Patient Advocate

[paramedicmike]

From a liability standpoint I can see that taking place. All it takes is for that patient to be injured and you'll be liable because you had them in equipment not designed to handled his/her heft.

This thread seems to have struck a nerve with you. What's up?

[RaceMedic]

I do not refuse care, my hospital is a charity hospital. I will not work for a private... just a personal choice.

Let me ask you this though... You would not put a PT on the floor of your ambulance, and by the way i do respect that decision. But by the way you asked that question just now, Would you honestly put that 1000lbs PT on your 750lbs rated stretcher?

And if not and you had no other bed available How would you treat the PT ? On the floor ?

You can not put the PT on something that will not and is not rated to support the weight. You will have to make adjustments. I believe my ER beds are rated for 1200lbs. they are considerably more stout than a standard ambulance cot.

Edited October 12, 2011 by RaceMedic

[ERDoc]

So does that mean if a 1000 lb patient presents to your ER, you will refuse care because your stretcher is only regulated for 750lbs ?

You are comparing apples and oranges. I don't have the choice to refuse care to anyone. I also don't have a choice as to what stretcher they go on. If the biggest I have is rated for 750 lbs and the pt is 1000 lbs, I cannot tell them, "Wait until tomorrow when we can get the appropriate equipment to care for you. Your heart attack should be okay for another day." Again, you are mixing up the 911 mentality, which is also the ER mentality versus an IFC mentality. We don't have a choice, we can't refuse the patients, we make due with what we have. In the case of the OP, there is a choice. That choice involves providing the safe, appropriate equipment that the pt needs. There is no time urgency there.

Now, once that 1000 lb pt is on my stretcher, I have some choices. I am not going to put him/her on a CT table that can only hold up to 350 lbs. It is not safe for the pt or the equipment. I will make the appropriate arrangements for the pt to be treated at a facility that can handle his/her size with the appropriate equipment. If that means that the pt has to wait for the next morning to get an ambulance that can accommodate her size then that is what is going to happen. Again, they have either put themselves in this situation or have been dealt a crappy hand. In either case it is unacceptable to ask a provider to risk their safety and livelihood at risk. I'm not sure what your issue is with seeing the obvious here.

Would you put that same 1000lb pt into a helicopter that was only rated to carry up to a 350lb pt?

EDIT: Wait, I just realized from your profile that you are a manager. That explains why you would expect a crew to put themselves at risk for a few dollars.

Edited October 12, 2011 by ERDoc

[DFIB]

Doc one again has hit the nail on the head. Safety comes first in non emergency situations. First safety is for the provider (me), next for the patient. This combined safety provides safety for my company.

If imminent danger demands that a move must be made that is unsafe for the patient we save life, limb and function in order.

If an unsafe move is your only option to save life, limb or function it may be considered.

Nothing in the original post would indicate any risk to life, limb or function so safety is first. In this instance options do exist. The original post patient is not in a war zone, burning building or third world country. The provider has options to ensure the best, safest move.

He protects himself, his patient and his company,

Why would he be chastised understanding the situation and making the correct decision?

[DwayneEMTP]

HLPP can you truly not see past your ems manager/obesity advocate point of view to see that once again you are ignoring the reality of risk/benefit? I know that you are smart enough to grasp the concept...what is going on?

Also, out of the last 5 years I've spent all except about 14 months doing remote medicine. That means, in most cases, treatment to resolution or until transfer to a higher level of care can be arranged. I often fight this battle from folks that freak out and want to endanger relatively stable patients in a relatively unsafe manner. I'm often unpopular because I believe that they can wait for a more appropriate, and often more expensive means of transport.

Please, please, please Google risk/benefit-cost/benefit. Understanding it will not only help you make sounder decisions, but unfortunately you will find it painful too, as you see you're black and white world turn to gray.....

Dwayne

[systemet]

I am sorry, but I would have terminated you.

How do you think this would promote a "safety culture" in the work environment? Do you feel that firing someone for exercising judgment and having a genuine concern about the safety of the patient will promote safety in the future? Or do you think that it's more likely that providers will be reluctant to identify concerns to management and will engage in more risky and potentially dangerous behaviour?

Furthermore, if OP is otherwise a model employee is this really sufficient cause to terminate? Isn't best management practice in this situation to attempt to coach and counsell OP so that they become a more productive employee and adhere more closely to SOPs? Wouldn't it be a waste of OP's (presumed) valuable experience, and the cost involved in hiring and training him/her?

Obviously this situation is a judgement call. I've been fortunate enough to work in a service where a bariatric truck is part of the fleet. In the setting of a scheduled stable patient transfer, I would wait until this unit was available. Granted, that doesn't appear to be an option here -- but I can't fault the OP for having a safety concern, and I think I would have done the same thing.

As you say in one of your many posts, we all have the right to the opinion. But that also means having your opinion challenged. What I don't understand is the logic and reasoning you're using in your thought processes. I don't understand why you've felt it necessary to attack usalsfyre, especially when you suggest that because he would refuse to transport a scheduled stable patient due to an identified safety concern that he's somehow bigoted, racist or hates drunks? Not only does such an ad hominem attack have no place in a mutually respectful professional discussion, it also does nothing to strengthen you argument and is logically incongruent. Not to mention rude.

