real medical intake, they just have a nurse that sees inmates 'in the morning'. I worked in a South Florida county jail that screens all intakes for medical problems/ risks and a 'EMS clearance' was never acceptable to admit an inmate to the jail. We were required to actually have a copy of the inmates discharge summary from the ER and place it in the file. If a person was tazed, sprayed with OC spray, or injured in any fashion during arrest, they had to go to the ER first, if the Cops didn't take em' we refused to admit them to the jail until they did. As a paramedic you are not legally allowed to clear any one for anything, you are not a Doctor. When this happens to you never, I repeat NEVER tell the cops that "he's OK to go to jail." because if something happens you could be held liable for negligence. You should tell the arresting officer that you have not identified any obvious life threatening injuries but that the inmate should be medically cleared at the ER. Most agencies I have worked for had protocols that prohibited EMS from medically clearing arrestees, and LEO's know that and never called us for that, the Cops you are dealing with are lazy, they don't want to go sit at the ER for 6 hours waiting for this guy to get cleared so they are putting a lot of unnecessary liability in your court.
Jeff said:Every agency I have worked for has allowed the police to call us to "clear" people to go to jail. I have never been given any guidance or criteria on how to do this properly and I know it was not covered in the 1998 DOT Paramedic curiculum. I think this exposes the medic to an unreasonable amount of liability plus it isn't safe for the patient.
-
Permalink Reply by Skip Kirkwood on
-
Justin, again not so in every case in every place. There are plenty of places where, using approved protocols, paramedics perform "medical clearance" for jails, mental health crisis, and detox. Usually these clearances consist of nothing more than taking a history, a set of vital signs, and a couple of other simple evaluations (same as they would if done by a doc).
It is a colossal waste of time to transport people who have no apparent medical need to an ED, where they occupy a bed (often with a "sitter" or security officer) for hours, taking up space that could be used to care for sick people, in order to fulfill some administrative fantasy that people can't go to jail without the blessing of a doctor. Being tazed or sprayed with pepper are neither medical emergencies - they are the induction of discomfort through external means. (Worked once in a town where the police chief, without consulting anybody, decreed that anyone who had been tazed would be seen in the ED. Lasted about a week, until the hospital administrator and the ED director had a sit-down with the police chief. New policy forthcoming....).
Please, if you're going to offer advice in absolutes, confine it to the law and medical practice of jurisdictions of which you are absolutely certain, lest you lead your colleagues in another environment astray. There are some systems where we all work together, to save those 6 hours (in some cases many more) in the interest of public service!
-
Permalink Reply by Justin P on
-
Skip, you sir are wrong and I'm going to call you out on it. Jeff stated "I have never been given any guidance or criteria on how to do this properly and I know it was not covered in the 1998 DOT Paramedic curriculum." Therefore I am simply telling him that he should not be doing this if its not in his protocols, if he's never been trained in it and doesn't feel comfortable with it. Yes I understand that there are different protocols in different states/ regions and that in certain circumstances medics may be capable of doing this, but my response wasn't meant to decree to all EMS providers should never do this under any circumstances, just in the circumstances that Jeff outlined, I feel that its a huge liability. IF you and your folks with your deep pockets in Wake county want to pony up 3 million dollars to settle a law suit then that's yall's call, but most small agencies would go bankrupt over that.
JEMS Connect is the social and professional network for emergency medical services, EMS, paramedics, EMT, rescue squad, BLS, ALS and more.
© 2013 Created by JEMS Web Chief.
