Considered Abandonment?

MedicPrincess

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In our service, often times once we get on scene the medic does an assessment and determines the call to the BLS and the EMT will ride it in. At what point would you consider this practice to be abandonment of the patient by the medic?

I had a discussion with a newer EMT than I am that ANY time the Medic makes contact with the patient and assesses and then allows the EMT to attend that patient, it is abandonment. What do you think>

Or how about those calls where the medic will throw the 4 lead on to "take a quick look" and when the rhythm is normal, they pull it off and BLS the call so the EMT rides. Would you consider that abandonment because an ALS procedure was preformed?

This is an especially important issue for me since I am in Medic school now and it really won't be to long before I am making the ALS vs. BLS decision.
 

akflightmedic

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The practice is perfectly legal and is usually defined more clearly within the service you work for.

There have been many times when I arrive first and its a laceration or something clearly BLS, after my assessment I hand it off to the EMT. No big deal. Where the problem arises is when medics get lazy and start stretching the definition of BLS just to avoid one more report and an EMT jumps in not knowing better due to their lack of experience.

I do have a problem with hooking the pt up to the monitor, taking a look, removing it, then handing it off. I will NEVER do that EVER. If I have enough suspicion to hook them up to the monitor, then they are staying on it period!

There have been many times I have transported BLS patients simply because I wanted more time with the patient to probe into some ALS assessments. This has saved my behind numerous times because inevitabally you will always find an issue if you probe enoough. I am not saying every patient is ALS, however we need to use more discretion when determining what is truly ALS or BLS.

Having said all of that, in my opinion, it is ok to hand off a patient after an ALS assessment to an EMT as long as the pt did not require active airway assistance, IVs, meds and/or cardiac monitor to determine BLS or ALS.

Aside from that, have at it!!!
 

MMiz

I put the M in EMTLife
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Our service has a very strict policy for this, and once a patient is even seen by an ALS provider, the patient is an ALS patient. We consider seeing/talking to a patient as part of the evaluation. If an ALS unit evaluates the patient, then the patient goes via ALS.
 

fyrdog

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We do on occasion hook up a patient to the monitor and then downgrade to BLS if appropriate. In our view the monitor is a diagnostic tool to confirm the patient’s cardiac rhythm. I have never heard of a medic in CT getting in any trouble for this. But we have had medics not cardiac monitor and get into trouble because they were unable to confirm and document the patient’s rhythm, mostly presumptions and a few other calls.

I personally view the monitor as a diagnostic tool not a therapeutic one. Defib, Pacing cardioversion are therapeutic. While I don't necessarily view it as black and white I will agree if you suspect something and put the monitor on you probably shouldn't downgrade.
 

Wingnut

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We're a bit more strict. The medic evaluates by talking to the pt and deciding but if a monitor or any kind of BLS thing is done the pt has to remain ALS status.
 

akflightmedic

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It is a diagnostic tool, however what symptoms did the patient exhibit in order for you to be suspicious enough to place a monitor on them? And if they were symptomatic or had the right complaints to warrant an ECG, why would you not leave it on and continue ALS monitoring? I guess I am clueless...you would have to tell me what type of patients you would hook up and then disconnect after viewing their cardiac activity. SOB, CP? No, cause those are ALS calls unless they are SOB secondary to a panic/hyperventilation attack but if you recognize those for what they are, you usually never get to the monitor or transport for that matter. So maybe ABD pain? No, thats ALS, they need a line and pain control. A diabetic? No, cause they need a line and med administration. See my point? I just do not know where you would feela need to downgrade once you have applied. And if you are able to downgrade by whatever reasoning you may supply me, my next question would be why? DO we not owe the patient the best continuous medical assessment possible? Not trying to be antagonistic, I truly do not understand when or why you would downgrade prehospitally.
 

Jon

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Around here, if the medic assesses the patient, they can turn it over to BLS, but they still write a chart, as does the BLS service.

The question is, what makes an assessment? If the patient is put on the monitor, that would be an assesment. Sometimes the medic will do a brief history and exam (at the BLS level only) and detetrmine it is BLS and they are OK to leave. Around here, we often document that type of occurance as "ALS cancelled by BLS." An example - a paitent with a minor laceration, but it was dispatched ALS. There are gray areas. If the medic is on your truck, and does an ALS-level assesment, IMHO, then the MEDIC still writes the chart, even if it was determined to be a BLS transport. The EMT can still ride it in, but the Medic must write the chart.
 

