# Can Medics be wrong?



## Jon (Aug 25, 2008)

The topic came up in another thread that perhaps ALS isn't always right, and sometimes they do things that are wrong in front of us.

What if a medic is preforming an ALS-level skill in front of "you" a hypothetical BLS provider who for some reason knows the procedure is wrong... like large bore IV's in the hands out of "spite".

What do you do?


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## Hastings (Aug 25, 2008)

Jon said:


> The topic came up in another thread that perhaps ALS isn't always right, and sometimes they do things that are wrong in front of us.
> 
> What if a medic is preforming an ALS-level skill in front of "you" a hypothetical BLS provider who for some reason knows the procedure is wrong... like large bore IV's in the hands out of "spite".
> 
> What do you do?



Purposely doing something to harm the patient? Keep quiet until you can *tell a supervisor ASAP*.

Doing something you believe is incorrect? Well, as a Paramedic myself...

As long as it's not placing the patient in danger, don't question me in front of the patient or bystanders. In a respectful way, ask me *WHY* I did things as I did them AFTER the call is over and we're in private. Phrase it in a "desire to learn" manner. Be respectful. Don't tell me I did something wrong. Accept that there may be alternative ways of doing things. 

If it is causing risk to the patient however, find a VERY diplomatic (and more so, subtle) way of asking me about it. Do not confront me in front of the patient or bystanders. I am wrong sometimes. Tread lightly, be respectful, be subtle. As long as you act in that manner, I am very open to hearing your opinion on how something may be done in a better way.


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## Ridryder911 (Aug 25, 2008)

Me do something worng?... You'r kidding?.. 

Seriously, I make mistakes everyday. I hope & pray that they will not cause harm or injure anyone, with saying that remember it is a team effort. If your leader goes down, so do you. There is not a "my patient' rather it is "our patient". There maybe times I may have missed something in the history, or did not see witness something, or even just blindly got tunnel vision and started heading down the wrong path. As well, as alike some of the others posted, maybe I was just being a rear end (hey! It happens, were all human). 

Hopefully, my EMT has learned to discreetly inform me, let me know or give me hint. I much rather have my pride or ego bruised than to allow harm or do wrong. We all screw up .. and anyone that says differently is either a liar or is very, very dangerous. 

My new saying is : " _They say you learn from the stupid mistakes you have made, in that case I must be very bright!"_

Again, hopefully the mistakes we make are minor and are few. With time we have learned off ours and observing others. Unlike other professions are mistakes can be costly so we have to be extra cautious. No one is exempt...

R/r 911


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## MJordan2121 (Aug 25, 2008)

Well put RidRyder


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## Sasha (Aug 25, 2008)

Jon said:


> What if a medic is preforming an ALS-level skill in front of "you" a hypothetical BLS provider who for some reason knows the procedure is wrong... like large bore IV's in the hands out of "spite".
> 
> What do you do?



That is malpractice. Properly report it ASAP.


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## emt19723 (Aug 25, 2008)

Jon said:


> The topic came up in another thread that perhaps ALS isn't always right, and sometimes they do things that are wrong in front of us.
> 
> What if a medic is preforming an ALS-level skill in front of "you" a hypothetical BLS provider who for some reason knows the procedure is wrong... like large bore IV's in the hands out of "spite".
> 
> What do you do?



how am I as a BLS provider going to KNOW that what my Medic is doing is wrong, unless it is so blatant that it would spit on you, or you been running BLS so long that you totally know every ALS protocol and you just dont want to be a Medic?

ok, yeah, ive definitely had quite a few pts that were ignorant and whatnot, but i would also like to think that my medics around here would be more professional than that. I would have to go along and say that if a medic did something and i didnt understand, i would approach him in a respectful way and say something to the extent of......why did you do this this way? or....could we have done it this way....? 
and depending on the response i got would dictate if any action would be required. if i got an intelligent, sensible answer.....it ends there. if i would get something like..."oh, just because..." or "the pt was being an a--hole..."  yeah, then Medical Command would definitely be getting involved.


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## Sasha (Aug 25, 2008)

My B. Not malpractice, malfeasance.

And one does not have to be a medic to know that IVs in the hands hurt. One also does not have to be a medic to know that large bore IVs hurt, and if an EMT is working with a medic long enough, they would start to learn when a large bore IV is appropriate. 

