Guest guest Posted March 26, 2004 Report Share Posted March 26, 2004 I appreciate Steve's comments but must make one clarification. I did not mean to suggest that the changes I prophesied would necessarily do the most good for the most patients. I was merely reciting what I foresee happening, good or bad. I personally would like to see a paramedic or two on every truck everywhere. Also, although I believe that I did say that I understood that I was generalizing, I do want to reiterate that I did not intend to paint all medics in the big city systems as being lazy and incompetent. However, it has been my unfortunate experience to observe substandard and poor practices in the big Texas FD EMS services. I also will say that I took my paramedic training in Houston 23 years ago and that I felt that the standard of care then was excellent. The medics from Houston FD who trained me were topnotch in every way. Apologies to any medic out there in Big D, SA, and Houston who does stand for quality and does the right thing. GG. In a message dated 3/26/2004 8:46:07 AM Central Standard Time, slemming@... writes: I would like to make some brief comments on Gene's original statement. I appreciate his line of thinking in that he believes this would do the most good for the most patients. I agree the rural and frontier areas deserve much attention. This could be started by shifting grant monies from being given to the larger cities. It appears many times that grants are awarded to these larger entities so that it " appears " that they are being fair and not just playing to the volunteer and small community services. Should a large city with millions in its budget be awarded tens of thousands more, or should it go to an all volunteer department trying to scrape by with donations and bake sales and 14 employees? Seems simple to me. I believe that his theory was started after reviewing some of the published studies. We should be careful and not make sweeping changes to our treatment and systems based on the data of one or a few studies. Rather, these things should be surveyed over a period of time and the eventual decision is based on what is right for our patients. Most importantly, the citizenry of your community decides the level of service that you provide. If they wish you to be staffed to the hilt with the most current prehospital practices and highest level of provider, that's what they will pay for. If not, they will run the majority as BLS units with some ALS or MICU units. Be careful in painting the fire based EMS systems with all one brush stroke. I did my paramedic internship in Dallas and can attest partially with what he says. In my station and shift, some could not care less about being on " the box " and went through the motions every shift, but one guy in particular joined the department just so he could be a medic. Needless to say, he was very knowledgeable and professional and took me under his wing to make sure I was learning the proper way. One of the larger issues is developing the smaller and volunteer EMS systems so that higher levels of certification and licensure are there, adequately trained and compensated. Training is one of the first areas to get hit budget-wise and gets side tracked when more important issues arise. Some of the smaller agencies don't have full-time training officers. This oversight is even worse in volunteer departments for the most part. I wholeheartedly agree the EMS Basic skill level should be advanced, but then we as a " profession " should advance as well. Maybe the newly formed TDH or an independent consultant group could mail a questionnaire to every provider in the state to assess staffing levels, certification/licensure, budget, level of care, and critical need. This could also be done anonymously through a website link so that no one would be in fear of speaking " officially " and receiving the wrath of the employer who would try to sugar coat the response. Just my individual thoughts. It's a good road to start on to see where it leads. Who knows maybe we could effect long term change. Lt. Steve Lemming, AAS, LP This e-mail is confidential and intended solely for the use of the individual(s) to whom it is addressed. Any views or opinions presented are solely those of the author and do not necessarily represent those of The City of Azle or its policies. If you have received this e-mail message in error, please phone Steve Lemming (817)444-7108. Please also destroy and delete the message from your computer. For more information on The City of Azle, visit our web site at: < http://azle.govoffice.com/> Trends While driving the West Texas highways as I frequently do, I have lots of time to think. Yes, I know that driving and thinking can be dangerous, but I do it anyway. Yesterday I read the abstract of the new study that shows that trauma patients who were ventilated with BVM did better than those who were endotracheally intubated. So much for intubation of the trauma victim. As more and more evidence based studies come online it becomes more and more apparent that good EMS can be carried on much of the time without Paramedics. Basic EMTs now can use the Combitube, and ought to be using the Combitube, can give Epi 1:1000, NTG, aerosol bronchodilators, and defibrillate with the AED. This leads me to reconsider the deployment of EMTs and Paramedics. Currently, Paramedics are concentrated in large urban areas where scene to hospital transports are likely to be relatively short. There are many fewer Paramedics per capita in the rural and frontier areas. The big city Paramedics, at least in the case of Houston, San , and Dallas, are fire service based. These fire services have been notoriously poor at motivating Paramedics toward improved educational standards and improved standard of care. The existing culture in FD EMS, particularly the larger ones, is that medics are 2nd class citizens to firefighters, and are either doing penance in Hell for sins committed or going through the prescribed years of Purgatory on their way to a better life as a full time firefighter. [i would be afraid of being tarred and feathered, drawn and quartered, beaten, shot, burned, and hanged by some of those medics for making those statements except for the fact that there are no medics from any of the large fire departments who take part in this list. So they'll never know. ] Big city FD medics do not seek to improve their knowledge base as a rule, do not seek to improve or expand their clinical skills, and don't want a wider scope of practice. And why should they? They're so close to good hospitals that unless they follow the California model of sitting on the scene while starting IVs and giving their patients manicures and pedicures prior to transport, they seldom get to do the advanced skills that they now know how to do. Therefore, it makes sense to seriously restrict the number of Paramedics in those services. EMTs with an AED, a Combitube, a Geezer Squeezer and a mindset for immediate transport can do just about all that's necessary for those patients who are going to survive. If the AED works, flying squad Paramedics arrive to give the antidysrhythmics if the scene is more than 8 minutes from the nearest hospital, or after defibrillating, the EMTs scoop and haul and get them into an ER within that time. For those where the AED doesn't work, load and go, do the Combitube and Geezer Squeezer enroute and get them to the hospital where they can properly be pronounced dead. Paramedics in the flyers would not be firefighters at all, would be a different category of worker assigned as 3rd service liaison to the fire service, would have advanced training, and because there would be relatively few of them, they would get to do their advanced stuff often enough to stay in practice. Their training would be similar to the Australian model which is about 5 times more comprehensive than most Paramedic education/training in this country. Paramedics would be sent to calls where medical skills are needed, where pharmacology will make a difference and IV access is needed, and where complicated dysrhythmias are going on and the patient is beyond the selected txp time to hospital. Paramedics would be deployed around the perimeters rather in the center of the city so that they could run both in and out. Their deployment would be mostly limited to call locations where transports to hospital would be more than a few minutes. Fire services would send nobody to Paramedic school, but they might add IV access by saline lock to the basic skills, thereby often having access immediately available either to responding Paramedics or to hospital ER pe rsonnel. Much training money would be saved and EMTs could be rotated on and off the ambulances much more easily since their skills sets would be less. EMTs have always had great extrication, lifting and moving, and other basic skills. There would be no need for them to worry about going much further than that. Thus, the Paramedic concentration would shift from city where it is not needed, to country, where it is. Rural services have a much greater need for Paramedics with advanced assessment, diagnostic, and clinical skills than are usually needed in large cities, simply because they are often looking at transport times of anywhere from half an hour at best to 2 or 3 hours. Much more pharmacology is used by those medics, and although they do not get as many calls as big city medics, the calls they do get tend to more likely be seriously sick people. Therefore Paramedics are needed more in the rural areas. The rural paramedics I know are by and large a lot better educated and better practitioners than the large city FD Paramedics I have witnessed in action. They HAVE to be better because they've got their patients for a Loooooong time and they are apt to be Reeeeally sick. Most of the rural medics I know study relentlessly, spend lots of time between calls looking up cool EMS stuff on the Internet and talking over calls. They are more interested in their patients because they are not as fatigued every shift and not as burnt out. They also may know their patients as neighbors, which is a powerful incentive for excellence. Yes, exceptions always exist, and generalities are dangerous, but generally speaking I think many will agree with me. So, in sum, I predict that in the next 10 years we'll see a redistribution of Paramedics from city center to rural areas, and most big city services will revert to mostly Basic EMT staffing. Rural areas will finally find a way to fund better services when