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docB

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Yikes!

http://news.aol.com/health/article/paramedics-accused-of-molesting-patients/275005

Is this a real issue? Sure but this article is downright alarmist.

One of the most excrutiating portions:

Exactly how many of these EMTs were alleged to have committed their crimes on the job is unclear. But some of more shocking cases include:
— A Chattanooga, Tenn., EMT accused in a lawsuit of giving a 30-year-old woman an extra dose of morphine and then completely undressing her in the back of an ambulance even though her injuries were minor.
So much for gaining full exposure. Looks like if their injuries are only "minor" then you don't expose.
 

leviathan

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Yikes!

So much for gaining full exposure. Looks like if their injuries are only "minor" then you don't expose.
Heh. At first I thought you were going to defend the news article about how atricious his/her actions were. I guess they COULD have been malicious, but pushing narcotics for a patient in pain and exposing injuries doesn't sound out of the ordinary to me.
 

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EMT's in no states that I know of can give narcotics.. So that is my first problem with the article.. I agree out of 900,000 you have 129 complaints and it doesn't say how many of those were unfounded.. No profession is perfect but I think the headline is in poor taste..
 
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Nah, we gave narcs for pain.


and then I read the article......

wow
 
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docB

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EMT's in no states that I know of can give narcotics.. So that is my first problem with the article.. I agree out of 900,000 you have 129 complaints and it doesn't say how many of those were unfounded.. No profession is perfect but I think the headline is in poor taste..
The article uses EMT and paramedic interchangebly because no reporter in the history of media knows the difference.
 

howelljolly

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The article uses EMT and paramedic interchangebly because no reporter in the history of media knows the difference.
They also used the verbage "ambulance attendant", in the article.

:boom:

I guess I should be satisfied that they didn't call them Ambulance Drivers.

They mention 3-person crews as a possible deterrant to this sort of nonsense. If that were to be mandated, we will be seeing the Great EMT Shortage of 2009. They say that some states will allow sex offenders to practice as EMTs. I think we can assume that the 129 individuals in question did not overlap with those... otherwise we'd have heard about it already.

I wonder if this sort of thing happens across other medical professions, and is just not reported... or less so.

Not long ago there was a report of a whole lot of women that were molested by an OB/Gyn.
 

docB

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They also used the verbage "ambulance attendant", in the article.

:boom:

I guess I should be satisfied that they didn't call them Ambulance Drivers.

They mention 3-person crews as a possible deterrant to this sort of nonsense. If that were to be mandated, we will be seeing the Great EMT Shortage of 2009. They say that some states will allow sex offenders to practice as EMTs. I think we can assume that the 129 individuals in question did not overlap with those... otherwise we'd have heard about it already.

I wonder if this sort of thing happens across other medical professions, and is just not reported... or less so.

Not long ago there was a report of a whole lot of women that were molested by an OB/Gyn.
And that OB/GYN was turned into lots of great copy for reporters as well.

I know that AMR has looked at the possibility of putting cameras in the rigs instead of using an additional EMT. I do think that we may see 3 person crews in the future. The additional person wouldn't have to be an EMT. It could be an FR or even a totally untrained person (ie. CPR and basic scene safety, OSHA lifting, etc. but little else). On the plus side it could turn into a new entry level position for EMS. On the down side it would cost, it would change the long established partner dynamic and there would be additional risk of injury by having to have the third wheel ride in the jump seat all the time.

Just to show how complex this issue gets some in EMS HR have pointed out that disruption of the partner dynamic would be a good thing in the instances of sexual assault and harassment among partners.
 

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If three person crews becomes standard for this reason, that would really be embarrasing

(like my spelling)
 

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Not a chance of three person crews becoming standard. There will be some gnashing of teeth and moral outrage and then by the time you're watching 24hrs of "A Christmas Story" it will be largely forgotten

Also in terms of numbers don't lose sight of the fact that even though some of these cases may be very unfortunate misunderstandings or out and out malicious there are probably more examples of people who get away with sexual assault or are fired for "unspecified" reasons.
 

emedpa

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in another example paramedics were actually found to have cut someone's clothes off and tied them down with straps....
 

