Refusal, still collect vitals?

What gear do you need for this call besides the stretcher?

A monitor to see what we were working with? We ended up calling it, as obviously traumatic arrests have a terrible outcome. He was not pulseless when first provider got to him. So after he went pulseless we needed to meet our criteria to call a trauma pronouncement.

Again we didn't know they were doing CPR until we walked up to it. So we needed the basics to treat the wounds to begin with.

So you just roll up to GSW's with a stretcher? Feel sorry for your pts.
 
Why would you be doing anything on scene with a traumatic cardiac arrest? Unless you're going to pronounce, of course.
 
A monitor to see what we were working with? We ended up calling it, as obviously traumatic arrests have a terrible outcome. He was not pulseless when first provider got to him. So after he went pulseless we needed to meet our criteria to call a trauma pronouncement.

Again we didn't know they were doing CPR until we walked up to it. So we needed the basics to treat the wounds to begin with.

So you just roll up to GSW's with a stretcher? Feel sorry for your pts.

We really stress having short scene times with our major trauma patients. I can and have rolled up with just the stretcher. My partner can set up the back of the ambulance, the fire department can help me get them loaded, and we'll do everything en route. Doing anything else on scene is just wasting time.
 
If the patient has a complaint and is refusing care, you need to get some vital signs. If the patient has no complaint, then they aren't refusing care since they don't need any care. That is not a refusal, that's a no patient found/no ambulance needed, or whatever you want to call it.

If you can't get vital signs because the patient refuses assessment, document that in your refusal.

As for bringing in gear? If you're the first person on scene you better bring your AED/monitor, first in bag, and oxygen.
 
We really stress having short scene times with our major trauma patients. I can and have rolled up with just the stretcher. My partner can set up the back of the ambulance, the fire department can help me get them loaded, and we'll do everything en route. Doing anything else on scene is just wasting time.

Yep that was our plan, once we saw CPR. Throw on a 4 lead and pads and get out of dodge. Once the 4 lead was on it was pretty obvious we were not getting him back. Took us about a minute or two of on scene time to call it.
 
Fair enough. My approach is to go in assuming we're transporting and if it looks like a pronouncement I'll have my partner bring in the monitor. We transport nearly all our penetrating trauma arrests (except to the head, of course). Our trauma surgeons had a guy with multiple GSWs to the chest that survived neurologically intact after about 40 minutes of CPR.

By the way, re-reading my earlier post, that came of snottier than I intended. Sorry about that.
 
Fair enough. My approach is to go in assuming we're transporting and if it looks like a pronouncement I'll have my partner bring in the monitor. We transport nearly all our penetrating trauma arrests (except to the head, of course). Our trauma surgeons had a guy with multiple GSWs to the chest that survived neurologically intact after about 40 minutes of CPR.

By the way, re-reading my earlier post, that came of snottier than I intended. Sorry about that.

Its all good man. I think that was our line of thinking when we saw him (pronouncement) which is why we spent the extra minute or two getting the monitor going.
 
Echoing what others have said, if they let you, take a set of vitals, if they don't want you touching them at all, simply document that.

As far as gear, go ahead and just grab your first in bag for all calls automatically. Better to have it and not need it then need it and not have it. If your partner is questioning you why your grabbing it for your "obviously" BS call just tell him/her that. I've been on the run that was dispatched as a minor fall only to find an unconscious/unresponsive patient with a respiratory rate of 6 and diminished tidal volume. Not exactly a call I would want to walk in with just a gurney and nothing else.

For us, if we arrive on scene first or at the same time as the paramedic engine company, we'll bring in the gurney, BLS bag (that contains both airway and trauma supplies) and the Zoll, while the FF/medics on the engine grab their drug box. If the engine is on scene first, they'll grab their Zoll and drug box and a small airway bag and we'll bring in the BLS bag when we get on scene, unless the engine radios us with specific equipment requests (gurney only, c-spine, etc).
 
