PatrickW

In no particular order... Activated Charcoal Glucagon Epi 1:10 Epi 1:1 Atropine Furosemide Lidocaine Procainamide D50W Sodium Bicarbonate Magnesium Sulfate Dopamine Amiodarone Albuterol Naloxone Solu-Medrol Adenosine Thiamine Terbutaline Diphenhydramine Morphine Midazolam Lorazapam Etomidate Succinylcholine NTG Spray ASA Oxygen Normal Saline D5W

What does your physical assessment involve if the pt has no complaints? Detailed head to toe? What do you tell them the risks of refusing transport are for someone with no complaints? What do you tell them when they ask why you, the healthcare provider, think they should let you transport them? Since they are a pt, what does your treatment and transport of them usually consist of? Do you call for a second ambulance while you work the full arrest? I agree they need emotional support, however if they do not have a medical complaint or ask for EMS for themselves we aren't going to transport them as a patient. I don't know that they won't have pain later, and I don't know that they won't contact some lawyer. What I do know is that the person did not request EMS or want EMS, they claimed that they did not need EMS because they were not injured, and I will document that. Is there some case that you can cite where leaving someone with no apparent injury who stated they don't need EMS was considered abandonment, or are you just trying to use scare tactics? I don't know about your system, but taking a truck (or however many it would take to do a whole school bus full of kids) puts a major strain on the entire system and delays response times for true emergencies from people who want EMS. Yes, there is harm done.

How does a refusal only take a few minutes for you? Do you not take two sets of vital signs? Is the refusal you're obtaining just a signature, or is it an informed refusal following advising the patient of the risks involved with refusing (which I'm not sure what they are for someone who says they aren't hurt or ill and don't need EMS)?

Of course I can't be sure that there isn't anything wrong with them, but I can't thoroughly assess everyone that is involved with any call. How do I know that the family member of the full arrest I'm working isn't going to stroke out from the hypertension associated with the event? If they don't ask for us and they don't want us, I'm not going to sit there and do a detailed history and physical, including vital signs, and then suggest that they be taken to the hospital regardless of my findings. I can't police the community for illness and injury, assessing everyone I come across or everyone involved in an event I'm called for. If I get called to an MVA and a pedestrian jumped out of the way to avoid it, do I need to get a refusal from them if I ask them if they're ok? How about a school bus that brakes quickly, one patient complaining of neck pain. I have to obtain histories, physicals, and refusals from all the other children and their parents? That's ridiculous. The 911 service I work for does have a transport policy, and we are able to treat and release some patients if they do not meet our transport criteria and both crew members are comfortable doing so. "You call, we haul" is ridiculous.

The replies here really puzzle me. In the hypothetical situation of an MVA with no injuries, what would the people with no injuries be refusing? Transport for no injuries? Is that implying that you, as the healthcare provider, are suggesting that these people be transported to an ER, even though they have no complaints? In my system, a refusal means that the patient meets transport criteria and the patient should be transported to an ER. To obtain a refusal, we have to inform the patient of the possible consequences of refusing transport (for example, for neck pain we would warn them that if they have a spinal injury and refuse transport, they could become paralyzed and die), and by signing the refusal they acknowledge that they accept these possible consequences to refuse. I can't imagine doing a refusal on someone who has no complaints. What would I tell them the refusal means? With few exceptions, anyone who denies injuries on an MVA is not a patient. They are a person involved in an MVA who isn't hurt and doesn't need EMS. There would have to be extenuating circumstances for me to assess someone who claims they aren't hurt and don't need an ambulance, and tell them that they need to go to the hospital.

Most dispatch centers record all phone calls (obviously), so if your dispatch center has the ability to forward phone calls, you can call the dispatch center and ask to be put through to the hospital. If anything comes up, the recording can be pulled.

Well, that's a relief!

Well, I don't think there are different scopes of practice for EMT-Bs on a BLS-only truck vs. EMT-Bs working with EMT-Ps, and I didn't know you were arguing for one. If you'll notice, in the scenario I posted, I stated only objective criteria. That scenario is from a call I was on, and all I stated was the facts of what happened. BGL low, symptoms, BGL brought up, no symptoms. Make of that what you will, but no where did I state that the low BGL was the only issue and no where did I state that the patient should not be transported. With such a condescending, holier-than-thou attitude I don't understand how you can expect people to not be offended by your posts. I understand you're passionate, however I don't think too many adults would agree that name-calling, insulting intelligence, and a general condescending attitude are helpful in anyway to proving your point. Really, you're qualified to tell me that "I don't know how much I don't know" from a few posts of mine with a differing viewpoint on BLS use of glucometers. Seems somewhat hypocritical, even. Thanks for "entertatining my tangent", though.

