# Just Because



## Ewok Jerky (Aug 22, 2011)

Showed up for a transport today, Leg and Hip Pain. Firemedic on scene hands over care and after we load on the gurney firemedic says to me "lets het her on a cannula just 'cause, you know..."


i was like "huh?" I didn't want make a scene, we had already had to diffuse a situation that the captain was about to blow out of control. So I pulled out a cannula and before I put it on the Pt I noticed firemedic was not really paying attention so I just put it on the gurney and wheeled nanna outta there.

This is not about O2 for every Pt (plenty of threads on that already), its about scene-politics

Is it appropriate to "call out" a higher medical authority over something like that? on-scene, in front of crews and Pt and Family?  For you medics, would you be insulted if I questioned you why you wanted me to do something?  

BTW-we charge like $100 for O2 or something stupid like that.


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## Sandog (Aug 22, 2011)

Well, should we not trust our medics? They have more training, and just because they are fire-medics does not diminish their knowledge. Fire-medics go through the same training as non-fire medics. Medic trumps basic, that's it.


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## JPINFV (Aug 22, 2011)

Sandog said:


> Well, should we not trust our medics? They have more training, and just because they are fire-medics does not diminish their knowledge. Fire-medics go through the same training as non-fire medics. Medic trumps basic, that's it.




If the best reason a medic can come up with is "just because" then, no. We shouldn't trust them.


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## sir.shocksalot (Aug 22, 2011)

beano said:


> Is it appropriate to "call out" a higher medical authority over something like that? on-scene, in front of crews and Pt and Family?  For you medics, would you be insulted if I questioned you why you wanted me to do something?


It's totally appropriate to call out another provider, but not in front of their patient/family (unless it's a straight up 'will kill the patient' error). With something silly like oxygen it's best to wait until after the call, and in every case it's best to be as polite and un-confrontational as possible.

I am all for people's suggestions for treatment options, lord knows I can miss silly things from time to time and having someone else willing to make suggestions can help avoid missing things or getting a second opinion. Also it's a good opportunity to learn as a basic.

That all said, scene politics can take a big dump on patient care. At an agency here in Denver/Metro area the FD calls all the shots and the ambulance (also ALS) must follow their direction. This leads to worse scene dynamics than in CA where at least the ambulance is BLS and the FD is ALS so there is a clear distinction in certification levels. In this particular CO agency a FD medic could say "lets do some oxygen, you know, just cuz." And an equally certified private medic _must_ follow that order or be fired, regardless of how much the private medic can disagree. The private medic will still be fired even if the FD was wrong and the private medic was right and said error results in patient death. So take some encouragement that at least your system isn't that messed up  . 

Don't ask me why a provider on the non-transporting vehicle has any say in patient care. My belief is that if you are making decisions about the care of the patient you should arrive at the hospital with the patient, even if you don't attend. This way if you screw up and turn an ALS patient to a BLS provider, at least you are at the hospital to try and explain yourself. But I guess that is a topic for another thread ^_^


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## truetiger (Aug 22, 2011)

Yes, it would be very inappropriate to "call out" someone on scene. It would be appropriate to politely ask why. In the scenario you mentioned above, I would of wheeled nanna out to the rig with the nasal cannula in place and then performed my own assessment and determined whether or not she needed the oxygen. If the medic thought it was necessary to put her on oxygen, I would at least left her on the oxygen until I could do my own assessment.


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## Aprz (Aug 22, 2011)

*Fire:* Lets get her on a cannula just 'cause, you know...
*Me:* (Great idea, but) lets get her into the ambulance, and have my partner assess her first. We have oxygen in there if she needs it.


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## Sasha (Aug 22, 2011)

"im sorry what did you say the medical reason to apply oxygen was? So i can document it in my report..."

Sorry but considering they charge $100 for O2, while it isnt life or death it is being a patient advocate to challenge it. Frivilous charges on a bill can stress the patient financially. Later on down the road they may need to make the choice between buying their meds or paying their bill and a bigger bill "just cause... you know" is unethical. 
Dont be a jerk about it, and if its going to turn into an argument let it go... but at least put your foot down.

