It is the patient's choice right?

[NoOnesAngel]

To clarify I was in college before I started my EMT-B course...I have A&P1 and 2, I have psych as far as it would go at the Comm & Tech college I attended, I have sociology and I have college algebra, I lack my microbiology...and a few other classes...because I was up for the RN program...but dropped out after recieving my EMT-B because it's what I thought I wanted to do.

I also am not a "driver" I am not allowed to drive. I work the back and live in the back I am not allowed behind the wheel of an ambulance even if my partner is a medic. It's a small company with hundreds of flaws. I'm wary of the surrounding services...I know I lack what I should have already aquired in two years of being an active EMT-B. It is my own fault, but I do as I am told, and I recieve a paycheck for it...which let's faceI need...the bills don't pay themselves. As far as telling my employer to ram the job some place not nice....that will insure I do not get a job at any of the other services. I have been with this company for two years and I have never called in...he will not be pleased with my decision to move on...and I dread it.

You can not even suggest any constructive criticism without it being a week of punishment (being overlooked for dispatch to any calls other than BLS transports).

It's possible that even if I do give a two weeks...I will still not get a job...that's how they work all of the owners/operators around here...stay on the phone everyday discussing who has decided to leave...it's a game to them...

I do appreciate all of your input. Thank you.

[Dustdevil]

I do appreciate all of your input. Thank you.

No. Thank you! You are rapidly becoming my fvaourite n00b here at EMT City. Your attitude is great, and your head seems to be in the right place. It's just a shame that you are not surrounded by more quality people and positive energy in your work environment.

While I think it is unfortunate for you that you bailed on nursing for this joke of a job, nursing's loss is our gain, and I am glad you're here. I truly hope that EMS does turn out to be what you are looking for, because that would be a positive thing for both of us. But, for you to reach that point where the rewards and satisfaction are enough to hold you here, you're seriously going to have to get through paramedic school without any further delays. What you are doing now is just frustrating you.

I look forward to watching it all come together for you. Good luck!

[MedicTroll]

[/font:f1217efaea] Know this is a little late but I just seen it for the first time. You made this statement. "I love my job, I just guess I'm getting fed up not knowing exactly what I can or can not do. It'll get better. Always look to the bright side of things."

It rather scared me to see someone in this field make a statement like this, cause if your holding a card you should and better know what to do. Period. Every state have Protocols, they cover just about everything you do even rules of where to transport. I've worked in private land and I butted heads many times, but I always came out on top cause I knew my Protocols and worked within them, and could justify every action by them.

As too the incident you addressed, Did you do anything wrong? Well, not knowing your state guidelines I can't say for sure, but for what you stated it does seem you could have done thing a little different which would have avoided all this. Not to give into other services, just to all work well together for the good of the patients. There will come a day when you will need that PD backup or that FD assist and you what them to came quickly and be a help to you, it is best to keep a good "professional" relationship with them. Now if it was me, I would have not rushed to leave then scene (total BS your dealing with no one was really hurt and seemed the driver knew she was going to be in trouble and wanted a get away). So I would have given the Officer a little time to sort things out and also maybe save him a trip over state lines. In this cause your action most likely cause him an arrest cause not only did you remove the suspect from the scene, you took them over state lines (which could have created a situation where the Officer couldn't issue a ticket or make an arrest cause the subject was cross state line. So personally I would have made sure the officer understood where the patient wanted to go and if he might have used a minute or two before we transported, especially since it was total BS and no one was hurt and just wanted to get away before they got a ticket.

Now before anyone gets on there soap box and runs their mouths without really reading what is being said, if the patient was really injured or was a trauma then no waiting at all. But in THIS CASE, where it is truly BS what does it hurt to work with the Officer and let him sort everything out. PD remember all, if you did it my way the next time you need PD that Officer would be there before you hung you mic up.

[iMac]

The patient pays for the trip=the patient tells where they want to go.

[NoOnesAngel]

okay...and here we go again I'm going to look the ignorant little EMT yet again...trust me I'm use to it at this point...but i'll continue on...I know this isn't going to be pretty...

MedicTroll you say it scares you that I hold an EMT card...our state has protocols...I work in KY so if you please you can look them up call KBEMS whatever you wish...I also work in WVA they have protocols...my service has duel CONs...and therefore I've never had a problem before transporting pts over the stateline...

Now as far as protocols go and so forth...in EMT class I was taught how to transport all sorts of things...how to do all kinds of things...in our state guidelines...I too am allowed to do these things...but when it comes to the verbal instructions given to me and my fellow employees I AM NOT ALLOWED to do these things...and this all gets very confusing and frustrating...I am not to give epi...i'm not transport a pt with an iv none whatsoever ....i'm not to admin albuterol...even though it's clearly stated in WVA protocols that med comm is to be called and it's to be administered....but the service constantly asks us to butt heads with what is clearly written out by the states...so we are in a constant state of do i or do i not and more often then not we do what we aren't suppose to because of whatever reason the service has...and we get exactly what I got...a very public very loud verbal reprimand...I've been doing this for two years....I'm about to be fired for butting heads and if i don't get fired i'm quitting...and I'm hoping it will be different at another service.

[1EMT-P]

If the patient is alert & oriented & stable then YES they can request to be transported to XYZ hospital, but if the patient is in Police Custody or if they are altered or if they are a minor of if they are unstable then no you do not have to honor their request.

Most EMS agencies have Standard Operating Procedures and Protocols in place that deal with issues like this, I would urge you to ask your employer for a copy of your SOP's and review them, If your agency does not have SOP's then I would start looking for a new job ASAP...

GOOD LUCK,

1EMT-P

[RGalyon0911]

If ever in doubt never forget OLMD is there. Also in AL it is pt's req. As long as it does not leave your community with no ambulance coverage. They can req whatever hospital they want even if that particular hospital is on diversion.

[toutdoors]

NoOnes, it sounds to me like you are stuck between a rock and a hard place. I say this because from the sound of it you are caught between what state protocols say and what your boss says. The thing that sounds a little scary is that if your boss is telling you not to perform a skill that your state protocols are listing in your skill level; who is gonna be the party responsible if you end up in litigation some day because you followed your employer's instructions, but diverted from state protocols? Especially if those orders in the company are not written down?

Our medical director signs off on the protocols that the state has set out. Pretty good deal for us I think. Keeps things simple, you know the state protocols, you know your protocols by default. Can't get into to many gray areas there.

As far as how much weight bears on respecting patient wishes? Well, for us it is pretty simple, all trauma goes to the Level II trauma center here in town, even if we bypass the other hospital. Cardiac arrest that is transported goes to closest hospital. If you are conscious, alert, orientated, you get your pick. I should clarify that on the trauma destination, it obviously correlates to whether or not a patient warrants a trauma center. The minor traumas, such as broken arm, cuts, stuff like that still gets their choice; most of the time. We have always been told by our medical director, field supervisor, and boss, that if we truly feel that the patient needs the services of the trauma center, we take the patient there, and explain to the patient why we are going.

As far as the officer is concerned, well sometimes you just have to beg for forgiveness. Did you make a mistake? I am not sure from the sounds of it. Like Medic Troll said, if it was a serious patient, of course you would have been getting and going, no waiting on anyone. Hindsight is always 20/20. I am guessing this was more than likely one of those calls that were like so many other where nothing really weird ever happens, and you did what you normally do. Then all of a sudden the officer realizes who the driver was, and now is upset, maybe at you, or at himself, or just the situation. The thing is, you were not there when he found out, so you are by default the guilty party. You will learn this as a parent someday also, when you ask the child in the house who did it. (They will tell you it was the one who is not in the room at the time.) Learn from it, don't lose any sleep over it. If that is the worst mistake you ever make in emergency services work, you will have a very blessed career.

[TheOldMan]

I am from WV, and I am familiar with the EMT-B protocols. NoOnesAngel

stated she could give Epi, that is only with a Epi-pen or Epi-pen Jr, only after getting medical command approval. Albuterol can be given by a BLS squad only, if she has her medic partner driving, Med Com, probably won't allow her to administer the Tx. My suggestion to you would be, the next time your 'lazy-butt' medic partner is driving and you know your patient needs more care than you give in your BLS scope of practice, get on the radio and request ALS back up. I will also say WV, is probably about 20 years behind in updating ALS and BLS protocols.

[NoOnesAngel]

First...My partner and she has been my partner on the truck for over a year and a half...has never had her medic..in fact she just recently got her cert as a FR . *GASP* -Evil CPR drivers - So...no medic was being lazy.

As far as the protocols I listed...they were just examples...