ccmedoc

That is your opinion, and I respect that. I don't believe my logic is faulty..That is my opinion. I don't think I would turn him in either. If I knew him, I would definitely have a talk with him though... One question. If the public believes we may be policing them, or our own profession under the auspices of professional remediation, they lose confidence or faith in us as medical providers. Now, if they find out we knew the doc was there and did nothing, does this send a better message? In my opinion that is a stronger message that we only care for our own. Especially if the girl was not medical. Is this faulty logic? Like I said I would not turn him in, in this scenario. I have a fair amount of loyalty to my profession and my coworkers.. 8)

Its not as to whether we are to police or report illegal activity. You may not have a legal responsibility, but morally you may..depending on your convictions. The question is more directly whether we should police ourselves as a profession. The broad sense of 'ourselves' as the medical profession. I think we may have a responsibility, in this case, to take up concerns with the ED Physician. If nothing could be corrected at that point, or an adequate reason given, then additional recourse could be taken. Professionally. If this person was not chemically altered at work, this is one aspect of the problem. How he is portraying the profession and damaging public trust by being inebriated and setting a bad example in public, this is a professional issue that must be addressed...for some. 8) He can do what he wants on his own time and in his own home. Another professional issue with possible repercussions is that he should not be doing cpr, or other interventions altered. Whether at the party or at the hospital. This is negligent. I would like to reiterate, as a citizen and a professional, you have a moral and ethical responsibility to report illegal activity. Whether you see it this way or not, you have to live with it. :wink: We all have our own limits of tolerance before we believe action must be taken. -opinion :wink:

I was kinda curious how this thread would go..... 8) I was right.. Ethics and moral issues aren't argued well here anymore...Poor temperament?? :shock: -Just an observation :dontknow:

I 100% agree. I have not heard a compelling argument to the contrary. Simply not wanting to do it is not an effective argument. There are benefits to the on scene or at the station draws. There are not many realistic drawbacks. There are many IV starts in the field that are initiated for no other reason than because they can be. I would wager that the chance of infection from a simple venipuncture blood draw is much less than placing a catheter in one's arm for extended time. Again, I say, if the infection is a consistent problem, then there are much larger problems here than having to do the draw to begin with. It is income generation, it helps keep the flow from the ED, it helps the law with deterrence, and it does not paint EMS as anything other than community minded..Protocols are easy to put into place with the right system. This also is a non-issue. Does this not apply to any invasive procedure in the field. Be professional and take necessary precautions. See above infection statement.. :wink: (-My opinion. Any use of the word 'you' is a generalization and not directed to any one person..)

They tried it here.. But it didn't work so well..AS you can see. Here too..web page Of course Arizona has no state regulations for licensing Phlebotomists either..AFAIK :shock:

MRSA spiders are invading the cities up here :shock: ....We see dozens of people bit by these little critters on a monthly basis.

This was in no way intended for you, but a generalization..I saw I had put it in too late to fix it. The complete quote.. Meaning that the medical field, especially community health, is a tough field. The public expects us to make snap decisions in their best interest. Even well thought out decisions can go awry. Some in our field cannot think past their protocols, or refuse to be the change agent to do so. Whether that be question them or attempt to change them. In not being willing to think past these protocols, which are most often guidelines and not set rules, they sometimes cannot act in the public's best interest. It is easy then to say, "My protocols say I cant, so I wont". You have to practice with your mind, your heart, and your common sense..and at times they all contradict each other. It is up to us, as individual professionals to choose which is right for us and follow. Some are not willing to make that choice and put it on the protocols, regardless of their feelings. Its hard for me to put into words, a feeling mostly. This is the best I can explain now.. I take my responsibility for the community very seriously, both as a Medic and a nurse. I try very hard not to breach the trust of a patient, but at times it is necessary for their health and continued well being. It is not all black and white, and none (or very little) of this is taught in school. Certainly not in Paramedic school.

