patient right to demand ambulance transport

I understand the confusion. In one of the systems I worked thr transporting medic had no athourity even if we where onscene first. The city fire deparment had total scene and pt controle even if they did not ride in. Pretty :censored::censored::censored::censored:ty system.

usalsfyre said:
We can't refuse transport. Both cases get transported, with accurate documentation as to the reason for the call.

I am curious about the "scene control saying get them out of the city". What exactly does that mean? How are transport decisions not up to the transporting medic?
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ffemt8978 said:
Can't change the protocols until EMS providers are better educated in medicine.
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Not complicated deciding who needs ambulance transport vs who doesn't. Anyone not educated well enough needs to be out of EMS.
 
Sure it is when there are those who believe its only an emergency if its a cool trauma or theyre gasping for breathe. Woman presenting with abd or lower back pain? Just indigestion or stressed muscle

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I often ask myself why this person needs ambulance transport. Either way, we just do it.
 
The only issue I have with that paper (I actually think the results are probably very valid) is they did not then provide education and repeat to see if the deficiency was easily correctable.
 
JPINFV said:
Apparently it's more complicated than you think.

http://www.ncbi.nlm.nih.gov/pubmed/16798145
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You're confusing needing an ambulance transport with who needs to be admitted. Two, sometimes coinciding, but radically different things.



And now I want to see a study for:

Physicians
HEMS nurses
ICU/ED/Med surg nurses.


All with the same tools that EMS has out in the field.
 
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Linuss said:
You're confusing needing an ambulance transport with who needs to be admitted. Two, sometimes coinciding, but radically different things.



And now I want to see a study for:

Physicians
HEMS nurses
ICU/ED/Med surg nurses.


All with the same tools that EMS has out in the field.
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Really it's not terribly hard with
a good basic assessment. The problem is the majority of paramedics have never been taught anything beyond the ED.
 
Linuss said:
You're confusing needing an ambulance transport with who needs to be admitted. Two, sometimes coinciding, but radically different things.



And now I want to see a study for:

Physicians
HEMS nurses
ICU/ED/Med surg nurses.


All with the same tools that EMS has out in the field.
Click to expand...


Irrelevant. Paramedics are saying that they, with their current education and tools available, can safely and competently determine who needs to go to the hospital and who doesn't. Furthermore, education and training is vastly more important than anything else.
 
Did the paramedics in that study know the hospital's ICU admission criteria? In my area the different hospitals have different criteria for ICU admission, so an ICU patient at one hospital may be an acute care unit patient in another.
 
Aidey said:
Did the paramedics in that study know the hospital's ICU admission criteria? In my area the different hospitals have different criteria for ICU admission, so an ICU patient at one hospital may be an acute care unit patient in another.
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...yet could only predict 62% of the patients who needed to go to be admitted to either.
 
JPINFV said:
Irrelevant. Paramedics are saying that they, with their current education and tools available, can safely and competently determine who needs to go to the hospital and who doesn't. Furthermore, education and training is vastly more important than anything else.
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No, it is not irrelevant. The issue at hand is who needs and/or benefits from ambulance transport, not who needs to be admitted for further testing and/or treatment.




And again, until we see the percentages for physicians and nurses under the same circumstances, the 'study' is rather invalid. No control? No other variables to see if it's just education or other factors?


Crappy 'study'.
 
They don't just admit every patient to a ward.
 
I dont think the study is flawed necessarily. It just needs to be understood and taken into consideration that Paramedics in the field do not have the same tools or lab results to base their decision off of that hospital providers do.

The study should make specific mention of that limitation and not sound as though Paramedics don't have the assessment capability to accurately make the admission determination.

If Paramedics had access to imaging and blood work than I think this study would show something completely different. And also, put an RN in the field with limited data and lets see what the same study show's?
 
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RNs aren't making admission decisions and the decision not to transport a patient could very easily result in a patient who needs to be admitted never making it to the hospital.
 
18G said:
I dont think the study is flawed necessarily. It just needs to be understood and taken into consideration that Paramedics in the field do not have the same tools or lab results to base their decision off of that hospital providers do.

The study should make specific mention of that limitation and not sound as though Paramedics don't have the assessment capability to accurately make the admission determination.

If Paramedics had access to imaging and blood work than I think this study would show something completely different. And also, put an RN in the field with limited data and lets see how the study go's?
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I was just trying to think of some of the last few patients I've seen, and I don't think my accuracy would be much better, even given that I've worked in an ICU and on a cardiac floor as an RN.

We just don't get the full picture in the field, we don't get to see how the patient responds to treatment in the ER, and we aren't on the cutting edge of what's possible as a treat and release in the ER.

That guy who missed dialysis 2 days this week and is now edematous, with abdominal pain and hypertension? Is he getting admitted or are they going to dialyze him in the ER and send him home?

The guy with the extensive history of diabetic wounds with the copperhead bite? Are they going to want to continue the IV abx beyond the first 12 hours to preempt the infection that's almost certain to develop?

How about the guy who was woken from sleep with wheezing and rales? There's nothing on his 12 lead to indicate that it's more than just COPD exacerbation and pneumonia, but what if there is?

I think that even with great assessment skills, you just can't always predict with great accuracy what's going to happen in the patient's course.
 
JPINFV said:
RNs aren't making admission decisions and the decision not to transport a patient could very easily result in a patient who needs to be admitted never making it to the hospital.
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Absolutely. Making the decision not to transport is often making a permanent decision for patients with regard to accessing health care for their issue. People really do believe that being seen by a paramedic and "checked out" is useful for something, and if the medic says they're ok, then they roll with that and seek no further care.
 
abckidsmom said:
I was just trying to think of some of the last few patients I've seen, and I don't think my accuracy would be much better, even given that I've worked in an ICU and on a cardiac floor as an RN.

We just don't get the full picture in the field, we don't get to see how the patient responds to treatment in the ER, and we aren't on the cutting edge of what's possible as a treat and release in the ER.

That guy who missed dialysis 2 days this week and is now edematous, with abdominal pain and hypertension? Is he getting admitted or are they going to dialyze him in the ER and send him home?

The guy with the extensive history of diabetic wounds with the copperhead bite? Are they going to want to continue the IV abx beyond the first 12 hours to preempt the infection that's almost certain to develop?

How about the guy who was woken from sleep with wheezing and rales? There's nothing on his 12 lead to indicate that it's more than just COPD exacerbation and pneumonia, but what if there is?

I think that even with great assessment skills, you just can't always predict with great accuracy what's going to happen in the patient's course.
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This is why I am always more in favor of transporting to a hospital where the patient can have a workup and be monitored and assessed for more than 15-20mins.
 
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