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The article uses EMT and paramedic interchangebly because no reporter in the history of media knows the difference.
In all fairness if you look up a paramedic's cert and see that they are an "EMT-P" it isn't that unreasonable to call them an EMT. If you really want to help keep people straight then don't have the paramedic as part of the EMT system but it's own designation, w/o the EMT-P.

Also as to the third rider question, I hope it doesn't become a mandated thing because we generally don't have the man power for it, and you get to a point where it is crazy to try to prevent any situation where someone in a position of power is alone with another person. (Imagine if every doctor, therapist, etc needed to have a third person in the room at all times.) That being said I think it is reasonable to have guidelines that you should have a third person there in situations where there is a risk of something being construed as sexual or inapropriate (rape victims, young minors, disrobing patient's of the opposite sex etc) Good thing to think about to avoid being accused of something when doing a normal exam.
 
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howelljolly

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Some state's paramedic certs are abbreviated MICP.... mobile intensive care paramedic. (thats the first level of medic, not to be confused with CCEMTP or CFP)
 
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Wow, another case about an EMT in a sexual harrasment case. Imagine that, but what's also realized sometimes is RNs, MDs, CNAs, etc are also all involved in various cases. I have watched a friend destroyed over a malicious case, so using a third rider for just observation is definitely not needed and probably will not help the issue to be quite honest. Not to mention the huge shortage that it will place on this field, and also lowering pay for those Medics and EMTs that do a good job in the field and deserve more pay than they receive already (it's sad that I see people leaving the field every day to make a decent living and be able to afford life in general, irregardless of the level of certification).
However, in some systems where you routinely have a long transport time, as in the case of one system that I know of locally, yes absolutely we need a third level of provider and I would go to argue that an EMT-Intermediate may make a great person for this. However, this is an ideal world not realistic in all probability.
 

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In all fairness if you look up a paramedic's cert and see that they are an "EMT-P" it isn't that unreasonable to call them an EMT. If you really want to help keep people straight then don't have the paramedic as part of the EMT system but it's own designation, w/o the EMT-P.

Also as to the third rider question, I hope it doesn't become a mandated thing because we generally don't have the man power for it, and you get to a point where it is crazy to try to prevent any situation where someone in a position of power is alone with another person. (Imagine if every doctor, therapist, etc needed to have a third person in the room at all times.) That being said I think it is reasonable to have guidelines that you should have a third person there in situations where there is a risk of something being construed as sexual or inapropriate (rape victims, young minors, disrobing patient's of the opposite sex etc) Good thing to think about to avoid being accused of something when doing a normal exam.
If the guidelines suggested in the National Institute of Health's "Future of Emergency Care: Emergency Medical Services at the Crossroads, document are adopted, EMTs will be divided into EMT-R (first responder), EMT, EMT-A ("advanced" which would absorb all of these silly EMT-I, EMT-C, /85, /99 titles that vary from state to state), and paramedic, as jbar suggested. When I am certified as a paramedic in a few months I don't care if people want to consider me an EMT-P I just care that they recognize that paramedics both know and can do a whole lot more than EMT-Basics or any other level of prehospital provider.

Three-person crews where the third rider is there to chaperone these apparent throngs of EMTs and paramedics so that they don't lose all self-control and molest their patients would be a huge waste of resources and essentially tells your personnel that you don't trust them right off the bat. Same with cameras; instead of just ripping apart PCRs in a deposition, lawyers will also have tapes and stopwatches ready to guess (and insinuate) what you are doing in every grainy, black-and-white frame. Terrible idea.

Of course there are cultural concerns regarding privacy and propriety when the doctor is male and the patient is, for example, a Saudi-born Muslim woman in need of a GYN exam. Atul Gawande talks a little about how this is treated by doctors in various countries in one of his books. Personally I don't know if I could do the ole' advise-the-husband-or-male-relative-to-move-the-hole-in-the-sheet-over-the-part-of-the-body-that-needs-to-be-examined routine without elevating my pressure twenty or thirty points. That's a different topic altogether, however... Point is, with regard to liability/safety concerns, EMS providers already allocate resources differently when the call presents a sensitive situation, e.g., female psych patients being transported involuntarily usually get a female tech in the back to avoid any allegations of misconduct.
 

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When I am certified as a paramedic in a few months I don't care if people want to consider me an EMT-P I just care that they recognize that paramedics both know and can do a whole lot more than EMT-Basics or any other level of prehospital provider.
You will be sadly disappointed if you expect lay people to know or care about the difference between a basic and a paramedic. See the comments about ambulance drivers.
 

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You will be sadly disappointed if you expect lay people to know or care about the difference between a basic and a paramedic. See the comments about ambulance drivers.
consider yourself lucky if a layperson assumes you're a fireman.
 

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I don't expect much from the general public in terms of knowing the difference between EMT-Bs and Paramedics. It'd be nice but I don't expect it. I do expect the media to have at least a little bit of journalistic rigor and get it closer to right. I do think it's a problem when docs and nurses don't know the difference. I recall a trauma surgeon berating an EMT-B (who for various, appropriate reasons brought in a critically ill trauma patient) for not intubating the patient. That's not cool.
 

emedpa

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consider yourself lucky if a layperson assumes you're a fireman.
now THAT is truly insulting.....I'm sure you know the difference but for those who don't:
emt-p>emt-I> emt-basic>firefigher.

also(and I will get flack for this): emt-p(dedicated ems)> firefigher/emt-p(they got the medic cert so they could run into fires....)

firefighter=lifting assistance for the most part.....

hey, I wouldn't want to run into burning buildings so I give them loads of credit for that...but when they try to do ems for the most part=scary.....
 
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leviathan

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I don't expect much from the general public in terms of knowing the difference between EMT-Bs and Paramedics. It'd be nice but I don't expect it. I do expect the media to have at least a little bit of journalistic rigor and get it closer to right. I do think it's a problem when docs and nurses don't know the difference. I recall a trauma surgeon berating an EMT-B (who for various, appropriate reasons brought in a critically ill trauma patient) for not intubating the patient. That's not cool.
Up here EVERYONE is a paramedic. We are either primary care or advanced care paramedics. It makes it a lot easier for the public to understand what is what.
 

emedpa

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Up here EVERYONE is a paramedic. We are either primary care or advanced care paramedics. It makes it a lot easier for the public to understand what is what.

what is the difference in scope between a primary care and an adv. care medic?
is is basically like our emt-intermediate vs paramedic?
 

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also(and I will get flack for this): emt-p(dedicated ems)> firefigher/emt-p(they got the medic cert so they could run into fires....)
That's a bit out of line. What about areas like Los Angeles (where you trained, if I'm not mistaken) where there are no single-function paramedics at any agency that responds to 911 calls?
 

emedpa

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That's a bit out of line. What about areas like Los Angeles (where you trained, if I'm not mistaken) where there are no single-function paramedics at any agency that responds to 911 calls?
LA CITY fire medics are firefighters in an administrative capacity only. they do not go to the fire academy or fight fire. they are designated ems units within the fire dept.

LA COUNTY medics are of variable quality and often are only 1st responders who hand off to amr as soon as they arrive on scene.

ems is one of those things that you need to do all the time to be good at. if you are mostly a firefigher( or a volunteer....) your ems skills will not be as good as someone who does only ems.
it's like flying an airplane....there is a reason all those small planes crash...they are flown by folks who are not full time pilots...they are rock stars, politicians, lawyers, etc....
 

pseudoknot

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LA CITY fire medics are firefighters in an administrative capacity only. they do not go to the fire academy or fight fire. they are designated ems units within the fire dept.
I do not believe this is correct. All firefighter/paramedics with LAFD have been to the fire academy, and they have numerous paramedic engines, so yes, they do fight fire in addition to running EMS calls. I'm pretty sure that FF/PMs do rotate in their assignments between the engine and RA, but I will have to confirm this.

edit: single-function paramedics were eliminated in LAFD in 1992, and since then all new hires have been through the fire academy:
http://www.cert-la.com/FireWatch/FireWatch-0405-Emergency-Medical-Services-EMS.pdf

My point was simply that it's inappropriate to disparage all fire-based EMS providers as inferior, when in some areas all EMS is run by the fire department. Many people in LA do go into fire because they want to do EMS.

ems is one of those things that you need to do all the time to be good at. if you are mostly a firefigher( or a volunteer....) your ems skills will not be as good as someone who does only ems.
it's like flying an airplane....there is a reason all those small planes crash...they are flown by folks who are not full time pilots...they are rock stars, politicians, lawyers, etc....
Possibly. This is a somewhat specious argument here since fires make up only 10-20% of the call volume at most fire departments in the west coast. If you are a firefighter/paramedic in LA, you're mostly a medic and only occasionally a firefighter.

