Do you properly secure patients to the cot?

[brentoli]

Common sense should trump the supposed laws and regulations.

[JPINFV]

Then you need to tell your bosses that your patients are not properly restrained, and then document the date and time you told the, and who was present. In writing would be great.

You're assuming that my bosses actually care. These are the same people who think that an ambulance on a long distance RT transport is fine with 800 LPM in the main tank, training units are fine with just the trainee and FTO which forces the FTO to drive, and that sirens are ok as long as 1 out of the 2 speakers work properly.

[brentoli]

These are the same people who think that an ambulance on a long distance RT transport is fine with 800 LPM in the main tank.

Eh.... 1LPM works just fine. Really. I promise.

[AnthonyM83]

Sorry, but to even think that family, child, etc is able to recognize potential risks during the event of the crisis is not even negotiable. As well, we teach during kinematics of trauma (per PHTLS, ITLS, ATLS, etc) to hold a child during impact is impossible. It would be hard press to defend one self, when 3 of our own national organizations, discuss this in the national education courses and teaches the hazards of such.

Sorry parents, either need to be restrained in the front seat or my preferred method is per another vehicle (except epilgottits cases). Definitely, never in the arms of the parent or even the medic.

I did a 2 year study on pediatric restraints or lack of, enough to write a Federal grant to purchase every EMS truck in my state a child restraint/carrier for the trucks. I was amazed on how EMS, Police, and FD were exempted, assuming they were safer... which we know they are not.

R/r 911

No, the assumed risk is for us. We're risking being injured by the child.

As for parents, if they're young children I personally prefer them in the back with the child, as it cuts back on the crying and squirming significantly. Whether in front or back, every non-patient has always been restrained witout exception.

I'd definitely prefer having some method to restrain a child supine on gurney, though.

[Laura Anne]

yes, it does sound harsh, and IT IS harsh. and yes it certainly is called life. but "life" is also the reason for patients dying because they cannot afford the surgery to cure it, and also the reason for massive employee layoffs and plants moving to foreign countries for cheaper labor in the unending search for the "bottom line". this is all called life but does that make it right? what is destroying the delivery of medical care in the united states is not the fault of the patient, nor the emergency caregiver. it lies in our legal system. to think that, in making a run where the patient states that they FULLY understand their situation and the risks they are taking, and still refuse care, the provider can be sued for negligence for not providing the medical care the patient did not want, and be held liable is a DISGRACE. that being said, we return to the question at hand. i am a human with frailties and medical conditions, the majority of which are beyond my control. i did not ask to be claustrophobic. it is just something that happened. before anyone asks, yes i have had extensive treatment in an attempt to rid myself of this condition, and for reasons unknown to the therapist or me, it has failed. so that leaves me the victim of a MVA with injuries for which emergency care is summoned. after all the physical examinations,histories, and investigations have taken place, the EMS makes the determination i must be transported to the emergency room. it has been recommended that i go, i do not refuse, i want to go, but because of a technacality of our laws, i cannot. i have never doubted the advantages which wearing seatbelts offer. i wish i could wear mine. i am not against mandatory usage laws nor primary enforcement, but all states i am aware of which have adopted mandatory safety belt usage laws contain EXEMPTIONS to cover people who cannot wear seatbelts for medical reasons. is there a reason why our EMS cannot offer these exemptions? this would save people like me tons of anguish and pain. i do not possess the knowledge to diagnose or treat myself, so therefore i refrain from so doing. i ask only that when deciding what is the best option for the patient, that this be done by making use of ALL pieces of the puzzle, including what the patient can tolerate. is it better to leave a patient at roadside to fend for himself than to treat/transport him? i hear most of you already saying that it is not the responder not offering care but the patient not accepting it. on the surface this is indeed hard to disagree with, but disagree i must, because your decision is based on flawed evidence that the patient is making a "choice" not to accept treatment. this cannot be farther from the truth. you must understand that it is NOT a choice when i refuse and resist restraint application, it is a fact of life. claustrophobia isn't something you can turn on and off depending on the situation. it is not something a person chooses to be. YOU JUST ARE. there is something very fundamentally wrong with a system that will not make exceptions in order to offer care to ALL individuals. it is true that it is not our fault, but it is also true that it is us who must fix it. thank you and may God bless you all.

i wish to say to laura anne, please tone down that attitude. you are not SUPERMAN, nor WONDER WOMAN either. and please do not be offended as this is constructive criticism. you come across as a "big know-it-all with a huge superority complex". and i wager that this is far from the truth, and a mistaken impression. i realize the laws are important and what you put at risk if you break them. i find it hard to disagree with your reasoning. what makes this an even more complicated issue is the realization that i know and accept the advantages seatbelts offer and agree that i should wear mine. this is very difficult for me, as i accept your premise and realize you are right. but i do not feel that you understand my problem and the reality resulting from it. understanding and compassion for people, not derision, will make you a far better medic than you obviously already are. finally, answer this question for yourself----------how many of your past actions and decisions made as an emergency care provider would have been different if you did not have the need to worry about the possibility of being sued?

mackeydad,

Let me start by saying once again I am sorry to hear that you have a condition that would interfere with properly transporting you in my care/vehicle. And no, I am not you, and I do not have your condition, and therefore cannot fully comprehend the horror you feel. I cannot truly understand the issue you face from in your shoes, but this doesn't mean that I am incapable of being compassionate. I actually get criticized by some co-workers for being a "hand-holder". Quite honestly, I am proud to be one and to show that I truly care for my patients. Unfortunately, this does not change the fact that the law is the law, and the safety of everyone in my care, including myself is in jeopardy the moment I decide I am above the law. And yes, I agree that it is a disgrace that one can be held liable for their actions or lack of in this situation. To think that it comes down to someone who is in need of medical assistance and not getting it due to legalities is a very, very sad part of the job. Once again though, at the end of the day, I will do what is best for myself, my patients, my co-workers, and above all my own family. This means abiding by the rules and regulations set forth by the government, which ever one it may be. This means properly restraining my clients for their best interest. Again, I know this is not what you consider to be in the best interest for your well being, but in my eyes and the eyes of the law, it is. I honestly cannot think of a less harsh way to state a fact, but the bottom line of our jobs as health care providers is to maintain the lives of all involved including our own above all. Isn't that what they teach us in EMT school? To protect ourselves and not to be placed in harms way because if we do, we are no good to anyone and may only become another patient on the scene?

Now, as far as being 'WONDER WOMAN', only my boyfriend calls me that...ahem :oops:

Seriously though, you're constructive criticism, as you call it, stating that I come across as a "big know-it-all with a huge superiority complex" is far from the truth. I am, yet again, a compassionate person and I do understand to a point that you have a condition that makes this topic at hand very difficult for you. It will not change the bottom line when it comes to my patient care. If my opinion and professional conclusion makes me come across as stated above, then so be it. I only wish there were a better solution for you and others in your shoes. What would you do to better this type of an issue for persons such as yourself from a legal standpoint? Perhaps this is a subject that you should take up and fight for in the legal system?

I wish you the best of luck with your condition.

[mackeydad]

mackeydad,

Let me start by saying once again I am sorry to hear that you have a condition that would interfere with properly transporting you in my care/vehicle. And no, I am not you, and I do not have your condition, and therefore cannot fully comprehend the horror you feel. I cannot truly understand the issue you face from in your shoes, but this doesn't mean that I am incapable of being compassionate. I actually get criticized by some co-workers for being a "hand-holder". Quite honestly, I am proud to be one and to show that I truly care for my patients. Unfortunately, this does not change the fact that the law is the law, and the safety of everyone in my care, including myself is in jeopardy the moment I decide I am above the law. And yes, I agree that it is a disgrace that one can be held liable for their actions or lack of in this situation. To think that it comes down to someone who is in need of medical assistance and not getting it due to legalities is a very, very sad part of the job. Once again though, at the end of the day, I will do what is best for myself, my patients, my co-workers, and above all my own family. This means abiding by the rules and regulations set forth by the government, which ever one it may be. This means properly restraining my clients for their best interest. Again, I know this is not what you consider to be in the best interest for your well being, but in my eyes and the eyes of the law, it is. I honestly cannot think of a less harsh way to state a fact, but the bottom line of our jobs as health care providers is to maintain the lives of all involved including our own above all. Isn't that what they teach us in EMT school? To protect ourselves and not to be placed in harms way because if we do, we are no good to anyone and may only become another patient on the scene?

Now, as far as being 'WONDER WOMAN', only my boyfriend calls me that...ahem :oops:

Seriously though, you're constructive criticism, as you call it, stating that I come across as a "big know-it-all with a huge superiority complex" is far from the truth. I am, yet again, a compassionate person and I do understand to a point that you have a condition that makes this topic at hand very difficult for you. It will not change the bottom line when it comes to my patient care. If my opinion and professional conclusion makes me come across as stated above, then so be it. I only wish there were a better solution for you and others in your shoes. What would you do to better this type of an issue for persons such as yourself from a legal standpoint? Perhaps this is a subject that you should take up and fight for in the legal system?

I wish you the best of luck with your condition.

i begin by offering my apologies to you. many posters probably feel my comments and criticism of you were harsh also. i don't want this to sound like a "me against them" crusade. policies and protocol are developed with the interests of the vast majority in mind, and there will be others who will comply because it is the law. this is good. the more people who wear safety restraints, for whatever reasons, the better and safer our society becomes. my only problem concerns those not in this vast majority, for whom these policies and laws become a major burden upon those who cannot comply. for this reason government offers "exceptions" in order that those with legitimate reasons for not complying do not become "criminals" on the surface it would seem that our E.M.S. would do the same. however, as with everything else, there is a big picture to consider. unlike seatbelt regulations, where exemptions physically hurt only those who chose not to buckle up, that is not the case here. we must consider the safety of the provider, also in the patient compartment. that is why i think the best solution in my case is sedation. this will allow me to be transported, restrained for safety, in a way that meets the safety considerations of the provider. i have been sedated many times with no problems. i have discussed this issue with my P.C.P., at great length, and he concurs that, provided the need is emergent, transportation is necessary, and this is the only way to accomplish same, that he recommends i be sedated. this is far from the optimum, but ANY way trumps NO way. i have always thought that one of the major tenets of emergency, out of hospital medicine, is to offer the BEST CARE POSSIBLE TO ALL OUR PATIENTS. it is my humble opinion that strict adherence to this one size fits all regulation falls short of this tenet. i think continuing this fight within the legal system would only be beneficial if E.M.S. would alter their protocol as a result. you and i would agree that a system which leaves patients desiring care on the streets due to a technacality in the law is far removed from the best system. hes E.M.S.ever been the defendant in a lawsuit brought by a patient not given transport for these very reasons? this is indeed a thorny issue for all concerned. and finally, for laura anne, please continue to be a hand holder. you meet people at the most critical, and stressful times of their lives, and holding their hand says "i care" like nothing else. i apologize again if i offended you in any way. thank you for your comments.

[Dustdevil]

Minus 10 for overquoting.

We only need to read these posts once, Mack. Please edit out or delete all those quotes (the stuff framed in white) from your replies. You're killing our bandwidth.

[spenac]

Common sense should trump the supposed laws and regulations.

"Common sense" Whats that? Is it really allowed?

[Dustdevil]

"Common sense" Whats that? Is it really allowed?

It is rarely seen in this business.

After all, most people with considerable common sense would never choose EMS as a profession in the first place.

[katbemeEMT-B]

So, I have a new twist to this. We were on a call yesterday. Two vehicle MVA, three victims. Two were treated at the scene and refused transport but went by private vehicle to the hospital (mommy yelled at them later for not going with us) . The other was moved to a back board where we proceeded to strap him in. He started screaming at us, "Get those F***kin things off me, they're choking me". Nothing was even close to his neck other than the c-collar which he was fine with before. Once we got him to the cot we loosened the chest strap and he continued to bitch at us and flail around. We opted to secure his hands under the straps to prevent an further injury to his back and neck. Once we had him in the ambulance he started to threaten us with a law-suit for improperly restraining him. He told us he is extremely claustrophobic and couldn't breath. We explained to him that the straps are necessary for his safety and ours. He wouldn't budge. The Deputy Sheriff on scene popped in to see if all was well and we explained to him what was going on. The deputy told the guy if the straps are removed he gets a ticket for improper restraint not us. The patient still insisted. We needed to get this patient to the hospital so it was time to start making deals. We secured the backboard to the cot with the cot straps. We then loosened the chest and leg straps of the board. We left the waist strap secured tight. We padded him on either side with towels and blankets to ensure as little movement as possible. While we did this, the deputy had called Med Control and explained the situation to them. Med Control told the deputy to tell us to head towards the hospital, but do so at a lower rate of speed. They also told him to tell us to pad the patient (too late, already done). They would assume all responsibility (yes, said to a third party, our butts were covered). We left the scene with a patient who was calmer and we were able to help.

When doing our PCR (we don't have the electronic ones), we included the conversation between the deputy and Med Control. We had them both sign below the paragraph stating that they did indeed say what was written and relay that information to us. Document, document, document!!! Our butts are covered as we were acting under a direct order of Med Control. Now, I wouldn't have called MC, but the deputy was tired of dealing with this guy and didn't really want to give him a ticket so he took things into his own hands. Was it the right thing to do? Probably not, but MC knows the deputy and respects him as he is pretty good at accurately assessing a patient. Apparently they felt comfortable with it and were willing to take the chance. At the hospital, MC told us that if we ever come across this again, just call them.

The one thing I still don't understand is that we also had him in head blocks and had O2 on him but that didn't bother him at all. He did tell us it's just when his body is restrained. Weird.

I still don't feel comfortable leaving a patient unrestrained, but I guess sometimes you have to do what works. The key is to find some one higher up than you to give the okay so it's on their butt. :twisted: