Comments on this story; signs and symptoms of a stroke.

[emt seeking first job]

This story is sort of getting to me. I am not even certain it is true as it was told to me by someone who heard it from a relative who worked at the same IFT service as the person who it happened to.

According to the story, routine patient being transported from nursing home to some facility for treatment. Enroute, the patient developed signs and symptoms of a stroke. The person calls their dispatch for instructions and dispatch tells them to being patient back to nursing home to see what they "the nursing home" wants to do. I did not hear what the outcome was.

95% of the time I just listen to a spontaneous utterance. I just listen. I make eye contact and some appropriate facial expression. I supressed my urge to ask more, yadda yadda (ie my real time persona).

To myself, I thought about what I would have done. Basically, the boiler plate assesment, interventions and rapid transport to the nearest stroke center or other ER depending on where I was.

NOW MY QUESTION FOR THE FORUM TO EXPERIENCED IFT PEOPLE IS:

What would have happened if I had done the above and transmitted, "base, be advised, we are en route to the ER, patient is (say the same thing in one sentence that I would to the triage nurse).

No may I go, just advising I am on my way.

Would the boses at the IFT have grounds for internal or external discipline ?

I am 45 now so I realize they might not do anything about that, however, it might get someone on the :censored::censored::censored::censored: list so if I were late one day or brought the rig back with a scratch or a dent, they might react to that more harshly then had I not done something to tick them off.

In the culture of IFT, if you encounter a situation where it is indicated to take someone to the ER, is it commonly done to radio the base to get permission, or do you just say you are on the way.

BEFORE SOMEONE ELSE SAYS IT, I realize the story is third hand, through many filters, nonetheless, if you are so inclined please comment.

If the question offends you then just ignore it. This is a thread, not a PM.

 

[the_negro_puppy]

 

[JPINFV]

NOW MY QUESTION FOR THE FORUM TO EXPERIENCED IFT PEOPLE IS:

What would have happened if I had done the above and transmitted, "base, be advised, we are en route to the ER, patient is (say the same thing in one sentence that I would to the triage nurse).

No may I go, just advising I am on my way.

Would the boses at the IFT have grounds for internal or external discipline ?

Grounds? Probably not, but that probably won't stop the shadier locations, provided your assessment is sound. For example, confusing new onset of symptoms with persistent symptoms of a past stroke would not be a good thing. If you're going to upset the tea kettle, you need to have your ducks in a row and be able to justify your actions correctly. It should be like lights and sirens or calling paramedics as an EMT. You should be careful when pulling these triggers, but do so without hesitation when you need to pull them.

In the culture of IFT, if you encounter a situation where it is indicated to take someone to the ER, is it commonly done to radio the base to get permission, or do you just say you are on the way.

If I'm rerouting a patient or upgrading to lights and sirens, then I'm not asking dispatch anything, I'm telling them. They aren't there. They aren't seeing what I'm seeing. They don't have a complete picture.

Perfect example of ask vs tell. I was driving a RT critical care transport for a vent dependent patient. We get halfway to the original receiving hospital when the RT comes across an order in the packet where it looks like they changed the destination on us. At this point in this case, I'm pulling off the freeway while asking dispatch to contact the sending facility. During this time, the patient desaturates, and the RT asks the EMT in the back if he is comfortable bagging the patient while she prepares to suction the patient. He states he isn't comfortable with the BVM, and she tells me to go to the second facility and upgrade to code 3. Now, I'm telling dispatch that I'm upgrading, and rerouting to the second receiving facility.

/cool story bro

 

[DrParasite]

just remember, your can be disciplined for almost anything, especially at an IFT company. whether or not it's legal or not (ie, would stand up to a court case) is a toss up.

also, you can be punished for violating a company rule (ie, no L&S, no consulting dispatch, no calling for ALS, no diverting, etc) because those are the company rules. don't like them, either try to change them, or find another company.

that being said, you can have the department of health go after you if you violate one of their protocols, even if it's following the company's rules.

lastly, remember, more often than not the most important thing to an IFT company (esp a for profit IFT company) is billing, not patient care. so if you do something that can affect the insurance payment, or a contract with a facility, or cause them to lose revenue in any way, despite it being int he patient's best interest, you can find yourself out of a job.

 

[BEorP]

During this time, the patient desaturates, and the RT asks the EMT in the back if he is comfortable bagging the patient while she prepares to suction the patient. He states he isn't comfortable with the BVM, and she tells me to go to the second facility and upgrade to code 3. Now, I'm telling dispatch that I'm upgrading, and rerouting to the second receiving facility.

/cool story bro

What concerns me most is that there are EMTs who aren't comfortable bagging...

 

[emt seeking first job]

What concerns me most is that there are EMTs who aren't comfortable bagging...

I never wrote that.

 

[emt seeking first job]

This is a place to discuss things like I posted.

If you like posting those, why not go to 4chan...?

 

[emt seeking first job]

thank you for answer

just remember, your can be disciplined for almost anything, especially at an IFT company. whether or not it's legal or not (ie, would stand up to a court case) is a toss up.

also, you can be punished for violating a company rule (ie, no L&S, no consulting dispatch, no calling for ALS, no diverting, etc) because those are the company rules. don't like them, either try to change them, or find another company.

that being said, you can have the department of health go after you if you violate one of their protocols, even if it's following the company's rules.

lastly, remember, more often than not the most important thing to an IFT company (esp a for profit IFT company) is billing, not patient care. so if you do something that can affect the insurance payment, or a contract with a facility, or cause them to lose revenue in any way, despite it being int he patient's best interest, you can find yourself out of a job.

I did hear a story about medicaid or care not paying if the patient walks to the rig, so everyone goes on a stretcher, I could live with that.

I am just curious, if an IFT person got disciplined directly for not calling for permission to go to an ER, would the DOH interviene if that person went to them ?

I would make a guess it would not go down like that, the person would not get disciplined for that, but every other little thing they did wrong which for another person would go unnoticed.

I just heard of a person who got fired for taking a cell phone call while bagging a patient. And that person is trying toreport their former employer for a bunch of stuff. However, taking a cell phone call while bagging a patient, is an all glass hose with stones flying everywhere.....

 

[emt seeking first job]

Grounds? Probably not, but that probably won't stop the shadier locations, provided your assessment is sound. For example, confusing new onset of symptoms with persistent symptoms of a past stroke would not be a good thing. If you're going to upset the tea kettle, you need to have your ducks in a row and be able to justify your actions correctly. It should be like lights and sirens or calling paramedics as an EMT. You should be careful when pulling these triggers, but do so without hesitation when you need to pull them.




If I'm rerouting a patient or upgrading to lights and sirens, then I'm not asking dispatch anything, I'm telling them. They aren't there. They aren't seeing what I'm seeing. They don't have a complete picture.

Perfect example of ask vs tell. I was driving a RT critical care transport for a vent dependent patient. We get halfway to the original receiving hospital when the RT comes across an order in the packet where it looks like they changed the destination on us. At this point in this case, I'm pulling off the freeway while asking dispatch to contact the sending facility. During this time, the patient desaturates, and the RT asks the EMT in the back if he is comfortable bagging the patient while she prepares to suction the patient. He states he isn't comfortable with the BVM, and she tells me to go to the second facility and upgrade to code 3. Now, I'm telling dispatch that I'm upgrading, and rerouting to the second receiving facility.

/cool story bro

Thank you for the answer.

I was not there and could not question the person who it happened to.

I am assuming the signs and symptoms came about while enroute during a second or third assesment.

Yes, I would call for paramedics.

Not having worked in IFT, I am just guessing, you have to keep yourself squeeky clean, even if they like you, because if they dont, they can use other things to can you.

I saw that happen as a cop.

I even knew one boss who would "allow" people to get away with things and keep a "file" on people so when there was a dispute he could dig all that :censored::censored::censored::censored: out.

 

[Sasha]

At an at will state the only groubds they need is "i dont want to keep you employed anymore"

Ive taken a pt who developed chest pressure, sob and HTN en route, to a SNF per dispatxh but thats when you go up "you sure you want to accept this pt? You sure? You dont want to send her the ER? Will you call us back when shes dead? Oh youre not gonna accept her now? Kthnx bye!"

 

[Sasha]

Grounds? Probably not, but that probably won't stop the shadier locations, provided your assessment is sound. For example, confusing new onset of symptoms with persistent symptoms of a past stroke would not be a good thing. If you're going to upset the tea kettle, you need to have your ducks in a row and be able to justify your actions correctly. It should be like lights and sirens or calling paramedics as an EMT. You should be careful when pulling these triggers, but do so without hesitation when you need to pull them.




If I'm rerouting a patient or upgrading to lights and sirens, then I'm not asking dispatch anything, I'm telling them. They aren't there. They aren't seeing what I'm seeing. They don't have a complete picture.

Perfect example of ask vs tell. I was driving a RT critical care transport for a vent dependent patient. We get halfway to the original receiving hospital when the RT comes across an order in the packet where it looks like they changed the destination on us. At this point in this case, I'm pulling off the freeway while asking dispatch to contact the sending facility. During this time, the patient desaturates, and the RT asks the EMT in the back if he is comfortable bagging the patient while she prepares to suction the patient. He states he isn't comfortable with the BVM, and she tells me to go to the second facility and upgrade to code 3. Now, I'm telling dispatch that I'm upgrading, and rerouting to the second receiving facility.

/cool story bro

Wtf do you mean they werent comfortable with the bvm

 

[Handsome Robb]

What concerns me most is that there are EMTs who aren't comfortable bagging...

I never wrote that.

Read JP's post...

I agree with what everyone else said. If I'm the attendant and my patient deteriorates in front of me, I am going to make sure that patient receives the appropriate level of care. With that said, if you like your job you need to operate within your company's SOPs and Protocols.