Im with Ensihoitaja on this....lugging in a lot of kit to every call is silly. Sure, you ought to bring a monitor and bag on most things, but I think people get way too carried away with it. ECG doesn't change a lot of things.
 
If we're getting a call for a public assist and fire is already on scene I won't bring anything in generally. They've got all their bags, why do I need mine too? Work smarter not harder. I can think of 3 situations where immediate intervention is warranted and that's arrest, FBAO or severe anaphylaxis. All things I can treat out of fire's bag if I absolutely have to.

In the 3+ years ok 2.5 years since I was out for a while with my shoulder, I haven't walked into something that was dispatched as BS and found it to be one of the above and we run 1500-1800 calls/year each as in each employee.

Yea I would have to agree because every call except 1 I did not bring anything in except my gurney,gloves and a pen, mostly due to the fact that the FD was already there doing an assessment. The only reason I brought the jump bag with me on the 1 call was only because we arrived first on scene since the call went over the radio as we drove by the place.
 
Im with Ensihoitaja on this....lugging in a lot of kit to every call is silly. Sure, you ought to bring a monitor and bag on most things, but I think people get way too carried away with it. ECG doesn't change a lot of things.
How so? For myself it changes quite a lot of things.
 
We can carry our Zolls one handed with the carry handle, or sling them over the shoulder...not exactly lugging it IMO, especially when you can just put it on the gurney and not even really thinking about it, especially since on the gurney is where we typically put it after we clean and dress the gurney at the hospital before we clear...just pull it out of the back, close the doors and go, have everything you need right there
 
2 sets of vitals are required for us as long as the patient is willing to let us take them.

We are also required to take in our blue bag on every call. That's just our standard jump back with O2 supplies, trauma stuff, and intubation kit.

If I get called for a public or lift assist. I am guilty of not bringing anything in.
 
Shoot, I kinda feel stupid now. I guess I figured on a refusal, they were refusing everything and essentially didn't want us to touch them. I'll try to ask the medic next time I see him and see if that was his expectation.
that's slightly different than a "routine" refusal.

if the patient is willing to permit you to take vitals, than by all means do so. But are you going to force them to allow you to touch them to get vitals? what if they don't want to be touched? is it in their best interest to try to get them?

The biggest thing to do is document what happened. For the most part, If I walk into the front door, and the patient tells me GTFO, than that's good enough for me. no vitals needed, documented as such. Not worth getting the patient more worked up, or getting physically attacked, by a patient who doesn't want me in his house. There are always exceptions, but that's how I handle most calls.

with the exception of an EDP call (they are typically not dying, and can go violent pretty quickly), I always brought my first in bag and a carrying device inside for all calls inside a structure. even the BS ones. I've been burned in the past by in accurate information (people lie to dispatchers all the time), and I like being able to handle the unexpected. Try to get vitals and a full assessment if possible, but if it will make the patient's condition worse, documents as to why you didn't.
 
Strokes, insulin shock, pretty much all non-arrested trauma, hyperthermia....
How about chest pain, ABD pain, palpations, SOB, and any of the other many things that can be caused by issues with the heart?
 
Good points in the first 2 answers. I would have tgought the same thing. If protocol dictated to do it I would try, but again if its a refusal touching the pt could escalate to a battery. As someone stated, the narrative is our best tool of defense in those scenarios.
 
It depends on your agency and call volume how most medics operate. Vitals are essential on every call. You should complete a full history and assessment as practice and as a habit. The easy calls are where you create good habits so that it will be muscle memory on a difficult call.
 
How about chest pain, ABD pain, palpations, SOB, and any of the other many things that can be caused by issues with the heart?

You can and probably should obtain the monitor for that.

I chuckle when I see people carrying Lifepacks onto MVCs "to get the refusal!"
 
It depends on your agency and call volume how most medics operate. Vitals are essential on every call. You should complete a full history and assessment as practice and as a habit. The easy calls are where you create good habits so that it will be muscle memory on a difficult call.

Certaintly. The trick is knowing which ones are needed and which may be extraneous.
 
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