Pt w a Dr for a wife??

[911fixer]

i have been in EMS for 12 years now. I am a Paramedic now and this happened when i was a basic a while back. I was working for a private company in Massachusetts who has tons of contracted facilities and towns all surrounding Boston. Anyway, we were dispatched to a "skilled nuring facility" for a pt w nausea, vommitting and diarrhea, and a high temp. When we arrived my partner went straight to the pt to find out what was going on while i gathered the appropriate paperwork. I couldnt help but to overhear two RNs talking about a pt w 9/10 substernal chest pain. so i asked what that was all about and they told me it was our pt. trying to be professional i didnt say what i was thinking which at this point " are you :censored::censored::censored::censored:ing kidding me, how do you forget to mention that when you call us" also we did not have 911 for the town, but a contract w the facility. so needless to say i got on the radio and requested ALS from the town. I went in the pts room to find the pt, with his wife next to him. She immediately had attitude. my partner looked at me with that look as if something happened when i wasnt there. after small arguments and pt got loaded on the stretcher. The closest facility was Hospital Z (gotta protect myself from the bull:censored::censored::censored::censored hospital hands down. i was told that medics are going to be a lil longer than i cared to wait. i told the wife where we as basics were taking the pt and she started to raise her voice and told us that we wouldnt be, and demanded that we take her husband to the opposite side of the city where she was a decorated Dr. I politely reminded her that we were not going against our protocols. She continued to rant on, about how she is on the "board of this" "the president of that", and so on and if we didnt adhere to her wishes that the hospital she works at ( who just signed a giagantic contract with our company) she will have the contract dropped. At this point we r in the back of our truck and its already in drive, thank god she didnt plan on riding with us. But i also know how this company is with its contracts, and if she actually did manage to get the contract pulled my job would without a doubt be terminated. i called my dispatch supervisor and told them what was up, and i was told to whatever happens i better go to wherever she wants him to go. Me and my gut so didnt want to listen to this douche, so i figured i would call other supervisors and try to get the answer i wanted which was go to hospital Z, not hospital X. Litterally all four people who i spoke with all told me to go to Hospital X cuz if we do loose a contract it would be on my ***. Sooooo off to hospital X we go. unbelievable, i am so pissed at this point i just want the call to be over, and to make matters worse, my partner somehow managed to get us lightly t boned in the back quarter panel of the van ambulance, sending me head first into a cabinet( i was standing trying to do something..b/p, lung sounds or whatever i was doing) pt kinda wobbled a bit but was very secure so he didnt even realize what was going on anyway. the pt got ASA, 02, and was very taken care of to the exact protocol. On arrival at the hospital and pt care was transferred to MDs in the ER. i gave my report, i also gave Dr douches name, and nobody even recognized the name. we obviously beat her there cuz we have lights and sirens and she didnt. i told them everything and how she tried to dictate our treatment and everything else with the call. Just as i finished explaining to all the ER staff in the room what happened, in she comes. At this point everyone tells her to get out, and they all say we dont care who you are, or how important she was, she needed to leave. one of the ER nurses researched this lady to find out what her deal was. Come to find out this so called Dr.......turns out to be a psych Dr....and not on any boards, or a member of anything worth anything. UNREAL, i didnt ask what kind of Dr she was because i was too busy trying to take care of my pt, and didnt really care what kinda Dr she was.
Question being, what would anyone else have done, i know if i went to the closest hospital i hands down would have gotten fired. i know i could have faught it later on and prob won, but i had bills to pay and couldnt afford to lose my job or even my emt basic card...
i think of this call alot, and yes i would do things a lil different as a medic in this position. but at the time i only had about maybe two years of exp under my belt. I am just curious to see what everyone else thinks or would have done. thanks...hahah srry this is so long but wanted to paint you the whole picture.

 

[VFlutter]

I went in the pts room to find the pt, with his wife next to him. She immediately had attitude. my partner looked at me with that look as if something happened when i wasnt there.

Is it possible that your partner may have said or done something to cause this attitude? Some people just have attitudes no matter what but many times people who have legitimate reasons or concerns.

I live in a city with multiple hospitals. Some are great others are not. There is a hospital, a level one trauma, a mile from my house. I would never go there even if my life depended on it. If EMS told me they had to go to the closest facility I would politely go AMA and call a taxi. Also if I go to the hospital I work at all my specialists are there and my insurance covers 100% of inpatient costs. That is a huge deal.