It is never OK to intentionally cause the patient more discomfort because you don't like them. I hate when I hear medics make the joke "Oh he ticked me off so he got a 16 instead of an 18". Not funny. Do your job, do it right.


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## Ridryder911 (Aug 25, 2008)

Sasha said:


> That is malpractice. Properly report it ASAP.



Actually, this is NOT malpractice or negligence. I have started large bore IV's in the dorsum of the hand for trauma patients, so the event itself is not wrong just the intent. 

There is a practice of deterrence medicine that is practiced and is a fine line of ethical behavior. Such as placing an NG tube, catheter, IV's (which is all considered treatment) especially on first time OD's, youth, that are rather exhibiting attention seeking behavior and not suicidal ideologies. After treating, I have had many youth exclaim and tell others to never attempt such... I will only perform such from recommendation or orders of a physician. 

The main problem with this call is that the medic became angered at the patient. In which I really do understand. If no one understands that or attempts that they themselves have never have not been calloused or maybe rougher than usual to certain patients, then they are either lying or never responded to many calls. It is when one goes over the line as in this case. 

The partner (no matter what level) should discuss the action that occurred with the medic. If one feels that it will not be corrected or feels that further action should occur contact the Supervisor. That is what the Supervisor is there for. 

R/r 911


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## Sasha (Aug 25, 2008)

You are correct _if_ starting large bore IVs on that patient was a reasonable and appropriate action, and _if_ the medic would have done the same to a similar patient who had not ticked him off, then it was not negligence.

I know quite a few medics who have been in the business longer than I have been alive, great medics, and have never once observed them or heard about them being unnecessairly rough with any patient, no matter if the patient has threatened them, yanked out IVs, been an AIDS/HIV patient who tried to intentionally bite them/expose them to the infected fluids and called them everything but a child of god.

Causing harm to your patient because they have pissed you off is not appropriate and if you feel the need to do so then maybe you should take a look at why you're in the field and reconsider your career choice.


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## MedicPrincess (Aug 25, 2008)

Sasha said:


> I know quite a few medics who have been in the business longer than I have been alive, great medics, and have never once observed them or heard about them being unnecessairly rough with any patient, no matter if the patient has threatened them, yanked out IVs, been an AIDS/HIV patient who tried to intentionally bite them/expose them to the infected fluids and called them everything but a child of god.


 
It happens.  To everyone.  If you haven't seen it, you haven't been around very long.  If you haven't heard them talk about it, it because its not everyday open conversation.  Make a point to ask them if they have ever put a 14g in someone because they were drunk/beligerant/violent/ect.  Or have they ever inserted an NPA in a pt that they knew was faking unconscious, just because they can.  Or some other form of creative "painful" stimulus.  

I am known for my "Eating Butterflies, pooping Rainbows" theres a bright side to everything alwasy smiling attitude.  And when someone does push the right buttons, the people I work with are often surprised when I am not as pleasent as my norm.

As for what to do if I am.... w.. wr...wr...wro...  Yea.. I can't even say it 

My partner knows, and has seen it from me when dealing with other Paramedics, that unless what is happening is going to actually cause the patient additional harm... or in one recent case.... the actions are going to actually kill the patient....  there is a time and place to ask questions and correct.  

If my partner is going to attempt to correct my or question what I am doing in front of other providers or a physician, they had better make sure their correction is 110% correct.  I once had an EMT interrupt my report to the trauma team on an intubated trauma patient.  She started with "thats not what happened....." and continued.  She wasn't even close to the events.  When she took a breath, I sent her out of the room, apologized for her, and continued on with the accurate report.  When I finished and met her back at the truck, we came to an understanding that will never happen again.

It is possible for me to be wrong.  Sure.....  After all, there is a town call Hell, and it does snow there...  J/K.  

The point is, we all need to understand there is a time and place for everything.  And 99% of the time, embarassing your partner (either EMT to Medic.... or Medic to EMT) is never the right time.  Thats what the back of the truck, with the doors shut, and its just the two of you is for.


No Witness to the bloodshed!....  hahahahahha!!!


