My ambulance service runs at whatever level we can, usually paramedic but today we were running at a basic level. The crew consisted of me(emt-b) and my partner(FR). We were dispatched for a male patient that had fallen. Upon arrival pt. it standing and stable, stating he had a funny feeling in his chest and the next thing he knew he was on the ground. textbook syncope I thought and decided to have a teir set up with ALS when we rendevous, the paramedic wanted to change cots(i stated no) and then wanted the pt. to walk to the other ambulance instead of her getting in and going with us(which is how it always happens) we have identical rigs so there all equipment could be used. Im new and also a basic so I let her decide what to do so the pt walked to the other ambulance. When my supervisor found out about this incident i got put on probation for not telling her no get in and go in our rig. Is this unfair?
teiring
- Thread starter EMTGUY12
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If the rigs were identical why not load your patient on your cot into their truck and take their empty cot into your truck? The patient has already demonstrated that he could deteriorate when vertical. Why chance it again?
You are responsible for the patient until the transfer of care. That normally happens once the patient is safely in the ALS truck or the medic is in your truck, and you give him/her your report. The medic didn't allow the patient to walk to the other rig, you did. You just allowed the medic to talk you into it.
I'd chalk it up to a learning experience. Is the medic employed by the same service you are? I would think he/she was also reprimanded.
You are responsible for the patient until the transfer of care. That normally happens once the patient is safely in the ALS truck or the medic is in your truck, and you give him/her your report. The medic didn't allow the patient to walk to the other rig, you did. You just allowed the medic to talk you into it.
I'd chalk it up to a learning experience. Is the medic employed by the same service you are? I would think he/she was also reprimanded.
Looking back identical isnt quite the word. We have all the same ALS and BLS equipment as the tiering rig but our cots have different glove/general assesment things on them so switching cots wouldnt work. We are both out of the same hospital but we are based 14 miles out whereas they are at the hospital.
Ridryder911
EMS Guru
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Wow! .. Does your state not have standards on licensure for services? So they can Hodge podge what a service can deliver? BLS then maybe ALS, who knows what you might get? If this is so.. it is shameful.
Couple of things. First proof read your posts, it is hard to decipher what you are writing. I am sure if it is important to you enough to post, then it should be important enough to write it legibly.
Now, this endorses why Basics should NOT be triaging and transporting based upon their assessment. Your statement stating...."he had a funny feeling in his chest and the next thing he knew he was on the ground. textbook syncope"...Scares the h*ll our of me.! Don't know what textbook you are using, but PLEASE throw it away!
The statement of "had a funny feeling in his chest" was your first hint!
Second, I hope that your Paramedic is investigated for poor care. Walking a patient with previous chest pain that presented with the syncopal episode is gross negligence.
Sorry, there appears to be so many problems on this call from your State EMS Laws to the care on the scene, to whom transported. Your service needs to review this call in detail to prevent problems and even litigation from occurring. If this call is the way you presented, the Paramedic needs to be reprimanded or possibly removed from EMS as well.
Lucky, you just got two weeks and I hope the Paramedic care is closely reviewed and action is taken against them as well.
C'mon folks the patient deserves better!
R/r 911
Couple of things. First proof read your posts, it is hard to decipher what you are writing. I am sure if it is important to you enough to post, then it should be important enough to write it legibly.
Now, this endorses why Basics should NOT be triaging and transporting based upon their assessment. Your statement stating...."he had a funny feeling in his chest and the next thing he knew he was on the ground. textbook syncope"...Scares the h*ll our of me.! Don't know what textbook you are using, but PLEASE throw it away!
The statement of "had a funny feeling in his chest" was your first hint!
Second, I hope that your Paramedic is investigated for poor care. Walking a patient with previous chest pain that presented with the syncopal episode is gross negligence.
Sorry, there appears to be so many problems on this call from your State EMS Laws to the care on the scene, to whom transported. Your service needs to review this call in detail to prevent problems and even litigation from occurring. If this call is the way you presented, the Paramedic needs to be reprimanded or possibly removed from EMS as well.
Lucky, you just got two weeks and I hope the Paramedic care is closely reviewed and action is taken against them as well.
C'mon folks the patient deserves better!
R/r 911
Airwaygoddess
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Patient care
Good patient care is first and foremost, A patient that presents with chest discomfort should be treated as a possible cardiac problem. With all of the new data coming out on younger patients with chest pain, (yes folks patients in their 30's and 40's are having MI's!
) We need to air on the side of caution, treat within our scope of practice and request for ALS as soon as possible for definitive care.
