my first it's a women... no its a man

[Private Paramedic]

a couple of months back I attended an MVA around the corner from my office (first on scene after hearing the crash) and found 1 intoxicated male trying to impress the blonde next door by doing a wheelie on an unregistered trail bike. Of course, the bike flipped and he went with it. After calming him down from the head injury, hand injury, intoxication and embarassment, pt became combative again after I started a PCR on him. It seems that he did not want police involved and was afraid that the PCR would be handed over to Police (I have actually politely told Police in the past to go get a court order before I will release a patient care report, they are confidential for a reason...)

After sorting this out, the pt gave false details, name, address, etc. No licence that I could verify against. Pt disappeared after refusing to sign PAC (Patient Advice Card - given to patients who decline treatment/transport). 5 minutes later, packing gear up into the ambulance, girlfriend turns up to collect the damaged motorbike, and I ask how Paul (pseudonym) is going, and the girlfriend replies "His name is Peter (pseudonym)", and through her I verify his details further.

It shows that despite the trust, some people still do not want to share pertinent information. How many men actually admit to taking viagra when you have to administer GTN?

Some choose not share info when they feel that law enforcement will be involved for an issue. And you cannot imagine how many patient care reports I have completed that bear the name of

John or Jane Doe, with the address of refused to disclose. I generally write a physical description of the patient, along with the words "Patient refused to disclose identity to paramedic" and have the trusty partner countersign the PCR as witness. That way, if they sue, it is as good as a declined treatment.

As far trauma assessments, I rarely will feel the crotch of a patient, and in 11 years I have not without a good reason. Even as a male, with female patients, I will not touch the chest area unless necessary for treatment or assessment (ecg, respiratory, etc) and even this is done after verbal informed consent if able.

I have even dealt with an intoxicated patient who swore blindly before the deities that they fractured their tib/fib on perfectly level ground while walking to the shops.... and when you look up you see the balcony on the second floor of the local bar with people leaning over and giving the thumbs up after the patient decided that gravity no longer applied.

Just remember, there is a small detective in us all, that must be suspicious of what patients tell us until proven (or disproven).

[Richard B the EMT]

One time I had a 2 car collision, with one vehicle rolled over, but landing on it's wheels. The rolled vehicle had 2 occupants. Neither had any complaints, and I was originally going to accept the Refused Medical Assistance, until a friend in the bystanders, who witnessed the accident advised me of the rollover.

Subsequent to the advisement, my partner and I initiated full spinal involvement protocols, pursuant to NY State DoH and FDNY protocols for Trauma Center Candidates, for both, and transported to the Trauma Center. 2 minutes after transfer of care at the TC, the driver suddenly passed out and started vomiting.

While not involving a mistaken identity due to cross dressing, it does show how a missed detail can be the one potentially fatal item.

FYI, the second vehicle, and it's 2 occupants were handled by another team that arrived seconds before I arrived, and transported to the local ER. Vehicle 2 had front end damage, both were seatbelted (all 4 patients were), with airbag deployed. Vehicle one, an old battered looking car, had side damage, and no airbags, due to the vehicle's age.

[MetalMedic]

We've all done it. In class we had a person who I made the mistake of reffering to as "him". When she corrected me, I insisted that no, she was a he. I felt like a fool, but it's water under the bridge now. So it happens to the best of us.

Heck a few years ago a male friend of mine disappeared off the face of the planet. I ran into another friend of mine with a beautiful woman next to her. I introduced myself to the new woman and said, "I don't think we've met before," she replied with, "Yes we have, I used to be *Brad*." Talk about ackward.

-MetalMedic

[emtcutie]

I have a couple thoughts:

First, why is this in "Funny stuff"? Do you find it funny that there was a question as to the gender of one of the individuals you transported?

Second, and I'd like you to really think about this, was it really smart to transport two patients from a wreck as you described without any immobilization? Do you really think that someone who's been through a wreck like what you described is capable of making a competent decision regarding not wanting to be transported? Do you think, given the excitement and adrenaline rush of having been in the accident, that there was a chance that they were so hyped that they might not feel an injury right away?

