# Pt w a Dr for a wife??



## 911fixer

i have been in EMS for 12 years now. I am a Paramedic now and this happened when i was a basic a while back. I was working for a private company in Massachusetts who has tons of contracted facilities and towns all surrounding Boston. Anyway, we were dispatched to a "skilled nuring facility" for a pt w nausea, vommitting and diarrhea, and a high temp. When we arrived my partner went straight to the pt to find out what was going on while i gathered the appropriate paperwork. I couldnt help but to overhear two RNs talking about a pt w 9/10 substernal chest pain. so i asked what that was all about and they told me it was our pt. trying to be professional i didnt say what i was thinking which at this point " are you :censored::censored::censored::censored:ing kidding me, how do you forget to mention that when you call us" also we did not have 911 for the town, but a contract w the facility. so needless to say i got on the radio and requested ALS from the town. I went in the pts room to find the pt, with his wife next to him. She immediately had attitude. my partner looked at me with that look as if something happened when i wasnt there. after small arguments and pt got loaded on the stretcher. The closest facility was Hospital Z (gotta protect myself from the bull:censored::censored::censored::censored hospital hands down. i was told that medics are going to be a lil longer than i cared to wait. i told the wife where we as basics were taking the pt and she started to raise her voice and told us that we wouldnt be, and demanded that we take her husband to the opposite side of the city where she was a decorated Dr. I politely reminded her that we were not going against our protocols. She continued to rant on, about how she is on the "board of this" "the president of that", and so on and if we didnt adhere to her wishes that the hospital she works at ( who just signed a giagantic contract with our company) she will have the contract dropped. At this point we r in the back of our truck and its already in drive, thank god she didnt plan on riding with us. But i also know how this company is with its contracts, and if she actually did manage to get the contract pulled my job would without a doubt be terminated. i called my dispatch supervisor and told them what was up,  and i was told to whatever happens i better go to wherever she wants him to go. Me and my gut so didnt want to listen to this douche, so i figured i would call other supervisors and try to get the answer i wanted which was go to hospital Z, not hospital X. Litterally all four people who i spoke with all told me to go to Hospital X cuz if we do loose a contract it would be on my ***. Sooooo off to hospital X we go. unbelievable, i am so pissed at this point i just want the call to be over, and to make matters worse, my partner somehow managed to get us lightly t boned in the back quarter panel of the van ambulance, sending me head first into a cabinet( i was standing trying to do something..b/p, lung sounds or whatever i was doing) pt kinda wobbled a bit but was very secure so he didnt even realize what was going on anyway. the pt got ASA, 02, and was very taken care of to the exact protocol. On arrival at the hospital and pt care was transferred to MDs in the ER. i gave my report, i also gave Dr douches name, and nobody even recognized the name. we obviously beat her there cuz we have lights and sirens and she didnt. i told them everything and how she tried to dictate our treatment and everything else with the call. Just as i finished explaining to all the ER staff in the room what happened, in she comes. At this point everyone tells her to get out, and they all say we dont care who you are, or how important she was, she needed to leave. one of the ER nurses researched this lady to find out what her deal was. Come to find out this so called Dr.......turns out to be a psych Dr....and not on any boards, or a member of anything worth anything. UNREAL, i didnt ask what kind of Dr she was because i was too busy trying to take care of my pt, and didnt really care what kinda Dr she was.
Question being, what would anyone else have done, i know if i went to the closest hospital i hands down would have gotten fired. i know i could have faught it later on and prob won, but i had bills to pay and couldnt afford to lose my job or even my emt basic card...
i think of this call alot, and yes i would do things a lil different as a medic in this position. but at the time i only had about maybe two years of exp under my belt. I am just curious to see what everyone else thinks or would have done.  thanks...hahah srry this is so long but wanted to paint you the whole picture.


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## VFlutter

911fixer said:


> I went in the pts room to find the pt, with his wife next to him. She immediately had attitude. my partner looked at me with that look as if something happened when i wasnt there.



Is it possible that your partner may have said or done something to cause this attitude? Some people just have attitudes no matter what but many times people who have legitimate reasons or concerns.

I live in a city with multiple hospitals. Some are great others are not. There is a hospital, a level one trauma, a mile from my house. I would never go there even if my life depended on it. If EMS told me they had to go to the closest facility I would politely go AMA and call a taxi. Also if I go to the hospital I work at all my specialists are there and my insurance covers 100% of inpatient costs. That is a huge deal.  

Oh and if you told me I had to go the closest facility because of "protocol" I would get an attitude.

Long story short: A patient has the right to request what hospital to go to, even in emergencies. As long as the request is not absurd then it should be granted. If the patient has CP and the hospital they want to go to does not have PCI capabilities then that might be a reason to argue. 



911fixer said:


> Just as i finished explaining to all the ER staff in the room what happened, in she comes. At this point everyone tells her to get out, and they all say we dont care who you are, or how important she was, she needed to leave. one of the ER nurses researched this lady to find out what her deal was. Come to find out this so called Dr.......turns out to be a psych Dr....and not on any boards, or a member of anything worth anything. UNREAL, i didnt ask what kind of Dr she was because i was too busy trying to take care of my pt, and didnt really care what kinda Dr she was.



So called psych doctors, "Physiatrists" as we call them, are still Medical Doctors. But that does not really matter. 

The patients family has a right to at the beside up until the point that they interfere with care. 

The fact that the nurse had the time to look up who this lady was makes me think the patients was not very unstable. 



911fixer said:


> Question being, what would anyone else have done, i know if i went to the closest hospital i hands down would have gotten fired. i know i could have faught it later on and prob won, but i had bills to pay and couldnt afford to lose my job or even my emt basic card...
> i think of this call alot, and yes i would do things a lil different as a medic in this position. but at the time i only had about maybe two years of exp under my belt. I am just curious to see what everyone else thinks or would have done.  thanks...hahah srry this is so long but wanted to paint you the whole picture.



I would have taken the patient to the hospital they requested as long as the patient was relativity stable and the requested hospital was appropriate.


