You are here: Home / Archives for Management

Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

DC Fire and EMS Being Sued for Retaliation After Problems Were Reported

Tue, 25 Feb 2014 22:05:57 -0500 by
 

Big city EMS departments like to brag about how good they are, but are they good?
 

“If you think about how much progress we’ve made in the last two years, I’m very pleased with the deployment we have now. Are we 100 percent yet? No, but we’re working on it,” Miramontes said. [1]

 

No sensible person should argue with progress, but –

How bad were things?

How bad are things now?

How much work needs to be done to get to the level of competent?

What are the problems?
 


If this does not play, it is available at the link in the first footnote.
 

According to D.C. paramedic Gene Ryan, there has been mismanagement, but according to David A. Miramontes MD, FACEP, NREMT, Assistant Fire Chief, things have dramatically improved. Dr./Asst. Fire Chief Miramontes is management.

Whom should we believe?
 

“If you’re a burn patient with agonizing pain I could fix that, I could take your pain away, but hopefully you live in the right neighborhood,” Ryan said. “Hopefully it’s the neighborhood that carries that medication, and that’s hit or miss.”

In response, Assistant Fire Chief David Miramontes told News4 control drugs are deployed to more than 90 percent of the department’s units.[1]

 

Well, morphine and diazepam (Valium) are probably hard to come by, so the problems are to be expected, right?

No.

DCFEMS also carries fentanyl (Sublimaze) and midazolam (Versed) according to their protocols from 2012.[2] Why the failure to provide these basic ALS (Advanced Life Suopport) medications on the ALS ambulances?

Is there any reason why any fire department EMS service should not have excessive amounts of pain medicine on every ALS ambulance? If there is one thing fire departments should be familiar with, it is burns.

Burns mean pain – a lot of pain.

Anyone who has dealt with significant burns knows that more than 100 mg of morphine or more than 1,000 mcg (more than 1 mg) of fentanyl is not an unreasonable dose.

How can a medical director who is also an Asst. Fire Chief tolerate that? Or is the medical director the problem?
 


 

The dose for burns is half of what is permitted for every other painful condition.

What possible legitimate reason is there for not adequately stocking overstocking pain medicine?
 

Half a year ago, there was a problem with ambulances catching fire and running out of fuel. Management blamed the employees and claimed to be unaware of problems. In other words, management was failing to manage. The job of management is to help the employees to do their job well, not to make excuses.
 

Fire officials say they are trying to address various problems in the department. They hired a private consultant for $182,000 to audit the fleet after the inspector general found that they had lost track of reserve vehicles, listing many fire engines as ready for duty when they had, in fact, been stripped and sent to scrap yards.

After more than 60 ambulances had mechanical issues last month, including many with broken air conditioning during a heat wave, . . . .[3]

 

More than 60?

Out of how many ambulances?
 

Ambulances and Medic Units

  • 14 ALS Medic Units

  • 25 BLS Ambulances[3]

 

More than 60 out of 39 in just one month.

Time to replace some ambulances.

But ambulances are expensive. We can’t afford them.
 


 

14 Heavy Mobile Equipment Mechanics plus 3 foremen in the top 25 DCFEMS overtime earners.[4]

Maybe the heavy mobile equipment they work on does not include ambulances, but this suggests that there is a problem with the management of equipment. Is the equipment too old. Is the department understaffed? Is there some other reason for these employees being over-represented?
 

But top fire officials have accused the rank and file of contributing to the breakdowns and staffing shortages through neglect or incompetence,[3]

 

Our employees are out of control and we are powerless to do anything?

That excuse does not appear to be valid.

DCFEMS has gone through a bunch of medical directors, but adequate stocking of ambulances is still just something to dream about? Is the medical director able to make decisions independently, or is he being not able to exercise authority?

I do not know the answers, but the more people keep failing to fix the problems, the more it looks like DCFEMS needs to be scrapped and remade from scratch with new management. The duct tape is not working.

Mismanagement and retaliation vs. out of control employees?

Management is not making a persuasive case.

–

Footnotes:

–

[1] D.C. Paramedic Plans to Sue Fire Department
By Mark Segraves
Saturday, Feb 22, 2014 | Updated 5:00 AM EST
News4 NBC Washington
Article

–

[2] Emergency Medical Services Manual and Pre-hospital Treatment Protocol
David Miramontes, MD FACEP, Assistant Chief, Medical Director
Kenneth B. Ellerbe, Fire & EMS Chief
Effective Date: September 14th, 2012
Revision Date: September 24th, 2012
Version: 1.1
Page 146/303
Protocols at DC.gov in PDF Download format.

