ThePsilocybeVibe
Forum Ride Along
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Hello out there!
This is a long one for those of us in Los Angeles County. This is something we all do everyday and yet it's amazing how many different answers I've received from coworkers and folks from other companies. Scary, really.
At risk of oversimplifying what we do as EMT-1's in LA County, our job is to make sure our PT's get the appropriate level of care according to our assessment. Break ur toe, BLS. Break your skull, probably ALS. Stable vital sign trends, BLS. Vitals that look like 3 different Lotto tickets, ALS.
Right? Simple.
"What's the Effing Scenario?!" u ask? Well...
U arrive for a transport from Skilled Negligence Facility to an ER an hour away. RN reports PT has Athlete Vitals...120/80, yadda yadda...But u assess at bedside and find PT's vitals are...Well I won't waste ur time...Lets just say they're unstable as all hell with an obvious altered mental status that daughter says is absolutely abnormal. She's usually talking but now she's mumbling 'bout Lucy In The Sky With Diamonds.
ALS? Yep, I'd say so. But remember that DNR?
Question: According to LA County protocols, does a valid DNR order allow the EMT-1 to transport an unstable patient? I ask this because my company (I'm positive it ain't the only company doing this) suspended my partner and I for refusing this transport, pending investigation. I'm losing money 'cause they felt they're losing theirs. My field ops supervisor literally told us that a DNR means "transport anyone, anytime, anywhere"...It's scary because half the EMT's I asked said they agree...The reasoning being "they're gonna die anyway. All u have to do on this transport is sit there."
It absolutely BLOWS MY MIND how some of us think. My understanding is that a DNR is only a piece of paper UNTIL respirations cease or pulse disappears. Up until THAT POINT, the patient is still a living, breathing human being that deserves the best treatment we can offer. Hell...Some of my coworkers told me DNR's dont need oxygen! Scary as hell. I dunno...Correct me if I'm wrong but a DNR is not license to do whatever the heck u want because "they're gonna die anyway."
Here are LA County's EMS Protocols:
http://ems.dhs.lacounty.gov/policies/Ref800/Ref800.htm
Specifically DNR's: http://ems.dhs.lacounty.gov/policies/Ref800/815.pdf
I find no language that demonstrates that a DNR affects transport decisions in any way until a PT's respirations, pulse, or both cease.
This is a long one for those of us in Los Angeles County. This is something we all do everyday and yet it's amazing how many different answers I've received from coworkers and folks from other companies. Scary, really.
At risk of oversimplifying what we do as EMT-1's in LA County, our job is to make sure our PT's get the appropriate level of care according to our assessment. Break ur toe, BLS. Break your skull, probably ALS. Stable vital sign trends, BLS. Vitals that look like 3 different Lotto tickets, ALS.
Right? Simple.
"What's the Effing Scenario?!" u ask? Well...
U arrive for a transport from Skilled Negligence Facility to an ER an hour away. RN reports PT has Athlete Vitals...120/80, yadda yadda...But u assess at bedside and find PT's vitals are...Well I won't waste ur time...Lets just say they're unstable as all hell with an obvious altered mental status that daughter says is absolutely abnormal. She's usually talking but now she's mumbling 'bout Lucy In The Sky With Diamonds.
ALS? Yep, I'd say so. But remember that DNR?
Question: According to LA County protocols, does a valid DNR order allow the EMT-1 to transport an unstable patient? I ask this because my company (I'm positive it ain't the only company doing this) suspended my partner and I for refusing this transport, pending investigation. I'm losing money 'cause they felt they're losing theirs. My field ops supervisor literally told us that a DNR means "transport anyone, anytime, anywhere"...It's scary because half the EMT's I asked said they agree...The reasoning being "they're gonna die anyway. All u have to do on this transport is sit there."
It absolutely BLOWS MY MIND how some of us think. My understanding is that a DNR is only a piece of paper UNTIL respirations cease or pulse disappears. Up until THAT POINT, the patient is still a living, breathing human being that deserves the best treatment we can offer. Hell...Some of my coworkers told me DNR's dont need oxygen! Scary as hell. I dunno...Correct me if I'm wrong but a DNR is not license to do whatever the heck u want because "they're gonna die anyway."
Here are LA County's EMS Protocols:
http://ems.dhs.lacounty.gov/policies/Ref800/Ref800.htm
Specifically DNR's: http://ems.dhs.lacounty.gov/policies/Ref800/815.pdf
I find no language that demonstrates that a DNR affects transport decisions in any way until a PT's respirations, pulse, or both cease.