Things we can do nothing about?

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tsuna51

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If you get called for something like a stubbed toe, what would you do and say to the patient? Would you just tell them that there is nothing you can do for it and still offer a ride to the hospital/make them sign an AMA if they don't want to? I was just wondering because my teacher said something about how if they call you then you should always offer a ride to the hospital.
 
Depends on local protocols and if paramedics are empowered to perform a paramedic initiated refusal of care.
 
It depends on your department protocol. In the rural department I am on, if it's something that is not urgent and nothing we can do for it, we'll tell them that, and tell them if they want it checked out their best bet is to go to the ER themselves or call their doctor and we'll have them sign a refusal. Of course taking them to the hospital also adds another hour to an hour and a half to our run time taking us out of service as the sole provider for a 190 square mile area for that length of time... If they insist on going via squad, we do take them.

In the city, our transport time is 6 minutes on the off chance that we hit all the lights red, so we'll usually take them since turfing them would take more time.

That being said, be wary of those "little" calls. Our department was dispatched for knee pain, and we walked in with just a first in bag (it's just knee pain, how bad can it be right?) and we looked like we were caught with our pants down when we got there and she was a full arrest! (For those that are interested, it was a PE caused by a clot in her knee and by the time we got there, with a 15 minute response time, it had dislodged).
 
It all depends on your protocols and your company. For my company we are not allowed to tell a patient no they don't need an ambulance transport. No matter what they call us for we are "more then happy" to take them to the hospital. If they want to refuse transportation then we have a "wonderful" 12 step process to help change their mind. If they still say no then we let them sign the paper.

Now I think all that ^ is BS even though I have to do it. IMO I believe that the ambulance crew should be able to decide if the patient needs to go or not. I would love to be able to say "you don't need an ambulance. Call a taxi or hop in your car and drive to the hospital for your hang-nail".
 
Oh ok, thanks guys. I am taking my final for my program tomorrow but I just feel like if I get hired somewhere then I am just expected to know what to do in every situation. I am really confident with my skills, but I just feel like I am unprepared to deal with a situation by myself without being told by the people I'm riding along with. It seems like it is mostly spelled out in the local protocols though.
 
any place that you work for, well any reputable place that you work for will put you on as a third man or even as a fourth man until you get the hang of things. you are not expected to know what to do in every situation your first day out! (any anyone who makes that assumption is an idiot)
 
tsuna51 said:
Oh ok, thanks guys. I am taking my final for my program tomorrow but I just feel like if I get hired somewhere then I am just expected to know what to do in every situation. I am really confident with my skills, but I just feel like I am unprepared to deal with a situation by myself without being told by the people I'm riding along with. It seems like it is mostly spelled out in the local protocols though.
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I know that lots of people take not knowing something as a sign of weakness, but don't get caught in that trap. There are many things you won't know. Nobody will ever knowing everything (although plenty will try to make you think they do). So ask when you have a question or look it up. Remaining ignorant can cost you and your patient, so keep up on your protocols and if you don't know something, don't feel bad about finding out.

Who occasionally flips through his protocol manual? I do. Why? Because the other night we had a patient who fell and struck his head. He was the perfect candidate for an exam to clear his c-spine in the field. I turned to our junior crew member and asked, "Do you want to perform and advanced spinal?"

I was met with the blankest stare you could ever ask for. She said, "I don't know what that is." So I went through it with her and asked her after the call if she ever read our protocol manual which has an excellent flow chart for the algorithm. She shook her head and said, "Not completely."

She was presented with the perfect scenario to apply protocol knowledge and she couldn't because she never bothered to learn. So don't let that be you. Know your protocols, understand what's expected of you in the most common types of calls you get in your area.

But above all, if you don't know, ask. None of us were born knowing even though you'd swear some EMTs came into this world driving an ambulance out of their mother's womb.
 
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Multiple learning modes

Some folks are reading learners, some are visual (like demonstrations), some are hands on, some are auditory (lectures) etc. Your protocols will dictate practice at your employer's, as long as they are within the applicable local, state, county, federal, etc etc laws and protocols.
 
"So, do you want us to take you to the hospital?"

That often elicits "Do you think I should go?"'


To which I respond with something that attempts to cover my own butt while attempting to give my medical advice. blah blah xray, blah blah blood work, blah doctor, blah blah.



(The ones who clearly should be checked out don't get given the option, just 'Let's go get checked out'... ahh wordplay)
 
What we're taught to say is this (in reply to "Do you think I/my mom/child/etc needs to go?")

When nothing seems wrong:

"Do I think you should go? I can't make that call, I don't know how you're feeling. From what we can tell from our assessment and our equipment, everything looks normal, but that doesn't mean it is. We're not doctors and we don't have the extensive equipment they do in the hospital. We can only say that from what we can tell you look fine, and if you want to go we can certainly take you if that's what you decide."

When a trip to the ER would be prudent, but not emergent:

"You probably need to go to the ER to get checked out. Do we need to take you? From what we can tell, probably not, but we're not doctors and we don't have the extensive equipment they do in the hospital. We can only say that from what we can tell you look fine to have your husband/mom/etc drive you to the hospital, but if you all are move comfortable with us taking you, we'd be more than glad to do so."
 
