Glucagon without an IV

[spenac]

You can not force patient to go. By waiting to treat until enroute to the hospital you have denied the patient to make a choice, you have forced them to go by with holding needed medical care until convenient for you regardless that it would have been best to treat immediately. THAT IS WRONG AND YOU JUST COST THEM A LOT OF MONEY.

I agree with mandatory transport of these patients:

1. You are making an assumption as to what caused the hypoglycemia, it could just as easily be due to overdosage of insulin, an infectious process, or a metabolic problem. Not my choice, patients choice right to decide. Yes more can be happening such as sepsis, etc.

2. You are administering a medicine to a patient and then leaving them behind with untrained personnel to monitor the patient. I doubt that you routinely leave a chest pain patient at home whose symptoms were relieved by 1 ntg tab that you administered. Why not give 5mg of Valium to a seizure patient and then leave them at home, or give 5mg of morphine to that chronic back pain patient and leave them at home ?

Actually if patient chooses to stay home after treatment or to go private car I can not force them. My protocols actually allow for treatment on location and then we even can decide they do not need ambulance transport

3. At best, the patient is mildly altered while signing your refusal. No they have to be fully alert and oriented to allow refusal or for us to deny transport.

4. You have no guarantee that their blood sugar will not drop again. There are no guarantees in life. Again they as a compentent adult say no I can not force them.

5. Most services are operating at loss or razor thin profit margin, and it is expensive to send a crew to the scene, administer meds, and wait with that patient for 30-45 minutes. Insurance does not pay for no transports, and most patients do not pay if you do bill them some minimal charge.

It is about patients rights not the budget. It is wrong to deny your patient the right to decide what will be done.

[p3medic]

Bill them for services, get the refusal signed, do another call...problem solved.

[crotchitymedic1986]

when you have an unconscious trauma patient, do you wait for them to wake-up and "make a decision" ?

Seizure, syncope, drunk, and diabetic patients are greatly underserved by EMS in my humble opinion

[scott33]

You are administering a medicine to a patient and then leaving them behind with untrained personnel to monitor the patient. I doubt that you routinely leave a chest pain patient at home whose symptoms were relieved by 1 ntg tab that you administered. Why not give 5mg of Valium to a seizure patient and then leave them at home, or give 5mg of morphine to that chronic back pain patient and leave them at home ?

If you are referring to the comments made by "Hetzvanrental", you may wish to do a bit of research on "treat and release / treat and refer" pathways which are currently the norm in the UK (which is where he practices) and you will realise just how ironic your comments are. The reason people transport everyone in the US, as already mentioned, is that it generates more money, and covers the arse of the provider legally. Give the provider as much scope, and tools at their disposal as the in-hospital staff (to a degree) for the types of calls mentioned, and many of these conditions can be treated at home. Paranoia over the "what-ifs" does not stop at the hospital doors.

Most services are operating at loss or razor thin profit margin, and it is expensive to send a crew to the scene, administer meds, and wait with that patient for 30-45 minutes. Insurance does not pay for no transports, and most patients do not pay if you do bill them some minimal charge.

Again, nothing whatsoever to do with "HVR's" comments as "billing" does not exist where he practices.

[crotchitymedic1986]

I transported the type of patients you routinely refused to transport because it was what was best for the patient. Money had nothing to do with it, as most were uninsured or insured through Medicaid. The problem is that often times, transport decisions are not based on what is best for the patient. Just google "paramedics / emts / ems / ambulance blamed in patient death".

[scott33]

The problem is that often times, transport decisions are not based on what is best for the patient. Just google "paramedics / emts / ems / ambulance blamed in patient death".

You will get a lot more results if you Google "Nurses / Doctors / surgeons / anesthesiologist blamed in patient's death". Simply offloading the patient doesn't solve the problem, or even begin to look at the big picture.

Bottom line is, that many of the people we transport to the ED, do not need to be transported to the ED. As someone who is employed in both EMS and Emergency nursing, I know that sometimes the "home remedy" is what is really best for the patient.

Doesn't generate much $$$$ though does it? :roll:

[crotchitymedic1986]

I have no responsibility over what happens at the hospital, that is the hospital's problem. My responsibility is to do what is best for the patient in front of me. In the absence of lab and xray you are taking a "gamble" everytime you leave a patient behind. For minor injuries and illnesses, the gamble is minimal, but for patients who lost consciousness for any period of time, it is a much greater gamble. You will probably win that gamble 80-90% of the time, but when you are wrong, the patient could die. I hope you are right 100% of the time.

[scott33]

I have no responsibility over what happens at the hospital, that is the hospital's problem. My responsibility is to do what is best for the patient in front of me. In the absence of lab and xray you are taking a "gamble"

What labs and x-rays do you think we do on a S/P hypoglycemic, who presents to the ED alert and orientated, with no complaints, and no real desire to be there? Having previously received either oral glucose or Dex by the ambulance staff - None! It's repeat FS, a sandwich, D/C home and follow up with your PMD. Job done.

[crotchitymedic1986]

The ER I worked in routinely did CBC and a pre and post chem panel (usually just a chem 7)

[scott33]

The ER I worked in routinely did CBC and a pre and post chem panel (usually just a chem 7)

Isn't that known as battery?