Legal / Ethical Question....

joemt

joemt

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I was having a discussion with a "colleague" yesterday and we disagreed on the following scenario... please read this and give me your opinion on how you think this situation should be handled.

Your on a Rural Volunteer Fire Dept, that also runs Medical calls(but does not transport). You receive a dispatch that ends up being a "full code"... you arrive at the same time or shortly after the ambulance.... you administer CPR, and provide "assisting" care (suctioning, being the IV Pole, loading the patient, etc).... The ambulance has obtained their information on the call.... Do you as a member of the Rural Volunteer Fire Dept. need to follow up with your own documentation, or can you just let it go, because the ambulance personnel on scene completed theirs. The argument is.. since this is a BLS call (somehow we're now separating running "CPR based" calls from other medical calls).. that documentation is not needed.

What do you think? I'd tell you what side I was on, but don't want to slant opinions posted
 
If you mean is there a need to do a run sheet, absolutely yes. Those documents are important to record runs, activity levels, response times, etc. If you are referring to a PCR (patient care report), I would again say yes. The PCR that the ambulance crew turns in will be their "version" of what happened. Probably doesn't happen too often, but if there was a discrepancy in what happened and what was documented, the documented crew wins, no questions. If we run a call and get an ALS intercept, don't think for a minute I don't document the crap out of the call. It's already a bad call getting worse (hence, ALS backup); wouldn't you want something to read over in court four years later when you're on the stand and the plaintiff's attorney is asking questions about something that happened during the last Presidential administration at 3 a.m. in a snowbank? Ink is cheap, use it copiously...

P.S. PM me and let me know if you agree or if you think I'm full of beans; the suspense is killing me :P
 
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run report is required for all pt interaction in ma. even if your a non transp unit or you transfer care to als. still need ot chart it
 
I will throw in my 2 cents with my second post. We have to fill out a running sheet for the job as soon as we drive out of the garage even if we get turned back or its a TNR.
 
I was a member of a volunteer FD. And most definantly YES YES YES, you need to follow up with your own documentation on every single call, whether its a full code or a LOL with toe pain.

Couple reasons...

1. When (or if, and if your not, I will say someones not so bright) you apply for the many grants available, they will require justification of the need for the equipment or money your requesting. While you won't send them your run reports, having completed them will aid in being able to provide factual data, not just approximated or pulled from the *** data because now your trying to remember what you did and when.

2. In this litigious world we live it, it is possible to find yourselves sitting in depositions someday. Should one of your "customers" decide they didn't like the way you were pounding on grandmas chest and start looking for money, you can bet any lawyer worth their salt will be looking at everyone they can, including that small little rural volunteer FD. A well documented report will save your butt.

3. You can bet your bottom EMS has documented that you were there. If you were there first, and doing CPR when they arrived, it is documented. Not only is that documented, but if they are smart they have it documented whether or not your CPR was effective (good depth on compressions, bagging at the appropriate rate, etc). If you get there at the same time, they will document what you did in the code, whether you were the ones bagging, or suctioning, maintaining C-Spine, etc.

Bottom line, if you are running calls and having to do anything with a persons life or property, you are a complete idiot if your not keeping your own documentation. And if your not keeping your own documentation, could you please provide me with directions to your town, as you see, I need a new car and I'm coming to slip and fall there.
 
Everytime you get toned out for a call, it should be logged. If an ambulance, rescue truck, fire truck, chief's truck, whatever... rolls off the pad, there should be a run sheet.

You should also request that the ambulance fax a copy of the completed pre-hospital care report (or whatever you call it there) to your headquarters to get filed away with the run sheet.
 
In one word, YES!
 
rescuecpt said:
You should also request that the ambulance fax a copy of the completed pre-hospital care report (or whatever you call it there) to your headquarters to get filed away with the run sheet.
Click to expand...

That's something that we've never thought of. Hrm. I think we'd have a heck of a time getting AMR to cough up copies of their PCRs, though.

We're a non-transport agency, but we do a PCR on every single patient that we do something for. Yes, we'll even do a PCR on a minor laceration. We explain to them that we're a)not billing them and b)are an on-site BLS agency and are not physicians and if they have any further questions or concerns to either see us or see their regular doctor OR to seek further treatment from the nearest emergency room. Then we have them sign it.

I think that it's usually better to over-document things than to poorly document them.
 
Absolutely! We not only would write a report documenting all that we did, but if available would attach to the MIR a copy of the MIR of the transporting agency.
 
The service I work for provides backup 911 EMS service to a few communities. One time we got called out for an ETOH patient. The FF/EMT on scene gave me his half-done county report and I finished it, and turned it in.

We got the usual RLS audit, and I got a written warning in my file because of the incident. The original agency and transporting agency should have their own run reports.
 
I would and instruct my students to always do your own paperwork. Every agency has diffrent rules but I want paperwork from my providers at my station at all times. On every call Just CYA:excl:
 
Document, Document, Document!!!!! And when you think you have documented enough, DOCUMENT some more!!!!! CYA!!!!! ALWAYS!!!!! You never know when you will be called up in court. It doesn't matter if the rescue squad did take that call over, you provided care before thier arrival. Anytime you provide care, you must document the details of that care. I used to be in the same situation. I was a member of a rural volunteer FD who responded first responder prior to Rescue Squad arrival. We always documented. It's the only way to go. Here is an example why... and codes are worse because you are dealing with down time, when your first shocks were if any, when cpr was first inniciated... etc. But... we responded to a wreck one night. One of our yahoo EMT's didn't want to wait for the responce truck to get there and they chose to yank the patient out of the vehicle without properly trauma packaging the patient. That patient ended up with paralisis from the waist down. Now weather he caused this or not, it fell back on him because he failed to act properly at the scene. Then he didn't fill out a PPCR. He left himself wide open. He got sued, lost his certs and now he is living across the street from the house he used to own in a trailer he is renting, I'm sure he says daily... "I used to own that house". What an idiot.

But always document no mater what anyone tries to tell you. If it ain't written, it didn't happen!!!!!
 
Every jurisdiction has it's own protocol on how to do things, however, in my jurisdiction there is paperwork for every single tone drop, even if we don't make it out the door. At least for the rural volunteer FD I run with. With the ambulance I run with (we cover the same area as the vol. FD I run with) we do paperwork everytime we actually see a patient and say, "hi, I'm Joe EMT. What's going on today?" The run sheet for a code can get pretty long.
 
As long as we are running with an engine/ladder from our dept, there is only one report written. The first provider will write what happened up to arrival of the transporting unit, and then the tech on the ambulance writes the rest of the report. If we are running with a different dept. for whatever reason, we have to write our own report anytime we actually make patient contact. Any person who calls and has a complaint when we arrive gets paperwork done on them. If we have a disregard, then we only have to do a unit report on the computer. It includes what we were dispatched on, where it was at, and the outcome (disregarded). If we are called to "assist a citizen" we only do a unit report on those as well.

So, in answer to your question, in that situation, yes I would complete a run report documenting everything I had done while on scene.
 
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