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

[Eydawn]

Here's a funny concept... how about if you have any doubt as to whether you're comfortable letting the patient refuse, you run all your diagnostics at hand, and then call the doctor with the information and let it rest on the doctor's shoulders? Isn't that what medical control is for?

And yes.... the asthmatic who's still wheezing but feeling some better after a nice O2/albuterol round is going to be screwed later if they refuse and don't get full symptom resolution. But if they're not hypoxic, not going to die right here right now in front of you, alert and oriented (forget X3... they are oriented or they aren't) and the doctor says they're being stupid but can refuse, then you refuse them.

Vent... I really don't get where you're coming from here. I didn't read anything in CBEMT's posts that led me to think that he didn't pursue all avenues available to him with this particular patient. And yes, sometimes we must kidnap the patient for their own good... but thankfully, we have doctors to contact to back those decisions up...

WTF happened to this thread???

Wendy

CO EMT-B

[spenac]

Here's a funny concept... how about if you have any doubt as to whether you're comfortable letting the patient refuse, you run all your diagnostics at hand, and then call the doctor with the information and let it rest on the doctor's shoulders? Isn't that what medical control is for?

And yes.... the asthmatic who's still wheezing but feeling some better after a nice O2/albuterol round is going to be screwed later if they refuse and don't get full symptom resolution. But if they're not hypoxic, not going to die right here right now in front of you, alert and oriented (forget X3... they are oriented or they aren't) and the doctor says they're being stupid but can refuse, then you refuse them.

Vent... I really don't get where you're coming from here. I didn't read anything in CBEMT's posts that led me to think that he didn't pursue all avenues available to him with this particular patient. And yes, sometimes we must kidnap the patient for their own good... but thankfully, we have doctors to contact to back those decisions up...

WTF happened to this thread???

Wendy

CO EMT-B

Exactly the fighting has ruined what would have been a nice discussion to see how various minds think.

OK to help get back on track. We diagnos regardless of what people call it or we could not treat.

[CBEMT]

I do apologize for the way the thread has gone. I guess it's the Irish in me- I can't just sit here and let somebody who's never met me, never met the patient, and wasn't on the scene sit behind a far-away keyboard and insinuate that I'm some dope who's a poster child for bad EMS.

HELL no. Ask Dust what my dedication to EMS education and self-improvement is. He picked me up from the airport after I flew halfway across the country to get continuing ed that my license doesn't even require.

At my full-time job I "kidnap" people all the time, but they're drunk.

[spenac]

Would you push a cardiac drug say Adenosine w/o some sortof diagnosis?

[Eydawn]

I think what we're really arguing here is the semantics of actual physician diagnosis vs working diagnosis for field treatment.

Yes, they are different. Yes, there is reason we take our patient, even with a working field diagnosis, to a real physician for the final say. We *must* make some sort of diagnosis in order to treat. That doesn't mean it's the only diagnosis the patient gets, nor that it is completely the correct diagnosis for that particular patient.

Does that make any sense? We do diagnose symptoms for the purpose of treatment, but we cannot give a patient a full diagnosis to work with in the future.

Wendy

CO EMT-B

[spenac]

But it is a diagnosis, field, working or otherwise. Occasionally it is actually the final diagnosis once confirmed by the doctor.

[Eydawn]

What is the problem here? I'm confused.

Wendy

CO EMT-B

[spenac]

No problem you have grasped what is common sense that a diagnosis of some sort must be made to treat. That diagnosis may evolve over time and with more tests.

Yet many have said and even many books say we do not diagnos. And that just gets my goat.

[Eydawn]

Again, confusion over the semantics of the word "diagnose" I think.

Dictionaries are your friends...

Wendy

CO EMT-B

[Monhae]

I understand your argument. I do. I'm a firm believer in improving our assessment skills. Our medical director is big on Differential Diagnosis. I'm happy we have someone who wants us to think. I'm considered the slow old guy. The "pup medics," no offense intended, around think in hyper-terms. Load and go. Short scene times. Jump on those ALS skills ASAP. There in too big a hurry for the "good stuff" to slow down and really dig into a patient's situation. Too many or the "old guys" are into the "hell this is the same old crap again" mode and overlook the small clues and take too long sometimes or don't give enough treatment. We have a gap in quality patient care. Don't misunderstand me. I'm not saying that those mentioned don't give QPC, but that there are gaps and the occasional patient falls through those gaps. We consider this acceptable and we should not. We think too often, well I really should have done more for that guy, but on another call, identical, we do the same old thing again. Anyone watch House. I love House. I know that he is a fictional character, but I strive to be that type of diagnostician. To find the deeper clues. To look at medical and trauma from outside the box. I base my treatments on the patient and the assessment, not some pre-determined guideline. That is all a protocol is. A guideline. I deviate or combine protocols on occasion. I call medical control adn say, "hey, this is what I have, can I do this instead." But I make sure that any deviation or alteration is backed with a strong assessment of the patient and the situation. We need to be more than the sum of our cirtifications and the minimum standards of care set down by our state. We need to be the life line and the voice of reason for our patients. We have the best picture. We see the environment. The ER does not. We are a liason for care. I rambled a bit.....sorry.

I also support the idea of treatment and not transporting, but it must be weighed carefully with what is best for the patient. That is opening up a can of liability worms you should be careful about opening. I forsee much discussion and experimentation before that concept ever sees real consideration.

Jimmy