Refusal to backboard

[Sublime]

Pt is confused, cannot tell you what year it is, but can tell you her name and where she is. she know's the president is Barak Obama. Basically Alert and oreinted x 2(out of 4).

Shouldn't that be AO x 3? She is alert and oriented to Person, Place, and Event. Only thing she failed is time. That's pretty good for a 90 year old nursing home patient. If I was in a nursing home I probably wouldn't know the day/month either.

 

[firecoins]

Shouldn't that be AO x 3? She is alert and oriented to Person, Place, and Event. Only thing she failed is time. That's pretty good for a 90 year old nursing home patient. If I was in a nursing home I probably wouldn't know the day/month either.

a/ox4 is person, place, time & event

 

[Sublime]

a/ox4 is person, place, time & event

Right... he said she knows her name, where she is, and that the president is barack obama. Thats person, place, and event.

She didn't know the month... which would be time.

EDIT: Correction. It was the year she did not know. But same concept.

 

[JPINFV]

Uhh... Seriously? :unsure:

What kind of malarkey is this?

When there's a hospital within 15 minutes in most places and a paramedic crew within 5-8, there really isn't need for online control at the EMT level. If an EMT needs online control, then the patient needs paramedics or a hospital, not online control to tell the EMT to take the patient to the hospital or call paramedics.

 

[martor]

When there's a hospital within 15 minutes in most places and a paramedic crew within 5-8, there really isn't need for online control at the EMT level. If an EMT needs online control, then the patient needs paramedics or a hospital, not online control to tell the EMT to take the patient to the hospital or call paramedics.

Well this call would be a waste of time for an ALS unit. If patient is A&Ox2 but is able to understand the risk with no spinal precautions then I would as Pt to sign. It is similar to an AMA. If they understand what is going on and is coherent enough to talk to you about the situation than transport in POC.

I work for a small private and when I need medical control I use the same radio that I use to let ED know that we are coming. I have NEVER heard of a BLS crew with no radio to contact base hospital.

 

[Aidey]

When there's a hospital within 15 minutes in most places and a paramedic crew within 5-8, there really isn't need for online control at the EMT level. If an EMT needs online control, then the patient needs paramedics or a hospital, not online control to tell the EMT to take the patient to the hospital or call paramedics.

But technically, online control is still available right?

 

[JPINFV]

Well this call would be a waste of time for an ALS unit. If patient is A&Ox2 but is able to understand the risk with no spinal precautions then I would as Pt to sign. It is similar to an AMA. If they understand what is going on and is coherent enough to talk to you about the situation than transport in POC.

I agree, but why do you need medical control for that?

 

[JPINFV]

But technically, online control is still available right?

Nope. The non-911 units (in Orange County) don't even have the standard radio setup that paramedics use to contact medical control. There' the MCI radio which can be used as a backup radio for medical control, but it's not the standard medical control radio.

 

[Handsome Robb]

I'm still failing to see how spinal motion restriction is indicated for this patient.

I agree with Socal, she's A&Ox3 which by my protocols is competent. If her back didn't hurt already it sure will after she bumps down the road on a hard spine board and lays in the ER for God knows how long before she's cleared off the board.

Lumbar spine pain doesn't indicate spinal motion restriction. With focal neuro deficits absolutely but other than that...no. Thoracic or Cervical pain does though.

 

[Aidey]

Nope. The non-911 units (in Orange County) don't even have the standard radio setup that paramedics use to contact medical control. There' the MCI radio which can be used as a backup radio for medical control, but it's not the standard medical control radio.

How on earth is that legal? I would think that all ambulances would be required to have some way to contact medical control.

 

[EMT11KDL]

I work both for a 911 agency and a IFT Agency, we always have some sort of medical control on both units. If we are picking up a patient to take them somewhere else, there has to be a Doctor their at that facility 99% of the time, or one at the facility we are currently at. Also, you can always call the ER and speak to a Physician there, and get online medical control from them. Or call your own medical director.

 

[JPINFV]

How on earth is that legal? I would think that all ambulances would be required to have some way to contact medical control.

Where's the law that says every ambulance has to have access to online control... period? The scenario where an IFT EMT level ambulance needs online medical control and nothing else is extremely extremely rare. If an EMT is thinking that they need to divert, then the answer is going to be to divert and not waste time on the radio talking to someone who's going to tell you to divert. This is espeically true since most of the time the radio call is going to take about the same time as simply transporting to the closest ED.

