As EMS/PHC Providers; Are We That Lazy?

[Richard B the EMT]

Would you be able to share your protocol for this or direct me to a thread if it has already been shared? Thanks!

BEorP, you are aware that Kiwi is in New Zealand? Different country and protocols.

Better update him, yourself, Ben.

[crotchitymedic1986]

kiwi may i ask how many deaths due to your service's laziness is too many ?

[Happiness]

This is why I personally will ask my pt to go to the hospital to make sure they are ok. If they dont want to go I will tell them what the consequences could be and make sure that the form is signed.

Lately though with all that being said we have been called more to cells, as they have brought in a new policy that states a person that is brought in under the infulance has to do a breathalizer and the number has to be in a certain range. This is alright I guess but we do have the ability to say that the person in question is ok and we will sign the paper and go. The unfortunant issue arising with this is that the boys (as we call them) will just play possium and then we get called and they spend their time at the hospital in a nice warm bed instead of the cold cement of the drunk tank.

Document Document Document is all I can say

[Bieber]

hate to break it to you but the role of the Professional Emergency Care Provider is to direct people to the most appropriate means of meeting their care needs , whether it's telling them to go to Wally-World for 20 p box of paracetamol or calling in helimed to fly them to a tertiary centre - via every outcome in between, the key variable is knowing what outcome when and documenting the decision process and differential findings that led you to that outcome.

while Ambulance services are glorified taxi services , ambulance crew will be paid as taxi drivers.

buit it isn't in vast trtacts of the civilised world

nothing to do with lawyers and everything to do with poor clinical management and poor preparation for clinical practice, the legal aspects are as a result of that and of the'mother may i' system rather than Paramedics being Health Professionals in their own right ...

This post deserves an award.

kiwi may i ask how many deaths due to your service's laziness is too many ?

Since when was clinical excellence and competency deemed laziness? Oh, that's right. Ever since parawannabes decided that instead of increasing their education and becoming true clinicians, they'd rather remediate the whole profession to defaultist taxi drivers that have no common sense and no strength of conviction to elevate themselves and become the folks who can make these kinds of decisions on their own.

Edited April 16, 2011 by Bieber

[NYCEMS9115]

Yes, as EMS/PHC we are "PRACTITIONERS." We provide Emergency Prehospital Care. We have knowledge in the Science of Medicine. We can read ECG rhythms, start IVs, intubation, and administer medications.

Like I tell my employees; that's nice but documentation is paramount. It may be the only thing that will protect you. Not doing a Call Report like in the examples are not standard of care. The release in the 2y/o's case was not signed by the parent. The asthmatic woman; no Call Report was generated. That's lazy.

If you can just tell the patient that they don't need an ambulance; then that's great. In NYS, you can't. So, in my Region I can't tell the patient they don't need an ambulance. Plus, who am I? I'm a Paramedic, where in NYS you don't need a HS/GED to be a EMT. You can have a criminal record. Paramedics don't need a college degree. Some finish Paramedic School in 5months. What I'm saying is; our training might be in depth because we tell ourselves that but the curriculum disputes that. Well in NYS, it does.

[usalsfyre]

The cases described aren't laziness, they're stupidity (political correctness be damned).

Some of the laziest providers I've had the displeasure of knowing throw everyone in the truck, do as little treatment as they can get away with, and write a half assed report.

The problem with leaving people at home in the US is the average medic is too uneducated to tell who can stay and who can't. Cases above happen because a lot of providers are too stupid to realize this.

The "just one life/I don't want to get sued/transport is our job" crowd is keeping EMS in the dark ages. Right now EMS provides questionable benefit for expensive service that only transports to the most expensive hospital real estate per hour outside the OR. EMS in current form won't survive a real cost benefit analysis. There will be people asking uncomfortable, hard to answer questions at some point. As to price tags on human life? Like it or not, it's done daily.

[crotchitymedic1986]

Bieber, since when is leaving patients home to die a sign of clinical excellance ? Thats the problem with this generation, you are too concerned about the procedures and treatments you can do to a patient, versus good old fashion assessment. As long as you can do RSI or use a drill to IO someone, you think you have accomplished something. Be a patient advocate first, a paramedic practicum advocate second.

[usalsfyre]

Bieber, since when is leaving patients home to die a sign of clinical excellance ? Thats the problem with this generation, you are too concerned about the procedures and treatments you can do to a patient, versus good old fashion assessment. As long as you can do RSI or use a drill to IO someone, you think you have accomplished something. Be a patient advocate first, a paramedic practicum advocate second.

