Arrest at doctors office/clinic

[Arkymedic]

Ok I got a question for you guys. Was called to the clinic for SOB 30ish male whiteout of lungs with pneumonia and when pt was moved to stretcher pt went into respiratory then cardiac arrest. When you have an arrest at a clinic do you usually take one of the doctors with you if they want to go? What about the tube? If the lead doctor in clinic wants to perform the tube before you roll do you let them or what do you do? I know a doc can maintain patient care if they are willing to go with you and assume liability for pt but unsure about the tube. I had never had a doc want to get involved in the code much less intubate so I was curious as to what ya'll might do in same situation.

 

[Flight-LP]

No and no..................

 

[Ridryder911]

I agree with Flight.. however; I realize medical politics as well. Usually, I have found in previous experience with Doc's at the scene they are more than willing to "turn it over to you" ASAP. Especially, when they realize you "*have it under control".. (*i.e. realize, you know more about the code, than they do!)

They called me, not vice versa..

R/r 911

 

[Guardian]

I agree with rid and flight, but, if the doctor wants to assume command of pt care all the way to the hospital, you have to let them. If they're in charge and they want to tube, you have to let them. After all, they have more medical knowledge in their finger than you have all together. I'd try and prevent a doctor from tubing the pt if they weren't going to continue care all the way to the hospital. If I couldn't, no big deal, I'd just document the heck out of it.

 

[akflightmedic]

I agree with rid and flight, but, if the doctor wants to assume command of pt care all the way to the hospital, you have to let them. If they're in charge and they want to tube, you have to let them. After all, they have more medical knowledge in their finger than you have all together. I'd try and prevent a doctor from tubing the pt if they weren't going to continue care all the way to the hospital. If I couldn't, no big deal, I'd just document the heck out of it.

Not to split hairs with ya mate but I do disagree slightly. By all means, I am willing to work as a team and involve the physician if it is practical and I am confortable with him, but the comment that "if he wants it...I have to let him" is totally incorrect.

I already have medical oversight and am trained in all advanced airway management. He called me for my emergency abilities, whatever they may be. When the patient gets on my stretcher or in my ambulance, it is now my domain and I do not let have to let him do anything at all. In fact, I could have him removed from the scene if it were hampering my ability to do my job or compromising patient care.

I do not wish to sound like an ***, but it is true regardless if he is their personal doc or not. I also have to consider how many codes or intubations have they actually done this year versus me and which is better for the patient.

Lucky for me, I have never really had a doc become pushy or obstinate. They usually are more than willing to let you take over and absolve them of all liability at that point. They will help as much as possible, for example one time in a clinic the doc moved chairs out of the way and held the door for us, he even carried a bag to our truck, so yes they can be useful....lol.

But almost every critical patient I have recieved from a clinic call-in, the doc gave a quick report, the nurse thrusted paper at us and we were gone in a flash. The only time I remember a doc getting really nervous was when he called us for SVT. He wanted us out the door but what was best for the patient was us doing a 12 lead and chemical conversion right there. He just stood back, didnt say a word and was thoroughly impressed after all was said and done.


I reread all the above and tried to think of a better way to display context but it is near impossbile. I am not cocky and high and mighty, just stating the facts. Let the record show I am and have been more than agreeable when working with the clinic docs...lol.

 

[Grady_emt]

I agree that most of the time when we encounter an MD in the field, it's a quick "ya'll ok" replied by yes and then "have a good one". They are usually more than happy to just go about their business.

I don't know about other places, but we have a specific protocol just for this situation. I'll paraphrase the important stuff.

An Appropriately licensed GA physician can and may assume control of pt treatment. The following conditions must be met.
1) MD can produce a cirrent State of GA Medical License, or is easily recognized as a licensed physician (hospital ID, location of incident, etc)
2) The onscene MD shall acompany the pt to the hospital in the ambulance. (exceptions made to disaster or MCI where MD may be better utilized at the scene)

If MD assumes care, then the following shall occur
1) The MD's license number and exp date are to be placed on the PCR
2) The Medic or EMT-I will only carry our procedural or medication orders in their scope of practice
3) The onscene MD shall sign the PCR
4) If the medic is uncomfortable at any point with and aspect of pt care, they shall immediately contact Med-Control and communicate their concern and seek further advise.