 

[Brandon O]

While in practice you're right (in areas like SoCal, anyway), in principle I would think that most areas would mandate the ability to access online medical control as a fundamental and inextricable component of an EMS system.

 

[zmedic]

Where's the law that says every ambulance has to have access to online control... period? The scenario where an IFT EMT level ambulance needs online medical control and nothing else is extremely extremely rare. If an EMT is thinking that they need to divert, then the answer is going to be to divert and not waste time on the radio talking to someone who's going to tell you to divert. This is espeically true since most of the time the radio call is going to take about the same time as simply transporting to the closest ED.

For new york state protocols I found this:

Obviously, significant indirect (off-line) medical control has been assumed in the development of these protocols. It was also assumed that appropriate local direct (on-line) medical control at both the basic life support (BLS) and advanced life support (ALS) level will be provided.

http://www.health.ny.gov/professionals/ems/pdf/2008-11-19_bls_protocols


Many places that do transfers are also providing EMS, if you get called to a nursing home to transfer a septic patient to the hospital, you are going to be expected to provide care that complies with the state protocols. At the very least you are going to be acting under the license of the medical director for the service, and have written protocols. I think most medical directors give their crews some way to contact them or another doctor if they have a question. It's less an issue of if BLS crews need medical control that often, and more an issue of if your license is on the line, you are going to give your crews a chance to talk to someone before they do something stupid.

I'm pretty sure all the big companies (AMR, rural metro etc) that do IFT have a number for their EMTs to call for medical control.

 

[JPINFV]

For new york state protocols I found this:

Obviously, significant indirect (off-line) medical control has been assumed in the development of these protocols. It was also assumed that appropriate local direct (on-line) medical control at both the basic life support (BLS) and advanced life support (ALS) level will be provided.

http://www.health.ny.gov/professionals/ems/pdf/2008-11-19_bls_protocols

So everyone has to follow NYS protocols now?

Many places that do transfers are also providing EMS, if you get called to a nursing home to transfer a septic patient to the hospital, you are going to be expected to provide care that complies with the state protocols. At the very least you are going to be acting under the license of the medical director for the service, and have written protocols. I think most medical directors give their crews some way to contact them or another doctor if they have a question. It's less an issue of if BLS crews need medical control that often, and more an issue of if your license is on the line, you are going to give your crews a chance to talk to someone before they do something stupid.

I'm pretty sure all the big companies (AMR, rural metro etc) that do IFT have a number for their EMTs to call for medical control.

Assuming it's not gross negligence, what stupid things are you expecting EMTs to do with they're huge scope of oxygen and oral glucose?

Also, do you think that the medical director's medical license is on the line for what paramedics do? Um, I'd love to see the story where a physician lost his medical license for something a crew did on offline protocols.

 

[Handsome Robb]

Also, do you think that the medical director's medical license is on the line for what paramedics do? Um, I'd love to see the story where a physician lost his medical license for something a crew did on offline protocols.

Kinda off topic but if I remember correctly the physician that talked those two Jersey medics through the field c-section a while back had to take a one or two day remediation class about being an on-line med control doc while the two medics lost their certs. I may be wrong though.

It's odd to me that BLS crews down there don't have access to online medical control. From what I hear it's different elsewhere, especially California, but I rarely call OLMD. Only really call for termination orders. I'd be willing to bet that a BLS crew could get OLMD if they really needed it with a cellphone call to the charge desk of the hospital or worst case scenario to the front desk and asking for a transfer, but like JP said, by the time you jumped through those hoops you'd more than likely be at a hospital or already committed to transport to the original facility.

 

[crazycajun]

Also, do you think that the medical director's medical license is on the line for what paramedics do? Um, I'd love to see the story where a physician lost his medical license for something a crew did on offline protocols.

So would I. If the information given to me by a family attorney is correct, the person (in this case medic/emt) performing the procedure holds the liability. It would be the same as calling for orders for morphine and the online doctor telling you to admin 50mg morphine IV push. It is our job to ensure the orders are correct and question an order we know is a mistake. Should you push the morphine and the PT die I do not believe a judge and jury would understand your explanation of "The doc told me to do it"