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## Aidey (Aug 22, 2011)

That is usually the time I point out the patient's SpO2 is a perfectly acceptable number, if that doesn't work I just take it off in the ambulance. Or hook up the O2 to the portable tank and don't turn the tank on.


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## Shishkabob (Aug 22, 2011)

California.  Fire-medic.   'Nuff said.





beano said:


> Is it appropriate to "call out" a higher medical authority over something like that? on-scene, in front of crews and Pt and Family?  For you medics, would you be insulted if I questioned you why you wanted me to do something?



If it's a safety thing, yes.

If it's a technique thing and it's just the way the medic (or any level) runs the call; No.   You can question why I did something all you want after a call, because maybe you didn't understand my thought process, but if you do it DURING a call, we're going to have a talk.


Provider level is irrelevant in this situation-- what matters is if it's a safe decision or not.   Just a month ago, I didn't agree with what a doctor in a clinic was doing in a peri-arrest, and it was a dangerous decision that was not right for the patient, so I started doing my thing to keep the patient alive.  That is ok, because as I said, it was a safety issue, and I can stand by my decision in court or in front of my superiors if required.


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## the_negro_puppy (Aug 22, 2011)

why not a NRB?


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## Sasha (Aug 22, 2011)

But the fire medic wasnt running the call, he was handing it off, giving the OP the call to run

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## usalsfyre (Aug 22, 2011)

Question politely? Abso-freaking-loutely. I should be able to articulate to you why I'm performing an intervention. If I can't I probably need to think about if it's appropriate anyway. 

Call me out rudely? Not unless I'm about to do something you know, for a fact, is going to kill the patient. The same goes for refusing an order.


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## abckidsmom (Aug 22, 2011)

Polite:  "do you think she really needs that oxygen?  She's setting well and in no distress."

Rude:  "I don't PUT people on oxygen unless they really need it."

To me, it sounds like he knew the patient was sicker than just whatever the main deal was, but he was busy turfing it to the basic crew and really hoped the pt wouldn't get sicker during the ride.


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## jjesusfreak01 (Aug 22, 2011)

the_negro_puppy said:


> why not a NRB?



Can't tell if trolling, or actually unsure...


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## Tigger (Aug 22, 2011)

If the patient is alert and with it you could always just ask if the patient wants the oxygen. If we go to a facility with its own first responders and the guy that meets me at the door tells me the patient is on an NC because "you guys took a while and we didn't want to look like we didn't what we were doing," I'm going to ask the patient if she's breathing ok, and if she wants to remain on the oxygen. If she says no, off it comes. I don't want to show up at the ER and have the staff ask why I have a patient with no breathing issues on O2, and we don't even bill for it.


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## Handsome Robb (Aug 22, 2011)

jjesusfreak01 said:


> Can't tell if trolling, or actually unsure...



I think he's joking...


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## EMTtoBE (Aug 22, 2011)

Nvrob may I ask where you work


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## abckidsmom (Aug 22, 2011)

NVRob said:


> I think he's joking...



Agree.  Just joking, right?


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## fast65 (Aug 22, 2011)

I'm wondering why the medic is passing off care to a basic, are you a medic/basic rig?


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## STXmedic (Aug 22, 2011)

fast65 said:


> I'm wondering why the medic is passing off care to a basic, are you a medic/basic rig?



I'd assume the patient was capable of BLS transport and was downgraded by the medic to a BLS crew...


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## MassEMT-B (Aug 22, 2011)

PoeticInjustice said:


> I'd assume the patient was capable of BLS transport and was downgraded by the medic to a BLS crew...



That or I know in some parts of cali fire dept treats the pt then privates transport to hospital.


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## Handsome Robb (Aug 22, 2011)

MassEMT-B said:


> That or I know in some parts of cali fire dept treats the pt then privates transport to hospital.



This is true. If it's a BLS truck and the pt is deemed ALS the FF/Medic rides in on the private truck. If it's an ALS truck the firemedic will transfer care to the medic on the private ambulance.


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## DesertMedic66 (Aug 22, 2011)

I would not have put the patient on O2. The medic already did his assessment and handed over all patient care to you. When the patient is under my care I will listen to what you suggest but it doesn't always mean I'm going to follow it. 