This is the wrong attitude. It is a co-op for the benefit of the patient. If the medical control gives this person authority to provide additional orders above, or in addition to, your scope of practice, then it is a good thing... Right? I think we would all agree that blind arrogance is bad. If the Nurse was also to be required to be a paramedic, would that change the attitude?? -Just curious.. Just a side note..The requirement of the nurse being at least Baccalaureate trained puts their situational thinking way ahead that of the average paramedic, or nurse for that matter..I expect this will not sit well with some, but it is what it is. If this is not a requirement for the MICN, then it should be.. edit: I would venture to say that if not working under direct orders, all nurses work under protocols. haven't seen an opportunity yet to freelance..well not too many anyway

I find this interesting. By the public trust, do you mean the public one person at a time, or the community as a whole. Where does the public trust begin and end? where does our responsibility to the community end and the responsibility to the single person begin? This is, indeed, a medical issue at this point for the well being of the person, and the community in general. As long as the BAC is being performed asd part of a police investigation, it is not a betrayal of trust or breach of ethics. This does not in any way allow for EMS policing the community. It should not retard the ability to care for them. The major point to this is that we, the EMS personnel, are not initiating the investigation into the patients BAC. The Police are. We are a tool at this point and it is unethical not to participate in an investigation towards a possible felony. If you are providing care and it becomes evident that the patient is intoxicated, it does not need to be divulged to the police. The medical control will need to know for treatment and that is all. It would then be unethical or immoral to alert the PD to the fact that the patient was intoxicated. This, I feel, is the difference. There is no betrayal. It is a tough place to be in a medical profession where you have moral and ethical responsibilities to the community, law enforcement, and the individuals you care for. By the definition of your comment, I take it that it would also be immoral or unethical to report a person, whether intoxicated, deranged, or simply agitated, that tells you they will kill themselves at the earliest convenience or kill a certain party by name. This is your legal responsibility, but would you forgo your responsibility to your community in lieu of the patient in front of you? Who is being betrayed.. Different, but similar situations. Welcome to the medical field, and community service. The public you serve trust and rely on you to make the correct decision, both for the majority and the individual. If you choose to hide behind protocols, then so be it. You still have to take a moral and ethical stand. I, for one, will not hold that against you. I may not agree with you, but...... -Just my opinion..I have a few..

What do you think a seizing brain is using.....Oxygen and glucose, you would be right. The longer the patient seizes, the greater possibility of damage from said seizure. If the patient is not hypoglycemic and you give them glucose, they continue to seize and increase the chance of damage. If the Benzo is given and the seizure stops, additional treatment can then be given. Much brain damage can result from a seizure. Whether it be from Hypoglycemia, hypoxia, or the hyperstimulated state itself. This is beyond the scope of this answer, and is controversial in and of itself. If patient history dictates that the seizure is glycemic in origin, then it would be prudent to give glucose. Stopping the seizure before glucose administration affords the opportunity for a very patent line to administer it. I don't know about you, but I have to be VERY sure of the patency of the line before I administer glucose through it.. Just my thoughts, and I think I could provide an argument to med control for bending the protocols a bit. An educated argument will get you a long way. After all, protocols are simply guidelines, right..Not hardfast rules to be followed blindly..

Absolutely. These patients should be evaluated every time.

A quick assessment as in patient/scene safety, allergies from family, and ABC's yes. This is assuming you do have multiple people on scene. I have been in these situation with one partner and that is all. If the patient is seizing when you get there, priority is stopping the seizure. What kind of vitals will you get on a seizing patient?? Do they answer questions?? Pupillary reaction on a seizing patient?? Does it matter?? I will agree that multitasking is expected and quick assessment is warranted. I was more insinuating that an assessment as to cause could wait until after the seizure is stopped, and airway is secure, or at least patent. Any questions to bystanders can be done while initiating treatment. While we are assuming, we will assume there are knowledgeable bystanders also.. IV is not contraindicated, only difficult at times. Who said contraindicated? If the patient is in a very active generalized seizure, IM administration will likely calm them enough to initiate IV access. Every patient that has been in seizure before your arrival needs and IV/lock. This is proper and safe medical practice. Even if the patients family says they never seize more than once in a while, get IV access.

