Opinions: Medic Refuses Intercept

[GhostMedic29]

This question is open to anyone who can provide a professional answer. This question involves a small department who utilitizes a paid on call crew with a volunteer back up crew. The situtation I am about give you in an ACTUAL situtation that occured here very recently and I just wanted some input from other medics and EMT's.

Our department was dispatched to a medical call this past week. The c/c from the patient was for CP. A BLS unit responded initially to the call. Upon their arrival they initated patient care in accordance with our protocols. O2 therapy was initated at 15L via NRB. The patient was also give (4) 81mg ASA as per protocol. The patient describe her pain as a dull crushing type pain which radiates into her left arm, left jaw, and back. Patient rated her pain 10/10. NTG gave minimal relief.

The lead EMT on the truck made the determination for ALS intercept. The medic who was scheduled to be on call was notified via cell phone of the situtation and informed that due to the patient's condition, the crew felt that ALS care was required. The medic informed the crew "I'm not responding, I'm spending time with my kids. Just take them to the hospital". When I heard this conversation after the call I was livid for one.

The lead EMT on the truck made the decision to have ALS intercept from a local fire department which operates ALS pumpers. When the medic from the FD got on board our unit, a 12 Lead EKG was obtained and showed elevation in Leads II, III, and AvF. An IV was established, the patient's vitals were WNL. Due to having minimal relief from the NTG, Morphine was administered at 4mg for pain. A copy of the 12 Lead was transmitted to the ER. On arrival of the patient at the facility, the patient was taken immediately to the Cath Lab for placement of a stent.

My opinion is this. The medic who initially refused to provide ALS care on this call even though he was requested is guilty of negligence and breach of duty. This medic was being paid by the department to be available for calls and refused to respond. This medic is also our Deputy Chief. The EMS Chief is investigating this matter internally for now, but the state has also be made aware as has the family of the patient.

The chief has asked for my opinion about this situtation and I informed him the best thing we could do is terminate the individual who refused the call above and hope our agency isn't sued by the family or sanctioned by the state authority. This is not the only call concerning this individual, but one of several. It in my opinion that this individual is a liability to this agency and those that we serve.

What are the opinions of my fellow EMS professionals.....

[Just Plain Ruff]

This question is open to anyone who can provide a professional answer. This question involves a small department who utilitizes a paid on call crew with a volunteer back up crew. The situtation I am about give you in an ACTUAL situtation that occured here very recently and I just wanted some input from other medics and EMT's.

Our department was dispatched to a medical call this past week. The c/c from the patient was for CP. A BLS unit responded initially to the call. Upon their arrival they initated patient care in accordance with our protocols. O2 therapy was initated at 15L via NRB. The patient was also give (4) 81mg ASA as per protocol. The patient describe her pain as a dull crushing type pain which radiates into her left arm, left jaw, and back. Patient rated her pain 10/10. NTG gave minimal relief.

The lead EMT on the truck made the determination for ALS intercept. The medic who was scheduled to be on call was notified via cell phone of the situtation and informed that due to the patient's condition, the crew felt that ALS care was required. The medic informed the crew "I'm not responding, I'm spending time with my kids. Just take them to the hospital". When I heard this conversation after the call I was livid for one.

The lead EMT on the truck made the decision to have ALS intercept from a local fire department which operates ALS pumpers. When the medic from the FD got on board our unit, a 12 Lead EKG was obtained and showed elevation in Leads II, III, and AvF. An IV was established, the patient's vitals were WNL. Due to having minimal relief from the NTG, Morphine was administered at 4mg for pain. A copy of the 12 Lead was transmitted to the ER. On arrival of the patient at the facility, the patient was taken immediately to the Cath Lab for placement of a stent.

My opinion is this. The medic who initially refused to provide ALS care on this call even though he was requested is guilty of negligence and breach of duty. This medic was being paid by the department to be available for calls and refused to respond. This medic is also our Deputy Chief. The EMS Chief is investigating this matter internally for now, but the state has also be made aware as has the family of the patient.

