Who is responsible for your patient?

[Bieber]

I make the treatment decisions for my patients. Patients, and the parents of patients, do not get to request or implement treatments that I myself have not decided to give; they can refuse any treatment, but cannot request one unless I believe it is necessary.

And family members ride up front, unless it's a low acuity pediatric patient.

As far as the article goes, I haven't read the entire thing nor was I there, so I can't pass judgment without having all the facts.

[DwayneEMTP]

...I make the treatment decisions for my patients. Patients, and the parents of patients, do not get to request or implement treatments that I myself have not decided to give; they can refuse any treatment, but cannot request one unless I believe it is necessary...

How can they know what you believe is necessary so that they know what to request? Here you go again with your certainties Beebs...

I can see not implementing without your permission, but not requesting without your permission? That's a bit harsh, right?

Have you never, with a chronically ill patient, looked first at the site where they point and say, "This is the easiest place to get an IV on me..."?

You are going to find someday that you WILL run on patients that know more about their condition or their childrens condition and it's treatment than you ever will. It will pay you big dividends to listen to them. Some have explained their conditions and treatments to me at a level that I was pretty sure that they were telling the truth, but well above my ability to follow.

Anyway, someday, and it will come, when you're called to a home to transport a child and the living room will have a hospital bed, IV pumps, bags of fluids piggybacked with second, third and forth drips, monitors, medications, and a really, really sick child...when that mom or dad, or brother, or sister tries to tell you what's best...you really, really better listen, as in my experience most of the people in those types of families could teach a physician level M&M on whatever it is that's slowly killing their baby...

Just a heads up...

Though you sound very certain above, I've know you long enough now to know that you can change your mind on a moments notice given good, productive information...

But for now...do it 'cause I said so!!

Heh...ok, maybe not...

Dwayne

[EMTDenny]

I don't have much expeience as EMT yet but letting some one intervene in professional care by stating that, he is a family member and also a health care professional ext... Can lead to lots of legal problems. A few to name are negligence and abandonment. Plus, if they are a health care professional, why would they bother calling an ambulance. Do what you have to do and drive them to the ED. But calling an ambulance then trying to help is proberly just a way for them to leave a blame on some one.

Just saying, still fresh in the field hoping to start paramdic school in a year.

Denny

Edited February 11, 2012 by EMTB.Denny389

[Eydawn]

I'd have to see a physician or PA or NP's state licensure card and it would become a conversation between them and my medical control (as long as they weren't psycho and I genuinely believed they had something to offer my patient.

Bieber- you seriously won't let a patient request treatment? We want patients to be their own advocates as much as possible, right? We want them to be educated, and question their care, and understand it so they feel like part of the team and are more likely to comply and less likely to sue, right? Where is that thought process coming from- it's really not something I'm understanding...

Dude. You're off inna ditch here. If I'm a severe asthmatic, and I know that I don't respond well to duoneb, and you're hell bent on giving it to me, instead of just sticking with albuterol, I'm going to be one pissed off patient. If I know that I don't respond well to a certain drug, or inquire as to whether you have a drug that I do respond well to (and we're not talking pain related seeking issues here), what do you do, just say "I'm your paramedic and I know best so you shush and let me do my thang"?

Now, I can see you shutting down a patient who doesn't know what's going on, and educating them as to why you're making treatment decisions... but a patient with a chronic illness or for whom this is not their first medical rodeo is a whole different story and you better at least be able to empathetically respond to the request and provide good evidence as to why that is not your intervention of choice...

Wendy

CO EMT-B

[nypamedic43]

I don't have much expeience as EMT yet but letting some one intervene in professional care by stating that, he is a family member and also a health care professional ext... Can lead to lots of legal problems. A few to name are negligence and abandonment. Plus, if they are a health care professional, why would they bother calling an ambulance. Do what you have to do and drive them to the ED. But calling an ambulance then trying to help is proberly just a way for them to leave a blame on some one.

Just saying, still fresh in the field hoping to start paramdic school in a year.

Denny

First you have to actually neglect to act or actually abandon the patient to get those kind of legal problems. I dont know anyone here that would do that. It also doesnt matter if they are a healthcare professional. If a doc or a nurse or a PA or NP shows up on scene as a BYSTANDER, they cannot say how a patient gets treated if it is out of my scope of practice UNLESS they are willing to follow through with said treatment, ride in to the ED with me and take full responsibility for said treatment., explaining to med control why they deemed it necessary to supercede my authority on my ambulance and start a treament that could possibly have waited for 10 minutes. On top of that, bystanders can be utilized for help with carrying a patient or CPR. They are protected under the Good Samaritan Law.