I've seen too many instances in which EMTs are a bit too wishy-washy. If a patient asks me if I think they should go, I'm a step ahead of them saying something like:

"Here's what I'd like to do for you... we're going to put you on some oxygen, take a look at an EKG of your heart and give you some medicine that can help the pain. So we'll get you to our ambulance and get you going to the hospital. Sound good?"

So far, the answer has always been "yes."

If it's not an emergency, I'll say something like:

"Since you called and we're here, why don't we take you to checked out? If it turns out to be nothing, the peace of mind will be worth it. Whaddya say?"

I usually get a "yes" for these folks, too.

No skin off my nose to take someone to the hospital. Last I checked, it's what they pay me to do.
 
if its something not serious and there is nothing remarkable upon assessment, ill tell them they will probably get seen quicker by their MD then the ER, but either way i always recommend they go seek advanced medical care. you can come with me or go see your doc.
 
Elk Oil said:
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No skin off my nose to take someone to the hospital. Last I checked, it's what they pay me to do.
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Im sorry - I'm paid to provide emergent care outside of the hospital to hopefully prevent someone dying...not to play taxi to the lazy.

It IS skin off my back to take someone who doesn't need to go because theyre taking potentially life saving resources out of service for upwards of 3 hours...and yes, I have cleared from a call where an ambulance wasn't needed to being literally 30 seconds away from doing a critical life saving intervention. If we had transported, the next ambulance was 20 minutes away....he would have died without a doubt in my mind.



The sooner we drop the "you call, we haul" mentality...and the supporters of it, the beyer as we can move on to real medicine. Not everyone that calls needs to go by ambulance.
 
if we dont think they need to go by ambulance...we do the whole...we are more than happy to take you if you want to go but you would probablly be seen quicker if you followed up with your PCP.

If they want to go and really dont need to...we will bring them to the waiting room and we turn into a really expensive taxi cab.
 
Linuss said:
Im sorry - I'm paid to provide emergent care outside of the hospital to hopefully prevent someone dying...not to play taxi to the lazy.

It IS skin off my back to take someone who doesn't need to go because theyre taking potentially life saving resources out of service for upwards of 3 hours...and yes, I have cleared from a call where an ambulance wasn't needed to being literally 30 seconds away from doing a critical life saving intervention. If we had transported, the next ambulance was 20 minutes away....he would have died without a doubt in my mind.

The sooner we drop the "you call, we haul" mentality...and the supporters of it, the beyer as we can move on to real medicine. Not everyone that calls needs to go by ambulance.
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I agree with a few of your points. And I think that, to a degree, things like this are grown from the culture of the communities we serve. We're community-focused and will perform some services like assisting people back into their homes and stuff like that. We don't do any IFT -- we're only 9-1-1.

When I worked the fast life in the big city, we were much more like what you described. Out in the sticks, though, we're a "kinder, gentler" service, for lack of a better term. Nobody on our service is fooling themselves by thinking everything we do is "real medicine," nor is it our goal to drop our current methods because we rely on donations and billing to survive.

Now I know I'm raising some hackles with that last statement. We are not driven by finances. We don't needlessly transport patients or "up-code" our billing. We transport and treat appropriately and we take it as a matter of pride that we play the finances straight. We don't go to calls looking to drum up business.

But if we have the choice of encouraging the patients to allow us to take them, why wouldn't we? All other things being equal, we're happy to take someone to the hospital. Our townsfolk LOVE us, send us donations and thank-you cards with regularity. This year we also sought a significant increase in our town's budget line because we have to start funding a new ambulance. Without so much as a murmur, the vote passed unanimously. And a big part of that is because our community knows we care about them. Since we only do 250 to 300 calls a year, we're not too worried about overlapping calls. It's only happened a couple of times in the past two years.
 
I have spent plenty of time coming up with ways to say that while someone may need checked out, they don't necessarily need and ambulance or ER to get that accomplished. Of course, regardless of what I say, it is always prefaced by, "We are more than happy to take you to the ER in the ambulance, however..." or "We are more than happy to take you, however, honestly, all we can do for X is give you an expensive taxi ride."
 
We're a service

...and sometimes we serve best by moving the people to a facility whether WE think it necessary or not.

The idea of making sure we're available for "real" emergencies is an illusion and perhaps improper definition of our role. The frequency of an IFT for example, significantly interfering with the preservation of someone's life is negligible.

We're there as a first line to serve the medical needs of individuals in our communities, and our job is to get them to the next stage of care. The way our systems are set up, the only options we have to work with are ER's.

That's not our fault, nor is it the fault of the patient.
 
While I'm always happy to transport if that's what the patient wants, I'm not above advising the patient that he or she may be seen quicker by their PCP or at an urgent care than the ED because the ED will triage regardless of how the patient gets there. I won't necessarily initiate the refusal, but I'll suggest alternatives, if I think that an alternative destination is appropriate and in the patient's best interests. Of course I also let the patient know that I can't transport them to that alternate destination though. I have, on occasion, made phone calls to help the patient arrange for self-transport though.

Sacramento County does have a Paramedic initiated refusal of care... but when I last worked here, that policy hadn't been initiated.
 
Linuss said:
"So, do you want us to take you to the hospital?"

That often elicits "Do you think I should go?"'


To which I respond with something that attempts to cover my own butt while attempting to give my medical advice. blah blah xray, blah blah blood work, blah doctor, blah blah.



(The ones who clearly should be checked out don't get given the option, just 'Let's go get checked out'... ahh wordplay)
Click to expand...

^^^ Yep!
 
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