Was I wrong?

[triemal04]

Is the paramedic in this call "in charge" or not? If they are in charge enough to "give directions" with fallout, that's OK but should' they also write up the PCR and take responsibility for all decisions relating to the patient?

Same goes for "triaging" to BLS after an ALS assessment. This doesn't seem much different than the dynamics when a BLS ambulance asks for an ALS intercept....if a medic evaluated the patient and determined they were not needed, I would expect that medic to document their assessment....the BLS provider certianly can't be expected to do that.

anyone want to take bets on whether the OP's partner was going to write up his own trip sheet?

Well...yeah. If I have to assess a patient and then turn care over to a lower level, or to a different paramedic, then of course I'm going to write a report. That's just common sense.

But really...who gives a :censored::censored::censored::censored: who writes, or doesn't write the report? If that is really the all important thing to some people I'd encourage them to open their eyes a little more; much better things to be concerned about in EMS.

 

[Brandon O]

I think its more an issue with the RAD-57 we use, while a decent piece of equipment, its far from perfect. If its not placed perfectly on the finger it will throw weird numbers.

Shouldn't be consistently decreasing with apnea though; motion artifacts are usually bouncy and quick-changing.

If an EMT is not willing or capable of learning or becoming comfortable with actual patient care and working within their scope...well...maybe time for a new job.

Sure. But that's something to figure out in the calm of the garage or supervisor's office, not with the patient (any patient) in front of you.

 

[ZombieEMT]

One consideration, though, is that the person delegating to you may not know your experience and qualifications. The fact that a medic might feel he can manage a patient with BLS methods doesn't necessarily mean the green EMT he's turfing to feels the same.

You can argue whether that EMT "ought" to have that competence, or you can hash it out afterwards and convince someone they were wrong, but when you're on scene with a real patient, I think caution wins. If the patient comes unwound, it will be hard to argue later it was a legitimate down-triage.

I disagree, I do not think this is a consideration, at least in EMS. I can speak from a New Jersey EMT POV, an EMT is an EMT. If something is within an EMTs scope, they should be able to do it. If you are hired as an EMT, whether you have been in the jobs for 6 days or 6 years, you should at least have the same scope of practice. If I, as an EMT choose to master the skill of IV, via phlebotomy class, that does not mean I can use it in the field. All EMTs in NJ have the same scope. Theoretically one EMT should be the same as another.

If you can not handle the job your were hired to do, you need to resign or be fired.

 

[Brandon O]

I disagree, I do not think this is a consideration, at least in EMS. I can speak from a New Jersey EMT POV, an EMT is an EMT. If something is within an EMTs scope, they should be able to do it. If you are hired as an EMT, whether you have been in the jobs for 6 days or 6 years, you should at least have the same scope of practice. If I, as an EMT choose to master the skill of IV, via phlebotomy class, that does not mean I can use it in the field. All EMTs in NJ have the same scope. Theoretically one EMT should be the same as another.

If you can not handle the job your were hired to do, you need to resign or be fired.

This isn't a question of scope of practice. There's no strict distinction of "how badly sick" a patient can be to ride BLS versus ALS (although in some areas there may be isolated criteria, such as "syncope goes ALS [if available]"). It's a question of individual capacity to manage specific patients based on their complexity and overall requirements.

There are an infinite number of patients who may be better off in the care of one provider than another, regardless of their certification. In a perfect, machine-like world, this might not be the case, and in that world the junior member of a crew wouldn't need to take cues from his senior partner; anybody with a patch would be equally capable of assuming scene command at an MCI; and the 19-year-old hired yesterday would be just as ready as Johnny Gage to handle the crashing patient who needs six things done while making complex decisions and directing a cohesive course of care. But that's not planet Earth.

Now, I agree that if someone consistently can't manage patients like other reasonable providers with the same training and experience, there should be remediation or maybe they shouldn't work there anymore. That's different from whether you should force them to take Patient X who's here right now. They're telling you they're not capable of providing adequate care for that person; if you ignore that, and the patient dies horribly somewhere on the highway, it may or may not be their fault, but it's definitely, unquestionably yours too.

 

[ZombieEMT]

I again state that I completely disagree. It is a matter of scope of practice. You are trained and certified to do the exact same things. If there is no need for ALS, its BLS. One EMT has the same training as the next. Them feeling comfortable is different but not mean they shouldnt

 

[DrankTheKoolaid]

I disagree, I do not think this is a consideration, at least in EMS. I can speak from a New Jersey EMT POV, an EMT is an EMT. If something is within an EMTs scope, they should be able to do it. If you are hired as an EMT, whether you have been in the jobs for 6 days or 6 years, you should at least have the same scope of practice. If I, as an EMT choose to master the skill of IV, via phlebotomy class, that does not mean I can use it in the field. All EMTs in NJ have the same scope. Theoretically one EMT should be the same as another.



If you can not handle the job your were hired to do, you need to resign or be fired.

In a dream world that would be great. But reality is provider level does not equal same level of training, understanding or even competence at that provider level. Which is absolutely shameful.

 

[eju218]

I don't care if it's a stubbed toe, if the basic isn't comfortable, then the medic gets the call. That is part of the responsibility that comes with that big capital P after your EMT-.

Totally agree! At my company all ALS techs have to 'hand down' all calls to BLS. In other words, if an ALS tech refuses to take a call and makes the basic tech the call, the ALS tech is liable. They sign the PCR stating that the patient does not require ALS care.

And unless chest pain is CLEARLY muscular and/or skeletal in nature; it's an ALS call.