I'm going to do my own assessment of the patient and go from there. If the firemedic doesn't already have the patient on O2 then the patient *probably* doesn't need it. My response to the firemedic would have probably been "we will start O2 enroute" but never get it started. It doesn't disrespect anybody.


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## Shishkabob (Aug 22, 2011)

You being a Basic, he being a Medic, maybe he had a reason to put the patient on a NC, but didn't feel like explaining it to you?  (Some medics are like that)

Just because you didn't see a reason doesn't mean there wasn't one, let alone a valid one.  Kind of silly to ignore a higher persons recommendation without you yourself understanding why they wanted it, just because you didn't like the answer.




Just sayin'.


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## JPINFV (Aug 22, 2011)

Linuss said:


> You being a Basic, he being a Medic, maybe he had a reason to put the patient on a NC, but didn't feel like explaining it to you?  (Some medics are like that)



...then the medic can attend the patient all the way to the hospital. 



> Just because you didn't see a reason doesn't mean there wasn't one, let alone a valid one.  Kind of silly to ignore a higher persons recommendation without you yourself understanding why they wanted it, just because you didn't like the answer.



Kinda of silly to engage in "because I said so" while handing off the patient. If the paramedic is truly that concerned, then it should be communicated in the hand off report, otherwise the EMT's response to the same query from the ED staff is going to be, "Just because."


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## Shishkabob (Aug 22, 2011)

Agreed on both accounts... but not totally unrealistic considering the area, and mindsets of such, either.


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## Handsome Robb (Aug 22, 2011)

My question is, what if the medic charts the o2 but you never started it then it goes to court? He asked to you do something and you didn't do it, and in a situation like I stated above now it's his *** in a sling.

Just playing the devils advocate, I don't need my head bitten off.


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## Sasha (Aug 22, 2011)

Linuss said:


> You being a Basic, he being a Medic, maybe he had a reason to put the patient on a NC, but didn't feel like explaining it to you?  (Some medics are like that)
> 
> Just because you didn't see a reason doesn't mean there wasn't one, let alone a valid one.  Kind of silly to ignore a higher persons recommendation without you yourself understanding why they wanted it, just because you didn't like the answer.
> 
> ...



That is the wrong mentality.

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## Shishkabob (Aug 22, 2011)

Sasha said:


> That is the wrong mentality.
> 
> Sent from LuLu using Tapatalk



And never said it was right.



But choosing not to do something because you didn't like their explanation, but had no other reason, is just as wrong, no?


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## Lady_EMT (Aug 22, 2011)

NVRob said:


> My question is, what if the medic charts the o2 but you never started it then it goes to court? He asked to you do something and you didn't do it, and in a situation like I stated above now it's his *** in a sling.
> 
> Just playing the devils advocate, I don't need my head bitten off.



Something I considered, and when I thought about it, I worked it out.

Technically, if the medic didn't start the O2, then handed the PT off, no where in his report should it say he started the pt on O2. His report should end with "transferred care to [ambulance company] crew, pt care terminated." That way, there is no confusion on anything. If the medic says he put the pt on O2, but didn't, then he deserves any repercussions that meet him in the court system if it gets down to that.

On the other side of the argument, If the medic put the pt on O2 before transferring pt care, then the receiving crew took the pt off of O2, then the crew needs to chart and record why they made that decision. That way, the entire call is covered from point A to point B, without any confusion on what happened to the O2.


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## Lady_EMT (Aug 22, 2011)

Linuss said:


> You being a Basic, he being a Medic, maybe he had a reason to put the patient on a NC, but didn't feel like explaining it to you?  (Some medics are like that)
> 
> Just because you didn't see a reason doesn't mean there wasn't one, let alone a valid one.  Kind of silly to ignore a higher persons recommendation without you yourself understanding why they wanted it, just because you didn't like the answer.
> 
> ...



Yes, I agree with you, but I also agree with everyone else that the question should be asked WHY the pt is on O2. If a medic says, "Just because," then I'm going to ask the pt if they are having any chest pain/difficulty breathing. If not, then I will remove the O2, recording my reasoning in my report, and be done with it. If the pt says that they were having chest pain/difficulty breathing, and the O2 helped, then of course I'm going to leave it on. 