The chief has asked for my opinion about this situtation and I informed him the best thing we could do is terminate the individual who refused the call above and hope our agency isn't sued by the family or sanctioned by the state authority. This is not the only call concerning this individual, but one of several. It in my opinion that this individual is a liability to this agency and those that we serve.

What are the opinions of my fellow EMS professionals.....

Ok for starters, at least the patient got ALS care.

As for the medic in question, they are the on duty on call crew so they are responsible for responding. Their response is their responsibility and they are in the hot seat which rightfully so.

I would let the state investigate this as it sounds like they are.

If there is a pattern with this individual then department policy should be followed and discipline should rightfully follow.

Unfortunately you are a interested bystander and you really only have input as far as the chief has asked you and since you were not there I would be reluctant to become very much involved unless you have witnessed this type of behaviour before firsthand. Otherwise you become just a material witness with hearsay evidence.

If it truly happened the way you say it did then I would allow the wheels of discipline turn the way they turn. You cannot really get involved if you were not there on this particular call.

What you have to keep in mind is this, and I'm not saying this is what did or didn't happen but remember that many things get blown out of proportion on calls like this. Did he truly say this or did he have other things to say. Would it have been quicker to get the patient to the hospital than it would have been to get him to the rendevous point?

Would the delay in getting this particular person to you be more than the time it would have taken the bls crew to get to the ER?

Did the medic actually say what he said or was there more to the story/phone conversation that was not relayed to you.

I'm sure your medic has a side to the story that you were not privy to.

There are a lot of unknowns on this so I would be hesitant to call for his head until the investigation is concluded. If indeed it truly went down like you say it did and that is proven then by all means discipline up to the level allowed.

If not then a different tact needs to be taken.

[GhostMedic29]

Ok for starters, at least the patient got ALS care.

As for the medic in question, they are the on duty on call crew so they are responsible for responding. Their response is their responsibility and they are in the hot seat which rightfully so.

I would let the state investigate this as it sounds like they are.

If there is a pattern with this individual then department policy should be followed and discipline should rightfully follow.

Unfortunately you are a interested bystander and you really only have input as far as the chief has asked you and since you were not there I would be reluctant to become very much involved unless you have witnessed this type of behaviour before firsthand. Otherwise you become just a material witness with hearsay evidence.

If it truly happened the way you say it did then I would allow the wheels of discipline turn the way they turn. You cannot really get involved if you were not there on this particular call.

What you have to keep in mind is this, and I'm not saying this is what did or didn't happen but remember that many things get blown out of proportion on calls like this. Did he truly say this or did he have other things to say. Would it have been quicker to get the patient to the hospital than it would have been to get him to the rendevous point?

Would the delay in getting this particular person to you be more than the time it would have taken the bls crew to get to the ER?

Did the medic actually say what he said or was there more to the story/phone conversation that was not relayed to you.

I'm sure your medic has a side to the story that you were not privy to.

There are a lot of unknowns on this so I would be hesitant to call for his head until the investigation is concluded. If indeed it truly went down like you say it did and that is proven then by all means discipline up to the level allowed.

If not then a different tact needs to be taken.

I've witnessed various other actions with this same medic. Your right, I was not on this call, but I have read the PCR with the Chief as part of the internal investigation and it was documented who the medic was, what has requested, and what his response was. As for the bystander, I am actually assiting with the internal investigation as requested by the Chief of EMS. In a way I guess I am a bystander per se, but not so much as I have interviewed all crew members who responded to that call, all members were interviewed separately and all gave basically the same consistent account.

The medic in question has yet to provide his statement regarding his decision or refusal to respond with regards to this call. As for the state, they are involved with this investigation but they are allowing our department to conduct the internal investigation first. In the event the internal investigation uncovers any violation of protocols or state rules, then the state steps in and follows up from there.

I just posted this to see what other EMT's and Medics think about this situtation, that's all.

[Just Plain Ruff]

I've witnessed various other actions with this same medic. Your right, I was not on this call, but I have read the PCR with the Chief as part of the internal investigation and it was documented who the medic was, what has requested, and what his response was. As for the bystander, I am actually assiting with the internal investigation as requested by the Chief of EMS. In a way I guess I am a bystander per se, but not so much as I have interviewed all crew members who responded to that call, all members were interviewed separately and all gave basically the same consistent account.

