pt has no complaints....

[KEVD18]

you witness an mva. compact car rearends a full size pickup at at least 40mph. +air bag deployment, +deformity to vehicle, +seatbelt use. -loc, -head trauma. pt denies c/p. sob, d/n/v. pt's only complaint is a small amt, 3/10 of lover back pain. p.e. is completely unremarkabel in all respects.

do you transport this pt? in ma, there is a significant moi. as long at the pt doesnt refuse care, every effort should be made to transport this pt. it is the same for you all? do er's know about htis???

the reason i ask is becuase i had this sit tuesday. when i brought the pt to the er, i delivered my report to the recieving nurse. i got to the part about "the pt has no significant complaints" and the nurse gave me a ration of sh*t. "well if he has no compalint, whyt is he here. were very busy you know. let him wait in the waiting room(meanwhile, the pt is in full spinal prec). the whole thing just really aggravated me

/rant off

 

[Wingnut]

Well as far as our county goes, that is a definite transport, the MOI alone dictates that we'd have to. The only way that pt would not be going is by signing a refusal.

 

[Stevo]

what if s/he wants to go, say 'for insurance reasons' , and has no complaints ?

 

[Chimpie]

Originally posted by KEVD18@Jun 30 2005, 11:46 PM
i got to the part about "the pt has no significant complaints" and the nurse gave me a ration of sh*t.

That's where I would have written that the pt complained of lower back pain - 3/10.

Let me ask this: In your words, why did you transport?

 

[KEVD18]

well, i guess i need to mention that the pt's back pain didnt show up until interviewed by the er nurse(convienent how that works huh?)

i transported the pt due to a significant moi. the amt of damage to the vehicle, speed of the crash(remember i witnessed the accident) airbag deployment and what not. all this put together suggests that there is injury. the pt may not know it yet, due to the fact that his adrenaline is still running and he probably cant feel pain the same way as he would straight.

i know i was right in transporting. i just dont like the response i got from the er......

 

[Chimpie]

Good. Taking with what you saw, what you know about what kind of injuries can be caused in something like that, and with the information that was given to you by the pt., do you think you could have written something else down?

 

[Jon]

in PA, "significan MOI" is enough for a trauma alert, even a flight.

Jon

 

[Stevo]

radiologists , imho, owe the brunt of thier biz to ems. we bring in people fully immobilized because they wish to 'get checked out' whom they tend to that have no complaint.

this is due to lack of a rule out most localities have. Some states, like Maine for instance actually allow ems to rule out low moi incidents. Canada does also iirc...

they realized a decline in the overall costs in the system due to this, and yes there may be some adrenaline masking incidents that slip through the cracks in it, yet defensive medicine only serves as a cya, not the patient

how many people have i hurt with backboards over our old roads ? gawd only knows, studies for pressure necrosis 12,24,48 hrs after reveal the only injury was what WE introduced to the patient

ems is not for the weak is it? nor should it be goverened by such sorts, imho they should allow us to refuse a non-complaint patient and should dream up whatever protocall is necessary to do so

they should also allow us to declare death other than the head being seperated from the body by more than 3 feet, as i'm sick of flogging corpses for the family's viewing pleasure

AND WHILE WE'RE AT IT, i'm not a freakin' taxi driver either. i counted 9 people in our rig once! we even had thier luggage! holy saviour on a stick, do i need a hat license?

~S~

 

[KEVD18]

i was just5 irked that the er nurse was busting my balls for bringing in a pt the had no sig. complaints. i SAW the wreck. this perwson needed to be checked out. end of story. just would have been nice if the er staff picked up on this.......

 

[Stevo]

sure KEVD18,
i would be too, and hey you and i are just doing our job right?

we've had very similar incidents at our er with a certian snitty old nurse who's face would crack up and fall off if she smiled...

many times we bring in our frequent flyers, and all they really are is lonely, no valid (allbeit sponsoring soaring stocks in Pitzer) complaints...

so if some er staff doesn't like it, then why don't thier nurses unions confront JACHO for standards allowing them to rule out these sorts, and heave them back in our rigs?

after all, admissions takes what kind of $$$$ ? , or maybe it's ommissions that account for more $$$$ ?

~S~

 

[Ridryder911]

Simply stating per patient request, should have been signficant enough, with a brief description of MOI. I am sure this is not the first or last she has seen that night, that wants to be r/o for injuries for insurance reasons.

She should know as well as ER, we have to "play the game" & evualuate all that request.

Be safe,
Ridryder 911

 

[TTLWHKR]

Since you cannot deny transport, as that would constitute abandonment; transport for the hell of it. Patients can have very serious injuries and have little or no pain. I had a guy from an MVA w/ a C-Spine injury similar to a "hangman's fracture". He only had pain in his left hand...

What can it hurt to transport? That's what we're here for anyway.

 

[Stevo]

if we introduce unnecessary costs, are we part of the solution, or problem fellas?

