Protocol V. On-Scene Judgement Calls

[JPINFV]

Okay maybee someone does need to stand up for the EMT:
1...2...3 NOT IT!!

Visitors and regulars, please not the [sarcasm] and [Godwin] tags used in this post.

[sarcasm]

How dare you all judge those poor EMTs? You were not there. You don't know what they saw. Maybe they had superior vision than all of us and could tell a blood pressure and pulse just by looking at the patient! Similarly, we should all be glad that he prevented the spread of such horrible and immoral diseases such as AIDS by keeping all of his equipment clean. Would you want you're daughter's boyfriend's aunt's best friend's cousin treated using a blood pressure cuff and stethoscope that had been used in the past on someone with AIDS!?!?! [Godwin] Maybe the Third Reich was right with how to manage the sorts of populations who gets AIDS![/godwin] [/sarcasm]

 

[Sasha]

Visitors and regulars, please not the [sarcasm] and [Godwin] tags used in this post.

[sarcasm]

How dare you all judge those poor EMTs? You were not there. You don't know what they saw. Maybe they had superior vision than all of us and could tell a blood pressure and pulse just by looking at the patient! Similarly, we should all be glad that he prevented the spread of such horrible and immoral diseases such as AIDS by keeping all of his equipment clean. Would you want you're daughter's boyfriend's aunt's best friend's cousin treated using a blood pressure cuff and stethoscope that had been used in the past on someone with AIDS!?!?! [Godwin] Maybe the Third Reich was right with how to manage the sorts of populations who gets AIDS![/godwin] [/sarcasm]

Hey if the pulse ox could pick up a pulse in his finger that means he at least had a BP of 80, and by the sounds of the beeping on the pulse ox you could estimate the pulse.

Touch a patient??? Why ever would you touch a patient?

 

[Shishkabob]

Patients, especially of the female variety, have cooties.


I don't want cooties.



I throw my IV caths at them hoping to get a flash.

 

[JPINFV]

^
Darts?

 

[mycrofft]

Anyone ever put the pulse ox on the arm the machine is squeezing for BP?

There ought to be a thread about bad protocols and bad protocol systems, but I've stirred enough exlremento today.

 

[traumamama]

such yummy descriptions of waste products Makes me hungry! I am having a bowl of Jolly Time popcorn; what is everyone else eating One thing that has always amazed me in my 30 years of EMS-how we can talk about all the details of a gross call while we are eating-of course everyone around us has left Sick! We are all sick!!

 

[JPINFV]

One thing that has always amazed me in my 30 years of EMS-how we can talk about all the details of a gross call while we are eating-of course everyone around us has left Sick! We are all sick!!

That really has nothing on a medical school commons during gross anatomy.

 

[traumamama]

OK. So tell me a story-I will go and find a midnight snack

 

[JPINFV]

OK. So tell me a story-I will go and find a midnight snack

Discussing how the practical went, especially in terms of how the professors tagged the corpus spongiosum of the penis.

Discussing the sounds and smells of cutting through parts of the skull using a reciprocating saw.

Discussing one professor's list of "party tricks" such as the cremaster reflex and kegal exercises.

Sexual history/genitourinary review of system components during our standardized patient (SP) encounters (one of my classmates asked his SP if he had any "vaginal discharge" by accident. Good laugh for everyone involved, including apparently the SP).

Let's just say that there's been some conversations that would have been very awkward a few short months ago that now easily pass for everyday conversation.

 

[Miss Xina]

Why was this patient's glucose level checked? He may have been anxious from hypoglycemia..

I don't know enough about Hepatitis to say anything but really, knowing the patient has these diseases would make me LESS scared because I know what he has!

I'm more scared of the patients who don't tell me anything.. you don't have a clue then!!

Also, did the EMT give him oxygen via NRB or nasal cannula? If NRB then he could have vomited up into the mask or could have needed suctioning...

Do you think there'd ever be a time when we could check the blood-alcohol level in patients? I had a patient who was a known alcoholic who was unresponsive to painful stimuli so the medics didn't give him oxygen because he was known to them and they just assumed he was drunk.

When the Drs saw him and checked his alcohol level, it was way below what he normally is and they had to check for brain damage!!

I don't know what the results were, but the fact that the medics were lazy and didn't give him o2 and the patient was unconscious for different reasons leads me to think we should be provided with the tools to check alcohol levels.

