Just Plain Ruff Posted April 10, 2008 Posted April 10, 2008 taking a cue from a post from spenac You are on the way to a cardiac arrest - 7 mins out A mass casualty incident comes out which is 4 miles behind you. Bus versus dirt truck. 15 potential patients with 2 ejections. You get the idea. You arrive on scene and find a 57 year old male who c/o hurting his ankle but it never was a cardiac arrest, the frantic caller didn't see anything but the guy collapsing in his garage and called before they investigated further. So it was dispatched as an arrest. You explain to the guy that there is a very very bad accident down the road with the 15 patients and some ejected. You even explain to him that it is children involved. The patient tells you "I don't give a damn, you are gonna take me to the hospital to get checked out. You do have other ambulances on don't ya?" Basicallly the guys a prick but that's beside the point. What do you do?
spenac Posted April 10, 2008 Posted April 10, 2008 I do a quick triage on him. No immediate life threatening injurys and it will cause him no harm to go private car, I tell him no he will have to get someone else to drive him. I am even nice enough to suggest he go to another hospital as ours will be busy with the mass casualty event and he will have to wait forever if he shows up there. But I have that option based on my medical director. Even if not allowed to do this, I think I would risk disciplinary action by refusing in order to go help those that really need help.
Just Plain Ruff Posted April 10, 2008 Author Posted April 10, 2008 I would also do the same spenac. It's the old adage "the needs of the many outweigh the needs of the few,,, or the one" It's a lose lose situation but I'd like to hear from others.
AZCEP Posted April 10, 2008 Posted April 10, 2008 You handle the call that you were assigned first, then make your way to the glamour. Yes, I'd suggest that this patient could transport himself, but that is no different than if there wasn't another call happening. If the management of the MCI hinges on one transport unit there is a bigger problem here than which call to handle.
JPINFV Posted April 10, 2008 Posted April 10, 2008 Evil way: Declare him a part of the MCI and green tag him. Safe way: Medical control
Eydawn Posted April 10, 2008 Posted April 10, 2008 You are obligated to provide care for the first patient you were assigned to. If you have issues with it after determining the guy's a prick, then call medical control and see what they want you to do. A good doc will tell you to leave the patient with the non-life threatening injury with a cop until another unit can get there... It's no different than running on a call for a "cardiac arrest" in a local convenience store and passing a 3 car accident on the highway on your way in... you go where you were told, you call in the accident, and you wait for further instructions. If dispatch is responsible for telling you where and when to go, then turn it over to dispatch! Advise them that you may be a faster resource for the big hairy mess... and let them make the decisions. Didn't we discuss this under the guise of "do you stop at an accident you see on your way to a call" a couple months ago? Doesn't seem much different to me... just a larger sort of accident. Wendy CO EMT-B
Just Plain Ruff Posted April 10, 2008 Author Posted April 10, 2008 wendy wendy wendy, the voice of reason. I posted this scenario and after about the third or fourth reply I remembered that thread.
ccmedoc Posted April 10, 2008 Posted April 10, 2008 I don't think you have a legal obligation to transport the patient if the transport is not, in your mind, medically necessary. You need to triage him, make your findings known, maybe call MC, and at the very least indicate you will be back for him later. If you must leave, that is. You just need to be sure he is stable. If something happens remotely related to the ankle problem that turns out serious, then you are is huge trouble. I figure, why take the chance?
tniuqs Posted April 11, 2008 Posted April 11, 2008 Declare him a part of the MCI and green tag him. Safe way: Medical control Love the way you think JPINFV That is if one CAN contact medical control, could it be the MD may be kinda overwhelmed already ? Politically situational awareness, is very important IMHO. So just for added interest in this "senario" .... lets factor in some mitigating circumstances, shall we ? 1- The weather conditions ? POOR ? ... that's always the case for me. 2- So just what are the availabe and "timely" resources that are at dispatchers disposal ? 3- Is this remote farming community ? 3- Due to wx conditions .... is a Helo availible ? So maybe if your lucky (a > 40 minute response for mutual aid ? hope I am not misleading TOO much ? 4- Any further updates from EMS crews / Fire Chief/ RCMP/ or Incident Comander on scene ? (What are THEY requesting? ie could this be defurral to a higher authority ?) [hr:b4927f7333] You do have other ambulances on don't ya?" Umm not near enough sir ! Maybe write a letter to your MLA while you wait in ER ? Is your hand ok, here is a special pen that I will lend you :twisted: [hr:b4927f7333] You handle the call that you were assigned first, then make your way to the glamour. WTF ? PLEASE factor out the bs glamour comment and the high rating of the "prick scale' really has no bearing in this type of senario I would surely HOPE. [hr:b4927f7333] So: In this senario: These are the children of a small farming community are they not ? That you are entrusted and funded to serve ? Next Question to Buddy: When did you last have a drink ? Does buddy smell of ETOH ? .... see where I am going with this ? You want evil, mobey your the diet pepsi of :evil: You want bad press, just ask yourself this Sir "How will this community respond when they hear that you insisted that I transport you with a just a busted leg when there easily could be a child that is not breathing ? Under ones breath .... don't think I want to be your sorry ass when that hits the local moccasin telegraphy, cough, splutter, gag. [hr:b4927f7333] No immediate life threatening injurys and it will cause him no harm to go private car, I tell him no he will have to get someone else to drive him. I am even nice enough to suggest he go to another hospital as ours will be busy with the mass casualty event and he will have to wait forever if he shows up there. Now that IS the voice of reason and experiance, fortunatly we do not have the crazy ass laws that you do down south that prempt common sense. NO court in Canada in would even proceed with any litigation or abandonment issues under these circumstances and even if they did, AND thanks to Ralphy the max "buddy" could even sue for is pain and suffering = 4 G, besides that no way "buddy" would get even close to that, even IF he was succesful that. My bet is the local Judge would file it .... "G" .... no evidence to procced, I think the RCMP would hide their laughter, if "buddy" even attempted to made a complaint, perhaps stopp him to check his lights next week ? I bet the Mayor would love some "ammunition" as well to improve funding ... You think ? Question mobey ..... is this an ALS service ?:evil: If Not where is the Closest ALS service ? You are obligated to provide care for the first patient you were assigned to Not here THANK DOG ! NO criminal intent = it again goes to "tort law/civil law" for YALLs a completely different cultural view, based on a thang called "the reasonable man" Yes a very different legal system, I suggest politely unless one has a very good understanding of CANADIAN laws one could look very silly, perhaps ignorant too ... just saying. One would be judged by a peer group, ie other medics and IF a regulatory body was involved ... I bet $$$$$$$ that NO way they would even touch THIS type hypothetical senario, I suspect there would be quite a few "volunteers" for ACR or C+C investigations, for the good of the proffession is ALL. Even IF it did go to courts, just perhaps, with a smart litigator the circumstances would be "quietly" made public ? AGAIN (don't think I want to be "buddy's" sorry ass in a small community that knows you hit your dog last week, meh !) cheers and an a very interesting senario , any further information in this hypothetical senario? any deaths ? any transports ? Or was it just a practice run ? :roll:
tniuqs Posted April 11, 2008 Posted April 11, 2008 Late Thoughts : I wonder if Dr. L. Francisscutti would like to comment about this senario ? He is after all a serious advocate and on the Alberta Trauma Prevention Council. Maybe about seatbelts in School Buses ? Maybe about ALS in Rural Communities ? Maybe about improved municipal funding formula's ? Maybe about provincial EMS direction ? Maybe about other things, hes one smart guy ! just wondering is all ? cheers
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