If someone has a medical complaint that will result in an admission because of the complaint (not a pre-planned elective admission) then management of that complaint should begin with EMS, especially if they called EMS for the complaint. Until we are given better point of care testing, and EMS Education programs step up and begin to teach a true H&P to paramedic students, then paramedics only have previous experience to go on to make that judgement call, outside of calling and consulting with the ER doc, or the patient's primary care physician.
I think it's possible you misunderstood me. I was just saying that plenty of people NEED EMS who will never be admitted. The examples I gave were just 3 off the top of my head.
I took some time off of EMS to be a mom these past several years. During that time, I learned that people will call for just about anything *when they are not comfortable with the situation*. Sure, it's not a big deal to you or me because we've dealt with similar situations many times before. But to the patient, they are unable to cope with their problem.
Across the board, the people I've gotten to know outside of EMS really believe that EVERY paramedic knows the right answer to the situation, and they will go along with what you say, even if it doesn't seem right to them, or if they still aren't comfortable with the situation or whatever. So if you (general you) suggest that maybe they don't need to go to the hospital, it's more than just a suggestion. They take it as a recommendation.
I'm going to put it in all caps, for emphasis: OUR WORDS CARRY MUCH MORE WEIGHT THAN WE KNOW. These people are in a crisis, and our words, whether positively or negatively recieved, are greatly magnified to the patient/family.
Speaking of which, I am not outside of contacting a patient's primary care physician (of course with the pt's permission) and speaking with them regarding the patient's condition and the need for transport vs follow up in the PCP's office. PCP's seem to very much appreciate that from EMS providers, and I feel that we as EMS providers need to involve the patient's PCP in transport decisions where there is not an urgent matter to be attended to and time is permitting. I also wont leave a diabetic with a hypoglycemic episode until I've made a follow up appointment with either their PCP or their endocrinologist.
Im a big believer that if we want to start being respected as medical professionals.. then we need to behave like a medical professional... not a blood hungry heathen...running from call to call looking for the "best" call of the night.
I like your ideas, but they run right along the edge of safe practice. I like talking to the PCP too, but again, I have to stress, our words carry much more weight than we think. If you start to downplay the patient's condition in any way, the doctor will listen to you and believe that. It's absolutely imperative to paint the most conservative picture possible for the patient's safety, if this is the way you want to operate.
Standard behavior among paramedics is to transport diabetics with hypoglycemic episodes to the hospital. I could argue that people in the first hour after a hypoglycemic episode are NOT competent. Have you ever felt that sensation? Try reaching for a thought, through the mud that is your brain, when the medic is saying, OK, let me get you a sandwich and we'll just go on back to the station. Sign here.
It's not always possible for a person to articulate whatever nagging doubts they have about the situation. I had an insulinoma in the placenta during one of my pregnancies. The blood glucose lows were LOW, down to 8-12, frequent, and very annoying. We had to call an ambulance several times before we got the diagnosis. Each time, we (two very competent medics) refused transport, and the medics totally agreed. THAT WAS SO STUPID. What I needed was an ER. But the culture was such that, well, the emergency's over...what do we need to be here for? Right. They needed to be there for the repeat drop in BG, and the seizure that accompanied it, in the car on the way to the hospital. That's what.
Sorry to be preaching. It's not just at you, believe me. This is a soap box I really believe is overlooked in the busy, slightly burnt-out, maybe a little bored, undereducated medics that I encounter in every single type of system out there. Except, ironically enough given the climate on this forum, the well-paid fire-based EMS system I'm familiar with.