I'll listen to a medic if they give a good reason. Even if they're just covering all the bases, they should have a better reason than "just because."


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## JPINFV (Aug 22, 2011)

Linuss said:


> But choosing not to do something because you didn't like their explanation, but had no other reason, is just as wrong, no?




No. Argument: Nuremberg.


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## Shishkabob (Aug 22, 2011)

JPINFV said:


> No. Argument: Nuremberg.



People of Nuremburg that had plenty of reasons to not follow what was ordered beyond "I don't like your explanation"... eg "I don't want to kill innocent people" or "They aren't war criminals"


Refusing to follow a (potentially) more educated providers medical decisions simply because you don't understand something without doing your own due diligence is silly.  

If you're going to refuse, atleast have a basis to refuse.  "That's not safe for the patient", or "Why does the patient require O2 when they aren't short of breath and sats look fine?"




Lady_EMT said:


> the question should be asked WHY the pt is on O2. If a medic says, "Just because,"



EXACTLY!  But if you don't ask for an explanation, you darn well better have some reason to refuse to follow what was called for beyond "I don't like the answer 'just because'  "  You darn well better be able to expand upon your decision.




Don't follow an order blindly, but don't refuse an order just as blindly either.


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## JPINFV (Aug 22, 2011)

Linuss said:


> People of Nuremburg that had plenty of reasons to not follow what was ordered beyond "I don't like your explanation"... eg "I don't want to kill innocent people" or "They aren't war criminals"
> 
> 
> Refusing to follow a (potentially) more educated providers medical decisions simply because you don't understand something without doing your own due diligence is silly.
> ...



I agree with your last paragraph, however your argument so far is that "Because I said so," while an inappropriate response, would answer that last question. You're saying that the fact that I find "because" to be inappropriate doesn't mean that I shouldn't follow the order. 





> EXACTLY!  But if you don't ask for an explanation, you darn well better have some reason to refuse to follow what was called for beyond "I don't like the answer 'just because'  "  You darn well better be able to expand upon your decision.


So far I have the conversation going like this. 

"Oh, by the way, put the patient on a nasal cannula."
"Why?"
"Just because."

The way I'm reading it, the explanation is "just because" and "just because" is not an appropriate medical justification in any situation. There's nothing to expand on because "just because" isn't a valid reason on its face.


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## Shishkabob (Aug 22, 2011)

All I'm saying is you damn well better have a good reason to not do something someone credentialed higher tells you to do besides not liking "just because" when it comes to court.

Not saying I like the answer or agree with the oxygen administration, but I'm also not going to risk my license for not doing something someone higher wanted because they didn't want to give an answer that satiates my curiosity, when I have no other legit medical basis to refuse.


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## Sasha (Aug 22, 2011)

Linuss said:


> And never said it was right.
> 
> 
> 
> But choosing not to do something because you didn't like their explanation, but had no other reason, is just as wrong, no?



Not really considering there was no legitimate explanation and the treatment was superfluous based on the assesment.

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## truetiger (Aug 22, 2011)

Why not just leave the O2 on while you load the patient? 2 extra minutes on low flow O2 isn't going to make a difference. Save the @#$% measuring contest with the fireman and do your own assessment.


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## JPINFV (Aug 22, 2011)

Linuss said:


> All I'm saying is you damn well better have a good reason to not do something someone credentialed higher tells you to do besides not liking "just because" when it comes to court.
> 
> Not saying I like the answer or agree with the oxygen administration, but I'm also not going to risk my license for not doing something someone higher wanted because they didn't want to give an answer that satiates my curiosity.




This isn't just about satisfying the EMT's curiosity. It's about satisfying the ED's curiosity as well.

Let's take this a step further. You're doing an interfacility transport as a paramedic from one ER to another and I'm giving you report. I start a drip (say, paracetamoxyfrusebendroneomycin) immediately before transport and you ask me why I started the patient on a new drug. My response is, "Just because." By your reasoning, that should satisfy any and all concerns you have since I don't, as a higher credentialed medical provider, have to justify my orders to you.


