Just Because

[MassEMT-B]

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

That or I know in some parts of cali fire dept treats the pt then privates transport to hospital.

 

[Handsome Robb]

That or I know in some parts of cali fire dept treats the pt then privates transport to hospital.

This is true. If it's a BLS truck and the pt is deemed ALS the FF/Medic rides in on the private truck. If it's an ALS truck the firemedic will transfer care to the medic on the private ambulance.

 

[DesertMedic66]

I would not have put the patient on O2. The medic already did his assessment and handed over all patient care to you. When the patient is under my care I will listen to what you suggest but it doesn't always mean I'm going to follow it.

I'm going to do my own assessment of the patient and go from there. If the firemedic doesn't already have the patient on O2 then the patient *probably* doesn't need it. My response to the firemedic would have probably been "we will start O2 enroute" but never get it started. It doesn't disrespect anybody.

 

[Shishkabob]

You being a Basic, he being a Medic, maybe he had a reason to put the patient on a NC, but didn't feel like explaining it to you? (Some medics are like that)

Just because you didn't see a reason doesn't mean there wasn't one, let alone a valid one. Kind of silly to ignore a higher persons recommendation without you yourself understanding why they wanted it, just because you didn't like the answer.




Just sayin'.

 

[JPINFV]

You being a Basic, he being a Medic, maybe he had a reason to put the patient on a NC, but didn't feel like explaining it to you? (Some medics are like that)

...then the medic can attend the patient all the way to the hospital.

Just because you didn't see a reason doesn't mean there wasn't one, let alone a valid one. Kind of silly to ignore a higher persons recommendation without you yourself understanding why they wanted it, just because you didn't like the answer.

Kinda of silly to engage in "because I said so" while handing off the patient. If the paramedic is truly that concerned, then it should be communicated in the hand off report, otherwise the EMT's response to the same query from the ED staff is going to be, "Just because."

 

[Shishkabob]

Agreed on both accounts... but not totally unrealistic considering the area, and mindsets of such, either.

 

[Handsome Robb]

My question is, what if the medic charts the o2 but you never started it then it goes to court? He asked to you do something and you didn't do it, and in a situation like I stated above now it's his *** in a sling.

Just playing the devils advocate, I don't need my head bitten off.

 

[Sasha]

You being a Basic, he being a Medic, maybe he had a reason to put the patient on a NC, but didn't feel like explaining it to you? (Some medics are like that)

Just because you didn't see a reason doesn't mean there wasn't one, let alone a valid one. Kind of silly to ignore a higher persons recommendation without you yourself understanding why they wanted it, just because you didn't like the answer.




Just sayin'.

That is the wrong mentality.

Sent from LuLu using Tapatalk

 

[Shishkabob]

That is the wrong mentality.

Sent from LuLu using Tapatalk

And never said it was right.



But choosing not to do something because you didn't like their explanation, but had no other reason, is just as wrong, no?

 

[Lady_EMT]

My question is, what if the medic charts the o2 but you never started it then it goes to court? He asked to you do something and you didn't do it, and in a situation like I stated above now it's his *** in a sling.

Just playing the devils advocate, I don't need my head bitten off.

Something I considered, and when I thought about it, I worked it out.

Technically, if the medic didn't start the O2, then handed the PT off, no where in his report should it say he started the pt on O2. His report should end with "transferred care to [ambulance company] crew, pt care terminated." That way, there is no confusion on anything. If the medic says he put the pt on O2, but didn't, then he deserves any repercussions that meet him in the court system if it gets down to that.

On the other side of the argument, If the medic put the pt on O2 before transferring pt care, then the receiving crew took the pt off of O2, then the crew needs to chart and record why they made that decision. That way, the entire call is covered from point A to point B, without any confusion on what happened to the O2.

 

[Lady_EMT]

You being a Basic, he being a Medic, maybe he had a reason to put the patient on a NC, but didn't feel like explaining it to you? (Some medics are like that)

Just because you didn't see a reason doesn't mean there wasn't one, let alone a valid one. Kind of silly to ignore a higher persons recommendation without you yourself understanding why they wanted it, just because you didn't like the answer.




Just sayin'.

Yes, I agree with you, but I also agree with everyone else that the question should be asked WHY the pt is on O2. If a medic says, "Just because," then I'm going to ask the pt if they are having any chest pain/difficulty breathing. If not, then I will remove the O2, recording my reasoning in my report, and be done with it. If the pt says that they were having chest pain/difficulty breathing, and the O2 helped, then of course I'm going to leave it on.

I'll listen to a medic if they give a good reason. Even if they're just covering all the bases, they should have a better reason than "just because."

 

[JPINFV]

But choosing not to do something because you didn't like their explanation, but had no other reason, is just as wrong, no?

No. Argument: Nuremberg.

 

[Shishkabob]

No. Argument: Nuremberg.

People of Nuremburg that had plenty of reasons to not follow what was ordered beyond "I don't like your explanation"... eg "I don't want to kill innocent people" or "They aren't war criminals"


Refusing to follow a (potentially) more educated providers medical decisions simply because you don't understand something without doing your own due diligence is silly.

If you're going to refuse, atleast have a basis to refuse. "That's not safe for the patient", or "Why does the patient require O2 when they aren't short of breath and sats look fine?"

the question should be asked WHY the pt is on O2. If a medic says, "Just because,"

EXACTLY! But if you don't ask for an explanation, you darn well better have some reason to refuse to follow what was called for beyond "I don't like the answer 'just because' " You darn well better be able to expand upon your decision.




Don't follow an order blindly, but don't refuse an order just as blindly either.

 

[JPINFV]

People of Nuremburg that had plenty of reasons to not follow what was ordered beyond "I don't like your explanation"... eg "I don't want to kill innocent people" or "They aren't war criminals"


Refusing to follow a (potentially) more educated providers medical decisions simply because you don't understand something without doing your own due diligence is silly.

If you're going to refuse, atleast have a basis to refuse. "That's not safe for the patient", or "Why does the patient require O2 when they aren't short of breath and sats look fine?"

I agree with your last paragraph, however your argument so far is that "Because I said so," while an inappropriate response, would answer that last question. You're saying that the fact that I find "because" to be inappropriate doesn't mean that I shouldn't follow the order.

EXACTLY! But if you don't ask for an explanation, you darn well better have some reason to refuse to follow what was called for beyond "I don't like the answer 'just because' " You darn well better be able to expand upon your decision.

So far I have the conversation going like this.

"Oh, by the way, put the patient on a nasal cannula."
"Why?"
"Just because."

The way I'm reading it, the explanation is "just because" and "just because" is not an appropriate medical justification in any situation. There's nothing to expand on because "just because" isn't a valid reason on its face.

 

[Shishkabob]

All I'm saying is you damn well better have a good reason to not do something someone credentialed higher tells you to do besides not liking "just because" when it comes to court.

Not saying I like the answer or agree with the oxygen administration, but I'm also not going to risk my license for not doing something someone higher wanted because they didn't want to give an answer that satiates my curiosity, when I have no other legit medical basis to refuse.

 

[Sasha]

And never said it was right.



But choosing not to do something because you didn't like their explanation, but had no other reason, is just as wrong, no?

Not really considering there was no legitimate explanation and the treatment was superfluous based on the assesment.

Sent from LuLu using Tapatalk

 

[truetiger]

Why not just leave the O2 on while you load the patient? 2 extra minutes on low flow O2 isn't going to make a difference. Save the @#$% measuring contest with the fireman and do your own assessment.

 

[JPINFV]

All I'm saying is you damn well better have a good reason to not do something someone credentialed higher tells you to do besides not liking "just because" when it comes to court.

Not saying I like the answer or agree with the oxygen administration, but I'm also not going to risk my license for not doing something someone higher wanted because they didn't want to give an answer that satiates my curiosity.

This isn't just about satisfying the EMT's curiosity. It's about satisfying the ED's curiosity as well.

Let's take this a step further. You're doing an interfacility transport as a paramedic from one ER to another and I'm giving you report. I start a drip (say, paracetamoxyfrusebendroneomycin) immediately before transport and you ask me why I started the patient on a new drug. My response is, "Just because." By your reasoning, that should satisfy any and all concerns you have since I don't, as a higher credentialed medical provider, have to justify my orders to you.

 

[Shishkabob]

Not really considering there was no legitimate explanation and the treatment was superfluous based on the assesment.

Sent from LuLu using Tapatalk

I don't need to give a legitimate explanation to first responders about why I do or do not want something done while on scene. My word is/should be enough unless they see a safety issue. Unless my partner has the knowledge to backup refusing what I want done, it should be done.

And considering my assessment also goes deeper than my partners', I also don't expect them to always see what I see when it comes to treatment modalities.





There's a time and a place to question why, and if it's not a safety thing, infront of the patient is neither the time nor place.

 

[Shishkabob]

This isn't just about satisfying the EMT's curiosity. It's about satisfying the ED's curiosity as well.

Let's take this a step further. You're doing an interfacility transport as a paramedic from one ER to another and I'm giving you report. I start a drip (say, paracetamoxyfrusebendroneomycin) immediately before transport and you ask me why I started the patient on a new drug. My response is, "Just because." By your reasoning, that should satisfy any and all concerns you have since I don't, as a higher credentialed medical provider, have to justify my orders to you.

I wouldn't take the patient off a medication that a doctor put on for the sole reason he said "Just because". I should, as anyone should, have a good and legitmate reason to stop a higher providers treatment beyond "I wanted to".


I'd do what I could to find out the reasoning if I didn't understand it, but just stopping it for NO other reason is silly.



I've gone against a doctors orders before, but I had reason to. See the difference?