Just Because

[Ewok Jerky]

Showed up for a transport today, Leg and Hip Pain. Firemedic on scene hands over care and after we load on the gurney firemedic says to me "lets het her on a cannula just 'cause, you know..."


i was like "huh?" I didn't want make a scene, we had already had to diffuse a situation that the captain was about to blow out of control. So I pulled out a cannula and before I put it on the Pt I noticed firemedic was not really paying attention so I just put it on the gurney and wheeled nanna outta there.

This is not about O2 for every Pt (plenty of threads on that already), its about scene-politics

Is it appropriate to "call out" a higher medical authority over something like that? on-scene, in front of crews and Pt and Family? For you medics, would you be insulted if I questioned you why you wanted me to do something?

BTW-we charge like $100 for O2 or something stupid like that.

 

[Sandog]

Well, should we not trust our medics? They have more training, and just because they are fire-medics does not diminish their knowledge. Fire-medics go through the same training as non-fire medics. Medic trumps basic, that's it.

 

[JPINFV]

Well, should we not trust our medics? They have more training, and just because they are fire-medics does not diminish their knowledge. Fire-medics go through the same training as non-fire medics. Medic trumps basic, that's it.

If the best reason a medic can come up with is "just because" then, no. We shouldn't trust them.

 

[sir.shocksalot]

Is it appropriate to "call out" a higher medical authority over something like that? on-scene, in front of crews and Pt and Family? For you medics, would you be insulted if I questioned you why you wanted me to do something?

It's totally appropriate to call out another provider, but not in front of their patient/family (unless it's a straight up 'will kill the patient' error). With something silly like oxygen it's best to wait until after the call, and in every case it's best to be as polite and un-confrontational as possible.

I am all for people's suggestions for treatment options, lord knows I can miss silly things from time to time and having someone else willing to make suggestions can help avoid missing things or getting a second opinion. Also it's a good opportunity to learn as a basic.

That all said, scene politics can take a big dump on patient care. At an agency here in Denver/Metro area the FD calls all the shots and the ambulance (also ALS) must follow their direction. This leads to worse scene dynamics than in CA where at least the ambulance is BLS and the FD is ALS so there is a clear distinction in certification levels. In this particular CO agency a FD medic could say "lets do some oxygen, you know, just cuz." And an equally certified private medic must follow that order or be fired, regardless of how much the private medic can disagree. The private medic will still be fired even if the FD was wrong and the private medic was right and said error results in patient death. So take some encouragement that at least your system isn't that messed up .

Don't ask me why a provider on the non-transporting vehicle has any say in patient care. My belief is that if you are making decisions about the care of the patient you should arrive at the hospital with the patient, even if you don't attend. This way if you screw up and turn an ALS patient to a BLS provider, at least you are at the hospital to try and explain yourself. But I guess that is a topic for another thread ^_^

 

[truetiger]

Yes, it would be very inappropriate to "call out" someone on scene. It would be appropriate to politely ask why. In the scenario you mentioned above, I would of wheeled nanna out to the rig with the nasal cannula in place and then performed my own assessment and determined whether or not she needed the oxygen. If the medic thought it was necessary to put her on oxygen, I would at least left her on the oxygen until I could do my own assessment.

 

[Aprz]

Fire: Lets get her on a cannula just 'cause, you know...
Me: (Great idea, but) lets get her into the ambulance, and have my partner assess her first. We have oxygen in there if she needs it.

 

[Sasha]

"im sorry what did you say the medical reason to apply oxygen was? So i can document it in my report..."

Sorry but considering they charge $100 for O2, while it isnt life or death it is being a patient advocate to challenge it. Frivilous charges on a bill can stress the patient financially. Later on down the road they may need to make the choice between buying their meds or paying their bill and a bigger bill "just cause... you know" is unethical.
Dont be a jerk about it, and if its going to turn into an argument let it go... but at least put your foot down.

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[Aidey]

That is usually the time I point out the patient's SpO2 is a perfectly acceptable number, if that doesn't work I just take it off in the ambulance. Or hook up the O2 to the portable tank and don't turn the tank on.

 

[Shishkabob]

California. Fire-medic. 'Nuff said.

Is it appropriate to "call out" a higher medical authority over something like that? on-scene, in front of crews and Pt and Family? For you medics, would you be insulted if I questioned you why you wanted me to do something?

If it's a safety thing, yes.

If it's a technique thing and it's just the way the medic (or any level) runs the call; No. You can question why I did something all you want after a call, because maybe you didn't understand my thought process, but if you do it DURING a call, we're going to have a talk.


Provider level is irrelevant in this situation-- what matters is if it's a safe decision or not. Just a month ago, I didn't agree with what a doctor in a clinic was doing in a peri-arrest, and it was a dangerous decision that was not right for the patient, so I started doing my thing to keep the patient alive. That is ok, because as I said, it was a safety issue, and I can stand by my decision in court or in front of my superiors if required.

 

[the_negro_puppy]

why not a NRB?

 

[Sasha]

But the fire medic wasnt running the call, he was handing it off, giving the OP the call to run

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[usalsfyre]

Question politely? Abso-freaking-loutely. I should be able to articulate to you why I'm performing an intervention. If I can't I probably need to think about if it's appropriate anyway.

Call me out rudely? Not unless I'm about to do something you know, for a fact, is going to kill the patient. The same goes for refusing an order.

 

[abckidsmom]

Polite: "do you think she really needs that oxygen? She's setting well and in no distress."

Rude: "I don't PUT people on oxygen unless they really need it."

To me, it sounds like he knew the patient was sicker than just whatever the main deal was, but he was busy turfing it to the basic crew and really hoped the pt wouldn't get sicker during the ride.

 

[jjesusfreak01]

why not a NRB?

Can't tell if trolling, or actually unsure...

 

[Tigger]

If the patient is alert and with it you could always just ask if the patient wants the oxygen. If we go to a facility with its own first responders and the guy that meets me at the door tells me the patient is on an NC because "you guys took a while and we didn't want to look like we didn't what we were doing," I'm going to ask the patient if she's breathing ok, and if she wants to remain on the oxygen. If she says no, off it comes. I don't want to show up at the ER and have the staff ask why I have a patient with no breathing issues on O2, and we don't even bill for it.

 

[Handsome Robb]

Can't tell if trolling, or actually unsure...

I think he's joking...

 

[EMTtoBE]

Nvrob may I ask where you work

 

[abckidsmom]

I think he's joking...

Agree. Just joking, right?

 

[fast65]

I'm wondering why the medic is passing off care to a basic, are you a medic/basic rig?

 

[STXmedic]

I'm wondering why the medic is passing off care to a basic, are you a medic/basic rig?

I'd assume the patient was capable of BLS transport and was downgraded by the medic to a BLS crew...