Oh and if you told me I had to go the closest facility because of "protocol" I would get an attitude.

Long story short: A patient has the right to request what hospital to go to, even in emergencies. As long as the request is not absurd then it should be granted. If the patient has CP and the hospital they want to go to does not have PCI capabilities then that might be a reason to argue.

Just as i finished explaining to all the ER staff in the room what happened, in she comes. At this point everyone tells her to get out, and they all say we dont care who you are, or how important she was, she needed to leave. one of the ER nurses researched this lady to find out what her deal was. Come to find out this so called Dr.......turns out to be a psych Dr....and not on any boards, or a member of anything worth anything. UNREAL, i didnt ask what kind of Dr she was because i was too busy trying to take care of my pt, and didnt really care what kinda Dr she was.

So called psych doctors, "Physiatrists" as we call them, are still Medical Doctors. But that does not really matter.

The patients family has a right to at the beside up until the point that they interfere with care.

The fact that the nurse had the time to look up who this lady was makes me think the patients was not very unstable.

Question being, what would anyone else have done, i know if i went to the closest hospital i hands down would have gotten fired. i know i could have faught it later on and prob won, but i had bills to pay and couldnt afford to lose my job or even my emt basic card...
i think of this call alot, and yes i would do things a lil different as a medic in this position. but at the time i only had about maybe two years of exp under my belt. I am just curious to see what everyone else thinks or would have done. thanks...hahah srry this is so long but wanted to paint you the whole picture.

I would have taken the patient to the hospital they requested as long as the patient was relativity stable and the requested hospital was appropriate.

 

[911fixer]

Yes the one out of five nurse did have a second, there were about seven rns and docs in the room at that point, and the requested hospital was about ten to 15 miles out of the way, nit sure the outcome of pt. But i think i shoulda went to closest hosp...

 

[VFlutter]

and the requested hospital was about ten to 15 miles out of the way, nit sure the outcome of pt. But i think i shoulda went to closest hosp...

Why?

 

[911fixer]

9/10 substernal chest pain w radiation to arms, and jaw. As a basic emt, and ALS nowhere around, i shouldnt have taken the chance. I dont exactly remember his vitals but he wasnt in very good shape, all i could do was ASA, and O2, and drive fast. Maybe if i were ALS at the time i would have gone a lil bit further, but it would have depended on the details...dont really wanna be touring the city w a pt w severe chest pain.

 

[NomadicMedic]

Here's a few questions... was it really cardiac chest pain? Are you sure? Did the patient have a productive cough? What is his pain reproducible on palpation or inspiration? Was he gray? Was he diaphoretic? Did he have a cardiac history? What was his temp? How long has he had nausea and diarrhea? What meds was he taking? Why was he in a skilled nursing facility in the first place? How far out was ALS? Since you seemed uncomfortable with this patient and unable to manage him with anything other than a diesel bolus, why did you decide not to wait?

I think it's important to remember, not all chest pain is cardiac. And you, as a basic, without a monitor or any real assessment skills other then "chest pain or not chest pain" can't really determine what's going on or where that patient needs to go.

Now, if you explained it carefully and calmly, "Ma'am, I strongly suggest that your husband should go to the closest facility because I believe he may be having some cardiac issues and should be evaluated quickly. Once he's stabilized, if needed, he can be transferred to the facility where you're on staff."

Last question, did you give him 15 L of oxygen on a non-rebreather?

 

[VFlutter]

Last question, did you give him 15 L of oxygen on a non-rebreather?

How did I forget to ask that?!

 

[Aidey]

The fact that you played mom against dad with the supervisors is a huge no-no too. I don't know about your company, but that would result in major trouble where I am at. Even if it isn't something you'll get in trouble for, it is very very poor form.

 

[firecoins]

No call to a med control doctor?

If the pt is a doctor, they can take responsibility but must come with the pt.

 

[J B]

No call to a med control doctor?

If the pt is a doctor, they can take responsibility but must come with the pt.

I was going to say, isn't the pt's wife technically "higher level of care"?

 

[mike1390]

No call to a med control doctor?

If the pt is a doctor, they can take responsibility but must come with the pt.

This, Iv done it a couple times usually the "well im just a dentist comes out at that point."

Also did I read right that you got "lightly T-boned".... and continued to the hospital? thats a hit and run

Could you not have an ALS intercept enroute?