What I do not understand is why the other ambulance did not bring the gurney to the patient if equipment exchange was an issue. Any patient that is cardiac, respiratory, or hemo dynamically compromised, you do not make them walk, as far as I'm concerned, let's not add insult to injury to the patient.
With every patient contact, there is a lesson to be learned, please remember that not every patient will not present with the same signs and systems. -_-
I hope this helps.
Good patient care is first and foremost, A patient that presents with chest discomfort should be treated as a possible cardiac problem. With all of the new data coming out on younger patients with chest pain, (yes folks patients in their 30's and 40's are having MI's!
) We need to air on the side of caution, treat within our scope of practice and request for ALS as soon as possible for definitive care.What I do not understand is why the other ambulance did not bring the gurney to the patient if equipment exchange was an issue. Any patient that is cardiac, respiratory, or hemo dynamically compromised, you do not make them walk, as far as I'm concerned, let's not add insult to injury to the patient.
With every patient contact, there is a lesson to be learned, please remember that not every patient will not present with the same signs and systems. -_-
I hope this helps.
BossyCow
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We used to have a similar situation. We received ALS support from a private ambulance service that could only bill the patient if they transported. We had a mutual aid agreerment that meant they couldn't bill us. Medics were pressured by their agency to move the pt into their rig if at all possible.
In time it was determined that ALS to a BLS agency was not 'mutual' aid and they were allowed to bill us for the medic. They billed our agency, not the pt, so we bled money since we had no system in place for billing a patient. Since then, we have started a 3rd party payer program which seems to have solved the issue.
In time it was determined that ALS to a BLS agency was not 'mutual' aid and they were allowed to bill us for the medic. They billed our agency, not the pt, so we bled money since we had no system in place for billing a patient. Since then, we have started a 3rd party payer program which seems to have solved the issue.
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As far as the paramedic wanting the patient in their ambulance, and refusing to go with you "which is how it always happens" why would you want to take two rigs out of service instead of just one? By transferring the patient to the medic rig, your rig would remain available for another call.
I agree with the others about the apparent lapse in care, and would hope that steps are taken to prevent that from happening in the future.
I agree with the others about the apparent lapse in care, and would hope that steps are taken to prevent that from happening in the future.
Outbac1
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AHHH!! One of the benifits of a province (state), wide service. All trucks are equipped the same. We do intercepts and hand offs all the time. For an ALS intercept the ACP will get in the originating truck and use its resources. If the pt is serious both originating PCP's will stay on board, one to drive and one to assist. The remaining unit will follow the first to the hospital. However the second unit is available to do a first response if required. If the pt is not that serious the original attending PCP will drive the medic and the other will jump in the other truck to make a two person unit.
The patient doesn't move.
In a long haul hand off the pt stays in the original truck and the new medic crew gets in and takes over pt care for the rest of the trip. The original transporting medics take the second crews truck and are now available for calls. Here any empty truck, (no patient), is an available truck. You don't have to be in your home area to be used on calls. Some of our long transfers can be 5 -6 hours.
The patient doesn't move.
In a long haul hand off the pt stays in the original truck and the new medic crew gets in and takes over pt care for the rest of the trip. The original transporting medics take the second crews truck and are now available for calls. Here any empty truck, (no patient), is an available truck. You don't have to be in your home area to be used on calls. Some of our long transfers can be 5 -6 hours.
BossyCow
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Interesting to me that the EMT is in trouble for following the instructions of the higher credentialed employee on scene. Since they both work for the same agency, the higher authority should be the one responsible for determining the Tx Plan. Makes me wonder if the EMT convinced the EMT-P that this was 'a typical syncope' and not a cardiac scenario. For the lower credentialed employee to be placed on probation over this, gotta wonder if there are other examples of poor pt care on the part of the EMT-B which motivated the employer.
JPINFV
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Was both units from the same company?
If were, then I honestly fail to see the problem with switching units. It simply shouldn't matter. Yea, it might suck being bumped off of a good case, but 3 months down the line it won't matter.
On the other hand, if you are dealing with seperate companies then there's the reimbursment issue. To me, the same thing applies. If my managers want to get upset because a medic asked a crew to transfer a patient to a different company (actually did have a fire medic tell me to transfer to a different company. This, per county EMS, is not supposed to happen), then so be it. This isn't Anchorman and I'm not going to fight people for turf (patients).
If were, then I honestly fail to see the problem with switching units. It simply shouldn't matter. Yea, it might suck being bumped off of a good case, but 3 months down the line it won't matter.