It's clear that transporting this patient is very different from working a pediatric cardiac arrest, yet you've chosen to draw an equivalency between the two. As several (many?) poster's have identified, there's a whole different risk / benefit at play here. It seems that most people who've responded here would be quite willing to transport this patient in a less than ideal manner if there was an acute life-threat. It also makes little difference as to whether other procedures, such as IV dopamine in a CHF / sepsis patient, are dangerous but accepted. This doesn't make this situation any safer.

Not one person here has said anything negative about the obese. In this particular instance being discussed, it's already been suggested that there's another medical reason for the patient's weight -- although I don't think that really matters. Is it not possible to have this discussion without it turning into an argument and a series of personal attacks?

[medicgirl05]

First of all, yes I am still employed. Probably because I am one of the only 2 medics they have right now. High employee turnover...wonder why?

I am unsure why we are comparing my situation to that of an emergency call. I think they are two completely different things. If this same scenario had presented as emergent I definetely would have done something different. Also, as I mentioned it was not the patients fault that she had a medical condition causing her to be so heavy and neither is it my fault. I did not refuse her because she was "too fat" but because it was unsafe to transport her.

This is the first transfer I have EVER refused so it isn't like I look for excuses to not do my job. In fact, we stayed at the hospital trying to find an alternative for the patient for an hour and a half. Much longer than the actual transport would have taken.

I also don't like the innuendo that I am giving false information. I do however appreciate the input.

I understand that the risk of a wreck may be low....Do you understand what would happen if there was a wreck? Even a small one? Any idea what I could lose?

[Krysteen]

OP, I would have commended you on your critical thinking. To blatantly put that " I would fire you" is a reflection of my poor management skills. I have unfortunately worked under those types in my career and I would love to put on my resume I was terminated solely due to the fact I had my safety and my patient's in my best interest. I am myself a manager for a governmental agency both 911 and transport. I could put it up on my profile, but frankly I don't put myself up on a pedistool. I rather apply my managerial skills in a more effective way.

[hatelilpeepees]

I am the one being attacked here, as far as my management skills go, feel free to attack, but as a manager I have to enforce all policies fairly, and we have a policy that does not allow the medic to refuse a call. You can disagree with the company's stance, but that is our policy. And I disgree with most people's answer that a safety concern can be variable and open to interpretation. If you refuse to transport this patient due to MVC concerns, then I say you can not transport any patient, as no patient is safe in the back of an ambulance during an MVC, the stretcher will come loose from the floor, the plexiglass and all supplies will become airborn missles. You can't have it both ways.

[ERDoc]

How do you think this would promote a "safety culture" in the work environment? Do you feel that firing someone for exercising judgment and having a genuine concern about the safety of the patient will promote safety in the future? Or do you think that it's more likely that providers will be reluctant to identify concerns to management and will engage in more risky and potentially dangerous behaviour?

Furthermore, if OP is otherwise a model employee is this really sufficient cause to terminate? Isn't best management practice in this situation to attempt to coach and counsell OP so that they become a more productive employee and adhere more closely to SOPs? Wouldn't it be a waste of OP's (presumed) valuable experience, and the cost involved in hiring and training him/her?

Obviously this situation is a judgement call. I've been fortunate enough to work in a service where a bariatric truck is part of the fleet. In the setting of a scheduled stable patient transfer, I would wait until this unit was available. Granted, that doesn't appear to be an option here -- but I can't fault the OP for having a safety concern, and I think I would have done the same thing.

As you say in one of your many posts, we all have the right to the opinion. But that also means having your opinion challenged. What I don't understand is the logic and reasoning you're using in your thought processes. I don't understand why you've felt it necessary to attack usalsfyre, especially when you suggest that because he would refuse to transport a scheduled stable patient due to an identified safety concern that he's somehow bigoted, racist or hates drunks? Not only does such an ad hominem attack have no place in a mutually respectful professional discussion, it also does nothing to strengthen you argument and is logically incongruent. Not to mention rude.

It's clear that transporting this patient is very different from working a pediatric cardiac arrest, yet you've chosen to draw an equivalency between the two. As several (many?) poster's have identified, there's a whole different risk / benefit at play here. It seems that most people who've responded here would be quite willing to transport this patient in a less than ideal manner if there was an acute life-threat. It also makes little difference as to whether other procedures, such as IV dopamine in a CHF / sepsis patient, are dangerous but accepted. This doesn't make this situation any safer.

Not one person here has said anything negative about the obese. In this particular instance being discussed, it's already been suggested that there's another medical reason for the patient's weight -- although I don't think that really matters. Is it not possible to have this discussion without it turning into an argument and a series of personal attacks?

Holy crap. This was probably one of the best post on here in a long time. I think I'm in love. Kudos systemet!

First of all, yes I am still employed. Probably because I am one of the only 2 medics they have right now. High employee turnover...wonder why?

I think you have been able to answer your own question. I think it is safe to say that most of us have worked for such a company. You have my sympathies. Just know that you did the right thing.