 

[Carlos Danger]

If the pt is a doctor, they can take responsibility but must come with the pt.

I was going to say, isn't the pt's wife technically "higher level of care"?

That's only if they are trying to give orders which contradict your protocols. In the case described, the wife wasn't trying to do that; she was simply a family member demanding transport to a further facility, which is allowed.

OP, from what you presented here, I don't think you did anything wrong. Patients (or their families) have the right to make decisions which are not in their best interest, and we have to honor those decisions.

The only thing I would ask is, why did you call your supervisor rather than medical control? Next time call the doc and let them make the decision and take the responsibility. That's exactly what they are being paid to do.

 

[RocketMedic]

i have been in EMS for 12 years now. I am a Paramedic now and this happened when i was a basic a while back. I was working for a private company in Massachusetts who has tons of contracted facilities and towns all surrounding Boston. Anyway, we were dispatched to a "skilled nuring facility" for a pt w nausea, vommitting and diarrhea, and a high temp.

Although probably fairly sick, BLS for the most part.

When we arrived my partner went straight to the pt to find out what was going on while i gathered the appropriate paperwork. I couldnt help but to overhear two RNs talking about a pt w 9/10 substernal chest pain. so i asked what that was all about and they told me it was our pt. trying to be professional i didnt say what i was thinking which at this point " are you :censored::censored::censored::censored:ing kidding me, how do you forget to mention that when you call us" also we did not have 911 for the town, but a contract w the facility. so needless to say i got on the radio and requested ALS from the town.

Mistake 1: Assess your patient. The RN report is great, but did you investigate or just go "chest pain omg!!!!" Also, where was your partner in this?

I went in the pts room to find the pt, with his wife next to him. She immediately had attitude. my partner looked at me with that look as if something happened when i wasnt there.

Uncooperative, entitled, educated family. An EMTs worst nightmare.

after small arguments

You already lost, EMS is customer service. Don't argue with family. If you're going to do something against their desires, inform them that it will happen and why.

and pt got loaded on the stretcher. The closest facility was Hospital Z (gotta protect myself from the bull:censored::censored::censored::censored hospital hands down.

Closest does not equal most appropriate. Did X have the patients records, payment, etc? Did they have the prior relationship that Y already had? Was X really going to do anything other than MONA and a stat transfer to Y?


i was told that medics are going to be a lil longer than i cared to wait.

You panicked. Why not wait if you already activated 911?

i told the wife where we as basics were taking the pt and she started to raise her voice and told us that we wouldnt be
Damned education!

, and demanded that we take her husband to the opposite side of the city where she was a decorated Dr.
Read this as "where my family usually gets care and he is well-known."

I politely reminded her that we were not going against our protocols.
Doctors vs protocols, hmmm...can you see why your IFT EMT Basic protocols didnt mean much to her?

She continued to rant on, about how she is on the "board of this" "the president of that", and so on and if we didnt adhere to her wishes that the hospital she works at ( who just signed a giagantic contract with our company) she will have the contract dropped.
Cue to apologize and let your partner tech this one, you both being EMTs and all. Defuse the situation, shes way, way more important to your boss than you are.

At this point we r in the back of our truck and its already in drive, thank god she didnt plan on riding with us.
No kidding, she would have to run and jump.

But i also know how this company is with its contracts, and if she actually did manage to get the contract pulled my job would without a doubt be terminated.
True.
i called my dispatch supervisor and told them what was up, and i was told to whatever happens i better go to wherever she wants him to go. Me and my gut so didnt want to listen to this douche, so i figured i would call other supervisors and try to get the answer i wanted which was go to hospital Z, not hospital X. Litterally all four people who i spoke with all told me to go to Hospital X cuz if we do loose a contract it would be on my ***. Sooooo off to hospital X we go.
So you have time to supervisor shop, but not 911 or transport to X? What condition was your patient in?

unbelievable, i am so pissed at this point i just want the call to be over, and to make matters worse, my partner somehow managed to get us lightly t boned in the back quarter panel of the van ambulance, sending me head first into a cabinet( i was standing trying to do something..b/p, lung sounds or whatever i was doing) pt kinda wobbled a bit but was very secure so he didnt even realize what was going on anyway.
So you go emergent, sustain a vehicle contact en route (lots of risk and danger here), left the scene of the collision with your patient on board...

the pt got ASA, 02, and was very taken care of to the exact protocol.
Thank goodness. Why?

