Who is responsible for your patient?

[Kiwiology]

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.

You may be surprised to realise such an attitude here can breach your patients legal rights under our Health and Disability Act and Code of Health and Disability Consumer Rights. Specifically you may be found to have breached the patients right to independence, right to be free from coercion, right to receive services of an appropriate standard and right to effective communication. You may also be held accountable by the professional authority for Paramedics and their Code of Conduct when it comes in next year.

Patients often know what is best for them, or what works and what doesn't, e.g. where to put in a drip, if glucagon works for hypoglycaemic Little Timmy, whether or not adenosine works for Nana, if Cousin Cletus with the chronic pain syndrome after being run over by them Sperlunkin boys down yonder's pickup truck responds well to morphine etc.

[EMTDenny]

Denny I'm not trying to beat you up for your post.

Nonsense, I appreciate the feedback.

[DFIB]

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

QUote from 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

I an still a pup in EMS and my experience is vastly limited compared to most of the posters. That said, I have been privileged since a very young age to have personal relationships with many doctors and nurses who are some of the most kind, giving and selfless people I could ever hope to know. Men and women who work all year hoarding medical supplies so they can spend their vacation time working in 100 plus degree weather, treating some of the poorest most disadvantaged people in the world. People who have true clarity and purpose in sharing their God given skills with others.

I started being their "human IV pole", bag-man and water-boy to grow into their friend and companion. During that time I was graced with hearing exhausted medical professionals talk to each other on an intimate level. One of the lessons I learned from them was that if your patient and their family understands that you truly care for them the odds of a lawsuit is almost non-existent. One of the key skills in showing our patients love and caring is listening to them and explaining how we are going to help them in a compassionate way.

The outcome of many of our patients is inevitable regardless of our interventions. If those patients think we cared enough to listen and involve them in their own care their appreciation will outweigh their frustration from a poor or tragic outcome.

My mom who was one of the smartest most giving people I have ever known once told me, "Listen to your patients son, they will tell you what is wrong with them". What she did not know was the amount of thankfulness her advice would produce in the people I serve.

Edited February 12, 2012 by DFIB

[Richard B the EMT]

Our state protocol book has a page specifically for this .. [ paraphrasing] : To medical providers. If you wish to intervene in the care at emergency scene, you must accept responsibility and travel in the ambulance to the hospital. You will be the attending physician.

FDNY EMS Command has similar. It used to be, the call reports had a section on the back where an MD on the scene wanted to direct patient care, he'd sign to assume the responsibility, and be informed he'd have to accompany the patient to the ER, or face patient abandonment. Now, it's also protocol to have the intervening MD speak with the OLMC MD,

[Kiwiology]

Locally speaking we are autonomous practitioners who do not work under the thumb of a physician nor do we have such a complex medico-legal system designed to sue the pants off of everybody left right and centre; having said that if a physician wants to help then it would be pretty ignorant of me to disregard their opinion.

[Richard B the EMT]

Kiwi, I presume your agency has a policy for a way to verify that the "Doctor" is an MD or DO, not a DVM (veterinarian), or a PhD, before allowing said Dr to ride along and render "care", doesn't it?. Just confirming.

[Kiwiology]

Kiwi, I presume your agency has a policy for a way to verify that the "Doctor" is an MD or DO, not a DVM (veterinarian), or a PhD, before allowing said Dr to ride along and render "care", doesn't it?. Just confirming.

We do not have osteopathic physicians and to specifically answer your question, no we do not.

Our medico-legal framework is much more relaxed and less labyrinthine than yours, we are autonomous practitioners who make our own decisions and as such are responsible for them.

The likelihood of a Doctor wandering up out the blue and offering to help is extremely low so much so I've never experienced it and heard of it happening once; even if they do offer in all truth they are likely to be put to work holding a bag of fluid or getting a BGL CPR, providing manual ventilation or some other task like that.

Let's say I can't intubate somebody (not that we should really be intubating people any more anyway) and there just happens to be a Consultant Emergency Physician or an Anaesthetist pop up out of the blue who is volunteering to have a go for me sure I'd let him at it.

Should a Doctor or any other healthcare professional identify themselves and offer to help the most they'd get 99.9% of the time is "we've got it thanks".

Now, if I'm really stuck on forming a diagnosis and a physician happens to pop up and offer a hand sure, who am I to disregard their knowledge and experience?

Edited February 14, 2012 by kiwimedic

[Richard B the EMT]

The fear I am expressing is that of someone calling themself a Doctor, who is not one.

I have only had 1 time, over 38 years, where someone walked up to me, at the scene of a call, and offered help as a pysician. In this instance, the help was in doing CPR on a submersion victim, where we had to carry the victim, and assorted equipment, over 2,000 feet across soft sand to where we had parked the ambulance on a paved walkway, CPR for 2 minutes, and running with everything for 10 seconds, then resuming CPR, repeating these steps 6 or 7 times to reach pavement. With switching off the personnel compressing and venting, we had 2 EMTs (one of them being me), a Park Aid (who was an off duty EMT with my VAC), and the Doctor.

The 5 mile trip to the ER was done in 12 minutes, and the ER crew worked the guy up for another half hour, until they called it. Regrettably, this was the first recorded death in the Gateway National Recreation Area, Riis Park/Fort Tilden/Point Breeze Division, from when the place had become a part of the National Park Service in 1970. I am aware of at least 12 more, to date.

[Kiwiology]

Like I said we are autonomous practitioners responsible for our own actions, if somebody identities themselves as a physician we have no legal obligation to do anything they request, there is however professional respect due and the acknowledgment of collegial support which should be taken into account

Many of the physician I know are well aware they are not experts in the management of out of hospital acute events and will leave it to the ambos but if they offer to help then where possible I will put them to work holding fluid or doing CPR etc

Because we are autonomous practitioners with our own guidelines a doctor can not legally direct us to provide care nor would I accept such a request unless made in collaboration but I doubt such a circumstance has ever occured here

Again, our medicolegal system is much less complex

[wrmedic82]

Legally speaking, you are responsible unless that RN is going to assume care throughout the whole patient care process. (unlikely story). I have seen this first hand on a couple occasions and it has helped, but also has almost come close to biting me in the butt.

It's a judgement call