Question on "Abandonment"

[trevor1189]

Say there is a patient at a doctors office because they feel ill. Upon exam, they find that the patient's blood pressure is extremely low and call 911 for an ambulance. From what I understand you cannot leave a patient once medical care has been started, unless someone with more education/certification takes over. So how can a doctor pass a patient off to EMTs without going with them? Does this fall under some other law?

Just curious.

 

[medicdan]

YOU cannot transfer care to a lower level, but the doctor can. Since the goal of the transfer is to transfer the patient to higher medical capacity (the technology and expertise of an ER), the doctor releases care to you. The doctor is the one with the medical license, you are practicing on someone else's.

 

[BossyCow]

Yep, otherwise everytime the doc walks out of the room to go check on another pt, he'd be abandoning you.

 

[trevor1189]

Gotcha, that makes sense now. Was thinking about a ride along and it got me wondering.

 

[trevor1189]

Yep, otherwise everytime the doc walks out of the room to go check on another pt, he'd be abandoning you.

Yeah lol, I didn't really think about that point until now. :wacko: I was thinking more emergency situations/critical patients.

This whole thread kind of makes me look stupid, but oh well. Brain fart I guess...

 

[EMTinNEPA]

As an Emergency Medical Technician of every level, everything you do at your job or on a call at a volunteer service is an extension of a doctor's license to practice medicine. As such, you cannot leave a patient or pass a patient off to someone with less training without documented permission from a doctor. If you pick a patient up at a doctor's office, the doctor who called you obviously is giving you permission to transport and treat the patient.

 

[medic417]

As such, you cannot leave a patient or pass a patient off to someone with less training without documented permission from a doctor.

Not correct. A paramedic can downgrade to a basic as long as nothing above the level of the basic protocol is attached to the patient. You do not have to call the doctor to do this unless that is your local policy.

 

[EMTinNEPA]

You do not have to call the doctor to do this unless that is your local policy.

Which it is... as it should be.

 

[medic417]

Which it is... as it should be.

Mother may I should never be the policy. A real education and some independent think are what it should be.

 

[exodus]

Mother may I should never be the policy. A real education and some independent think are what it should be.

And we obviously aren't in a perfect world. This isn't a utopia and how it should be. This is how it is. REALITY.

 

[medic417]

And we obviously aren't in a perfect world. This isn't a utopia and how it should be. This is how it is. REALITY.

I'm glad my reality does not include mother may I. Definitly would change careers before I would work in a system like that. If you can't trust your people fire them and get some you can trust.

 

[EMTinNEPA]

I'm glad my reality does not include mother may I. Definitly would change careers before I would work in a system like that. If you can't trust your people fire them and get some you can trust.

Then my entire region would be left without an EMS system since most doctors don't trust "ambulance drivers" simply because they don't have MD or DO after their name. I would trust most of the providers in this region with my life, but the doctors beg to differ. The hardest thing to do is to see the world the way it is and not the way you want it to be.

 

[VentMedic]

Then my entire region would be left without an EMS system since most doctors don't trust "ambulance drivers" simply because they don't have MD or DO after their name. I would trust most of the providers in this region with my life, but the doctors beg to differ. The hardest thing to do is to see the world the way it is and not the way you want it to be.

That is a very broad statement. Can you give us some specifics?

 

[EMTinNEPA]

That is a very broad statement. Can you give us some specifics?

Why? I'm sure you've had a medical director who treated you like dirt. That's 95% of the physicians at area hospitals.

 

[VentMedic]

Why? I'm sure you've had a medical director who treated you like dirt. That's 95% of the physicians at area hospitals.

No, I can't say that I have had a medical director treat me like dirt. I'm sure some may be out there that do treat EMS providers like that. But, I wanted specifics. Does your medical director not grant you any of the abilities listed in your state scope?
Just saying they don't like you is more of a personal statement than a valid argument against your doctors.

 

[EMTinNEPA]

No, I can't say that I have had a medical director treat me like dirt. I'm sure some may be out there that do treat EMS providers like that. But, I wanted specifics. Does your medical director not grant you any of the abilities listed in your state scope?
Just saying they don't like you is more of a personal statement than a valid argument against your doctors.

CPAP is a BLS skill in Pennsylvania. Do any of the BLS trucks I run on have CPAPs? Nope. Activated charcoal has been taken off the trucks period. Upriver, medics can't carry fentanyl, ativan, lasix, versed, or lidocaine. Combitubes were supposed to become a BLS skill, but that was shot down. That better?

 

[triemal04]

CPAP is a BLS skill in Pennsylvania. Do any of the BLS trucks I run on have CPAPs? Nope. Activated charcoal has been taken off the trucks period. Upriver, medics can't carry fentanyl, ativan, lasix, versed, or lidocaine. Combitubes were supposed to become a BLS skill, but that was shot down. That better?

While I won't disagree that there are doc's out there that do not understand and/or like EMS, and that some may be medical directors somewhere (though that doesn't make a lot of sense) you might want to either rethink why these things are happening, or have some good reasons for why the lack of those meds and equipment is the doc's fault.

Have any of the services you work for requested to get CPAP? And that does not mean the line personnel, but the management...you know, the people that run the service.

How many of the services you work for need CPAP? Or activated charcoal, or combi-tubes?

Activated charcoal is not part of many places treatments. Whoopee. Same for combi-tubes.

Who "shot down" combi-tubes as a BLS skill? Why was it done?

Those medic's that can't carry the drugs you listed...why? Is it because they carry alternatives to them and their service (remember, that means the people running it) has never requested to carry something else? Is it because the doc who's responsible for their actions has, possible justifiably or not, no faith in their abilities?

Before you start blaming everything on someone else, it might be good to answer these questions...lend a bit more validity to what your saying.

 

[BEorP]

As an Emergency Medical Technician of every level, everything you do at your job or on a call at a volunteer service is an extension of a doctor's license to practice medicine. As such, you cannot leave a patient or pass a patient off to someone with less training without documented permission from a doctor. If you pick a patient up at a doctor's office, the doctor who called you obviously is giving you permission to transport and treat the patient.

Everything? Even when you put a splint on you are using the physician's license?

 

[spisco85]

The problem with EMS is the low requirement for education which would make anyone skeptical about letting them use their medical license. With good QA/QI, strong membership willing to show the doctor they care, and quality continuing education a good medical director will be more lenient with protocols.

That is the bare minimum right now. Hopefully in a few years there will be more stringent education requirements. Basics with more hours of training or maybe even pre-reqs to get into the class. AAS for Intermediates and BS for Paramedics. I don't mean management though, I mean fully 4 years learning the science, and skills of being a good paramedic.

Holy :censored::censored::censored::censored:, I'm starting to sound like the rest of the education guys....

 

[EMTinNEPA]

While I won't disagree that there are doc's out there that do not understand and/or like EMS, and that some may be medical directors somewhere (though that doesn't make a lot of sense) you might want to either rethink why these things are happening, or have some good reasons for why the lack of those meds and equipment is the doc's fault.

Have any of the services you work for requested to get CPAP? And that does not mean the line personnel, but the management...you know, the people that run the service.

How many of the services you work for need CPAP? Or activated charcoal, or combi-tubes?

Activated charcoal is not part of many places treatments. Whoopee. Same for combi-tubes.

Who "shot down" combi-tubes as a BLS skill? Why was it done?

Those medic's that can't carry the drugs you listed...why? Is it because they carry alternatives to them and their service (remember, that means the people running it) has never requested to carry something else? Is it because the doc who's responsible for their actions has, possible justifiably or not, no faith in their abilities?

Before you start blaming everything on someone else, it might be good to answer these questions...lend a bit more validity to what your saying.

1. All of them.
2. How many services need trach kits?
3. Emergency tracheotomies are only allowed in severe trauma to the head, neck, and face making any other airway impossible, but not for any other airway threat. Some places don't even carry them.
4. Not sure, to be honest. It was shot down because somebody didn't trust us or was too lazy to train us.
5. They used to carry those drugs. They got pulled when we got a new medical director because he, unjustifiably, has no faith in our medics.

And what, I need to qualify everything I say with seven reasons I said it?