 

[KEVD18]

if he wants to take control of the pt and appropriatley document such, along with teching the call all the way to the H, then im kool with it. anything less is a no go.

 

[MMiz]

I think it's safe to say that most docs working in clinics don't want to be coding in the back of an ambulance with a patient.

They call you, they smile while you load the pt on the stretcher, and then they smile as you cart them away. That has always been my experience.

 

[Greg]

I agree that most of the time when we encounter an MD in the field, it's a quick "ya'll ok" replied by yes and then "have a good one". They are usually more than happy to just go about their business.

That's almost word-for-word from an MVA i ran a while back.

 

[Guardian]

Not to split hairs with ya mate but I do disagree slightly. By all means, I am willing to work as a team and involve the physician if it is practical and I am confortable with him, but the comment that "if he wants it...I have to let him" is totally incorrect.

I already have medical oversight and am trained in all advanced airway management. He called me for my emergency abilities, whatever they may be. When the patient gets on my stretcher or in my ambulance, it is now my domain and I do not let have to let him do anything at all. In fact, I could have him removed from the scene if it were hampering my ability to do my job or compromising patient care.

I do not wish to sound like an ***, but it is true regardless if he is their personal doc or not. I also have to consider how many codes or intubations have they actually done this year versus me and which is better for the patient.

Lucky for me, I have never really had a doc become pushy or obstinate. They usually are more than willing to let you take over and absolve them of all liability at that point. They will help as much as possible, for example one time in a clinic the doc moved chairs out of the way and held the door for us, he even carried a bag to our truck, so yes they can be useful....lol.

But almost every critical patient I have recieved from a clinic call-in, the doc gave a quick report, the nurse thrusted paper at us and we were gone in a flash. The only time I remember a doc getting really nervous was when he called us for SVT. He wanted us out the door but what was best for the patient was us doing a 12 lead and chemical conversion right there. He just stood back, didnt say a word and was thoroughly impressed after all was said and done.


I reread all the above and tried to think of a better way to display context but it is near impossbile. I am not cocky and high and mighty, just stating the facts. Let the record show I am and have been more than agreeable when working with the clinic docs...lol.

Doctors have licenses to practice medicine. That means they can take charge of pt care anytime they want and for any reason. In practice, I agree with what you've written for 99% of our encounters with doctors. But, if you work long enough, you will encounter the one doctor who is the exception. In this instance, it is important to know your place. Having said that, there is a lot of grey area. I worked a call once where an elderly doctor was on scene asking for valium so that he could rsi. The only problem was, the pt was in cardiac arrest! The old doctor was a hard headed man and I had to basically ignore him to work the arrest. I give this example to concede that there are plenty of exceptions to the rule. But, I would be willing to bet your protocols (guidelines) tend to agree more with me.

 

[akflightmedic]

Well I must say your stance is interesting and for a learning experience I would love to see what state and what law supports it.

Just because an individual is a licensed physician does not mean he can take care from you if he so desires. You are already working under a physician who has control. You had the official, legal duty to act, not him.

My old service carried these little business cards and if a doc offered assistance, we handed him the card to read.

It went along the lines of :

Thanks for your offer of assistance, The medics work for ..... under the license of ...... and are highly trained in .....according to the standard of..... If you wish to take over patient care, you are more than welcome provided you can display on your person a valid state physician license, a valid ACLS/BLS card, be willing to ride in with the patient, do the report AND be the patients primary physician for the duration of their hospital stay. You also need to contact me, their medical director at xxx xxxx anytime night or day and tell me what you have and what you want to do and why these medics should not do it.


Usually by the time they finished reading, we were loaded in the ambo or they had reconsidered...lol.

But no, seriously it still stands...no doctor will ever take over because they want to. Not that I am better, but if they can not prove these things or I do not know them, whats the point? Now I will certainly welcome assistance if I know them or they indeed follow the set rules for such a procedure, but in my almost 15 years of EMS, this has NEVER occurred.