–

[3] Two D.C. ambulances catch fire while on call
By Peter Hermann
Published: August 13, 2013
Washington Post
Article

–

[4] Response to Questions Asked by the Committee for “Fiscal Year 2011 and 2012 Performance Oversight”
Government of the District of Columbia Fire and EMS Department
Council of the District of Columbia
Committee on Public Safety and the Judiciary
Phil Mendelson, Chair
February 3, 2012
Document in PDF Download format.

.

Filed Under: Drug Shortages, Heresy, Management

Sign the Refusal Form, Ask Them To Leave, and Drive Him To the Hospital – EMS Patient Perspective

Thu, 07 Nov 2013 14:00:28 -0500 by
 
At The EMS Patient Perspective, Bob Sullivan writes about one great example of EMS incompetence. Unfortunately, it is a personal one.
 

She had called 911 for my grandfather, who was entering his later stage of dementia, and had passed out. In the background I heard a paramedic from the company I used to work for explain that his blood pressure and EKG were normal, that he did not need to go to the hospital in an ambulance, and that it was safe to drive him themselves or follow up with his doctor on Monday.[1]

 

But if we tell them to go away, what happens if something changes on the way to the hospital?

Unless the bad outcome is something as blatantly obvious as a cardiac arrest, these less than competent people are probably only going to make things worse.

Even if it is a cardiac arrest, they might not treat the patient appropriately. I have had a very experienced medic (been around for a long time, but apparently only had a single day of experience thousands of times over) ask me why I was defibrillating a patient with obvious ventricular fibrillation on the monitor.

Another decided to move the patient to the ambulance to intubate after he placed the tube in the esophagus and the patient began vomiting. No suction. No ventilation. Just carry the patient with the obstructed airway out to a place where he felt more comfortable.

Would this EMS squad be any better?

We have no reason for confidence in their abilities or judgment.
 

Syncope is a true emergency.

A lack of arrhythmia does not mean that it is not an emergency.

A lack of abnormal vital signs does not mean that it is not an emergency.

Many patients will not end up with a definitive diagnosis after treatment in the ED (Emergency Department).

Did the medic(s) apply the San Francisco Syncope Rule to determine that this patient does not need to go to the ED?
 

Clinical decision rule

Five risk factors, indicated by the mnemonic “CHESS,” were identified to predict patients at high risk of a serious outcome:

  • C – History of congestive heart failure

  • H – Hematocrit < 30%

  • E – Abnormal findings on 12-lead ECG or cardiac monitoring17 (new changes or nonsinus rhythm)

  • S – History of shortness of breath

  • S – Systolic blood pressure < 90 mm Hg at triage

Note: ECG = electrocardiogram.[2]

 

I doubt that the medic(s) ever even heard of the San Francisco Syncope Rule, but even if aware of it, here is how it should be applied.
 

The San Francisco Syncope Rule should be applied only for patients in whom no cause of syncope is evident after initial evaluation in the emergency department.[2]

 

Only
 

   after
 

       evaluation
 

           in the ED
 

               should we even begin to consider syncope to be a non-emergency.
 

If I search in the dark, with no light, for a black cat and cannot find the cat that really is there, does that make the cat disappear?
 


Image credit.
 

To proclaim that it was safe to leave my grandfather home after a five minute assessment and one set of vital signs was negligent.[1]

 

That should be obvious to everyone.

To every medical director.

To every medic.

To every basic EMT.

To every police officer.

To every mail carrier.

To every drunk not yet passed out on the corner.

This is a failure of EMS education, management, and medical oversight.

The easiest way to get rid of the dangerous people who do not understand this is to sign the refusal form and get them as far away from people they may harm as possible.
 

What if the patient (or family) do not want to go to the ED? That is entirely different and would require several posts to cover.

–

Footnotes:

–

[1] Sign the Refusal Form, Ask Them To Leave, and Drive Him To the Hospital
November 6, 2013
The EMS Patient Perspective
Article

–

[2] San Francisco Syncope Rule to predict short-term serious outcomes: a systematic review.
Saccilotto RT, Nickel CH, Bucher HC, Steyerberg EW, Bingisser R, Koller MT.
CMAJ. 2011 Oct 18;183(15):E1116-26. doi: 10.1503/cmaj.101326. Epub 2011 Sep 26. Review.
PMID: 21948723 [PubMed – indexed for MEDLINE]

Free Full Text from CMAJ.

