Question on "Abandonment"

[Aidey]

Back on topic...

Say there is a patient at a doctors office because they feel ill. Upon exam, they find that the patient's blood pressure is extremely low and call 911 for an ambulance. From what I understand you cannot leave a patient once medical care has been started, unless someone with more education/certification takes over. So how can a doctor pass a patient off to EMTs without going with them? Does this fall under some other law?

Just curious.

As has been said above, the physician can give permission for you to take the patient, and in most cases it's not going to be abandonment.

Where it can become abandonment is if there is a reduction in level of care. Using your example, the say the doc hooks them up to an EKG and the EKG shows the patient is in a junctional rhythm and that is why their BP is low. The doctor calls 911 and a BLS truck shows up and transports the patient.

Since the BLS truck doesn't have EKG capability it can be abandonment on the MDs part if he turns over care because the patient needs a EKG and a crew capable of dealing with a cardiac emergency.

 

[triemal04]

1. All of them.
2. How many services need trach kits?
3. Emergency tracheotomies are only allowed in severe trauma to the head, neck, and face making any other airway impossible, but not for any other airway threat. Some places don't even carry them.
4. Not sure, to be honest. It was shot down because somebody didn't trust us or was too lazy to train us.
5. They used to carry those drugs. They got pulled when we got a new medical director because he, unjustifiably, has no faith in our medics.

And what, I need to qualify everything I say with seven reasons I said it?

Not everything, but when you make a blanket statement like you did, it's a pretty good idea to have all your facts in order and be able to explain what you mean if questioned. And to be sure that what you said was accurate. For instance:

These services that requested CPAP, are all 911-based, or are some transfer companies? What are the transport times for them? (doesn't neccasarily make it right, but if it's very short I can see why someone would say no) Same goes for activated charcoal. And depending on who you ask it's not that effective for how we use it. (depending on who you ask)

Not sure where the trach comments came from.

The combitube...so you don't know, but are just making an assumption that it was removed because someone "didn't trust you and was to lazy to train you." Wow. Good on you for that. Hope you know there are many more reasons for that to happen.

Why does the new doc not have any faith in his medic's? Is it because they were making multiple mistakes? No QA/QI? No internal training for them? Poor initial training as a paramedic? Do they need them? (not saying that part is right, but all the ones you listed have alternatives which I bet are carried)

I'm still not saying that you are completely wrong, but you may want to take a real hard look at your service, what they do, how they train people in house, how paramedics in PA are educated and trained, and then maybe ask the doc why this is happening.

 

[EMTinNEPA]

Not everything, but when you make a blanket statement like you did, it's a pretty good idea to have all your facts in order and be able to explain what you mean if questioned. And to be sure that what you said was accurate. For instance:

These services that requested CPAP, are all 911-based, or are some transfer companies? What are the transport times for them? (doesn't neccasarily make it right, but if it's very short I can see why someone would say no) Same goes for activated charcoal. And depending on who you ask it's not that effective for how we use it. (depending on who you ask)

Not sure where the trach comments came from.

The combitube...so you don't know, but are just making an assumption that it was removed because someone "didn't trust you and was to lazy to train you." Wow. Good on you for that. Hope you know there are many more reasons for that to happen.

Why does the new doc not have any faith in his medic's? Is it because they were making multiple mistakes? No QA/QI? No internal training for them? Poor initial training as a paramedic? Do they need them? (not saying that part is right, but all the ones you listed have alternatives which I bet are carried)

I'm still not saying that you are completely wrong, but you may want to take a real hard look at your service, what they do, how they train people in house, how paramedics in PA are educated and trained, and then maybe ask the doc why this is happening.

1. All 911, transport times of 20 minutes to one hour.
2. Yes, the fault HAS to lie with me and my peers.
3. No, none of the alternatives are carried.

 

[medic417]

Why? I'm sure you've had a medical director who treated you like dirt. That's 95% of the physicians at area hospitals.

I've never been treated badly by medical directors or even any ER doctor. In fact so far every time I go in and request even more advanced guidelines for our Paramedics to work under they have been approved. But then again we all come in and prove we are educated enough to handle it. It is sad that medical directors look at your service as "ambulance drivers" and not as PreHospital Medical Professionals. I would hope it is because of the actions of a few and not the actions of the majority.

 

[triemal04]

1. All 911, transport times of 20 minutes to one hour.
2. Yes, the fault HAS to lie with me and my peers.
3. No, none of the alternatives are carried.