If I was that RT, I probably would have smacked that EMT upside the head for that answer.

 

[Sasha]

Read JP's post...

I agree with what everyone else said. If I'm the attendant and my patient deteriorates in front of me, I am going to make sure that patient receives the appropriate level of care. With that said, if you like your job you need to operate within your company's SOPs and Protocols.

Exactly. Sometimes you've got to go about it in a roundabout way, sometimes you have to ask for forgiveness instead of asking for permission (ie don't tell them where you are and how you got there "Unit 106 arriving at suchandsuch hospital will landline for further details" Sometimes you have to delay care a little to get a nurse to be your back up. Especially if you work under contracts, your company will want to keep those nurses happy because it keeps the facility happy. sometimes the keyword is "The nurse wants..."

Working for crappy IFT company has taught me how to be crafty.

 

[mycrofft]

To the OP

1. How would it sound in court: "I took the pt to an inadequate care facility because a dispatcher told me to"? (Ouch). The nursing facility might want them taken to a particular hospital because their MD has admitting privileges there, but if the pt is "hurtin' " and it's across town, there are troubles in wait there too.

2. Can they use it against you? In the sense that a law court would uphold a suit against them when they fire you? If they are smart they would not put it on paper, so, yes, not legally maybe but they might if they are dingbats or there a worker has a pattern of flouting protocols in other matters. (BTW, in many places such instances are not usable in employment actions after a year has passed. Always check your employee file if it is legally possible for errors and stuff like that). And DOH protecting you? Not probably!

3. When someone (like a dispatcher or a deputy) has a bonehead order or suggestion for me, I tell them that I am "officially informing" them of the problem, and I lay it out then and there, and ask them if they will accept responsibility for the patient. You might get reamed later, but the answer is almost always "NO"; if it's yes, then it's their problem and you might start looking for a job with a better company. And sometimes they convince me they're right, I say so and make it happen.

Sometimes we all make a mistake like telling the driver to turn back, and leaving the mistake-maker a way out to save face (then discuss it later) will often make things work out better in the long run.

 

[Smoke14]

I always do what is right for the patient and I do not consider politics or contracts when taking care of a patient.

 

[emt seeking first job]

1. How would it sound in court: "I took the pt to an inadequate care facitlity because a dispatcher told me to"? (Ouch). The nursing faclity moight want them taken to a particular hospital because their MD has admitting privileges there, but if the pt is "hurtin' " and it's across town, there are troubles in wait there too.

2. Can they use it against you? In the sense that a law court would uphold a suit against them when they fire you? If they are smart they wold not put it on paper, so, yes, not legally maybe but they might if they are dingbats or there is a pattern of flouting protocols in other matters. (BTW, in many places such instances are not useable in employment actins after a year has passed. Always check your employee file if it is legally possible for errors and stuff like that). And DOH protecting you? Not probably!

3. When someone (like a dispatcher or a deputy) has a bonehead order or suggestion for me, I tell them that I am "officially informing" them of the problem, and I lay it out then and there, and ask them if they will accept responsibility for the patient. You might get reamed later, but the answer is almost always "NO"; if it's yes, then it's their problem and you might start looking for a job with a better company.

Sometimes we all make a mistake like telling the driver to turn back, and leaving the mistake-maker a way out to save face (then discuss it later) will often make tnhings work out better in the long run.

Thank you.

I read that a few times.

I have learned that a lot of times, "command presence", or something like that, you hold your ground, their is a way a subordinate can control the situation without losing his job.

I sincerely mycroftt and everyone else who has replied.

I have printed out this thread and added it to my private file of things to read over, a personal SOP if you will.

If someone adds to it I will print it out again.

Thank you all.

 

[emt seeking first job]

Let me rephrase the DOH question.

Not that I want to do this, but, does the DOH ever go after a private ambulance service for protocol violation ?

I saw the website for records of individual people being disciplined but never an organization.

The only time I heard of an IFT being in trouble was for billing abuse or fraud.

 

[usalsfyre]

lastly, remember, more often than not the most important thing to an IFT company (esp a for profit IFT company) is billing, not patient care. so if you do something that can affect the insurance payment, or a contract with a facility, or cause them to lose revenue in any way, despite it being int he patient's best interest, you can find yourself out of a job.

Right, since money's not AT ALL important to a 911 provider...

 

[usafmedic45]

Not that I want to do this, but, does the DOH ever go after a private ambulance service for protocol violation ?

It depends. Most of the time in most states, such repeated and flagrant violations are simply dealt with by the medical director backing out which shuts the service down without that "state" getting involved. That said, be very cautious voicing even a hint of such desires or leanings or you will find yourself unable to find employment.

 

[mycrofft]

DOH could surprise you negatively, too.

They COULD side with the transport service. If they did, what would your next level of appeal be?
Sometimes you have to stand up and take it when bad things happen, but usually there is a better and more productive way...judo, not WWF.

Bad day for the frog AND the egret: