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We always talk about making things idiot proof, then they keep improving the model of idiots.

You are correct with your thinking, but to really make sure everything is documented, don't just use the 'is this a patient' idea. Document any contact whether patient or not, complaint of not, arrived scene or not. With this understanding, the paperwork stinks, but better than your butt. Get a policy Get a new QA/QI person Sounds like you need both.

P instructor is right. Documentation is crucial to CYA. I don't know the particulars of your service, but is your partner solely responsible for completing the run sheet or can you do it? If so, then do it yourself. If your partner needs to do the documentation, then say something like "I know you don't want to or think we need to, but I'm going to do a quick assessment and document what I find". Offer to do everything and maybe you'll guilt them into helping. If not, then do it yourself. It's a touchy area since our fire companies get called for invalid assists. They show up, put the person back in bed, whatever- and they go home. If the fire crew is a first responder level, the only paperwork they file is a NFIR- which is a general form for any fire call. No further documentation or refusals needed. Now if an ambo is called and finds the same scenario, then our credo is if there is patient contact, then you must do an exam, obtain vitals, document that contact, obtain a signature, and call it in to medical control as a refusal. Obviously common sense may dictate other actions. Example- the other day we were called at 1AM for someone allegedly unconscious for unknown reasons. We arrived and found a guy who was having trouble working his home BP machine. He said it would not give him a reading. No complaints, he was just taking his vitals before bedtime to document them for his doctor. We checked the machine- it worked fine, it gave a nice normal reading within his normal range, and that was it. He would never admit that he used a BS complaint to get help, but it was obvious that's what happened. Did I document a patient encounter, obtain a signature, do an exam? No, I simply stated the facts on the run sheet. If I get called on the carpet for that, then so be it, but I've been doing this for 30 years and that has yet to happen. (Knock on wood. LOL) Technically, did I break protocol? Yep, and I would have no real defense of my actions, but then again, if the person actually had a complaint- other than an equipment problem or a bed ridden patient that needed help reaching their box of cookies because their caretaker in another room would not wake up- true story- then I do the whole routine.

It sucks, but you need to document each and every call regardless of patient contact or not. Even the documentation may not keep you out of trouble in some instances. Example: I was dispatched to a residence for male with chest pains. While responding, our Comm Center advised that patient called 911 now and refuses any help, does not want EMS, fire, or PD. I even documented this 'cancelled call' with all particulars of address, information obtained over the radio, times and location we were at. Approximately 25 minutes later, another crew dispatched to same location for 'unconscious party.' Fire arrived scene a few minutes prior to EMS and radioed that patient 'Code Blue, CPR in progress." Moral - the wife of the patient initially called 911 because patient was complaining of severe chest pains. Patient then himself called 911 to cancel without the wife knowing. Wife was apparently hysterical because it took EMS 30 minutes to respond to her request. Was going to court until my documentation of 'cancelled call' came to light. You never know when something can or may happen, so even the most mundane call should be documented in some fashion whether you like it or not. Secondly, it is also your responsibility even though you are the basic compared to the medic. You both make up the crew that responded to the patient's requests, and are both equally responsible. I know there will be others responses to this thread, pro and con. Do what you need to do, even with the aspect it still may go to court.

Something Bieber said really struck a chord with me. He mentioned that he wishes more of us would become involved in sites such as this- coming together, sharing, bitching and moaning- and most importantly, learning. Many of us tend to become myopic in our views- whether they be professional, political, or spiritual. A place such as this allows us to vent our spleens, and more importantly realize that whatever problem we have, chances are another provider has either dealt with it or will deal with it at some time. (Here comes the geezer part-) I can't believe I am saying this but when many of us started in this business, the internet as we know it did not exist, and computers had the same processing power as today's wrist watch. Often times I wondered what it would be like to work in another area- what their system would be like, and would they have the same problems we had. I had neither the inclination, nor the means to actually explore my questions, so I just dealt with the problems we had. First I helped organize a union at our company, become disillusioned with that after awhile, then I took a management job because I wanted to change things instead of bitching and moaning. Both efforts were marginally successful because I learned that middle management is a horrible place to be, and only slightly better than being on the bottom rung of the food chain. Here we have a great resource, and I gotta say- Bieber is wise beyond his years. He gets it, and it makes me feel good that someone like him is the future of the profession. I see so many guys become frustrated and end up becoming a FF or getting out of the business altogether. They get beat down and figure if you can't beat 'em, join 'em. I get that, but I'm too old for that road now. Keep up the fight, dude. I wish you luck-and great resolve- you're gonna need both.

