Do you grab vitals on pts that dont want to be transported.

chickj0434

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Example. Had 21 year old male who almost passed out at gym while doiing hiit workout. Friends say he got dizzy and couldnt catch his breath and pt states he felt like he was almost going to pass out. Get on scene pt is outside standing looks perfectly fine no current complaints. Says he had covid months ago and thinks he may have asthma now. Pt states he does not want to go to the hospital. Crew advises pt to at least bring this incident up with his primary care physician. Crew obtains refusal.

Now do you guys grab a set if pt states he doesnt want to go to hospital. We are a very busy fire department so quicker we are on scene the better.
 
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DesertMedic66

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2 full sets of vitals on all AMAs as required by my company policy.
 

flipdizzy

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Absolutely. Of course the consciousness, alert, and orientation patient has the right to refuse if he or she wants, but yeah. Do an assessment. Even in a busy agency, run one call at a time and do a thorough job on that call. Then go in service and run another.

On calls like that I always ask myself what would I want the provider to do if that was my mom or dad or loved one? Say ok, throw deuces and roll out? Or at least try to do an assessment?
 
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Jim37F

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Well, unless the patient is adamant that we don't touch them, while one guy is interviewing them, the other starts grabbing vitals... so by the time you get to the "I don't wanna to go to the hospital" part there's at least 1 set of vitals... should be pretty easy to get a second set for the AMA while the medic is going through that particular assessment without taking all day on scene either
 

CALEMT

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2 full sets is my department and county policy. I used to be assigned at a station that ran over 3,000 calls a year. Was never to busy to not grab vitals for a refusal.
 
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chickj0434

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2 full sets is my department and county policy. I used to be assigned at a station that ran over 3,000 calls a year. Was never to busy to not grab vitals for a refusal.
Thanks for all the responses. Are ambulances run around 10,000 calls a year. Not sure exactly what our protocol is i am going to look into it.
 

EpiEMS

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Vitals on all refusals, preferably two sets. In this case, I’d get HR, SpO2, possibly a BGL, BP + orthostatic BPs, lung sounds, and a temp.
I’d also ensure ALS assessed the patient - near syncope from exertion could be cardiac - and let them take the refusal if I think I might be missing something.

As my protocols clearly state: “Syncope that occurs during exercise often indicates an ominous cardiac cause. Patients should be evaluated at the ED.” I’m pushing that line & will get medical control to help me if need be.
 
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mgr22

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Chickj0434, don't think of vitals as an administrative issue -- e.g., two sets required, just for the paperwork. You should want vitals asap because they'll help you figure out how the patient is doing and what to do next. Plus, vitals may help you convince the patient to allow transport.
 

DrParasite

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Now do you guys grab a set if pt states he doesnt want to go to hospital. We are a very busy fire department so quicker we are on scene the better.
I guess my question is, why would you not? I know very few fire departments that are constantly going from call to call to call for their entire shift (EMS is a different story), and even fewer that are too busy to actually do the job that is expected of them (of which EMS is a core component, despite what some might want). Now, if you are an FD ambulance, I can see you being busy, but not too busy to do the job that you are expected to be doing.

Now, if I am on the engine, and arrive a few minutes before the ambulance, will I skip taking vitals if they are walking in the door as I pull out a BP cuff? sure, because the ambulance will get them momentarily, so the patient's vitals will be assessed by SOMEONE. But if I'm on an ambulance, even one in a busy system (and for the record, I have worked in some busy systems) I am definitely getting at least one set of vitals on the patient prior to a refusal.

The only time I won't is if the patient says "Get the F away from me, don't touch me" and starts walking away. I'm not going to tackle someone in order to obtain vital signs. But these are few and far between.
 

wcspa

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I would agree with many of the points above. I'd simply reiterate that vitals signs are hugely determinant data points in medical decision making. As stated above, unless the patient was adamant against being evaluated, as an EMS professional you have an obligation to perform an examination.

Many patients who may be against transport to the ED (initially) will be open to a quick prehospital examination. Imagine that after obtaining a set of vitals and a 12-lead ECG you catch a Brugada pattern and convey that information to the patient. That may change his mind regarding the transport and even if it did not, you have now at least given him the necessary information for an informed consent or refusal (assuming he has capacity).
 

wcspa

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Do you want to go to the hospital? Get in the truck. No? Sign here, refused AMA.

10-8.
I would disagree with this approach. The patient may not know whether or not he wants to go to the hospital. Again, employing my example above -- what if during a basic assessment you find a potentially life threatening pathology, e.g. Brugada, WPW, Wellens T-waves, sustained ventricular tachycardia, hypoxemia, marked hyperglycemia, high-grade AV block, etc. (all of which, I'd argue, are within the differential for the initial patient who had an episode of dyspnea and presyncope during exertion)? The information you gained ought to change how you approach this patient.

