EMS Question Regarding Incident In Emergency Room

[MrJones]

...waiting with abated breath....

 

[Jon]

...Also, a reason I recommended it is that a lot of people won't even realize that as an option. The option won't be given to them simply because the ER wants to get them in and out as soon as possible. Plastic surgeon definitely cares more about the appearance of a scar than a physician would.

What if the hospital did have a plastic surgeon on hand (knowing he could do a better job) but just let the physician take case if it? Just playing a little devils advocate.

First... You do know that a plastic surgeon IS a physician, right?

Sutures leave scars. I've never been convinced that a plastic surgeon is going to do a significantly better job on a simple laceration repair than a "regular" residency-trained EM physician.

Additionally, unless it's a tertiary care center, the Hosptial is unlikely to frequently consult plastic surgery on cases.



All that aside - it's really bad form to talk down the folks you're handing care off to. How would you like it if the nurse at a sending facility said "these folks just have an advanced first aid card and a drivers license. They really don't know anything medically, and you don't need to tell them anything."

 

[KellyBracket]

This is a great discussion! Love to hear all the different points of view.

One thought - most emergency staff are pretty good at suturing up kids, mostly since kids are so good at jumping off stuff, falling down, or misusing sticks. Chins, eyebrows and lips are fairly routine in the ED! So, we get a lot of practice. Of course, there are a few infrequent situations that call for the specialist's touch (e.g. a lac of the margin of the eyelid). But folks in the ED are pretty good at recognizing those.

 

[CentralCalEMT]

This is only my opinion. You also have to remember that you are dropping off the patient and going back into service and will have no more contact with the patient. The ER has to deal with that patient up to discharge. Giving the patient who has no medical training (and probably will take the word of EMS as if it is absolute truth) an idea about what the ER is going to do may very well complicate the job the ER has, if their treatment is different from what you told them. If the wound is very minor, or there is no plastic surgeon on call or one is unavailable, then even if the ER doctor does an amazing job, then the patient may very well go away feeling mistreated when, in fact, they were treated well. Do you tell every abdominal pain to make sure they get a GI consult? Does every headache need to be seen by a neurologist? I could go on and on. I think it is better to leave those calls up to the ER attending staff. Most ER doctors do not want to be sued if they treat a patient inadequately and are fully capable of determining what type of treatment a patient needs without EMS putting ideas in the patient's mind about what they need.

 

[JPINFV]

First... You do know that a plastic surgeon IS a physician, right?

Since when did that happen?

...excuse me, ortho is calling trying to punt another patient for an uncontrolled hypertension of 142/70.

 

[Handsome Robb]

Since when did that happen?

...excuse me, ortho is calling trying to punt another patient for an uncontrolled hypertension of 142/70.

:lol:

 

[samiam]

I will not recommend something quite as specific as this to a patient. However if a patient wants to be seen at the local hospital with extremely limited capabilities, I may advise them against it. I wouldn't want an ER doc who does only a few sutures a year to sew me up when I have better options less than hour away.

Tigger I feel like this could get you into even hotter water advising against it like that lol. ER's tend to have the "only a doctor can give medical advice" rule and it is usually strictly enforced. For example a xray tech probably can look at a xray and know that your foot is broken and even know what kind of fracture it is but they are not "allowed" to tell the patient because they are technically not qualified and it has to be done by a doctor. I have even seen nurses who when asked what a medicine is for etc will only read word for word what is on the label of the product because only the doctor is qualified to give medical advice. Obviously this depends on the location and the department but this is common in the ER

 

[Tigger]

If the patient is sick we are going to have a conversation to the effect of "yes the Level IV can in theory accept you, but they are likely to transfer you out netting two ambulance bills and two hospital bills. The choice is yours, however."

For things like sutures if someone asks my opinion I'll give it to them. I wasn't clear in my first posting, I would not provide unsolicited advise in this situation. But if they're sick and need a legitimate hospital, then all bets are off.

 

[samiam]

That's what I figured you meant