.

Filed Under: Assessment, Heresy, Management, Physician Oversight

How Do We Stop Dangerous Paramedics From Harming Patients?

Sat, 02 Nov 2013 08:00:27 -0400 by
 

What is dangerous?

How about looking at a clearly sick patient and saying You aren’t sick enough to get a ride in my ambulance based on I don’t know.
 

“He came in and said, ‘This is another attention-grabber; she’s faking it; there’s nothing wrong with her,’ ” Chavez said. After Tate continued to balk at authorizing her transport to the hospital, despite her vomiting and other symptoms, she said her family used a car with bad brakes to drive her themselves. She was hospitalized for the next seven days.[1]

 

This does not appear to be a good example of assessment skills.

This may be an example of a lack of assessment, but we do not know what was done, assessment-wise.
 

Her treatment by Tate became part of the Albuquerque Fire Department’s basis for firing the 10-year paramedic lieutenant last January. A five-month internal investigation of Tate’s conduct turned up so many serious instances of misconduct that AFD Chief James Breen testified this week that he didn’t consider rehabilitation, suspensions or other type of lesser discipline.[1]

 

He has been doing such a bad job that management considers him to be irredeemable?

It seems that the problem is a lack of oversight.

He has been a medic for ten years.

He is a lieutenant.

As an officer, he is in a position where he is supposed to have demonstrated more than the usual amount of responsibility. After ten years, the officers above him should already have an idea of what kind of assessment and treatment he provides, or fails to provide. If this is a sudden departure from the assessment and treatment he has been providing, then there should be a consideration of possible causes, such as PTSD (Post-Traumatic Stress Disorder).
 

The AFD undertook an investigation that included a review of 18 months of 911 calls that involved Tate.

Of the 300 or so reports Tate filed on those calls, about two-thirds raised red flags or showed some type of problems, according to testimony from now-retired fire department EMS commander Jon Sigurdson.[1]

 

I would expect to hear about problems the same week I wrote the charts, especially if this involved most of my calls. If I could write 200 problem charts without negative feedback, then that would suggest that the problems were not detected by the QA/QI/CYA department until after a specific complaint.
 

One call was labeled cancelled by Tate in a report, even though the patient showed abnormal heart rhythms at the scene and wasn’t transported.[1]

 

Maybe they have different rules there, but a cancel is a call where I never even begin to assess the patient, never mind hooking up the heart monitor (or was the patient on some other heart monitor?).
 

Some 911 calls appeared to be dismissed as “anxiety attacks,” even though paramedics aren’t supposed to diagnose patients, testimony showed.[1]

 

We do diagnose.

I have had plenty of patients who were hyperventilating, but were able to be calmed to the point where they no longer wanted to go to the hospital. All of these patients were advised to call 911 again if their symptoms returned. If a patient wants to go to the hospital for anxiety symptoms, I take them.
 

Many of Tate’s reports “were so grossly inadequate it was virtually negligence,” Sigurdson said.[1]

 

I see that as a failure of oversight.

This appears to be a response to a complaint that resulted in recognition of serious problems that had not previously been seen as serious.

Remediation is almost always the first step, but recognition of the problem before it becomes overwhelming is important.
 

He also said his report writing improved after the records management section notified him about incomplete reports.[1]

 

What message does management seem to have been sending?

You are doing a good enough job to be one of our officers, even though some of your charts are not complete. Were other problems mentioned?
 

Testimony showed that Tate’s “bedside manner” provoked complaints from patients and their families in the past, but not until another AFD lieutenant complained about Tate’s treatment of his 16-year-old daughter last year did AFD officials look at his standard of medical care to patients.[1]

 

And there are other examples of complaints.

Why has it taken so long to address these? Has remediation already been attempted several times?

There is an article from 2012 that describes several other problems over the past decade for a Brad Tate that works for Albuquerque Fire Department.[2]
 


Image credit.
 

He does look intimidating in this picture, so maybe management is was intimidated by him.

–

Footnotes:

–

[1] Most of paramedic’s reports raised flags
Albuquerque Journal
By Colleen Heild / Journal Investigative Reporter
Thu, Oct 24, 2013
Article

–

[2] Firefighter in hot water – Family suing over accident
By Alex Tomlin
Updated: Thursday, March 21, 2013, 11:23 AM MDT
Published: Tuesday, October 2, 2012, 8:28 AM MDT
KRQE.com
Article

.

Filed Under: Assessment, Ethics, Heresy, Management

Japanese man dies after 25 hospitals reject him

Sun, 10 Mar 2013 22:00:08 -0400 by
ResearchBlogging.org
 

In January, in Japan, 25 hospitals refused to permit an ambulance to transport a man who was pronounced dead when he finally arrived at a hospital.

Were the patients already in the ED (Emergency Department) less stable than this patient?

Was this patient going to be the straw that breaks the camel’s back and result in the deaths of other patients already in the ED?

What kind of evidence do we have to justify diversion?
 

Paramedics rushed to his house but were told in turn by all 25 hospitals in the area that they could not accept the man because they did not have enough doctors or any free beds, a local city official said, adding some institutions were contacted more than once.[1]

 

We do not know if he would still be alive if he had been transported to the first ED, or to the second, or to the third, . . . . We do not even know the cause of death. However, this is a good way to introduce the topic of diversion.

Diversion is not just a problem in Japan, but also in the US and other countries. It has become more convenient for many people to go to the ED than to wait to see a primary care physician. Until that problem is fixed (assuming that it ever is fixed), is diversion appropriate?

There have been a couple of studies in San Diego of what happens when diversion is minimized, or eliminated.

Even though volume went up, diversion dropped to almost zero.
 


 


 
Click on images to make them larger.

The authors acknowledge that the main limitation of this study was the short time frame of the analysis, comparing one week to another.[2]

 

In a longer study, diversion decreased and the need for transfers between hospitals dropped. There did not appear to be any negative consequences of minimizing diversion.
 


 

 

In summary, a community-wide effort to improve getting patients to requested EDs and decreasing ambulance diversion hours can be successful in a large community with an urban, suburban, rural, and remote population distribution. The success of such a process had the additional effect of decreasing the need for ED interfacility transfers for payer request reasons.[3]

 

In this month’s Annals of Emergency Medicine is a study looking at what happened when Massachusetts banned diversion.

 

 

 

 

 

Figure 1. Changes in ED length of stay by hospital among A, admitted patients and B, discharged patients. C, Changes in ambulance turnaround time by hospital. D, Changes in total hospital volume before and after a ban on ambulance diversion by hospital.[4]

 

It seems that the benefits of diversion are just another medical myth.
 

Research has led to the consensus that crowding is largely due to output factors, particularly the practice of boarding admitted patients in the ED2,7-10 because of lack of inpatient capacity. Ambulance diversion, in contrast, is an input factor, which has little effect on ED crowding.4 [2]

 

Very few of the patients coming in to the ED are arriving by ambulance.
 

On July 3, 2008, the department released a policy directive ending the practice of ambulance diversion in the state, except in cases of internal hospital disaster.17 The policy took effect on January 1, 2009, allowing hospitals 6 months to prepare for the changes necessary for its implementation. This policy represented the first statewide ambulance diversion ban in the United States.[2]

 

A lot of the bad things were supposed to occur when diversion was banned.

None of them happened.
 

Preliminary reports from hospitals suggest that the end of ambulance diversion has been a relative success because of operational changes made at individual hospitals in anticipation of the ban.24,28 Early reports from Boston Emergency Medical Services (EMS) suggest that there has not been an increase in ambulance turnaround time as feared, although this has not been formally studied.29 [2]

 

At the Gathering of Eagles conference, this was one of the topics.
 

-It negatively impacts EMS operations and could jeopardize our ability to respond to the next critical patient.

-It often results in patients being transported to ED’s other than where their MD’s or medical records are.

-It negatively impacts patient satisfaction and provider morale.

-It does little if anything to reduce ED overcrowding.[5]

 

In places that use diversion, when all of the hospitals are on divert, the dispatch center is supposed to notify the hospitals that dispatch will be making destination decisions until things improve. I have not seen any explanation for why that was not the case in Japan.

Diversion does not appear to provide any real benefit to anyone, except that it is consistent with the superstitions of many people, and medical people are as superstitious as gamblers.

