We don't need "training" in EMS

[atropine]

To be fair, I wouldn't sign off on allowing what most of the fire medics in Southern California do anyways. Guess that's why they aren't allowed to interpret 12 lead ECGs, right?

What are talking about?, all of the departments in LA County/ Orange County, San Diego County and Riverside County are using 12-leads.

 

[atropine]

Because of "liability", thats why no MD's will sign off on something like this. They have way mor to lose than a $13.00 per hour job/hobbie.^_^

Actually there are a number of Medical directors that do allow taking patients to clinics rather than ER. And often this is done by the Paramedic w/o calling medical control. These medical directors are more involved and know their Paramedics thus trust them.[/QUOTE]

Well thats cool if the MD knows and trust the medics, Where Iam at not only do we have a county MD, my department has it on MD, and several other departments have there own MD, so that getting to know and trust is kind of hard I guess.

 

[thegreypilgrim]

What are talking about?, all of the departments in LA County/ Orange County, San Diego County and Riverside County are using 12-leads.

Yeah, they're using them but as far as LA County goes (and probably Orange too) you're not allowed to interpret them. You have to go by what the machine diagnosis printout says...which can be horribly wrong sometimes.

 

[JPINFV]

What are talking about?, all of the departments in LA County/ Orange County, San Diego County and Riverside County are using 12-leads.

Interpret!=use.

Cardiovascular Receiving Center (CVRC) triage: If field 12-lead machine interpretation identifies “Acute MI”, "Acute myocardial infarction suspected", or "infarct-acute" – report this to the base hospital for possible triage to a CVRC.

http://ochealthinfo.com/docs/medical/ems/treatment_guidelines/03 Cardiac/C-15.pdf

Paramedics should utilize the computerized analysis of the EKG machine. If the computer analysis of the 12-lead EKG indicates an acute STEMI or the manufacturer’s equivalent of STEMI, this information shall be conveyed to the base hospital. Transmit, if capable, the 12-lead EKG demonstrating STEMI to the receiving STEMI Receiving Center (SRC) if requested.

http://ems.dhs.lacounty.gov/ManualsProtocols/MCG/MCG-12LeadEKG.pdf

That's not interpreting a 12 lead, which is what I specifically said.


Yea, Riverside uses it, but if I recall correctly, most of Riverside is also run by AMR and not the fire departments.

 

[46Young]

I think a case can be made for being able to refer pts to urgent care and/or sobering centers without making a formal "diagnosis". Obviously with the increased scope of practice for paramedics in this scenario there would have to be various legal reforms and updates in local policies/protocols to account for these new features of pre-hospital care. As I understand, most jurisdictions permit paramedics to determine in certain situations that no services are needed. You do a thorough assessment and exam of the patient and you determine that there are no apparent life-threats - this is not anything new or something paramedics do not do already. In fact this is done all the time when paramedics downgrade patients from ALS to BLS transport. If you ever find yourself in court one day and an attorney asks you, "Why did you arrange for my client to be transported by a lower medical authority? What was your diagnosis so you felt this was appropriate?" You need not answer with a diagnosis, the correct response is simply, "I completed a thorough assessment and exam of my patient in accordance with Advanced Life Support parameters and the patient was not found to have any anomalies. There was no immediate threat to life or limb, hence BLS transport is completely appropriate."

Not every patient you release at the scene is done so "Against Medical Advice." They do not all need to sign your release form, and having them sign it anyway does not provide any liability protection in such scenarios because there is no medical advice which they are going against.

You don't need to make a formal diagnosis to determine a patient to be stable. If you can release a patient at the scene and it's not an AMA situation already, why can you not just refer them to urgent care? Especially in this hypothetical scenario with increased paramedic education and scope of practice? Same things with ETOH patients and sobering centers. I'm not talking about being able to enroll them in a rehab facility, but just taking them to a facility that can protect them from themselves until they sober up. They already have such facilities in places like Santa Barbara and Oakland here in California where police officers (people with no medical training or at most a First Responder cert) can transport drunks to. Why is it different for EMS?

Why couldn't Medical Directors draft protocols for these sorts of things? Even if you have to call in to medical control and get the attending physician's approval to defer to urgent care or sobering center, why can't this work even under a paramedic's "suspected diagnosis"?

Police officers aren't trained to the EMT B or P level, and are therefore unaccountable for a trained medical evaluation prior to taking the ETOH pt to a sobering center.

Working under an OMD's license, having protocols, and also having OLMC to gain an attending physician's approval are all ways for the medic to avoid liability, rather than being required to make a definitive Dx and take full onus for your decision. That's what I was saying. Using your training to make sound pt care/referral decisions in accordance with your agency's guidelines.

 

[46Young]

Consider also that a good number of agencies will have S.O.P.'s and protocols making it difficult to release pts onscene or acquire refusals, due to the high abuse potential by lazy providers who don't want to transport.

NSLIJ required us to contact OLMC for all refusals, then also call our supervisor so that they could possibly talk the pt into going along for txp.