Ethics Question: BLS Turfing

[Serberrus]

Judgement call, how bad is the pain? Its obviously not life threatening. Is that medic needed elsewhere? Will tying up that medic leave a significant area without rapid ALS coverage? Too many factors for a simple answer.

 

[triemal04]

No that's not the case, in the system I'm talking about I always tried to encourage partners to start off every patient contact and give me the signal when I needed to take over. Obviously I'm doing my own assessment while they are doing this also. And the majority of the paramedics there had the same mindset. We always encourage further education and stepping out of there comfort zones to encourage them

Ok...that's more as it should be...but not what you said...and in that case, if the EMT remains in charge any billing above the BLS level would be fraudulent.

 

[triemal04]

I am not going to take up a physicians time at this facility for someone with non descript unidentifiable pain with stable vitals that I think will likely end up going to triage (and thus the waiting room) anyway at this ER.

I usually agree with you, and have the same sentiments when this topic or similar ones come up...but the above is pretty bad.

It's not fun to have lousy and/or improper protocols that you have to follow, and it's unfortunate that you have to get permission before you can do certain things...but if you are using that as a reason to not treat someone that you otherwise would...that's wrong.

If you have a patient that, if you didn't have to get permission, would be treated with a specific medication, then you really should be doing what is needed to get permission.

Now, if you wouldn't be treating that person regardless of what was required before doing so then all bet's are off. Maybe that was what you meant in the above quote?

 

[Wheel]

I usually agree with you, and have the same sentiments when this topic or similar ones come up...but the above is pretty bad.

It's not fun to have lousy and/or improper protocols that you have to follow, and it's unfortunate that you have to get permission before you can do certain things...but if you are using that as a reason to not treat someone that you otherwise would...that's wrong.

If you have a patient that, if you didn't have to get permission, would be treated with a specific medication, then you really should be doing what is needed to get permission.

Now, if you wouldn't be treating that person regardless of what was required before doing so then all bet's are off. Maybe that was what you meant in the above quote?

I think this is what he meant.

 

[triemal04]

I think this is what he meant.

Most likely, just wanted to be sure.

 

[Rialaigh]

I usually agree with you, and have the same sentiments when this topic or similar ones come up...but the above is pretty bad.

It's not fun to have lousy and/or improper protocols that you have to follow, and it's unfortunate that you have to get permission before you can do certain things...but if you are using that as a reason to not treat someone that you otherwise would...that's wrong.

If you have a patient that, if you didn't have to get permission, would be treated with a specific medication, then you really should be doing what is needed to get permission.

Now, if you wouldn't be treating that person regardless of what was required before doing so then all bet's are off. Maybe that was what you meant in the above quote?

If you have a patient that should get morphine because they are hurting, but you can't get an IV, are you going to drill an IO just to give them 4 of morphine for a 20 minute transport...I sure hope not. In the same way I am not going call a physician for a patient that is in pain that has been going on for 2 days, is non descript, I can't find a source for, and I don't need the pain medication to move or transport them.

The difficulty of the intervention and the amount of time it takes is factored into whether or not it is worth doing for the patient

 

[DrankTheKoolaid]

Ok...that's more as it should be...but not what you said...and in that case, if the EMT remains in charge any billing above the BLS level would be fraudulent.

Sorry I wasn't more clear. lol im on duty and system was going into the crapper and I had to make it brief

 

[Rialaigh]

The fact that you don't want to bother the doc to get orders to medicate a patient that may need it is beyond disturbing.

Here's a pro tip. BOTHER THE DOC.

I medicate patients that NEED the pain medication to be treated, moved, transported, extreme pain that is affecting vitals or breathing..etc... Other medication of patients in pain is not a NEED...it is a luxury just like a blanket to keep them warm or fluids to rehydrate them a bit before the ER.

 

[abckidsmom]

If you have a patient that should get morphine because they are hurting, but you can't get an IV, are you going to drill an IO just to give them 4 of morphine for a 20 minute transport...I sure hope not. In the same way I am not going call a physician for a patient that is in pain that has been going on for 2 days, is non descript, I can't find a source for, and I don't need the pain medication to move or transport them.



The difficulty of the intervention and the amount of time it takes is factored into whether or not it is worth doing for the patient

I can usually get access, but this is one of those times that calls for intranasal fentanyl.

 

[abckidsmom]

I medicate patients that NEED the pain medication to be treated, moved, transported, extreme pain that is affecting vitals or breathing..etc... Other medication of patients in pain is not a NEED...it is a luxury just like a blanket to keep them warm or fluids to rehydrate them a bit before the ER.

Blankets are not a luxury. They are BLS care, and one of the key parts of taking good care of sick people.


Fluids are often just the first step in making people feel better.

