A LMRFD firefighter brought up the fact I complain that the majority of the LMRFD firefighters live in other towns, and only one LMRFD firefighter lives in the fire district. That's TRUE....
I complain about not having firefighters living here because like the major rain storm we had about a year ago that closed Pierce Ferry Road, firefighters from Meadview were unable to make it to a call near Dolan Springs we are left unprotected and alone.
If a major disaster closed US-93 we would be left with the two firefighters on duty to cover the 144 square mile fire district as well as the 2200 square miles the ambulance covers.
The term "volunteer" contrasts with career firefighters who are fully compensated for their services. In fact the majority of fire departments in the United States are volunteer. Of the total 29,727 fire departments in the country, 19,762 are all volunteer; 5,421 are mostly volunteer; 1,893 are mostly career; and 2,651 are all career
LMRFD firefighters paramedics are paid around $700.00 per shift.(plus the cost of benefits).. I donate my time to help the town of Chloride. So I'm sorry, I suppose the LMRFD firefighter who complained that I volunteer for Chloride would also like me to stop volunteering for the Red Cross. I guess he thinks all of us who GIVE out time and energy should just stop helping our neighbors.
I'm SORRY but helping neighbors helping neighbors is what makes living in a small town all about, and what makes America great.
I guess he thinks all the volunteer firefighters and Red Cross volunteers who selflessly leave their homes and families at personal risk to help others in neighboring communities and states should just stop. Sorry but it's what I've always done and will continue to do.
For someone who comes to our community for profit to belittle anyone who volunteers hours of their time and energy to obtain the required training to help others should tell you something about that person....
Monday, October 30, 2017
How Many People Are Interested in the LMRFD's Problems and Potential Liability
Apparently 2,602 People this month alone.... almost 15,000 in the last two years
Sunday, October 29, 2017
I Was Asked How Many Fires I Had Responded To For NACFD?
The answer is NONE. Why? Because I respond to fires and EMS calls in Chloride and it's been well over three years since Chloride has had a structure fire.
Why? Because NACFD teaches Chloride residents fire safety and has installed 48 smoke alarms for free. NACFD has given Chloride an AED (Automatic External Defibrillator) and trained 5% of Chloride residents in CPR AED use and first aid and giving another CPR AED training November 4th. (Sorry it's Full)
NACFD is proactive rather than reactive by training their residents in fire safety. Knowing Chloride is remote like most of the LMRFD, NACFD's fire safety, smoke alarms, CPR/AED and first aid training help residents help each other prior to the arrival of professional EMS or fire services.
Why? Because NACFD teaches Chloride residents fire safety and has installed 48 smoke alarms for free. NACFD has given Chloride an AED (Automatic External Defibrillator) and trained 5% of Chloride residents in CPR AED use and first aid and giving another CPR AED training November 4th. (Sorry it's Full)
NACFD is proactive rather than reactive by training their residents in fire safety. Knowing Chloride is remote like most of the LMRFD, NACFD's fire safety, smoke alarms, CPR/AED and first aid training help residents help each other prior to the arrival of professional EMS or fire services.
Saturday, October 28, 2017
I'll No Longer Post information on Chatter Box. The administrator Told Me My Posts Were a "Drama Magnet"
UPDATE October 29th 2017
It appears my new post simply saying "New Post on My Blog, Please Read" I put on Chatter Box this afternoon was also deleted by Chatter Box Administration.
So Please Check Here Often. I'll TRY to advise people of new posts to my blog on Chatter Box, but they may get deleted....
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Even thought only two or three people most of who don't even live in the fire district post negative comments and far more people like my posts and support the things I try to educate tax payers of the 144 square mile fire district and those in the 2200 square miles covered by the LMRFD ambulance, I was told by an administrator that my posts were a "Drama Magnet".
I was called an idiot and other names over and over, and that wasn't considered a "personal attack" Yet when I mentioned that an administrator had told me that my educational posts about the fire district were a Drama Magnet my post was deleted as a personal attack. Apparently you are not allowed to criticize the people who run Chatter Box without having your post removed. So much for free speech....
If I'm allowed to post links to my blog on Chatter Box in the future I will. Other wise please check back often for education about problems in the LMRFD that will one day cost the district millions of dollars in a lawsuit....
It appears my new post simply saying "New Post on My Blog, Please Read" I put on Chatter Box this afternoon was also deleted by Chatter Box Administration.
So Please Check Here Often. I'll TRY to advise people of new posts to my blog on Chatter Box, but they may get deleted....