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## Shishkabob (Aug 22, 2011)

Sasha said:


> Not really considering there was no legitimate explanation and the treatment was superfluous based on the assesment.
> 
> Sent from LuLu using Tapatalk



I don't need to give a legitimate explanation to first responders about why I do or do not want something done while on scene.  My word is/should be enough unless they see a safety issue.  Unless my partner has the knowledge to backup refusing what I want done, it should be done.

And considering my assessment also goes deeper than my partners', I also don't expect them to always see what I see when it comes to treatment modalities.  





There's a time and a place to question why, and if it's not a safety thing, infront of the patient is neither the time nor place.


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## Shishkabob (Aug 22, 2011)

JPINFV said:


> This isn't just about satisfying the EMT's curiosity. It's about satisfying the ED's curiosity as well.
> 
> Let's take this a step further. You're doing an interfacility transport as a paramedic from one ER to another and I'm giving you report. I start a drip (say, paracetamoxyfrusebendroneomycin) immediately before transport and you ask me why I started the patient on a new drug. My response is, "Just because." By your reasoning, that should satisfy any and all concerns you have since I don't, as a higher credentialed medical provider, have to justify my orders to you.



I wouldn't take the patient off a medication that a doctor put on for the sole reason he said "Just because".  I should, as anyone should, have a good and legitmate reason to stop a higher providers treatment beyond "I wanted to".


I'd do what I could to find out the reasoning if I didn't understand it, but just stopping it for *NO other reason* is silly.



I've gone against a doctors orders before, but I had reason to.  See the difference?


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## JPINFV (Aug 22, 2011)

Linuss said:


> I also take the patient off a medication that a doctor put on for the sole reason he said "Just because".  I should, as anyone should, have a good and legitmate reason to stop a higher providers treatment beyond "I wanted to".



What's your justification here for not following the physician's order that is somehow not applicable to the exact same situation with an EMT refusing the same justification from a paramedic.


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## Shishkabob (Aug 22, 2011)

JPINFV said:


> What's your justification here for not following the physician's order that is somehow not applicable to the exact same situation with an EMT refusing the same justification from a paramedic.



Are you talking about the real-life time I refused to follow a doctor, or the hypothetical story you threw out?


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## Shishkabob (Aug 22, 2011)

An ILS truck is called for a transfer of a bradycardic patient on a chronotrope.  The Intermediate doesn't know the chronotrope being used too well.  When asked why this specific chronotrope is being used as opposed to another one, the sending physician states "Because it is", and doesn't expand upon his reasoning.

Once in the truck, the Intermediate stops the chronotrope drip because he didn't like the answer. 



Is the Intermediate in the right?


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## JPINFV (Aug 22, 2011)

Linuss said:


> Are you talking about the real-life time I refused to follow a doctor, or the hypothetical story you threw out?




I'm trying to get at why a paramedic not following a physician's order is any different from an EMT not following a paramedic's order when the same argument ("Just because, and I don't want to explain myself to you") is used by both the physician and the paramedic.


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## Shishkabob (Aug 22, 2011)

JPINFV said:


> I'm trying to get at why a paramedic not following a physician's order is any different from an EMT not following a paramedic's order when the same argument ("Just because, and I don't want to explain myself to you") is used by both the physician and the paramedic.



Just because.   h34r:


PS-- Never said it was.


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## Sasha (Aug 22, 2011)

Linuss said:


> I don't need to give a legitimate explanation to first responders about why I do or do not want something done while on scene.  My word is/should be enough unless they see a safety issue.  Unless my partner has the knowledge to backup refusing what I want done, it should be done.
> 
> And considering my assessment also goes deeper than my partners', I also don't expect them to always see what I see when it comes to treatment modalities.
> 
> ...



If you want a treatment done and refuse to or cant justify why that treatment is done than you have no business downgrading the call. If your assesment "sees something" that requires o2 shouldnt you tell the emt so they know what to monitor for changes?

Roleplaying for a moment here, if i was that emt and you wanted to dictate the treatment you either ride in with me or keep your mouth shut. Especially if you wont tell me why.