Yes, the fault just HAS to lie with the doc and his peers. See how easy that is to do without providing any proof? All you've done so far is say that your medical director and other doctors don't like you and then listed out some meds and equipment that was removed/refused to carry as proof. You do know that there are multiple reasons for why that could happen, right? And that some of the blame may rest with YOU. Seriously, why does this new doc feel that way? Is there something these services are lacking? Is there something that PA is lacking in how it trains and educates it's EMT's and paramedics? I'll say it again:

Why does the new doc not have any faith in his medic's? Is it because they were making multiple mistakes? No QA/QI? No internal training for them? Poor initial training as a paramedic?

I'm still not saying that you are completely wrong, but you may want to take a real hard look at your service, what they do, how they train people in house, how paramedics in PA are educated and trained, and then maybe ask the doc why this is happening.

You've said what he's done or not allowed, now you need to be asking why this is happening. You've allready admitted that you don't know why some of it has; all you're doing is making a great ASSumptions here.

And nobody carries valium, morphine or amiodarone? Really?

 

[EMTinNEPA]

Yes, the fault just HAS to lie with the doc and his peers. See how easy that is to do without providing any proof? All you've done so far is say that your medical director and other doctors don't like you and then listed out some meds and equipment that was removed/refused to carry as proof. You do know that there are multiple reasons for why that could happen, right? And that some of the blame may rest with YOU. Seriously, why does this new doc feel that way? Is there something these services are lacking? Is there something that PA is lacking in how it trains and educates it's EMT's and paramedics? I'll say it again:


You've said what he's done or not allowed, now you need to be asking why this is happening. You've allready admitted that you don't know why some of it has; all you're doing is making a great ASSumptions here.

And nobody carries valium, morphine or amiodarone? Really?

And all you did is jump into a thread late and try to pick a fight. And it doesn't matter if I ask why, things are NOT going to change. I got fired from a job for asking why rules were in place and disagreeing with them, so I don't really care any more. What's more likely... one doctor with a bone up his *** for EMS or hundreds of EMTs and paramedics who are incompetent morons?

 

[triemal04]

And all you did is jump into a thread late and try to pick a fight. And it doesn't matter if I ask why, things are NOT going to change. I got fired from a job for asking why rules were in place and disagreeing with them, so I don't really care any more. Is it the "EMT-B" behind my name? You trying to put me in my place?

Actually, I jumped in to ask some questions about your claim that your medical director treats you like dirt and the doc's in PA don't trust you. What I'm curious about, and still am, is how valid that claim was. Unfortunately, so far you haven't done a lot to help prove it. Yes, you've listed some things that were removed...but the "why" is more imporatant.

Don't be so fast to blame someone else for something that you don't like; they very well may have a good and appropriate reason for doing it. Something it appears you refuse to consider...maybe for a good reason?

Edit:

What's more likely... one doctor with a bone up his *** for EMS or hundreds of EMTs and paramedics who are incompetent morons?

Actually, hate to say it, but both are just as likely.

 

[EMTinNEPA]

Actually, I jumped in to ask some questions about your claim that your medical director treats you like dirt and the doc's in PA don't trust you. What I'm curious about, and still am, is how valid that claim was. Unfortunately, so far you haven't done a lot to help prove it. Yes, you've listed some things that were removed...but the "why" is more imporatant.

Don't be so fast to blame someone else for something that you don't like; they very well may have a good and appropriate reason for doing it. Something it appears you refuse to consider...maybe for a good reason?

I don't "refuse" to consider it. There's no point in considering it because it's not going to change.

 

[VentMedic]

CPAP is a BLS skill in Pennsylvania. Do any of the BLS trucks I run on have CPAPs? Nope. Activated charcoal has been taken off the trucks period. Upriver, medics can't carry fentanyl, ativan, lasix, versed, or lidocaine. Combitubes were supposed to become a BLS skill, but that was shot down. That better?

You are talking about BLS service. Does your service also provide ALS? Do you do 911 as BLS? Is there not an ALS truck responding also to 911?

Because something is listed as a "BLS" skill may not mean all providers are up to accepting that skill and additional responsibility nor may they have a need for it. Also, so far there is not a mandate in your state to have CPAP on your truck. The same for Combitubes.

If there is also a need for CPAP or intubation, would there also not be a need to call ALS that has advanced interventions?

Review the literature as to why activated charcoal has been taken off the trucks. Medicine evolves as there not longer appears to be a need for something. Maybe you should be upset that the MAST is no longer on the truck since that is also one less "skill" or piece of equipment no longer carried.

The drugs you mentioned also have their controversies and there are other alternatives to treatment. Lasix has fallen out of favor. Lidocaine vs Amiodarone? Etomindate? Valium? Morphine? Do you know what other drugs they carry?

A state may allow for RSI and pericardiocentesis but that doesn't mean every service needs these skills or is ready to take on these skills due to variations in competencies. Some may be upset by not having these skills but most understand why that may not be happening for them.