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## Sasha (Aug 25, 2008)

MedicPrincess said:


> It happens.  To everyone.  If you haven't seen it, you haven't been around very long.  If you haven't heard them talk about it, it because its not everyday open conversation.  Make a point to ask them if they have ever put a 14g in someone because they were drunk/beligerant/violent/ect.  Or have they ever inserted an NPA in a pt that they knew was faking unconscious, just because they can.  Or some other form of creative "painful" stimulus.
> 
> I am known for my "Eating Butterflies, pooping Rainbows" theres a bright side to everything alwasy smiling attitude.  And when someone does push the right buttons, the people I work with are often surprised when I am not as pleasent as my norm.



We have, it's come up in class, especially during the legal chapters. I still believe it's wrong and don't find it funny at all.


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## VentMedic (Aug 25, 2008)

MedicPrincess said:


> Make a point to ask them if they have ever put a 14g in someone because they were drunk/beligerant/violent/ect. Or have they ever inserted an NPA in a pt that they knew was faking unconscious, just because they can. Or some other form of creative "painful" stimulus.


 
Anytime you do an invasive procedure, which even an NPA is considered to be, you may have to justify your actions.  Yes, I do document anytime a patient comes to the ED with a bloody nose for further investigation especially if no airway was warranted.   There had better be good documentation on the Paramedic's part to justify the bloody nose.   Hospitals are now documenting everything carefully since any acquired infections may not be covered by insurances such as Medicare. 

While a 14 guage might be required in a hand on rare occasions, that is a large catheter for small vessels that could blow easy if one is not careful.    Thus, serious damage can occur depending on what fluid or med was being pushed.   Again you may have to justify your reasons for insertion if not for the hospital at least for reviews from your medical director.  

You should not be in pre-hospital medicine to correct established behavior, to judge others or to be the one who provides the punishment.   If this is what makes you feel good about your job or you get your superiority kicks by intentionally causing pain when not justified, maybe medicine (which comes with enough pain) should not be your career choice.   Play by the accepted practices of establishing consciousness in the short time you are with the patient.   If you do this, you will make your company's attorney much happier by not having to defend your actions.


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## MedicPrincess (Aug 25, 2008)

Let me say this.....  I, personally, have not done the 14g or NPA or whatever to a pt.  I have also stopped another provider from doing the same on a patient I would be transporting.  I have also asked more than one person why they would feel the need to further injure someone they were supposed to be helping.  Usually I am just reminded I am still "new" and I would do it too sometime.

Mine is generally an attitude thing.  I am not as cheerful with someone as normal.  I may not catch the legs as quickly as the stretcher gets pulled out.  We will probably be "out" of pillows.  The extra nice to haves just won't be there.


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## Blacke00 (Aug 25, 2008)

MedicPrincess said:


> Usually I am just reminded I am still "new" and I would do it too sometime.



This would be alot like telling somebody that just started at Burger King with you, that it's ok if I spit on this guy's whopper because someday you'll do it too.

I know I'm nowhere near even being that new guy yet, but if the person who I'm supposed to be learning from did something like this (regardless of job or circumstance), they'd forfeit all earned respect and credibility from me.

It's low and petty, period. (IMHO of course)


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## mikie (Aug 25, 2008)

I would probably wait till the patient is transferred to the ER or wherever before questioning what the medic did.  Now if (s)he is about to do something horrible and obviously wrong, I might quietly say to him/her.  but nothign to frighten the patient or question their authority.


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## VentMedic (Aug 25, 2008)

MedicPrincess said:


> Mine is generally an attitude thing. I am not as cheerful with someone as normal. I may not catch the legs as quickly as the stretcher gets pulled out. We will probably be "out" of pillows. The extra nice to haves just won't be there.


 
Again you are judging your patients. Your judgement may someday cloud your assessments and the ability to make medically sound decisions. 

Alcohol, drugs and nicotine (cigarettes) are addictions whether we like it or not. If a person is being an absolute jerk, are you absolutely sure that there is not some chemical/electrolyte imbalance, injury or some cerebral event that might be the cause? Does making a patient uncomfortable really give you that much satisfaction? Maintaining a professional attitude even in the worst of situations is a skill that must be obtained to make it in the healthcare profession. 

I've also found patients respond better to a kind but professional attitude more than a bad arse b!%*& in the back of the truck or at the bedside in the hospital.


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## Hastings (Aug 25, 2008)

I also feel VERY uncomfortable with the very casual attitude some medics have about treating patients poorly or unprofessionally. Everyone does it? No, everyone doesn't do it. And no, I don't believe for one second that it's part of being a paramedic. I believe when you start doing things like that, it's time to take a break. I just find this attitude extremely depressing.

Call me naive if you will, but I will never believe that it is normal or acceptable to hurt a patient, whether you think they deserve it or not.


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## Jochempeiper (Aug 25, 2008)

I can pretty much read any EKG rythmn, it doesn't mean that I will call out "PVC, TOMBSTONE T-WAVE!" etc. If I see something that I MAY think is wrong with a monitor, I will ask him/her to check out the monitor for himself/herself. I have confidence in my Medics, but if something may seem odd about what they're doing, I'll ask them in private, as they would do with me, it doesn't matter that they're a medic, it is all about respect.


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## Hastings (Aug 25, 2008)

Jochempeiper said:


> I can pretty much read any EKG rythmn, it doesn't mean that I will call out "PVC, TOMBSTONE T-WAVE!" etc. If I see something that I MAY think is wrong with a monitor, I will ask him/her to check out the monitor for himself/herself. I have confidence in my Medics, but if something may seem odd about what they're doing, I'll ask them in private, as they would do with me, it doesn't matter that they're a medic, it is all about respect.



I like you. You can be my partner.


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## Jochempeiper (Aug 25, 2008)

you're making me blush


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## Katie (Aug 25, 2008)

everybody is wrong sometimes.  first rule is do no harm.  if it's abundantly obvious and it is placing the pt in danger then you need to speak up (in as tactful a way as possible).  if not ask questions later.


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## emt19723 (Aug 25, 2008)

i think i read the post from which this topic stemmed from. and although, the other post that i read was pretty much on the "WTF was that guy thinking???" side of my mind. i definitely think that this is a good post to have on here. behavior like what i read should never be tolerated.

We do this job, obviously, because we want to HELP people. when you even start to THINK about how you can get one up on, or teaching a pt a "lesson", it's time for you to find a new line of work. people call us in their time of need...no matter how petty WE may think it is, its usually a big deal to the pt. we need to be as respectful as possible.


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## Jochempeiper (Aug 26, 2008)

I ran with a un-named Float Medic who let a guy go to the Hospital with only a 20 Gauge IV. The bad part is the guy was having almost constant PVC's and Tombstone T-Waves and his QRS complex was all stretched out with a slight ST Elevation.


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## Flight-LP (Aug 26, 2008)

Jochempeiper said:


> I ran with a un-named Float Medic who let a guy go to the Hospital with only a 20 Gauge IV. The bad part is the guy was having almost constant PVC's and Tombstone T-Waves and his QRS complex was all stretched out with a slight ST Elevation.



I don't understand. What is the problem with a 20 guage IV cath??


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## reaper (Aug 26, 2008)

I guess he means there was no 12 lead done or is in that group that thinks every IV should be 16ga or bigger!


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## snaketooth10k (Aug 26, 2008)

The pain is definitely something that might be a problem with a person with a rhythm like that... sound like a gentle breeze could put them into a full arrest...


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## VentMedic (Aug 26, 2008)

2 lines are preferred since there are issues of drug compatibility during tx ine the ED, 2nd line for security as well thrombolytics need their own line. However, if one line is established the other one can be established in the ED if there are other immediate things that may need to be addressed such as airway in addition to the one IV. If it is only one paramedic and one EMT, who is driving, one may have to prioritize to get the most immediate treatment done. 

There were several points not mentioned by the poster such as:

Tthe length of transport.

Whether the paramedic thought it was best to get moving if one line was already established. 

Pain issues which treatment can be initiated with the first line.

If the patient is a hard stick, multiple sticks in the back of a truck has its risks.

In the ED, there are times when any established IV is an amazing thing from some crews.


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## BossyCow (Aug 26, 2008)

*Presentation is EVERYTHING!*

I think it all has to do with how you phrase your comments. "WTF did you do THAT for?" is probably going to raise the hackles on the most patient, competent medic. Asking the medic, "Did you see this?" or "would you like me to..... (insert the task you think should have been done) for you?" will get a whole different reaction.

