Guest guest Posted April 5, 2002 Report Share Posted April 5, 2002 My response would be this - As an EMS Professional, I have worked fender benders where the victims do not seem to be hurt at first, BUT, I have gotten refusals from patients, left the scene and had to return to the same scene not 30 minutes later. The patient had a fx of the c-spine and a pinched nerve in the neck to warrent a " total packaging " . So therefore, if EMS has arrived on scene, what does it hurt to have the patients checked out and releases signed? Mike Stockton, AAS-EMT Paramedic/Firefighter/Dispatcher Arklatxemt@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2002 Report Share Posted April 5, 2002 I cannot emphasize enough the importance of thorough documentation of informed refusal. Not one in 100 medics does this, and few services have in place a CQI plan to catch these cases and get supplemental docs in a timely fashion. I routinely get called to look at these cases two years later after the process server has dropped " paper " on them, and they then have to deal with all the considerable unpleasantries of defending a lawsuit. And the poor medics may find out, to their utter horror, that their certification or license is laid on the line over it. Remember, that the company or governmental provider has no control over what the certifying/licensing agency does with a medic's license or cert. The company can win the suit or their insurance carrier settle it out of court and the medics still give up their right to practice. Then it's " Goodbye, it's been nice to know ya. " from the company to the medics. Even worse, the medics can be stuck with a judgment against them individually or charged criminally. Your insurance will not cover a criminal defense. And chances are your employer won't either. Learning documentation is not easy, and practicing it religiously takes discipline, professional habit, and lots of thought. But all ought to learn to practice defensive documentation. It doesn't take a rocket scientist to identify most of the cases that have lawsuit potential. Just put yourself on the other side of the picture from yourself and ask yourself what would you and your family do if this happened to you? The time and money invested in a program of " risk management " which would help to improve understanding of good documentation and lawsuit avoidance techniques are minuscule compared to the costs of defending a lawsuit that are not covered by the insurance carrier. These expenses are time lost to depositions, court appearances, emotional wear and tear on the parties, and lots of other tangible and intangible expenses. Gene E. Gandy, JD, LP 4250 East Aquarius Drive Tucson, AZ 85718 520 299-4448 home and fax (call before sending fax) 903 530-9826 cell Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2002 Report Share Posted April 5, 2002 " If an ambulance arrives on scene of a MVA, there are patients, whether or not they choose to seek medical attention at that time or not. " I question the validity of this statement. You are dispatched to an MVA, unknown if it is " major " or a " minor " , you arrive on scene and it turns out to be a fender-bender, little to no damage to the vehicles at all. What makes the arrival of an ambulance on the scene change the status of the occupants of these vehicles to " patients " ?? I am now a police officer full-time, sometimes a caller will call in an accident and not know or give enough information, the MVA is dispatched as an unknown with us (the PD), fire and EMS all responding. I get on scene and it is a " minor " as described above, there are no patients, there is no mechanism of injury to produce a patient. I cancel fire and EMS. If the ambulance shows up, there is still no patients. Before the flames come my way, I began working in EMS in 1987 full time up until I switched to law enforcement, I still work part time in EMS. I am not negating none of the exceptions to what I described above, wierd stuff happens. But if there is not a patient, there is not a patient. This seems like common sense to me. I am quite familiar to court and lawsuits, both in EMS and especially now as a cop. I tell folks who threaten to sue me to take a number these days. I am not closed minded about this, but someone give me a good reason why the belief exists that when we show up in an ambulance, the people involved in whatever we show up on turn magically into patients. Officer Moseley, Licensed Paramedic Cleburne Police Dept. __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2002 Report Share Posted April 5, 2002 , You make some important and valid points. All this stuff about who's a patient and who's not actually turns upon the facts of each case and what's reasonable under the circumstances. It's when the facts turn bad that lawsuits happen. You may say that when somebody says they're going to sue you you say, " Take a number " but I know that you don't actually mean that, or if you do, you haven't yet been through a sufficient number of lawsuits. They're no fun for anyone. I know your department has been through some, so perhaps you're blanked out on the subject, but I doubt it. Medics can do much more than they usually do in preventing lawsuits by adopting a stance which involves at least personal contact with each person on scene and questioning to be sure that no injuries are present and that they are not impaired in some way which would affect their ability to relate an injury. A good medic develops a sixth sense about this and practices defensive documentation. I can give you an example of a case which illustrates the danger of non-medical personnel making a determination that no ambulance is needed. (I'm not talking about you. I know you've got medical training.) I once heard EMS dispatched to a one car accident near Tyler. I was about 2 miles from the scene and it was on my way. I continued there and just before I arrived heard a DPS officer cancel