You know, a lot of things in EMS just don’t make sense. Spinal immobilization, continued use of Lidocaine, Lasix, Epi the list can go on. I suppose we do these things for a variety of reasons. Following protocols, job security, going along to get along etc.

One thing that has been really buttering my biscuit these days is this whole patient signature thing. This idea that having the patient sign the privacy form, billing form, no fault form etc. clarifies why they are in the ambulance. To me if they are in the ambulance it “implies” they want to be there. If they can’t sign because they are unconscious etc. it still “implies” they want to be there and having me or a nurse sign that they couldn’t sign is ridiculous.

Shouldn’t our documentation be enough to state why they were transported. How we found them, their complaints, our findings and treatments. Isn’t that all enough to warrant the need for an ambulance? Why do we subject patients to signing unfamiliar forms and computer screens when they are in duress. Chest pain, difficulty breathing, trauma and otherwise. “Oh excuse me sir, I know you are having chest pain and your 12 lead is showing a STEMI but can you allow me stop everything I am doing to save your life and direct your attention to my billing form.”

“Ma’am I know you are immobilized to a flat board with a stiff collar on your neck and although this alone should be enough of unnecessary treatment, can you sign this no fault form while on your back unable to move your head and in a most uncomfortable position”

My personal favorite. The 80-90 year old patient who can barely see, has arthritis and is being asked to use a computer screen and stylus… (what’s a stylus) to sign their name. Now press hard, don’t let your hand rest on the screen, no lets try again, oh wait, that’s good enough, I know it looks nothing like your signature….. ”UNCLE!!”

“What” you say, “most patients can sign”? They aren’t in duress or in precarious positions not to sign? Maybe these patients should be going by some other means to the hospital. Perhaps they should be signing before you transport, that in your opinion they don’t require an emergency transport and that they may be required to pay the ambulance bill themselves.

Sure some patients need the ambulance and they most likely can also sign. But why is that part of the deal? Shouldn’t our assessment, care and documentation of it all assure the need for ambulance transport?

Now there are those who will say that it only takes a few minutes to get a signature. Its not a big deal, its part of the job and on and on. While this may be true at the root of it all, requiring these signatures has evolved in EMS from not needing them, to sometimes needing them to needing them is mandatory, patient condition be damned.

To me, the fact that the patient is in the ambulance accepting transport and treatment as I document the same on my report implies they want to be there and agree to being transported. I don’t know about you but I have not seen ambulances driving around snatching people off the street and taking them to emergency rooms against their will. But I guess if they did, as long as they got a signature somehow it would be OK.

The past few weeks have left me drained. No audio podcasts this week, since my voice is still shot from my illness. I have been sicker than I have ever been in my life and I feel as if I am starting to have delusional dreams both while I am sleeping and awake.  One is I keep hearing EMS providers in NYC calling for the Mayor to be fired over the snow storm in December.

Now, I understand the frustration and anger over the Mayors handling of the storm emergency and also his finger pointing at EMS implying that they did not do their jobs well enough during the storm. Of course the first head to roll for the lack of response was the EMS Chief himself John Peruggia. We talked a little about this during the last live podcast and many asked why is EMS being punished for any response issues when it was clearly a lack of access to patients and streets from little to no snow removal by the Sanitation department.

EMS being the lowest entity in the cities mind and the easiest to make some type of example of as a knee jerk reaction to the outcry of long EMS response times, patients dying or not being reached in time, is the obvious first line of political attack from above. What the EMS Chief could have done better to get crews to patients in the unplowed streets I just don’t know. But here is my thing.

Making statements that the Mayor and his inner circle should be fired is just ridiculous. This is not going to happen. While it is unfortunate that Peruggia was demoted from his position and others I am sure will follow from other agencies. The Mayor isn’t going anywhere. Setting up Facebook groups and trying to make a case that the Mayor should be fired as if it can actually happen just makes EMS look like children stamping our feet because we are angry that we didn’t get any recognition for our actions during the storm or because EMS is somehow being singled out at the moment as the scape goat for what went wrong.

As providers who where there, you now better and instead of an “Off with his head” mentality you should be offering solutions for future emergencies of a similar nature. I may be a bit delusional right now from my illness, but I am not that bad off where I think the Mayor getting fired will happen any more than I think the Tooth Fairy is going to get thrown in prison for stealing my teeth.

Sometimes these Facebook groups that get started can be great and open up great ideas and keep people informed on a specific topic. We have to be aware though that what we write and how we write our posts there are seen by many. Even those that we may not think read them at all. Such as the general public and even the Mayors Office.

So when statements like this are posted  “….Why hasn’t the Mayor and his Butt Boy Sanit. Commish. been investigated by the D.A.’S office for Crim. Negligent Homicide in any deaths of New Yorkers…”  and “The firing process should start with the mayor, then the sanitation commisioner….” or “….they doing a investigation as to what happen .Ok here is what happen streets not plowed NYPD FDNY and EMS where getting stuck in the snow that what happen…”

They do nothing to help the future or even the present other than venting and while I understand the anger and frustration that may bring on these comments. As EMS professionals we need to take a step back and think about what we post in a public forum that so many can see. Is the mayor going to get fired? No. Are there other solutions that can be looked at for the future? Definitely. So let’s get that thought process going, the next storm is just around the corner. Good luck Abdo.

Should 911 EMS services be free? I wonder sometimes that if local government paid for the 911 EMS services provided and we didn’t bill patients, how different the system would be. Would there be more abuse due to people feeling that their taxes are paying for it? Would local government become more aware of the EMS industry and find ways to reduce abuse and offer other solutions like community paramedicine?  Perhaps even giving the ability for EMS crews to decline ambulance transport for patients who don’t require it.

What are your thoughts? Take the quick poll below and feel free to post comments on your views and what you think a solution could be and if free EMS is a good or bad thing.

Get This – Survey Results – GlowDay.com

I have a feature on my other blog Authorized Transmissions that I most likely will be moving here soon called Monday Minutes. These are just some quick audios on calls I had, observations and tips. I recently posted one on some negative feedback I received and thought you might find it interesting to take a listen.

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