Would you stop?

[Just Plain Ruff]

7 pages - no agreement

I agree with the previous poster with his picture of the dead horse.

I just put this last thought out to you all who say never stop

Let's say You are the one trapped in the car. You see an ambulance drive up, stop, look and then drive off. What are you going to think.

I think we are all looking at this from a protocol standpoint but I for one would stop only if I had a non-critical patient and check, but then again, the majority of my experience has been rural where the next closest ambulance is 20-25 minutes away. So Yes, I would stop but only if I did not have a critical patient.

[Lone Star]

I doubt half of you know what it is like to opperate in urban EMS service where this type of thing happens so simply on that have no right to comment. We all make choices on the information we have at that moment and they did, lives were saved by the actions of this crew and no they should not be fired.

Don't know what its like to operate in urban EMS? I'm thinking you just put your foot in your mouth on this one! I for one have worked in the metro Detroit area for several years. That's about as 'urban EMS' as you can get! Granted, its not NYC, or DC...but it definately isnt Mayberry RFD either!

Until you know all the facts, might be a good idea to refrain from making inane statements like that....unless you like the taste of shoe leather.....your call.

I don't know the stats on the urban vs. rural poplulation on here - but I do agree that these type things do happen very often in the urban setting. It's not often that weapons are involved or that it ends in a shootout - but us folks that do urban EMS are much more likely to encounter these type situations where we come across another incident while in transport or enroute to another call - it happens quite often here.

Either way, for you folks that seem to think it's quite easy to just wave and smile as you drive by another incident that needs your assistance - I just can't understand how you do it? If I'm enroute to another call (regardless of priority) and I come across bystanders waving me down from the sidewalk as they huddle around a male patient that appears unresponsive - I'm supposed to just keep on driving when I'm already there? Or the same scenario where your transporting a minor illness such as a 9 month old who likely had a febrile seizure - that warrants you just passing an incident that looks much more critical just because you have a patient on board? Your there - yet you just keep on going? That's just pure stupid...

Ultimately nc, it comes down to one fairly important word...PROTOCOL. If your protocol says that you're 'out of service' when you're transporting a pt (regardless of the 'severity' of the pt's condition)....then you have no business stopping!

The protocols were put in place for more reasons than to just 'inconvenience' you! Your feelings are not a 'factor' on whether you follow them or not. Protocols were not adopted because you think they make sense or not.....

The protocols were put there to establish an educated continuum of care, whether you agree with it or not.....whether you like it or not! Violations of protocol will result in disciplinary action up to and including loss of licensure and possible criminal charges.

Secondly, since you don't know the etiology of the febrile seizures, it's not prudent to dismiss them as a 'minor problem'!

[Just Plain Ruff]

From the National institute of Neurological Disorders and Stroke

http://www.ninds.nih.gov/disorders/febrile...le_seizures.htm

A nice fact sheet on febrile seizures.

[Just Plain Ruff]

One additional thing - What if your protocols do not address this issue?

I know Dust, the system that does not address this issue "SUCKS" but with that aside - what if your service doesn't have protocols to address this???

[Lone Star]

One additional thing - What if your protocols do not address this issue?

I know Dust, the system that does not address this issue "SUCKS" but with that aside - what if your service doesn't have protocols to address this???

If company policies and procedures don't cover this, then check your local protocols - set forth by the county medical control. They trump company policy any day of the week!

If you don't get an answer there, then check your States protocols.

If you STILL can't find a definative answer, then start asking questions at the local Medical Command level, then State.

Someone somewhere has set forth a book of 'rules' that govern how you operate as an EMT in that state. If there is no protocols listed anywhere in the state, then its nothing but chaos, and lawsuits just BEGGING to be filed!

[vs-eh?]

I don't think there will be a consensus on this issue. People base it on personal experience, company policy, and what constitutes abandonment (amoung other things). People can come up with all the ridiculous scenarios they want. In the end, if it is spelled out in black and white that you don't stop (regardless of anything) you don't stop. Obviously not all situations are like this in EMS and in medicine. My opinion is as always, as long as you can rationalize your decision and it is deemed reasonable, you go with it.

I assume the service I work for has a policy outlined for stopping after being flagged down/witnessing an accident. I can't recall ever reading it or know where I could find it, but I'm sure it's there. I am of the opinion that unless you have an "emergent" patient, that you can take the minute or two to briefly assess this new patient. You aren't abandoning anyone (your partner is still in the back), it is just that your 15 minute ride to the hospital, may take 17 minutes now. Surprisingly enough, your brief ABC professional assessment could actually benefit this new patient.

But people will always come up with the "what ifs". What if this "new patient" has a gun? What if your knee pain that you were transporting goes into cardiac arrest while you are stopped?

That's fine. Again the word reasonable always applies in these situations...

I'll extend this wordy post by providing a personal example that (generally speaking) is not grossly uncommon here...

During my ACP preceptorship we attended a psych call. General BS psych call, a young girl, no self harm or anything, she may have been "off her meds", I don't recall. Basically your standard "pysch" questions, her in the jumpseat and a taxi drive to the hospital. Shortly following transport a PCP car asked for ALS for a cardiac arrest on the street. We were less than 1 min from that scene. My preceptor radioed saying we had a stable patient and would be able to render assistance. We arrived on scene, received report (ROSC with just CPR), traded off patients and rendered appropriate ALS care to the patient who actually needed it (intubation, IV, etc...). Our original patient was never abandoned, just switched off. And you know what, if it came right down to it and we needed the paramedic that was watching our pysch patient? I would have sent a FF in to watch her.

People can disagree all they want. That's fine. I'm sure a lot of things that happen in my system would surprise people, and vice versa.

[tskstorm]

Lets focus on this word.

Theory.

You think it should be this way.

Problem.

Thats not reality.

Reality: You have delayed care of the patient you are responsible for and currently transporting.

Thats bad. Thats reality.

well its not really MY theory, its NYS, NYC's and FDNY's ... so blah to you

p.s. the policy/protocol in nyc and nys says they have to stop, and you all agree to follow the protocol that says your " out of service " if you have a patient on board, so why not comply with the protocol/policy of stopping like they currently say to.

[Richard B the EMT]

OK, this issue won't go away.

Shall we say that in some jurisdictions, you have to stop or be in trouble, in others you're in trouble if you do stop, and in yet others it becomes a strictly moral issue as to stopping or not.

There seems to be no "across the boards" "cookie cutter" answer, nor will there be.

All I can advise all of you, if in similar situation, is follow department/county/state or provence/country protocols, whatever they are, and for that jurisdiction, you shouldn't be incorrect.

[Lone Star]

OK, this issue won't go away.

Shall we say that in some jurisdictions, you have to stop or be in trouble, in others you're in trouble if you do stop, and in yet others it becomes a strictly moral issue as to stopping or not.

There seems to be no "across the boards" "cookie cutter" answer, nor will there be.

All I can advise all of you, if in similar situation, is follow department/county/state or provence/country protocols, whatever they are, and for that jurisdiction, you shouldn't be incorrect.

I agree Richard.

While most companies/counties/states have an established set of protocols for their area, it's clearly going to be different from location to location.

That being said, most protocols are written by the 'forward thinking' of the Medical Control, there are some areas (primarilly rural) that do not use such 'forward thinking' and cannot fathom such events occurring. Thus, most of the changes to medical protocols becomes a 'reactionary' move as opposed to a 'pre-emptive' one.

These protocols are set forth for each area, in accordance to what the medical directors feel will best serve that area. What works in suburban St. Louis won't necessarilly apply as well in metro Detroit, or the backwoods of Kingman, IN.

If we each take the time to learn our own local protocols, and follow them to the best of our abilities, (whether we agree with them or not), there should be no 'fallout' from our actions.

Moral obligations and legal obligations will more often than not be in direct conflict. It is our responsibility as health care providers (regardless of level of licensure), to weigh the consequences of each, and try to decide what is best for the patient, while balancing this with the legal parameters that we have to work within.

At best, we can only follow the established scope of practice and the local protocols that have been handed down from Med Control, and give the patient the best care that we can!

Be safe....

[Dustdevil]

Not dangerous situation.. but still I got my ass reemed for stopping for another patient.. Because even if we got patient in back of ambulance and brought him to the hospital I would have then 2 patients instead of just one and Yes I can handle that but apparently my bosses didn't think it wise to have one tech per 2 patients. aww well they are private company and they can deal with the ramifications.. I'm not losing my cert for their stupidity anytime soon..

Very true. Sounds like you have enough stupidity of your own to lose your cert and your job without their help.

What makes you think your boss was wrong and you were right? Are you some kind of EMS legal genius wasting your talents working a dialysis transfer truck? Please point us to what educational source makes you so certain that you know better than your boss. because I think we're all looking for such an indisputable source as you seem to have, that we would actually defy our bosses over. Did you have the guts to tell him that to his face? Or are you just going to silently tell yourself that you're smarter than him and do whatever you want in the future, regardless of what your employer tells you?