Your opinion of police officers.

hometownmedic5

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It is my considered opinion that, if everybody in public safety would just stay in their lane, we’d all get along much better. Instead, we all think we know how to do the other guys job better than him because we saw it done differently that one time and maybe we benefited from that method, so why dont we try that again...
 

Tigger

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At the end of the day, if the patient wants to go the hospital by ambulance, I'll take em with a smile. If I feel that they were unduly pressured by law enforcement, urgent care staff, or whomever, that's something that can be addressed after the fact.

Cops assessed the situation pretty well. Maybe they’ve had more years, seen more patients than the crew you rode with...
Alternatively it was also their first accident involving a semi and were intimidated by what appeared to be significant damage. Is my assumption somehow less valid than yours? You know what they say about assumptions. I certainly don't assume most law enforcement officers have your attitude, and that goes a long way in my dealings with them.
 

Aprz

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Just to throw an entirely different perspective here for you...not that this is our job to think about, however the cop may have had presence of mind to do so as an advocate for the truck driver (patient). Remember, we are all members of a team, this is a team sport. Someone non-EMS may point out something obvious or not so obvious which we inadvertently missed or did not think about. That is ok, it happens. When it does, say thank you and then do not forget the lesson.

As for the semi driver....this is his OFFICE, possibly his HOME. When the driver gets in a crash, at the moment he may be thinking not so clearly or his concern is elsewhere (the other drivers, did they die or get hurt)....once the dust has settled, the reality is this driver's office was just involved in a crash. Are any of you familiar with the rules/regs of the D.O.T and any other agency (Federal or State) which may have guidelines imposed on these guys? Are you familiar with the paperwork and stress which comes post-incident? What about his employer? Or if he is self-employed, what about his chosen insurance carrier?

This accident could have tons of negative impacts on his current and future employment options. If he has even the slightest physical pain at this moment, it behooves him even more to go get checked out now, but sticking strictly to the point I am trying to make...possibly, going to get examined now to have his state of mind, his physical self, and possibly to self-submit for drug/tox screen right then will alleviate any future actions from his employer or from the other patient's themselves. If the other party's insurance carrier manages to see the inside of the court room or even if they try to settle before that, him having had an immediate medical exam along with tox/ETOH screen might simply shut down that.

So long winded, however the cop just may well have had the patient's best interest in mind and truly helped him far more than any EMS'er or ambulance ride, but as part of the team, we should "assist" with our role and let the cop get the credit for the point.
Woah. Woah. Woah. That sounds a lot like crew/cockpit resource management (CRM)...


Um, I notice a lot of providers tend to take "I'm OK" or do a visual glance as being enough to "assess" patients. After my brother was in a car accident and ignored by the paramedics in the county I work in, they didn't check his vital signs, they didn't touch him, and he did want an assessment (he did end up going to urgent care with me), I try to do my due diligence to make sure everyone was offered assessment, vitals, and stuff like that on scene. I just felt awful for my brother because he felt like he was ignored by my co-workers even though he did get the appropriate care later on going to urgent care. That's pretty much why I put an effort or try to insist on assessing patients even when they say "Nah, I am fine." (usually I don't take the first no, but I honor their right if they continue to insist that they think they'll be OK/don't want to be assessed). I don't want them to feel stupid for being assessed by paramedics or regretting not getting an assessment later on. I find it doesn't really prolong my on scene time that long even if I do it to 3-4 patients, and since usually they have little to no injury, the paperwork isn't too bad. Sometimes I'll get patients who say they are OK, deny having injury, and then I'll find something like an abrasion on their elbow or something that they weren't aware they had. I think it is important to inform them the pros and cons of both, that there can be a big bill associated with transport, they could end up in the waiting room like people who drove their themselves, urgent care may be a good option, they probably will be in pain later on that can be treated with over the counter medications, and that my training is to look for immediate life threats rather than medically clearing them. I tell them that low risk does not mean no risk. Usually most people still decide not to be transported anyways. Maybe just doing this more often has gotten me really good at getting refusal, but I feel like I transport less patients now than before when I used to tunnel vision on one or two transport patients.