–

Footnotes:

–

[1] Saitama man dies after hospitals reject him 36 times
Japan Today
Mar. 06, 2013 – 02:31PM JST
Article

–

[2] The effects of minimizing ambulance diversion hours on emergency departments.
Khaleghi M, Loh A, Vroman D, Chan TC, Vilke GM.
J Emerg Med. 2007 Aug;33(2):155-9. Epub 2007 Jun 18.
PMID: 17692767 [PubMed – indexed for MEDLINE]

–

[3] Community trial to decrease ambulance diversion hours: the San Diego county patient destination trial.
Vilke GM, Castillo EM, Metz MA, Ray LU, Murrin PA, Lev R, Chan TC.
Ann Emerg Med. 2004 Oct;44(4):295-303.
PMID: 15459611 [PubMed – indexed for MEDLINE]

–

[4] The effect of an ambulance diversion ban on emergency department length of stay and ambulance turnaround time.
Burke LG, Joyce N, Baker WE, Biddinger PD, Dyer KS, Friedman FD, Imperato J, King A, Maciejko TM, Pearlmutter MD, Sayah A, Zane RD, Epstein SK.
Ann Emerg Med. 2013 Mar;61(3):303-311.e1. doi: 10.1016/j.annemergmed.2012.09.009. Epub 2013 Jan 24.
PMID: 23352752 [PubMed – in process]

Free Full Text Download in PDF format.

–

[5] Taking a Turn For The First: Taking Aim at Diversion Practices
S. Marshal Isaacs, MD, FACEP
Gathering of Eagles XV
February 23, 2010
Presentation slides in PDF format

75-year-old Japanese Man Dies After Hospitals Reject Him 36 Times
By Yue Wang
March 06, 2013
TIME.com
Article

–

Khaleghi, M., Loh, A., Vroman, D., Chan, T., & Vilke, G. (2007). The Effects of Minimizing Ambulance Diversion Hours on Emergency Departments The Journal of Emergency Medicine, 33 (2), 155-159 DOI: 10.1016/j.jemermed.2007.02.014

–

Vilke, G., Castillo, E., Metz, M., Upledger Ray, L., Murrin, P., Lev, R., & Chan, T. (2004). Community trial to decrease ambulance diversion hours: The San Diego county patient destination trial Annals of Emergency Medicine, 44 (4), 295-303 DOI: 10.1016/j.annemergmed.2004.05.002

–

Burke, L., Joyce, N., Baker, W., Biddinger, P., Dyer, K., Friedman, F., Imperato, J., King, A., Maciejko, T., Pearlmutter, M., Sayah, A., Zane, R., & Epstein, S. (2013). The Effect of an Ambulance Diversion Ban on Emergency Department Length of Stay and Ambulance Turnaround Time Annals of Emergency Medicine, 61 (3), 303-3110 DOI: 10.1016/j.annemergmed.2012.09.009

.

Filed Under: Ethics, Gathering of Eagles, Heresy, Management, Mythology, Research Blogging

Firing the employee does not solve the problem

Tue, 04 Dec 2012 14:30:11 -0500 by
 

I last wrote about the wonderful people at Quicky’s and how they are devoted to booting emergency vehicles that have responded to emergencies.[1]
 

Eyewitness News saw workers continuing to boot cars in their parking lot Monday morning. A worker at Quicky’s convenience store said the employee, identified in a police report as Ahmed Sidi Aleywa, who booted a working ambulance Friday has been fired.

“The guy that did this, he came from another country. He didn’t even know what an ambulance looked like. He’s been fired,” said Ali Colone, a man identified as a worker at Quicky’s. The owners declined to comment, but Colone said the owners are sorry it happened.[2]

 

That is a pathetic attempt at covering up the problem by firing the employee, but the booting continues. Nobody seems to have needed an emergency response from an ambulance in the parking lot, so we do not know if they are still booting ambulances.

I do not expect Mr. Colone to have a long career at Quicky’s, but that might not be a bad thing.
 

Quicky’s parking lot is private property. The city Code says private companies are allowed to boot, but they must be licensed with the city, they can only charge a maximum of $90 to remove the boot. Quicky’s signs say they’re charging at least $115.[2]

 

Did that employee buy the boot and independently decide to boot vehicles in the parking lot?

Or –

Did the employer buy boots and tell employees to boot vehicles?

This should not be a trick question.

Yes, the employee should have known better.

Did the owner, or manager, ever tell the employees (those assigned to put on the boots) that there were to be no exceptions?

