Protocol V. On-Scene Judgement Calls

[medichopeful]

I also, occasionlly don't do vitals on hospice transfers when there is an order in their chart for no vitals. Sometimes their skin tears so easy or is so sensitive that it would be considered almost cruel to do them. They're not necessarily a/o. But I doubt you'll ever run into that on 911.

Good point, but I was focusing on only 911 calls. <_<

 

[Miss Xina]

Bingo! EVERY patient could have some icky floating in their blood, and should be treated as such. Many people are not forthcoming with this information because they are afraid they will be treated like this guy was, with disdain and would not get less than the EMT/Medic's best care.

Bravo for him for caring enough about their safety to be forth coming about his PMHX. You don't treat them any differently than any other person, wear gloves!

Oh man, I truly assume all patients are infected either internally or externally. Who knows if they washed their hands after their last sexual encouter or number two in the loo?

I am paranoid about this because I consider BSI to be more of a priority than Scene Safety, yet with Scene safety, you can withhold treatment by refusing to enter the scene until the police secure the area.

Scene safety- you can SEE the dangers already present or developing.
BSI- y'can't!

 

[Miss Xina]

Vital signs should always be taken. However, there are 2 exceptions to this rule that I can think of:

1) The patient (who is CAO) refuses to let you take vitals
2) When there is no time to do it, basically because you are performing life-saving procedures or because you have enough things to do first and you have a short transport time.

Also, I am a little concerned that you have EMT-Bs with 13 years of basic experience. Why doesn't he continue his education?

I was wondering that, but I didn't want to step on any toes, I just got my EMT-B license over the summer and I am already enrolling on the general ed classes for the paramedic associates.


figure get those out of the way before I embark on the paramedic side of it and it'll make my life easier

I couldn't stay in the same level for too long, I'd feel like I was wasting time.

 

[Miss Xina]

I was reading through, and I just saw something about "questioning" an individual with more experience. I just want to point out, that you should ALWAYS question somebody if you are not sure why they did something in the field. No doubt in my mind that it is the right thing to do.

HOWEVER, make sure you do it at the right time. Preferably, after the call is done. And do it in a respectful way. Make it a conversation, NOT an accusation. You will get much more information that way.

LOL I am such a child in that way. I am always asking "Why?" or "How?"

I find that they don't mind because it's pure curiosity mixed with humility. I think they appreciate an interested rider

 

[medichopeful]

I am paranoid about this because I consider BSI to be more of a priority than Scene Safety, yet with Scene safety, you can withhold treatment by refusing to enter the scene until the police secure the area.

Why would you consider BSI to be of more priority than scene safety? If the scene isn't safe, you shouldn't be considering BSI. If you need BSI, the scene needs to be safe.

So basically, you can't use BSI unless the scene is safe. So why is it a second priority?

 

[Miss Xina]

Why would you consider BSI to be of more priority than scene safety? If the scene isn't safe, you shouldn't be considering BSI. If you need BSI, the scene needs to be safe.

So basically, you can't use BSI unless the scene is safe. So why is it a second priority?

My point is, BSI is MORE important to me because I cannot see, or definitely know what is present on a disease level but you CAN see what is making the scene dangerous.

I am in complete control of BSI. I'm never in complete control of Scene Safety.

So, it may not be in the order of BSI first then Scene Safety, but I do consider it more important.

 

[Sasha]

BSI is part of scene safety.

 

[Miss Xina]

BSI is part of scene safety.

Sigh, I know. I fear people are missing the point.

I notice how some medics/EMTs don't change the sheets after each patient. That worries me. I would also just wipe down everything that comes into contact with patient when time permits.

Obviously, I am not gonna be able to do this after each call, but I think it's important to at least try.

The Pulse Ox thing (Sorry. I literally just woke up) wasn't working properly because it was too dirty. That was an eye opener for me. That taught me that tools need to be cleaned so they can work properly.

It's a nice dream, and I know it's not always possible, but I would make an effort at the beginning, end and whenever else is possible to just give everything a once-over. Just to be on the safe side

 

[JPINFV]

Oh man, I truly assume all patients are infected either internally or externally. Who knows if they washed their hands after their last sexual encouter or number two in the loo?

Who knows if the person who opened the door before you washed his/her hands as well? I always find it funny that EMS as a whole yells about BSI and universal precautions, yet it seems that almost no one really knows what universal precautions really is. This said, vomiting blood means you take precautions.

 

[Miss Xina]

Who knows if the person who opened the door before you washed his/her hands as well? I always find it funny that EMS as a whole yells about BSI and universal precautions, yet it seems that almost no one really knows what universal precautions really is. This said, vomiting blood means you take precautions.

LOL, I kinda clean my hands a few times in every day life.

Maybe I am OCD??

Talking of which, what possible reasons are there for vomiting blood? We didn't go over this in school.:unsure:

 

[bunkie]

LOL, I kinda clean my hands a few times in every day life.

Maybe I am OCD??

Talking of which, what possible reasons are there for vomiting blood? We didn't go over this in school.:unsure:

Really? Where did you go to school? We had an entire day of lecture on this. I honestly think I'd look for a refresher with another program.

 

[Onceamedic]

A couple of things that are occupational hazards..

1 - the frequent flyer. You run on this person 20 times and its the same old bull crap. The 21st time, they are having a CVA or MI or whatever.