Set a standard and make sure the details are spelled out clearly along with expectations and consequences, Have specific goals and benchmarks set and ensure you have your medical director back you up. Also, you will have to take the lead by setting a good example. After you set the standard and begin changing the underlying culture of the service I would also suggenst the following: 1) You should look at having a mandatory monthly meeting, perhaps two different dates to catch all your employees. This meeting should be several hours long and would cover a refresher topic. Airway, paeds, toxicology and so on could be covered. 2) you should implement a good QI/QA process and mandate 100% compliance. In addition, at least one chart review should be performed at the monthly meeting along with frank discussion that should be preferably facilitated by your medical director. 3) Look at contracting with a larger, high volume service and mandate that your employees get a day of ride time under a qualified preceptor every quarter. In addition, implement a quarterly skills verification session and if you guys do invasive procedures, quarterly clinical verification such as spending a day in the theatre for airway management is highly recommended. 4) Mandate that your employees spend some time rotating through hospital specialty clinical areas such as ICU and Labour and Delivery every six months to a year. 5) Recognise and respect the crew members and have a mechanism in place for identifying and rewarding people. Let them know that they are valued and integral components of the team. Take care, chbare.

Just the hearse drivers. ha ha My life has been full and I have been privileged to have held jobs in so many different careers - all of which have made me the person I am today. But, when I first became a first responder, age became my biggest enemy. Well, fear of age. I'm too old to do this full time. I'm too old to work a 24 hour shift. I'm too old to go back to school. Heck, I'm too old to be smart enough to keep up with the young farts getting in to this business. Guess what? I'm not too old. And, with my background, I have the patience and wisdom to get through a call...calmly. With a little more experience under my belt, I'll be able to add "assuredly" to that sentence. People look at me with reverence. Even as a newbie, my patients feel comfortable with me because they think I've been doing this for years. Finally, gray hairs pay off. Look at me now. I graduated the full program in record time after not having taken a full load of classes in 20 years and with good grades. Yes, the 20 year-old students grasp the material a little more quickly than I at first glance...but I have the ability to take multiple concepts and merge them together. 24 hour shifts...heck. I work 48 hour shifts. It may take me a little longer to recover, but I eat/drink/live healthy, so I'm not worried about burnout. And, (I know...never start a sentence with "but" or "and") I have enough of a background that I can bring more than just my medic skills to the table. I hope this will make me more of a value-add to my service. As my husband says frequently, everything happens for a reason.

Wait for the police to arrive... If you fight him, and he injures himself; you've 1: Not accomplished anything; and 2: Opened a legal can of worms. Suggest he sit down and relax, and you do the same. If he were to become unconscious.. Treat him. If not, you're safety always comes first. I'm in a rural area too, we don't have police on duty at night. They're all "State Police", but they have to respond from home, like us; "On Call". But I'm not going to injure myself, or help someone to premature disability, just b/c they made a bad choice. I'm usually pretty good at convincing people they need to go. But I've been hit, spat upon and kicked a few times; and it's just not worth the fuss. Tell the cops to step it up, just try to convince the person to sit still, and chill.

Every Man Suspect... Its a whatever topic. We can't get along; we can't trust one another; what is this field becoming? A bunch of Pre-Madonnas. A self-centered bunch of people. Its my way or the highway attitude. People who have a little bit of knowledge: think they're experts. Glory hounds. Skells. Poor Technicians. Also late; never checks the Ambulance or Equipment. Air and chair is the routine. Bringing a laptop is part of the Checklist. Waits for food before responding. Falsification of paperwork. Liar. IV pokemon; missing a"l the time. The best Esophageal Intubator. Identifies all ECG as Sinus. Nasal Cannula all patients. Drives 2MPH so everybody sees them. Always goes out of service for anything. Drama bringer. Hits the skirt. Inappropriate always. Never offers. Thinks the work fu#k is French. Insubordinate. Never restocks. Cruising for chicks. Can't splint. Thinks they're hot sh#t. Invincible. Cocky. Sleeps at CME Letures. No call, no show. Bangs out last minute. Doesn't flush. Doesn't know the Protocol; makes it up as he goes along. Takes the credit. Can't lift. Blames other. WTF!