# Would you walk this pt out to the truck?



## DragonClaw (Feb 21, 2021)

About 19: long story short,  guy is altered and might be on something,  locks himself in the gas station bathroom 

Cop notes he's altered, diaphoretic,  stumbling, weak. Pt claims sickle cell. 

This is not to attack any of the medics,  but I mean,  doesn't that open you up for liability if you walk the pt and they fall, injuring themselves?

I mean,  the guy took some verbal nudging to get up but followed commands and answered questions after a second. 

But at the same time,  he seemed kinda unfit to walk as it is an unnecessary risk. 

I don't think I would,  but then again,  I've heard a lot of medics use the "Airway, Breathing, Can you walk to the ambulance", because they're not waiters and aren't gonna just baby every pt. 

There was a medic from NY I knew and worked with a few times that I didn't like.  Once we had to take a Bari discharge an hour and a half or so from ED to home. We were told someone would be there for the pt. On arrival, we find out,  that person is sick and cannot take care of our pt. 

It was a basic call and we were assist. The primary crew was BLS. I know them,  they're a good team.  Us basics all agree there's no way we can leave her. She can't walk or feed herself or anything,  she's too weak. 

The medic on the other hand threw a hissy fit. Saying we just need to leave her there by herself and she'll be fine,  blah blah blah. He goes,  "Back in newyork,  we would have just yeeted her" abd he gets up on one leg and pulls the other up abs does that basketball throw pose and shoots his arm to indicate he'd just toss the pt in and leave.

He gets kinda mad but we're all firm,  we're taking her back. He's mad the whole time back, but he drives our unit. 

I learn later that he tried to blame the primary crew for trying to leave her. 

As for the second,  is there really any defense for getting to leave her? If she was AOX4 GCS15 and wanted to,  having no idea when she'd get help,  would you?


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## planetmike (Feb 21, 2021)

If the patient is alert and oriented, and can understand and explain back to you the risks of being left alone, then you might be justified in leaving the patient. If the patient is weak and can't take care of herself, leaving the patient probably isn't the right path to take.


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## DrParasite (Feb 22, 2021)

DragonClaw said:


> This is not to attack any of the medics,  but I mean,  doesn't that open you up for liability if you walk the pt and they fall, injuring themselves?
> 
> I mean,  the guy took some verbal nudging to get up but followed commands and answered questions after a second.
> 
> But at the same time,  he seemed kinda unfit to walk as it is an unnecessary risk.


I didn't watch the entire video, how did he get to the bathroom?  I'm assuming he walked, right?  I did see him walking out to the ambulance, so I am assuming he was able to walk.  

Truth be told, I probably walk more people than the majority of my coworkers; if they can walk, even with some assistance, they should, as it's safer for all involved.  And if they do get woozy, then you can safely lower them to the ground, and plan an alternative.  But if they have a clinical reason not to walk (cardiac/respiratory issue, every time they sit up they pass out, etc), I have no issues carrying them to the truck.

That being said, if you are doing a discharge, and the patient can't care for themselves, and their caretaker isn't able to care for them, why on earth would you leave them there?  it's a recipe for disaster.  your medic was wrong.  Yes, the person will need to have a plan to take of themself, but if their plan (the caretaker) is unable to, then things will be bad, the patient will go downhill, and you will be dragging the bari patient out on a 911 call.  There is no defense to making the decision leave a bed-confined person at home, when they have no ability to care for themselves.  Not even in NY.  

However, if she was AOx4, GCS 15, understands the risks... well, people have the right to make stupid decisions about their healthcare.  But before I left, I'd be on the phone with my supervisor, and if they didn't give me an answer I liked, I would call my director/administrator, and document who I spoke to, and what they said, because it's not going to end well.


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## DragonClaw (Feb 22, 2021)

DrParasite said:


> I didn't watch the entire video, how did he get to the bathroom?  I'm assuming he walked, right?  I did see him walking out to the ambulance, so I am assuming he was able to walk.
> 
> Truth be told, I probably walk more people than the majority of my coworkers; if they can walk, even with some assistance, they should, as it's safer for all involved.  And if they do get woozy, then you can safely lower them to the ground, and plan an alternative.  But if they have a clinical reason not to walk (cardiac/respiratory issue, every time they sit up they pass out, etc), I have no issues carrying them to the truck.
> 
> ...



