Questions

[bdoss2006]

So I have quite a few questions here. Hopefully I won’t get berated for these…



If you get the classic call that someone wants to be “checked out” for some random reason, what all do you do? Do you just check vitals, or what all assessment would you do? I know that’s situation dependent, but what is kind of a general guideline?



Are there any situations where you can legally and safely say a patient shouldn’t go to the hospital? Or do you always have to say they should no matter how minor the issue?



This is more of a convalescent question, but if you have a patient going to a doctors appointment or dialysis etc., and something is off such as a vital sign, what do you do? Of course you treat it, but at what point do you take them to the hospital instead?



When giving report, what medical history and/or medications if any should you tell them? With the patients with the mile long medical history list, it’s not practical to tell everything, so do you just tell what’s pertinent to the current complaint?



How do you know when to deliver on scene? I know crowning is a definite sign, but what else?



When you run a standard run of the mill public service/lift assist with no complaints, what assessment should you do? Should you check vitals? I know most people I work with don’t.



How do refusals work on a patient that’s non competent? Especially with something such as a lift assist for an elderly patient with dementia, that’s not A&O, they can’t legally refuse. What do you do in that situation?



What is the purpose of encouraging people to stay awake? I can’t remember that being covered in my class.



Should you ever tell someone what you think is wrong? If you have a good suspicion should you say or not?



When do you treat an abnormal vital sign id they’re asymptomatic? Especially if it’s normal for them.



I know this is a lot and hopefully I won’t get berated like usual.

 

[mgr22]

You're asking for instructions covering many situations with lots of variables. I think formal training and clinical experience are better routes to the answers you seek. Meanwhile, my general advice would be to act in ways that
(1) are consistent with your standards of care,
(2) don't make patients worse,
(3) are as close as practical to how you'd want your favorite family member treated, and
(4) don't delay definitive care by people with more skills and better tools than you.

Bonus advice: Leave out the remarks about being berated. They're annoying and won't solve your problems.

 

[MMiz]

If you get the classic call that someone wants to be “checked out” for some random reason, what all do you do? Do you just check vitals, or what all assessment would you do? I know that’s situation dependent, but what is kind of a general guideline?

ABCs, vital signs, and focused history based on their complaint.

Are there any situations where you can legally and safely say a patient shouldn’t go to the hospital? Or do you always have to say they should no matter how minor the issue?

We suggested patients go to their primary care provider and urgent care all the time. We just followed our protocols for refusal of care.

Some examples: small lacerations, colds, insect bites, splinters, anxiety attacks, etc.

This is more of a convalescent question, but if you have a patient going to a doctors appointment or dialysis etc., and something is off such as a vital sign, what do you do? Of course you treat it, but at what point do you take them to the hospital instead?

I would consult with a supervisor or medical control if I wasn't sure what to do.

When giving report, what medical history and/or medications if any should you tell them? With the patients with the mile long medical history list, it’s not practical to tell everything, so do you just tell what’s pertinent to the current complaint?

I would list the most pertinent medications, medical allergies, and then verbally say that I'd provide a written list of the rest.

When you run a standard run of the mill public service/lift assist with no complaints, what assessment should you do? Should you check vitals? I know most people I work with don’t.

You've asked this before. You should be checking vitals. I don't know anyone that didn't, even on our dialysis runs.

How do refusals work on a patient that’s non competent? Especially with something such as a lift assist for an elderly patient with dementia, that’s not A&O, they can’t legally refuse. What do you do in that situation?

If they don't have the capacity to make decisions, they cannot legally refuse care. Is there a guardian, power of attorney, or next of kin?

No matter what I'd likely contact medical control and sometimes needed to contact the police department.

Follow protocols.

What is the purpose of encouraging people to stay awake? I can’t remember that being covered in my class.

Initially they thought that losing consciousness would prevent the worsening of a condition. We now know that's not true.

Having the patient stay awake helps in assessing their condition and changes in condition.

Should you ever tell someone what you think is wrong? If you have a good suspicion should you say or not?

Sure. It's all in how you word it. Use cautious language. I'd say, "A lot of your symptoms are consistent with x..." or "This could be..." I'd then say what I was going to do for it, and defer to more highly trained providers.

When do you treat an abnormal vital sign id they’re asymptomatic? Especially if it’s normal for them.

Treat the patient, not just the numbers.

 

[bdoss2006]

ABCs, vital signs, and focused history based on their complaint.



We suggested patients go to their primary care provider and urgent care all the time. We just followed our protocols for refusal of care.

Some examples: small lacerations, colds, insect bites, splinters, anxiety attacks, etc.