KEVD18

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in ma, or at least in my service, once an als intervention has been performed, it is an als call. this includes application of the cardiac moniter. my opinion, if yo had cause to believe a cardiac moniter was needed for the eval, i now believe its required for the t/p
 

Jon

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I've seen times when a medic has applied a patient to a cardiac monitor as part of his assessment and then turned it over to BLS. It is rare, but it has happened. If the medic is turning it over to BLS, though, the medic needs to document his assessment.
 

brentoli

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No one has mentioned one point...
Every Paramedic is also an EMT.
If a Medic has done a BLS assessment, which should include the assesment of upgrading the level of care or not, and decided it was BLS with out using any ALS procedure... then how is it wrong for a Medic to hand it off to an EMT.
 

Jon

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Well said, but as a former paramedic student, I will say that there is such a thing as an "ALS assesment" without actually putting someone on a cardiac monitor or checking their BgL. Medics are looking for different things to a point... Yes, they do a BLS assesment, but they also "look a little closer" The big question - Do they find anything that actually needs a full ALS-workup? Or is it just BLS?

If it is just BLS, then you can make a case that they preformed the same assesment that any fresh out of school EMT would. I argue that that isn't the case, though... it comes down to the general impression based on experience and education that the new EMT doesn't have.

If it is ALS, then the medic needs to do a full ALS workup. In a single-tier system, than this means that the medic will probably ride it in. In a dual-tier system, the medic MIGHT get permission from command to release the patient to BLS based on their further assement.


Ok... I'm rambiling and exhausted... I hope you get the general idea, at least.

Jon
 

brentoli

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I see your point Jon...
but...
Not every EMT is fresh blood either. I think when EMT's are working with the same medics long enough, they know what those medics are looking for in the ALS assesment and they know where those medics draw the lines at.
Yeah.. it is a case by case basis. But if I am 100% comfortable with a pt, and a medic asks if I want them or not... I am not going to think that medic is abandoning the paitent. Maybe it is because we use a private service (R/M) but it just doesn't seem like thats such a big issue where I am from. Hopefully it stays that way too! B)
 

Jon

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That is Exactly what I am saying... around here, we often document such as "ALS recalled by BLS" - this is when ALS really has made no patient contact. ALS's chart is nothing more than call location, times, and "Recalled by BLS upon arrivial" I think there is NOTHING wrong with this.

The issue becomes - what happens if the medic evaluates the patient and then turns it over to BLS... and the patient isn't a flagrently B(L)S patient? In theroy, if the Medic did an assesment and determined the patient wasn't in need of ALS treatment, the medic still did an ALS Assesment and the call can be billed ALS... but, because the Medic did an assesment, the medic needs to write a chart with the assement, and perhaps get released by command.

The other can of worms is what if the medic wants to release the call to BLS, but BLS isn't comfortable with the patient?
 

brentoli

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Ok well don't forget to look at what time I posted that. It was the end of my day. I see where you are coming from now though. And personally, and I hope every other EMT is like this, I won't let a medic bully me into taking a call if I am not comfortable with it. If I have any issues with my pt I won't hesitate to ride it in doing a medic assist.
 

DT4EMS

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This is a common question. The answer has already been stated here in the thread.

1) Do you have a policy that allows it?

2) Is the call truly BLS?

Is the EMT refusing to "tech" the call because he/she is lazy or truly feels uncomfortable?

In my 16 years of EMS this has never been a problem for me. I have worked very urban environments and extremely rural ones. If an assesment was perfromed and I found the patient to be BLS, I have asked if my partner wanted to tech the call. If they didn't I didn't ask any questions and just took it.

An EMT can be a great partner or can be a driver. The choice is theirs. I never thrust a new EMT into the patient care realm until they felt comfortable. On the same note, I didn't stick them with all of the BS calls either.

I have been lucky enough to have hungry EMT partners that you had to almost physically remove them from the back of the truack because they would thrive on patient care................. but I have had others that would slam the door on you to race around to the front.......... (They work for fast food joints now) :)
 
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