On arrival at the hospital and pt care was transferred to MDs in the ER. i gave my report, i also gave Dr douches name, and nobody even recognized the name. we obviously beat her there cuz we have lights and sirens and she didnt.

Emergent IFT, RACING THE REAPER!

i told them everything and how she tried to dictate our treatment and everything else with the call.
Damned pesky educations...
Just as i finished explaining to all the ER staff in the room what happened, in she comes. At this point everyone tells her to get out, and they all say we dont care who you are, or how important she was, she needed to leave. one of the ER nurses researched this lady to find out what her deal was. Come to find out this so called Dr.......turns out to be a psych Dr....and not on any boards, or a member of anything worth anything. UNREAL, i didnt ask what kind of Dr she was because i was too busy trying to take care of my pt, and didnt really care what kinda Dr she was.

Assessment flaw, know your enemy. Guarantee your interaction with supervisors would have gone more smoothly with that knowledge calmly conveyed.

Question being, what would anyone else have done, i know if i went to the closest hospital i hands down would have gotten fired. i know i could have faught it later on and prob won, but i had bills to pay and couldnt afford to lose my job or even my emt basic card...

Fought.


i think of this call alot, and yes i would do things a lil different as a medic in this position. but at the time i only had about maybe two years of exp under my belt. I am just curious to see what everyone else thinks or would have done. thanks...hahah srry this is so long but wanted to paint you the whole picture.

Well, I would have used better English...
My input is in your quote above.

Bluntly, you did a horrible job here, should have been fired for your interactions and the collision, should be reeducated on the patient assessment and care.

 

[911fixer]

Lol...if this happened tommorow things would be way different than ten yrs ago when it happened. Yes med control, yes better assesment, ..and so forth... And as for family requesting a facility.. that wasnt the case, families dont have any clue about contracts nor would they even threaten that as a family member. Also yes the closest hospital would have been the most appropriate. Why wait for ALS would have already been at hospital by yhe time we were even able to meet them. The pts normal hospital was the closest.. and as far as supervisors go, i didnt wanna lose my job so i wanted to confirm the dropoff point as well as try to go to closest...if something were to happen i could have said i was doing what i was told by several superiors.. but like i said things would be waaay different today, i learn from my mistakes and every call i go on i learn something. I dont know everything like some of the people on here think they do...the whole call was a :censored::censored::censored::censored:show...and none of u were there...its good to gey everyones opinion thank you for all the input its appreciated.. i have way more exp now than then. So

 

[911fixer]

Also alologize for my typos. Haha im using my phone to post and have a small keyboard on it..

 

[NomadicMedic]

How about this, you're a medic now. What would you have done differently?

 

[911fixer]

Haha the purpose of me even starting this thread was to ask what eveyone else would have done..not for me to get picked apart...i am confident w my skills and have been a very succsessful medic so i am not explaining what i would do now as a medic.. nice try tho

 

[firecoins]

That's only if they are trying to give orders which contradict your protocols. In the case described, the wife wasn't trying to do that; she was simply a family member demanding transport to a further facility, which is allowed.

OP, from what you presented here, I don't think you did anything wrong. Patients (or their families) have the right to make decisions which are not in their best interest, and we have to honor those decisions.

The only thing I would ask is, why did you call your supervisor rather than medical control? Next time call the doc and let them make the decision and take the responsibility. That's exactly what they are being paid to do.

The original post says the protocol was to go the closest hospital. That was being contradicted.

 

[NomadicMedic]

Haha the purpose of me even starting this thread was to ask what eveyone else would have done..not for me to get picked apart...i am confident w my skills and have been a very succsessful medic so i am not explaining what i would do now as a medic.. nice try tho

Well, if it wasn't your intent to get picked apart, you picked the wrong topic.

You provided lousy customer service, you didn't follow the protocol established to guide EMTs down the correct pathway, you left the scene of an accident, you overreacted to a simple chest pain call ... Also, you insulted the patient's wife for being a forceful medical professional and ridiculed her throughout the thread.

What would I have done differently? Everything. Starting with a job search.

As for you spelling? I wrote this on an iPhone and I managed to spell everything correctly.

 

[Carlos Danger]

The original post says the protocol was to go the closest hospital. That was being contradicted.

Sure.

But a patient can always refuse to go to specific hospital and go somewhere else instead. At least in every system I've ever been involved in.