This appears to be another example of the idiocy of zero tolerance rules.

The police seem to have gone after the wrong person, or not enough people.

There ought to be laws for interfering with EMS personnel in the performance of their duties, but we in EMS need to be accountable for the way we behave during emergencies.

 

The Quicky’s Discount convenience store is at 2701 Tulane Ave., across from the Orleans Parish Criminal District Courthouse in New Orleans.[3]

 

The employee was doing what he was told. He should have known better, but he was doing what his manager told him to do.

Nobody appears to have made any claim to the contrary.
 

Who was pocketing the money from the boots?

The employee?

The owner/manager?

Was a portion going to the employee?
 

In EMS, too often we fire/discipline employees for following the managers directions.

And too many in EMS think that just following directions is an acceptable way to treat patients.

–

Footnotes:

–

[1] New Orleans paramedics tending to patient at Quicky’s convenience store find ambulance ‘booted’
Sun, 02 Dec 2012
Rogue Medic
Article

–

[2] New Orleans paramedics tending to patient at Quicky’s convenience store find ambulance ‘booted’
By Erik Ortiz
New York Daily News
Published: Sunday, December 2, 2012, 5:05 PM
Updated: Sunday, December 2, 2012, 5:05 PM
Article

–

[3] Man who booted ambulance issued citation, fired
wwltv.com
Posted on December 3, 2012 at 1:17 PM
Updated yesterday at 10:35 PM
Katie Moore / Eyewitness News
Article

.

Filed Under: Ethics, Heresy, Management

New Orleans paramedics tending to patient at Quicky’s convenience store find ambulance ‘booted’

Sun, 02 Dec 2012 21:30:26 -0500 by
 

The Quicky’s Discount convenience store is at 2701 Tulane Ave., across from the Orleans Parish Criminal District Courthouse in New Orleans.[1]

 

In EMS we see all sorts of bad behavior, but some people are more callous and stupid than even we expect.

Booting an ambulance treating a chest pain patient is definitely a newsworthy form of contemptible behavior. Eventually, this has the possibility of eventually resulting in a Darwin Award.[2]
 

A boot removed from a New Orleans EMS ambulance left the vehicle with a flat tire.[1]

 

Does it matter how bad parking is?

Is it ever justifiable to boot an emergency vehicle, of any kind, on an emergency call?

Is there any reason the person who placed the boot, or ordered that it be placed, or both, should not be facing criminal charges?

Has the manager of the store been looking to teach EMS a lesson?

There is a lot that we do not know about this, so there may be something important we do not know, but WTF?
 

Employees at Quicky’s declined to comment about a parking boot placed on the ambulance in the store’s lot.[1]

 

Silence is not the right choice.

Silence tells people that the truth is worse than they suspect – and people will already suspect it is very bad.

Is this the message the management mean to send?

Whatever you are thinking – it’s worse than that!
 

Paramedics were responding to a call about a man having chest pains. After arriving to the store and putting the patient inside the ambulance, the paramedics heard a “loud noise” as they tried to drive away, Tate said. They then realized the vehicle had been booted.[1]

 

There always seems to be someone dumber and even more callous than we expect. A friend of mine told me that a doctor told her to move the cardiac arrest patient out of the doorway so that patients could get through. While I was not there, it is something that I might expect from some doctors.
 

Tate said the medics left the vehicle with the lights flashing.

A sign on the property reads: “If you leave the property for any reason your vehicle will be booted,” according to WWL-TV.[1]

 

A prominently posted apology and some sort of free food for EMS personnel would seem like maybe just the beginning of an apology by Quicky’s.

Maybe just the beginning.

Maybe.
 

The Quicky’s Discount convenience store is at 2701 Tulane Ave., across from the Orleans Parish Criminal District Courthouse in New Orleans.[1]

 

Things appear to be unchanged, except that the lowest level person responsible is reported to have been fired – Firing the employee does not solve the problem

–

Footnotes:

–

[1] New Orleans paramedics tending to patient at Quicky’s convenience store find ambulance ‘booted’
By Erik Ortiz
New York Daily News
Published: Sunday, December 2, 2012, 5:05 PM
Updated: Sunday, December 2, 2012, 5:05 PM
Article

–

[2] Darwin Awards
Wikipedia
Article

.