Most medics I know understand the team concept and appreciate me being an involved member of the team. Our ALS is from another agency and when they come into our ambulance for the transport they are unfamiliar with where stuff is and what we have with us. We have to work together.


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## firetender (Aug 27, 2008)

The overall issue here is how do you handle witnessing bonehead things happening at the hands of your peers (who can include Docs, RNs, etc.) and then, 

#1) keep yourself out of trouble

#2) register your personal displeasure

#3) at least letting the person involved know that his/her negligence/whatever doesn't go unnoticed, and

#4) doing SOMETHING to assure it won't happen again

This is really tricky territory. The biggest hurdle is figuring out if what you witnessed was benign or dangerous. Sometimes it's hard to figure. 

Bringing it to this forum is a great step because it's a safe place to get perspective without drawing attention to the person OR yourself.

The hard part, for me, was rarely was it isolated incidents. After a while I would notice an individual's pattern, and it wasn't about good patient care.

I believe in a stair-step system.

FIRST: Figure it out for yourself if it's something that requires further action.  If you're not sure, talk to someone in confidence, without naming names. Get clear on where you're going and be able to state it in just a couple of sentences.

SECOND: Unless there would be some danger involved, approach the person concerned. Starting with "Something happened that I'm not comfortable with and I wanted to check it out with you." is a good, neutral start. 

(Make sure, if it's a heavy subject, that you don't set yourself up for failure by trying this on the fly, or at an inconvenient time for one of you. It shows that the subject is worthy of respect when you ask to set a short block of time where you can focus on it together.)

THIRD: If there's resistance, stonewalling or the like, don't press the issue.  Give it a little time and then talk to someone else about it to help you figure the next step.

If you are reasonably well-received, then just talk about it rather than drive it to a conclusion. Listen, listen, listen.

FOURTH:  If you feel you need to ask that something NOT happen again (while with or around you), be specific about your request. If it's serious enough, let the person know that you consider this an agreement between you and that you made the choice to talk to him/her directly, first and if it happens again you'll need to involve others.   

These are just some tips from my experience, use them as you will, but don't just sit on things that need to be expressed.


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## Jochempeiper (Aug 28, 2008)

He didn't use the chest pain protocols. He didn't do anything except take vitals and run a IV


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## himynameismj (Aug 29, 2008)

Honestly, 
there is no reason not to confront ALS if you believe they are wrong, but do so afterwards unless you see the patients life at risk. Also, rank and experience helps. I know captains that have been doing this for longer than the paramedics have even been alive. It's those guys who can come off abrupt and/or hostile and be heard, more or less out of respect of their age. If you haven't even hit CC yet, don't even bother but tell your own CC.


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## Ridryder911 (Aug 29, 2008)

What is a CC?


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## himynameismj (Sep 3, 2008)

Ridryder911 said:


> What is a CC?



crew chief, sorry

bottom line is though, medics are people and all people can be wrong.


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## BossyCow (Sep 3, 2008)

himynameismj said:


> Honestly,
> there is no reason not to confront ALS if you believe they are wrong, but do so afterwards unless you see the patients life at risk. Also, rank and experience helps. I know captains that have been doing this for longer than the paramedics have even been alive. It's those guys who can come off abrupt and/or hostile and be heard, more or less out of respect of their age. If you haven't even hit CC yet, don't even bother but tell your own CC.



I have an issue with the term 'confront'. Its always possible to address an issue without being confrontational.


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## marineman (Sep 3, 2008)

After reading all those posts I forget what the OP even said but I remember I felt like you should say something. There is a real fine line you can walk but don't cross. In general using a needle larger than necessary basically goes on a case by case basis depending on the mental status I gather from the medic at the time and if it's a recurring behavior or not. 

A couple fun tricks we learned in class that can be used that I usually don't have a problem with unless they're abused.

If you think a patient is faking being unconscious/unresponsive hold their hand straight up in front of their face and let go. If it hit's them in the face you can be about 99% sure they're out, if it misses they're faking.

If a patient is drunk and you don't mind cleaning or better yet if they're at their own house, have one person stand on each side of him and each time you ask a question alternate who's asking it. If you use this method pray that the patient is facing your partner when the game ends, it's kind of like EMS Russian roulette.


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## reaper (Sep 3, 2008)

marineman said:


> After reading all those posts I forget what the OP even said but I remember I felt like you should say something. There is a real fine line you can walk but don't cross. In general using a needle larger than necessary basically goes on a case by case basis depending on the mental status I gather from the medic at the time and if it's a recurring behavior or not.
> 
> A couple fun tricks we learned in class that can be used that I usually don't have a problem with unless they're abused.
> 
> ...



Have fun explaining how your pt recieved a broken nose, en route to the hospital!! There are better ways to draw out fakers, without inflicting injury!


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## Onceamedic (Sep 3, 2008)

reaper said:


> Have fun explaining how your pt recieved a broken nose, en route to the hospital!! There are better ways to draw out fakers, without inflicting injury!



Well that there would be your self inflicted injury.


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## BossyCow (Sep 4, 2008)

reaper said:


> Have fun explaining how your pt recieved a broken nose, en route to the hospital!! There are better ways to draw out fakers, without inflicting injury!



Broken nose from a hand drop? I don't think so not unless the patient is holding a brick in that hand!

I've also heard a way to check on fakers is to have that discussion loudly with your partner about whether or not you will need to do the large bore IV with the 'really big needle'  or some other invasive or painful sounding procedure. "Gee... you know, if we could just hear a moan or something to know that they didn't need this"... "No, lets not do that, its really painful" ... "I think we're going to have to if they don't come to..."... Amazing how many fakers will feel much better all of a sudden


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## Ridryder911 (Sep 4, 2008)

reaper said:


> Have fun explaining how your pt received a broken nose, en route to the hospital!! There are better ways to draw out fakers, without inflicting injury!



Arm or hand drop are acceptable ways of checking level of consciousness. Also cornea reflex, eye lash reflex and even a mirror... One cannot resist looking at themselves (taught by a neurologist in ASLS).

Personally, I have found that most instances are "attention seeking behavior" for some reason or another. I will whisper in their ear, that I know they can hear me and that I also know that they are not really unconscious and knock the poop off. If it is they want out of the environment, to continue such behavior otherwise they need to awaken. 

I don't know how many will suddenly start coughing, appear that they are awakening. If they do continue their behavior, I will inform that I will be transporting them to the hospital and load them into the EMS unit. Then I inform that they are alone, they again have the chance to awaken or I must proceed with the treatment of such. These treatments can and will be extremely painful, and they may have tubes in every orifice. 

I have very few that did not "suddenly revive"; and some that actually never flinched from a IV. Although, I never have seen one that did not flinch from a nasal trumpet. 

Again, I attempt to get the reason of the behavior. 

R/r


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## Outbac1 (Sep 4, 2008)

As the Sweathogs said 

   "Up your nose with a rubber hose!"


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## EMTDON970 (Sep 4, 2008)

*medic mistake*

A medic making a mistake??? NO!!!!!!!!!


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## emtlady76877 (Sep 5, 2008)

Yes a medic can make a mistake. As a paramedic student I think an EMT should ask questions in a professional manner that makes him or her think you want to learn and at the same time it will point out their mistake if they are making one.


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## RESQ_5_1 (Sep 6, 2008)

I try to treat each pt with the same level of respect regardless of any behavior they exhibit. As VentMedic said, I find a pleasent attitude and trying to speak to them calmly can usually defuse their behavior. If not, at least i got to be the grown-up during the entire ordeal. 

I have used the "drop test" a few times. generally, I hold it above the forehead. And, only about 3-4 inches above. It doesn't make a hard impact. I'm only trying to determine where the landing will be. 

As far as deliberately causing pain or discomfort to a drunk/belligerant/abusive/faking pt, I would hope that I would be self aware enough to remove myself from EMS when I get to the point that this becomes behavior I would be willing to try to justify. I used to work long-term care and actually had an Alzheimer's pt give me a black eye while I was trying to change his linens. Not because I did something to blatantly upset him, I worked graveyard and he just wanted to sleep. I simply walked out of the room until my anger dissipated. Then, I went back in and finished my job.


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## BLSBoy (Sep 9, 2008)

Wow. There are some pretty self righteous people in here. 
Oh, you don't like the 18 in the back of your hand?
We have to start distal, and work proximal when it comes to IVs. Why is it so big? Well Sir, since you are extremely intoxicated, chances are you will need fluids given to you at the hospital, as well as medications to correct any electrolyte imbalances. 