If they are seizing, stop the seizure. This could be with IV meds or IM. Dont risk sticking yourself or others trying to get a line on a seizing patient. If they are post-ictal, check the sugar. If they weren't Hypo. before the seizure, they may be now. I would say to use the IM if available. I also think if the patient is seizing when you get there, you have a problem. Do not prolong the seizure to look for cause initially. Stop the seizure and then assess. Seizing patients do not breath well, so Airway is a concern of your partner while you stop the seizure. :wink:

I think I would get a warrant. Implied consent for something not medically necessary for survival is a bit out of bounds. Someone driving erratically and appears altered needs to be evaluated for hypoglycemia, among other things. Alcohol on the breath does not constitute anything, especially if the officer mis-construes a fruity odor of DKA with the "alcohol smell".. Extending this to a blood draw for BAC is a court decision. There are boundaries to every practice, This is one IMHO..In or out of hospital; Nurse, Medic, or Doc.

WOW, This thread turned seriously foul.. I think that an ethical discussion could be argued any way you want, depending on your conventions. What this boils down to is do you have an ethical and/or moral duty to protect the public from this offender. The Draw must be authorized by the detainee by signature, or is court ordered and a warrant is present. At least around here. It is up to you, and your companies policies whether you can ethically do the job. No one can force you to do it, but it feels like that sometimes. As for sterile, this is a nonissue. How many ED, Jail infirmary, or lab rooms are sterile. The kit has provodine and assorted other goodies to use, and any materials used from your own stash needs to be logged and charted. Paper work is paramount. A good aseptic technique should be observed, as in any venipuncture. If this is an issue, than bigger problems exist..IMHO! Chain of evidence is short. The kit is opened, the draw is done, wherever it is done, the specimens are bagged, tagged, and signed at that point. The Medic can chart the time, date, tag, officer, badge#, and any other extraneous thoughts that may enter their head. At that point the time to lab is most likely no different that from a jail to the lab. I am not sure that this is even an issue. Due care can be taken with transport of the specimen, the outlabs do this all the time.. To touch on whether it is the Medics job or not, it depends on what you signed on for. I think it would be prudent to train and educate a few designated personnel to perform these draws, as the legal ramifications may be lessened if consistency can be shown. Consistent procedures and controls would be key. Officers and medics alike, can do this service. I would not be opposed to basics doing blood draws if properly educated. Phlebotomists are not extremely highly trained in their wiles, after all. I may be wrong, as it happens all the time... To start a program and offer sign on for perspective candidates for the job would weed out the morally and ethically challenged. There are companies around here that obtain the urine samples for companies that have truck drivers in accidents. Granted, it is not the blood draw we all fear, but important just the same. It could go to court, it could be contested, and it is NOT OUR JOB!!..I detest the last phrase more than I could possibly elaborate on this forum. It is a cop out, suffice it to say. With the crowding in the EDs in the nation, the space constraints, and the complaints from posters here about waiting for a room for 30 minutes or longer. Does it not seem a bit logical to perform these draws in the police station, in the back of an ambulance, in the jail, as opposed for tying up a nurse, and the room to provide this service? I think so, but logic doesn't always dictate.. As to the posters who repeatedly say that they can't fathom how nurses and docs can ethically or morally deal with this phenomenon known as the legal blood draw. Your perspective is a bit short sighted. If you have the tunnel vision you were supposedly trained not to have, then the patient is the person in front of you and you can touch. It is your ethical responsibility to help this person and, sometimes, it is necessary to incarcerate this person to help them. Whether it is detox or prison. Can you also, depending on the perspective, see the community as your patient. How could you, ethically or morally, let this person into your community if they are intoxicated, or are prone to driving intoxicated? I pray the one you couldn't perform the legal BAC draw on doesn't go out and hurt you or yours. I am not advocating to substitute for lab techs, nurses, or docs. I do, however, think that this is 'Your Job' if you are to do your part for upholding the law and maintaining a sense of community well-being. Being a healthcare professional is a bit more than dealing with AMIs, strokes, MVCs, and the occasional asthma attack. If you want more, you have to do more. Did we ever conclude that Paramedics, on the whole, were a profession.? I used to believe so.. 8) -Just another opinion..Nothing fancy..

