pampering patty Posted October 12, 2007 Posted October 12, 2007 We responded to a call 35 minutes before the end of our shift. It turns out it is a "regular". The person really needed to go the hospital based on protocal,however the pt's son said he would be able to stay and keep an eye on her. My partner told me to go and get the clip board,which means "get the refusal paper". The pt was CAOx3 despite having a BS of 56 after having oral glucose,orange juice,egg sandwich with ketchup. We spent over an hour with this person, she ended up signing the paper stating "I'm fine and I don't want to go to the hospital" I still can't help but feel we should have insisted she go even though it would have meant we would of had a "fight" on our hands. I think we "saved our butts" by having the refusal paper signed but I still have a feeling of some wrong doing. Is this just a new emts guilt?
spenac Posted October 12, 2007 Posted October 12, 2007 If a person meets your medical directors criteria for refusal (ie A&OX4) they have the legal right to say no. Just like if enroute to the hospital a patient changes their mind and wants off you have to let them. As far as should you have encouraged her to go more times, only you know that answer, which it seems like you already know it. Learn from the call and go forward, don't dwell on the past.
dahlio Posted October 13, 2007 Posted October 13, 2007 I agree with spenac, take it and move on. It's definitely a good thing that someone else was around, just in case he was going to pass out. But overall, it is the patients decision if he's competent, of legal age, and AOx3(or 4, whichever your prefer).
AnthonyM83 Posted October 13, 2007 Posted October 13, 2007 If you're ever really concerned, could you have them them speak to your online control / medical base? Then it can call on them?
emt322632 Posted October 13, 2007 Posted October 13, 2007 As everyone else has said, if this patient was alert and oriented and did not want to go to the hospital, they have every legal right to say no. Just out of curiosity...what was the BGL on recheck? It does take sometime for BG to rise when given orally...just wondering. Enough procrastination, back to my paper!!
akroeze Posted October 13, 2007 Posted October 13, 2007 Yeah, my suggestion would also be that the sugar level could still rise as the "heavier" (for lack of a better term) items get accessed.
Dustdevil Posted October 13, 2007 Posted October 13, 2007 ...and AOx3(or 4, whichever your prefer). It is not a matter of what you prefer. It is a matter of doing a full assessment or not. If you are only assessing three parameters of orientation, then you are not doing a full and proper assessment. If you are assessing all four parameters, but only charting three, you are not doing a full and proper documentation. If you are assessing all four parameters and she is only oriented to three of them, then she is not fully oriented and is incompetent to refuse. And, of course, if you have only heard of three parameters and don't know what we are talking about, your education sucked. This is not some new, regional quirk that somebody just pulled out of their arse. This has been a standard for twenty-five years. There is proper practice, and there is improper practice. For true professionals, there is no "choice" of which one you want to practise.
AnthonyM83 Posted October 13, 2007 Posted October 13, 2007 Los Angeles county only uses A&O*3, but I was told it was due to a lot of medics upgrading patients when they couldn't remember the exact event, such as car accidents...where it is apparently common not to remember the exact impact even though there wasn't loss of consciousness. My fav around here is when a patient is obviously confused, definitely not able to make a proper decision, often piss drunk, but he can answer the when, where, who questions, so he's A/O*3
Dustdevil Posted October 13, 2007 Posted October 13, 2007 LOL! Excellent point! That's why real professionals don't chart by the numbers at all. We either say the patient is fully oriented, or else we say exactly what he is and is not oriented to, expanding on any deficits. This works in the medical world. Unfortunately, as we have seen, in the EMS world, a large percentage of the practitioners were never taught a proper assessment in the first place.
NREMT-Basic Posted October 13, 2007 Posted October 13, 2007 I have heard three used and I have heard four. In my system, if you say "pt is a/o times4" they would have no idea what you are talking about. Im not saying this is a good thing, and I have heard many explanations of what the fourth A/O is. For me, it is person, place, time and event, as in "can you tell me what happened to you?" Maybe this means my education sucked but that is what I ask. When I call it in, knowing that A/O x4 would confuse them, I say "Pt is or is not A/O to person, place, time and event at this time." I may also include things like memory looping, changes in emotional state, etc. And yes, I cram alot into my 30 second call-in because I am sure of what I am saying and can speak very quickly and clearly.
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