What, you don't like that green rubber thing in your nose?
I'm so sorry, you were demonstrating the signs of being unconscious. We have to protect your airway, to ensure you keep breathing. 

You don't like that NG tube? Sorry sir, but you ingested a large amount of (name your substance here) and we may need to administer activated charcol to neutralize the effects of it. 

That cathoter? Checking for blood in the urine sir. Also, you are in no condition to become mobile, so you can't get up to go to the bathroom. 

Ron White said it the best, stupid should hurt. 
All of those are painful, albeit necessary procedures. 
If the pt. didn't want them done, they wouldn't have put them selves in that position in the first place. 
And Reaper, you are too early for April Fools day. It is a well known procedure that is used by medical professionals everywhere. 
What would you prefer? 
Tickle them?<_<


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## VentMedic (Sep 9, 2008)

Its not the therapy that is at issue but the intent with which it is done.  If it is your sole intention to hurt a patient because you don't like them or their lifestyle then you probably have no place in medicine.  And, don't bother applying at for corrections or law enforcement because they would prefer not to have people who's only mission in life is to be judge, jury and executioner.


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## reaper (Sep 9, 2008)

BLSBoy said:


> Wow. There are some pretty self righteous people in here.
> Oh, you don't like the 18 in the back of your hand?
> We have to start distal, and work proximal when it comes to IVs. Why is it so big? Well Sir, since you are extremely intoxicated, chances are you will need fluids given to you at the hospital, as well as medications to correct any electrolyte imbalances.
> 
> ...



Sorry, Haven't seen it used in years. There are better ways to determine LOC. As mentioned earlier, you have other choices to determine if they are faking. Sternal rub, graze the eyelashes, earlobe pinch, finger nail pinch, and the always famous comedy routine. Until you see damage done from a hand drop on a real LOC pt, you won't understand.


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## BLSBoy (Sep 9, 2008)

reaper said:


> Sorry, Haven't seen it used in years. There are better ways to determine LOC. As mentioned earlier, you have other choices to determine if they are faking. Sternal rub, graze the eyelashes, earlobe pinch, finger nail pinch, and the always famous comedy routine. Until you see damage done from a hand drop on a real LOC pt, you won't understand.



Seen it used in ED, prehospital, and in the psych unit. From EMT to MD. 
You pinch/rub a person, and they have a tendency to swing.


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## reaper (Sep 9, 2008)

That's your choice. You are the provider on scene, you choose what method you use.


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## BossyCow (Sep 9, 2008)

BLSBoy said:


> Seen it used in ED, prehospital, and in the psych unit. From EMT to MD.
> You pinch/rub a person, and they have a tendency to swing.



Absolutely. I would rather explain why the guys own hand accidently hit him in the face than explain why I was pinching him. Now, I don't use the hand drop as a general LOC check.  I use it when I see things that make be believe that the pt is most likely faking it. I don't do it to be mean or spiteful. A sternal rub is painful. I don't know how high you foilks are holding the hand to cause damage, but I've never seen it. Again, unless the guy has a grip on a brick, I think the hand drop is pretty tame.


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## reaper (Sep 9, 2008)

You would be surprised at how little force it takes to fx a nose. I have seen it done. Lots of paperwork after the fact.

Sternal rubs are supposed to be painful, that is the response you want. But, they do not leave damage.

As I stated, you are the provider. It is your call on how to handle the pt. I have seen the results and will not use it. This was to inform the poster that there can be after affects to using it.


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## medic219 (Sep 9, 2008)

All that P means is that we can do ten times the procedures as basics. That leaves you ten times the amount of things to screw up.


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## EMTDON970 (Sep 13, 2008)

medic219 said:


> All that P means is that we can do ten times the procedures as basics. That leaves you ten times the amount of things to screw up.



Or 10 more ways to save a medic....


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## EMTCop86 (Sep 14, 2008)

I am a little late on this post but here is how it works...medics are humans, humans make mistakes, therefore medics make mistakes.... I love my logic class, lol.


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## reaper (Sep 14, 2008)

EMTDON970 said:


> Or 10 more ways to save a medic....



WHAT???

Are you ever gonna give up on the BS that EMT's save Medics?


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