At what points do people start and stop being your patient? (Hairsplitter alert).

[mycrofft]

Oh, good, the search engine says no similar threads...until I inserted "hairsplitter alert". What are your feelings on this?

What must occur for someone to become your patient?

Ditto for them to stop being your patient?

Are there instances where you owe a service to someone despite that they are not, strictly speaking, "your patient"?

Is this different between various certifications and degrees?

 

[fma08]

They way I've understood it is they become my patient when they consent to treatment/transport from the field, or when they are placed on my cot for a transfer. They stop becoming my patient when they are put on the hospital bed and I have given report to a nurse or physician, or the cot of a provider of equal or greater level.

Instances where I would provide services when they are technically not my patient would be helping out in the hospital where I work, or helping my partner with something if it's his/her call.

(I sense a trick in the question you asked but I'll bite )

 

[Seaglass]

For someone to become my patient, they must give consent (if applicable), not already be under higher-level care, and somehow seem to need or want my help. They become my patient as soon as I start interacting with them as such, and leaving them becomes abandonment. Except in mass casualty situations, of course, where I get to triage.

They stop being my patient when I transfer care, when they sign a release form, or if I judge them to be simply too dangerous to treat and have PD take custody.

Even if I'm on an ALS crew, the patient is still officially mine... in fact, officially all of ours until we give report. In practice, the rest of us all defer to the most senior medic or OIC, but if we see them screwing up and don't say anything, we're in deep trouble too.

 

[NomadicMedic]

They become my patient when I make contact ... and they cease being my patient when I give a complete report to the receiving Doc and get a signature on my paperwork showing that care was transferred.

Anytime in between, I'm responsible.

 

[firetender]

Are there instances where you owe a service to someone despite that they are not, strictly speaking, "your patient"?

If that's the hub of your question, you owe nothing to no one except by mutual agreement. In your role as professional, you're expected to conform to certain standards. Beyond that, it's something worked out individual to individual -- understanding must be clear the professional aspect is over.

 

[mycrofft]

I'm enjoying this exchange.

OK, her are some scenarios:
1. You find someone unconscious, no other people around.
2. You see a person walking down a street, repeatedly striking a child on the head and face with a coiled leather dog leash.
3. The person you begin or began care on dies (abscence of vs, dependent lividity, cooling body, obviously mortal wound, your pick).

Pick one.

PS: "Viva RAH!"

 

[fma08]

OK, her are some scenarios:
1. You find someone unconscious, no other people around.
2. You see a person walking down a street, repeatedly striking a child on the head and face with a coiled leather dog leash.
3. The person you begin or began care on dies (abscence of vs, dependent lividity, cooling body, obviously mortal wound, your pick).

Pick one.

PS: "Viva RAH!"

First question, are we on duty? If yes, then:

Scenario 2: Call for PD, the scene isn't safe. Plus, you are obligated to report suspected child abuse (which in this case I think it goes a bit past the suspected mark)

 

[firetender]

The person you begin or began care on dies (abscence of vs, dependent lividity, cooling body, obviously mortal wound, your pick)

If it's my pick I'm going to wipe off my fingerprints and get rid of it; then, move to somewhere I can live on a beach.

 

[Seaglass]

OK, her are some scenarios:
1. You find someone unconscious, no other people around.
2. You see a person walking down a street, repeatedly striking a child on the head and face with a coiled leather dog leash.
3. The person you begin or began care on dies (abscence of vs, dependent lividity, cooling body, obviously mortal wound, your pick).

Pick one.

PS: "Viva RAH!"

1. Depends. I'll probably determine whether they're actually unconscious (hey, people sleep in some really weird places, especially when drunk), and breathing. Most likely, I'll start compression-only CPR, keep an eye on them until EMS arrives, or leave them alone. If EMS does arrive, I probably won't say I'm an EMT unless I've actually done anything with them that a first aider couldn't or unless directly asked.

2. I call PD and CPS. Depending on the circumstances, I may or may not also intervene personally, which I'll certainly consider. Not my patient unless I can safely provide medical care, though. Will be giving my info to PD as a witness regardless.

3. Still my patient until they meet the criteria to determine death. Then I get to hang around for the coroner or morgue people. My patient, but my dead patient is different from my living patient. Then I don't really have the option of sneaking off without giving much personal information, because I'm probably in for all kinds of legal fun.

 

[mikeN]

I know in mass, care starts once you see/talk to your patient. Responsibility is transferred once they are on the receiving facilities equipment. Care is transferred full once a report is given to a nurse or higher.

 

[EricCSU]

At Austin/Travis County EMS, we have a very specific definition of who is a patient. To be a patient, the person must meet any of the five criteria:

1. Has a complaint suggestive of potential illness or injury.
2. Requests evaluation for potential for potential illness or injury.
3. Has obvious evidence of illness or injury.
4. Has experienced an acute event that could lead reasonably to illness or injury.
5. Is in a circumstance or situation that could reasonably lead to illness or injury.

The most common example of a person who we respond to but is not a patient is a report of a person lying on the sidewalk or side of the road. Upon arrival, the person is awake or is easily woken up and is alert and oriented. They were merely sleeping. They did not call us. They do not have any complaints. They do not have any evidence of injury/illness. Also, the ambient conditions are such that they are not placing themselves in harm from exposure.

Eric