# what would you do....



## ThatPrivate (Jan 1, 2013)

I remember a few year back a husband asked that only white nurses and doctors. I believe at first the hospitals complied with the requested but a lot of people were really upset with it.  So that for me thinking what happens when these types of requested are made in the field. I understand some people have religious belief that come into play (only having a female provider exam a women, or the husband must be present in the room while the medics are with his wife). I understand these and I don't have a problem with those request. The request  I don't know how to handled are the ones that discriminate against a provider because of age, race or gender. I have listed 4 examples of what would you do in these situation. Please be honest and feel free to share any stories that a person didn't want treatment from you based on something superficial and not about ability.


An older African American women doesn't want you (a 27 y/o white male)  because she doesn't want any white people to touch you. 

A 76 y/o white male with chest pain doesn't want you (a Hispanic male) or your partner (an African American female) to treat him or even in his house.  He doesn't refuse care, just yours. He calls 911 and request a white crew to come.

A middle age women who has signs and symptoms of a TIA doesn't want your partner (who is the paramedic) to treat her because he looks like he belongs in middle school. Your only a basic. 

A white women calls 911 because her husband woke up with chest pain. You anydyour partner are both Hispanic. When you arrive the wife ask for an “English speaking medic“ before you or your partner even say a word (both speak English as your first language). The women also ask if you were "legal“. She refuses to let you or your partner in the house.

What would you do in each situation? I understand that we have to respect people's belief but how about when those belief are based on hate and ignorance? None of the people had an altered mental status. Would you get PD involved,  contracted dispatched or requested another unit?  Please keep it civil. I don't want it to get shut down by the CL.


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## VFlutter (Jan 1, 2013)

Many of the people with these type of prejudices will never change and can not be reasoned with but some of them can be persuaded. If possible to accommodate the request I would just try to do what they want, it would be easier for everyone. If you not you can simply state that "I am the professional here to help with this emergency. If you do not wish to accept my services then you can wait until another crew arrives which may take X amount of time and may result in serious injury or harm to yourself."

I get this every once in the while in the hospital. Sometimes women do not want me to take care of them. We just assign them a new nurse. Much easier when you have a full staff unlike EMS. If it is about race, sexual orientation, etc we still try to accommodate it but only to a certain point and then the nurse supervisor has a stern talk with the patient.


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## PaddyWagon (Jan 1, 2013)

The answer from my basic class would be to evaluate their mental status, educate them on the consequences of their choices, get them to sign off on their refusal (with witness if possible) and call dispatch.

That's just book learnin' though, is that a decent framework to work under?


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## Tigger (Jan 1, 2013)

If someone is of the proper mental status to refuse care, they can do so for whatever reason they would like. I would document it as a refusal and fill out the appropriate forms. I would probably then get a hold of dispatch and try and get a supervisor to me as well as the "requested" crew if possible. As mentioned, to accommodate their request just makes it easier for all involved. If that is not possible I guess I would just tell them it's either or us or wait a while, it's up to you.


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## ffemt8978 (Jan 1, 2013)

We try to honor patient requests within certain limits:
1) It is legal
2) It is safe
3) It is possible with the resources we have (i.e. same gender provider)


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## bigbaldguy (Jan 1, 2013)

I've only been in EMS a short time and I've run into pretty much all of these situations. I do live in Texas however so that's really not as surprising as it sounds.

Chase is right people like this rarely change and the odds you'll make a difference in their prejudice on that one call is minimal. It's easier to just make allowances if you can do so without impacting their care or that of other patients.

Unfortunetly beating the stupid out of people is out of our scope, in fact even diagnosing stupid can be very difficult. That said I did read about a recent trial being run in the UK using a special diagnostic device called an AAS. As I understand it the patient and or bystander suffering from a suspected acute case of stupid is given the AAS (a small round pliable sphere the size of a tennis ball) and then asked to place his feet at shoulder width while slightly flexing his knees and holding the AAS overhead. He is then asked to keep his focus on the AAS while counting backwards from 10. On reaching 1 the patient or bystander is then kicked in the crotch by the most senior medic present. If the patient displays any discomfort or pain this is considered a positive sign for stupid. After a baseline is established the test should be repeated every 2 to 3 minutes in order to show trending. It can sometimes help to have several different providers perform the test so as to rule out any false positives. If EMS personnel become fatigued fire personnel and volunteers from the local soccer league may be utilized but must be carefully monitored by a qualified medic. Early results have been promising and a newer AAS prototype using a battery driven crotch probe is in development by medtronic the makers of the Lucas Device. This device will shorten the testing interval to once every 30 seconds and significantly reduce provider fatigue while increasing quality and consistency of the test. In the words of Joe Monterini chief public relations spokesman for Medtronic "This new device is incredible and was actually developed with the help of David Beckham one of our investors. This thing can deliver a Beckham quality kick every 30 seconds for 4 hours per battery and every unit will ship with 4 batteries. We may not have a cure for stupid yet but we sure as hell can test the hell out of somebody for it."


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## firecoins (Jan 1, 2013)

we do not honor their requests. They can sign a document refusing treatment but not transport or they can RMA outirght.


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