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## Shishkabob (Aug 22, 2011)

And I never said I didn't agree with that view a single time.


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## Sasha (Aug 22, 2011)

So why are you defending the medic?

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## jjesusfreak01 (Aug 22, 2011)

Sasha said:


> If you want a treatment done and refuse to or cant justify why that treatment is done than you have no business downgrading the call. If your assesment "sees something" that requires o2 shouldnt you tell the emt so they know what to monitor for changes?



Agreed. I'll do whatever the medic wants onscene...until he decides to hand the call to me. At that point its my patient and if he wants something else done and I don't see the reason, he needs to justify it to me. If a medic is downgrading the call to BLS, then there will be a very simple explanation for why he wants the oxygen.


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## Shishkabob (Aug 22, 2011)

Sasha said:


> So why are you defending the medic?
> 
> Sent from LuLu using Tapatalk



No.

I'm saying if you're against the explanation of "Just because", your defense for refusing to do something better not be "Just because", too.


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## truetiger (Aug 22, 2011)

Out of curiosity, did the OP do his own assessment?


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## Ewok Jerky (Aug 22, 2011)

Thank you for the lively discussion, wish id had a chance to chime in sooner but its been a busy shift and im typing on my phone so please excuse grammatical/silly errors.

I was on scene during medics assessment, no indication for O2, medic did not get pulse-ox. Vitals were unremarkable.

Also I would like to add that O2 is a BLS skill, so while medic is higher authority this is not the same as medic asking me to hook up the monitor and me questioning why. Nor is it the same as refusing an order from a dr

I hate to change the scenario but what if we tested BG and it came back 120, no ALOC, and medic told me to administer oral glucose?


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## firetender (Aug 23, 2011)

*Please don't change; we're not through here*

*What is real?*

The higher credentialed medic determined that his patient was a BLS call, felt no need to intervene, he did NOT apply the O2 himself

He handed the care of the patient off to the OP.

It's the OP's patient now!

*POLITICS, Part I:* 

He asks OP to put the pt. on O2. I forget, did he say how many LPM?

By now, OP should know if applying the O2 will harm the patient.

If no harm, apply the O2.

If "potential" for harm but no *imminent* danger to patient

*Apply the O2.*

Why? Because if OP moves fast enough that patient will be out of sight of the medic, in OP's ambulance and UNDER OP's CONTROL and legally, OP's responsibility.

*END POLITICS Part I*

*Now* go back and do a _*THOROUGH*_ assessment.

If OP's conscience says give the Medic his due unless OP is *sure* he knows enough to countermand his decision, keep the O2 on while pt. gets assessed. 

Adjust or remove O2 according to *the current *assessment. 

*Document.* 

*HINT (You owe me ten bucks!):* _the status of patients often change in transport!_

*POLITICS Part II:*

You'll notice no mention of even talking to the guy. Why? Because under those circumstances OP is *not* going to be able to educate him, and...

under those circumstances OP will soon be in charge. *NOTHING ELSE MATTERS other than the welfare of the patient!*

*Moral of the story:* *Understand when you become in charge. If you can accelerate the process of you getting there, then do that. Once that happens, YOU can be the guy who says: "Just because*" and then let the guy downwind of you agonize over how to handle you!*

Your friendly firetender

* While, of course, you back it up with your best clinical judgment.


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## shfd739 (Aug 23, 2011)

truetiger said:


> Why not just leave the O2 on while you load the patient? 2 extra minutes on low flow O2 isn't going to make a difference. Save the @#$% measuring contest with the fireman and do your own assessment.



I'm thinking this given the situation. Heck I do this around here so it doesn't look like the "big mean transport paramedic is ignoring or second guessing our treatments" to the first responders. Especially given their propensity for putting NRBs on every freaking body "just because". 

I really hate having to play nice. 
---
- Sent from my electronic overbearing life controller


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## the_negro_puppy (Aug 23, 2011)

jjesusfreak01 said:


> Can't tell if trolling, or actually unsure...





NVRob said:


> I think he's joking...





abckidsmom said:


> Agree.  Just joking, right?