Doctors and nurses call ambulances just like us regular people do. And for the record I have pushed the nosy neighbor doc out of the way on a scene before and it was just this last week. Had an unresponsive diabetic, talked to the husband, let him know what I wanted to do for his wife, which he was in agreement with. I checked her BGL with my glucomenter, turned off her insulin pump, started a line and gave her an amp of D50. All of a sudden theres a ruckus on the steps. The neighbor, who is a doctor, and his wife came thumping up the steps. Demanded to know what I was doing for her and THEN demanded that I take her to the hospital. Oh NO you didnt go there....So I politely explained to the nosy neighbor doctor that it really wasnt any of his business what I was doing and that discussing my treatment plan with HIM was a violation of the HIPAA law and asked him to please remove himself from the room before I called the police. He left...in a huff, muttering under his breath that he was gonna call my boss.

Anyway, by now the patient is waking up. I rechecked her BGL which was coming up well. She was able to talk to me and understand what I was telling her. I rechecked it again and by now she is fully coherant and refusing to go to the ED. I explained that she needed to eat something, call her personal doc and blah blah blah...DC'd the line, put a bandaid on the site, sign here, have a great day and if you need us, call us back.

Pediatric patients under the age of 5 have a parent ride in the back with them. Other parents can ride in the front. I havent ever had a parent try to direct my treatents of thier child. But I always listen to them to. We have a couple kids in the area that are super sick all the time and Dwaynes description of a scene is pretty accurate for them. The parents are know whats going on and how to treat it and usually when these parents call, its because something isnt going the way it should and they need some extra help. Thier guidance and advice is most valuable in this situation.

I have to say there have been a couple of times when I have allowed significant others ride in the front and they try to tell me what to do from the front seat. They are politely told by my partner that it isnt a good idea because A. they arent married and B. we are allowing them to ride as a courtesy.

Oh and the nosy neighbor doc did call my boss. I had already told him about the incident and he was aware that he may call. So when he did, nosy neighbor doc was again politely told that it wasnt any of his business and next time to stay out of the way.

Edited February 12, 2012 by nypamedic43

[EMTDenny]

Thanks for clearing that up for me nypamedic.

[nypamedic43]

Denny I'm not trying to beat you up for your post. However, that being said, things like neglect and abandonment, duty to act and scope of practice are covered fairly well in the basic class. They are then beaten into us in medic school. The Good Samaritan law is mentioned but not really gone over in depth.

Our job is so much more that just throwing a patient in the back of an ambulance and driving them to the hospital. As you gain experience and run a few bad calls, or even a few good calls, your understanding of what this field really entails will become more clear to you. You will also realize that you are going to treat your patient to the best of your ability...regardless of who is looking over your shoulder.

[DwayneEMTP]

The main thing to remember on that is that, as mentioned before, that the vast, vast majority of the time there need be no issue.

If things start out shitty for some reason, try and figure out what that reason is. Sometimes it will be just because there is so much excitement and they want to be part of it. In that case, thank them for helping and give them a job.

I've found that asking ANYONE to hold the fluids is a winner. They are then the center of attention and the most important person in the room. And that makes anyone happy. On TV the person with the fluids is always the hero. Hit by a truck, multiple rocket launcher strikes, eaten by an aligator....Start an IV, yell, "Don't you leave me!" a few times and all is well with the world. Funny maybe, but no one is ever a problem again if you put them in charge of holding up the IV bag.

Or they truly want to help because they're afraid that no one is doing anything. Then give them a job and explain to them what is being done...

Or a camera crew will show up, and then you're simply screwed because you won't be able to find your patient for all of the firemen crowding around..

But for most things, there's a kind, logical solution. If things go off into the ditch normally you'll be able to follow the tracks back to the the crew. Though they will rarely see it that way.

Dwayne

[Eydawn]

My two favorite tricks! Human IV pole, and to back up a group, start a roll of Kerlix with one person and have everyone hold a section... insta-barrier!

I agree that it usually doesn't have to be a problem. I still am curious to see what Bieber's thought processes are...

Wendy

CO EMT-B

[MongoMedic2]

The only thing I can think of on my behalf is that I explain what I am doing and why to those around.

Toni

Toni,

Out of all the conversations, I think that is the key when treating the patient. Explain what you are doing what outcomes you are looking for and keep the patient and family informed of what is going on. This way the family member whether they are a HCP or not should feel more confident that their love one is being cared for by someone who has a clue of what they are doing. One other little trick that I do, if I have a family member hovering is send them on an errand for me. No not to get me a cup of coffee, but something that may help me out like a list of meds or find that patients lucky teddy bear. Something like that allows them to feel involved in the care of their loved one.

As far as a family member taking over medical care of my patient, I have never in my twenty years had that attempted. However, I think that communication is the key to not running into this situation. Just my thoughts.

MongoMedic