Since I have not been here much lately, can someone tell me where this took place..State and county area.. I dont think I can say anything that wasn't already said, at least not any better than Doczilla. It's still hard to deal with, and second guessing whats already done is futile. We learn and move on. Not to be a sh!t, but I dont really want to be caught ill in this part of the world. Nothing personal :shock:

Ouch!! Spoken like a true 'Super-medic'......... :shock: -Read sarcasm-

OK.... I have not seen a post or comment in recent visits to warrant a response. The topics tend to be a bit repetitive and simple at times. I don't have the time to participate in witless banter at every turn..More often than not these are nothing more than "pissing contests" and simple inflammatory arguments. This comes to mind: "Never argue with a fool, onlookers may not be able to tell the difference."-Mark Twain (?).... I am all for an educated, learning experience. A lot of topics here do not meet this criteria and seem to be started for the sake of starting something, nothing more. Then I think perhaps, just maybe, I set my standards too high? I think this is not the problem. I believe the quote is: "It is better to remain silent and be thought a fool than to speak out and remove all doubt." -President Abraham Lincoln. I'm not sure, but perhaps this applies here.. :shock: (Topic??) Once again, there is my opinion....

Its hard to see, but they look like store employees in the background with gloves from a first aid kit, and law enforcement providing compressions. In the end, it would appear that they got a BASIC ambulance, doesn' t look like he can offer any more than a BVM and the stethoscope you saw.. Although I agree that they should have provided better CPR or attempted resuscitation, the probability is that they were not medical providers, and not the least bit interested in providing any.. I am kind of surprised that cpr was done at all, law enforcement very seldom participates in resuscitation any further than calling for meds and placing AED pads around here..Sad state of affairs, indeed :?

[stream:e08c616167]http://www.fileden.com/files/2008/8/13/2048424/program/americans.wav[/stream:e08c616167] I think this may be bad etiquette...oh well

Quite possibly she needs to find the compassion for herself before she can show it for others..Or maybe she doesn't even know what is (beyond a dictionary definition). :shock: It must be a cold, harsh way to live without the ability or willingness to show compassion, especially at such a young age. She is, of course, very welcome to have her opinions. I cannot, however, see her having a long, prosperous, or enjoyable career in any profession involving service to humans( or any living thing, for that matter), with the attitude she is demonstrating. I would venture a guess that these burned out medics she speaks of have and show compassion, and the accompanying empathy, for their patients. The fact that they don't show it openly with their co-workers may an old school machismo act, or simply a coping strategy for years of bombardment with bad situations and even worse outcomes. So does Cynical deserve compassion..certainly. Does she deserve my, or other's, respect for her and her opinions? Not a chance. I suspect this is not the least bit important to her _Just another opinion_

You know, hmmmm ............I think I just lost a few IQ points for reading this... :shock: Maybe it's just me.. :roll: Good thinking with the kids. Some don't figure the additional responsibility into the equation.

Not at all worth a response......

THAT is one of the funniest, yet very true, statements I have ever heard...I laugh out loud every time I read it... Thanks for giggle In my opinion, Laura Anne has the most realistic, adult view of this whole thing. I can't stomach much of the he vs. she rhetoric.

Son of citationmachine If you must... :shock: