ERDoc
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I think this is probably one of those cases where a picture is worth 1000 words. Seeing this kid may sway us one way or another.
Abd pain
- Thread starter RedAirplane
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RedAirplane
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Unfortunately, my artistic abilities are terrible, or I'd draw you one. My instinct said he "looked sick" but my colleagues may have disagreed, leading to where we stood.
ERDoc
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I hear you. The problem with internet forums, is that each one of us will form a picture of what this kid (or any other pt) looks like and it may be nothing close to what you saw.
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RedAirplane
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I'll ask a simpler question then.
If you are a non transporting EMT, when does abd pain (pediatric, geriatric, male, female, whatever) warrant transport? When does it warrant ALS?
The answer has already been given to you. When they request to be evaluated or when someone calls for them. Even then, they do not have to be transported and they can deny anything they feel like denying if they have the mental capacity to do so. If they are a minor, their guardian makes that decision, not you. If they have asked for help and it meets ALS requirements or it does not feel right to you, request ALS.
Not to be blunt (not that I really care) but almost all of your posts lead me to believe you are confused about this whole EMT thing. Its really not that hard, and it seems you are making it a lot harder then it is.
Take a step back, you don't and shouldn't be walking around events trying to make people patients. If they request your services, then by all means do what you need to do. But if all they do is request water or a bandaid, then just give them what they asked for. No need to start throwing coma/seizure/death lines at people who are a little dehydrated.
If they come to you and request services and you take vitals and come up with some possible differentials and they deny being transported, inform them of some legitimate risks. If they still deny, explain to them your refusal form and say call or find us if anything changes.
Being a basic is just that, basic. Treat it as such and life will be a lot easier.
Brandon O
Puzzled by facies
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Sounds extremely boring.
Brandon O
Puzzled by facies
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Can't really simplify this one down, unfortunately. Abdominal pain needs transport when you suspect it portends an illness that requires prompt care.
Same for ALS, although their role would typically be pain management (which a lot of them are reluctant to provide... 'nother story), supportive care if needed (fluids, airway management, anti-emetics, etc), and an ECG if there's any chance it's a cardiac etiology. Most abd complaints don't need ALS.
With all of that said, while there are many abdominal "urgencies" that need to be worked up in hours or "today," there aren't as many (especially in fairly well-appearing patients) that are life-and-death emergencies where minutes matter. A patient with reliable follow-up who's being driven by dad to the ED, or perhaps a PCP, is often a reasonable disposition.
YMMV and exceptions abound.
Edit: I was going to add that "medicine is hard," but as Chewy noted above, it doesn't have to be. However, you've chosen to try and function on a level where it is hard, which I applaud. So in your case: medicine is hard.
RocketMedic
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Ishan, putting aside the juvenile and condecending load of crap Chewy20 just laid down, I would say that the determination for ALS hinges on sentinel findings in assessment (vital signs, etc), observed levels of distress (pain, vertigo, nausea, vomiting) and skin tones. The original patient should have gotten an ALS assessment in my opinion.
To those on the "not-a-patient" bandwagon, I say this. For shame. We are advocates of the sick and injured. This person presents to us in a manner which appears to be distressed, and your answer is to shrug and point to a technicality (which appears driven by finances). DEMedic, I am disappointed in how cavalier you sounded there. No, he's not a "patient", but we ought to expend a little effort in seeing what ails him to this degree. Chewy, you come across as a condescending ambulance driver.
To those on the "not-a-patient" bandwagon, I say this. For shame. We are advocates of the sick and injured. This person presents to us in a manner which appears to be distressed, and your answer is to shrug and point to a technicality (which appears driven by finances). DEMedic, I am disappointed in how cavalier you sounded there. No, he's not a "patient", but we ought to expend a little effort in seeing what ails him to this degree. Chewy, you come across as a condescending ambulance driver.
NomadicMedic
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Is every homeless person you see on the street a patient? I'd bet most of those guys have aches and pains and and an upset tummy. Do you stop and assess every one of them? Walk up and offer your services to all of 'em? How about every patient in a nursing home? I bet most of those folks look pretty sick. Hell, you'd need a city bus to transport all of them!
Be a patient advocate, WHEN THEY'RE ACTUALLY A PATIENT.
Until they come up and say "my son is sick, and I need help" they're NOT a patient. If you offer help when they DIDN'T ask for it and they decline your help, they're NOT a patient.
Don't be obtuse. Recognize that most sick people don't need EMS and certainly don't need some first aider with a hardon to be Mr. Richard Rescue insinuating themselves into their life.