If the EMTs were nervous about the patient's Hep and HIV status, they could have just taken proper, or extensive BSI precautions. I'm sure the patient may not have minded.

We need to be able to thoroughly check our patients to see if it IS just the alcohol. Assumption is not a diagnosis or reliable method of deciding what treamtents are needed!

 

[thatJeffguy]

I appreciate all of the informative posts that have come forth here. In every job develops the tendency to allow routine to set in and cut corners. If you work as a Broom Management Technician at the diner, that's OK. When your actions could cost a life, gobs of someone else's money or a licensure/career that you care about, it's not the time to cut corners. My aspiration is to be the type of medical professional that never allows a lackadaisical attitude to take root.

 

[firecoins]

how is this a protocol versus on scene judgement thread?

 

[Sasha]

I don't know enough about Hepatitis to say anything but really, knowing the patient has these diseases would make me LESS scared because I know what he has!

Bingo! EVERY patient could have some icky floating in their blood, and should be treated as such. Many people are not forthcoming with this information because they are afraid they will be treated like this guy was, with disdain and would not get less than the EMT/Medic's best care.

Bravo for him for caring enough about their safety to be forth coming about his PMHX. You don't treat them any differently than any other person, wear gloves!

 

[Sasha]

how is this a protocol versus on scene judgement thread?

Protocol is get vitals on every patient, poor on scene judgement is "This guy is just a drunk, we don't need no stinkin vitals"

 

[medichopeful]

Vital signs should always be taken. However, there are 2 exceptions to this rule that I can think of:

1) The patient (who is CAO) refuses to let you take vitals
2) When there is no time to do it, basically because you are performing life-saving procedures or because you have enough things to do first and you have a short transport time.

Also, I am a little concerned that you have EMT-Bs with 13 years of basic experience. Why doesn't he continue his education?

 

[medichopeful]

Bingo! EVERY patient could have some icky floating in their blood, and should be treated as such. Many people are not forthcoming with this information because they are afraid they will be treated like this guy was, with disdain and would not get less than the EMT/Medic's best care.

Bravo for him for caring enough about their safety to be forth coming about his PMHX. You don't treat them any differently than any other person, wear gloves!

For the OP (seeing as you don't have any training, not a bad thing), every patient DOES have an infectious disease until proven otherwise.

It's sad that Sasha is correct about people withholding information because of the level of care.

(Sasha: I'm not saying you're sad. I think you know what I mean )

 

[RescueYou]

Basic vitals should ALWAYS be taken at some point or another. You need at least one set of base vitals to at least compare to or give to the hospital. Now, I've been on calls where I've never taken the bp, but I've never taken a call when I didn't check pulse, respirations, LOC, and pupils. Pulse ox isn't even absolutely necessary, but it's good that it was taken.
As daedalus said, uncooperative patients are a whole new story...
But truthfully, vitals are necessary. Universal precautions are there for a good reason!

 

[medichopeful]

Sorry for triple post

I was reading through, and I just saw something about "questioning" an individual with more experience. I just want to point out, that you should ALWAYS question somebody if you are not sure why they did something in the field. No doubt in my mind that it is the right thing to do.

HOWEVER, make sure you do it at the right time. Preferably, after the call is done. And do it in a respectful way. Make it a conversation, NOT an accusation. You will get much more information that way.

 

[Sasha]

Vital signs should always be taken. However, there are 2 exceptions to this rule that I can think of:

1) The patient (who is CAO) refuses to let you take vitals
2) When there is no time to do it, basically because you are performing life-saving procedures or because you have enough things to do first and you have a short transport time.

Also, I am a little concerned that you have EMT-Bs with 13 years of basic experience. Why doesn't he continue his education?

I also, occasionlly don't do vitals on hospice transfers when there is an order in their chart for no vitals. Sometimes their skin tears so easy or is so sensitive that it would be considered almost cruel to do them. They're not necessarily a/o. But I doubt you'll ever run into that on 911.

 

[RescueYou]

I'm more specifically concerned with the abstract issue here; protocol versus the on-ground judgment call of a trained professional. How frequently is that an issue and how should a neophyte deal with such things?

PS. The field is very different than classroom shiz most of the time. Protocol is often bent for the sake of the patient. You can't plan for every scenario. This is where the "6th sense" and personal ability to make clear judgments of the EMT are key....nonetheless, again, vitals should always be taken.