JPINFV
Gadfly
- 12,681
- 197
- 63
What's your justification here for not following the physician's order that is somehow not applicable to the exact same situation with an EMT refusing the same justification from a paramedic.
Just Because
- Thread starter Ewok Jerky
- Start date
What's your justification here for not following the physician's order that is somehow not applicable to the exact same situation with an EMT refusing the same justification from a paramedic.
Shishkabob
Forum Chief
- 8,264
- 32
- 48
Are you talking about the real-life time I refused to follow a doctor, or the hypothetical story you threw out?
Shishkabob
Forum Chief
- 8,264
- 32
- 48
An ILS truck is called for a transfer of a bradycardic patient on a chronotrope. The Intermediate doesn't know the chronotrope being used too well. When asked why this specific chronotrope is being used as opposed to another one, the sending physician states "Because it is", and doesn't expand upon his reasoning.
Once in the truck, the Intermediate stops the chronotrope drip because he didn't like the answer.
Is the Intermediate in the right?
Once in the truck, the Intermediate stops the chronotrope drip because he didn't like the answer.
Is the Intermediate in the right?
Last edited by a moderator:
JPINFV
Gadfly
- 12,681
- 197
- 63
I'm trying to get at why a paramedic not following a physician's order is any different from an EMT not following a paramedic's order when the same argument ("Just because, and I don't want to explain myself to you") is used by both the physician and the paramedic.
Shishkabob
Forum Chief
- 8,264
- 32
- 48
h34r:
Last edited by a moderator:
Sasha
Forum Chief
- 7,667
- 11
- 0
If you want a treatment done and refuse to or cant justify why that treatment is done than you have no business downgrading the call. If your assesment "sees something" that requires o2 shouldnt you tell the emt so they know what to monitor for changes?
Roleplaying for a moment here, if i was that emt and you wanted to dictate the treatment you either ride in with me or keep your mouth shut. Especially if you wont tell me why.
Sent from LuLu using Tapatalk
Shishkabob
Forum Chief
- 8,264
- 32
- 48
And I never said I didn't agree with that view a single time.
Sasha
Forum Chief
- 7,667
- 11
- 0
So why are you defending the medic?
Sent from LuLu using Tapatalk
Sent from LuLu using Tapatalk
jjesusfreak01
Forum Deputy Chief
- 1,344
- 2
- 36
Agreed. I'll do whatever the medic wants onscene...until he decides to hand the call to me. At that point its my patient and if he wants something else done and I don't see the reason, he needs to justify it to me. If a medic is downgrading the call to BLS, then there will be a very simple explanation for why he wants the oxygen.
Shishkabob
Forum Chief
- 8,264
- 32
- 48
No.
I'm saying if you're against the explanation of "Just because", your defense for refusing to do something better not be "Just because", too.
truetiger
Forum Asst. Chief
- 520
- 14
- 18
Out of curiosity, did the OP do his own assessment?
OP
OP
Ewok Jerky
PA-C
- 1,401
- 738
- 113
Thank you for the lively discussion, wish id had a chance to chime in sooner but its been a busy shift and im typing on my phone so please excuse grammatical/silly errors.
I was on scene during medics assessment, no indication for O2, medic did not get pulse-ox. Vitals were unremarkable.
Also I would like to add that O2 is a BLS skill, so while medic is higher authority this is not the same as medic asking me to hook up the monitor and me questioning why. Nor is it the same as refusing an order from a dr
I hate to change the scenario but what if we tested BG and it came back 120, no ALOC, and medic told me to administer oral glucose?
I was on scene during medics assessment, no indication for O2, medic did not get pulse-ox. Vitals were unremarkable.
Also I would like to add that O2 is a BLS skill, so while medic is higher authority this is not the same as medic asking me to hook up the monitor and me questioning why. Nor is it the same as refusing an order from a dr
I hate to change the scenario but what if we tested BG and it came back 120, no ALOC, and medic told me to administer oral glucose?
firetender
Community Leader Emeritus
- 2,552
- 12
- 38
Please don't change; we're not through here
What is real?
The higher credentialed medic determined that his patient was a BLS call, felt no need to intervene, he did NOT apply the O2 himself
He handed the care of the patient off to the OP.
It's the OP's patient now!
POLITICS, Part I:
He asks OP to put the pt. on O2. I forget, did he say how many LPM?
By now, OP should know if applying the O2 will harm the patient.
If no harm, apply the O2.
If "potential" for harm but no imminent danger to patient
Apply the O2.
Why? Because if OP moves fast enough that patient will be out of sight of the medic, in OP's ambulance and UNDER OP's CONTROL and legally, OP's responsibility.
END POLITICS Part I
Now go back and do a THOROUGH assessment.
If OP's conscience says give the Medic his due unless OP is sure he knows enough to countermand his decision, keep the O2 on while pt. gets assessed.
Adjust or remove O2 according to the current assessment.
Document.
HINT (You owe me ten bucks!): the status of patients often change in transport!