governments get on top of the learning curve and figure it out. Rural EMS costs a pittance of what big cities spend. Your thoughts? Mr. Grady Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2004 Report Share Posted March 27, 2004 Most do, that's your medical director's license that he/she spent 11+ years getting.... You should NEVER " no load " anyone you've administered meds to, if their BS is dropped so low that they can't correct it themselves, there's a good chance that there's an underlying reason that needs follow up care. We may perform a lot of the same functions that ER doctors do, but we don't have the education or the resources (lab, CT, X-ray) that they do. That's why they get the big bucks and we don't. If you want to be able to make decisions like a doctor, then spend the time, money and effort, and go to med school like they did. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2004 Report Share Posted March 27, 2004 In a message dated 3/27/2004 11:52:38 AM Central Standard Time, hatfield@... writes: We need to be able to explain to our patients that there is not a need to be seen in the ER right now, this could just as easily be followed up at your Dr.'s office in the morning. If our assessment skills are strong, if our decision making skills are good, than we can help alleviate some strain on overburdened EMS systems, as well as the overburdened ER's. IF you're talking about stubbed toes, that's fine. But if you're wrong, there can be serious consequences. I can agree that both EMS systems and ERs alike are overburdened by people using EMS as a taxi service or the " if I go in by ambulance I'll get taken back right away and seen quicker " mentality and using the ER as their PCP, but that's when the ER and EMS personnel need to get together and set forth guidelines and standards for " no loading. " Once a pt has been seen & evaluated by a doctor in the ER, he reserves the right to tell them that they're not going to die in the next 24 hours, so they need to f/u with their PCP. But there again, he has the education & malpractice insurance to be able to do that. Besides if they turned them away at the triage desk telling them that their complaint was BS, then it's an EMTALA violation. You figure EMTALA came around because too much of that was happening. Do we really want some type of EMTALA laws regulating EMS? It would be much easier to be practical. If it's a foot pain that started 4 months ago at 2 am thing, feel free to offer up your opinion that they'd be better served by their PCP, if you're having to give Xopenex for SOB, err on the side of caution and take them in. It's better than being called back 2 hours later when they're in respiratory arrest. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2004 Report Share Posted March 27, 2004 What if it's not a case of failure to eat or take insulin? Hypoglycemia, also called low blood sugar, occurs when your blood glucose (blood sugar) level drops too low to provide enough energy for your body's activities. Hypoglycemia is uncommon except as a side effect of diabetes treatment, but it can result from other medications or diseases, hormone or enzyme deficiencies, or tumors. Can you diagnose that in the field? Are you really willing to take the chance??? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2004 Report Share Posted March 27, 2004 In a message dated 3/27/2004 2:33:05 PM Central Standard Time, mpate1104@... writes: I'm a little curious as to how you " mandate " that these patients be transported. If you have an alert, well-oriented adult patient who has been informed of the risks (and who may very well understand his illness just as well, or better, than you do), and that patient chooses to not go to the ER, how do you " mandate " that he go? Maxine Pate ----- Original Message ----- From: Salvador Capuchino Jr What if your D50 pt's BS drops again after you leave? What if your Epi pt goes into PSVT or worse? Our company mandates that everyone who receives a medication be transported to ER for f/u care/tx. If you have an alert, oriented pt who wants to refuse and hasn't been given any meds, then let them. A lot of Medical Directors mandate as Salvador says that your pt understand that if they're given meds, they're taking a ride. Because it's their license, they don't want to leave that decision making to you. For them Meds=Transport. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2004 Report Share Posted March 27, 2004 What if your D50 pt's BS drops again after you leave? What if your Epi pt goes into PSVT or worse? Our company mandates that everyone who recieves a medication be transported to ER for f/u care/tx. TRENDS Question: Does everyone transport every patient you medicate to the ER? 25 g of D50-patient is now A & Ox4, just got a little out of whack. Breathing treatment with 0.3 mg of epi. Patient A & Ox4, lungs clear, O2 98%. Do all of these patients need to go to the ER? Some patients call because their car is broke, ran out of meds, or some other problem. They all should get the same assessment and care but do they need transport to back log an already understaffed ER? If we could use the doc-in-the-box clinics and return the ER to what it is supposed to be the world would be rosy. Thoughts? Barry Meffert Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2004 Report Share Posted March 27, 2004 Guess I have the same question. Especially when in comes to your hypoglycemic patients, you push the D50 and they come around. Most don't want to go to the hospital after that. It is a condition they have had for years and understand completely. How can you force a patient to get in the box if they don't want to. And furthermore why would you want to. As long as they are A & Ox4 and understand the risks involved, it is their choice regardless of the interventions you have already started. Quinten FF/NREMTP Re: TRENDS In a message dated 3/27/2004 2:33:05 PM Central Standard Time, mpate1104@... writes: I'm a little curious as to how you " mandate " that these patients be transported. If you have an alert, well-oriented adult patient who has been informed of the risks (and who may very well understand his illness just as well, or better, than you do), and that patient chooses to not go to the ER, how do you " mandate " that he go? Maxine Pate ----- Original Message ----- From: Salvador Capuchino Jr What if your D50 pt's BS drops again after you leave? What if your Epi pt goes into PSVT or worse? Our company mandates that everyone who receives a medication be transported to ER for f/u care/tx. If you have an alert, oriented pt who wants to refuse and hasn't been given any meds, then let them. A lot of Medical Directors mandate as Salvador says that your pt understand that if they're given meds, they're taking a ride. Because it's their license, they don't want to leave that decision making to you. For them Meds=Transport. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2004 Report Share Posted March 27, 2004 I understand that your company mandates it, but what does your medical director say, (personal opinion) it may be the same, not trying to pick things apart, I am merely curious to know if your Med. Dir. Also believes that every patient who receives any medication from EMS needs to be transported. If it is solely the belief of your company, than one could reason that it is a financial only decision, or at least based mostly on financial reasons. While there are some instances that require a patient to be transported, there are an equal number who don't need it. You cannot categorize all into either side of the debate. I can't count the number of patients anymore who I gave D50 to, wait for a bit, reassess, and then bug out. Same with Albuterol/Atrovent/Xopenex breathing treatments. To me, this is what we need to become to some degree. We need to be an extension of our physicians; we need to be the liaison between the patient and the ER, not just the method of transportation. We need to be able to explain to our patients that there is not a need to be seen in the ER right now, this could just as easily be followed up at your Dr.'s office in the morning. If our assessment skills are strong, if our decision making skills are good, than we can help alleviate some strain on overburdened EMS systems, as well as the overburdened ER's. From: Salvador Capuchino Jr What if your D50 pt's BS drops again after you leave? What if your Epi pt goes into PSVT or worse? Our company mandates that everyone who recieves a medication be transported to ER for f/u care/tx. From: ultrahog2001@... Does everyone transport every patient you medicate to the ER? 25 g of D50-patient is now A & Ox4, just got a little out of whack. Breathing treatment with 0.3 mg of epi. Patient A & Ox4, lungs clear, O2 98%. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2004 Report Share Posted March 27, 2004 Not here to criticize anyone's company or policies but that seems to be a bad way to treat patients. If I take a blood sugar and it is to low for the machine to pick-up I push the D50 then and there. Not wait for the time it takes to get them on a stretcher and on the unit. (Takes a while to move a 300pound patient in some cases) If the patient comes around and says they don't want to go and they are fully aware of the risks, I notify my ER Doc on duty, get signatures and move on to the next call. I don't think I have ever told anyone that they can just go AMA if they get tired of being in the ER. Re: TRENDS Hint: Load and Go. Initiate treatment in the bus while enroute. Most of the time we tell them they can sign out AMA at the ER on arrival. Re: TRENDS In a message dated 3/27/2004 2:33:05 PM Central Standard Time, mpate1104@... writes: I'm a little curious as to how you " mandate " that these patients be transported. If you have an alert, well-oriented adult patient who has been informed of the risks (and who may very well understand his illness just as well, or better, than you do), and that patient chooses to not go to the ER, how do you " mandate " that he go? Maxine Pate ----- Original Message ----- From: Salvador Capuchino Jr What if your D50 pt's BS drops again after you leave? What if your Epi pt goes into PSVT or worse? Our company mandates that everyone who receives a medication be transported to ER for f/u care/tx. If you have an alert, oriented pt who wants to refuse and hasn't been given any meds, then let them. A lot of Medical Directors mandate as Salvador says that your pt understand that if they're given meds, they're taking a ride. Because it's their license, they don't want to leave that decision making to you. For them Meds=Transport. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2004 Report Share Posted March 27, 2004 What further care will be provided in an ED for a patient that failed to take his/her insulin or failed to eat at the appropriate time or any of the other routine cases that we see daily in the diabetic patient. It is not playing MD it is Paramedicine Technology. We should be a true extension of the physician and emergency department not merely a mode of transportation. There are times when the ED needs to be taken to the patient and there are times when the patients needs to be taken to the ED. Just my thoughts, , LP Re: TRENDS Most do, that's your medical director's license that he/she spent 11+ years getting.... You should NEVER " no load " anyone you've administered meds to, if their BS is dropped so low that they can't correct it themselves, there's a good chance that there's an underlying reason that needs follow up care. We may perform a lot of the same functions that ER doctors do, but we don't have the education or the resources (lab, CT, X-ray) that they do. That's why they get the big bucks and we don't. If you want to be able to make decisions like a doctor, then spend the time, money and effort, and go to med school like they did. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2004 Report Share Posted March 27, 2004 Actually, the literature has shown that it relatively safe to administer D50W to a hypoglycemic and allow the patient to refuse transport. The same holds true with heroin addicts in Australia. Usually, paramedics will administer naloxone, wake them up and allow them to refuse transport. Several studies have looked at long-term follow-up of these two sub-groups and found them safe for treat and release. BEB Re: TRENDS Most do, that's your medical director's license that he/she spent 11+ years getting.... You should NEVER " no load " anyone you've administered meds to, if their BS is dropped so low that they can't correct it themselves, there's a good chance that there's an underlying reason that needs follow up care. We may perform a lot of the same functions that ER doctors do, but we don't have the education or the resources (lab, CT, X-ray) that they do. That's why they get the big bucks and we don't. If you want to be able to make decisions like a doctor, then spend the time, money and effort, and go to med school like they did. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2004 Report Share Posted March 27, 2004 I'm a little curious as to how you " mandate " that these patients be transported. If you have an alert, well-oriented adult patient who has been informed of the risks (and who may very well understand his illness just as well, or better, than you do), and that patient chooses to not go to the ER, how do you " mandate " that he go? Maxine Pate ----- Original Message ----- From: Salvador Capuchino Jr What if your D50 pt's BS drops again after you leave? What if your Epi pt goes into PSVT or worse? Our company mandates that everyone who recieves a medication be transported to ER for f/u care/tx. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2004 Report Share Posted March 27, 2004 If it's not, then you would have found that in your assessment. Or if it is in association with other issues, you would have found that as well, either through the patient or family members. If the patient remains with an altered LOC, there is no way to obtain a reputable history, therefore they go. Point is, you cannot group all patients together, there are some Diabetics that you can 'fix' and leave at home, same with asthma patients, and a myriad of other ailments. That's the key here, a THOROUGH assessment, not a finger prick, an amp of D50, another finger prick, then out the door. No different than one breathing treatment, no matter what flavor, then out the door. A thorough assessment followed by an appropriate treatment, followed by another assessment. Then you make a decision, with the patient as to the necessity of transportation vs. follow up with their own physician. Am I willing to diagnose a tumor in the field, of course not, am I willing to administer D50 or a breathing treatment in the field, then let the patient make an informed decision as to taking an ambulance to the ER after I do an assessment? Sure, I do it now. When in doubt, I transport. I have to rely on my knowledge, what I learned in school, what I learned on the streets, and what countless old timers have taught me. Mike Re: TRENDS What if it's not a case of failure to eat or take insulin? Hypoglycemia, also called low blood sugar, occurs when your blood glucose (blood sugar) level drops too low to provide enough energy for your body's activities. Hypoglycemia is uncommon except as a side effect of diabetes treatment, but it can result from other medications or diseases, hormone or enzyme deficiencies, or tumors. Can you diagnose that in the field? Are you really willing to take the chance??? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2004 Report Share Posted March 27, 2004 How very true. What's going to happen if you " stay & play " and pushing D50 doesn't work? Or you push too much and they go from 40 to 240? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2004 Report Share Posted March 27, 2004 In a message dated 3/27/2004 4:31:41 PM Central Standard Time, hatfield@... writes: 2) the fact that a service states that you will be " turned in to TDH for decert procedures by the MD for practicing medicine without a license " for explaining and giving the patient the ability to decide on their own medical care. I am quite sure that Wes and/or Gene will chime in if I am wrong, but I have to say with regards to the latter " That's the biggest line of s*** I have heard for a long time. " It may be a line of bs when it comes to our opinion, but as I said before, you're practicing under THEIR license. If they've clearly stated in their protocols that if you push meds, you take a ride, and you don't get the proper documentation (a lot of medical directors want you to call them or secondary medical control to get " permission " ) and follow their rules, they can and will yank your patch. Especially in private services. They are there to make money, no ride, no money. It's 1/2 medicine, 1/2 politics. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2004 Report Share Posted March 27, 2004 Was not trying to give a 'cookbook' problem and answer. Just wanted to point that telling a patient to go AMA when they get in the ER is not good patient care. And we should not transport just for the sake of transporting so we can make money of the call. When a patient makes a rational decision not to go to the hospital we should listen and not think about how much money our CEO is losing out on. OK I am off my soapbox for the night. Quinten FF/EMT-P Re: TRENDS How very true. What's going to happen if you " stay & play " and pushing D50 doesn't work? Or you push too much and they go from 40 to 240? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2004 Report Share Posted March 27, 2004 Was not trying to give a 'cookbook' problem and answer. Just wanted to point that telling a patient to go AMA when they get in the ER is not good patient care. And we should not transport just for the sake of transporting so we can make money of the call. When a patient makes a rational decision not to go to the hospital we should listen and not think about how much money our CEO is losing out on. OK I am off my soapbox for the night. Quinten FF/EMT-P Re: TRENDS How very true. What's going to happen if you " stay & play " and pushing D50 doesn't work? Or you push too much and they go from 40 to 240? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2004 Report Share Posted March 27, 2004 I do strongly agree with you on that. However, our CEO has said that refusals need to stop. That we are practicing medicine by telling a pt that he/she does not need to go. The COO has said that anyone who is heard saying this will be turned in to TDH for decert procedures by the MD for practicing medicine without a license. Also comments have been made and reading between the lines...transport is recommended in every case due to financial reasons. We are getting paid to do a job (transport pts). If we are not bringing in income, then why should we get paid. I tend to agree to some part, but yes I see that a stubbed toe at midnight with the bed is no reason to go to the ER. RE: TRENDS I understand that your company mandates it, but what does your medical director say, (personal opinion) it may be the same, not trying to pick things apart, I am merely curious to know if your Med. Dir. Also believes that every patient who receives any medication from EMS needs to be transported. If it is solely the belief of your company, than one could reason that it is a financial only decision, or at least based mostly on financial reasons. While there are some instances that require a patient to be transported, there are an equal number who don't need it. You cannot categorize all into either side of the debate. I can't count the number of patients anymore who I gave D50 to, wait for a bit, reassess, and then bug out. Same with Albuterol/Atrovent/Xopenex breathing treatments. To me, this is what we need to become to some degree. We need to be an extension of our physicians; we need to be the liaison between the patient and the ER, not just the method of transportation. We need to be able to explain to our patients that there is not a need to be seen in the ER right now, this could just as easily be followed up at your Dr.'s office in the morning. If our assessment skills are strong, if our decision making skills are good, than we can help alleviate some strain on overburdened EMS systems, as well as the overburdened ER's. From: Salvador Capuchino Jr What if your D50 pt's BS drops again after you leave? What if your Epi pt goes into PSVT or worse? Our company mandates that everyone who recieves a medication be transported to ER for f/u care/tx. From: ultrahog2001@... Does everyone transport every patient you medicate to the ER? 25 g of D50-patient is now A & Ox4, just got a little out of whack. Breathing treatment with 0.3 mg of epi. Patient A & Ox4, lungs clear, O2 98%. ------------------------------------------------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2004 Report Share Posted March 27, 2004 , I think what Maxine is talking about, (I am sure she will correct me if I'm wrong)is that if the patient is alert and oriented, he/she clearly has the option and the legal right to tell you " I don't want to go. " How then can you mandate that you take them? Maxine, do I have that right? On a side note with regards to making your patient understand that if they are given meds, they have to go, how do you explain to a patient with a blood sugar of 40, giving you the 1000 yard stare, and oblivious to the world around them, " Maam, we are going to give you medications, and if we give them to you, we MUST take you to the hospital " , if they have a blood sugar of 40, they are in no condition to make a decision, therefore we treat under implied consent, with a blood sugar of 120, alert and oriented, and under informed consent, they tell you to p*** off and leave you alone, your mandate means nothing to them. The next time you go, you could well load them first, and hold off on the D50 till you get outside the ER, and run like hell to get them inside before they wake up, or, you could say that since they didn't cooperate with your mandate (I have used that word for lack of a better term) you aren't going to give them anything. I always give the speech about, " The next time I come out here for the same thing, we all have to be in agreement that you are gonna go with us, agreed? " They usually do. Mike Re: TRENDS In a message dated 3/27/2004 2:33:05 PM Central Standard Time, mpate1104@... writes: I'm a little curious as to how you " mandate " that these patients be transported. If you have an alert, well-oriented adult patient who has been informed of the risks (and who may very well understand his illness just as well, or better, than you do), and that patient chooses to not go to the ER, how do you " mandate " that he go? Maxine Pate ----- Original Message ----- From: Salvador Capuchino Jr What if your D50 pt's BS drops again after you leave? What if your Epi pt goes into PSVT or worse? Our company mandates that everyone who receives a medication be transported to ER for f/u care/tx. If you have an alert, oriented pt who wants to refuse and hasn't been given any meds, then let them. A lot of Medical Directors mandate as Salvador says that your pt understand that if they're given meds, they're taking a ride. Because it's their license, they don't want to leave that decision making to you. For them Meds=Transport. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2004 Report Share Posted March 27, 2004 You can scare them into going. And although it may be lying, what can I really do to keep admin off my back? Re: TRENDS In a message dated 3/27/2004 2:33:05 PM Central Standard Time, mpate1104@... writes: I'm a little curious as to how you " mandate " that these patients be transported. If you have an alert, well-oriented adult patient who has been informed of the risks (and who may very well understand his illness just as well, or better, than you do), and that patient chooses to not go to the ER, how do you " mandate " that he go? Maxine Pate ----- Original Message ----- From: Salvador Capuchino Jr What if your D50 pt's BS drops again after you leave? What if your Epi pt goes into PSVT or worse? Our company mandates that everyone who receives a medication be transported to ER for f/u care/tx. If you have an alert, oriented pt who wants to refuse and hasn't been given any meds, then let them. A lot of Medical Directors mandate as Salvador says that your pt understand that if they're given meds, they're taking a ride. Because it's their license, they don't want to leave that decision making to you. For them Meds=Transport. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2004 Report Share Posted March 27, 2004 Hint: Load and Go. Initiate treatment in the bus while enroute. Most of the time we tell them they can sign out AMA at the ER on arrival. Re: TRENDS In a message dated 3/27/2004 2:33:05 PM Central Standard Time, mpate1104@... writes: I'm a little curious as to how you " mandate " that these patients be transported. If you have an alert, well-oriented adult patient who has been informed of the risks (and who may very well understand his illness just as well, or better, than you do), and that patient chooses to not go to the ER, how do you " mandate " that he go? Maxine Pate ----- Original Message ----- From: Salvador Capuchino Jr What if your D50 pt's BS drops again after you leave? What if your Epi pt goes into PSVT or worse? Our company mandates that everyone who receives a medication be transported to ER for f/u care/tx. If you have an alert, oriented pt who wants to refuse and hasn't been given any meds, then let them. A lot of Medical Directors mandate as Salvador says that your pt understand that if they're given meds, they're taking a ride. Because it's their license, they don't want to leave that decision making to you. For them Meds=Transport. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2004 Report Share Posted March 27, 2004 Also our refusal rate was pretty high after midnite. So now, if you get a refusal or get cancelled enroute, you are still up for the next call. And you will continue to be until you transport. Re: TRENDS In a message dated 3/27/2004 2:33:05 PM Central Standard Time, mpate1104@... writes: I'm a little curious as to how you " mandate " that these patients be transported. If you have an alert, well-oriented adult patient who has been informed of the risks (and who may very well understand his illness just as well, or better, than you do), and that patient chooses to not go to the ER, how do you " mandate " that he go? Maxine Pate ----- Original Message ----- From: Salvador Capuchino Jr What if your D50 pt's BS drops again after you leave? What if your Epi pt goes into PSVT or worse? Our company mandates that everyone who receives a medication be transported to ER for f/u care/tx. If you have an alert, oriented pt who wants to refuse and hasn't been given any meds, then let them. A lot of Medical Directors mandate as Salvador says that your pt understand that if they're given meds, they're taking a ride. Because it's their license, they don't want to leave that decision making to you. For them Meds=Transport. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2004 Report Share Posted March 27, 2004 If I have an alert, oriented patient who chooses to refuse, whether he has been given meds or not, I have to let him. Even if he agreed to transport prior to the meds, and then changes his mind after the meds, I have no choice but to let him, as an alert and well-oriented adult cannot legally be transported against his will. Would a person who was not oriented prior to the meds (as in the hypoglycemic patient) even understand what he is agreeing to when you tell him that he has to be transported after the meds? If he doesn't understand, is his agreement binding even after he becomes well-oriented? I understand the need for caution. I understand that a proper assessment and reassessment is critical. I understand the need to make sure that the patient is making an informed decision. I understand the need for complete and accurate documentation. But I sure don't understand how anyone can " mandate " that a well-oriented adult patient be transported, whether he wants to go or not. I know that if I'm that patient and you're that medic and I say I'm not going, then you're not taking me, no matter what your department or your Medical Director says. And that's a decision that hasn't been made by the medic--it's a decision that has been made by me, the patient. Patients do have that right. Maxine Pate > > If you have an alert, oriented pt who wants to refuse and hasn't been given > any meds, then let them. A lot of Medical Directors mandate as Salvador says > that your pt understand that if they're given meds, they're taking a ride. > Because it's their license, they don't want to leave that decision making to you. > For them Meds=Transport. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2004 Report Share Posted March 27, 2004 Private. Re: TRENDS In a message dated 3/27/2004 2:33:05 PM Central Standard Time, mpate1104@... writes: I'm a little curious as to how you " mandate " that these patients be transported. If you have an alert, well-oriented adult patient who has been informed of the risks (and who may very well understand his illness just as well, or better, than you do), and that patient chooses to not go to the ER, how do you " mandate " that he go? Maxine Pate ----- Original Message ----- From: Salvador Capuchino Jr What if your D50 pt's BS drops again after you leave? What if your Epi pt goes into PSVT or worse? Our company mandates that everyone who receives a medication be transported to ER for f/u care/tx. If you have an alert, oriented pt who wants to refuse and hasn't been given any meds, then let them. A lot of Medical Directors mandate as Salvador says that your pt understand that if they're given meds, they're taking a ride. Because it's their license, they don't want to leave that decision making to you. For them Meds=Transport. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2004 Report Share Posted March 27, 2004 Now well, of course it depends on every situation. We all know that not every call is the same. If blood sugar is too low, then I treat on-scene. If pt is too heavy for rapid load and go, then I treat on scene. I do believe everyone knows the difference. Sorry to make you assume I treat otherwise. Re: TRENDS In a message dated 3/27/2004 2:33:05 PM Central Standard Time, mpate1104@... writes: I'm a little curious as to how you " mandate " that these patients be transported. If you have an alert, well-oriented adult patient who has been informed of the risks (and who may very well understand his illness just as well, or better, than you do), and that patient chooses to not go to the ER, how do you " mandate " that he go? Maxine Pate ----- Original Message ----- From: Salvador Capuchino Jr What if your D50 pt's BS drops again after you leave? What if your Epi pt goes into PSVT or worse? Our company mandates that everyone who receives a medication be transported to ER for f/u care/tx. If you have an alert, oriented pt who wants to refuse and hasn't been given any meds, then let them. A lot of Medical Directors mandate as Salvador says that your pt understand that if they're given meds, they're taking a ride. Because it's their license, they don't want to leave that decision making to you. For them Meds=Transport. Quote Link to comment Share on other sites More sharing options...
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