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Mon Aug 3 19:32:14 BST 2009

Matt,

These are questions that are required to be asked of EVERY pt at the hospital.

Bobby

________________________________
From: "cadeth66 at aol.com" <cadeth66 at aol.com>
To: Trauma-List [TRAUMA.ORG] <trauma-list at trauma.org>
Sent: Monday, August 3, 2009 7:34:11 AM
Subject: Re: Taser in ER

  While I may not be a paramedic, just a mere EMT-B. I have almost never asked"do you feel safe at home" to someone experiencing 10/10 pain from any fracture or injury because there are obviously more pressing issues at hand, such as pain management? Splinting and stabilization of the fracture?  I can't even say I've ever seen a MICN/MICP ask if a patient "feels safe at home" unless the injury would preclude them from carrying out needed tasks or ambulating safely, and they should consent to treatment and transport. 

Asking someone if they have a problem with drinking I do ask, only if there is a reason. Naturally one would ask if someone is a smoker if the call is respiratory in nature

There is a time and place for these questions. I've never seen it done during Triage or in a prehospital care. At least where I'm from

Matt
Sent from my Verizon Wireless BlackBerry

-----Original Message-----
From: htaed_rd at 123mail.org

Date: Mon, 03 Aug 2009 06:54:04 
To: Trauma-List [TRAUMA.ORG]<trauma-list at trauma.org>
Subject: Re: Taser in ER

I never stated that JCAHO/TJC is specific to agitated patients. There is
no research on their effect on outcomes. What is available is the
opportunity to observe the way they create more and more tasks for the
triage nurse to accomplish in addition to patient care. In many cases,
it has become tasks that are accomplished in stead of patient care.

One anecdote. A local nurse/paramedic transported a patient to the ED
with an ankle fracture. 10/10 pain, but the person supposedly providing
patient care is asking if the patient feels safe at home, has problems
with smoking or drinking or whatever else the magical JCAHO/TJC
incantations are at the time. As if the same questions will not have to
be documented at the hospital. The only abuse the patient is concerned
with is the lack of any benefit from a high priced ambulance ride, where
the nurse/paramedic is neglecting patient care to ask these ridiculous
questions, that have not yet been imposed on EMS. That is abuse. 

Is patient care so close to perfect everywhere, that we need to find
ways to distract nurses from providing patient care, that we need to
cross-train nurses as social workers. It isn't that these questions
should not be addressed, but they have no justification being placed
ahead of patient care. And they are placed ahead of patient care. 

The whole thrust of the JCAHO/TJC rules is to take the emphasis off of
patient care and place it on creating a pleasing appearance. It is
nothing but BS.

Another example is the 4 hour time limit for initiation of antibiotic
treatment of pneumonia.

Tim Noonan.

