To AMA or Transport

[scubanurse]

I agree with what others have said... should have gotten med control online and pulled your partner aside to tell him your thoughts...by being silent about what you fet went wrong you're just as much at fault if something goes wrong.

[FireMedic65]

Patients vitals were normal. Why no BGL? These should be done for every patient with an altered mental status and seizures. If you are a BLS unit where was ALS?

1.If the patient is an adult, normally AOx4 confirmed by parents, and is confused due to seizure. Can patient be legally turned over to parents in the absence of medical POA??

No, he is a legal adult. Unless there are circumstances where he cannot make decisions on his own and has someone with a power of attorney, the decision to go or not go is his. Being that he is altered and cannot answer questions appropriately, he goes to the hospital.

2. If parents talk to patient's physician concerning txp, is it prudent for the medic onscene to make contact with the physician?

That's great that they consult with his neurologist, but at the time being, this patient is your patient. Even if he is still in the care of this physician. Unless his neurologist is a command physician, he cannot make the call on whether he can be released from EMS.

3. With the lack of medical POA, unconfirmed request by patient's physician, and the patient obviously confused. Would you have made transport decision for the patient on the side of the family's request or the side of the patient.

Inform the parent's they cannot make that decision legally. It appears the parents felt pretty strong about not letting you take him to the hospital. I would have consulted with medical command and let him talk to the parents and let him explain the situation.

The responses I got from the medic I was working with was that the decision was on the side of the patient, and that the parents can sign on behalf of the patient, and hold up legally. (not sure I agree with that, but I dont know)

Not sure on the legalities in Texas, but here in Pennsylvania if the patient (legal adult) cannot make a decision on their own for what ever reason, a spouse may sign for them. Also, I see now you had a medic partner. Why didn't he assess this patient fully? BGL must be taken for every altered mental status patient.

Parts in bold were made by me to answer the questions.

[NYCEMS]

First off why the first responders have him on 2 liters nasal instead of 10 to 15 lpm nonrebreather is an issue by itself.

Next you have to speak up if you feel somethings wrong. If you get called into court blaming it on your partner won't save your a..

The pt is an adult and another adult cannot sign a rma-ama without a power of attorney. That doctor can't tell you anything without the pt approval, and your guys AMS. Call medical control or a supervisor if you have a problem with a call. That's what there their for.

I don't care if you partner had 20 yrs on the job and you had 1 day, don't be intimidated. I've found that if you speak up and show your not just there for show your partners will respect you more. Those that don't like it won't want to work with you making you life easier. Skells like working with skells. They eventually become unemployeed.

You know he's going to have to lie thru his teeth on that report. Written the way it happened will have you both looking for a new career.

good luck, your concern shows you have pride in your work. Don't let anyone take that away!!!

[Lone Star]

I can only reiterate whats already been said.

Remember that unless you see valid/legal documentation, the DNR, DPOA/Guardianship does NOT exist!

Since the patient is no longer a minor, it's their decision EXCEPT when you cannot determine that they're CAOx4 (Concious, alert and oriented).

The patient's 'neurologist' only got a 'scene overview' from the parent, not the medical professionals on scene. This tells me that the neurologist didnt get a complete assessment of the patients condition. Furthermore, the neurologist ISN'T the patients primary physician, nor the online medical direction; therefore they have NO INPUT to the situation.

Knowing that the patient is not completely alert and oriented, and therefore UNABLE to make an informed decision; by definition, your partner breeched his duty to act and abandoned the patient. Since you did nothing (by your own story) to be the patients advocate, you're just as guilty as he is.

It's my considered opinion that you should have contacted online med control to confirm this, and notify a supervisor about the issue, and your partner's lack of treatment and willingness to abandon the patient.

The only thing I see that you can do now is write up an incident report, and hope that this whole situation doesn't come along and bite you in the ass.

Ignorance of the law and protocols is NOT a valid defense in court!

[FireMedic65]

I can only reiterate whats already been said.

Remember that unless you see valid/legal documentation, the DNR, DPOA/Guardianship does NOT exist!

Since the patient is no longer a minor, it's their decision EXCEPT when you cannot determine that they're CAOx4 (Concious, alert and oriented).

The patient's 'neurologist' only got a 'scene overview' from the parent, not the medical professionals on scene. This tells me that the neurologist didnt get a complete assessment of the patients condition. Furthermore, the neurologist ISN'T the patients primary physician, nor the online medical direction; therefore they have NO INPUT to the situation.

Knowing that the patient is not completely alert and oriented, and therefore UNABLE to make an informed decision; by definition, your partner breeched his duty to act and abandoned the patient. Since you did nothing (by your own story) to be the patients advocate, you're just as guilty as he is.

It's my considered opinion that you should have contacted online med control to confirm this, and notify a supervisor about the issue, and your partner's lack of treatment and willingness to abandon the patient.

The only thing I see that you can do now is write up an incident report, and hope that this whole situation doesn't come along and bite you in the ass.

Ignorance of the law and protocols is NOT a valid defense in court!

Well said. I totally neglected the fact that this person is every much as liable as the other. From reading the little story, I see a few problems, but that's besides the point.

Not to mention he admitted fault to it on a public forum with quite a bit of witnesses

[Lone Star]

Well said. I totally neglected the fact that this person is every much as liable as the other. From reading the little story, I see a few problems, but that's besides the point.

Not to mention he admitted fault to it on a public forum with quite a bit of witnesses

I can only hope that when this comes back to haunt the OP, (and it WILL), that the 'bite' isn't too painful!

[FireMedic65]

I can only hope that when this comes back to haunt the OP, (and it WILL), that the 'bite' isn't too painful!

*deletes his posts from this topic*

I seen nothing your honor

[Lone Star]

*deletes his posts from this topic*

I seen nothing your honor

[croaker260]

Furthermore, the neurologist ISN'T the patients primary physician, nor the online medical direction; therefore they have NO INPUT to the situation.

Well, good post except for the statement above.

Many patients for all intents and purposes do not have a "primary care physician, or only see one once or twice a year (or even less), but see their specialist every few months or even every month. To discount or assume that one has no valid input is setting your self up for a pissing match on scene/on phone and problems later in review.

Additionally, a jury or Judge might take the view that you were ingoring a powerful rescource in the care fo this patient.

The way to handle it is to follow your protocols for advice from a physician other than your medical control, hopefully you have a well written one. Now these ae usually written for problem docs on scene, but cover this situation as well.

Simply make contact with the neurologist, and explain (tactfully) on the front end of the conversation that you certainly want his input and insight, but any medical orders or advice must be confirmed by your med control doc before you put them into place.

Therefore, in this case, you speak clearly and articulate your assessments and concerns well, note his comments and reccomendations , get his phone number so your doc and he can talk if needed ..may not be...and then call your doc with this extra and vital insight in hand.

If you work in a system where you have the technology to do this over a recorded line, even better, but most systems do not have that easily ascessible.

Edited April 19, 2009 by croaker260

[Arizonaffcep]

Ok...I had to re-read the initial post before I felt ok to comment. That being said, most of what I have to say has already been said about POA/HC, etc, parents can't legally sign for him blah blah blah. So here's my question...why is his liver chirrotic? I would assume ETOH abuse? If that's the case, is the HX of SZ from DT's from past attempts at quitting? If that's the case, and the bleed is from a head bonk, and this SZ is from DT's, then it was a definate medical emergency that was abandoned. If not...still should have been transported, parent's wishes be damned-cause they can't sign (he's a big boy, no matter what mommy wants to think). Just my thoughts and/or questions.