Filed Under: Ethics, Heresy, Management

Ambulancegirl Makes Unreasonable Accusations in a Comment

Sat, 28 Jul 2012 08:00:02 -0400 by
–

Ambulancegirl made the following comments on Roanoke County Attorney Paul M. Mahoney Caught in a Conspiracy Over Ex-Adult Film Star –

As a paramedic I think we should be held to high standards as public servants. I personally would not want a ex porn star or criminal responding to me.

Her previous career does not affect her ability to provide patient care.

Where did your criminal comment come from. Her previous career is not criminal. Is your previous career criminal?

Why not state that you would not want a serial killer to take care of you?

As long as you appear to be going for guilt by imaginary association, why wimp out?

Go for the Godwin.

Would you want Hitler taking care of you? No? Then you would not want an ex-adult film star taking care of you – You have been warned!

We already have too many irrelevant rules interfering with good patient care.

Why should we think that adding this kind of rule is in any way good for patients?

What other legal activities should be used to permanently prohibit people from employment in EMS, just to satisfy the most easily offended among us.

I feel like a victim because of what that person used to do!

You must give me the power to punish them to satisfy my need to control others.

–

I would not want to have to worry about being sexually assisted or robbed or murdered in the back of an ambulance.

Sexually assisted?

What do you need sexual assistance with?

How much money were you planning to offer for sexual assistance?

What makes you think that she would accept your money?

If you meant sexually assaulted, then she probably does NOT want to be sexually assaulted by you.

That would be criminal – and it has nothing to do with her previous occupation.

I have not seen anything that suggests that she has sexual assault on her mind.

On the other hand, depending on what you intended to write, you do appear to have sexual assault on your mind.
 

Ambulancegirl, please do not sexually assault your patients or your coworkers.
 

Likewise, what does being robbed or murdered have to do with any of this?
 

Ambulancegirl, please do not rob or murder your patients or your coworkers.
 

–

As EMTs or Paramedics paid or volunteers the public looks up to us and how can we look professional in the eyes of the public if we higher ex porn stars or criminals!

I have not seen any indication that she ever committed a crime.

If you want to prohibit people who have worked in jobs you do not approve of, what other jobs should we include?

Bankers?

Door to door salesmen?

Priests?

Politicians?

Polices?

Lawyers?

Singers?

Psychiatrists?

Zookeepers?

Farmers?

Bartenders?

All of these are jobs that are legal, but each of these jobs is considered unethical by some people.

Who decides?

You?

–

Yes sex is normal but selling it isn’t .

EMS is not normal, either.

What is your point.

Only normal people should apply for abnormal work.

No.

We are not normal.

Pretending to be normal is just a lie.

–

Is she really retiring from that line of work!

I have no reason to doubt her

and

I have no reason to believe any of your hypothetical accusations.

–


Image credit.

That picture of her with her legs spread wide apart looks like it was made at a fire station!

I cannot tell where the picture was taken.

There is something red behind her and to the side of the clock on the wall.

Red = fire station!

The wall is painted white.

White = inside a fire station!

She appears to be sitting on red cushions.

Did I mention what red means?!?!?!

The generic setting of the picture does not appear to have anything fire-related in it.

Clearly, she is hiding the fact that she is surrounded by vulnerable young boys, tempting them to grow up to be Hitler!

But suppose Ambulancegirl’s conspiracy of taking a picture of a woman inside a fire station with clothes on is true.

Are we going to prohibit women from wearing shorts and a T-shirt in firehouses?

Are we going to prohibit men from wearing shorts and a T-shirt in firehouses?

Are we really that crazy?

I know. Ambulancegirl is selling Ambulancegirl brand firehouse burqas.

Pay close attention.

Red = fire station!
 

Image credit.

–

Maybe she needs to find another career one that doesn’t require you to be in the public eye as an upstanding citizen.

Maybe you, Ambulancegirl, are the one who should find another career. Perhaps a career where it is more acceptable to use deceit.

We have plenty of unusual people in EMS.

We need to be more open about how unusual we are, not try to shame people to leave EMS just because they do not fit some misleading stereotype of some pillar of the community.

If we keep throwing stones at each other for being different, there will not be anyone left to take care of patients.

We do the dirty work that nobody wants to know about.

We will never be normal.

We need to stop ostracizing people just for being a little bit more abnormal than we are.

We need to stop ostracizing people just for being a little bit more open about being abnormal than we are.

–

Also read Would You Have Your Chest Massaged By a Porn Star? at A Day In The Life Of An Ambulance Driver.

