Trust other provider's interpretation?

MMiz

MMiz

I put the M in EMTLife
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Would you trust another provider's interpretation of an EKG or patient condition and treat your patient based on that knowledge?

Do you always verify yourself before you treat?
 
If I was with another medic helping out, maybe.

If I was taking over patient care and I was going to treat the patient?

No way. Full stop.

Who would do this?

Always, ALWAYS verify yourself before you treat a patient.
 
No.

We just suspended a medic with 20+ years as a medic because he trusted the doctor got the intubation but during transport the EtCO2 was less than 5 with no waveform.

I never trust or base my treatments off of what another medic tells me. I will do my own assessment which may confirm what they said.
 
Of course you do.

Do you turn off the nitro and heparin during a STEMI transport just because the patient feels better and the ST segments have resolved? Or DC the antibiotics during a transport of a septic patient if you didn’t see the lactate and cultures? Do you go way down on the PEEP just to see them desat for yourself before you concur with the diagnosis of atelectasis? Do you stop CPR to assess for a pulse yourself when your partner tells you there isn’t one?
 
Even at as a BLS provider, I always verify - arrived at an MVC, found (BLS non transporting) FD doing CPR and attaching an AED on a patient...with a palpable pulse (no, not just during compressions). Similar stories with unnecessary oxygen administration abound. I can only imagine how many EMS providers find ALS fire departments practicing unsound medicine.
 
Remi said:
Of course you do.

Do you turn off the nitro and heparin during a STEMI transport just because the patient feels better and the ST segments have resolved? Or DC the antibiotics during a transport of a septic patient if you didn’t see the lactate and cultures? Do you go way down on the PEEP just to see them desat for yourself before you concur with the diagnosis of atelectasis? Do you stop CPR to assess for a pulse yourself when your partner tells you there isn’t one?
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But do you verify those settings or do you just roll with it? If you are at a rural hospital doing an IFT and your ventilated patient has a PIP in the 50s and a Pplat of 45 are we just going to roll with it as is or are we going to verify and change these settings?
 
If your partner is of equal training, why would you not trust his abilities?

Do doctors trust the assessment of other doctors? Do nurses trust the assessments if other nurses?

If the respiratory therapist says they hear wheezing and wants to give Albuterol, are you really going to say "no, not until I hear the wheezes for myself?"

I totally understand wanting to verify the tube is placed properly for yourself, but see what point does it come to the point where you can trust your partners assessment skills?
 
DrParasite said:
I totally understand wanting to verify the tube is placed properly for yourself, but see what point does it come to the point where you can trust your partners assessment skills?
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I’ve worked with and have seen EMTs and medics who make horrible treatment choices and or provide incorrect or made up assessment findings. I have seen patients come in from the field with bilateral needle T’s because the patients BP was low aside from them having a major exterior bleed. I have seen TXA given for reasons we are not able to give it for (it’s a trial drug so we have a very limited patient population).

If I arrive at a car accident and an EMT says “he needs to have a needle T” I am definitely going to confirm it.
 
Trust, but verify. I have partners that I absolutely trust what they say. Going with the EKG example, if I am working on something and they say it's normal, I trust them. I will still look when I finish, but it won't jump to the top of my list. On the other hand, if they tell me to stop and look now (and it happened with my last STEMI) I trust that they have a reasonable concern that needs to be addressed now.

Just the other week, my partner said we needed the tourniquet. I did look at it, but not before I got everything ready first. I trusted what he said, prepared accordingly, did A quick double check, and we put on the toueniquet.

I will always look at something myself, but I will also let what they inform me of direct how I choose to organize things.
 