On Mon, 03 Aug 2009 05:23 +0000, ghowd at statems.net wrote:
> Perhaps you could cite a reputable journal or accepted study showing the
> causitive link between  JCAHO certification and increased mortality and
> morbidity of agitated patients?
> Guy E. Howd EMTP, EMSIC
> Clinical Quality Coordinator
> STAT EMS
> The information contained in the e-mail is confidential and propriety. It
> is not to be disclosed or made public without the expressed consent of
> STAT EMS, Inc.
> 
> -----Original Message-----
> From: htaed_rd at 123mail.org
> 
> Date: Mon, 03 Aug 2009 00:44:46 
> To: Trauma-List [TRAUMA.ORG]<trauma-list at trauma.org>
> Subject: Re: Taser in ER
> 
> 
> The same CMS that requires JCAHO/TJC certification? JCAHO/TJC is
> possibly the greatest threat to good patient care. That is supposed to
> convince me that it is somehow in the patient's best interest to allow
> their agitation to progress to the point of injury or death  of the
> patient and/or staff)?
> 
> Tim Noonan.
> 
> On Sun, 02 Aug 2009 22:59 -0400, cyberg66 at aol.com wrote:
> > Before it was shut down, King Drew Medical Center in South LA was cited
> > by CMS for allowing it's county police officers to use their tasers to
> > control psychiatric patients. After the hospital administration said it
> > retrained staff on proper control methods, officers still showed up at
> > drills with tasers. This was one of the many problems that led CMS to
> > revoke the hospital's ability to bill Medicare. The rules of engagement
> > that work for police on the street are a setup for liability if not
> > modified for the hospital.
> > 
> > -----Original Message-----
> > From: Steven P. Rogers, RN <rogers3 at socal.rr.com>
> > To: 'Trauma-List [TRAUMA.ORG]' <trauma-list at trauma.org>
> > Sent: Mon, Aug 3, 2009 10:02 am
> > Subject: RE: Taser in ER
> > 
> > 
> > 
> > I work in a County hospital.  As such, there are LA County Police
> > patrolling
> > the property and various departments.  They are POST Certified, Sworn Law
> > Enforcement Officers.  They carry all types of weapons (Guns, Rifles,
> > Shotguns, Less Lethal Weapons) including tasers and they have had the
> > occasion to deploy them within our ER.  For those that think it is not
> > necessary, ENA (and other organizations) see's workplace violence as a
> > high
> > concern amongst ER nurses.  Also, there have been several assaults of
> > patients onto staff, patients and others, including doctors being shot to
> > death in LAC/USC!  So please do not say it is not necessary!
> > 
> > We also have a private security firm managing all points of entrance into
> > our hospital and they are armed with baton's..They too have been
> > assaulted
> > although they are not trained to the same level as our County Police.
> > 
> > 
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org
> > [mailto:trauma-list-bounces at trauma.org]
> > On Behalf Of cadeth66 at aol.com
> > Sent: Sunday, August 02, 2009 2:35 PM
> > To: Trauma-List [TRAUMA.ORG]
> > Subject: Re: Taser in ER
> > 
> > I personally believe its over-kill for any Hospital security guard to be
> > armed.
> > 
> >  Granted some of the people we treat may be potentially dangerous most
> >  of
> > the time a situation can be verbally de-escalated
> > 
> > 
> > 
> > Matthew Schumacher, EMT-B
> > 
> > Sent from my Verizon Wireless BlackBerry
> > 
> > -----Original Message-----
> > From: Jon Hoerner <jhoerner at gmail.com>
> > 
> > Date: Sun, 2 Aug 2009 17:30:23
> > To: Trauma-List [TRAUMA.ORG]<trauma-list at trauma.org>
> > Subject: Re: Taser in ER
> > 
> > 
> > Here in PA, there is a Level-1 Trauma Center that has not one, but all
> > of their security officers carrying tasers.  However, they aren't
> > using the typical "yellow" colored tasers.  All of their's are black
> > so it almost looks like they are armed unless you know what you are
> > looking at to realize it is just a taser.
> > 
> > I haven't heard of any of their security officers actually using the
> > taser...
> > 
> > Since I'm not involved in hospital security, I won't question their
> > reasoning but it does make me wonde
> > r just a little bit.
> > 
> > Jon Hoerner, BS NREMT-P
> > Allentown, PA
> > 
> > On Sun, Aug 2, 2009 at 5:11 PM, <ghowd at statems.net> wrote:
> > > None here in Michigan, thank the gods of liability. At face value, this
> > may be one of worst, potentially ironic, ideas I've heard of in some
> > time.
> > > ------Original Message------
> > > From: Andrew J Bowman
> > > Sender: trauma-list-bounces at trauma.org
> > > To: Trauma & Critical Care mailing list
> > > ReplyTo: Trauma-List [TRAUMA.ORG]
> > > Subject: Taser in ER
> > > Sent: Aug 2, 2009 14:09
> > >
> > > I saw in the USA TODAY that Eastern Maine Medical Center ER would be
> > > purchasing a Taser to keep in the department. Any others have one in
> > > their ER?
> > >
> > > Typed by my index finger and sent from my iPhone.
> > >
> > > Andrew J Bowman
> > > Acute Care Nurse Practitioner
> > > Trauma Nurse Specialist
> > > Paramedic
> > >
> > > Witham Health Services
> > > Emergency Department
> > > Lebanon, Indiana
> > > 765-485-8500 Work
> > > 765-426-4189 Cell
> > > 765-485-8509 Fax
> > > --
> > > trauma-list : TRAUMA.ORG
> > > To change your settings or unsubscribe visit:
> > > http://www.trauma.org/index.php?/community/
> > >
> > >
> > > Guy E. Howd EMTP, EMSIC
> > > Clinical Quality Coordinator
> > > STAT EMS
> > > The information contained in the e-mail is confidential and propriety. It
> > is not to be disclosed or made public without the expressed consent of
> > STAT
> > EMS, Inc.
> > > --
> > > trauma-list : TRAUMA.ORG
> > > To change your settings or unsubscribe visit:
> > > http://www.trauma.org/index.php?/community/
> > >
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