Without doing a basic assessment (assuming he/she allows you to do this), you are not allowing the patient to make an informed decision about his/her medical care. It's like you put together 4-5 pieces of a huge puzzle and asked them to guess what the picture was -- or, in the case of "So do you want to go to the hospital?", no pieces whatsoever beyond the patient's own intuition.
 

Phillyrube

Leading Chief
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I would disagree with this approach. The patient may not know whether or not he wants to go to the hospital. Again, employing my example above -- what if during a basic assessment you find a potentially life threatening pathology, e.g. Brugada, WPW, Wellens T-waves, sustained ventricular tachycardia, hypoxemia, marked hyperglycemia, high-grade AV block, etc. (all of which, I'd argue, are within the differential for the initial patient who had an episode of dyspnea and presyncope during exertion)? The information you gained ought to change how you approach this patient.

Without doing a basic assessment (assuming he/she allows you to do this), you are not allowing the patient to make an informed decision about his/her medical care. It's like you put together 4-5 pieces of a huge puzzle and asked them to guess what the picture was -- or, in the case of "So do you want to go to the hospital?", no pieces whatsoever beyond the patient's own intuition.
I would agree 100%. But if he wants nothing to do with you how much time you gonna waste? He's an adult, he said no. Document the crap out of it and move along.
 

wcspa

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I would agree 100%. But if he wants nothing to do with you how much time you gonna waste? He's an adult, he said no. Document the crap out of it and move along.
Sure, for cases where he declines, tells you to screw yourself, or walks away. For other cases, a modicum of effort can and should be expended.

"Hey man, I know you're feeling better now but how about we just check some vitals on you?"

9/10 times the above will work. If it doesn't -- document it. Looks better that you documented that you attempted to convince patient to acquiesce to an examination and he declined. All that was maybe maybe 30-120 seconds to ask depending on the flow of conversation.
 

DrParasite

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Imagine that after obtaining a set of vitals and a 12-lead ECG you catch a Brugada pattern and convey that information to the patient. That may change his mind regarding the transport and even if it did not, you have now at least given him the necessary information for an informed consent or refusal (assuming he has capacity).
wait, so you give everyone a 12 lead? fell down and banged your knee, let's get a 12 lead. your nose hurts? let's get a 12 lead. you were involved in a fender bender, but don't want to go to the ER? let's get a 12 lead.

I am not disagreeing that an assessment might pick up some asymptomatic things, you can spend an hour running every test under the sun just in case you might find something weird (abnormal labs), but at what point do you end up with the law of diminishing returns, where it becomes an unnecessary prehospital procedure that has a one in a million chance of finding something?
 

wcspa

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wait, so you give everyone a 12 lead? fell down and banged your knee, let's get a 12 lead. your nose hurts? let's get a 12 lead. you were involved in a fender bender, but don't want to go to the ER? let's get a 12 lead.

I am not disagreeing that an assessment might pick up some asymptomatic things, you can spend an hour running every test under the sun just in case you might find something weird (abnormal labs), but at what point do you end up with the law of diminishing returns, where it becomes an unnecessary prehospital procedure that has a one in a million chance of finding something?
No, not at all. You are misunderstanding my position. I'm commenting on the OP case in question, viz. a patient who experienced dyspnea with presyncopal symptoms. That requires a 12-lead. Your examples of minor extremity trauma, low-mechanism MVA, and nose pain -- of course there is no indication for a 12-lead.
 

FiremanMike

EMS Coordinator
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Do you want to go to the hospital? Get in the truck. No? Sign here, refused AMA.

10-8.
I’m not going to go into details, but I was involved in a death investigation that occurred after an approach very similar to that.

I would highly encourage your to abandon that practice at your earliest convenience. Remember - YOU are the paid adult on scene, YOU are the one they will turn to when it goes bad.
 

Fastfrankie19151

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Yes a set of vitals on every refusal if possible two sets and when indicated I notify als and let them take the chart. Most refusals are due to lack of insurance or not wanting to wait in the emergency room. If you keep that in mind most of the time you can get them to go. At least in my experience.
 

johnrsemt

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Yes get a set of VS on every patient that will let you, if not 2. Try to get a 12 lead on any syncopal or near syncopal. We had a crew a few weeks ago who had a new advanced that wanted to do a 12 lead on an 'panic attack'. The experienced Advanced was like why bother, but whatever you want it is your patient: she was hyperventilating due to the chest pain of an Acute MI, flew her most of the 130 miles to the Cath lab. The experienced crew member was taking credit for the 'save'.
 

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