# worried about losing my license



## LM2015 (Apr 5, 2015)

I work for an IFT company in California and we recently had a situation where we transported a pt that was ALOC. The snf staff stated that the pt was normally aloc but was more altered than normal. Vitals were stable. The "aloc" had been going on for about a week according to staff. We transported bls code 2. STUPID. I KNOW. You don't have to tell me how stupid we were. Now I'm worried about my license. I spoke to my supervisor but all he said was If you haven't heard anything yet i think you should be fine....it's been a couple weeks since this happened and I haven't heard complaints from anyone but Im thinking..isn't County gonna come after my license?


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## DesertMedic66 (Apr 5, 2015)

For transporting a patient code 2, I highly doubt you will lose your EMT certificate.


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## LM2015 (Apr 5, 2015)

It's not the code 2 I'm worried about it's the fact that he was aloc


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## chaz90 (Apr 5, 2015)

Still trying to see what the issue was here...I realize I work in a different system, but no one would raise an eyebrow about that here. The patient was "altered" for an extended period of time, and you took him to the hospital. What's the issue? His condition didn't deteriorate right? How close was the hospital vs. nearest ALS?


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## OnceAnEMT (Apr 5, 2015)

I'm assuming code 2 is non-emergent in your system?

I don't see the issue with transporting an altered x1 week patient non-emergent. If there was once a time-dependent emergency, the damage is already long done. If the story is as you describe it, it sounds like the negligence is on the nursing home's side, not yours.


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## STXmedic (Apr 5, 2015)

Perhaps CA doesn't allow BLS to transport acutely altered patients? Is that the issue?


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## CALEMT (Apr 6, 2015)

I've transported many patients that were ALOC and I still have my CA EMT cert. I don't really see what the problem is if their condition and vitals didn't deteriorate. You transported code 2 (no lights, no siren) which is perfectly fine, code 3 (lights/ siren) is not warranted based on the information you provided. Not to sure what you're so worried about, you'll be fine.


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## Ewok Jerky (Apr 6, 2015)

ALOC x1 week is not emergent. Maybe it was last week but not today. What's got you so worried?


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## LM2015 (Apr 6, 2015)

I guess I'm worried about my documentation. I feel like it looks bad on paper. Is this the kind of stuff county looks at when they audit?


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## OnceAnEMT (Apr 6, 2015)

LM2015 said:


> I guess I'm worried about my documentation. I feel like it looks bad on paper. Is this the kind of stuff county looks at when they audit?



If it was actually a stroke or MI or anything else that is at some point or another an emergency, then yeah, I'd hope it would be audited for the sake of the profession and well being of all patients. That said, you know what you did and didn't document, and you know there is nothing further you can do about it now. Don't pry for information from anyone over there, learn from this event (whether or not it amounts to anything in anyone else's mind), and make yourself better. It'll happen again.


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## CALEMT (Apr 6, 2015)

Again, what are you so worried about? Did he have a sign/ symptom that you didn't put in. Did you lie about anything? The PCR is already submitted/ exported then whats done is done. If documentation is what you're so worried about, look up some documentation threads on here to get some pointers. You'll get better at knowing what you need and don't need to document.


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## squirrel15 (Apr 6, 2015)

What county is it you work in? And do you work for a large or small company? Poor documentation can be an issue, but you should be able to ask someone within your company for help, and by redacting patient info, getting a generalized report idea from the helpful people of this site is possible through PM's. As for losing your license over the call you described even with poor documentation should not be an issue.


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## LM2015 (Apr 6, 2015)

I didn't lie but I did write that he was altered and that per facility staff it was not normal to pt.


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## LM2015 (Apr 6, 2015)

Definitely a learning experience thanks guys you've helped me relax a little


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## squirrel15 (Apr 6, 2015)

LM2015 said:


> I didn't lie but I did write that he was altered and that per facility staff it was not normal to pt.



I'm tired and have been up for 26 hours, so I apologize if this comes across as rude because I do not mean it to at all. But the reason we transport patients, is because something isn't normal. If everything was normal we would have no reason to be there. And ALOC does not necessitate ALS depending on patient presentation and medical history.