the ambulance since there were no injuries. About then I arrived and saw that a car had run off the road into a ditch and struck a culvert. There was substantial front-end damage to the car but the two occupants were standing up and walking around. I parked and approached everyone, identified myself as a paramedic and asked the trooper if I could check out the people. He said, " Sure. " So I approached them and engaged them in conversation. My first question to them was, " What happened.? " The woman driver said she didn't remember, and her male passenger said, " She had a seizure. " I immediately told the Trooper to tell EMS to continue, but about that time ETMC rolled up on the scene. They had been close and just continued to see what was happening. They transported the driver under their " Patient with Seizures Protocol. " The trooper was not to blame. He was giving out information based upon what he knew, but he was not a trained medical responder. So he made an error in assuming that there was no medical problem there. Bottom line, it's more economical to discourage lawsuits through good practices than to defend them later. It's just good practice to make personal contact with those on the scene and get a medic's view of them. East Texas Medical Center EMS has very strict and definite guidelines about this, and they are quite good at protecting their ass from suits based upon failure to identify a potential patient. I would invite anyone interested to contact their people to find out what their guidelines are. I'm sure they'll share them. Meantime, please, please, please, don't make unreasonable assumptions. Be suspicious of every scene, probe, investigate, and document. This will pay off in increased ability to sleep at night and not have nightmares about the patient who had an epidural and died 30 minutes after you left the scene. Gene E. Gandy, JD, LP 4250 East Aquarius Drive Tucson, AZ 85718 520 299-4448 home and fax (call before sending fax) 903 530-9826 cell Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2002 Report Share Posted April 5, 2002 , I called them " patients " because there really isn't another term that EMS can use to describe these persons. Maybe I should have referred to them as " occupants " . I wasn't implying that they needed medical attention or transport. Either way, I think that once an ambulance arrives on scene, they should sign an informed no-ride. You make a good point here. I agree that in these cases there really wasn't need for an ambulance, but due to the cellular phone revolution, we have to deal with poor initial call information. Subsequently, Fire and EMS personnel are being dispatched to calls that they should not have been sent to. However, once the ambulance arrives on scene, how hard is it to have the occupants sign an " informed refusal " form. I am not advocating " drilling " the " patient " about the call, but simply explaining to them that they " may have injuries " they are not aware of, even in a minor " fender bender " . This may sound ludicrous, and 99.9999% of the time really is not necessary. It's that 0.0001% that may cost a bundle in court later. I can't see that spending a few minutes to complete the form is that inconvenient, especially in this lawsuit happy world we live in. All it will take is 1 lawsuit saved by this documentation to make all the forms pay off. Some " patients " will complain about this process, saying it's not necessary. In my experience, once you explain to them that it's " procedure " or " company policy " they are more than willing to sign the form for you. Just explain to them you are simply doing your job. --- Moseley wrote: > > " If an ambulance > arrives on scene of a MVA, there are patients, > whether > or not they choose to seek medical attention at that > time or not. " > > I question the validity of this statement. > > You are dispatched to an MVA, unknown if it is > " major " > or a " minor " , you arrive on scene and it turns out > to > be a fender-bender, little to no damage to the > vehicles at all. What makes the arrival of an > ambulance on the scene change the status of the > occupants of these vehicles to " patients " ?? > > I am now a police officer full-time, sometimes a > caller will call in an accident and not know or give > enough information, the MVA is dispatched as an > unknown with us (the PD), fire and EMS all > responding. > I get on scene and it is a " minor " as described > above, there are no patients, there is no mechanism > of > injury to produce a patient. I cancel fire and EMS. > > If the ambulance shows up, there is still no > patients. > > Before the flames come my way, I began working in > EMS > in 1987 full time up until I switched to law > enforcement, I still work part time in EMS. I am > not > negating none of the exceptions to what I described > above, wierd stuff happens. But if there is not a > patient, there is not a patient. This seems like > common sense to me. > I am quite familiar to court and lawsuits, both in > EMS > and especially now as a cop. I tell folks who > threaten to sue me to take a number these days. > > I am not closed minded about this, but someone give > me > a good reason why the belief exists that when we > show > up in an ambulance, the people involved in whatever > we > show up on turn magically into patients. > > Officer Moseley, Licensed Paramedic > Cleburne Police Dept. > > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2002 Report Share Posted April 5, 2002 , I couldn't have said it any better myself. Eddie on, EMT-P RE: Fired Paramedics > > " If an ambulance > arrives on scene of a MVA, there are patients, whether > or not they choose to seek medical attention at that > time or not. " > > I question the validity of this statement. > > You are dispatched to an MVA, unknown if it is " major " > or a " minor " , you arrive on scene and it turns out to > be a fender-bender, little to no damage to the > vehicles at all. What makes the arrival of an > ambulance on the scene change the status of the > occupants of these vehicles to " patients " ?? > > I am now a police officer full-time, sometimes a > caller will call in an accident and not know or give > enough information, the MVA is dispatched as an > unknown with us (the PD), fire and EMS all responding. > I get on scene and it is a " minor " as described > above, there are no patients, there is no mechanism of > injury to produce a patient. I cancel fire and EMS. > If the ambulance shows up, there is still no patients. > > Before the flames come my way, I began working in EMS > in 1987 full time up until I switched to law > enforcement, I still work part time in EMS. I am not > negating none of the exceptions to what I described > above, wierd stuff happens. But if there is not a > patient, there is not a patient. This seems like > common sense to me. > I am quite familiar to court and lawsuits, both in EMS > and especially now as a cop. I tell folks who > threaten to sue me to take a number these days. > > I am not closed minded about this, but someone give me > a good reason why the belief exists that when we show > up in an ambulance, the people involved in whatever we > show up on turn magically into patients. > > Officer Moseley, Licensed Paramedic > Cleburne Police Dept. > > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2002 Report Share Posted April 5, 2002 And, I also agree with that statement. Eddie on RE: Fired Paramedics > , > > I called them " patients " because there really isn't > another term that EMS can use to describe these > persons. Maybe I should have referred to them as > " occupants " . I wasn't implying that they needed > medical attention or transport. Either way, I think > that once an ambulance arrives on scene, they should > sign an informed no-ride. > > You make a good point here. I agree that in these > cases there really wasn't need for an ambulance, but > due to the cellular phone revolution, we have to deal > with poor initial call information. Subsequently, > Fire and EMS personnel are being dispatched to calls > that they should not have been sent to. However, once > the ambulance arrives on scene, how hard is it to have > the occupants sign an " informed refusal " form. > > I am not advocating " drilling " the " patient " about the > call, but simply explaining to them that they " may > have injuries " they are not aware of, even in a minor > " fender bender " . This may sound ludicrous, and > 99.9999% of the time really is not necessary. It's > that 0.0001% that may cost a bundle in court later. I > can't see that spending a few minutes to complete the > form is that inconvenient, especially in this lawsuit > happy world we live in. All it will take is 1 lawsuit > saved by this documentation to make all the forms pay > off. > > Some " patients " will complain about this process, > saying it's not necessary. In my experience, once you > explain to them that it's " procedure " or " company > policy " they are more than willing to sign the form > for you. Just explain to them you are simply doing > your job. > > > > > > > --- Moseley wrote: > > > > " If an ambulance > > arrives on scene of a MVA, there are patients, > > whether > > or not they choose to seek medical attention at that > > time or not. " > > > > I question the validity of this statement. > > > > You are dispatched to an MVA, unknown if it is > > " major " > > or a " minor " , you arrive on scene and it turns out > > to > > be a fender-bender, little to no damage to the > > vehicles at all. What makes the arrival of an > > ambulance on the scene change the status of the > > occupants of these vehicles to " patients " ?? > > > > I am now a police officer full-time, sometimes a > > caller will call in an accident and not know or give > > enough information, the MVA is dispatched as an > > unknown with us (the PD), fire and EMS all > > responding. > > I get on scene and it is a " minor " as described > > above, there are no patients, there is no mechanism > > of > > injury to produce a patient. I cancel fire and EMS. > > > > If the ambulance shows up, there is still no > > patients. > > > > Before the flames come my way, I began working in > > EMS > > in 1987 full time up until I switched to law > > enforcement, I still work part time in EMS. I am > > not > > negating none of the exceptions to what I described > > above, wierd stuff happens. But if there is not a > > patient, there is not a patient. This seems like > > common sense to me. > > I am quite familiar to court and lawsuits, both in > > EMS > > and especially now as a cop. I tell folks who > > threaten to sue me to take a number these days. > > > > I am not closed minded about this, but someone give > > me > > a good reason why the belief exists that when we > > show > > up in an ambulance, the people involved in whatever > > we > > show up on turn magically into patients. > > > > Officer Moseley, Licensed Paramedic > > Cleburne Police Dept. > > > > > > __________________________________________________ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2002 Report Share Posted April 5, 2002 Sorry to wander a little off topic, but I am curious if anyone would be willing to send me a copy or description of a no-transport form that they currently use just for MVA's. Currently the service I work for uses one and only one patient report form which is long and quite cumbersome in design. Most " occupants " that I personally have dealt with do not mind the time it takes to speak with you and answer a few questions but our report forms are a little more detailed than is necessary for this type of incident, especially with multiple " occupants " , which is quite frequent in our area. Any help that you could provide would be greatly appreciated. Sorry about the runons...it's been a long week! Ann-Marie Veeck, LP on County EMS RE: Fired Paramedics > , > > I called them " patients " because there really isn't > another term that EMS can use to describe these > persons. Maybe I should have referred to them as > " occupants " . I wasn't implying that they needed > medical attention or transport. Either way, I think > that once an ambulance arrives on scene, they should > sign an informed no-ride. > > You make a good point here. I agree that in these > cases there really wasn't need for an ambulance, but > due to the cellular phone revolution, we have to deal > with poor initial call information. Subsequently, > Fire and EMS personnel are being dispatched to calls > that they should not have been sent to. However, once > the ambulance arrives on scene, how hard is it to have > the occupants sign an " informed refusal " form. > > I am not advocating " drilling " the " patient " about the > call, but simply explaining to them that they " may > have injuries " they are not aware of, even in a minor > " fender bender " . This may sound ludicrous, and > 99.9999% of the time really is not necessary. It's > that 0.0001% that may cost a bundle in court later. I > can't see that spending a few minutes to complete the > form is that inconvenient, especially in this lawsuit > happy world we live in. All it will take is 1 lawsuit > saved by this documentation to make all the forms pay > off. > > Some " patients " will complain about this process, > saying it's not necessary. In my experience, once you > explain to them that it's " procedure " or " company > policy " they are more than willing to sign the form > for you. Just explain to them you are simply doing > your job. > > > > > > > --- Moseley wrote: > > > > " If an ambulance > > arrives on scene of a MVA, there are patients, > > whether > > or not they choose to seek medical attention at that > > time or not. " > > > > I question the validity of this statement. > > > > You are dispatched to an MVA, unknown if it is > > " major " > > or a " minor " , you arrive on scene and it turns out > > to > > be a fender-bender, little to no damage to the > > vehicles at all. What makes the arrival of an > > ambulance on the scene change the status of the > > occupants of these vehicles to " patients " ?? > > > > I am now a police officer full-time, sometimes a > > caller will call in an accident and not know or give > > enough information, the MVA is dispatched as an > > unknown with us (the PD), fire and EMS all > > responding. > > I get on scene and it is a " minor " as described > > above, there are no patients, there is no mechanism > > of > > injury to produce a patient. I cancel fire and EMS. > > > > If the ambulance shows up, there is still no > > patients. > > > > Before the flames come my way, I began working in > > EMS > > in 1987 full time up until I switched to law > > enforcement, I still work part time in EMS. I am > > not > > negating none of the exceptions to what I described > > above, wierd stuff happens. But if there is not a > > patient, there is not a patient. This seems like > > common sense to me. > > I am quite familiar to court and lawsuits, both in > > EMS > > and especially now as a cop. I tell folks who > > threaten to sue me to take a number these days. > > > > I am not closed minded about this, but someone give > > me > > a good reason why the belief exists that when we > > show > > up in an ambulance, the people involved in whatever > > we > > show up on turn magically into patients. > > > > Officer Moseley, Licensed Paramedic > > Cleburne Police Dept. > > > > > > __________________________________________________ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 6, 2002 Report Share Posted April 6, 2002 Gene, You are right, I say " take a number " (actually I don't really say it to folks, just here among us friends) purely tongue in cheek. Lawsuits, or the threat of them, are zero fun anyday. I guess what the point I am trying to make, not very well it seems, is that Joe Blow on the street does not all of a sudden become a patient just because an ambulance shows up on scene. I am refering to instances in which there is no mechanism of injury at all, I mean really minor " minor " MVA's. I cancel EMS and fire before they get there or as they are pulling up, I wave them off. It is a wierd balance for me at times, as others will attest, to balance the cop and paramedic hat when I arrive at some particular call. Sometimes I forget which hat I am currently wearing. Like the time I intubated a patient and caused an engine company major chest pain to see a cop doing such a thing. They told me that they wanted to play with my gun, since I get to play with their toys. I took the hint and just try to be a light or door holder nowadays. If there is the slightest, .00001% chance of possible injury, a contact needs to be made by EMS. I have enough liability as it is, I don't need to put more on me. I think that this a matter of wording, or labeling, that kinda rubs me wrong. When I am stopped at a traffic light and Granny backs out of a driveway into the side of my car, causing little to no damage...I am NOT a patient. In my mind, a patient is one that actually requires care. This probably didn't clear up my point, I just got off a long 10 hour shift (Friday night to boot). Officer Moseley, LP Cleburne PD __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 6, 2002 Report Share Posted April 6, 2002 , I think this does a good job of supplementing your previous post. I knew what you were saying to begin with, but I wanted to make sure that it still clear that, as you say, it's a balancing act and common sense must prevail. I think it's a tremendous help to everyone to have law enforcement officers who are EMTs and Paramedics. Thanks for what you do. Gene E. Gandy, JD, LP 4250 East Aquarius Drive Tucson, AZ 85718 520 299-4448 home and fax (call before sending fax) 903 530-9826 cell Quote Link to comment Share on other sites More sharing options...
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