The Only Thing That Matters Is the patient in front of you

[iamyourgod]

Have you ever explained or proven your superiority to a cockroach. I am EMSGOD, I need not explain myself to you. But you should be grateful, as I have set myself up for a huge fall, all you have to do is challenge me with logical responses to my diatribes, and i will either be proven to be or not to be your GOD ---LOL (and yes, this is tongue in cheek). So prove me to be a mortal, it shouldnt be hard.

[Eydawn]

Discussion is the exchange of information from varying perspectives in a civil manner with the intent to educate or simply enjoy different viewpoints. All you've done so far, no offense intended, is bitch that we try to get out of treating low acuity patients and then insist that you're "discussing" something.

Why don't you get your coffee, sit and think for about 10 minutes before you hit reply to my post, and see how you might view your last few posts if you hadn't written them. Remember on the internet we don't have the benefit of body language or vocal inflection to help soften our points- right now, as I'm imagining a voice saying what you're saying, you seem like the underwear shrunk in the dryer, someone puked on your shirt, and the last thing you want to do is try to persuade, but rather bitch about your day (life, career... substitute here).

Best Regards and NO OFFENSE INTENDED,

Wendy

CO EMT-B

[iamyourgod]

no offense taken at all -- i love a lively debate. So to ask another related question --- what percentage of refusals are actual REFUSALS versus medics talking the patient out of going to the hospital. As an EMS professional, do you not see anything wrong with telling a patient to go to the Doctor tomorrow, and then handing them a piece of paper to sign that more or less says "we begged you to go to the hospital, but you refused, so now if you die tonight, its not our liability ?

And I am smiling big while typing all of these posts, I am not angry, but my underwear is riding my crack

[Eydawn]

Well, it is in the best interest of some patients to not ride by ambulance. Take for example the 6 y/o female who had a little tiny bit of bleeding post- tonsilectomy (1 week prior) who hurled because her pain meds made her nauseous and had a little red streak in it. Not vomiting blood, no real active bleeding, just tired, not dehydrated, good vitals, no history of anything...

Is it worth it to stick her with the stress of an ambulance ride and a large bill for mom just because we got called by an overreactive parent? She's perfectly fine to go by POV with a puke bucket (even though she's not nauseous anymore, but just in case) with her mom to the ER she wants to go to instead of the closest one we normally transport to. We offered the option, showed pros and cons of both, and mom chose to go POV. Do we suck?

Question for you. Is it appropriate, in your mind, to inform any given patient that ambulance transport is excessive for their condition? Or should we always operate on a "you call, we haul" system?

Wendy

CO EMT-B

[iamyourgod]

thank you wendy, but may i ask, how did you arrive at the 100% diagnosis that this patient didnt have a post operative infection -- how do you know she wasnt bleeding into her esophagus ? I will tell you a story about a girl that i treated while working in the ER of our childrens hospital. The infants complaint was drooling -- she had been to two hospitals and discharged, and EMS had been called to her home originally (but they got a refusal). Xrays were negative. When the child was scoped, she had a cellophane cigarette carton wrapper in her throat, right at vocal cord level --- didnt show up on xrays. How many children have died from being subjected to a horrible ambulance ride and bill, versus the 1000s that were left behind with fever symptoms that later turned out to be menengitis or other serious infection ?

[Eydawn]

No swollen lymph nodes, no fever, no signs of infection, no complaint of distress other than a tiny bit of a sore throat and nauseous. Am I 100 percent sure she didn't have an infection? No. Can you ever be 100 percent sure that the patient you see isn't about to die of a sudden, random coronary? No.

The medic also visualized the area pretty well... he saw a *tiny* bit of surface bleeding, looked just like she had popped a clot from the surgery site. She wasn't in any distress, mom called because she freaked out at seeing blood in the kid's puke.

I didn't make the final call, my medic did... and there is nothing we could have done for the kiddo in the back except for stick her with a needle (which she might not need) and give her a ride. I happen to agree with the medic's evaluation of the situation. Mom was strongly encouraged to take the kid to the ED for evaluation by an EENT doc (which mom really wanted to do, she wanted us to take the kid to the kid's specific EENT doc's hospital), and as we were packing up, they got going.

There's the knowledge that any refusal might have something you missed, but there is also the application of good evaluation skills and common sense. The trick is to approach every call with an open mind, rather than assuming "it's just another drunk" and seeing what you expect to see. If you do that, I feel strongly confident that we as prehospital providers can adequately determine when and when not to transport.

You didn't answer my question. Is it appropriate, in your mind, to inform any given patient that ambulance transport is excessive for their condition? Or should we always operate on a "you call, we haul" system?

Wendy

CO EMT-B

[hammerpcp]

Wendy, to me your and 'your medics' tx, assessment and advice sounds perfectly reasonable. This being said, "God" has a point about the bleeding into the esophagus. Since there is blood in the oral cavity or pharynx and blood is highly irritant on the stomach often causing nausea/vomiting it may not be prudent to assume the child was feeling ill due to medication side effects. My point in saying this is just that there were signs present indicating there may have been more to the pt's presentation.

I can only speak for myself on the original topic. I have never "talked someone out" of going to the hospital. Even if I though it was unnecessary or an abuse of the system, even if I had not had a break or eaten yet that day, even if it was four o’clock in the morning. I have on the other hand, made sure that the pt and pts family are making an informed decision in regards to their treatment options. This IS my responsibility as a medic.

[iamyourgod]

thank you hammer -- that is a good medic there. I never talk anyone out of going in the ambulance, its just too dangerous, unless it is something obviously simple, like an isolated small laceration. Take this example -- we all know what hyperventilation looks like --- when a hyperventilation patient presents in the field, they are often not transported based on signs/symptoms and a good pulse ox. The same pt comes to the ER, they are not discharged until they have had a blood gas. Until I-stats become cheap enough for EMS services to buy them, you shouldnt be talking folks out of going to the hospital -- even then, it wont be a good idea, but atleast you will have some science to back up your decision

[akflightmedic]

I never talk anyone out of going in the ambulance, its just too dangerous, unless it is something obviously simple, like an isolated small laceration.

You are already making justifications for your behavior, why can we not do the same based on our own personal expertise and knowledge?

Are we not concerned about tetany, or them becoming infected and/or progresseing into cellulitis? These are just two immediate examples that popped in my head that could occur from this "simple laceration". However, you seem quite comfortable/competent with your skills and knowledge to determine they do not need a ride to the ER.

I dunno, but hypocrisy comes to mind...

You are either a professional department or you are not. Being professional half of the day doesnt count.

I agree, do you think this statement from another thread is relevant to this one?

I have not given you any background because it is not necessary --- assume for a moment that i am just a lawyer who has never been in EMS -- i have a client who is suing your department, [s:fdc8178789]because you have created a hostile work environment for her[/s:fdc8178789] because you talked them out of going to ER for simple laceration and they did not do proper follow up care and got infected and lost the limb or had severe tissue damage. It would be a slamdunk case. Instead of trying to find an angle to attack me personally on, attack my arguement with facts. And i am sorry, if you are practicing your profession one way at 3pm and another at 3am, then you are not professional. Right is always right, and is usually the hardest thing to do.

See inserted change of words above.

apparantley we do not understand the definition of the word professionalism .

Apparently, none of us do.

[iamyourgod]

thats the best you could come up with ????? you can do better than that ---