Termination of care

[TreySpooner65]

I volunteer as an EMT for events. Oftentimes I get patients that quite honestly dont need to go to the hospital. What is the proper way to terminate care?

I dont want abandonment issues. I have AMA forms for when its necessary, but not everyone needs me to call an ambulance. What is the proper, safe way to wrap up something like that?

 

[Shishkabob]

"Do you want an ambulance called? No? Ok, sign this form"

 

[TreySpooner65]

So just ask EVERYONE for an ambulance :unsure: :rofl:

 

[Shishkabob]

Didn't say I liked / agreed with it, but unless you are comfortable / allowed to do provider initiated refusals, that's all you got.


Granted, you can get a bit creative in how you talk to patients if they want to go, but alas...

 

[JPINFV]

Are we at least plannning on being logical and, say, not offer to call 911 for patients who just need a band aid or ice pack?

Also, while I don't know the work history of the OP, this is why I don't suggest new EMTs do event standby or first aid.

 

[tssemt2010]

if they want to go to the hospital, typically you cant deny them transport, but typically at an event where they dont need immediate transport i would recommend them schedule an appointment with their primary care physician

 

[LucidResq]

I wouldn't feel comfortable advertising myself as an EMT while providing first aid for an event or amusement park or whatnot without the backing of a medical director. I have done both event standbys and an amusement park, each under a different service and each under a medical director. In each case, our refusal forms and procedures were worked out in collaboration with The Doc.

I did so as a newer EMT, but wouldn't have felt comfortable without the guidance of the several highly-experienced EMTs and medics I worked with.

 

[JPINFV]

Which is kinda of the problem with California since individual BLS ambulance services (not 100% sure about ALS to be honest) do not need their own medical director.

 

[LucidResq]

Also, if you're working events other than just beer festivals and shuffleboard competitions, you need to figure out what you're going to do with unattended minors. Are you going to make the 14-year-old girl with a headache go to the hospital because she's not with her parents? Will you accept a refusal via phone from the parents? What if she's with her 17-year-old big brother?

 

[LucidResq]

Which is kinda of the problem with California since individual BLS ambulance services (not 100% sure about ALS to be honest) do not need their own medical director.

I understand companies may not be driven to do so on their own volition, but even if legally they don't need one, they can get one, right?

 

[JPINFV]

I understand companies may not be driven to do so on their own volition, but even if legally they don't need one, they can get one, right?

I'm not sure. It's also depends very much on the county involved for ambulance service. Regardless, the county/region medical director has final say regardless. Additionally, I have serious doubts that most of the EMS regions care, or even want to deal with, first aid/event standby services.

 

[imadriver]

on the "doing it as an EMT" without a MD... Isn't that illegal? I know here in Florida an EMT cannot do anything without a MD, protocols, standing orders, and so on. I guess technically it wouldn't stop you from "volunteering" as a first aid provider, but you couldn't do it in, say, your work shirt. You'd have to do it as a "I'm here by myself to hand out bandaids" kind of thing.

 

[JPINFV]

on the "doing it as an EMT" without a MD... Isn't that illegal? I know here in Florida an EMT cannot do anything without a MD, protocols, standing orders, and so on. I guess technically it wouldn't stop you from "volunteering" as a first aid provider, but you couldn't do it in, say, your work shirt. You'd have to do it as a "I'm here by myself to hand out bandaids" kind of thing.

Well, the question with an area that has regional policies and a regional medical director that covers all services is, "Does first aid or event standby fall under the EMS system in place, or occur outside of it?" If the standby is done as a part of the EMS system, then the protocols and policies in no way matches the demands of the service. If standby is done outside of the EMS system, then are providers allowed to provide unsupervised care under their EMT or paramedic license?

Now, add the issues with providing any prehospital service, including IFT, where the regional or state-wide protocols are not set up in a manner to properly handle anything outside of prehospital emergency care where the default end point is an emergency department.

 

[Shishkabob]

on the "doing it as an EMT" without a MD... Isn't that illegal? I know here in Florida an EMT cannot do anything without a MD, protocols, standing orders, and so on. I guess technically it wouldn't stop you from "volunteering" as a first aid provider, but you couldn't do it in, say, your work shirt. You'd have to do it as a "I'm here by myself to hand out bandaids" kind of thing.

As long as you stick to strictly what a civilian can do, ie bandaging, splinting, etc, you don't need medical direction. Doing the 'advanced' stuff, such as medication... than yes, you do.

 

[JPINFV]

As long as you stick to strictly what a civilian can do, ie bandaging, splinting, etc, you don't need medical direction. Doing the 'advanced' stuff, such as medication... than yes, you do.

Assessing, diagnosing, and treating as a part of a job description could easily be argued that it is practicing medicine without a license unless otherwise authorized. Alternatively, what is stopping an EMT from providing OTC medication, in addition to using glucose monitors and pulse oximetry (both of which are medical devices available over the counter)? Similarly, why does, at least in California, the scope of practice for EMTs include specifically, "(6) Use various types of stretchers and body immobilization devices."

The problem is that it's one thing to provide first aid as a good Samaritan, it's quite another to do it for a pay check.

 

[Anjel]

Back on topic.

When I do standbys for the company I work for this is our policy:

Bandaid, ice packs, hot packs, etc: Hand them to them and say have a nice day.

If you think they need an ambulance and that they need to go to the hospital and they refuse...Then we do a PCR and a refusal.

If they agree to go, we call for a rigg and do a PCR just like any other call.

 

[TreySpooner65]

Are we at least plannning on being logical and, say, not offer to call 911 for patients who just need a band aid or ice pack?

Also, while I don't know the work history of the OP, this is why I don't suggest new EMTs do event standby or first aid.

This is what I'm referring too.. I get a lot of sprained ankles and abrasions. They dont need to go to the hospital for that.

Or what about a concussion (or suspected technically <_<). Should I just call 911 and have them transported?

 

[firecoins]

Once you give someone a bandaid, an icepack or hotpack, you are providing treatment. First you should be doing an assessment and filling out a PCR to document as such. It protects you from conditions they don't tell you about that could be potentially serious if not life threatening. Second you are providing a billable service. They could just as easily go to Duane Reade and buy a band aid but they approached an ambulance. Either they need your help or they don't.

 

[JPINFV]

Once you give someone a bandaid, an icepack or hotpack, you are providing treatment. First you should be doing an assessment and filling out a PCR to document as such. It protects you from conditions they don't tell you about that could be potentially serious if not life threatening. Second you are providing a billable service. They could just as easily go to Duane Reade and buy a band aid but they approached an ambulance. Either they need your help or they don't.

1. First aid or standby doesn't always necessitate billing the patient.

2. First aid or standby doesn't always necessitate the presence of an ambulance.

 

[JPINFV]

This is what I'm referring too.. I get a lot of sprained ankles and abrasions. They dont need to go to the hospital for that.

Or what about a concussion (or suspected technically <_<). Should I just call 911 and have them transported?

Concussion? I'd say yes. A much harder question is when do you transport the patient with mild dehydration and heat exposure in contrast to letting them sit in First Aid and drink some nice cold water?