spenac

Guys lets get back to what the original post was asking, Should all patients be stripped?

So dust if you want to refuse one type of treatment because of your beliefs I should tell you to get the hell off my ambulance and not treat you? Let's say your religion says bandaids are bad and you come on my ambulance with a small cut, while I should kick you off for wasting my time with a small cut, I should not kick you off for your beliefs, I should give you a 2x2 tell you to keep pressure on it and then deny transport as is not an emergency. If a person needs treatment and wants treatment but has different beliefs I should do my best to do what I can w/o harming the person physically or in my opinion more importantly spiritually. Treat the whole person!!!!!!!!!!!!!!!!!!!!!!!!

Guys lets get back to what the original post was asking, Should all patients be disrobed? Personally I see several benefits of it. Not miss something that could affect your choice of treatment for one. A possible side effect might be people deciding not to use ambulance for a Taxi, a big plus. Nurses would appreciate not having to place them in a gown.

You used the term "common sense" earlier dust well it doesn't take an x-ray to tell you somethings broke everytime sometimes common sense does. Also to properly exam a potential injury site takes touch as well as sight. I've known people with broken ribs (per doc later) that did not even flinch when palpated, but on visual you could see discoloration so I at least knew they had an injury even if they denied pain. I would still argue that even with it being a potential broken humerus would cause me to look beyond the arm and at least check shoulder, collar bone visually as well as palpated. By exposing for this signs of abuse if there would be seen. Dust if you throw out peoples beliefs then you go against what founded this country religious freedom. We need to work with others beliefs if we want them to respect ours. Don't have to agree with them but should respect them.

Humerus break requires serious moi in almost all cases, therefore should move you to do a more detailed exam. As far as removing clothes w/o moving arm use shears. By only treating cc we then would give aspirin to anybody with a headache only to let the doc find the CVA. We must avoid getting so focused we miss the big picture. Many times what the patients cc is, is actually the least critical problem. Think about trauma, usually the pain they complain about is not at the most serious injury locations. I guess because I spend more than an hour with each patient I have developed the mindset that there may be more than meets the eye and I proceed accordingly. Again in Texas anyone that suspects abuse must file a report.

Dude you miss the point in my area almost every female patient we get from 11 up to even close to 50 are OB active labor. Did you not catch the "in my part of the world" statement. We get dispatched headache and end up delivering. We get dispatched stomach ache deliver baby and have the little girl claiming it's not her's, get dispatched sob deliver baby. Would I think every headache is eclampsia, no, just based on complete comment OB with headache would need to rule out eclampsia, I should have gone more in depth sorry. I have been around some legal issues and the thing I learned, CYA, phobia nope. Gladly let you deliver all the babys if your here, gets messy and slippery at times back there.

Again this was a scenario that was brought up on another site, to the best of my knowledge not real. All partys that have witnessed or suspect child abuse are required to report it not just the doctors at least in Texas. Again a broken humerus should make a reasonably educated medic want to check that no other injuries occurred when you consider the amount of energy to break it. Had they examined the patient appropriately for type of injury the child had they would have seen signs of abuse and thus would have had to report it. First they failed to do proper exam then because of their improper action they failed to find or report possible abuse leading to childs death.

Dust a broken humerus would not cause you any thought of additional potential injury that would at least cause you to look under the shirt? I mean the healthy humerus is tough and requires a lot of energy to break. Energy transfers. Should you at least look for other possible injurys related just to this event and by doing this uncover the older wounds? Your right don't have to remove clothes for extremity splinting but you should if any possibility of additional injury and in this case lots of reason to think more injury possible. If anything about an injury should have triggered additional exams lawyers will be all over it if not done and thats what they will call standard of care that other people at same level of education would have looked deeper than just the arm. As far as abuse report child protective services should have received several notices of possible abuse but received none. Failure of EMS and hospital staff. EMS because reasonably the medics should have been inclined to exam a little closer due to the type of injury. Had it only been the wrist, easy to damage the wrist, could see just splinting without thinking of checking more than the arm.

Nope but you go to court the lawyers use anything at their hands to nail you for violating standard of care. Headache = eclampsia When I said it got reamed for it. But I believe in it.

I agree fully about common sense but some of the comments I received when I said it makes you wonder if it's illegal to say it. The way I understand is that disrobing a patient, or for that matter any other procedure, should be done basically same for any patient with similar complaint. For example if all the slim large breasted woman that you start IV's on have shirts and bras removed but you fail to do the same with fat small breasted woman it would be an easy case to prove wrongdoing. Consistency makes us better at what we do and makes it easier to defend our actions in a court of law if the need arises. It really is a case by case decision that needs to be made. But a side thought is that maybe it would stop some taxi rides if all required to disrobe, a point to ponder.