As for small planes, my understanding is that a lot of this is due to the aircraft themselves being inherently less safe, but I'm sure full time pilots are more competent.
 
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Theres some big city..... Philly, PA...I think.... where the FFs are all Medics, and its basically a punishment to be assigned to the ambulance for a particular shift. Anyone who's late, slow, tired, argumentative.... etc....

But what I didnt understand by emedpa's comment...
Are you saying that the FFs can not enter a structure fire unless they are crosstrained as a Medic? If they are only FF they are restricted to working outside the structure?
 

emedpa

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Theres some big city..... Philly, PA...I think.... where the FFs are all Medics, and its basically a punishment to be assigned to the ambulance for a particular shift. Anyone who's late, slow, tired, argumentative.... etc....

But what I didnt understand by emedpa's comment...
Are you saying that the FFs can not enter a structure fire unless they are crosstrained as a Medic? If they are only FF they are restricted to working outside the structure?

I worked in philadelphia as a civilian/non-ff/non volunteer for 3 yrs while in grad school. ems there is the worst I have ever seen anywhere....and that's saying a lot....

regarding the 2nd part of your post: there are places that require all ff to be medics(la county for example) so you have folks who really just want to fight fire going to medic school because they have to, not because they want to. it shows in the way they practice. there are some good ff medics out there but I would say they are the exsception and not the rule and if given a random choice of ff/medic vs civilian dedicated ems medic to take care of myself or my family I would decide against the fire medic every day....

pseudoknot said:
single-function paramedics were eliminated in LAFD in 1992, and since then all new hires have been through the fire academy:
http://www.cert-la.com/FireWatch/Fir...rvices-EMS.pdf

that's a damn shame.....I haven't worked in la since then so was unaware of the change. thanks for the update...
 

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Philly does not have firefighter/medics. The state of Florida does.

I just wish the medical community knew the difference between BLS and ALS ambulances. I had the explain the difference to my friend, a neurologist.

I guess gyn docs, psych and peds could excellent specialties for sex fiends/MDs
 
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As for small planes, my understanding is that a lot of this is due to the aircraft themselves being inherently less safe, but I'm sure full time pilots are more competent.
This is slightly off-topic, but small plane crashes are mostly due to four main causes, and most crashes are a combination:
1) The pilot gets in over their heads weather-wise (aka storms, dense fog, etc.)
2) The airplane has not been maintained properly
3) The pilot does some thing really stupid (aka not refueling, not doing ground checks before flying)
4) Really s****y luck (like flying into a bird)

I'm not a pilot, but I've had some hours of training and many hours in my father's plane, a small 4-seater.
 

emedpa

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Philly does not have firefighter/medics. The state of Florida does.

I just wish the medical community knew the difference between BLS and ALS ambulances. I had the explain the difference to my friend, a neurologist.

I guess gyn docs, psych and peds could excellent specialties for sex fiends/MDs
15 yrs ago they did. I knew several.
looks like they still do...from the philly fire home page:

"The EMS Unit is headed by a Medical Director and is responsible for administering a two-tiered system of pre-hospital emergency medical care and transport, which includes Advanced Life Support (ALS) Units, Basic Life Support (BLS) Units, and First Responder Engine and Ladder Companies. In addition, the EMS Unit assists in formulating plans for Emergency Medicine physicians to respond to the scene of multi-casualty incidents to assist with patient triage, treatment, and disposition. "
 

chimichanga

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...knowing the difference between EMT-Bs and Paramedics. I do think it's a problem when docs and nurses don't know the difference...
agreed...thanks for that point...

When I did RN CCT, I'd bring in a vented pt on 3 gtts, a receiving nurse would often call me an EMT...

idiot
 

emedpa

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agreed...thanks for that point...

When I did RN CCT, I'd bring in a vented pt on 3 gtts, a receiving nurse would often call me an EMT...

idiot
that's an honest mistake. when I was a cct medic I transported similar pts. unless they read your name tag they assume ambulance personnel= medic.
medics in many areas can transfer folks with heparin and ntg drips, pressors, etc
 
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