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## 911fixer

Yes the one out of five nurse did have a second, there were about seven rns and docs in the room at that point, and the requested hospital was about ten to 15 miles out of the way,  nit sure the outcome of pt. But i think i shoulda went to closest hosp...


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## VFlutter

911fixer said:


> and the requested hospital was about ten to 15 miles out of the way,  nit sure the outcome of pt. But i think i shoulda went to closest hosp...



Why?


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## 911fixer

9/10 substernal chest pain w radiation to arms,  and jaw. As a basic emt, and ALS nowhere around, i shouldnt have taken the chance. I dont exactly remember his vitals but he wasnt in very good shape, all i could do was ASA, and O2, and drive fast.  Maybe if i were ALS at the time i would have gone a lil bit further, but it would have depended on the details...dont really wanna be touring the city w a pt w severe chest pain.


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## NomadicMedic

Here's a few questions... was it really cardiac chest pain? Are you sure? Did the patient have a productive cough? What is his pain reproducible on palpation or inspiration? Was he gray? Was he diaphoretic? Did he have a cardiac history? What was his temp? How long has he had nausea and diarrhea? What meds was he taking? Why was he in a skilled nursing facility in the first place? How far out was ALS? Since you seemed uncomfortable with this patient and unable to manage him with anything other than a diesel bolus, why did you decide not to wait?

I think it's important to remember, not all chest pain is cardiac. And you, as a basic, without a monitor or any real assessment skills other then "chest pain or not chest pain" can't really determine what's going on or where that patient needs to go. 

Now, if you explained it carefully and calmly, "Ma'am, I strongly suggest that your husband should go to the closest facility because I believe he may be having some cardiac issues and should be evaluated quickly. Once he's stabilized, if needed, he can be transferred to the facility where you're on staff."

Last question, did you give him 15 L of oxygen on a non-rebreather?


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## VFlutter

DEmedic said:


> Last question, did you give him 15 L of oxygen on a non-rebreather?



 How did I forget to ask that?!


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## Aidey

The fact that you played mom against dad with the supervisors is a huge no-no too. I don't know about your company, but that would result in major trouble where I am at. Even if it isn't something you'll get in trouble for, it is very very poor form.


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## firecoins

No call to a med control doctor? 

If the pt is a doctor, they can take responsibility but must come with the pt.


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## J B

firecoins said:


> No call to a med control doctor?
> 
> If the pt is a doctor, they can take responsibility but must come with the pt.



I was going to say, isn't the pt's wife technically "higher level of care"?


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## mike1390

firecoins said:


> No call to a med control doctor?
> 
> If the pt is a doctor, they can take responsibility but must come with the pt.



This, Iv done it a couple times usually the "well im just a dentist comes out at that point."

Also did I read right that you got "lightly T-boned".... and continued to the hospital? thats a hit and run

Could you not have an ALS intercept enroute?


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## Carlos Danger

firecoins said:


> If the pt is a doctor, they can take responsibility but must come with the pt.





J B said:


> I was going to say, isn't the pt's wife technically "higher level of care"?



That's only if they are trying to give orders which contradict your protocols. In the case described, the wife wasn't trying to do that; she was simply a family member demanding transport to a further facility, which is allowed.

OP, from what you presented here, I don't think you did anything wrong. Patients (or their families) have the right to make decisions which are not in their best interest, and we have to honor those decisions.

The only thing I would ask is, why did you call your supervisor rather than medical control? Next time call the doc and let them make the decision and take the responsibility. That's exactly what they are being paid to do.


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## RocketMedic

911fixer said:


