Breaking the Rules

[MMiz]

As year after year passes, our society seems to be overtaken by more and more rules. Today I was teaching my students about being passionate, and how sometimes it may mean breaking a rule or two. Is it ever okay to break a rule in EMS?

• Would you feed a hungry woman with no significant medical history a sandwich if you knew she wouldn't be given food at the nursing home?
• Would you take the scenic route home if a patient asked, knowing that it would go against your service's rules?

 

[FFEMT1764]

NO and NO, I work for a 911 only service though. IF it were a private service I might take the senic route, miles=money.

 

[Ridryder911]

Yes & Yes

Rules are suggested guidelines. maleficence (best for the good) should be our goal, we are really in the people business.

You might have given more treatment, by the little act of compassion than that patient has received in years....

R/r 911

 

[FFEMT1764]

Rules here are like laws, you break them you lose your job!!

 

[jeepmedic]

I have and will continue to do what is in the best intrest of my Pt. so yes and yes.

"No one cares how much you know untill they know how much you care." This was taught to me about 15 years ago and it has been true more than anything else I was taught over the years. EMS has changed but this has not.

 

[MMiz]

If a patient asked to be driven on a two mile detour to see the street lined with Christmas lights you wouldn't do it? Lets pretend no calls were holding and there was great EMS coverage.

 

[fm_emt]

If a patient asked to be driven on a two mile detour to see the street lined with Christmas lights you wouldn't do it? Lets pretend no calls were holding and there was great EMS coverage.

If they can get up from the backboard after all that duct tape, they can look at whatever they want!

So,

a)Yes

b)N/A, as we don't transport

 

[Airwaygoddess]

As far as feeding a stable patient, i.e, my pt being transfered to a nursing home, yes I would. As long as I got a hand down report from the nurse. As we all know, sometimes those transfers can be up to a hour or sometimes more. Moving out of your service area, no. Because things can change so fast. I truely believe in talking to the patients, they were someones babies at one time....

 

[Guardian]

My answer is yes to all the questions for the reasons already given. Now, I'd like to give you'll another scenario. You are an ALS provider riding with a BLS provider. You are dispatched to a major wreck with 12 pts, two of which are yellow/reddish. You call for additional help and there aren't any more ems units available and your supervisor is out of town. You are the IC and have to decide what to do. No helicopters either, by the way...This actually happened to a friend of mine a few years back. He ended up sending the pts to the hospital with his emt driving and a nurse on-scene tending to the pt while he stayed on scene to be the IC until further help arrived. What do you guys think?

 

[jeepmedic]

My answer is yes to all the questions for the reasons already given. Now, I'd like to give you'll another scenario. You are an ALS provider riding with a BLS provider. You are dispatched to a major wreck with 12 pts, two of which are yellow/reddish. You call for additional help and there aren't any more ems units available and your supervisor is out of town. You are the IC and have to decide what to do. No helicopters either, by the way...This actually happened to a friend of mine a few years back. He ended up sending the pts to the hospital with his emt driving and a nurse on-scene tending to the pt while he stayed on scene to be the IC until further help arrived. What do you guys think?

You and your partner stay on the scene and treat the pts as best you can until more help arrives. This is no diffrent than being the first on the scene of a Plane Crash. The first truck in is the last out. You start triage and continue until all pts are triaged.

Now if you need to transport a pt. then you get the Fire Dept. drive you in and your EMT partner who will not get that ALS got to treat everyone tunnel vision can stay behind and triage.

 

[fyrdog]

We picked up a psch one morning who was crying a river. When asked what was bothering him he said he wanted an egg mcmuffin from Mickey Ds. I was teching the call when my partner desided to stop and get him his McMuffin.(not that I was entirely in agreement) The guy stop crying and said "You guys really care your the best" He did still go to the ER .


Last month I was bringing a PT to a nursing home on the rural street where I grew up. The patient had been living on one of the side streets. It was about a mile past the destination so I drove by so she could her old house. She thought that was really nice. Her daughter showed up about five minutes later to see her mom. The daughter knew her mom was at the nursing home because she lives in her mom's old house and saw the ambulance drive by.

 

[Guardian]

You and your partner stay on the scene and treat the pts as best you can until more help arrives. This is no diffrent than being the first on the scene of a Plane Crash. The first truck in is the last out. You start triage and continue until all pts are triaged.

Now if you need to transport a pt. then you get the Fire Dept. drive you in and your EMT partner who will not get that ALS got to treat everyone tunnel vision can stay behind and triage.

the pts were triaged, i said 12 pts, 2 were borderline red and needed immediate transport. The fire department can't help because they can't drive (according to policy) and emt can't tech the pt without a ALS provider in back (according to policy). Also, as the ALS provider, you're the automatic IC, and therefore your responsible for IC duty and not your emt. Not that you couldn't make the emt a temporary IC, but considering you've already been identified as the IC and are responsible, what would you do?

 

[Summit]

the pts were triaged, i said 12 pts, 2 were borderline red and needed immediate transport. The fire department can't help because they can't drive (according to policy) and emt can't tech the pt without a ALS provider in back (according to policy). Also, as the ALS provider, you're the automatic IC, and therefore your responsible for IC duty and not your emt. Not that you couldn't make the emt a temporary IC, but considering you've already been identified as the IC and are responsible, what would you do?

If the policy doesn't work, screw your policy!!!!

IC's may relinquish command (this is part of ICS). Give FD command. If they won't, give PD command.

Talk fire into driving. If they won't, get PD to drive.

ALS takes the 2 reds with a FD or PD driver. Haul ***!!!

BLS watches the yellows/greens, utilizing FD/PD/and the RN bystander to assist.

 

[EyeOn]

As year after year passes, our society seems to be overtaken by more and more rules. Today I was teaching my students about being passionate, and how sometimes it may mean breaking a rule or two. Is it ever okay to break a rule in EMS?

• Would you feed a hungry woman with no significant medical history a sandwich if you knew she wouldn't be given food at the nursing home?
• Would you take the scenic route home if a patient asked, knowing that it would go against your service's rules?

1. Though a nice gesture for wanting to satisfy a patient's request for food, if you know the nursing home would refrain food, then there must be a reason for it (meds maybe???) and if anything negative were to happen resulting from that food intake, you might be held liable.

2. If it's a nice quiet day and nothing signifcant would come out of taking a few extra minutes to take a nicer route, perhaps, but never if that route takes you too far off course. What if you got a call and you're expected to be at point A and thought to be able to get to point B quicker than anyone else, which is why you were called on, but you're off at point C? It can cause trouble.

So my final analysis...No and maybe.

 

[AnthonyM83]

Sometimes I have to remind myself it's okay to diverge from rules. Rules aren't universal laws we must follow. They're usually for a good reason, but still just man-made. If my ultimate goal is to help others, I might do it to make their day. You have to make sure you're not going to uninentionally cause a bigger problem (you have to understand why the rule is there) and weigh in possible consequences to you. If you consider both and compassion (or even common sense) wins over, then go ahead.

Of course, every now and then you might diverge from rules because you had to and you justify/document it best you can...but those don't seem to be the ones we're talking about.

 

[EyeOn]

If my ultimate goal is to help others, I might do it to make their day.

Oh hun...you just made my day...

Can I 'steal' Keifer Sutherland??? LOL

...I'm still waiting for season five to come out on DVD.

"...sorry sir, but this is a matter of national security..." h34r: POP!!h34r:

Ok. I'm done.

 

[Epi-do]

For the first one, as long as there was no reason why she couldn't eat, yes. The bigger issue for me in this scenario is if the patient is able to have food, why isn't the nursing home feeding her? When I was working private service, even if a patient missed a hot meal because of the time they were transfered back to the ECF, they would at the very least get a sandwich, salad, etc.

For the second one, I have actually done this before. I have also taken a patient out of a door that wasn't necesarily the closest one to the truck because it was a nice day and the patient asked to get a little bit of fresh air. If it is just a little thing that can easily be done, I don't have a problem doing it, if it will brighten someone else's day.

What if you got a call and you're expected to be at point A and thought to be able to get to point B quicker than anyone else, which is why you were called on, but you're off at point C?

Just wondering, if you are in the middle of transporting a patient, why would you be dispatched to another location where it is of importance to be there quicker than anyone else? Again, working private service, I have had runs stacked on me before, but nothing where time was truly an issue....releases from the hospital, dialysis returns, etc., but certainly not something where time could be an issue. Not to say we didn't try to pick those patients up at their scheduled time, just that in those situations there is nothing "life threatening" where you need to get there ASAP.

 

[EyeOn]

Just wondering, if you are in the middle of transporting a patient, why would you be dispatched to another location where it is of importance to be there quicker than anyone else? Again, working private service, I have had runs stacked on me before, but nothing where time was truly an issue....releases from the hospital, dialysis returns, etc., but certainly not something where time could be an issue. Not to say we didn't try to pick those patients up at their scheduled time, just that in those situations there is nothing "life threatening" where you need to get there ASAP.

Was just a thought if your 'boss' would know how long it takes to get to point A then to point B and can estimate where you may be at a particular time. This is also kind of narrowed down to simple, non-emergency transports. It's one of those scenerios that if the company you're working for is good at time management, you could get snagged if you're off driving to a vista point 20 minutes out of the way. Plus, that second call may include a patient where timing is important...such as a patient from a nursing home who may need immediate hospital care and you're suppose to be nearby at the time the call is requested.

I personally wouldn't take the chance of taking anymore than a few extra minutes just in case...whether it'd be to save your own job or to make yourself available when you're suppose to be available for when an emergency call does come in.

As I said, just a thought. Maybe a bit off in left field so to speak, but aren't those the ones that get EMTs all tangled up in their more crucial days? LOL.

 

[Epi-do]

Thanks for clarifying that for me!

 

[akflightmedic]

Good topic.

I remember about 10 years ago, I was working on the side for an interfacility service and I used to have requests like that often. Patients wanted a little extra sunshine, a fast food meal, etc. I was more than happy to oblige them.

For those of you that work IF transport, have you ever asked your patient on a nice day if they wanted a few extra minutes in the sun, instead of whisking them from bed to bed and being in the shade the whole time. You would be surprised how many of them smile so big and say they would love it.

I remember one particular gentleman that I was taking from hospital to IF. He wanted help cashing a check. He had been carrying it around for a while and no one was able to help him. He was old fashioned and wanted cash in his posession cause it gave him security. I said no problem. We drove him to the bank, I went inside and asked for the manager, explained the situtation and the manager came out and completed the transaction. The manager was impressed with our service and the patient was so happy, grinning ear to ear.

When I was new and working IF services, I learned a valuable lesson. Patients are going to be stacked no matter how fast you work and how much hurrying you do. So I changed my attitude. I quit walking extra fast, I quit going slightly above the speed limit, and I took my time with the patients. One patient at a time. Think of the one you are with, not the one you have to hurry and get to next on the list. I am not saying be slow and loaf around, I am saying observe all traffic laws, enjoy your walking from one place to another, enjoy your patients and breathe a little. With a little mental adjustment, the job becomes more tolerable and enjoyable.