On the other hand, if you are dealing with seperate companies then there's the reimbursment issue. To me, the same thing applies. If my managers want to get upset because a medic asked a crew to transfer a patient to a different company (actually did have a fire medic tell me to transfer to a different company. This, per county EMS, is not supposed to happen), then so be it. This isn't Anchorman and I'm not going to fight people for turf (patients).
To the OP: Assuming the paramedic was also disciplined, I would agree that this should be chocked up to a learning episode and the discipline was not unfair. I would make sure to clarify the procedure for ALS intercepts with your supervisor - but there is absolutely a problem in your allowing a syncopal/cardiac/whatever patient to walk from ambulance to ambulance - just because a medic says something doesn't make it so - you are a medical provider as well, and should have recognized that the pt. wasn't going anywhere except on a bedsheet or a cot.
I've never really understood the requirement (in many states) that for a service to be able to provide any ALS care, they have to be able to provide 24/365 ALS service. It seems given a choice between ALS sometimes and BLS the rest of the time and BLS all of the time, tehe choice seems obvious to me.
What? I'm not sure I follow -- but do we really need to start the "eliminate EMT-B's" war again? He (properly) decided that the patient was possibly high-acuity requiring ALS and set up an intercept. Are you saying that he should have remained on scene until ALS showed up?
Granted the OP didn't say in his post that he had suspicions of cardiac compromise, but he may well have said that to the responding medic. I don't see what is wrong with calling the episode syncope - if the pt. quickly regained consciousness upon falling than he did indeed experience a syncopal episode. That episode may have had a cardiac etiology, but it doesn't seem improper to me to call it syncope.
Even if the OP did make an error in diagnosis (And based on the information given I don't think he did anything grossly improper until the time of the intercept) - that hardly proves that EMT-B's should not be providing initial assessments of patients - only that he did a bad assessment. I venture to guess most EMT's would properly recognize and further investigate the possibility of a cardiac event, and that I could find a couple of paramedics, RN's, or ER Docs who have all made mistakes.
Finally -- and I hesitate to say this because i don't want to start another fight about internet intelligibility -- but I have to fight the urge to say something every time I read a post of yours, and I think I've finally lost the fight. Rid if I see you criticize one more poster for illegibility I may well explode. I can't believe I'm the only one who realizes that the vast majority of your posts are riddled with gross errors to the point that they often are truly indecipherable. Your post on this thread was one of your better posts perhaps - but it still had a number of more and less serious errors. I had no problem following the OP, but many a time I have simply ignored your posts because I can't figure out what the heck you are saying -- which is unfortunate because you generally have very intelligent additions to make to a conversation, if they can be decoded.
I've never really understood the requirement (in many states) that for a service to be able to provide any ALS care, they have to be able to provide 24/365 ALS service. It seems given a choice between ALS sometimes and BLS the rest of the time and BLS all of the time, tehe choice seems obvious to me.
What? I'm not sure I follow -- but do we really need to start the "eliminate EMT-B's" war again? He (properly) decided that the patient was possibly high-acuity requiring ALS and set up an intercept. Are you saying that he should have remained on scene until ALS showed up?
Granted the OP didn't say in his post that he had suspicions of cardiac compromise, but he may well have said that to the responding medic. I don't see what is wrong with calling the episode syncope - if the pt. quickly regained consciousness upon falling than he did indeed experience a syncopal episode. That episode may have had a cardiac etiology, but it doesn't seem improper to me to call it syncope.
Even if the OP did make an error in diagnosis (And based on the information given I don't think he did anything grossly improper until the time of the intercept) - that hardly proves that EMT-B's should not be providing initial assessments of patients - only that he did a bad assessment. I venture to guess most EMT's would properly recognize and further investigate the possibility of a cardiac event, and that I could find a couple of paramedics, RN's, or ER Docs who have all made mistakes.
Finally -- and I hesitate to say this because i don't want to start another fight about internet intelligibility -- but I have to fight the urge to say something every time I read a post of yours, and I think I've finally lost the fight. Rid if I see you criticize one more poster for illegibility I may well explode. I can't believe I'm the only one who realizes that the vast majority of your posts are riddled with gross errors to the point that they often are truly indecipherable. Your post on this thread was one of your better posts perhaps - but it still had a number of more and less serious errors. I had no problem following the OP, but many a time I have simply ignored your posts because I can't figure out what the heck you are saying -- which is unfortunate because you generally have very intelligent additions to make to a conversation, if they can be decoded.