> i have been in EMS for 12 years now. I am a Paramedic now and this happened when i was a basic a while back. I was working for a private company in Massachusetts who has tons of contracted facilities and towns all surrounding Boston. Anyway, we were dispatched to a "skilled nuring facility" for a pt w nausea, vommitting and diarrhea, and a high temp.
> 
> Although probably fairly sick, BLS for the most part.
> 
> When we arrived my partner went straight to the pt to find out what was going on while i gathered the appropriate paperwork. I couldnt help but to overhear two RNs talking about a pt w 9/10 substernal chest pain. so i asked what that was all about and they told me it was our pt. trying to be professional i didnt say what i was thinking which at this point " are you :censored::censored::censored::censored:ing kidding me, how do you forget to mention that when you call us" also we did not have 911 for the town, but a contract w the facility. so needless to say i got on the radio and requested ALS from the town.
> 
> Mistake 1: Assess your patient. The RN report is great, but did you investigate or just go "chest pain omg!!!!" Also, where was your partner in this?
> 
> I went in the pts room to find the pt, with his wife next to him. She immediately had attitude. my partner looked at me with that look as if something happened when i wasnt there.
> 
> Uncooperative, entitled, educated family. An EMTs worst nightmare.
> 
> after small arguments
> 
> You already lost, EMS is customer service. Don't argue with family. If you're going to do something against their desires, inform them that it will happen and why.
> 
> and pt got loaded on the stretcher. The closest facility was Hospital Z (gotta protect myself from the bull:censored::censored::censored::censored hospital hands down.
> 
> Closest does not equal most appropriate. Did X have the patients records, payment, etc? Did they have the prior relationship that Y already had? Was X really going to do anything other than MONA and a stat transfer to Y?
> 
> 
> i was told that medics are going to be a lil longer than i cared to wait.
> 
> You panicked. Why not wait if you already activated 911?
> 
> i told the wife where we as basics were taking the pt and she started to raise her voice and told us that we wouldnt be
> Damned education!
> 
> , and demanded that we take her husband to the opposite side of the city where she was a decorated Dr.
> Read this as "where my family usually gets care and he is well-known."
> 
> I politely reminded her that we were not going against our protocols.
> Doctors vs protocols, hmmm...can you see why your IFT EMT Basic protocols didnt mean much to her?
> 
> She continued to rant on, about how she is on the "board of this" "the president of that", and so on and if we didnt adhere to her wishes that the hospital she works at ( who just signed a giagantic contract with our company) she will have the contract dropped.
> Cue to apologize and let your partner tech this one, you both being EMTs and all. Defuse the situation, shes way, way more important to your boss than you are.
> 
> At this point we r in the back of our truck and its already in drive, thank god she didnt plan on riding with us.
> No kidding, she would have to run and jump.
> 
> But i also know how this company is with its contracts, and if she actually did manage to get the contract pulled my job would without a doubt be terminated.
> True.
> i called my dispatch supervisor and told them what was up,  and i was told to whatever happens i better go to wherever she wants him to go. Me and my gut so didnt want to listen to this douche, so i figured i would call other supervisors and try to get the answer i wanted which was go to hospital Z, not hospital X. Litterally all four people who i spoke with all told me to go to Hospital X cuz if we do loose a contract it would be on my ***. Sooooo off to hospital X we go.
> So you have time to supervisor shop, but not 911 or transport to X? What condition was your patient in?
> 
> unbelievable, i am so pissed at this point i just want the call to be over, and to make matters worse, my partner somehow managed to get us lightly t boned in the back quarter panel of the van ambulance, sending me head first into a cabinet( i was standing trying to do something..b/p, lung sounds or whatever i was doing) pt kinda wobbled a bit but was very secure so he didnt even realize what was going on anyway.
> So you go emergent, sustain a vehicle contact en route (lots of risk and danger here), left the scene of the collision with your patient on board...
> 
> the pt got ASA, 02, and was very taken care of to the exact protocol.
> Thank goodness. Why?
> 
> On arrival at the hospital and pt care was transferred to MDs in the ER. i gave my report, i also gave Dr douches name, and nobody even recognized the name. we obviously beat her there cuz we have lights and sirens and she didnt.
> 
> Emergent IFT, RACING THE REAPER!
> 
> i told them everything and how she tried to dictate our treatment and everything else with the call.
> Damned pesky educations...
> Just as i finished explaining to all the ER staff in the room what happened, in she comes. At this point everyone tells her to get out, and they all say we dont care who you are, or how important she was, she needed to leave. one of the ER nurses researched this lady to find out what her deal was. Come to find out this so called Dr.......turns out to be a psych Dr....and not on any boards, or a member of anything worth anything. UNREAL, i didnt ask what kind of Dr she was because i was too busy trying to take care of my pt, and didnt really care what kinda Dr she was.
> 
> Assessment flaw, know your enemy. Guarantee your interaction with supervisors would have gone more smoothly with that knowledge calmly conveyed.
> 
> Question being, what would anyone else have done, i know if i went to the closest hospital i hands down would have gotten fired. i know i could have faught it later on and prob won, but i had bills to pay and couldnt afford to lose my job or even my emt basic card...
> 
> Fought.
> 
> 
> i think of this call alot, and yes i would do things a lil different as a medic in this position. but at the time i only had about maybe two years of exp under my belt. I am just curious to see what everyone else thinks or would have done.  thanks...hahah srry this is so long but wanted to paint you the whole picture.



Well, I would have used better English...
My input is in your quote above.

Bluntly, you did a horrible job here, should have been fired for your interactions and the collision, should be reeducated on the patient assessment and care.


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## 911fixer

Lol...if this happened tommorow things would be way different than ten yrs ago when it happened.  Yes med control, yes better assesment, ..and so forth... And as for family requesting a facility.. that wasnt the case, families dont have any clue about contracts nor would they even threaten that as a family member. Also yes the closest hospital would have been the most appropriate. Why wait for ALS would have already been at hospital by yhe time we were even able to meet them. The pts normal hospital was the closest.. and as far as supervisors go, i didnt wanna lose my job so i wanted to confirm the dropoff point as well as try to go to closest...if something were to happen i could have said i was doing what i was told by several superiors.. but like i said things would be waaay different today, i learn from my mistakes and every call i go on i learn something. I dont know everything like some of the people on here think they do...the whole call was a :censored::censored::censored::censored:show...and none of u were there...its good to gey everyones opinion  thank you for all the input its appreciated.. i have way more exp now than then.  So


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## 911fixer

Also alologize for my typos. Haha im using my phone to post and have a small keyboard on it..


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## NomadicMedic

How about this, you're a medic now. What would you have done differently?


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## 911fixer

Haha the purpose of me even starting this thread was to ask what eveyone else would have done..not for me to get picked apart...i am confident w my skills and have been a very succsessful medic so i am not explaining what i would do now as a medic.. nice try tho


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## firecoins

Halothane said:


> That's only if they are trying to give orders which contradict your protocols. In the case described, the wife wasn't trying to do that; she was simply a family member demanding transport to a further facility, which is allowed.
> 
> OP, from what you presented here, I don't think you did anything wrong. Patients (or their families) have the right to make decisions which are not in their best interest, and we have to honor those decisions.
> 
> The only thing I would ask is, why did you call your supervisor rather than medical control? Next time call the doc and let them make the decision and take the responsibility. That's exactly what they are being paid to do.



The original post says the protocol was to go the closest hospital. That was being contradicted.


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## NomadicMedic

911fixer said:


> Haha the purpose of me even starting this thread was to ask what eveyone else would have done..not for me to get picked apart...i am confident w my skills and have been a very succsessful medic so i am not explaining what i would do now as a medic.. nice try tho



Well, if it wasn't your intent to get picked apart, you picked the wrong topic. 

You provided lousy customer service, you didn't follow the protocol established to guide EMTs down the correct pathway, you left the scene of an accident, you overreacted to a simple chest pain call ... Also, you insulted the patient's wife for being a forceful medical professional and ridiculed her throughout the thread. 

What would I have done differently? Everything. Starting with a job search. 

As for you spelling? I wrote this on an iPhone and I managed to spell everything correctly.


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## Carlos Danger

firecoins said:


> The original post says the protocol was to go the closest hospital. That was being contradicted.



Sure. 

But a patient can always refuse to go to specific hospital and go somewhere else instead. At least in every system I've ever been involved in.


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## Achilles

DEmedic said:


> Well, if it wasn't your intent to get picked apart, you picked the wrong topic.
> 
> You provided lousy customer service, you didn't follow the protocol established to guide EMTs down the correct pathway, you left the scene of an accident, you overreacted to a simple chest pain call ... Also, you insulted the patient's wife for being a forceful medical professional and ridiculed her throughout the thread.
> 
> What would I have done differently? Everything. Starting with a job search.
> 
> As for you spelling? I wrote this on an iPhone and I managed to spell everything correctly.









Somebody woke up on the wrong side if the bed 
However, I agree.


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## DesertMedic66

You got T-boned and your partner kept driving? cough cough Hit and Run cough cough


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## NomadicMedic

Ok. Admittedly my reply was a bit harsh, but I find the OPs unapologetic tone ridiculous. 

Maybe if it were phrased like this, "a few years ago I had a call that could have gone better... Here's what I did..." 

Maybe then I would have looked at it differently. Instead, I see a guy who appears to see nothing wrong with any of the issues that were pointed out and gets defensive when asked how he would behave today, with more experience and education under his belt. 

The majority of the job as an EMS professional is to serve as a patient advocate. That is job #1. If you're doing the right thing for the patient, without ulterior motive, you're doing the right thing. If you can't do that, well... I guess you'll have to stick with referring to a concerned patient's wife as a "Douche" and try to rationalize your poor behavior on an Internet message board.


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## 911fixer

Just because i mentioned she was a douche, does not mean i disrespected or treated her wrong in any way. I was polite w everything i said .. in case u missed the whole i was afraid to  lose my job or the company contract part. I was walking on eggshells w this guys wife.. i did know his pmh, why he was there to begin with. And ya pts or proxys can request a facility within reason, and furthermore chest pain as a basic as far as i was trained at the time should always be considered a cardiac problem, until proven otherwise by a higher level of care. And as for the hit and run.....we were hit and the other guy took off, but he also called our dispatch and everything was taken care of.. so there are parts of this lil episode that may have been left out...so the people that are trying to make it seem like i dont know how to do my job, or how to treat people and there families, are wrong to even try to judge me, nobody on here knows me from a hole in the wall.. i have had numerous  letters and cards of thank you sent to a few different employers for treating people w respect, reguardless if the call or outcome,....as a matter of fact even this 94 year old guy on this call thanked me for everything...his 46 year old wife started w the attitude, my partner and i were very professional. And nobody on here was there so thats that.. u dont know as much as u may think fellas


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## Achilles

Anybody watching Full House right now? That always calms me down h34r:


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## VFlutter

You are right, we were not there ourselves nor do we know you personally. But you posted a scenario on an Internet forum. Like it or not you are going to be judged. Not only are we going to judge the scenario but also the way you present yourself, your grammar, and your vocabulary. To be quite honest regardless of the scenario the way you presented yourself was atrocious. All of your posts sound highly unprofessional.


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## Clipper1

I see this as a crew who put their own concerns ahead of the patient's.

You failed to remember this woman was the patient's wife and probably his sole support for emotional care. You and your partner both chose to argue and disrespect the patient's wife in front of him which shows little concern for his chest pain.

The hospital staff is also at fault when they allowed  you to conduct yourself in an unprofessional manner  over the patient. They threw her out without getting any information from her when she probably was his DPOA.  The nurse who looked up the wife's credentials in the computer is clueless to the fact that hospital databases will list the services the physician is allowed within the hospital and not their life's achievements.  This was the patient's WIFE. Yes she identified herself as a doctor just the same as most EMTs and Paramedics identify themselves when the hospital cares for a family member. Some EMTs and Paramedics always show up in uniform to visit their family member even when off duty.  We don't throw them out although we may make them wear a gown over their uniform if they had been working with patients all day.


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## Ace 227

As has been said several times, it is the patients right to go to whatever facility they choose, within reason. If you truly felt that it was critically detrimental to your pt's condition to go 15 miles out of the way, have the pt or his wife sign a refusal form specifying they are refusing transport to hospital y.

I know you said you don't remember the exact values but what were his vitals like? Stable? WNL? If your pt was stable, perfusing well, and without apparent dyspnea or immediate life threats, then I see no reason why you needed to run this call in emergent or why you couldn't wait for ALS and let them deal with the wife.

As a paramedic now, why not address how you would handle the call differently? I find it a little odd that you refused to and a little odd that this call was from "10 years ago".

Also, maybe I'm expecting too much, but I would think in the world of computerized PCRs that your grammar, spelling, and punctuation would be a little better, regardless of what you are typing on. Paragraph formatting is helpful as well.


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## MarshalFoch

Halothane said:


> Sure.
> 
> But a patient can always refuse to go to specific hospital and go somewhere else instead. At least in every system I've ever been involved in.




Similar to the OP, I work BLS in Massachusetts in and around the Boston area. I know my company has a protocol system for where you can transport someone to, and what you need to do or document if you deviate from that. Any hospital within 20 minutes is acceptable, if it is appropriate. And I can tell you that in the Boston area almost *any* hospital is within 20 minutes unless it is going from south of the city to north or west. 

If the desired hospital is further than 20 minutes away, the patient must have one of a few reasons listed to need to go there. One of those reasons can be that the hospital has the patients information and doctors familiar with them (in other words, their preferred hospital) and you must call medical control. So there is no situation in which you cannot transport someone to their preferred hospital unless they need some form of care it can't provide that another facility can, you just have to call medical control. I don't know about all the companies in the area, but from what I've been told by others who work there at least two of the other large ones have the same policy.

I don't know the particulars of the case the OP posted, but I find it hard to believe they could have wanted to go to a hospital _that_ much further away. That being said, because of all the hospitals in the region it can make you feel uneasy to transport past what can easily be several facilities to go to a preferred one when so many private companies stress CYA. 

Still the first and often most important BLS skill is customer service, and in this case the crew performed poorly from the description. Patients will sometimes want to go somewhere other than the nearest facility, and almost all of the time it is not a problem. The few times it has been an issue, it has been easy to diffuse by simply and calmly explaining to them why I believe hospital X is a more appropriate choice than hospital Y, not just saying "My protocols". Think of how that sounds to someone hearing it, that is their loved one you are caring for and OEMS protocols or company policies are simply not an excuse they are going to take for an answer. I haven't had it happen but if that didn't work then there is always medical control, and if medical control agrees with the patient then wonderful, I've absolved myself and are deferring to a higher medical authority. If not, just the title doctor usually makes people on the phone a lot more amenable. That is what my protocols say.


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## DrParasite

are you kidding?  tell her to GTFO, if she wants to treat the patient, you can go home.  otherwise, get out of the way and let you do your job.

Actually, there are quite a few ways to handle the call.  first off, once you get involved in an MVA, you are OOS.  call another ambulance.  don't transport, unless you have the consent of law enforcement and your agency supervisor.

Treat the wife as the patient's wife.  She is obviously emotionally attached to her husband, so she will function as a wife more than a doctor.  that's also why most doctors have ethical rules about treating family members.  so while you can _probably_ get away with ignoring her medical commands, as the spouse she has certain expectations.

Remember, when it comes to an issue with you or maintaining a contract, a private company will fire you in a heartbeat, even if you are right, even if you did nothing wrong, even if the complaint is you hurt someone's feeling, or they inferred an offense that wasn't there.

Other than that, treat the patient to the best of your ability, following your protocols as best as you can.  Make the patient leave happy, make the family be happy with you.  

When in doubt, call a supervisor to the scene.  that's what they get paid the big bucks for.  Sometimes just having a supervisor there can help diffuse a situation.  Plus they have the operational authority to deviate from your normal protocols, or back you in enforcing the existing ones.


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## NomadicMedic

I'm assuming you're just kidding about the "tell her to GTFO" ... 

You are just kidding, right?


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## DrParasite

DEmedic said:


> I'm assuming you're just kidding about the "tell her to GTFO" ...
> 
> You are just kidding, right?


oh absolutely.  total joking and that should not be taken literally by anyone who wants to maintain their employment at their current position.

damn, should have made that clearer....


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## Sublime

I feel like the OP has been over criticized in this thread. 

Although I also feel like some things are kind of strange... such as you saying you're now a paramedic and this was an old scenario that happend while you were a basic, but you're just now posting this and can't provide an explanation of how you'd handle it now. And also you were t-boned on the way but still continued to the hospital...? And you could of presented it better but oh well.

To me it seems like you were just an inexperienced emt-b (which only gives you so much knowledge on how to properly handle this call) who was presented with an out of the ordinary scenario which you weren't prepared for. You sound like you did what you thought was right and you did an ok job in my mind (ignoring t-bone incident here).

In a future situation you should call med control immediately. This would of been your get out of jail free card. You would have your medical directors support. As far as the wife, her being a doctor is irrelevant. If she can make medical decisions for him you have to listen to her... if not go by what the patient wants.


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## VFlutter

Sublime said:


> I feel like the OP has been over criticized in this thread.



I don't


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## Sublime

Chase said:


> I don't



That's fine. I just don't feel he should be fired and such as others have stated. 

I think sometimes people forget what it was like to be new and inexperienced.


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## Ace 227

Sublime said:


> To me it seems like you were just an inexperienced emt-b (which only gives you so much knowledge on how to properly handle this call) who was presented with an out of the ordinary scenario which you weren't prepared for.



Maybe a form of "vetting" should be required since his tag says he's a Paramedic...

I'm sure its been suggested in the past and there is a reason why it hasn't been implemented. I just thought I'd mention it.


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## medicdan

Ace 227 said:


> Maybe a form of "vetting" should be required since his tag says he's a Paramedic...
> 
> I'm sure its been suggested in the past and there is a reason why it hasn't been implemented. I just thought I'd mention it.



http://www.emtlife.com/showthread.php?t=31286


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## Bullets

Chase said:


> The patients family has a right to at the beside up until the point that they interfere with care.





Halothane said:


> (or their families) have the right to make decisions which are not in their best interest, and we have to honor those decisions.


Both of these are wrong...The patient was conscious and alert, therefore the patient's family can go pound salt when it comes to care and treatment decisions. In most cases where i have family interjecting themselves in patient care, they are asked to leave twice, then they are removed. 

I have had family tell me all manner of reasons why i should listen to them, that they have a POA, very few are legitimate

If family identifies themselves as a doctor and they are telling me what they want done, they are informed that i will submit to their decisions provided they ride with me as an acting physician and i get all of their information for my chart. 



DEmedic said:


> I'm assuming you're just kidding about the "tell her to GTFO" ...
> 
> You are just kidding, right?



See above....ive told family's this many times, and i am still employed. Just have to do it in a way that they think they are being helpful


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## VFlutter

Bullets said:


> Both of these are wrong...The patient was conscious and alert, therefore the patient's family can go pound salt when it comes to care and treatment decisions. In most cases where i have family interjecting themselves in patient care, they are asked to leave twice, then they are removed.
> 
> I have had family tell me all manner of reasons why i should listen to them, that they have a POA, very few are legitimate
> l



Agree to disagree. Patient satisfaction and patient outcomes are improved when family is allowed to be at the bedside. This is why many ICUs are revising their visitor policies and most are going towards open visitation. 

They can interject all they want as long as it is not interfering with the care I am providing. I will do my best to explain why I am doing things my way. 

In my experience many of the family members have legitimate concerns, as in this scenario. 

For example if my grandma had to be taken to the hospital I would want to go with her. She is alert and oriented but has no clue what her medical history is, her medications, etc. If the EMT throws my grandma, who has pulmonary fibrosis, on a NRB @ 15Lpm when her SpO2 is 90% then I am going to say something. If they want to take her to a hospital that is not where her Pulmonologist is then I am going to say something. If they say "It is our protocol, GTFO" then things would get very heated.