I would consult with a supervisor or medical control if I wasn't sure what to do.



I would list the most pertinent medications, medical allergies, and then verbally say that I'd provide a written list of the rest.



You've asked this before. You should be checking vitals. I don't know anyone that didn't, even on our dialysis runs.



If they don't have the capacity to make decisions, they cannot legally refuse care. Is there a guardian, power of attorney, or next of kin?

No matter what I'd likely contact medical control and sometimes needed to contact the police department.

Follow protocols.



Initially they thought that losing consciousness would prevent the worsening of a condition. We now know that's not true.

Having the patient stay awake helps in assessing their condition and changes in condition.



Sure. It's all in how you word it. Use cautious language. I'd say, "A lot of your symptoms are consistent with x..." or "This could be..." I'd then say what I was going to do for it, and defer to more highly trained providers.



Treat the patient, not just the numbers.

ABCs, vital signs, and focused history based on their complaint.



We suggested patients go to their primary care provider and urgent care all the time. We just followed our protocols for refusal of care.

Some examples: small lacerations, colds, insect bites, splinters, anxiety attacks, etc.



I would consult with a supervisor or medical control if I wasn't sure what to do.



I would list the most pertinent medications, medical allergies, and then verbally say that I'd provide a written list of the rest.



You've asked this before. You should be checking vitals. I don't know anyone that didn't, even on our dialysis runs.



If they don't have the capacity to make decisions, they cannot legally refuse care. Is there a guardian, power of attorney, or next of kin?

No matter what I'd likely contact medical control and sometimes needed to contact the police department.

Follow protocols.



Initially they thought that losing consciousness would prevent the worsening of a condition. We now know that's not true.

Having the patient stay awake helps in assessing their condition and changes in condition.



Sure. It's all in how you word it. Use cautious language. I'd say, "A lot of your symptoms are consistent with x..." or "This could be..." I'd then say what I was going to do for it, and defer to more highly trained providers.



Treat the patient, not just the numbers.

So we don’t have protocols for refusal of care. I think that concerns me the most. Are we really qualified to say someone doesn’t need care? I mean know the obvious simple stuff, but what about if let’s say someone hits there head, but has no deficits, or any things suggestive of a head injury. What should you say? That you don’t recommend they go, or that we don’t have CT vision, and that they should be checked out?

 

[mgr22]

Are we really qualified to say someone doesn’t need care?

As an EMT, no. How you deal with that is up to you, your agency, and your system.

I don't know of any EMS systems without procedures for refusal of care, but if yours doesn't have them, you wouldn't be able to turf responsibility for tricky transport decisions to someone more thoroughly trained than you, which means you'd be absorbing risks that could lead to very bad days for you and your employers, which means you'd be better off transporting all 911 callers to destinations specified in your protocols -- assuming those callers are okay with that -- and thoroughly documenting your calls.

I see you're 18. I wasn't too aware of risk management at 18, but I also wasn't in EMS at 18. In the absence of written policy, you should listen to the voices in your head warning you that you're not qualified to provide definitive care, then ask your agency or system the same questions you're asking us.

 

[johnrsemt]

Why can't an EMT say no?
As an EMT-B I had runs to a daycare who would call 911 for every (and I mean every) boo boo. Child fell on concrete landing on hands, and has an abrasion.
Same with an adult.
Stubbed toes
A patient was at ED and released at 0500 this morning (it was 0900) and I am not feeling better yet. He was diagnosed with pneumonia, and told to go home and recover over 2-3 weeks, He hadn't even gotten his script filled. He thought they meant 2-3 hours, not weeks.

Maybe it is easier as a basic at 35, not 18

 

[mgr22]

Why can't an EMT say no?
As an EMT-B I had runs to a daycare who would call 911 for every (and I mean every) boo boo. Child fell on concrete landing on hands, and has an abrasion.
Same with an adult.
Stubbed toes
A patient was at ED and released at 0500 this morning (it was 0900) and I am not feeling better yet. He was diagnosed with pneumonia, and told to go home and recover over 2-3 weeks, He hadn't even gotten his script filled. He thought they meant 2-3 hours, not weeks.

Maybe it is easier as a basic at 35, not 18

Sure, there are situations where an EMT could discourage transport without consequences, but that doesn't mean we'd allow that unconditionally. We'd have to manage risks.

The OP said his/her system has no policy for refusals, then asked, "Are we really qualified to say someone doesn't need care?" without offering conditions or specifics. I think the assumption has to be, no, EMTs shouldn't have broad authority to make those decisions without consultation.