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## LM2015 (Apr 6, 2015)

I'm in LA County


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## Chris07 (Apr 6, 2015)

squirrel15 said:


> But the reason we transport patients, is because something isn't normal. If everything was normal we would have no reason to be there.


I want to run in your area. An area where people call 911 only for legitimate emergencies and with zero abuse of the system sounds like a Utopia.

To the OP:
To re-iterate like everyone else in this thread...you're fine. Transporting an otherwise stable increased ALOC x 1 week patient code 2 is hardly worth taking disciplinary action against. I mean there are medics in the system whose 12-lead knowledge is limited to identifying STEMIs and reading machine interpretations. I think we have bigger problems to deal with than going after an EMT who transported an otherwise stable patient to the hospital code 2. Live, learn, and grow.


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## LACoGurneyjockey (Apr 6, 2015)

LM2015 said:


> I'm in LA County


There it is. Yes, LA County protocol does say an acutely altered patient requires an ALS assessment. But this patient is not acutely altered. It's been going on for a week. You didn't break protocol because your patient wasn't acutely altered. Yes, it's not normal for them, but it's not a new/sudden onset. And nothing happened enroute. Even in hindsight, there was absolutely no need for ALS or code 3 transport. 
The county emsa doesn't give two ****s about something like this, and you have nothing to worry about. I don't see anything you could/should have done differently.


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## squirrel15 (Apr 6, 2015)

Chris07 said:


> I want to run in your area. An area where people call 911 only for legitimate emergencies and with zero abuse of the system sounds like a Utopia.



Lol well I'll play a technicality here just for my side of the argument to sound better, even if its still abusing the system. Calling 911 because the cookies are on top of the fridge instead of the drawer and they need help getting them, something is not normal


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## ITBITB13 (Apr 6, 2015)

Had you called 911 for that patient, we would've shown up, and the fire department would've sent him BLS code-2 anyway, just in our ambulance, not yours. It would've been the same thing.


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## hogwiley (Apr 6, 2015)

So what exactly is the issue? The words "BLS code 2" means nothing where I am, so I have no idea whether or not what you did(or didn't do) was in fact stupid. You said it was an IFT, so where did you transport this person, and did you report to wherever you brought them that the staff stated they had been "more altered than usual" for the past WEEK?

Also you stated the pt's vitals were stable, but what did your assessment reveal? What was their orientation? Fever? Blood sugar? Lung sounds? Stroke assessment? Pertinent hx? Physical exam? Anything abnormal about their urination? Are they on dialysis?

Did the staff just mention offhand they seemed a little more out of it the past week or was it something they seemed concerned over, since theres no way for you to know what this persons baseline mental status is? Apparently the staff weren't particularly concerned about this mental status change if they never did anything about it or contacted 911, so what has you so concerned?


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## ITBITB13 (Apr 7, 2015)

hogwiley said:


> So what exactly is the issue? The words "BLS code 2" means nothing where I am, so I have no idea whether or not what you did(or didn't do) was in fact stupid. You said it was an IFT, so where did you transport this person, and did you report to wherever you brought them that the staff stated they had been "more altered than usual" for the past WEEK?
> 
> Also you stated the pt's vitals were stable, but what did your assessment reveal? What was their orientation? Fever? Blood sugar? Lung sounds? Stroke assessment? Pertinent hx? Physical exam? Anything abnormal about their urination? Are they on dialysis?
> 
> Did the staff just mention offhand they seemed a little more out of it the past week or was it something they seemed concerned over, since theres no way for you to know what this persons baseline mental status is? Apparently the staff weren't particularly concerned about this mental status change if they never did anything about it or contacted 911, so what has you so concerned?



In LA County, the fd runs als units, and all the ambulances are private bls companies.

Code-3 means priority one, or lights & sirens

Code-2 means priority two, or no lights & sirens.

An ALS transport means the fd paramedics are riding in your bls ambulance

A BLS transport means there is no need for an ALS  follow up, and the bls ambulance transports alone.


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## OnceAnEMT (Apr 7, 2015)

So I gotta ask, what is code 1? Transport in firetruck?


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## Handsome Robb (Apr 7, 2015)

Grimes said:


> So I gotta ask, what is code 1? Transport in firetruck?



Some places use code 3 as lights and sirens, code 2 as lights no sirens and code 1 as no lights no sirens.


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## DesertMedic66 (Apr 7, 2015)

Grimes said:


> So I gotta ask, what is code 1? Transport in firetruck?


Code 3 is lights and siren
Code 2 is no lights and no siren but we have to go directly somewhere
Code 1 is we don't have anywhere we need to go and can do whatever we want haha.


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## OnceAnEMT (Apr 7, 2015)

DesertEMT66 said:


> Code 3 is lights and siren
> Code 2 is no lights and no siren but we have to go directly somewhere
> Code 1 is we don't have anywhere we need to go and can do whatever we want haha.



Got it, so y'alls code 1 is essentialling clearing scene, no patient found/pt refusal.


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## hogwiley (Apr 7, 2015)

Ivan_13 said:


> In LA County, the fd runs als units, and all the ambulances are private bls companies.
> 
> Code-3 means priority one, or lights & sirens
> 
> ...




Ok, so they DID in fact divert to the ER, which is what I figured. So I REALLY don't see what the issue is. Would they really expect them to go lights and sirens to the ER for an IFT where the patient had stable vitals and 911 was never called, for a patient that apparently has some sort of baseline dementia or diminished cognitive functioning, just because staff mentioned oh yeah the patient's mental status has declined a little over the PAST WEEK? What exactly would Paramedics have done en route to the ER that would make ANY difference? The pt was taken to the ER(to be honest many EMTs where I work probably would have just transferred them), so I cant imagine the OP would get in trouble for not calling for ALS or going lights and sirens.

Hell if I had called in a priority 1 and gone lights and sirens to the ER with this patient I would have probably gotten my *** chewed out(or gotten laughed at) when I arrived.


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## LACoGurneyjockey (Apr 7, 2015)

And therein lies the magic of LA County: Where every ALS transport is a lights and sirens transport. As it was so eloquently put by a fire medic, "If I'm riding in with you it's an emergency, so we go code 3".


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## Milla3P (Apr 8, 2015)

Did the person die during transport?
Did they get worse?
Did you willfully act in a way that is contrary to your licensure?
Were you drunk?
Did anybody freak out at the ED?
Do you know ANYBODY who has lost their license before?

If you can answer Yes to any of these, worry. If not, don't.


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## RebelAngel (Apr 23, 2015)

Would three of your peers have done the same thing? 
Do you feel you were negligent?


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## NPO (Apr 24, 2015)

LM2015 said:


> I guess I'm worried about my documentation. I feel like it looks bad on paper. Is this the kind of stuff county looks at when they audit?


There are a million reasons why someone could be altered. If it has been going on for a week, which we have to assume because SNF staff reported that, then it's probably not an "emergency." In most counties in California ACUTE altered level of consciousness is ALS criteria. A week is not acute. Do a stroke assessment, if its negative, document as such and carry on.


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## GirevikMedic (May 9, 2015)

Maybe I have saltiness showing through but...

ER call from SNF? Check.
Dementia patient (normally altered and setting considered, I'm assuming most likely)? Check.
Per SNF, more altered than normal? Check.
Per SNF, ongoing for extended time? Check. 

Were any of these phrases, or variations of them, used at any time as well?
- SNF: Not my patient, I don't know.
- SNF: My shift just started. 
- SNF: Normal = walking, talking, holding conversations. (In the room, you notice a wheelchair, padded bed railings, patient wearing only t-shirt and diaper, etc.)
- SNF: It's in the paperwork. (When asked about any other pertinent history or info)

Bonus round: Was this on a weekend and/or just after shift change to the night crew?

OP, just asking but are you new to the EMS/IFT? If so, you will soon find comedy, frustration, amazement and possibly fear and sadness in the truth of the above.

It sounds like this was your run of the mill SNF type incident. As long as the patient was stable, vital signs were acceptable (good practice to include recent blood sugar too), you didn't break county or company policy and you didn't leave the patient in worse shape than when you found him, I'd say you're fine. Just be careful with SNFs. Some are fine (perhaps even good, but in my experience that's rare) but most suck. Just make sure you have all the info/report and paperwork you need before putting the patient on your gurney and you should be good. If ALS is needed, though, don't be afraid to make the call.


