When does "care" begin?

[MMiz]

Back in Michigan my service said that as soon as I saw the patient I was assessing them, so either I got a refusal, transported, or called for a higher level unit. That unfortunately meant that I had to write a run report and get a refusal for most MVCs I saw on the side of the road.

Doesn't that seem a bit anal? I never complained, because it was the way things were, but does your assessment really begin with first visual contact?

 

[Sapphyre]

Yes, that does seem a bit anal. I mean, EVERY MVC you passed on the street, whether they called for assistance or not? Otherwise, I'd say, that yes, if you were dispatched (or happened to see something nasty happen right in front of you) that patient care does start once you see them.

 

[firecoins]

It starts as soon as I see a patient who has called for assistance.

 

[Hastings]

Back in Michigan my service said that as soon as I saw the patient I was assessing them, so either I got a refusal, transported, or called for a higher level unit. That unfortunately meant that I had to write a run report and get a refusal for most MVCs I saw on the side of the road.

Doesn't that seem a bit anal? I never complained, because it was the way things were, but does your assessment really begin with first visual contact?

Interesting to know what service you worked for, because that's how my service works. No, I don't think it's anal. If you make contact, you fill out a few things on a form. That is, if you make contact eventually. Yes, an assessment begins as soon as you see a patient. However, that doesn't mean you have to write a report about an incident you didn't even stop for.

 

[KEVD18]

patient contact. usually "hi. im kevin from the ambulance. what seems to be the trouble today".

if they wanted a report for every person i made visual contact with, id have to right up every hardbody at the beach....

 

[natrab]

The definition of "Patient Contact" can vary with your state legislature. In general, when you are dispatched to a call (i.e. someone requested 911), you now have a duty to act. Once you arrive at the call, the moment you make contact with the patient, you have official "patient contact." This usually means that some sort of report must be completed. Since we've done away with the AMA at this point where I work, we have to completed to "Refusal of Service" form with attached PCR for every pt we come in contact with. This means that even if they deny any medical problem and say that calling us was an accident, they must sign our form releasing our liability and we must write a PCR describing what was said by the pt (after all, they DID request us).

In general, all this paperwork isn't absolutely necessary, but employers usually have you to it to protect themselves and you as well. I usually cut paperwork for any call where the pt would be able to point me out and say that I was there (in front of a jury perhaps?) simply so that I have some record of what went on if I ever were called to court. I guess that means I'm saying yes to visual contact counting as patient contact (from a C.Y.A. legal perspective).

 

[mdtaylor]

In my eyes there is no set dividing line between providing care and not. For example...

You see someone that needs assistance. You are assessing them in your mind as you approach. Your assessment determines that the person is NOT capable of refusing treatment. You are on duty and have a duty to act. Therefore, your care began at the time you started assessing the patient.

You see someone that you believe may need assistance. You are assessing them in your mind as you approach. Once you speak to them you determine that they are competent and over 21, and refuse treatment. You are not on duty and have no duty to act. In this case you have not provided any care.

If you had a duty to act then local protocols may require vitals, refusal form, etc....

So, there are different situations where the line between providing care and not providing care may wander..

 

[reaper]

We get lots of calls that are called in by third person. Like in MVC's. Someone driving by calls on their cell phone. We get there and no one called themselves and no one wants EMS. We do a very very short PCR and leave.

They are not pt's unless they want to be. It they are old enough and competent, then they can choose.

 

[BossyCow]

In our system when the tones go out, a run number is generated. At that point we need to file paperwork regarding what was done for NFIRS. While this doesn't always require a pcr it does require at the very minimum an explanation of why there was no pt. care provided.

 

[TheMowingMonk]

Like everything I think its a cover your own *** type thing. I know my service if we see an accident on the side of the road we are required by our county to stop and give assistance (one exception is if we are currently transporting a pt) most of the time the people have AMA'd but you still need to do that paperwork, cause if they dont sign that AMA, then you leave and they decide later their neck hurts and try and sue you cause you didnt do anything about it when you looked at them, then you dang the AMA in their face and there is nothing they can do about it. Without that paperwork though you could be in big do do.

 

[Outbac1]

We too get a lot of third party calls for mvc's. After arriving and no wants our services and there are no obvious injuries and they appear competent we have no pt. Most often written as no pt. found. Our dispatch puts that in the call and we are back in service. No pcr. If there are obvious injuries or the crash was severe we press the potential pt. a little harder for an assessment.
If they still refuse we write it up as pt. refused assessment and transport. Or the pt. may allow us to do an assessment but refuse transport. We write it up accordingly. If they refuse to sign we just document that and we are on our way.

I believe your care begins when they have consented. Your assessment begins when you arrive and start looking.

 

[traumateam1]

My patient care begins when I say "Hi my name is Mitch and I'm with (whoever I'm with) what seems to be the problem today?" Then if they say "leave me alone!" I get a refusal signed and leave, if they say "oh I've been having chest pains for 20 minutes!" or whatever their C/C may be, than patient care has begun, and let the games begin. Woohoo!!