Do we diagnose, rule in/out, or just load and go.

[CBEMT]

Maybe you can find time in between snide comments to explain how a mighty all-knowing paramedic like Vent forcibly transports alert and oriented patients so that they can get the physician assessment you're so sure they so desperately need from thousands of miles away?

I'd love to hear what else I can do better since I'm clearly so incompetent. How help me Vent, help me! :roll:

[spenac]

You can not force treatment or transport on anyone that does not want it.

Speaking from personal experience with asthma, I have had to add O2 to break a severe attack. Once broke my regular meds maintained me just fine. I am sure many that we treat that are experienced asthmatics know this as well. That is why they ask for a treatment with O2 and then refuse transport. They know that they will be billed for expensive need less transport and tests. Often we as asthmatics can tell rather quickly how much relief we are getting. Other illnesses such as diabetes, angina, etc are similar in that people know what they need many times. That is why they refuse transport.

Do they sometimes need more? Yes but surprisingly they will often tell you that somethings still not right. Listen to your patients many times you can learn a little something from them.

[VentMedic]

Maybe you can find time in between snide comments to explain how a mighty all-knowing paramedic like Vent forcibly transports alert and oriented patients so that they can get the physician assessment you're so sure they so desperately need from thousands of miles away?

I'd love to hear what else I can do better since I'm clearly so incompetent. How help me Vent, help me! :roll:

Never used the word incompetent. However, as an EMT you might be under educated for complex situations.

A thousand miles away? How many respiratory patients do you think I see in one 12 hour shift if I am working in a hospital? 30 - 40 might be a slow day. Granted, if I was working ground transport, I might only see 3 or 4 and for flight they'll probably be intubated.

For goodness sakes! You are talking like there is NOTHING to do with an athma patient except give a neb or FORCE them to come to an ED. As an EMT how much do you know about pulmonary disease? You have used two little buzz words like COPD or asthma. How much time have you actually spent with these patients in you training or experience? How many extra classes or seminars have you taken to develop and understanding about these patients to use some other arguement rather than the usual "go or die"?

Did you look at their medication list, the number of doctors they are seeing , nutrition and living conditions? When we enter a home regardless of title since RNs and RRTs also go to the homes and must get these patients to come in to the hospital, we look at the whole picture. That may come with experience for you but you may also have to put a little effort to understand how different things affect the respiratory patient's decision making. There are skills to be learned for dealing with patients of all types from the manipulative to the obnoxious.

My advice if you want help: go back to school. Take A&P and Pathophysiology classes. Take CEU classes dealing with lung disease. Advance your education and knowledge.

My apologies because I can now see how as an EMT you might have difficulties convincing a respiratory patient what might be the best choice for them since you may not have the knowledge base to use the same arguments those that work regularly with these patients. But when you replace you lack of knowledge with arrogance, it is the patient that suffers. If you perceive my statements that come from experience and education as arrogance, then you truly do not have enough education and experience to your credit.

[CBEMT]

Never used the word incompetent. However, as an EMT you might be under educated for complex situations.

I'm not trying to be argumentative here, but I have a hard time understanding what about this situation you see as complex.

The reason I've reacted so strongly to your posts is that you're acting like this was an EMS-initiated refusal or something. I don't know how many different ways I can explain that this is not what happened. This post is my best effort.

[akroeze]

I'm agreeing with you here CB....

Vent, you seem to be completely missing what he is saying. He TRIED to get the patient to go but they refused to comply. Are you suggesting that he should have kidnapped the patient?

[CTXMEDIC]

How dare you argue with vent. you are but tiny tick turds compared to this mans wisdom and enlightenment.

I think ill have another beer now.

[VentMedic]

I'm agreeing with you here CB....

Vent, you seem to be completely missing what he is saying. He TRIED to get the patient to go but they refused to comply. Are you suggesting that he should have kidnapped the patient?

Some are just missing the point...about education.

If you only have a minimal knowledge about disease processes, the patient can state they have whatever to get anything out of your bag of medicine without you being the wiser. Patients can find out more about different diseases from the internet or from their neighbors than what you will find in many EMT or even Paramedic classes. If you can show the patient you might actually know a little about some things, they might listen. If you listen to some patients' statements "everyone has asthma" because their neighbors made the diagnosis based on some dear aunt told them about the wheezes. And the EMT has just confirmed this "diagnosis" without having proof of a history.

"The nice EMTs have been treating me for Asthma and didn't tell me I had anything wrong with my heart or had cancer". "I trusted their diagnosis."

Why are some so against exploring the bigger picture in the world of medicine than what is taught in an EMT book and a 110 hour EMT class?

[akroeze]

Some are just missing the point...about education.

If you only have a minimal knowledge about disease processes, the patient can state they have whatever to get anything out of your bag of medicine without you being the wiser. Patients can find out more about different diseases from the internet or from their neighbors than what you will find in many EMT or even Paramedic classes. If you can show the patient you might actually know a little about some things, they might listen. If you listen to some patients' statements "everyone has asthma" because their neighbors made the diagnosis based on some dearly departed aunt that had the wheezes. And the EMT has just confirmed this "diagnosis" without having proof of a history.

"The nice EMTs have been treating me for Asthma and didn't tell me I had anything wrong with my heart or had cancer". "I trusted their diagnosis."

Why are some so against exploring the bigger picture in the world of medicine than what is taught in an EMT book and a 110 hour EMT class?

Ok, I apologize. I had you misread on this issue. You aren't suggesting that this patient should have been kidnapped, for some reason you chose this thread as a spot to get on a soapbox about education standards. You'll have to forgive us for getting confused as this really isn't where you normally expect that kind of preaching.

[VentMedic]

Ok, I apologize. I had you misread on this issue. You aren't suggesting that this patient should have been kidnapped, for some reason you chose this thread as a spot to get on a soapbox about education standards. You'll have to forgive us for getting confused as this really isn't where you normally expect that kind of preaching.

Soapbox? Why is it that everytime the word "education" is brought up it is a "soapbox".

This can be an example of where the patient probably has more medical knowledge than the EMT and knows it. What is so wrong with suggesting that one educates themselves about medicine a little better than the general public they serve?

The education of an EMT is less than 200 hours and they can be easily manipulated by patients that know a little bit of pharmacology or buzz words they've picked up from the neighbors.

Okay soapbox: education, education, education. Some U.S. EMS providers need to get over their fear and insecurities of education and the people who have made an effort to become educated.

[akroeze]

Soapbox? Why is it that everytime the word "education" is brought up it is a "soapbox".

This can be an example of where the patient probably has more medical knowledge than the EMT and knows it. What is so wrong with suggesting that one educates themselves about medicine a little better than the general public they serve?

The education of an EMT is less than 200 hours and they can be easily manipulated by patients that know a little bit of pharmacology or buzz words they've picked up from the neighbors.

Okay soapbox: education, education, education. Some U.S. EMS providers need to get over their fear and insecurities of education and the people who have made an effort to become educated.

I was more trying to comment on the fact that the following was happening:

Person #1: Apples are red.

Person #2: Apples are horrible because I choked on one once.

Person #1: That doesn't change the fact that apples are red does it?

Person #2: Aren't you listening? Apples are HORRIBLE.

Repeat