He walked there,  as far as I know. It's not shown in the video but the store manager says he used the bathroom and locked himself in,  so I assume he got there fine enough on his own. 

Their caretaker didn't even live with them and was at their home. If that wasn't clear. 

I was pretty appaled by his demand.

She was like "Oh you have to take me back? Okay" 

She wasn't chomping at the bit to stay.  She was just bummed.

The hospital was displeased at our return.


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## StCEMT (Feb 24, 2021)

Anyone who can walk, walks. If they need an assist, give it. Especially some of the larger people who are mobile (we have one psych that has to be 400+), I am not at all interested in lifting them. Especially with the weather we have been having. 

Use good judgment and utilize your resources as appropriate. For most of what EMS does, a large percentage are perfectly capable of taking some initiative in their care and walking. A fairly significant portion of my patients ride the bench seat.


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## DragonClaw (Feb 24, 2021)

StCEMT said:


> Anyone who can walk, walks. If they need an assist, give it. Especially some of the larger people who are mobile (we have one psych that has to be 400+), I am not at all interested in lifting them. Especially with the weather we have been having.
> 
> Use good judgment and utilize your resources as appropriate. For most of what EMS does, a large percentage are perfectly capable of taking some initiative in their care and walking. A fairly significant portion of my patients ride the bench seat.


I've actually never ever had anyone ride on the bench or seen it. 

Hmm.


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## Ensihoitaja (Feb 24, 2021)

Our ambulances have an X printed on the bench seat for people to sit on.


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## StCEMT (Feb 24, 2021)

DragonClaw said:


> I've actually never ever had anyone ride on the bench or seen it.
> 
> Hmm.


I'm all for moving people when they need it. But the people using us as a taxi will not be getting lifted by me or my partner if they're physically capable. I have no desire to get hurt for some ******** complaint.


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## Jim37F (Feb 24, 2021)

Our EMS will happily walk people to the ambulance all day long.

They'll usually get belted into the gurney anyways once in the ambulance versus a special spot on the bench though.


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## DragonClaw (Feb 24, 2021)

Ensihoitaja said:


> Our ambulances have an X printed on the bench seat for people to sit on.


Is this a joke or literal?


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## VentMonkey (Feb 24, 2021)

DragonClaw said:


> Is this a joke or literal?


Literal. If you search and find that old _Paramedics_ show from the early 2000's/ late 90's on TLC, there's an episode or two with Denver EMS that shows them on a call. I think it was a shooting, IIRC.


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## DragonClaw (Feb 24, 2021)

VentMonkey said:


> Literal. If you search and find that old _Paramedics_ show from the early 2000's/ late 90's on TLC, there's an episode or two with Denver EMS that shows them on a call. I think it was a shooting, IIRC.



Why not just have them sit anywhere and belt them in?


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## Rano Pano (Feb 24, 2021)

DragonClaw said:


> Why not just have them sit anywhere and belt them in?


1. Sanitary reasons
2. Safety reasons

I personally have plenty of pts I don’t want sitting where I sit. It doesn’t matter if I clean the area afterwards.


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## NomadicMedic (Feb 24, 2021)

Ensihoitaja said:


> Our ambulances have an X printed on the bench seat for people to sit on.


Denver checking in.


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## NomadicMedic (Feb 24, 2021)

DragonClaw said:


> Is this a joke or literal?



the quote is, “oh no. The pram is for sick people. You sit on the X”

(Pram is Denver for stretcher... just like litter is Pennsylvanian for stretcher)


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## DragonClaw (Feb 24, 2021)

NomadicMedic said:


> the quote is, “oh no. The pram is for sick people. You sit on the X”
> 
> (Pram is Denver for stretcher... just like litter is Pennsylvanian for stretcher)


Isn't a pram a baby carriage?


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## NomadicMedic (Feb 24, 2021)

DragonClaw said:


> Isn't a pram a baby carriage?








						So what do you call it?
					

Just seeing the stats on our usage of the synonymous terms for a stretcher...



					emtlife.com


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## DragonClaw (Feb 24, 2021)

NomadicMedic said:


> So what do you call it?
> 
> 
> Just seeing the stats on our usage of the synonymous terms for a stretcher...
> ...