POLITICS Part II:
You'll notice no mention of even talking to the guy. Why? Because under those circumstances OP is not going to be able to educate him, and...
under those circumstances OP will soon be in charge. NOTHING ELSE MATTERS other than the welfare of the patient!
Moral of the story: Understand when you become in charge. If you can accelerate the process of you getting there, then do that. Once that happens, YOU can be the guy who says: "Just because*" and then let the guy downwind of you agonize over how to handle you!
Your friendly firetender
* While, of course, you back it up with your best clinical judgment.
What is real?
The higher credentialed medic determined that his patient was a BLS call, felt no need to intervene, he did NOT apply the O2 himself
He handed the care of the patient off to the OP.
It's the OP's patient now!
POLITICS, Part I:
He asks OP to put the pt. on O2. I forget, did he say how many LPM?
By now, OP should know if applying the O2 will harm the patient.
If no harm, apply the O2.
If "potential" for harm but no imminent danger to patient
Apply the O2.
Why? Because if OP moves fast enough that patient will be out of sight of the medic, in OP's ambulance and UNDER OP's CONTROL and legally, OP's responsibility.
END POLITICS Part I
Now go back and do a THOROUGH assessment.
If OP's conscience says give the Medic his due unless OP is sure he knows enough to countermand his decision, keep the O2 on while pt. gets assessed.
Adjust or remove O2 according to the current assessment.
Document.
HINT (You owe me ten bucks!): the status of patients often change in transport!
POLITICS Part II:
You'll notice no mention of even talking to the guy. Why? Because under those circumstances OP is not going to be able to educate him, and...
under those circumstances OP will soon be in charge. NOTHING ELSE MATTERS other than the welfare of the patient!
Moral of the story: Understand when you become in charge. If you can accelerate the process of you getting there, then do that. Once that happens, YOU can be the guy who says: "Just because*" and then let the guy downwind of you agonize over how to handle you!
Your friendly firetender
* While, of course, you back it up with your best clinical judgment.
I'm thinking this given the situation. Heck I do this around here so it doesn't look like the "big mean transport paramedic is ignoring or second guessing our treatments" to the first responders. Especially given their propensity for putting NRBs on every freaking body "just because".
I really hate having to play nice.
---
- Sent from my electronic overbearing life controller
the_negro_puppy
Forum Asst. Chief
- 897
- 0
- 0
Yeah I wasn't serious!
I don't know why people are getting so butthurt over this scenario. If the the patient was turned over to the EMT's care he can then assess her and remove 02 if he deems not necessary. I personally wouldn't have argued with the firemedic and just removed the nasal cannula once I had her loaded. Conflict resolution sometimes includes conflict avoidance.
truetiger
Forum Asst. Chief
- 520
- 14
- 18
This scenario is a perfect example of where a little common sense can take you a long way. Leave the patient on oxygen, load her, do your own assessment, and then either continue or discontinue the oxygen treatment. The call wouldn't even stick out. Option two, challenge the fire-medic. It'll turn into a huge deal and end with bad blood between the two agencies. Now, every call you run with them will be a p*ssing match. Seems like a pretty simple decision...
Melclin
Forum Deputy Chief
- 1,796
- 4
- 0
Godwin's law comes to mind in this thread.
War crimes and court cases aside, I've done most of the things mentioned here.
On one side I've ignored a doctor's orders and done my own thing, on the other side, I've continued treatments that I was reasonably sure were useless simply because I wasn't sure why they were in place (usually O2).
We have the benefit of ALS units that aren't complete idiots, and we also don't directly charge patients for every little thing we do, so your issue has some nuance to it that I don't usually have to deal with.
1. Try and get an explanation (if you're taking a handover, this really shouldn't be difficult).
2. If you were unable to find a delicate way of getting a reason for a treatment out of the the higher provider, my thought would be to continue it unless:
-dangerous.
-patently absurd (oxygen for a sore foot may fit into this category).
War crimes and court cases aside, I've done most of the things mentioned here.
On one side I've ignored a doctor's orders and done my own thing, on the other side, I've continued treatments that I was reasonably sure were useless simply because I wasn't sure why they were in place (usually O2).
We have the benefit of ALS units that aren't complete idiots, and we also don't directly charge patients for every little thing we do, so your issue has some nuance to it that I don't usually have to deal with.
1. Try and get an explanation (if you're taking a handover, this really shouldn't be difficult).
2. If you were unable to find a delicate way of getting a reason for a treatment out of the the higher provider, my thought would be to continue it unless:
-dangerous.
-patently absurd (oxygen for a sore foot may fit into this category).
Sasha
Forum Chief
- 7,667
- 11
- 0
The pulse ox is the most useless piece of equipment ever. Aside from a bite stick.
Errrr, I'd argue the trans-tracheal jet insuflator, esophageal detection device, Viewmax laryngoscope and the regular short-board might seriously challenge for that title...
I find a pulse-ox that displays a waveform to be pretty darn useful.
truetiger
Forum Asst. Chief
- 520
- 14
- 18
What did your assessment reveal? What complaints did the patient have? Med hx?