The World Health Organization "ranked the countries of the world in terms of overall health performance, and the U.S. [was]...37th." In the fairness of health care, we're 54th. "The irony is that the United States spends more per capita for health care than any other nation in the world" (The European Dream, pp.79-80). Pay more, get lots, lots less.

"The U.S. and South Africa are the only two developed countries in the world that do not provide health care for all their citizens" (The European Dream, p.80). Excuse me, but since when is South Africa a "developed" country? Anyway, that's the company we're keeping.

Lack of health insurance coverage causes 18,000 unnecessary American deaths a year. (That's six times the number of people killed on 9/11.) (NYT, Jan. 12, 2005.)

The United States is 41st in the world in infant mortality. Cuba scores higher (NYT, Jan. 12, 2005).

Women are 70 percent more likely to die in childbirth in America than in Europe (NYT, Jan. 12, 2005).

~S~

 

[vtemti]

Originally posted by TTLWHKR@Jul 1 2005, 10:48 PM
Since you cannot deny transport, as that would constitute abandonment; transport for the hell of it. Patients can have very serious injuries and have little or no pain. I had a guy from an MVA w/ a C-Spine injury similar to a "hangman's fracture". He only had pain in his left hand...

What can it hurt to transport? That's what we're here for anyway.

The "wacker" is right, are we not obligated by law to transport if called and the patient does not refuse? In fact, I always strongly suggest being checked out even if the patient has no CC, especially when the MOI suggest a possiblity of serious injuries. Remember also, that when the adrenaline is pumping full throttle, many symptoms can be easily covered.

It is technically not our job to diagnose nor do we have the "Big Toys" to correctly do it with so, don't let a comment like that get to you. Be happy with knowing that you did the right thing.

 

[Stevo]

i read a good jems article a while ago about refusals ALL being AMA , because they had the potential to backfire on a crew, so i've slipped it in ever since.

yet this non diagnostic operatus modi is really a copout. Note the latest Itech cric utilizes diagnostic based assessments we were taught years ago then told to forget
(until they dug it up again, and presto! a whole new set of old ems books with new covers)

see, they tried to dumb down ems, but it didn't work.....

assessment IS diagnostic, that's why we work suspected MI's, and if you didn't work the angle that presented as the most suspicious nurse Crachet is gonna get ugly on you isn't she?

yet if there's no injury, we've gotta assume one? dream on up?

let's put it another way (this has happened to me countless times) 10-50I patient w/o complaints stated or found, feneder bender , low moi, wishes transport to hospital BECAUSE S/HE NEEDS A FRIGGIN' RIDE!

what does your crew do? charge per mile?

~S~

 

[TTLWHKR]

We charged a base fee for:

Responding to the run, and "gathering the patient" :blink:

and then a certain fee per mile to the hospital

There was an even higher fee for non-emerg. transports + the mileage fee (to stop people from calling for transports)

The 'new' protocols in the Commonwealth of PA state that if the patient does not -physically- call 911 by themselves for assistance, then they do not have to sign a refusal - as they did not request EMS. It also frees EMS of any wrong doing if they refuse to sign, as long as the attendant DOCUMENTS why they would not sign. Always good to have a LEO witness for you.

 

[Stevo]

The 'new' protocols in the Commonwealth of PA state that if the patient does not -physically- call 911 by themselves for assistance, then they do not have to sign a refusal - as they did not request EMS

PA has a brain....

Here i've chased people down the street (involved in multiple car wrecks) to sign refusals

methinks it's true what Frank Zappa said, 'The world will end in paperwork"

 

[Flight-LP]

Awww, the age old battle between EMS and the ER. Bottom line is if the patient wants to go, they are transported. If an ER nurse has an issue with that, the should reconsider their career options. A truly good nurse is there for the patient, regardless of their complaint or lack of................................

 

[Jon]

Originally posted by Stevo@Jul 2 2005, 11:09 AM

PA has a brain....

WHAT!!!!

please share what you are somking with the rest of the fourm, Cheech!

Jon

 

[Jon]

This weekend, I got to play mini-ER with my P-school medical director with my Event EMS orginization. Had a Refusal AMA for pt. who presented with weakness and sudden onset SOB. Pt stated condition improved, but also conplained of chest palpitations.

one 12-lead later, we found a rightward-shifted axis, no other ectopy. Gee, what is a rightward shifted axis indicitive of?





When you remember the sudden onset SOB with no PMH?

















can you say PE????



Pt. was in TOTAL denial, and refused, even with Doc and Nurse telling her to go.





Remember, though, that some refusals are stupid, and I hate getting refusals at an MVA that was called in by a passer-by with "unknown injuries."

I do the "are you hurt?""Do you want to go to the hospital?" if I get No and No, and there is no "Trauma criteria" damage, restraints were reasonably used, and pt. is not obviously intoxicated / high. I will go availibe, no services required. Also, PD is usually onscene.



Jon