Save 1-2 million patients in 2009 ??

[crotchitymedic1986]

He doesnt have to assess, he just needs to verify that the patient is actually refusing. You have already assessed the patient and determined the need for transport, as you are asking them to sign AMA. The supervisor just asks the patient if they are truly refusing.

[WolfmanHarris]

So we're back at not being able to trust the on-scene providers to act in the best interests of their patient's medically. Using a pretty wide brush their to cover up incompetence and laziness when there's better ways to deal with it. If the provider is compelling refusals from patient's inappropriately, they're probably also doing other things wrong and should not be working any longer.

[crotchitymedic1986]

No doc, they do not need the direct supervision, because all mistakes, nearmisses, and mechanical failures are reported to the FAA. They can then study the mistakes, and make changes to insure that the mistake is minimized in the future, which is why air travel is the safest form of travel.

If EMS had to report all events that resulted in a negative patient outcome, to a central body, then we wouldnt need this bandaid.

Thanks for the pilot reference DUSt, that helped me alot.

[JPINFV]

I am sorry spin, i didnt understand, could you please rephrase

Who's "spin?"

[crotchitymedic1986]

Good point, and I agree, but here is the problem with that. Pt signs refusal after being told that they are OK and dont need to go by EMS. Patient signs refusal, pt dies within 24 hours of said refusal. If someone complains, medic holds up said refusal form and says I did everything I could to try to get them to go. How do you discipline that, unless you have a witness for the patient, but even then it becomes patient's family's word against the medic, who has a refusal form ?

sorry jpin, typing on a laptop

[WolfmanHarris]

But you're calling for direct supervision.

Once again we're in agreement about the need for better system quality improvement. I don't know for sure that we're in agreement on education, but I hope so. Where we're not in agreement is over your solution to the problem and I don't think its for lack of understanding of your perspective. I just don't think it's the way to go for all the reasons listed by myself and others above.

If you want to put the management types to work, put 100% PCR audit on every refusal. That will not only increase the accountability by the providers without creating management undermining them on scene, but help establish trending and reporting system wide.

[akflightmedic]

Good point, and I agree, but here is the problem with that. Pt signs refusal after being told that they are OK and dont need to go by EMS. Patient signs refusal, pt dies within 24 hours of said refusal. If someone complains, medic holds up said refusal form and says I did everything I could to try to get them to go. How do you discipline that, unless you have a witness for the patient, but even then it becomes patient's family's word against the medic, who has a refusal form ?

sorry jpin, typing on a laptop

Which is one of the reasons all of our refusals were typically witnessed by family members.

[Just Plain Ruff]

by your logic I'll bite I had a patient in critical chf pulse ox of 64%. He was adamantly refusing to go the hospital. He was a&OX3, had all his faculties about him.

He refused to go, the doctor was called and talked to him directly and he refused to go. we told him he would be dead in 20 minutes if he refused. He still refused. His family physician came to his house and he refused to go. in fact he told his doctor and all of us that he wanted to die and for us to get out of his house. We called in law enforcement they came and he threatened to have us arrested if we didn't leave. The cops said that since he was competent and knew all the pertinent questions that we had to leave.

We parked a couple of blocks away and after 20 minutes we called his house and his daughter answered and said he still didn't want to go.

We went back in service.

2 hours later we got called out to see him again and by the time we got there he had already passed away.

So by your logic our refusal apparantly was negligent because this refusal contributed to his death. Should we report this incident to someone so they can keep track of this "Alarming" statistic?????

Or were we just lazy?

[Arizonaffcep]

b. Many that do occur, do not result in lawsuits, because we whip out our Ace in the hole, "the refusal form that was signed by the patient" (although the medic told them they didnt need to go).

Where do you get this paranoia from? In the near decade I've worked EMS, I have only heard of medics doing this once or twice...and that's taking into consideration the surrounding departments, all of which I have at least one friend on...Where are you getting the numbers? If it's personal obs, why are you working for a crappy company? Would that not have made you a crappy medic by association?

[reaper]

Ok, I do not agree with having a supervisor overseeing my refusals. I always try and talk pt's into going to the ED, if they need to.

On that note. The last service I worked did have a slightly different refusal policy. Any refusal we did, we had to call a supervisor or dispatch on the radio. We would them switch over to an extra tac channel we had and we would give them a refusal report over the radio.

This was not asking for permission to refuse that pt and the supervisor never talked to the pt. All this was for was to have a recorded record of the report for liability reasons. The only reason we would call a supervisor is so they could acknowledge hearing the report clearly.

I had no problem with that system, as it did CYA. If a question came up, they could pull the tape on it.