Second, as both the letter writer and I have learned you have to pick your battles. Would it have done any good to bring up the MRSA issue with the sending hospital? Probably not. They could have simply said, “We told them.”. Or more abrasively, “Are you questioning our professional ability to give a simple transfer report?” I think the suggestion of Dave Konig represents the best of both worlds. You let it slide with the sending facility and keep your relations there happy while letting the receiving facility know about the MRSA before the patient reaches the room. “I just discovered this in the medical history on the way over and I wanted to make sure you knew.” Everyone wins.

Dave also makes a good point about hospice programs. Many hospice contracts require a patient to agree not to go to the ED in exchange for the hospice services, including in-patient care when appropriate. Under those circumstances an patient who goes to the ED is dropped from the program and becomes responsible for all medical bills. Whether that was the case with the patient in this instance is unknown. One service that I worked for had the director of a hospice service come out to a meeting and give us a presentation (did someone say education?) on the various services of hospice, why they may need a patient transported, and what we could do – within our scope of practice – to make things go as easy for the patient and family. It's about communication folks.

Third, like others here I have been in the situation where I needed to be a patient advocate. I was doing an interfacility transport of a trauma patient who still rated pain at 9 out of 10 after meds. I asked the nurse about additional meds and she said the patient had already received everything. I could have taken a chance, loaded the patient and called for pain management en route but I chose a more direct approach. I tracked down one of the ED docs and asked him to check on the patient with me since I did not feel comfortable accepting the patient in her current condition. When he saw the girl he readily agreed she required more meds and not only ordered more immediately but gave me orders for addtional meds en route if needed. No arguments with the nurse, no bad feelings and the patient got what she needed. However, there are those times when feelings be damned. I transported a cardiac cath patient, with a hx of a previous MI to a hospital. Nobody knew where he was supposed to go because there was a question about which of 2 procedures were to be done first. We were finally sent to one location only to find it empty. When we were redirected we got to a hospital room with no monitor and an aid told us to put the patient in the bed. I asked about the monitor and she said there was none and since he was not going to be there long he did not need it. I explained that he came from a monitored bed, he required a monitor in the ambulance and he was not leaving my litter until he could be placed on a monitor. She huffed out of the room and came back with a nurse who restated that a monitor was not available. When I explained that I would wait until one could be found she left in a huff to get a nursing supervisor, which I incidently thanked her for doing. She came back without a supervisor, but with a monitor. When I asked her to sign the receiving sheet, she rather rudely declined but the patient's wife who witnessed everything was more than willing to witness my note that the nurse refused to sign.

If we and the rest of the medical community (and/or the public safety community) want to be polite, we are the red-headed step-children. In not so nice terms, we are the bastards. Either way, we are the new kids on the block and we still have to prove ourselves everyday. It has not been easy nor will it likely get any easier, but there are ways we can stop shooting oursevles in the feet. 1. Look professional. If you wear a hat – one that is appropriate – wear it correctly. How you chose to dress/look on your own time is your business. If your dress impacts me and my professional it becomes my business. 2. Act professional. Everyone likes a joke. And God knows many times with what we see we need humor to get through. However, remember what your parents said about a time and a place for everything. The parking area outside the ED is not the place to have water fight with syringes. Nor is it appropriate to run up and bang on in-coming units. 3. Talk professionally. You do not need to be a walking dictionary or memorize Grey's Anatomy. For the most part just dropping the slang and cursing would go a long way. “Thank you.” You're welcome” Have a nice day.” would not hurt either. 4. Respect your patients. If you call your patient any one of the nasty words used in EMS to refer to, especially nursing home, patients, go get a job for FedEx or UPS. You will make more money, not have to put up with mouthy nurses or winey patients. These are people were are supposed to be caring for. Many times there may be nothing we can do except listen or hold a hand – and many times that is enough.

There are many things all of us can point to and complain about EMS and the systems, institutions and people we work with. I for one would not want to work anywhere else, as it sounds lilke the people who wrote before me feel.

Sorry this got to rambling but as the article stated, this pushed a lot of buttons.

Doesn't sound like a place I'd want to work anyway- and I've worked for one of the douchiest privates anywhere. On the other hand, around here it would take a lot more than one paramedic bringing in one patient for a hospital to cancel a contract. Nor is it my fault that the company depends so much on one facility and one home health agency. Does the owner have his retirement portfolio invested in only two mutual funds or stocks? Of course not.

Doesn't sound like a place I'd want to work anyway- and I've worked for one of the douchiest privates anywhere. On the other hand, around here it would take a lot more than one paramedic bringing in one patient for a hospital to cancel a contract. Nor is it my fault that the company depends so much on one facility and one home health agency. Does the owner have his retirement portfolio invested in only two mutual funds or stocks? Of course not.

I have come to realize that this is MY profession. I did not get into this line of work because Medicare and Medicaid pay out some decent rates and there is a steady line of work for the foreseeable future due to an increasingly aged population. I decided to dedicate myself to the preservation of life with dignity and honor regardless of the patients financial state, current or past medical history or even what crime they are accused of having committed.

I am overworked and more underpaid than any ER nurse thinks they are. I go to work in places that are not climate controlled. I go to work in places that people should not even live. But I will be damned if I will lay my ethics down at the time clock and act like the rest of the health care profession thinks I ought to.

Regardless what THEY think or how OTHERS may act, I AM A PROFESSIONAL and I will conduct myself accordingly. Yes I need my job; the kids need to eat and we like riding insted of walking, but my integrity can not be paid off.

I like to compare the struggles with or profession with the struggles against injustices of the civil rights movement. Somebody will have to stand up and make some noise and be heard…somebody may have to take the “bullet” for speaking out about what is wrong. But where will we draw the line? Who will speak up for integrities sake if we won't?

We have a long way to go to “cross the tracks” to get to the professional side of town, but that long journey starts with us ALL taking a step!! I take mine now…will you?

The cops managed to find her and bring her back a few hours later and I called my boss and explained everything so I didn't get in any trouble at work, but for weeks when I came into that ER you should have seen the dirty looks I got.