2 - minimization of symptoms. This happens to the mid level provider - not the newbie that is still enthusiastic and not to the veteran that has been bit in the *** and learned the hard way.

The solution to both is a thorough and complete assessment. If you do nothing else by the book - do the assessment well every time. That's what it means to be a professional. (and in case it's not obvious, a good assessment includes vitals. No excuses ever for not getting a set.)

 

[Miss Xina]

Really? Where did you go to school? We had an entire day of lecture on this. I honestly think I'd look for a refresher with another program.

Well, that taught me

It was a summer class, so we probably skimmed over it. We're taught to, like treat symptoms, not worry about causes.


Big lesson - we are not drs, we do not diagnose

 

[medichopeful]

My point is, BSI is MORE important to me because I cannot see, or definitely know what is present on a disease level but you CAN see what is making the scene dangerous.

I am in complete control of BSI. I'm never in complete control of Scene Safety.

So, it may not be in the order of BSI first then Scene Safety, but I do consider it more important.

Okay. I think I see what you mean.

 

[Miss Xina]

Okay. I think I see what you mean.

BSI is things I can wear/do to avoid unnecessary diseases/infections, Scene Safety is things in the scene, like cars on the highway, guns/knives present.

LOL, maybe I am the only one that differentiates it that way :wacko:

 

[bunkie]

Well, that taught me

It was a summer class, so we probably skimmed over it. We're taught to, like treat symptoms, not worry about causes.


Big lesson - we are not drs, we do not diagnose

Call me *****y today but I'm taking the bolded as a smart *** hit back. I was actually headed to go grab my books out of the car and give you a straight out of the book listing.

I know we are not doctors, but that isnt an excuse for being ignorant about the potential cause of a symptom and frankly, IMO what is wrong with the limited education of the basic system.

My program stresses that point as well, but we're also educated on WHAT, HOW and WHY, not just the thing we see. The more knowledge you have, the better off your patient is. If I dont have an idea of what is going on inside my PT to explain his symptoms I could miss something else entirely more important and then where are we?

Oh yeah jack, he's pale and cool, unresponsive and his abdomen is rock hard. Dont know whats wrong with him, guess well just stuff him in this chair here and give him a ride in. We wont bother treating him or giving vital information to med control because we only took a summer class and we aren't doctors.

Not being a doctor is not an excuse to be ignorant about the field you are in.

 

[Miss Xina]

Call me *****y today but I'm taking the bolded as a smart *** hit back. I was actually headed to go grab my books out of the car and give you a straight out of the book listing.

I know we are not doctors, but that isnt an excuse for being ignorant about the potential cause of a symptom and frankly, IMO what is wrong with the limited education of the basic system.

My program stresses that point as well, but we're also educated on WHAT, HOW and WHY, not just the thing we see. The more knowledge you have, the better off your patient is. If I dont have an idea of what is going on inside my PT to explain his symptoms I could miss something else entirely more important and then where are we?

Oh yeah jack, he's pale and cool, unresponsive and his abdomen is rock hard. Dont know whats wrong with him, guess well just stuff him in this chair here and give him a ride in. We wont bother treating him or giving vital information to med control because we only took a summer class and we aren't doctors.

Not being a doctor is not an excuse to be ignorant about the field you are in.

Ignorance is assuming you know it all already and refusing to learn more. You are actually telling me off for..what? Asking?

Maybe I shouldn't ask so many questions...

OK, I'll just stick to independent research and study like I usually do:sad:

 

[bunkie]

Ignorance is assuming you know it all already and refusing to learn more. You are actually telling me off for..what? Asking?

Maybe I shouldn't ask so many questions...

OK, I'll just stick to independent research and study like I usually do:sad:

Did I say I knew it all? No and I dont pretend too. I'm "telling you off" for your "big lesson" comment. Not for asking. The only stupid question is the question left unasked. Personally for the sake of your PT's I'm glad you asked. And I'm glad that you want to learn and recgonize the areas that were lacking in your program. It's good to learn. But your comment rubbed me the wrong way on the wrong day. Now, I'd be happy to go get my book out of the car.. even if its cold and wet outside. ^_^

 

[Miss Xina]

Did I say I knew it all? No and I dont pretend too. I'm "telling you off" for your "big lesson" comment. Not for asking. The only stupid question is the question left unasked. Personally for the sake of your PT's I'm glad you asked. And I'm glad that you want to learn and recgonize the areas that were lacking in your program. It's good to learn. But your comment rubbed me the wrong way on the wrong day. Now, I'd be happy to go get my book out of the car.. even if its cold and wet outside. ^_^

No, it's OK. I was merely saying the big lesson IN CLASS was that we do not diagnose.

I'd rather leave you rubbed the wrong way and wait for a medic or someone with many years of experience to tell me.

Seeing as they know more than what I would have been taught at school, I figured they would just, you know.. list stuff.

I'm just glad that the guys I ride with are more open to discussing stuff.

 

[bunkie]

No, it's OK. I was merely saying the big lesson IN CLASS was that we do not diagnose.

I'd rather leave you rubbed the wrong way and wait for a medic or someone with many years of experience to tell me.

Seeing as they know more than what I would have been taught at school, I figured they would just, you know.. list stuff.

I'm just glad that the guys I ride with are more open to discussing stuff.

Wow, ok, whatever. I'm going to stop now before I get banned. I like this place a lot and plan on sticking my uneducated arse around for quite a while.