Lastly, you need to find a new preceptor.

there is only so much you can do when a petient refueses everything except transport

[HERBIE1]

there is only so much you can do when a petient refueses everything except transport

Yep. I've had people tell me I can't cut their leather jackets(especially bikers), their brand new coat/shirt/pants.etc. Document, document, document. So I say something to the effect of- "I'll save your jacket if you sign this to verify you are willing to trade an unseen and potentially fatal injury for your article of clothing." Even with a statement like that, many people are perfectly OK with such a choice.

\\Shrugs..

[Richard B the EMT]

As to biker's "leathers", ask the biker, or other bikers with him/her, how to cut them off with the least amount of damage. If they have the leathers decked out with assorted patches, related to their motorcycling group (notice how I carefully avoid saying "Gang"), they might take you up on signing the release, instead of damaging the leathers. Be careful if even one of the patches indicates "DILLIGAF" (Does It Look Like I Give A F***).

If it's just plain protective leathers, remind them the insurance should take care of it, as it's replacing "Protective Gear". (Emphasis on SHOULD)

[paramedicmike]

there is only so much you can do when a petient refueses everything except transport

You're right. There is only so much you can do. But judging from everything you've posted here you didn't even do that. You mentioned you did a "brief assessment" (later described as a "rapid assessment") because the paramedic with whom you were working couldn't be bothered to do one. Just what constitutes a "brief assessment" on two patients involved in a rollover with entrapment? How much conversing/convincing did you attempt?

Yes. Sometimes just getting them to agree to go is a victory in itself. Sometimes you're not going to be able to get the patient to agree to anything without either harassing or forcing it on him/her (both of which are unprofessional, unethical and illegal). But from everything you've written it doesn't even sound like you really tried. Between a lazy paramedic who's more interested in the potential with the entrapped patient and your "brief... rapid" assessment it just sounds like you could've done a lot more.

Also, you didn't answer my question pertaining to what, specifically, makes any of this worthy to be posted in the "Funny Stuff" forum? Do you find the issue of a transgender patient comical?

[Kaisu]

there is only so much you can do when a petient refueses everything except transport

I have found that I can talk most patients into doing anything I want them to. It's a matter of time and patience, and trying to understand the real reason for the refusal. I also have to give a damn.

[paramedicmike]

I also have to give a damn.

Bravo! :punk: :punk:

I was looking for a little smiley that was clapping but there doesn't seem to be one.

[emtcutie]

You're right. There is only so much you can do. But judging from everything you've posted here you didn't even do that. You mentioned you did a "brief assessment" (later described as a "rapid assessment") because the paramedic with whom you were working couldn't be bothered to do one. Just what constitutes a "brief assessment" on two patients involved in a rollover with entrapment? How much conversing/convincing did you attempt?

Yes. Sometimes just getting them to agree to go is a victory in itself. Sometimes you're not going to be able to get the patient to agree to anything without either harassing or forcing it on him/her (both of which are unprofessional, unethical and illegal). But from everything you've written it doesn't even sound like you really tried. Between a lazy paramedic who's more interested in the potential with the entrapped patient and your "brief... rapid" assessment it just sounds like you could've done a lot more.

Also, you didn't answer my question pertaining to what, specifically, makes any of this worthy to be posted in the "Funny Stuff" forum? Do you find the issue of a transgender patient comical?

That's not what I meant, I find the mere fact that I didn't notice comical. And I really don't want to get in a whole views war on the matter either. As far as my rapid/brief assessment goes, i looked for obvious injuries, there pupils were pearl lung sounds clear and abdomen normal, and the only bleeding was from the very minor abrasions on their arms. and...1. yes i could have probably done more convinving, but I am still a little timid and shy about taking team lead; I am getting better, but as I'm sure most new emt's know its a little scary your first few times leading calls. I will consider this a learning experiance 2. they did make it quite clear that they didn't want treatment, and in the begining they didn't even want transport but they talked amongst themselves and decided they wanted to be with their grandfather 3. i wasn't about to question the man who signs my reviews. and 4. The paramedic who was teaching me is not lazy, he is a great medic and has thought me quite alot.

Edited April 8, 2011 by emtcutie