Be a patient advocate, WHEN THEY'RE ACTUALLY A PATIENT.
Until they come up and say "my son is sick, and I need help" they're NOT a patient. If you offer help when they DIDN'T ask for it and they decline your help, they're NOT a patient.
Don't be obtuse. Recognize that most sick people don't need EMS and certainly don't need some first aider with a hardon to be Mr. Richard Rescue insinuating themselves into their life.
RocketMedic
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....but is a visibly-ailing person who has been brought to your area a patient? I believe so.
It is. Which is why I continue to teach myself things and ask questions.
NomadicMedic
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I don't believe I'm falling into your troll trap, but I'll say it one more time. This kid WAS NOT a patient. His parents didn't come seeking help, they wanted a bottle of water. The kid was sick, but NOT SO SICK that they came seeking EMS. They didn't want to go to the ED and said 'we'll take him to the urgent care later, if he needs to go".
That is NOT a patient.
RocketMedic
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Because parents (fiscally-pressed ones at that) are clearly the best and only evaluators of a child's medical condition..
It does not matter what they think, they make the decisions for their child not you. What are you not getting about that? Just like people stroking out can refuse being transported against medical advice, these people can choose another route other than an ambulance.
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RedAirplane
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Our role is specifically not that. If it were, it would be a lot easier.
With altered patients, we specifically are directed to intervene and convince them to come for treatment in a sobering area so that they won't get into trouble later.
When a chest pain patient refused, teams followed her around (discreetly) as part of 'regular patrol' on bicycles with AEDs in case she arrested.
Life would be so much easier if I were on an ambulance, went to calls only from people who specifically asked. That's about 1% of my role. The other 99% is public safety, and sometimes, if you see someone slurring their speech or walking unsteady, stepping in (without battering or kidnapping, of course).
So my question is not when can I legally transport or not, but rather, what medical criteria are going to lead me to drop this as a non-issue or proceed further.
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RedAirplane
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Not arguing that they make the ultimate decision.
If someone presents with a laceration to the finger, we can bandage it up. If they are not on blood thinners, they can be on their way.
If someone asks for aspirin, we're going to ask some questions, and assuming no chest pain, blood thinners, etc, they can.
However, if someone presents asking for water because they're short of breath, they'll be told to sit, be given water. If they don't improve, then oxygen & ALS. These are clear and how we operate.
Abdominal pain is a gray area. And so I am asking, when is it more like a band aid, and when is it more like SOB/CP?
Obviously anyone can refuse, even a CP patient. And anyone (including finger guy) can choose to be evaluated/transported by ALS.
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RedAirplane
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See my post above.
If you see a guy walking past you clutching his chest...
Not intervening would be very bad in my role, possibly even negligent.
Parents don't want to go to the hospital, fine.
I'm asking when I should strongly recommend it (a la Chest Pain or SOB) and when it is something that can be offered but not really needed (difficulty swallowing).
Wait...WHAT? hahaha
Even if they are on blood thinners they can be on their way.
You can not make them sit because they are SOB, nor can you force oxygen and ALS on people.
If you are not exaggerating about this place you work, it sounds down right ridiculous.
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RedAirplane
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Blood thinners... we'll request that they hang out for 5-15 minutes to ensure that the bleeding stops.
We cannot make anyone do anything. If they don't want something, they legally refuse and we don't do it. But if they are SOB, we'll politely have them sit in the cool shade, ask them if they have had asthma, if they use an inhaler, and if they're not improving, we will offer an ALS assessment which would confirm or deny txp ("before you go, I'd just like one of my colleagues in the fire dept to take a look at you...")
It sounds ridiculous because it's non-traditional first response, and it's more than one place that I volunteer, so it's not a one-off, or else I'd be a bit more suspicious.
In a regular ambulance, a call comes in and you go to it.
You don't have to think about whether the arena is too hot/cold given the weather, whether there are adequate water supplies, etc.
Our mission is the health and wellbeing of all who take part in the event, so noticing people turning pink and politely asking if they want some sunscreen is very much part of the expectation.
NomadicMedic
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This isn't work, it's a volunteer gig. Sounds like Red Cross FAST.
And it's certainly not that way any event medical I've ever done works. We don't go looking for patients, nor do we try drum up patients by following around people who "look sick" or keep someone with a cut sitting in a tent for 15 minutes to make sure the bleeding stops.
It's ridiculous to the Nth degree.