First off, you are the first one to bring up the possibility of a low BGL being all that is involved, and you are the first one mentioning an EMS diagnosis and refusal. I did not say anything about either in my post, and it is in fact you who is making that assumption. Second, monitor placement is another skill that Basics are not allowed to perform (at least here). I'm not saying it never happens, but it's not in our scope. But let me get this straight, you're suggesting Basics should be forbidden to perform dextrosticks as part of their assessment because it only provides a BGL of which Basics can do little about, but instead we should be placing limb leads as part of an assessment even though we can do nothing with a rhythm strip? As for the point of this thread, the question posed at the end of the OP was "Who can offer reasons for and against this diagnostic tool for BLS providers?" You'll have to excuse me for pointing out how it is useful for me everyday I work.

Scenario: 60yo F complains of bilateral leg weakness. Gradual onset, it's 3AM now, she woke up to go to the bathroom and noticed her legs were very weak. No other complaints. History of IDDM and HTN. Good strong PMS. BGL turned out to be 48 mg/dl. Gave her some orange juice (or oral glucose) and suddenly she feels fine and has no complaints. With a BLS crew that didn't have the option of checking BGL, their options would have been: Transport while twiddling thumbs saying "I don't know what's going on!", or request ALS so that ALS can do the exact same thing BLS would have done on scene if they had a glucometer. Is that really what's best for the patient? It's also important to remember that not all BLS providers are part of BLS-only crews. I work with a paramedic and being able to check someone's glucose is a valuable tool for me as a Basic or Intermediate to have. When we have an unconscious patient, for example, it's nice for my partner to accomplish the "more ALS" aspects like starting a line, hooking up the monitor, etc. while I check the BGL (among other things, of course). It's just one less thing the medic has to worry about and one more thing the basic can accomplish for the good of the patient.

I understood that, my point was that referring to an RN as an LPN is not like referring to a Paramedic as an EMT, because the latter is accurate. EMT is an all-encompassing umbrella for the different certifications, so being a paramedic and being called an EMT should not be considered offensive or inaccurate. Sure, "paramedic" is a more accurate term, just as "RN" is a more accurate term for an RN than "nurse", but that's just the way it goes. Now, if someone referred to you as an EMT-Basic, then you'd have a complaint.

You're comparing apples to oranges. "Nurse" is a general umbrella including LPNs and RNs. "EMT" is a general umbrella including Basics, Intermediates, and Paramedics. Calling an RN a nurse is not an insult, and calling a Paramedic an EMT should not be considered an insult either. You're operating under the assumption that EMT means EMT-Basic (or Intermediate), which simply isn't the case. Look at the site you're on now. EMT City. Who is the "national governing body" of this profession? The national registry of EMTs. I just don't understand why there's stigma attached to the "EMT" title...despite popular belief, "EMT" is not a level of certification. It is many, including paramedic.

That's nothing when it comes to noticing small spelling/grammar/punctuation errors. I even notice that in the page title, "EMTs" is spelled with an unnecessary apostrophe!

I don't rely on machines for anything. I use all of my senses. For example, when checking someone's BGL, I don't use a silly high-tech machine. I taste their capillary blood. Mmm, hyperglycemia.

So if I'm a doctor and believe that I would be harming my patients by giving them blood transfusions (damning them to hell), I should be able to refuse to administer blood products to dying patients because of my own beliefs? Who's to say my beliefs are wrong? That's a huge taboo. You can't question other people's beliefs. Why? Because you can't. People are free to make all the stupid decisions they want about their own life, but when their beliefs start infringing on others' lives by withholding potentially life-saving procedures from someone else (like in the OP's case), that is negligent homicide. And really, I'd even go as far as to say that attempting to teach an impressionable child beliefs that may later cause their death is shameful abuse of power. There would be a lot less problems these days if kids weren't presented beliefs as fact at an early age and brought up to just accept it.