Your two female patients probably OB's if in my part of world so strip. "Common sense" get ready for a beating if any one catches that statement. Hospital gowns no problem use sheet to cover or buy disposable gowns for ambulance.

I agree with you here. The Brady paramedic book says to expose to examine chest area of patient for cardiac problems not codes but problems to properly assess, just one of many examples found in brady, mosby, aaos paramedic books where it mentions expose. I guess you could worm shirt up down sideways etc but then you never see complete picture, only pieces and could miss a key piece. I wonder how many here do heart, lung, and abd sounds thru the shirt instead on the skin? If your moving clothes around to do your exam it seems it may be more professional to just remove the clothing and do it like the doc, then maybe people would remember more than us being ambulance drivers.

Ok you made a statement that would require shirt cut away to be splinted actually can be done with shirt on, should it no. The humerus is a strong bone and would require force to cause. Should trigger suspicion that more thoracic injurys were possible and shirt would be removed to investigate. At this point bruises of various ages would have been visible and therefore the medics are required to report it as possible abuse, reporting it to just the ER doc is not enough needs direct report to child protective services. The standard of care for this injury would require at least shirt removal, in court you have to meet or exceed what is considered standard of care or your screwed. These medics splinted shirt on, therefore saw no other injurys, therefore made no report. As far as hospital in this scenario they screwed up and failed to report but thats their legal problem not EMS's. But had the medics seen it, reported and reported it child would have been possibly protected instead returned from hospital with parents and died of more abuse 3 days later. If the practice was to always remove clothing would not even have to rely on medics to think about whether the circumstances dictate it.

Part of arm that was broken was the humerus. Also if this was done would imagine most would not have clothes removed until in the ambulance to protect privacy. Even trauma where you strip them and flip them you should still try to protect right to privacy.

This subject was brought up on another smaller site and wanted to see your thoughts. It spun from a scenario of 2 medics being fired and facing legal issues for failing first to find the signs of child abuse and then by default failing to report it. Child died as result. They had listened to mothers explanation of arm injury and did not examine any other skin area, thus missed all the bruises of different ages on the child. Then idea was mentioned should we consider placing all patients in hospital gowns to avoid missing anything. At hospital it seems pretty much all patients are placed in gowns and Doctors then actually see all skin when examining patient. It was brought up that if patient doesn't complain about an area we could miss edema (to the low back, thighs, or buttocks which could be sign of heart failure), miss less obvious bed sores, miss bruising, etc. It appears that only severe trauma and OB patients have clothing removed. So whats your thoughts, should all patients have clothing removed and put in hospital gown or under sheet to avoid missing the less obvious? Do any services require something like this?

Thats for sure thats for darn sure. When we do deny someone a taxi ride they sometimes wait until they are sure we've gone to sleep (I swear they must be watching) and then call with a complaint and so they still get the free ride they wanted, just to late for lunch, but oh well breakfast is the most important meal. As far as plank walking those nasty shark bites really make a mess in my ambulance.

Yesterday I added a post that we have positive proof nothing wrong, just person wanting ride for lunch. We don't transport for lunch because supper specials much better, see we do put patient first. Just kidding would not transport as only wants ride to lunch.

As original poster I ask that you adjust the entire scenario to caller is perfectly healthy, no trauma, no medical, no mental, and we are 100% of this, I know in field no such thing, but for this scenario we have benefit of whatever means you choose, including a phone your god card, if you choose to use and you find caller 100 % okay just wanting a ride to hospital for lunch. Do you still take caller or not?

First will not go into rant that this is spin off of. Fraud is playing a big part in numerous services being raided, all ambulances, equipment, and paperwork being taken this year, just watch the news or do a search. Not only are the owners in trouble, any employee that knowingly did anything to deceive on run reports can face jail. In EMS legal we are always teach "If it's not on the report it did not get done". Really need to add "Don't write that you did it if you didn't". Should not have to teach it, it should be common sense but as others have said elsewhere many lack common sense, besides the lack of education. All the bad publicity continues to rob us the chance as a group to be looked upon as professionals. Now as far as statement if person is willing to agree to pay $900 taxi ride hall them. Most that say yes already know that there is limited collection rights of medical claims, so they just saved paying a licensed taxi $25 to get where they want. Then you also lose money with the man hours sending bill after bill. Finally you just write it off or maybe sell it to a collection agency for pennys on the dollar. In the end you have lost money even if no supplys other than fuel and time were used. Remember the charge for each transport is actually in large part paying for overhead that is the down time, the vehichle maintenance, building maintenance, insurance, etc,. So if a service is willing to provide non emergent transport (taxi for short) they should be able to require immediate payment just like real taxis do, just my thought. I'll leave now. See no rant. Have a great day. Stay safe. Lets keep learning from each other.

In this scenario 6 is closest to right. But like you say in real world people sometimes leave a lot out when they talk to us. I saw a form once and wish I could have gotten a copy of it but it stated something along the lines of what you verbally told him of insurance not paying, etc. Had an area where medics could put aprox cost of transport and seems like even asked something about deposit paid. Do not think it required deposit but guess it was there to put the idea in peoples minds. Then they signed it as well. I may have to design one as best I can and put it in English and Spanish then it by the lawyer to make sure don't violate any rights or laws.

The people in charge want the ambulance unlocked and running on seen. The only reason given is to avoid delays in getting equipment and to avoid having it not restart. My response it's going to be a much bigger delay waiting for a new ambulance to come in. Again working to change bad habits of the old timers here including myself.

First Ruff thanks thats the input I'm looking for. I have never worked out of the sticks. The biggest city I worked in was about 25000 with a nice hospital and that was a long time ago just for a weeks worth of clinical ride outs. I see your point already going there so no big deal taking them back with you. Also probably lot more work to deny transport paper wise. For us lot more paper work and a lot more risk but we remain for the community and paperwork still quicker than 4 hours. As stated elsewhere we still usually take almost every patient that asks. Before we deny we first try to reason with patients and some will agree to see their own Doctor or ride with family, etc. The ones that don't reason then we have the procedures in place to look at denying them. Ruff thank you for the insight into your area. Now Jake feel you man. We had a lady that we had agreed to take to the hospital as we were finishing loading her, her husband came over and said he would be waiting for us to bring her home as he was going to be to busy working his goats to go get her. We explained that we are unable to bring people back home per protocol, and he was ready to fight. We eventually just had to get in the ambulance and leave. He eventually went and got her I guess because we've gone and transported her several times since. He's never gotten rude with us again.

Ruff appreciate the input. This is so we we can learn what others do. Thats why I left this extremely generic, this has nothing to do with the immigration issue or my remote area it has to do with whether some people actually have to transport every caller that wants to go regardless of complaint or lack of complaint as some said in other posts. I am trying to get my mind wrapped around having no procedure in place that would allow you to say no to a request like this one. At least some have said in the poll they would contact MC to deny transport so they do have a mechanism available to say no way. I want to understand the way things work, that was the intent of the post the other day that went everywhere but where it was intended. We're not going to solve all the problems here but just maybe it will get us thinking out of our little boxes that we live and work, see the bigger picture then maybe we'll quit tearing each other apart. Comments on this and other forums have helped me open my mind to other methods some I now use. To address the other comments. As to the biggest abusers in my area calling with no real complaint are actually USA citizens. Most illegals are afraid to draw attention to themselves, so they wait till in bad shape or if faking they're prepared to leave. Some illegals may fake but at least we get to proceed as if something is wrong and we treat them as if what they say is happening is happening because as others have said we're not Doctors and we do not have all the tools to rule out the problems. We keep IV therapy, ECG, and other skills sharp because we must treat it as real, so we must be prepared in case it is. And many of the illegals that call do have actual problems or risk factors that come from limited or no medical care. OB patients no prenatal care, lots of untreated diabetes, hypertension, TB, etc. Health education is limited, it is sad that you are the first person to explain to the 12 year old girl what is happening and going to happen when she goes into labor. The only thing she knows is her mother tells her she needs to come to the USA so the baby will have a better life, so she sneaks into the USA and hides tell the pains start. So again please in this scenario just let me know what procedure you must follow whether it is just load and go with everybody or do you have options. If you want to explain the process or if I missed anything that in your opinion could affect your process just ask.

When I made the scenario hypoglycemia would have been the medical concern or head trauma but since alert and oriented he has right to refuse being checked, which he did by the don't touch. But when you explain to him the rules as you said he has all perfect textbook recommended vitals and perfectly mid line BGL. Gets mad that you messed up his hair but no signs of trauma on him and he denys any possible trauma. Then says "lets get on the road it's lunch time". Like that "special has changed" what you think liver and onions with a side of spinach maybe that will scare him off. We don't lock up here either and one of these days because of it we'll probably watch our unit going over the bridge into Mexico, but hey I don't set the policy. I have recommended to start locking up or at least shutting down and taking the keys if we're out but got no for answer so far.

SCENARIO CORRECTION. HERE LOOK HERE BEFORE BEATING ME UP PLEASE. All doors are locked unless you or your partner choose to hit the magic button and unlock them. Patient meets you at curb, never comes near your ambulance, conversation occurs on the curb unless you choose to invite the patient into the ambulance. If you choose to invite the patient in you assist them into the ambulance by whatever means you deem most professional. Hope this makes it so we can focus on what I am asking in the poll. I should have included report person for abusing 911 system as a poll option.