I usually use gurney, but will say stretcher, rarely cot. To old people I might tell them it's a bed on wheels,  but not a very comfortable one.

*shrug*


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## Tigger (Feb 24, 2021)

DragonClaw said:


> As for the second,  is there really any defense for getting to leave her? If she was AOX4 GCS15 and wanted to,  having no idea when she'd get help,  would you?


If a patient has demonstrated the capability to make decisions, you respect those decisions. You can educate, but you don't get to decide for the patient. 

As for walking a patient like that? I dunno. Maybe hold on to them if you're concerned. The bed does not solve all problems.


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## DragonClaw (Feb 24, 2021)

Tigger said:


> If a patient has demonstrated the capability to make decisions, you respect those decisions. You can educate, but you don't get to decide for the patient.
> 
> As for walking a patient like that? I dunno. Maybe hold on to them if you're concerned. The bed does not solve all problems.



I don't remember if she was in our case,  tbh. But she didn't want to stay alone particularly.


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## johnrsemt (Mar 1, 2021)

I have put patients on the bench, and airway chair.  If I am worried, I will put a blanket down 1st.     I clean them all well


  I have slept on the cot, when I have had to.  Mainly on 24 hour or longer shifts when we had no station. or on the empty leg of long out of town trips (22 hours was my longest).  Slept on the cot, bench, airway chair, passenger seat and drivers seat (we were all asleep at that point).


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## mrhunt (Mar 9, 2021)

if my pt can walk, they walk. End of story.  If i feel they are medically unstable to walk for whatever reason, or cannot physically do it due to injury or GCS then they are carried. 

But ive had healthy teenage girls with wrist fractures state "oh no, i cant walk".....yes. Yes you can, and you will. And they do! 

NOW! thats not to say that im just TRUSTING everyone to walk and i still have myself, a fire fighter or my partner in front and behind the pt extremely close and guiding the pt at all times, ready to catch them if they SHOULD fall or trip or whatever. Safety first. but thats just precautionary as i wouldnt be having them walk if i didnt think they could.


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## mrhunt (Mar 9, 2021)

every situation is different however, and as a disclaimer ive unfortunately HAD to make pts walk when i REALLY didnt want them to. 
Case in point, had a legit diff breather who was in an extremely cramped house and closest gurney could get was front door.  Dude was pushing 400lbs and Fire on scene got scared and stated they were gonna "wait in the engine, call us if you need us".....because for them diff breather automatically equals covid.

Dude is Satting in 60's on NRB @ 15lpm i put on and we need to go NOW. I cant wait 10 minutes to go outside, tell fire we need them, have them do a full PPE Covid-19 gear up and THEN come in and THEN carry the guy out....

And me and my partner cant physically carry him. 

SO i had to make him walk. And yeah, it wasnt good and made him worse until i was able to get more interventions in place on him at the rig . and i didnt wanna do it but It was the best out of all the bad options that i had available to me at the time. And he was already gonna get C-Pap anyways.


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## Tigger (Mar 9, 2021)

mrhunt said:


> if my pt can walk, they walk. End of story.  If i feel they are medically unstable to walk for whatever reason, or cannot physically do it due to injury or GCS then they are carried.
> 
> But ive had healthy teenage girls with wrist fractures state "oh no, i cant walk".....yes. Yes you can, and you will. And they do!
> 
> NOW! thats not to say that im just TRUSTING everyone to walk and i still have myself, a fire fighter or my partner in front and behind the pt extremely close and guiding the pt at all times, ready to catch them if they SHOULD fall or trip or whatever. Safety first. but thats just precautionary as i wouldnt be having them walk if i didnt think they could.


Do you walk grandma with a fractured wrist that you can easily get a cot next to?

I get the sentiment, but this job is also about customer service and making people feel good. As such, some people still get carried that have no medical reason to. Oh well.


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## mrhunt (Mar 9, 2021)

If i can easily get the stretcher next to them Then they stand with assistance (or not, whatever is required), and transfer over that way. 

I understand the customer service aspect but im there for people medically. And FYI, the teenager who broke her wrist was a good half mile away from our ambulance in rough off road terrain with only me and my partner to carry. 