.

Filed Under: Ethics, Heresy, Management

Roanoke County Attorney Paul M. Mahoney Caught in a Conspiracy Over Ex-Adult Film Star

Wed, 25 Jul 2012 08:00:46 -0400 by
–

Roanoke County Attorney Paul M. Mahoney and Roanoke Fire Rescue Squad Chief Richard E. Burch, Jr. are embroiled in an apparent conspiracy over an ex-adult film star.

Don’t tell anyone. We must protect their reputations, because this is all about reputation.

What did they do?

Never mind what they did – we want pictures –
 


Roanoke County Attorney Paul M. Mahoney.

From the picture, you can’t even tell that Paul M. Mahoney is up to no good.

Paul M. Mahoney is making a mockery of his employer – Roanoke County, Virginia. He is trying to stay out of the spotlight, because Roanoke County Attorney Paul M. Mahoney might be held to a standard of behavior that would result in his termination for bringing ridicule to the County of Roanoke Virgina.

Maybe the standards for Roanoke County Attorney Paul M. Mahoney are not as high as the standards for the volunteer EMTs in Roanoke County.
 


 

Roanoke County Attorney Paul M. Mahoney is assisted in this endeavor by –
 


Roanoke Fire Rescue Squad Chief Richard E. Burch, Jr.

Chief Burch brought his anxieties to the attention of Roanoke County Attorney Paul M. Mahoney.

What anxieties?

Chief Burch was told that a volunteer EMT is not a virgin – how can she work in Virginia? Clearly, she is mocking the whole State of Viginia, or the state of virginity, or the whole attitude of pretending that humans do not engage in intercourse and that we occasionally even enjoy intercourse. 😳

Captain Renault and I are shocked.

I confess that I am not a virgin, either – not that anyone cares.

OK. She is not just not a virgin, but she temporarily made her living being a non-virgin on camera.

Is Roanoke County Attorney Paul M. Mahoney’s job any more legal than acting in adult films?

However, Roanoke County Attorney Paul M. Mahoney seems to be demonstrating that his job is much less ethical than acting in adult films.

Let’s get her fired, but in a way that nobody will blame us. It would be best if her female chief did the firing, because that would be more politically correct than being fired by a bunch of guys who need to take some Ativan and mind their own business.

Have you two ever heard of the Streisand effect?[1]
 


Image credit.

An ex-adult film star can be distracting, but so can a lot of other people.

David Lee Roth, of the band Van Halen, is an EMT. He is not known for an ascetic lifestyle. Would it be inappropriate for David Lee Roth to volunteer?

What about someone with a criminal background? Would it be inappropriate for him, or her, to volunteer? Does it matter is the person has committed a misdemeanor, or a felony, or even worse – been elected to Congress?

As far as I can tell, it has not even been suggested that she is doing anything in uniform, or anything suggesting affiliation with the volunteer squad, that is in any way an inappropriate representation of the rescue squad.

Should she have to wear a scarlet A for Adult film star (retired)?
 
 
 
 

A
 
 

Should each members have to wear a scarlet P for Prude?

Should each members have to wear a scarlet R for Ridiculous?

This does generate a lot of press for Roanoke County, Virginia, just not good press.[2],[3],[4]

Roanoke County Attorney Paul M. Mahoney seems to be providing an excellent example of how to disparage the reputation of volunteer rescue squads using official documents while on duty.[5]

Someone currently getting paid for embarrassing the county is trying to force out a volunteer for previous work in an industry that does not meet his holier than thou standards.

–

See continuation in Ambulancegirl Makes Unreasonable Accusations in a Comment.

–

Footnotes:

–

[1] Streisand effect
Wikipedia
Article

–

[2] Porn star turned EMT could be in trouble over racy past
By EMS1 Staff
EMS1.com
July 16, 2012
Article

–

[3] My Take on the Whole Porn Star-Turned-Medic Issue…
The Fire Critic
July 12, 2012
Article

–

[4] Porn Star or Felon …which do you want in your station??
Iron Firemen
June 27, 2012
Article

–

[5] Re: Cave Spring Rescue volunteer
Official letter to Roanoke Fire Rescue Squad Chief Richard E. Burch, Jr. from Roanoke County Attorney Paul M. Mahoney
June 27, 2012
Document in PDF format

.

Filed Under: Appearances, Heresy, Management
« Previous Page
Next Page »