Remi said:
Do you turn off the nitro and heparin during a STEMI transport just because the patient feels better and the ST segments have resolved? Or DC the antibiotics during a transport of a septic patient if you didn’t see the lactate and cultures? Do you go way down on the PEEP just to see them desat for yourself before you concur with the diagnosis of atelectasis? Do you stop CPR to assess for a pulse yourself when your partner tells you there isn’t one?
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Preexisting interventions coming from the hospital are one thing, but other prehospital providers' treatments are another. If my partner says there's no pulse, I (usually - depending on the partner) have confidence that they are making a correct assessment. If PD or FD says there's no pulse, that's a whole 'nother story.

DrParasite said:
what point does it come to the point where you can trust your partners assessment skills?
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Fair point. But partners are different than other prehospital providers, especially non-EMS providers.

DesertMedic66 said:
If I arrive at a car accident and an EMT says “he needs to have a needle T” I am definitely going to confirm it.
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It'd be one thing for an EMT to tell you that there are diminished breath sounds on one side - to suggest an ALS treatment seems a bit beyond my role...not that I haven't said, "Hey, want me to [prep the nebulizer, set up a drip set, etc.]?" I think any medic would be remiss to not confirm this - especially 'cause it's an invasive treatment.
 
Remi said:
Do you stop CPR to assess for a pulse yourself when your partner tells you there isn’t one?
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I think this is probably the most basic example of this. Patient condition: cardiac arrest. do you trust your EMT partner or (gasp!!!) a firefighter to be unable to find a pulse? This is, of course assuming there aren't any other signs (patient is breathing, patient is saying "stop that hurts", etc) that would give you a hint that what you were told and what was actually happened were not the same (successfully intubated patient with a ETco 2 with no waveform).

As a general rule, when I was on the ambulance, unless I knew a firefighter had previously worked on an ambulance, there is a high probability that I am going to ignore almost everything they say, even if they are EMTs. Let me copy the demographics from you, and stick around if I need help carrying. They often mean well, but many of the firefighters I have met are horrible EMS providers.

Now that I'm down south, and the FDs go on more EMS calls, and actually fall under the county medical director, I have a little more faith in their abilities.... but unless they work or have worked on an ambulance, I am going to thank them for their assistance and do my own assessment. Been turned too many times in the past. And now that I'm no longer on the ambulance, when EMS arrives, I am totally ok with stepping back, letting them to do their thing, even if it means redoing everything I just did.

but if you can't trust your partner's abilities, than either you have trust issues, control issues, or the agency has training issues if they can't do their job properly. and a good partner does know when to have someone else confirm their findings, especially when they seem off (against, assuming you are the same training level; if it's a B/P crew, than the P is overall responsible and more educated, so I can see why they wouldn't trust an EMTs interpretation of an ALS skill).

If I was the medic, about to perform a highly invasive treatment, I'd probably want to verify for myself before I did something. cardiovert, needle decompression, various medications that are high risk / low frequency (but still appropriate when the patient's condition warrants it) such as amiodorone, sure, but if my partner says "hey, i think it's a stemi, or a stroke, or a trauma alert, or a 'hey, i think i see the head'," then no, I am going to trust their assessment and make the appropriate notifications and transport decisions.
 
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Trust but verify. What was done five minutes ago may not be good anymore; tubes can dislodge and IVs can infiltrate even if they were placed correctly and were working.

Who it is certainly plays a big role too. When I'm out in the field I know all of our Medics and RNs, and trust them quite a lot. When I'm in the ED and I'm getting a call in from a historically poor performing service my trust is MUCH lower. I know which RNs, RTs, and providers I trust in the hospital, and which I wouldn't allow to treat me too...
 
MMiz said:
Would you trust another provider's interpretation of an EKG or patient condition and treat your patient based on that knowledge?

Do you always verify yourself before you treat?
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Well, do you trust that person to take up and pay your bills and pay for your family's well being for the rest of your life should you lose your patch permanently after you are sued and lose due to taking their word for it? If you do trust them then by all means. Knock yourself out. Good luck.

However, if you don't trust them to step up and pay for your family, then don't take their word for it and reassess.
 
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