 

[Emtgirl21]

Our medical director carries a radio and will respond to MCI's and other serious calls all the time. I really like it but he is a former Paramedic so its a little different

 

[disassociative]

I don't know if it works like this in other states, but here in TN medics reserve the right to divert to a different facility(with a stable pt of course) if they feel the pt would not receive the appropriate care at the standard location. Remember, that is YOUR patient until the receiving provider signs the chart.
It is your name and license # on the bottom of the PCR.

 

[knxemt1983]

I dont know how it works everywhere else, but our med control has written a protocol, which is basically like the above. If doc is on scene, he must provide proof of license, and type, id, and he must sign pcr, as well as ride to the ed, but we maintain ultimate power to say "no I dont agree with that procedure", in which case the intervener physician must speak with med control to hash out the correct choice, but barring any dangerous procedure, the intervener makes the calls, because like is said above, they have much more medical knowledge than we do

 

[Jon]

I think that if the physcian was willing to produce ID, ride in with the patient, and sign the chart, than I'd not have an issue with him "playing". To some degree, he may just want to ride in an ambulance with the whoo-whoo's and the blinkeys on

As for service medical directors - I know of several former/current EMT-P's in the area who are currently attending physcians in level 1 TC's and who carry gear and radios in their POV's and respond if they are in the area or it "sounds good". If the doc is a command physcian... espicially YOUR command physcian, he brings all sorts of knowledge with him, and will understand what is involved in providing care to patients. Further, many times, he will provide on-scene medical control and send the patient with an ALS crew... but he's the medical director, and can do that!

 

[bonedog]

As other's have pointed out the physcians are much more knowledgable than we are. We have a great deal of knowledge about a small area.
That being said, at a meeting here for a thrombolytic in PEA trial, one of the lead cardiologists started questioning the emerg doc's about the treatment algorythm and was told to direct his question's to the ALS medics as they run many more code's than the emerg doc's. ( I remember calling for D/C order's for the third time one day and the doc asking me what was going on today as it was the 28th time she had been called... only one emerg in the GVRD)

 

[Ridryder911]

As other's have pointed out the physcians are much more knowledgable than we are. We have a great deal of knowledge about a small area.

Actually, they too are taught a broad scope and very small amounts. Not all physicians are taught emergency medicine or even how to read a 12 lead EKG or even have to perform intubation. This of course is why there is residency programs. So no, unless they are specific board certified or focused in the related problem, I do not feel they maybe more knowledgeable. I have seen too many patients die under the hands of "knowledgeable" physicians, with good intent but ignorant in current treatment and skills.

This is why I have a medical director to talk to.

R/r 911

 

[bonedog]

Rid when doing Critical Care we do attend to many "rescue's" in smaller area's.

I personally have never had any problems with doc's (touch wood), however, I believe, that when they see things are being done, some of which they may not have thought of, they tend to want to be helpful as opposed to trying to run the call. I did however have a admiral or something (lots of braid and cauliflower on his shoulders) off of a cruise ship ask me to defib at 400 joules, a surgeon from Sweden..... as you know it is practising medicine.

 

[RALS504]

While I agree that most patient transfers from clinincs do not require that the clinic MD or RN ride in to help me, there are alway those times when an extra pair of hands are invaluable. Here is another perspective from a medic/attorney on just such a case, consider it:

http://www.jems.com/news_and_articles/columns/Maggiore/A_Lesson_in_Negligence.html

By the way this is a great web site and this authors articles are awesome.
http://www.jems.com

 

[Aileana]

This is slightly off-topic, but for a SOB/SVT call I got a few nights ago, the nurse on scene came to the back of the ambulance and wanted to continue assisting. The ACP on scene took over, while the RN and PCP assisted. The RN seemed rather excited to be inside an ambulance, and was more than willing to help out. From my experience, RN's are usually fine with helping out, and equally fine with stepping out of your way if assistance is not needed. Have yet to have any experience with doctors on this though.