You sir are clueless... It's not leaving patients "at home to die". It's directing the patient to appropriate resources and looking after their finical well being (i.e. holistic care). The point of this is a GOOD assessment is done (no, you don't need labs or imaging) and a decision is made. If the problem is found to be somewhat benign, the patient stays at home, no need for an ED bill. If it's unclear or life threatening, it's transported. It doesn't have a damn thing to do with generation, other than old myths of I'm gonna get sued or leaving people at home to die keep creeping up. What it DOES have to do with is a whole crapload of providers who are unwilling to accept responsibility for their assessments and don't want to get the needed education to be able to do this. Your doing nothing but fear mongering and spreading misinformation. Edited April 16, 2011 by usalsfyre

[NYCEMS9115]

I think we can all agree that the EMS Profession can be better. You've encountered people who you just shake your head; wonder how did that person become an EMT-B/I/P. We had a fellow student who asked the most retarded question. We had partners who we've loathed; not because they were a bad provider but they were a bad person or not that they are a bad person but they were a bad Provider.

Just because you're an EMS Provider it doesn't make you a good Provider. It takes years of experience; some bad

and some good. Your upbringing, education, personality, and social function will dictate the Provider you'll be. Some people do this for various reasons but many do it for the wrong reasons. Just because they are fellow Providers; it doesn't make them right.

Remember that all patients are clients; healthcare is a business (unfortunately); clients make businesses thrive.

The issue with the 2 exemplars were the Providers didn't complete a Call Report. 2 things that Providers perform on a daily basis is NOT covered in class are:

PCR WRITING

and

DRIVING AN AMBULANCE

Not covered in depth. That's the issue....

[Kiwiology]

Clinical error is unavoidable, regardless of whether you are a Paramedic or a Consultant Physician, to say Ambulance Officers are unable to make rationalised clinical judgement about who should be transported and who should not because "they're not doctors!" is invalid.

As for our guideline for non transport:

Clinical Procedures:

NON TRANSPORT

Whenever personnel are called to a patient they must make three

decisions:

1. Is treatment required?

2. Is transport to a medical facility required?

3. If transport is required, what form of transport is most appropriate?

Obligations of personnel

Personnel must convey these decisions to the patient, as firm

recommendations, along with an explanation of benefits, risks and

alternatives. Personnel must:

• Fully assess the patient, including their competency.

• Take into account all available information, including non-clinical

aspects such as social factors.

• Act in the patient’s best interest.

• Allow competent patients to decline recommendations.

• Insist on treatment and/or transport if it is in the best interest of

an incompetent patient.

• Fully document assessment, interventions and

recommendations.

Transport must always be recommended if any of the following

criteria are met:

• Personnel are unable to confidently exclude serious illness or

injury or

• A treatment (medicine or IV fluid) or significant intervention has

been administered (for exceptions, see below*) or

• There is significant abnormality in any physiological recording,

including a temperature <36 or >38 degrees.

*There are some situations where a treatment or significant

intervention can be administered and then a recommendation made

that transport not occur. They are restricted to the following:

• A doctor has been directly consulted with (at the time and by

personnel dealing with the patient) and has decided that

transport is not required. The name and contact details of the

doctor must be recorded on the PRF.

• Paracetamol for minor discomfort, uncomplicated hypoglycaemia

or epilepsy, and palliative care patients. Details are in the relevant

sections.

Not all patients requiring transport to a medical facility require

an ambulance. It is appropriate to recommend private

transport provided all of the following criteria are met:

• The patient has not had any treatment (medicine or IV fluid), or

significant intervention administered by personnel and

• The patient is very unlikely to require treatment or significant

intervention during transport and

• A reasonable and appropriate alternative form of transport (for

example private car or taxi) is available.

When the patient or family insist on transport

Competent patients have the right to decline recommendations,

but patients and families do not have the right to insist on

transport that is not clinically indicated.

If the insistence of the patient or family appears to be based upon

genuine concern, and no other reasonable transport option is

available, then the patient should be transported.

If the insistence of the patient or family appears to be based on

maliciousness, convenience or petty concerns, then personnel may

decline to transport the patient provided they:

• Explain the reasons for not providing transport and

• Fully document their involvement with the patient and family and

• Forward the audit copy of the patient report form for formal audit.

Documentation

If it is not written down: it didn’t occur. Comprehensive

documentation must include:

• Details of patient assessment and findings.

• An assessment of the patient’s competence.

• All treatment and interventions provided.

• What was recommended and the reasons why.

• A summary of what was said to the patient and/or family.

• A summary of what the patient and/or family said.

• Why the patient was not transported.

If the patient is not transported then the patient copy of the PRF

must be given to them.

Ambulance Operations Manual:

Ambulance Officer Duty of Care

All patients attended are to be offered ambulance transport if the attending ambulance

crew judge the patient’s symptoms or condition warrants assessment or treatment by a medical

practitioner at a treatment facility within 2 hours or requires ongoing monitoring of their

condition. The patient may still decline ambulance transport

We had a long discussion with our Clinical Management Group about five years ago and it was said then it is not practical or necessary to transport every patient who calls for an ambulance to hospital.