Scenario-4 wheeler accident

[scratrat]

Is this a scenario, or are you trying to brow beat everyone into agreeing with you?

What do the protocols say. That is what matters. If "B" is the only trauma center, and your protocols say go to hospital "B" that is where we are going. This patient can not be guaranteed to not have an altered mental status. Did you know him before the accident? Your liability rests on the protocols, not on your heart.

Um no.

Protocols are GUIDELINES. If a patient is CAO x4, guess what? Your protocols don't mean jack. My protocols say I give NTG to someone with CP. What if they refuse? After I determine they are CAO x 4, I'd make sure to explain why declining NTG is not in their best interests. Then, guess what? They don't get it. If they tell me no, it's assualt to do anything otherwise. You cannot force your protcols on anyone who is not incapacitated.

And yes he can be guarenteed to not be altered. Do you know your name, age, location, present events, year, month, etc. etc. Is he NOT under the influence of alcohol or drugs? If you can answer them correctly, guess what? You're CAO x 4. Not to start an argument, but if you took this guy to the hospital he didn't want to go to, you're now charged with kidnapping.

[broken]

Um no.

Protocols are GUIDELINES. If a patient is CAO x4, guess what? Your protocols don't mean jack. My protocols say I give NTG to someone with CP. What if they refuse? After I determine they are CAO x 4, I'd make sure to explain why declining NTG is not in their best interests. Then, guess what? They don't get it. If they tell me no, it's assualt to do anything otherwise. You cannot force your protcols on anyone who is not incapacitated.

And yes he can be guarenteed to not be altered. Do you know your name, age, location, present events, year, month, etc. etc. Is he NOT under the influence of alcohol or drugs? If you can answer them correctly, guess what? You're CAO x 4. Not to start an argument, but if you took this guy to the hospital he didn't want to go to, you're now charged with kidnapping.

EXACTLY!!!!!!!!!!!!!!

I wanted the guys EMT revoked and him fired.Ambulance company owner says "what about his lively hood",I say "what about not being able to walk correctly!!!!!"Now,I have been left no choice but to sue and get attorneys involved,which I really didn't want to but im left NO CHOICE.

You guys should be more offended by this persons actions as he makes it harder on all the good,caring EMS personal that I know are out there.......Not to mention it makes malpractice go up!

[ERDoc]

Determining if some one can make their own decisions requires more than just being A&OX3 or 4 or 8. They have to have the capacity to make that decision. This means that they know and UNDERSTAND the consequences of being treated or not treated. You can decide if a patient has the capacity by doing an adequate assesment. It is not a very difficult thing to do. If you are not comfortable with your ability to assess a pts capacity, call medical control and let them get on with the doc. Taking a pt to a hospital that they do not want to go to (assuming they have the capacity), as previously stated, is kidnapping. Good luck defending that in court.

To the OP, as screwed up as this crew was, about the only thing they did do correctly was put you on your back and immobilize you. You should have been boarded and collared. You suffered a trauma severe enough to fracture your femur for christ's sake. There is no way to r/o cervical injury. Obviously, you were in a position to refuse this, but they should have leaned on you to go with the proper treatment. I'll let others debate the advice given by firemonkeys. However, it seems they missed the boat by not putting a traction splint on, which would have alleviated a great deal of your pain. Any ER should be able to handle the beginnings of a trauma (assuming they have a real ER doc and not an internist or surgeon there). You come in, get stabilized and get sent on to specialty care. If they have a CT they can handle trauma (even if they are not a designated trauma center). That is not to say that a trauma center wouldn't be a better choice.

The way this call should have gone down:

1. Pt fully immobilized

2. Traction splint applied and narcs given

3. Transport to hospital of pt's choice with emphasis made to pt that a trauma center would be the best choice.

[brentoli]

Ok that part of my post got construed.

I know you can vary from protocols. What I meant was, you have to show reason for that. You can not just say no we are not following them. You have to have a valid reason. If the pt passes the original assessment, then you can go with his wishes, I would probably consult online control first, but that is because I am an EMT-B.

Clear as New York water?

[broken]

Determining if some one can make their own decisions requires more than just being A&OX3 or 4 or 8. They have to have the capacity to make that decision. This means that they know and UNDERSTAND the consequences of being treated or not treated. You can decide if a patient has the capacity by doing an adequate assesment. It is not a very difficult thing to do. If you are not comfortable with your ability to assess a pts capacity, call medical control and let them get on with the doc. Taking a pt to a hospital that they do not want to go to (assuming they have the capacity), as previously stated, is kidnapping. Good luck defending that in court.

To the OP, as screwed up as this crew was, about the only thing they did do correctly was put you on your back and immobilize you. You should have been boarded and collared. You suffered a trauma severe enough to fracture your femur for christ's sake. There is no way to r/o cervical injury. Obviously, you were in a position to refuse this, but they should have leaned on you to go with the proper treatment. I'll let others debate the advice given by firemonkeys. However, it seems they missed the boat by not putting a traction splint on, which would have alleviated a great deal of your pain. Any ER should be able to handle the beginnings of a trauma (assuming they have a real ER doc and not an internist or surgeon there). You come in, get stabilized and get sent on to specialty care. If they have a CT they can handle trauma (even if they are not a designated trauma center). That is not to say that a trauma center wouldn't be a better choice.

The way this call should have gone down:

1. Pt fully immobilized

2. Traction splint applied and narcs given

3. Transport to hospital of pt's choice with emphasis made to pt that a trauma center would be the best choice.

They didnt roll me on my back...I wouldnt let them and the fire and rescue wouldnt let them.The closed fracture was clearly visible on the back of my leg.I was strapped on my left side with an air bag surrounding me so I couldnt roll.Firemonkeys DID THE RIGHT THING!!!

No way in hell would I let them roll me on my back or give any other medical attention after I was told to shut up when I screamed out in pain on the roughest 10ft ride ever or after I was told "youre gonna take this IV or were throwing you in the back of that cop car and taking you to jail,and then were gonna take you to hospital b anways.The EMT got out of the ambulance in a bad mood(8 fire and recue people confirmed this)

Prtocol isnt law and you cant shove it down my throat,even though they did with threats of jail and ending up in a crappy hospital(which I ended up in the crappy hospital anyways!!).The IV that they tried busted my vein as well.......

You think you know about pain??From the time I had my accident till the time I got anything for pain,it was almost 5 hours!!!!!!!!!!!!!!!!!!Being moved on and off back boards and stretchers 4 times.You guys have no clue on pain until youve had a frcture and are forced to move.

Then ER doctor wouldnt let me go until I had surgery.

[ERDoc]

They didnt roll me on my back...I wouldnt let them and the fire and rescue wouldnt let them.The closed fracture was clearly visible on the back of my leg.I was strapped on my left side with an air bag surrounding me so I couldnt roll.Firemonkeys DID THE RIGHT THING!!!

No way in hell would I let them roll me on my back or give any other medical attention after I was told to shut up when I screamed out in pain on the roughest 10ft ride ever or after I was told "youre gonna take this IV or were throwing you in the back of that cop car and taking you to jail,and then were gonna take you to hospital b anways.The EMT got out of the ambulance in a bad mood(8 fire and recue people confirmed this)

No, the firemonkeys potentially sentenced you to living your remaining years on a vent (think Christopher Reeve). They should have been arrested for interfering, but if you are ok with them putting you ability to walk and piss on your own at risk, who am I to judge. The EMTs that took care of you were total tools and shouldn't be practicing. That tenting would have resolved with a traction splint had the EMTs done their job properly. You were surround by incompetence and should feel lucky that you made it out as well as you did. It could have been worse.

[broken]

I respect youre professional opinion but I was there,100% on what the emergency was and aware of what I wanted for my medical care.And that was to get me to hospital a lighning fast to let a pro take a look,not some elderly half wit that calls themself doctor and is refusing to let you go,laying in the ER for 2 hours without pain meds.Not argue with me "saying its the law" and taking 45-55 minutes to drive 29 miles.No drinking,no drugs, a compliant,responive,in charge patient according to my states patient care protocols Section 2

http://www.adph.org/ems/assets/protocols.pdf

After talking to a reg emt director(?)he informed me that this amb service has had alot of problems(500 employees,90 ambulances)I dont want anyone else to suffer the consequences I have from down right LOW medical care.A police officer I knew says he hated to take prisoners there,1st words onut of my mouth were "dont take me to hospital b" the next word out the emt's was "thats where youre going,its the law"It was a lil 2-3 minute argument after that.At this point,im just over 1 hour since the accident.

So far,I count at least 15 infractions,They didnt even have shears as required by state protocol.The SOB's were quick to inform myself and my emergency contact person that "its the law,he has to go there" though

Flying out in the AM to get my "fix it" surgery done Monday.The weird thing is,im actually looking forward to it because it means I will WALK again.All from an EMT that did it for whatever reasons,wether he was following "protocol " or not.Clearly he hasnt read protocol for patient care?

Also remember,the ER doctors didnt roll me either.They didnt put it in traction till probably midnight or later.No cat scans,nada but a few x rays(which I know was mishandled as well,why I didnt want to go to the hospital anyways,I knew they were incompetent!!!!)And dont I know it I was lucky!!!!I thanked the lord he spared me seconds after the wreck.I was slung into the handlbars shattering my femur.I was 100% that I was OK on impact.I will never get on another cycle again though.To afraid of bad medical care since most in the med profeesion look at em like "organ donors"

[tniuqs]

No, the firemonkeys potentially sentenced you to living your remaining years on a vent (think Christopher Reeve). They should have been arrested for interfering, but if you are ok with them putting you ability to walk and piss on your own at risk, who am I to judge. The EMTs that took care of you were total tools and shouldn't be practicing. That tenting would have resolved with a traction splint had the EMTs done their job properly. You were surround by incompetence and should feel lucky that you made it out as well as you did. It could have been worse.

Once again Erdoc provides most intelligent and interesting commentary, Yes doc I do remember Superman, he as most Ventilator dependant quads took quite some time to die after repeated nosocomial pulmonary infections, and despite exemplary care.

Firstly:

I would like to welcome "broken" as I see that you are relatively new to this site.

So just whom do you think is responsible for the Initial Insult in this accident?

Was there any ETOH involved?

Just exactly what occurred, MOI?

Perhaps an upset of ATV climbing a hill to steep, any operators licence ?

What was the speed when this ATV accident occurred ?

So if your following here the "blame" in this event is not "JUST" in the care received.

But squarely upon the OPERATOR! I certianly hope that you are you following, I really dont think you will recieve what you are looking for on this site..but then again I could be wrong.

Secondly:

I sense that your involvement here is other than a Professional Inquiry ?

In fact the "tools" that treated you so poorly, could it be perhaps that you were just a just a bit overbearing, attempting to dictate your own care? Have you ever wondered why you were tod to shut up...or was it more like "calm down sir, please its in your best interest.

And so just who decided that Hospital "W" for... whatever, has such a poor reputation? Personally I have found (with a just a few years of experience under my belt) that one facility should NOT be judged based on opinions of others (I don't) well until I have personally been mistreated. The fact remains that your closed femur fracture could have been treated by most "non trauma designated facilities"

So just why did you not receive Medication for 4 hours for your Pain....hmmmm I wonder?

Now when ones physiological state (the flight or fight response) was overly stimulated, ones judgement is seriously affected and the way that OTHERs are treated on scene quite frequently can affect care.

This term LUCID ? as referred to prior is NOT medical term used routinely I suggest that knowledgeable individuals commentary prior should be appreciated, as I must agree I too would be highly suspicious of Head Injury with because I get rather annoyed when I have had very serious PAIN myself....... and I have.

Now the way I would have treated you?

1- Spinal immobilizing...without a doubt (ps I can RSI!)

2- Traction Splint to Extremity. (this relieves pain by reducing muscle spasm) a very effective "tool" in fact, but it cannot be applyed in the position you decribe.

3-Entonox prn for the move, in addition.."consideration of Narcotic analgesia" and a "touch of Benzos" chaser with the very anxious patient.

4- If possible Medivac....?

5- In light of review of "posts" Haloperidol 2.5 to 5 mgs IM.

cheers

[broken]

Secondly:

I sense that your involvement here is other than a Professional Inquiry ?

In fact the "tools" that treated you so poorly, could it be perhaps that you were just a just a bit overbearing, attempting to dictate your own care? Have you ever wondered why you were tod to shut up...or was it more like "calm down sir, please its in your best interest.

And so just who decided that Hospital "W" for... whatever, has such a poor reputation? Personally I have found (with a just a few years of experience under my belt) that one facility should NOT be judged based on opinions of others (I don't) well until I have personally been mistreated. The fact remains that your closed femur fracture could have been treated by most "non trauma designated facilities"

So just why did you not receive Medication for 4 hours for your Pain....hmmmm I wonder?

I know its my fault that I was riding a 4wheeler after working hard 60+ hours a week(more of that "organ donor" mentality)

Your statement copuldnt be further than the truth.And if so,how can 8 people on the scene say the same thing??Were we all dreaming?Even if I was (which I wasnt),what gives an ambulance driver the right to cripple someone or deem what they see is good for them WRONG?Overbearing or exagerating my ass!!!I could type all night and tell ya stuff that was done wrong with the hospital...like when I caught an elderly nurse checking my gaping wound out ungloved,and youre DAMN right I was adamant that she should get her hand the hell away from me.

It all changes when its you and things are too late and youre the one who is messed up.

Accident:riding a power line,VERY small incline,4 wheeler susp hit rut and stops slinging me right into the handlbars,I hear and feel the break and land in a rut on my left side,with my broekn right leg.1st thing I did was unzip my pants and check for a compound fracture and then took vital,pinching myself all over my body,wiggling toes.Moving fine in the rut as long as I pick up my leg(which I do to get on the backboard and on and off the gourneys)Tell my friend who's riding with me,"lets give it a min,I think I can get back on the 4 wheeler and ride it out"Well,I couldnt as it was just to painful to try and move the 1 leg,so I say call an ambulance.Been riding over 20 years,got my 1st one when I was 5,never had an operators license,theyre for OFF road and to the best of my knowledge,require no license.Also never been an EMT or work EMS but I know how to size somone up,myseldf included.

Ive gotten what I wanted,honest anwsers and to educate those few who might pull somthing like this.I know most people in the medical profession are great and caring people who do this to help others.Its when you personally run into that 1% of em that are SOB's,it certainily isnt a good situation ya know?

[VentMedic]

No, the firemonkeys potentially sentenced you to living your remaining years on a vent (think Christopher Reeve). They should have been arrested for interfering, but if you are ok with them putting you ability to walk and piss on your own at risk, who am I to judge. The EMTs that took care of you were total tools and shouldn't be practicing. That tenting would have resolved with a traction splint had the EMTs done their job properly. You were surround by incompetence and should feel lucky that you made it out as well as you did. It could have been worse.

We are judging other professionals now based on the scenario given to us by a patient who experienced a traumatic event. This is not an objective scenario. No disrespect to broken, but we probably do not have all of the facts. broken's anger is pretty evident in his posts.

If anybody has ever worked in a hospital, patients, especially those that have been through some traumatic event, may remember events differently every time they talk to somebody. This can be for a multitude of reasons ranging from the trauma itself to medications given later or to some emotional issues. They may hear something said at scene and hang on to it. The more they think about it while trying to justify what is happening to them, the more skewed objective thinking can become. And, you will get the "professionals" feeding them their opinions.

At least for the majority of this thread, the bashing or firemonkey language was kept at a minimum. After reading through some of the bashing posts lately, this would be the perfect place to come if you wanted people to critique poor EMT and Paramedic service. Why are we so quick to find fault within our own profession before we actually know all the facts? broken mentioned he wanted these guys fired. I do hope employers, judges and juries are more objective then some of the opinionated views expressed here on this forum out of deep seated issues of our own. I hope some of you don't make it a practice to engage in bashing other healthcare workers or hospitals when you are with your patients on the ambulances or in the ER. It is enough that they can read our bashing comments on a public forum about each other.

broken has now identified himself as a patient who was serviced by EMS in some capacity. We should treat him respectfully and keep any medical advice or opinion at a professional level.