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## ExpatMedic0

I do not mean to stray to far off topic..... but,
Another interesting point is that in most states if an off duty MD demands to take over patient care they can. So long as you state that they accept all responsibility and stay with the patient until patient care is handed over to another MD.
Your particular state or medical director may have specific rules or protocols for this and which MD's are allowed. 
From that perspective, if she identified herself as an M.D. and this is verified somehow, shes calling the shots. As long as she accepted full responsibility for the patient, its her show now, your unit is effectively commandeered by the MD. Any ideas on this perspective, if the doc was a shrink?


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## VFlutter

ExpatMedic0 said:


> Any ideas on this perspective, if the doc was a shrink?



They are still a Medical Doctor and went through medical school like all other specialties. And if I am not mistaken many of them also went through Internal Medicine residencies before specializing in Psych.


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## Aidey

One of the local hospital shrinks was an anesthesiologist for something like 10 years before switching to psych. I would guess that for the purposes of if someone is able to take over care that a psychiatrist would be able to if the other conditions were met.


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## JPINFV

ExpatMedic0 said:


> As long as she accepted full responsibility for the patient, its her show now, your unit is effectively commandeered by the MD. Any ideas on this perspective, if the doc was a shrink?


A physician, including psychiatrists, have an unrestricted license to practice medicine. It's unrestricted in terms of time, location, and scope of practice. Granted, they will be held to the standard of the specialty they're practicing (i.e. if the psychiatrist decided to do a heart transplant, they'd be held to the standards of a transplant surgeon), but there's nothing legally wrong with a psychiatrist taking over patient care on an ambulance. 

Also medical school and the first year of residency ("internship" year) are inherently general education. It's not like the psychiatrist wasn't educated in non-psych diseases and disorders and spent all 3 years of his/her psychiatry residency working with psychiatric patients.


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## chaz90

JPINFV said:


> A physician, including psychiatrists, have an unrestricted license to practice medicine. It's unrestricted in terms of time, location, and scope of practice. Granted, they will be held to the standard of the specialty they're practicing (i.e. if the psychiatrist decided to do a heart transplant, they'd be held to the standards of a transplant surgeon), but there's nothing legally wrong with a psychiatrist taking over patient care on an ambulance.
> 
> Also medical school and the first year of residency ("internship" year) are inherently general education. It's not like the psychiatrist wasn't educated in non-psych diseases and disorders and spent all 3 years of his/her psychiatry residency working with psychiatric patients.



And this is why I've seen a textbook that mentions a scenario in which a "moonlighting proctology resident" is the doc at the ED. Thankfully not something I've seen, but entertaining to read.


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## firecoins

chaz90 said:


> And this is why I've seen a textbook that mentions a scenario in which a "moonlighting proctology resident" is the doc at the ED. Thankfully not something I've seen, but entertaining to read.



hopefully he doesn't make an as of himself?

Ok someone had to go there and I did.


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## JPINFV

chaz90 said:


> And this is why I've seen a textbook that mentions a scenario in which a "moonlighting proctology resident" is the doc at the ED. Thankfully not something I've seen, but entertaining to read.




Did the fact that the ED was staffed by a colorectal surgery resident have any effect on the outcome of the scenario?


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## chaz90

JPINFV said:


> Did the fact that the ED was staffed by a colorectal surgery resident have any effect on the outcome of the scenario?



It was just an attempt at humor by the authors of the textbook. It was actually mentioned in the scenario that the doctor was attempting to remove the "funny looking underwear" from the patient (PASG pants). The whole book was incredibly outdated and mostly worthless.


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## Sublime

JPINFV said:


> A physician, including psychiatrists, have an unrestricted license to practice medicine. It's unrestricted in terms of time, location, and scope of practice. Granted, they will be held to the standard of the specialty they're practicing (i.e. if the psychiatrist decided to do a heart transplant, they'd be held to the standards of a transplant surgeon), but there's nothing legally wrong with a psychiatrist taking over patient care on an ambulance.
> 
> Also medical school and the first year of residency ("internship" year) are inherently general education. It's not like the psychiatrist wasn't educated in non-psych diseases and disorders and spent all 3 years of his/her psychiatry residency working with psychiatric patients.



This may be so, but someone claiming to be a doctor on my scene most likely isn't going to get too far. Honestly I wouldn't be comfortable letting a psych or surg. doctor taking over my patient. Just because at one point years ago before they specialized they learned general medicine doesn't mean they remain competent on treatments in an acute setting. Ask any surgeon to read an EKG for example. 

Thankfully my protocols state a doctor on scene can not tell me what to do, and if they want to take over care they must be in direct contact with our medical control and they must approve it first. I can't imagine it any other way. Who's to stop some crazy person or whacker from claiming they're a doctor on the streets?


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## JPINFV

Sublime said:


> Who's to stop some crazy person or whacker from claiming they're a doctor on the streets?



If only there was some sort of card that people can carry that can verify that the person is licensed to practice medicine.


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## Tigger

ExpatMedic0 said:


> I do not mean to stray to far off topic..... but,
> Another interesting point is that in most states if an off duty MD demands to take over patient care they can. So long as you state that they accept all responsibility and stay with the patient until patient care is handed over to another MD.
> Your particular state or medical director may have specific rules or protocols for this and which MD's are allowed.
> From that perspective, if she identified herself as an M.D. and this is verified somehow, shes calling the shots. As long as she accepted full responsibility for the patient, its her show now, your unit is effectively commandeered by the MD. Any ideas on this perspective, if the doc was a shrink?



I'm not so sure they can just commandeer the unit. Yes you can agree to transfer care, but I've never worked anywhere where the doctor could take over care unless the patient approves.


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## Sublime

JPINFV said:


> If only there was some sort of card that people can carry that can verify that the person is licensed to practice medicine.



And it's probably impossible for someone who wants to pretend to be a doctor to create such a card....

Also i've never seen a physician license and wouldn't know a legit one from a fake one.


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## JPINFV

Sublime said:


> And it's probably impossible for someone who wants to pretend to be a doctor to create such a card....
> 
> Also i've never seen a physician license and wouldn't know a legit one from a fake one.




So why have any license card? Do you carry your EMS license while working?