The EMT-B has a lot to do with it but not at a personal level. We are just trying to establish why you feel a need for such skills and would hope you could put your emotions aside to explain yourself a little better than just attacking doctors.

 

[triemal04]

I don't "refuse" to consider it. There's no point in considering it because it's not going to change.

Are you sure? If you know why these things are happening then...I don't know...maybe there is something that can be changed to fix the issue that the doctors have with you guys. That's the nice thing about knowing why something is happening...makes it so much easier to change it. Huh...just like in medicine.

Or you could just go on blaming the doctors and refuse to consider any other possibilities. You don't care, so I guess that'd work, right?

 

[EMTinNEPA]

Are you sure? If you know why these things are happening then...I don't know...maybe there is something that can be changed to fix the issue that the doctors have with you guys. That's the nice thing about knowing why something is happening...makes it so much easier to change it. Huh...just like in medicine.

Or you could just go on blaming the doctors and refuse to consider any other possibilities. You don't care, so I guess that'd work, right?

Doctor is right, ambulance drivers are wrong. Welcome to EMS in Northeastern Pennsylvania.

 

[triemal04]

Doctor is right, ambulance drivers are wrong. Welcome to EMS in Northeastern Pennsylvania.

Ok. That's the end of this then, getting rather pointless. But I do have to ask: what do you think would happen if everyone in EMS had that same attitude of not caring and never asking why so that changes could be made? If everyone always assumed the blame rested on someone else and not them? Think it might lead to a horrible standards and conditions for EMS? Oh wait...:unsure:

 

[EMTinNEPA]

Ok. That's the end of this then, getting rather pointless. But I do have to ask: what do you think would happen if everyone in EMS had that same attitude of not caring and never asking why so that changes could be made? If everyone always assumed the blame rested on someone else and not them? Think it might lead to a horrible standards and conditions for EMS? Oh wait...:unsure:

I'm pretty sure this was rather pointless as soon as medic417 chimed in with "not correct" and the rest of the paragod squad jumped on board. Thank you for hijacking the thread and ruining what was otherwise a decent discussion.

 

[medic417]

I'm pretty sure this was rather pointless as soon as medic417 chimed in with "not correct" and the rest of the paragod squad jumped on board. Thank you for hijacking the thread and ruining what was otherwise a decent discussion.

Excuse me you arrogant ....................

I nicely added an option of how this could be done based on OP's original posts. You then got your panties in a wad. Grow up.

Why is it when someone with more education offers a piece of advice based on experience and education they are called Paragod's? If my experience and education make me a Paragod then I thank you for the compliment.

 

[VentMedic]

I'm pretty sure this was rather pointless as soon as medic417 chimed in with "not correct" and the rest of the paragod squad jumped on board. Thank you for hijacking the thread and ruining what was otherwise a decent discussion.

I take it you won't be advancing your education since you have an attitude towards doctors and Paramedics. Thus, you may miss out on some of the "whys" to the assumptions you have made.

 

[triemal04]

I'm pretty sure this was rather pointless as soon as medic417 chimed in with "not correct" and the rest of the paragod squad jumped on board. Thank you for hijacking the thread and ruining what was otherwise a decent discussion.

Sure, not a problem. You do remember that it was you that brought up doctors not trusting EMT's and your medical director treating you like dirt, right? Guess this is more of the blaming someone else issue...:lol:

 

[medic417]

Medic417 demanded to know why paramedics had to call medical command to release to BLS. .

Never made any demand. Please calm down and take a deep breath. Now go get your education. Have agreat life.

 

[Epi-do]

Wonder how much longer before admin is along to put a stop to this one????

 

[triemal04]

Well that's the end of this thread. And it was just starting to get fun too. Oh well.

I've never really questioned you're pt care, or how good you are. What I've said is that the doctors might have many different reasons for what they are doing, some of which include the PARAMEDICS making mistakes, lack of eduction/training to use certain meds or advanced equipment, lack of good QA/QI etc etc...and that the more you refuse to entertain this idea, the more suspect it becomes.

And yes, you did bring this up. The first person to mention doc's not trusting EMT's (or ambulance drivers as you called them) was you. The first to mention a medical director treating his people like dirt was YOU. Trust me, if medic417 was to blame I'd happily blame him. But he's not.

Actually, pulling EMS Good Ol' Boy bull would be blaming everyone else for something, refusing to accept blame when it was appropriate, refusing to consider making changes, and always assuming that those with more education are out to get those with less. Sound familiar?

If you really don't like what's happening in your little corner of the world, then there is enough info in this thread alone that could get you started on trying to change things. But then...you don't care, so why bother?

 

[triemal04]

Wonder how much longer before admin is along to put a stop to this one????

Soon as the first mod logs on...could still have quite a bit of fun before that happens, so don't go to far.