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## SeeNoMore (May 10, 2015)

If your situation is all it took to lose your cert there would be a dramatic culling of our ranks.


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## OnceAnEMT (May 10, 2015)

SeeNoMore said:


> If your situation is all it took to lose your cert there would be a dramatic culling of our ranks.



Think of the raises!


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## Milla3P (May 10, 2015)

No raises. Mandatory $15/hr minimum wage for all paramedics.


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## OnceAnEMT (May 10, 2015)

Milla3P said:


> No raises. Mandatory $15/hr minimum wage for all paramedics.



 That's a raise in too many places.


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## samsbgm (May 21, 2015)

Just from the info you gave I would have done the same thing. First so many places have said that the pt was more altered then normal. Usually it's not true. Atleast in my experience. The wonderful thing about dementia is that they aren't always the same.  Let's just say it is this time. It's been going on for a week. Code 2 is fine. An 8 minute transport vs. a 5 minute transport is not making a difference with this pt. Take a sugar, start a line, and document appropriately. The most common problem among elderly altered pt is a uti.


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## BigBadWolf (Jul 10, 2015)

STXmedic said:


> Perhaps CA doesn't allow BLS to transport acutely altered patients? Is that the issue?


 
In my area BLS is only allowed to transport to ALS.  We cannot take a patient to the hospital even if we are right across the street.  Not really sure why this is in effect.


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## TransportJockey (Jul 10, 2015)

BigBadWolf said:


> In my area BLS is only allowed to transport to ALS.  We cannot take a patient to the hospital even if we are right across the street.  Not really sure why this is in effect.


That is probably one of the dumbest things i have ever heard


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## LACoGurneyjockey (Jul 10, 2015)

TransportJockey said:


> That is probably one of the dumbest things i have ever heard


LA County is probably one of the dumbest places I've worked.


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## Jim37F (Jul 10, 2015)

But even LA County says if your ETA to the hospital is faster than the ETA of ALS don't stick around waiting for ALS. (Of course the reality is that unless you literally are just across the street, ALS will almost always get to you faster than you can get to the hospital)


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## BigBadWolf (Jul 10, 2015)

TransportJockey said:


> That is probably one of the dumbest things i have ever heard


 
Its not really a problem since every ambulance that hits the road in our county has ALS on board but still a very odd rule.


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## ecphotoman (Jul 11, 2015)

LM2015 said:


> I work for an IFT company in California and we recently had a situation where we transported a pt that was ALOC. The snf staff stated that the pt was normally aloc but was more altered than normal. Vitals were stable. The "aloc" had been going on for about a week according to staff. We transported bls code 2. STUPID. I KNOW. You don't have to tell me how stupid we were. Now I'm worried about my license. I spoke to my supervisor but all he said was If you haven't heard anything yet i think you should be fine....it's been a couple weeks since this happened and I haven't heard complaints from anyone but Im thinking..isn't County gonna come after my license?


SNFs send train wreck patients to me in the ER all the time. They always hand off to EMS with a ****ty report and a BS reason as to how long the patient has been "not normal". I would not worry about it, there really isn't anyway that you could have done to improve or further harm the patient. Can you really code 3 a week long ALOC?


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## Akulahawk (Jul 11, 2015)

I get those patients too in my ED. Fortunately the local SNFs don't usually wait that long and all the transport units that are local are all ALS. If the patient has been altered from baseline for a week, the county will have a bigger beef with the SNF than with you, if they care much about going after anyone. You took the patient to the hospital for further evaluation and treatment as necessary, so unless you made the patient's condition worse, you should be good.


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## ecphotoman (Jul 11, 2015)

LACoGurneyjockey said:


> LA County is probably one of the dumbest places I've worked.


Pretty much, the way they have divided up the territory and run BLS rigs in so many places that need ALS. They fact that they let so many rinky dink company's operate in the county, its mind boggling.


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## Tigger (Jul 11, 2015)

TransportJockey said:


> That is probably one of the dumbest things i have ever heard


That's how it is where I am. Every 911 ambulance has to have a paramedic onboard. The BLS ambulances (special events, volunteer districts, transfer car) cannot transport to an ED, they must get an intercept.


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