The medic in question has yet to provide his statement regarding his decision or refusal to respond with regards to this call. As for the state, they are involved with this investigation but they are allowing our department to conduct the internal investigation first. In the event the internal investigation uncovers any violation of protocols or state rules, then the state steps in and follows up from there.

I just posted this to see what other EMT's and Medics think about this situtation, that's all.

fair enough. I wasnt' of course questioning your involvement but merely pointing out that as someone who wasn't there you or anyone else may not have all the information which you prove so far because the medic hasn't responded. This was by no means a question of why you were involved. I think a impartial (hopefully you are) second party is very important in situations as this.

Too many times we allow our personal prejudices get in the way of doing the right thing or doing what should be done. It's human nature to not want to cause undue harm or duress to a friend or co-worker.

If it all comes down to the way it really happened, what is your departments disciplinary process in dealing with a situation like this.

Has the medic in question been written up on the previous incidents or did people just bitch and moan about them.

Remember, if it's not written down you didn't do it in your care of a patient and this applies here as well, if the events or problems are not written down then they didn't happen. You need to have a good paper trail on this type of thing.

Good luck, I hope the correct outcome happens.

[HERBIE1]

I would hope that more than one person heard that medic's refusal to respond, other wise it's he said/she said. Regardless, if this person was on call and did not respond, that's inexcusable and certainly subject to whatever discipline the department allows. Additionally, if this person has exhibited similar behavior in the past, unless it's documented, it did not happen.

Tough situation since this person is a Deputy Chief, but clearly he's the wrong person for that job- as a boss or provider.

[GhostMedic29]

I would hope that more than one person heard that medic's refusal to respond, other wise it's he said/she said. Regardless, if this person was on call and did not respond, that's inexcusable and certainly subject to whatever discipline the department allows. Additionally, if this person has exhibited similar behavior in the past, unless it's documented, it did not happen.

Tough situation since this person is a Deputy Chief, but clearly he's the wrong person for that job- as a boss or provider.

As of today, the situtation has been handled. After careful review of the information submitted by the individuals who went on record and stated that the medic outright refused to respond to this request for ALS intercept, the medic has been suspended without pay by the department pending the outcome of the investigation.

[CBEMT]

By procedure, who notifies the medic of a request for ALS- the BLS crew, dispatcher, other? Who did in this case?

[JakeEMTP]

I agree with your services handling of the incident at hand. I can't help thinking though, w/o trying to highjack the thread, with a CP call, why isn't the medic automatically dispatched? Perhaps since I work in an all paramedic level system my thinking is clouded. But if the FD had a medic, why did a basic crew have to call a medic for CP?

Sorry, just thinking out loud.

[GhostMedic29]

Maybe I should have made myself clearer with this point. As of right now we are a volunteer service which utilitizes a paid on call system. We do have medics who help out from time to time, but they are not always around to respond, although it is helpful when they do respond. As for requesting the medic to respond, we are dispatched by the county 911 center so the EMT whichwas on the truck made the decision to call for ALS intercept.

Unfortunately the medic refused to respond, which left that BLS crew twisting in the wind. So rather than attempt to risk it, they called for ALS intercept from a neighboring FD that runs Paramedic Engines which in this case was the right call and the department supports that EMT's decision. We have several members who are currently completing a Paramedic program, and I am one of those members.

Sorry for any confusion guys, I didn't mean to mislead anyone about the situtation. But anyhow, the situtation has been handled internally with this individual being placed on administrative leave (unpaid) pending the outcome of the investigation. We are hoping this situtation can be resolved internally but we are going to have to see what develops.

[mobey]

I can't help thinking though, w/o trying to highjack the thread,

Sorry, just thinking out loud.

Since we are hijacking without intention.....

Does anyone else think 4mg MS is a little high for a loading dose on a known inferior?

I am kinda sheepish with my drugs at this point.... so maybe it isn't.

I'da started at 2.5.