During transport, who is in charge if L&S should be used. Also can you refuse treatment/transport?

[ghurty]

I am embarrassed to say this, but this is one of the problems with volly squads, that there is no real rules and guidelines.

The other night my (volly)BLS squad (in New Jersey) got into a heated debate of who is in charge during the patient transport. In particular - lights and sirens.

I am of the belief that the EMT treating is in charge, and that if he/she based on the patients status, tells the driver (usually not even an EMT), NOT to go with lights and sirens. Then the driver can NOT use them. And if the driver does, they are opening themselves up to sever liability issues. The problem is, that a lot of drivers love going with lights and sirens.

Other members claim, that the driver is in charge, and it is his decision whether to use lights or sirens. That "if we are transporting then it must be an emergency".

This led to a different discussion whether or not a EMS squad dispatched to a call can refuse treatment/transport if they feel that it is not a "real emergency".

I am of the belief that refusing transport would be considered abandonment, (thus being the reason why we need RMA's). They claimed that even though you arrive on scene and do a quick assessment, it is not considered abandonment until you actually start treating the patient.

So basically, the two questions are:

1) Who is in charge in regards to using lights and sirens during a transport.

2) Can you refuse treatment/transport of a patient if you feel it is not an emergecny.

Remember, we are dealing with BLS here.

It could be that I am wrong regarding both of these. I would love to hear what anyone has to say about this. Also if anyone has links to any legal documents, etc... We are dealing with New Jersey here, but any input would be appreciated.

Thanks

Edited September 9, 2009 by ghurty

[speedygodzilla]

It should be up to the attending EMT on rather to go lights and sirens. It should never be base on emergency driving be fun or quicker. It should be base on pt's condition, CVA symptoms, pt's s/s that make you think that the few minutes you save are really worth the extra danger of emergency transport.

The theory that it must be an emergency because were here is ridiculous. I only drive 911 calls where I work due to having a paramedic, and we only go emergent for transport probably 5 or less percent of the time. I assume the percentage is expected to go up with BLS and rural service but shouldn't be a drastic change in transport. The emergency is not yours and please don't make it yours. Use your assessment and if you truly are not sure ask medical control if they would like you to up grade after you "paint a picture" for them.

Use common sense, and I would think there would be some sort of protocol.

[ghurty]

I just want to point out, that I am not really looking for debate over "right or wrong", (I spent over an hour at the meeting debating) rather I am looking for facts and regulations.

Thanks

[akflightmedic]

Well said...it is ALWAYS the treating provider's decision on whether or not lights are used. Even if we roll up on a heavy traffic jam, the driver had better ask/request lights and sirens and have a good reason for wanting to do so.

If I instruct no lights and sirens and you decide to trump me, I will shut you down right there on the spot. You will not risk me or my patient when there is no reason to do so. I will have supervisors, dispatch, whomever it takes to make you stop that vehicle and/or stand down.

After the incident, I will ensure you will not drive for me again and possibly have you removed from the squad.

Harsh? Yes it is but we are talking about my life and my patient's life regardless of whether the driver cares for their own well being or not. A non medical driver will not ever trump my decision making skills when it comes to how we should transport.

Yet another reason, this should not be a hobby which functions under the guise of "helping others cause no one else will".

[FireMedic65]

Attending EMT is in charge of the patient.

Driver is in charge of the vehicle.

If the EMT says no lights and sirens, they are making judgment saying the patient is not in critical condition and can go to the hospital in a timely fashion. If the drive still insists on using the lights and sirens, I suppose, technically he is endangering that patient by putting the patient at risk by having them on and doing a more speedy transport.

This argument never really came up. It was always up to me if I wanted lights/sirens or not when transporting. If I were to be driving, I would ask the EMT/Medic what priority they would like to transport.

Ultimately, the senior emt/attending EMT that is GIVING CARE is in charge.

[akflightmedic]

In regards to your refusal issue, your contract/obligation/duty to act started the moment you went en route to their 911 call.

They sent a distress signal, you responded. Your presence on scene is now "medical treatment". A quick assessment, is treatment. If you leave at this point without follow through, it is abandonment, unless an equal or higher medical authority has shown up and takes over or you transport. Plain and simple...ask any lawyer.

2) Can you refuse treatment/transport of a patient if you feel it is not an emergecny.

Remember, it is THEIR emergency, NOT yours.

Whether or not you think it is an emergency is only relevant when deciding on which hospital to take them to, whether or not to call for ALS or whether or not to travel with lights and sirens.

[ghurty]

I'm glad to see that I am not completely crazy.

I am supposed to try to dig up some legal paperwork to show them. I emailed the state, and I hopefully they will be able to help.

In regards to your refusal issue, your contract/obligation/duty to act started the moment you went en route to their 911 call.

They sent a distress signal, you responded. Your presence on scene is now "medical treatment". A quick assessment, is treatment. If you leave at this point without follow through, it is abandonment, unless an equal or higher medical authority has shown up and takes over or you transport. Plain and simple...ask any lawyer.

Remember, it is THEIR emergency, NOT yours.

Whether or not you think it is an emergency is only relevant when deciding on which hospital to take them to, whether or not to call for ALS or whether or not to travel with lights and sirens.

I tried to explain, that if we were able to just say "we are not treating you", then why would we need RMA's.

Edited September 9, 2009 by ghurty

[joesph]

I almost wish we had no lights and sirens anymore they are constantly being abused and honestly the public is getting desensitized to them.

[Kiwiology]

The officer treating the patient decides the status which in general determines the status of transport (emergent vs non emergent)

Lights are used in transport I would venture about 1% of the time, lights and siren together about 1% of that 1%; generally emergent transport is only used for very sick people.

If we feel the patient does not need transport we can decline thier request/make a non transport reccomendation.

[stcommodore]

Are you kiding me? Threating somebody elses job/posistion over lights and siren useage? That's totally over the top! You have two people working as partners, working together on a shift/call/etc and they should be doing so as a team. But in the end it comes down to the highest trained provider. But really its lights and sirens, and not work a drag down fight.

When it comes to "provider initated refusal" you would need to have protocals with ALS and medical command support before ever doing something like that. I can't imagine that a BLS provider who hasn't even had basic anatomy could be expected to know everything necessary to tell someone they shouldn't go to the hospital.