Yeah I wasn't serious!


I don't know why people are getting so butthurt over this scenario. If the the patient was turned over to the EMT's care he can then assess her and remove 02 if he deems not necessary.  I personally wouldn't have argued with the firemedic and just removed the nasal cannula once I had her loaded. Conflict resolution sometimes includes conflict avoidance.


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## truetiger (Aug 23, 2011)

This scenario is a perfect example of where a little common sense can take you a long way. Leave the patient on oxygen, load her, do your own assessment, and then either continue or discontinue the oxygen treatment. The call wouldn't even stick out. Option two, challenge the fire-medic. It'll turn into a huge deal and end with bad blood between the two agencies. Now, every call you run with them will be a p*ssing match. Seems like a pretty simple decision...


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## Melclin (Aug 23, 2011)

Godwin's law comes to mind in this thread. 

War crimes and court cases aside, I've done most of the things mentioned here.

On one side I've ignored a doctor's orders and done my own thing, on the other side, I've continued treatments that I was reasonably sure were useless simply because I wasn't sure why they were in place (usually O2). 

We have the benefit of ALS units that aren't complete idiots, and we also don't directly charge patients for every little thing we do, so your issue has some nuance to it that I don't usually have to deal with. 

1. Try and get an explanation (if you're taking a handover, this really shouldn't be difficult).
2. If you were unable to find a delicate way of getting a reason for a treatment out of the the higher provider, my thought would be to continue it unless:
-dangerous.
-patently absurd (oxygen for a sore foot may fit into this category).


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## Sasha (Aug 23, 2011)

> I was on scene during medics assessment, no indication for O2, medic did not get pulse-ox.



The pulse ox is the most useless piece of equipment ever. Aside from a bite stick.


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## usalsfyre (Aug 23, 2011)

Sasha said:


> The pulse ox is the most useless piece of equipment ever. Aside from a bite stick.



Errrr, I'd argue the trans-tracheal jet insuflator, esophageal detection device, Viewmax laryngoscope and the regular short-board might seriously challenge for that title...

I find a pulse-ox that displays a waveform to be pretty darn useful.


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## truetiger (Aug 23, 2011)

What did your assessment reveal? What complaints did the patient have? Med hx?


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## mcdonl (Aug 23, 2011)

Lady_EMT said:


> I'll listen to a medic if they give a good reason. Even if they're just covering all the bases, they should have a better reason than "just because."



I will listen to a medic because they are they are a higher license level. They do not need to give a good reason. For crying out loud, it is not like he was asking the basic to do something above their license level.

Maybe here on the internet world you can just challenge every little thing a medic tells you to do, but in my state and on my service if you have a higher license level you are in charge of the patient.

The medic was transferring care to the basic with the instructions to put the patient on o2... once in the rig if the basic wanted to discontinue o2 therapy after the assessment... then so be it. At that point it is their call... dont get so butt hurt just because someone told you to do something.

I have used the term "just because" with a smile and a wink in front of a patient before because sometimes it is more relaxing for the patient to think that the care and steps being taken are precautionary instead of giving specific clinical reasons.


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## Sasha (Aug 23, 2011)

You project a sheep mentality.

No medic or basic should ever use "just because" as an excuse. It doesnt show youre precautionary, it shows that you are uneducated and feel like you have got to do SOMETHING even though nothing is indicated.

Sent from LuLu using Tapatalk


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## Tigger (Aug 23, 2011)

mcdonl said:


> I will listen to a medic because they are they are a higher license level. They do not need to give a good reason. For crying out loud, it is not like he was asking the basic to do something above their license level.
> 
> Maybe here on the internet world you can just challenge every little thing a medic tells you to do, but in my state and on my service if you have a higher license level you are in charge of the patient.
> 
> ...



It's not challenging anyone to ask why in a polite manner out of earshot of the partner. It's not like anyone has a problem actually putting the o2 on, but if a medic says "why don't you put her on it," don't you think it might be prudent to ask why she needs the oxygen?

Nothing wrong with being honest with patient either, many of the people we treat do want to know what is wrong with them and what we are doing for them. Mitigating circumstances (ie anxiety) aside, we need to be honest with our patients like every other healthcare provider is.