......................................................................................................
Even thought only two or three people most of who don't even live in the fire district post negative comments and far more people like my posts and support the things I try to educate tax payers of the 144 square mile fire district and those in the 2200 square miles covered by the LMRFD ambulance, I was told by an administrator that my posts were a "Drama Magnet".
I was called an idiot and other names over and over, and that wasn't considered a "personal attack" Yet when I mentioned that an administrator had told me that my educational posts about the fire district were a Drama Magnet my post was deleted as a personal attack. Apparently you are not allowed to criticize the people who run Chatter Box without having your post removed. So much for free speech....
If I'm allowed to post links to my blog on Chatter Box in the future I will. Other wise please check back often for education about problems in the LMRFD that will one day cost the district millions of dollars in a lawsuit....
Failing to fully treat a sick patient is one thing. But leaving a patient behind and not treating them at all after they called 9-1-1 is complete negligence
MY NOTE
This happens all too often in the LMRFD. This isn't a something I've heard... It's what I experienced when a friend called for a ride to KRMC.. Read my blog post LMRFD Ambulance Crew Asks Sick Patient's If They Want Help To Their Car? June 18th 2017 AND the featured post on the right side of the page..
Sooner or later failing to transport a critical patient will cost the LMRFD millions of dollars in a lawsuit.... PLEASE when this happens don't let the board members tell you the tax payers that nobody told them.
LINK TO ARTICLE EMS World Web Page
The EMS World Article
This happens all too often in the LMRFD. This isn't a something I've heard... It's what I experienced when a friend called for a ride to KRMC.. Read my blog post LMRFD Ambulance Crew Asks Sick Patient's If They Want Help To Their Car? June 18th 2017 AND the featured post on the right side of the page..
Sooner or later failing to transport a critical patient will cost the LMRFD millions of dollars in a lawsuit.... PLEASE when this happens don't let the board members tell you the tax payers that nobody told them.
LINK TO ARTICLE EMS World Web Page
The EMS World Article
Failing to fully treat a sick patient is one thing. But leaving a patient behind and not treating them at all after they called 9-1-1 is complete negligence. This is one way opposing counsel might frame the argument against an EMS crew and their agency over the inappropriate handling of a patient refusal.
Patient refusals are the greatest patient care liability in EMS. Only motor vehicle accidents have a higher incidence of litigation. Patient refusals are also a universal experience which every EMS provider will have deal with.
Why Patients Refuse
When EMS responds to a call, the expectation is that we will be treating and transporting a patient. But, there will invariably be calls where the patient will not want to be transported. Patients may refuse care for a variety of reasons. Some of the most common include:
- Poor comprehension due to altered mental status.
- Not appreciating the seriousness of their condition.
- Fear.
- Financial concerns.
- Denial.
In most cases, even if the need is questionable it is preferable to transport the patient to the hospital for further medical evaluation if at all possible. There’s only so much we can check for in the street and therefore much less reassurance we can give that something bad could not happen after we leave. Notwithstanding, it’s always better to transport the patient the first time we respond rather than later when we’re called back after their condition has worsened.
Expectations
Most people have seen EMS on TV and in the movies. Their expectation is that once EMS arrives on the scene everything will be OK. Sometimes that expectation is unrealistic, but even in those hopeless cases, if we act with diligence and professionalism, most people are not only satisfied, they’re eternally grateful for our effort despite the outcome.
The importance of acting professionally cannot be overstated. While we’re not doctors and can’t give our patients all the answers or assurances a physician might, we are expected to have enough medical knowledge to effectively answer the one key question that needs to be answered—whether the patient needs to go to the hospital for further evaluation or treatment. The answer to this question in most cases will be “yes.” One obvious exception are third party calls to 9-1-1 because someone thought there was a medical emergency or injured person, when in fact there was not.
Assessment is Knowledge
The first step to take in cases where a patient has expressed an interest in refusing care is to do as complete and comprehensive an assessment as the patient will allow. At a minimum, a full set of vital signs should be taken, assuming the patient will permit it. Touching anyone who has the mental capacity to understand the risks of refusing assessment and chooses to do so is battery and carries the potential of prosecution. If the patient refuses to allow any assessment, it is critically important that this fact be documented. If the patient does permit an assessment and abnormal vital signs are discovered, this may help convince the patient to allow treatment and/or transport.