So we carry her, And one of us falls causing greater injury to the pt (who inevitebly gets dropped) and injury to me or my partner in order to Make her "feel good"? I dont think so. 

Im more than willing to be the bad guy in order to have everyone be safe and have the best outcome.


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## DrParasite (Mar 10, 2021)

Tigger said:


> Do you walk grandma with a fractured wrist that you can easily get a cot next to?


Why not?  is something wrong with her legs?  how is she going to get home after the ER discharges her?  by ambulance?  or by taxi or a friend's car? is she unstable on her feet?  can we walk with assistance?  is she still in the location where she injured her wrist, or did she walk around the house to get ice, call 911, grab her things, etc.  

and, full disclosure, if she slips on the ice outside, there is a 99% chance I am bringing the cot to her (plus that helps me not fall on the ice too).  however, I can't bring the cot up to her 2nd floor bed room, with no less than three 90 degree turns to get to here.  If Grandma is 90 lbs soaking wet, no biggie; if grandma is 300lbs..... different story.  


Tigger said:


> I get the sentiment, but this job is also about customer service and making people feel good. As such, some people still get carried that have no medical reason to. Oh well.


No, it's not: medicine has never been about making people feel good.  It's about treating people appropriately.  Otherwise, the patient would dictate your treatment path, not their condition; otherwise everyone would get narcotic pain meds.  Now, customer service IS important, but it doesn't trump appropriate care, nor should you be providing excellent customer service at the expense of your own health and safety.  and yes, you want people to feel good, but that's not the goal of medicine either.  You want to deliver appropriate care, and allow the person to get better.

I've carried more people that had no medical reason in my career than I would like to admit (as I'm sure you have too).  How many back injuries have you suffered on the job?  I can recall one, which knocked me out of work for 2 weeks.  I have coworkers who needed back surgery (for one, the second was career ending).  Yes, lifting and carrying people is part of the job, but how would you feel if you lost money because you got hurt carrying someone who has no medical reason?


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## DrParasite (Mar 15, 2021)

mrhunt said:


> I cant wait 10 minutes to go outside, tell fire we need them, have them do a full PPE Covid-19 gear up and THEN come in and THEN carry the guy out....


Why didn't you just get on the radio, tell the engine to gear up and bring in a carrying device, and advice them to hurry because you had a really sick patient?


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## mrhunt (Mar 15, 2021)

Because we dont have com's with Fire directly.  Its 2 differnt dispatch systems.  And communication through there is SLOW.  Im talking a good 5 minutes slow.  Going that route would have actually been a WORSE option than me or my partner running outside.


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## DrParasite (Mar 15, 2021)

mrhunt said:


> Because we dont have com's with Fire directly.  Its 2 differnt dispatch systems.  And communication through there is SLOW.  Im talking a good 5 minutes slow.  Going that route would have actually been a WORSE option than me or my partner running outside.


I had a hunch that was the case... .sadly, it's an all too common occurrence, when fire and EMS can't talk to each other directly.


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## Fastfrankie19151 (Jul 3, 2021)

If they seemed stable enough to walk we walk with me on one side partner on the other just in case. If their is any doubt in our minds not theirs ours that they can safely walk then yup stretcher time. As for putting a patient sitting up on the bench seat no thank you. Yes they may be perfectly fine and yes they may be using us as a taxi but two scenarios scare me about letting a patient sit on the bench. 1. If we get in a accident and get sued and we will get sued it may be hard to justify a patient sitting on the bench instead of on the stretcher with all the appropriate safety restraints. Yes the bench has seat belts but still not giving a lawyer a chance to screw me. 2nd what if that calm stable patient suddenly takes a dive and codes or passes out or goes all psycho I rather them be on that stretcher in any of those scenarios.


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## medichopeful (Jul 3, 2021)

I never really understood this whole concern about walking people to the stretcher if they’re safe to do so. Patients walk in the hospital all the time, why should we be any different?


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## CharlotteGriffin (Jul 26, 2021)

NomadicMedic said:


> the quote is, “oh no. The pram is for sick people. You sit on the X”
> 
> (Pram is Denver for stretcher... just like litter is Pennsylvanian for stretcher)


litter....super common around me! Where does it come from...?


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