Sent from my out of area communications device.


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## JPINFV (Aug 23, 2011)

I once used "protocol" to justify to the ED nurse why the patient was on a NRB. I don't think I've ever felt dirtier after a call than after that call.


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## truetiger (Aug 23, 2011)

It was wrong for the medic to use "just because" as a reason. It would also be just as wrong to "call out" another provider on scene. The right thing to do would be to realize that it's not worth picking a fight over, continue the medic's treatment until you do your own assessment, and get on with life.


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## mcdonl (Aug 23, 2011)

Sasha said:


> You project a sheep mentality.
> 
> No medic or basic should ever use "just because" as an excuse. It doesnt show youre precautionary, it shows that you are uneducated and feel like you have got to do SOMETHING even though nothing is indicated.
> 
> Sent from LuLu using Tapatalk



Sasha, your inconsiderate and out of line comments like calling me, someone you do not even know uneducated is why your opinions are largely ignored.

Just because, is not always an excuse. If your personality you put across on here is the same that yuo share with your patients then well... you just would not understand what my post was saying.


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## shfd739 (Aug 23, 2011)

mcdonl said:


> Sasha, your inconsiderate and out of line comments like calling me, someone you do not even know uneducated is why your opinions are largely ignored.
> 
> Just because, is not always an excuse. If your personality you put across on here is the same that yuo share with your patients then well... you just would not understand what my post was saying.



I'm not sure where you are being called uneducated. I take this as directed to the medic that gave his reasoning for O2 as "just because". 


---
- Sent from my electronic overbearing life controller


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## Lady_EMT (Aug 23, 2011)

I'm just going to stand here and put one thing into the conversation that, I believe, has been said before, but I'm going to say it again.

This whole confusion could have been ended with a SIMPLE "May I ask for reasoning behind the oxygen? Is she having any chest pain/difficulty breathing/indications O2 will make her transport a bit easier?"

It seems like many people seem to have some communication problems with other departments and other medics/ems providers, if something as simple as "I'm going to put her on O2 just because" turns into such a heated debate, bordering an argument.


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## Sasha (Aug 23, 2011)

mcdonl said:


> Sasha, your inconsiderate and out of line comments like calling me, someone you do not even know uneducated is why your opinions are largely ignored.
> 
> Just because, is not always an excuse. If your personality you put across on here is the same that yuo share with your patients then well... you just would not understand what my post was saying.



It was a general you, not you personally. I don't know you and don't care if you ignore my opinion or not. Honestly, you're just another person on a message board.

My personality here is largely the same. I'm a patient advocate, I will always advocate FOR MY PATIENTS. Putting them on O2 will show up on their bill, and if they DO NOT need o2, why would I consent to administer a treatment that in my opinion is not clinically indicated and the person who is requesting said treatment is not able to provide me with a reason beyond "just 'cause you know."

It doesn't show anyone that "Just cause you know" you (general) are being proactive or percautionary. It just shows that you (again, a general you) are not educated or comfortable enough to know when not doing something is completely fine, thus must always DO something, therefore you (general) put them on O2 so YOU (general) feel like you've "done something".

If we are going to do stuff just to show the patient we are doing something, why don't we put every patient on high flow o2, monitor, IV of NS at TKO with a lights and sirens transport to the hospital.

After all, wont they feel better knowing that you(general) are taking percautions that are not clinically indicated?


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## mcdonl (Aug 30, 2011)

Sorry Sasha... that was a douch thing to say. I didnt mean it.


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## jjesusfreak01 (Sep 1, 2011)

I think maybe i'll give the patient some cardizem...just cause you know. 

Had a call working convalescence recently to discharge a patient, and when I went in the room I found them on a mag drip. Diabetic with wildly fluctuating sugar and just finishing a mag drip. Do I have the right to ask why and inquire about the patients recent treatments, or is "just because" good enough for me?


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## Bullets (Sep 1, 2011)

Is the medic not coming with you? Then ill do my own assessment, thank you very much. I dont think its too much to ask. Would the medic do any different if i was transfering care to him? i doubt it


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