Are we here to save lives? I would say no. We are here to make people feel better on their worst days. Very rarely do we save lives. Choosing not to take good care of people because it would bother the doc (stupid protocol) or take time restocking is lazy, pure and simple.

What's the line they have to cross before they NEED pain meds in your mind?

 

[NomadicMedic]

I medicate patients that NEED the pain medication to be treated, moved, transported, extreme pain that is affecting vitals or breathing..etc... Other medication of patients in pain is not a NEED...it is a luxury just like a blanket to keep them warm or fluids to rehydrate them a bit before the ER.

Pain management is not a luxury.

You might want to stop now before you embarrass yourself further.

 

[DrankTheKoolaid]

Pain management is not a luxury.

You might want to stop now before you embarrass yourself further.

That

 

[mycrofft]

I'm sorry, I've missed something.

Is there a rule or law or protocol that you can decide whether or not to treat a patient adequately, or at all, based on whether or not the case is exciting enough?

?!​

And as for billing over what you delivered, simple fraud.

PS: another debate to spark: "in enough pain"…starting in the late Nineties (remember "Pain is the latest vital sign"?) we got railroaded into giving pain Rx on demand and now we are fighting Rx abuse and addiction. Not that what YOU give on one call is going to addict anyone. And there are non-narcotic drug alternatives for many instances of "discomfort" (pain).

 

[Wheel]

I think there is a misunderstanding going on. I don't think anyone is saying don't treat someone that is truly in pain. The examples given have been pain that has been going on a while, with no apparent source, no change in vitals, no distress, etc. Is everyone here giving patients with non descript abdominal pain x 2 days narcs, when they aren't in distress?

I mean if a patient is in distress, or is having pain affect vitals, has a history of pain that needs to be managed (crohns, kidney stones, sickle cell, etc), or an obvious sign of pain, then absolutely treat it. I'm just wondering if you give pain meds to anyone that says they are in pain, regardless of presentation.

 

[Rialaigh]

I think there is a misunderstanding going on. I don't think anyone is saying don't treat someone that is truly in pain. The examples given have been pain that has been going on a while, with no apparent source, no change in vitals, no distress, etc. Is everyone here giving patients with non descript abdominal pain x 2 days narcs, when they aren't in distress?

I mean if a patient is in distress, or is having pain affect vitals, has a history of pain that needs to be managed (crohns, kidney stones, sickle cell, etc), or an obvious sign of pain, then absolutely treat it. I'm just wondering if you give pain meds to anyone that says they are in pain, regardless of presentation.

This, I believe I am being misunderstood to some extent. I have no non narcotic alternatives. And yes, Management of pain that appears to have the patient in NO distress is a luxury.

If you guys are giving narcs to every patient who SAYS their pain level is a 6/10 or higher then ...welp.....:unsure:

 

[Rialaigh]

just to pose a question do you give benzo's to every single patient who looks anxious and complains of anxiety? because anxiety is a real medical condition...and by what I am being told here we are obligated to treat it to the fullest extent regardless of whether it is an emergency at all or not.

 

[abckidsmom]

This, I believe I am being misunderstood to some extent. I have no non narcotic alternatives. And yes, Management of pain that appears to have the patient in NO distress is a luxury.

If you guys are giving narcs to every patient who SAYS their pain level is a 6/10 or higher then ...welp.....:unsure:

So what's the line they need to cross to qualify for non-luxury pain meds in your mind?

 

[Carlos Danger]

So what's the line they need to cross to qualify for non-luxury pain meds in your mind?

Well obviously, there is some judgment involved there.....

 

[Rialaigh]

So what's the line they need to cross to qualify for non-luxury pain meds in your mind?

Whats the line that they need to cross to qualify for Adenosine in the field, hr of 150? HR of 160 HR of 170? symptoms make a difference? history make a difference? does your ability to use cardizem change your decision making on it..is it a patient to patient decision for you?


I use my assessment as a whole to make the decision on pain medication. I don't look at my protocol book and ask for narcotics for every patient that complains of pain 6/10 or higher (as the protocol book says I CAN do). I don't have alternatives to narcotics, it's all I have. And Narcotics are not appropriate pain management for even all legitimate pain.

 

[triemal04]

just to pose a question do you give benzo's to every single patient who looks anxious and complains of anxiety? because anxiety is a real medical condition...and by what I am being told here we are obligated to treat it to the fullest extent regardless of whether it is an emergency at all or not.

Hey hey hey! Don't try and bring a shred of common sense into the great pain management debate; all that's allowed here is rhetoric, emotion, personal belief, the demand to do something so that we can do something, and treatments based on what happened to the provider.

If you have a patient that should get morphine because they are hurting, but you can't get an IV, are you going to drill an IO just to give them 4 of morphine for a 20 minute transport...I sure hope not.

Or you just give it IM. While I understand the point you're making...bad analogy.