What kind of calls do you feel DON'T require a trip to ER

[windsong]

When I was in the ED with my fiance, he was waiting his turn to get in to be seen, 2 ambulances come in, one was a man who was drunk and bleeding, they made him sit in the waiting room. The second ambulance came in and the lady was made to sit in the waiting room also.

The man who reeked so bad, we moved further up and away from him, the lady just sat there. She looked at these people waiting and started to swear at them, then she looks at the drunk and calls him honey thats to bad, next time slice his throat open and he just sits there. Security comes down the hall and sits at his usually place. The doors open and out comes another person to wait in the room, it's a young girl of 15 yrs of age. The parents show up and they started to argue with the nurses in the triage area, this was across from us, about how sick their daughter was, if thats the case they wouldnt of called 911 for her, just as they are arguing, she stands up and vomits bright red blood all over the floor and falls sideways to the floor.

The nurses run and my fiance say's he doesnt feel well, I said you dont have to stare at what's on the floor, so I gathered him up and we went for a walk.

So your right about some things, if it's not that serious, the waiting room is the time period to reflect, if this was indeed serious then the true quality of care needs to be questioned. So the medics to do paperwork and leave.

I can only imagine the lawsuit the hospital is going to have, we over heard 2 nurses talking about it, that 15 yr old girl died later that evening, she died at 10:16pm,you should of seen her she was white as a ghost. We never got out of there till 3:00am.

[Trauma_Junkie]

Some of you asked some follow up questions about my liposuction pt. I think we were guilty of doing some swaying the RMA. We, I mean, my partner explained to her that if we took her to the hospital that she would sit and wait a few hours for some blood samples to come back from the lab and they would give her more and/or different meds to make her feel better and treat the S+S that she had now. The patient also volenteered information about having an appointment with her doctor in 36 hours for a post op eval.

We still offered to transport and we did downplay her symptoms ... if we didn't down play her symptoms she probably would not have RMA'd.

[Just Plain Ruff]

Well that my friend is what they call inducing a patient refusal and that is plainly WRONG but then again I wasn't there so I don't know the whole story.

Still I'd reflect on the fact that you think you might have pushed her towards a refusal and not do that again. You had no idea what was wrong with the patient yet you pushed her and downplayed her symptoms. So what would have happened if 2 hours later you responded back to her home and she was significantly worse or in arrest.

I always found it distasteful that many medics that I know gloat as to how many refusals they get. I for one at one time was guilty of it until I was called into a deposition involving a refusal of care. It was a real eye opener.

I'm not preaching here (maybe I am but) but we need to remember that we DO NOT diagnose and inducing a refusal by saying that it's the meds acting up or your symptoms are normal for your complaint we begin to get on that slope.

This is something to think about.

One other thing - what would your services management view be if you told them you swayed the refusal? I'm sure it would not be a good view and would probably have elicited a significantly negative response towards you and your partner. I know that all the services that I have worked at they take a really really dim view on this and it is sometimes punishable by remedial training, suspension or termination.

[emtkelley]

In 36 hours your pt could have been dead. Merely speculation but it sounds as though your partner was more interested in returning to his warm happy spot in his bed than treating his patient. This stuff really pisses me off. I hope you have learned to be a better advocate for you pts after this snaffu.

[becksdad]

Emtkelley, you are absolutely right! We need to be strong advocates for our patients. One way to do that, I think is to become the best you can be through education and practice, application of common sense, and accurate interpretation of assessments (among other things). For what it's worth Trauma Junkie, I have worked a few times with a medic who is famous for obtaining refusals (translate that as coercing signatures). The way I got around that was to get to the patient first, and by the time I had formed an impression, asked them what hospital they wanted to go to before this medic could begin to work their "magic". One of these people ended up being a stroke alert. There are ways you can maintain your patient advocacy without it degenerating into a clash with other responders.

Just a follow up here - that medic talked a few too many people out of transport to the hospital and was summarily fired. Not even given the chance to resign.

[whit72]

I can count on one hand the times I have been present for an EMS provider trying to sway a person from being transported to the hospital.

It may be that are transport times are so short, it is easier to transport them, then to try and educate them on the proper use of the EMS system.

I can do the call and be back in bed in as little as a half hour. If my transport times were on the greater side of an hour I might be more inclined to advise a person with a broken toe to have a family member take them.

As far as the post op call. Hope you do not have a CQI officer or you might be hearing from them soon.

[hfdff422]

When in doubt.... transport! It saves lawsuits, but more importantly it could save a life. I felt that Becksdad layed it out the best. I do have long transport times, but will invariably try to convince patients to go to the hospital, especially if they called 911. I personally can get back to sleep better when I know my patient is taken care of than when I have to worry about their well being.

[Dustdevil]

Any time we as medics or emt's begin to play doctor and say oh it's only your pain meds causing this or something along that line we get on a true slippery slope.

post surgery, liposuction patient, nausea and vomiting - can you or your partner diagnose what is going on in that patients body?

I do not think so.

Any time we start to pressure someone to not go with us then we begin to be our own worst enemies.

Can anyone here tell us what many women with MI's present with as initial symptoms????? I belive that n&v is one of those classic signs in a woman.

Exactly. The first and biggest mistake here is the assumption that the symptoms have anything to do with the lipo or the medication, and that any EMT has the clinical sophistication to determine that. I can assure you that the ER will not make that assumption until a proper physical examination and laboratory has been performed. And even then, they will sometimes be wrong.

Your partner should be fired and reported for decertification. Your agency should initiate strict educational and operational standards to prevent this from happening again.

I can count on one hand the times I have been present for an EMS provider trying to sway a person from being transported to the hospital.

It may be that are transport times are so short, it is easier to transport them, then to try and educate them on the proper use of the EMS system.

Definitely. Excellent point. But since it still happens so frequently, it is certainly still an issue. I can think of several reasons why:

• 1. EMTs are inadequately educated for the job tlhey are performing.

2. EMTs are, to an alarming large extent, too stupid for the job they are performing.

3. EMTs are, to an another alarmingly large extent, too lazy for the job they are performing.

4. EMTs are, to a huge extent, disenchanted with the job they are performing because they aren't getting the constant adrenaline rush and blood and guts and action they saw on Turd Watch which caused them to go to EMT school in the first place, so they take it out on their patients.

• But yeah... he should be fired.

[BushyFromOz]

What kind of calls do you feel DON'T require a trip to ER

DOA's

[Just Plain Ruff]

yeah the only patients who don't require a transport are the ones who are warm and dead.

As for the partner who coerced(possibly just swayed) a refusal - as a supervisor and I had heard that, I'd have suspended him. Let me ask everyone on this board a question - but I'll do it in a different post