Whatever the patient’s chief complaint, if you have diagnostics available which could help you further assess them, such as an ECG for chest pain or glucometer for weakness, you should encourage the patient to permit this. As with the discovery of abnormal vital signs, an ECG which shows ischemia, a STEMI or even non-specific changes may strengthen your hand in changing the patient’s mind.
Competency to Refuse
Occasionally, despite the most legitimate need for ambulance transport and our best efforts to convince the patient to accept it, some patients will continue to refuse. If they’re mentally competent, they have that right despite the risks. One caveat here worth mentioning is that actual competency can ultimately only be determined by the courts. EMS providers evaluate the mental capacity of the patient to understand the situation and make an informed decision about their health. Since it is unrealistic to drag a judge into the street every time a patient wants to refuse care, this is where being familiar with your patient refusal protocols and knowing when medical command should be contacted is critical.
Contrary to the belief in some circles of EMS, a patient refusal—with all the liability associated with it—actually requires more documentation, not less, than most transports. The patient should be asked to sign a refusal form acknowledging that treatment and transport was offered and they refused. All cases should be documented as AMA (against medical advice) unless there is a protocol in your jurisdiction for EMS initiated refusal, which is rare (and not considered legal in many jurisdictions). There is no downside for an EMS provider to list a refusal as against the advice of EMS, but plenty of risk associated with any suggestion that the EMS providers encouraged or suggested the patient not to accept transport. If the patient refuses to sign the refusal form, document this fact and try to get a witness, preferably a police officer, to co-sign the form.
A valuable resource for patient refusals, as well as any other questionable circumstance, is online medical command. In many systems patient refusals involving any signs or symptoms of potential serious injury or illness, such as syncope, altered mental status, chest pain, shortness of breath or abnormal vital signs, are required to contact online medical command for patient refusal authorization. This adds one more safeguard and one more chance for the patient to reconsider. It also demonstrates that you went the extra mile and bumps the responsibility up to the next level in the medical chain of command.
Suicidal/Homicidal
Patients who exhibit suicidal or homicidal actions or threats, or express suicidal or homicidal ideations, are not considered competent to refuse treatment even if they meet all the other standards of competency. Police will most likely need to become involved in these cases. I would strongly caution all EMS providers to never transport a violent or potentially violent or threatening patient without proper restraints or sedation. Always maintain the safety of your crew as the highest priority.
Minors
The definition of “minor,” or the age of consent, varies from state to state. Minors are not permitted to refuse care unless they have been emancipated by the court, or are married, pregnant or serving in the military. If the parent or legal guardian is present, they may decide whether the minor should be transported or not. If a parent or guardian is not present and cannot be reached, transport the patient if the need is apparent and make sure a parent or guardian is notified as soon as possible. If the minor is ill or injured but clearly does not require hospital treatment, contact the police since the minor should not be left alone and legally can not refuse medical care. If the parent or guardian refuses transport of the minor for what you deem to be a significant illness or injury, or does not appear to be acting in the best interest of the minor, contact the police and medical command.
Power of Attorney
Other adult patients who are not deemed competent to make medical and legal decisions due to incapacitation or diminished mental capacity may sign over authority to make those decisions for them to a power of attorney (POA). In all cases of true medial emergency, these patients should be handled like any other patient. In non-emergency cases, authority to transport or refuse care is left up to the POA. If the POA is on the scene or can be reached without delay, they can advise you of their decision. If the decision is made to not transport the patient and this was communicated over the phone, you may want the POA to repeat their request to someone else on scene, preferably non-EMS personnel who can then sign the refusal form as a witness.
If the POA is not present and cannot be reached quickly, or time does not permit contacting them, the best course of action is for appropriate treatment to be rendered along with transport to the hospital pending notification of the POA.
Conclusion
The best overall course of action for handling patient refusals is to follow your local protocols. In most cases these protocols were thoughtfully developed with medical director involvement and legal consultation. Most issues arising from patient refusals are due to protocols not being followed. EMS providers should also remember to take advantage of the online medical command resource for medical guidance.
Joe Hayes, NREMT-P, is deputy chief of the Bucks County Rescue Squad in Bristol, PA, and a staff medic at Central Bucks Ambulance in Doylestown. He is the quality improvement coordinator for both of these midsize third-service agencies in northeastern Pennsylvania. He has 30 years' experience in EMS. Contact Joe at jhayes763@yahoo.com.
Some of My Training and Certifications
These are some of my training and certifications Yes most are old but are a life time of service and training...
Tuesday, October 24, 2017
My little blog is read by people all over the world
For some reason my little blog about our fire district is read by people all over the world