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## chaz90

JPINFV said:


> So why have any license card? Do you carry your EMS license while working?



That's a bit different. In uniform and assigned to a shift, the expectation is that your license has been checked by your employer. This would be the same as a doctor working at an ED I don't typically transport to. If he/she gives me an order to do something while there (IE give 5 mg Versed prior to a nurse being able to get it out of the Pyxis) and I do that, it was under the belief that they are properly licensed. If someone comes up to me and says they are a physician, I would absolutely check licensure before following their orders.


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## Sublime

JPINFV said:


> So why have any license card? Do you carry your EMS license while working?



Yes I do, although I don't feel the need to explain the obvious difference between me carrying my license while on duty and a random person outside of their place of work wanting to take over my job.


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## captinfocker

I hope you dont work for the company that I think you do


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## RocketMedic

captinfocker said:


> I hope you dont work for the company that I think you do



Who are you talking to?


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## Bullets

Chase said:


> Agree to disagree. Patient satisfaction and patient outcomes are improved when family is allowed to be at the bedside. This is why many ICUs are revising their visitor policies and most are going towards open visitation.
> 
> They can interject all they want as long as it is not interfering with the care I am providing. I will do my best to explain why I am doing things my way.
> 
> In my experience many of the family members have legitimate concerns, as in this scenario.
> 
> For example if my grandma had to be taken to the hospital I would want to go with her. She is alert and oriented but has no clue what her medical history is, her medications, etc. If the EMT throws my grandma, who has pulmonary fibrosis, on a NRB @ 15Lpm when her SpO2 is 90% then I am going to say something. If they want to take her to a hospital that is not where her Pulmonologist is then I am going to say something. If they say "It is our protocol, GTFO" then things would get very heated.



There is a difference between assisting EMS with information, which i always welcome. I cant count how many times ive said "you know him/her better then i do, is this normal ect"

And things like the patient and family arguing with each other about course of action, should we go or not, oxygen or not, ect. Ive had family demand we transport, claiming they have a POA, while the patient adamantly refuses to go. These family members are told to get out. 

My attitude with EMTs who are not on duty on scene is a very short leash. If family who are medical providers want to direct the patient care, then they should go get their own agencies ambulance or be prepared to sign some paperwork stating they have assumed care and we are simply being used as a taxi. In these cases they should also be prepared to recieve a summons to appear in court from our Police Officer for abusing the 911 system and causing a false alarm.


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## firecoins

I am required to to carry all credentials on me by New York State.  I am also required to display my company ID which has my picture on it.


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## captinfocker

Rocketmedic40 said:


> Who are you talking to?



I was referring to op


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## DrParasite

JPINFV said:


> So why have any license card? Do you carry your EMS license while working?


yes, probably 98% of the time when I'm working (the other 2% I have forgotten my wallet at home).  I usually carry my EMS card from the State in my wallet, and depending on what I'm doing, might even have my work ID in my pocket.  





Chase said:


> For example if my grandma had to be taken to the hospital I would want to go with her. She is alert and oriented but has no clue what her medical history is, her medications, etc. If the EMT throws my grandma, who has pulmonary fibrosis, on a NRB @ 15Lpm when her SpO2 is 90% then I am going to say something. If they want to take her to a hospital that is not where her Pulmonologist is then I am going to say something. If they say "It is our protocol, GTFO" then things would get very heated.


With all due respect, you can say whatever you want.... however, you called for the ambulance, and if I'm on the ambulance, I have my own rules to follow.  I might say "It is our protocol, GTFO", and if you have a problem with that, you are more than welcome to refuse all care, and when she dies, it will fall on you.  Further, if her pulmonologist is an hour away, and I am bypassing 4 other hospitals to get to the one she is at, you can say something, but it won't be changing the outcome.  If she's critical, local hospital can stablize her until she gets transferred.  If she's not, than sign the refusal and schedule a commercial ambulance to take her whereever you want.

Families can have a say in what goes on, but they are also emotionally involved in the situation; as the professional provider, you might have a very good reason to ignore what they say.  But you better have a really really good reason, along with the backing of your superiors, before you do, because you can expect a complaint to follow your decision.


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## Av8or007

At the same time, the family/pt may sometimes know the pts pmhx better. Using that pulmonary fibrosis example, i can see why the pt or family care providers might have an issue,  expecially if it was a very 'cookbook' medic or emtb performing care. Its 2013 and we still cling onto the oxygen dogma of  'if a little's good, then more is better'  - dogma that has been known to cause harm since the 1980's (by the rt's and pulmonary docs).


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## abandonallhope

RocketMedic said:


> Well, I would have used better English...
> My input is in your quote above.
> 
> Bluntly, you did a horrible job here, should have been fired for your interactions and the collision, should be reeducated on the patient assessment and care.



A horrible job? Judgmental much.....first of all why do we hammer closest facility over and over to our new techs if our Pt. complains of CO,SOB etc. if were only going to criticize them for following their protocols and education?

What interaction did he engage in that warrants termination?


Why does he need to attend ANY reeducation ? How is he responsible for the MVA when he was not driving 

We ( MANAGERS ) need to be empowering our crews not allowing them to be ordered around by every turkey that claims to be MD/DO.
I can already see it...had this tech decided to follow Pt's spouses instructions you would be arguing that he failed to exercise control over his scene.

Come on folks... We need to be supporting our fellow medics not chastising them. You don't see this type of internal discourse and open berating in the fire service or among fellow LEO's.


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## DrankTheKoolaid

No, when they screw up they need to be called out on it. 

We don't need coddled providers who have poor decision making capabilities. That is exactly why EMS in a lot of areas is the way it is. The Medical Directors have no faith in the technicians it has to allow to work in the system.


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## abandonallhope

DrankTheKoolaid said:


> No, when they screw up they need to be called out on it.
> 
> We don't need coddled providers who have poor decision making capabilities. That is exactly why EMS in a lot of areas is the way it is. The Medical Directors have no faith in the technicians it has to allow to work in the system.



I'm not advocating coddling however if you see anything in the post that I critiqued that could be construed to be constructive by all means feel free to point it out.

Secondly with almost 2 decades in EMS I feel confident in stating that our M.D.'s lack of faith or reluctance to permit more relaxed permission is firmly rooted in technician arrogance and overconfidence in practicing already approved modalities.

We all to often earn our "paragod" titles with our overly critical comments again like the ones I highlighted. It is just not reasonable to believe that anyone can glean the type of insight from the OP's  post to support the type of remarks that were given.

We need to be encouraging constructive criticism and skill building to our younger FTO's and mentors not supporting the type of comments we saw.
Many of these newer technicians are volunteers and are already making sacrifices to better themselves and their communities while so many other young folks are only interested in their own benefit.


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## DrankTheKoolaid

That was a blanket statement not directed solely at you. 

There were many errors in the scenario as given.   First is knowledge of protocols. Every EMS system I have worked has the same solution for MD at a scene. They can back off, assist or assume all patient care. Allowing this now irritated spouse to assume all care would have squashed the issue right then and there.  Unless this was a STEMI/CVA/trauma where the intended receiving facility was the ONLY specialize ED to cover it. Then maybe you can justify diverting to it after advising the spouse or have the spouse sign AMA against using that facility and document the hell out of it.

The second was allowing financial greed to dictate medicine when it may not have been in the patients best interest (not an OP problem) but piss poor unethical management problem. 

I won't even touch on the hit and run issue.

The end result is the same when care providers F up they need to receive constructive criticism as you put it ( just a PC way of saying being called on it) and education.


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## deftdrummer1

Where I work, you wouldn't have turned a wheel toward _any_ hospital until that ALS unit showed up at scene. 

End of story.


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## Tigger

deftdrummer1 said:


> Where I work, you wouldn't have turned a wheel toward _any_ hospital until that ALS unit showed up at scene.
> 
> End of story.



How does that help the patient at all? If the hospital is closer than an ALS unit, the hospital is your "ALS."


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## chaz90

deftdrummer1 said:


> Where I work, you wouldn't have turned a wheel toward _any_ hospital until that ALS unit showed up at scene.
> 
> End of story.



Seems like wherever you work needs a policy adjustment. If the hospital is closer than ALS, why wait for a paramedic unit just to transport to the same hospital?


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## TheLocalMedic

chaz90 said:


> Seems like wherever you work needs a policy adjustment. If the hospital is closer than ALS, why wait for a paramedic unit just to transport to the same hospital?



Deft is a dispatcher, so be gentle…  they don't know what it's like in the real world, lol.


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## deftdrummer1

The "real world" lol and you know nothing about dispatch I suppose, safe to say right? Obviously the pretentiousness of the "real" EMS world is alive and well here. 

Hey what EMS service couldn't use a policy adjustment or two? 

Reason they wouldn't turn a wheel is because BLS units don't transport ALS patients with my agency. Simple as that. If the patient codes in the rig whose fault is it then that the proper equipment is not on board?


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## Tigger

So if the patient codes while waiting on scene that is somehow better?


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## chaz90

deftdrummer1 said:


> Reason they wouldn't turn a wheel is because BLS units don't transport ALS patients with my agency. Simple as that. If the patient codes in the rig whose fault is it then that the proper equipment is not on board?



If BLS finds themselves alone on scene with an unstable patient, the decision needs to be made if an ALS intercept or the hospital itself is closer. If the patient is found in cardiac arrest I can understand waiting for ALS while performing high quality CPR and defibrillation on scene. Otherwise, what good is the BLS unit doing holding the hand of a critical patient while time to hospital<time to ALS?


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## deftdrummer1

No good, and I understand what you're saying. Like others have said generally it's bets to just get the patient in the rig and get going if a facility that offers the services required is within a reasonable distance. 

I don't make policy I just follow it until it's changed


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## TheLocalMedic

deftdrummer1 said:


> The "real world" lol and you know nothing about dispatch I suppose, safe to say right? Obviously the pretentiousness of the "real" EMS world is alive and well here.



Ah, don't be so quick to make assumptions.  I DID work in a fire/EMS 911 dispatch center in the not too distant past!  And having experienced both sides of the radio, I often advocate for our dispatchers.  It's a tough job, no doubt about it.  But now that I'm in the field, I can say with absolute authority that dispatchers simply don't know what it's like to be out here in the glorious fresh air, lol.  

One of the big things that dispatchers tend to forget is that those numbers in the computer are attached to real people, and those people get to be the ones to decide what needs to be done on the ground.  If I were an EMT and a dispatcher told me to wait for ALS instead of transporting to the ED (if ALS was not in the immediate vicinity), then I'd tell them to take it up with me later and just hit the road.  Y'all can't make me sit and wait if I don't want to!


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## deftdrummer1

I agree LocalMedic, but at the same time there's many in the field that think all dispatch does is sit around and watch movies and are only able to do what the computer tells us and not think critically. If it's not fair to make assumptions please don't make them about me and how I perform my job. 

I don't want to thread-jack, but I'd be willing to bet we see more eye to eye than you might think LocalMedic - and likely work for the same company.


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## TheLocalMedic

deftdrummer1 said:


> I agree LocalMedic, but at the same time there's many in the field that think all dispatch does is sit around and watch movies and are only able to do what the computer tells us and not think critically. If it's not fair to make assumptions please don't make them about me and how I perform my job.
> 
> I don't want to thread-jack, but I'd be willing to bet we see more eye to eye than you might think LocalMedic - and likely work for the same company.



Down boy!  Easy!  I didn't say any of that, in fact I noted that dispatching is a lot tougher than field crews think it is.  But, as I also mentioned, having worked both sides of the fence, I can appreciate the differences between the two sides.  Dispatchers, sitting in their little tower, often have delusions of grandeur.  They imagine that they're making all the decisions and making those units move about.  They forget that the boots on the ground are the ones actually piloting those units.  

Again, I used to be a dispatcher, so I feel that I can say this with a fair measure of authority.


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