Personally, I think police officers are the worst when it comes to medical calls where I am at. They've failed me too many times on things like trying to get patients to go with me, putting patients on 5150 holds (I had a call where a guy was hallucinating saying rats were eating his genital, he got aggressive and walked out of the ambulance when I told him he was welcome to leave/that I didn't want to be hurt/wouldn't try to physically stop him, I called law enforcement, and they wouldn't put him on a hold or help me secure the patient, yet they put a old lady on a 5150 hold because she was "confused" when she actually just couldn't hear, so once you yelled in her ear... she was totally with it). I find that law enforcement in my area tends to call for the dumbest things too like a cut on the toe, which I think should just be common sense. It might seem cocky or greedy, but I tend to cancel the fire department and law enforcement as soon as I can. I know they don't usually have my back on calls. I also don't usually waste my time trying to reason with them anymore.

In this example, if I felt like the truck driver wasn't really injured and just wanted to be checked out, I would thank the officers, assess them patient, tell him my findings, that I'd consider him a low risk patient (but not a no risk), that there could be a big bill, he could end up in the waiting room, and that if he still wanted to be transported, I'd be more than happy transport him (or call another ambulance to transport him).
 
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mgr22

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In this example, if I felt like the truck driver wasn't really injured and just wanted to be checked out, I would thank the officers, assess them patient, tell him my findings, that I'd consider him a low risk patient (but not a no risk), that there could be a big bill, he could end up in the waiting room, and that if he still wanted to be transported, I'd be more than happy transport him (or call another ambulance to transport him).
Are you saying that after the LEOs convinced the pt to go, you'd tell the pt he's low-risk, he might get a big bill, and he'd have to wait a long time at the hospital -- i.e., you'd discourage the pt from being transported?
 

Aprz

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you'd discourage the pt from being transported?
That is absolutely incorrect and misleading. I would not be discouraging them from being transported, but giving them a chance to make an informed decision. This means doing a full patient assessment (including a full head to toe like you did in EMT/paramedic school), and then informing the patient what I see, what I am thinking, potential problems, the pros by going by ambulance, what I will likely do during this transport if anything at all, and then the cons of going by ambulance (mainly financial).

When I do refusals, I go over each vital signs, what is taught as normal (eg "Your heart rate was 72. A normal heart rate is 60-100."). I would also go over things each thing I was looking for (eg "I looked for signs of a shock. Example signs are low blood pressure and a fast heart rate. Your blood pressure was 150/80, which above textbook perfect 120/80, and your heart rate was 72, which is within normal limits. I do not suspect shock. I looked for signs of spinal injuries, but you denied pain in the neck and back, and I did not see any obvious signs of a broken bone when I looked and touched your back."). Things like that. This would lead me to tell them that the safest option always is going by ambulance to the emergency department, that you'd have a paramedic nearby if your condition changed, and you'd get seen by a physician. I would tell them that as a paramedic, I trained to look for and treat immediate life threats, but that I cannot medically clear them. I cannot guaranty that everything is OK. I would tell them some problems might not be obvious right now, that they could slowly develop, and potentially become disabling or even deadly. Common examples I give is fractures that I cannot see because we do not have an x-ray in the ambulance, that they could have a slow/small bleed in the head that isn't causing any neuro deficits right now, but could in hours from now, or that they could have a small internal bleed somewhere else in their body that could eventually lead to shock. I would then say that right now, if I transported you, I do not anticipate that I would start an IV on you, I wouldn't give you any medications, and that I would expect to just monitor you and give you a ride. I would tell that based on my report to the hospital, they may potentially have me put them in the waiting room, that an ambulance ride does not guaranty that they will get a room right away at the hospital. I would tell that ambulance transport without insurance is usually >$2,000 (we don't know exact price because it depends on the mileage, and the prices I remember are old ones since they don't give us updated ones (they used to have us carry a sheet with all the price of each thing we charge for, but they stopped doing that)), that I cannot guaranty their insurance will cover it, and I don't know what their deductible is or co-pay is even if the insurance does cover it. I always make sure to say to patients that I consider low risk, ones who have no complaints that just want to be checked out, patients who have what I consider to be a minor injury (eg a cut on the toe, which I just got 2 days ago), is that "low risk does not mean no risk." I've always like to remind people of that. I tell them I am more than happy to transport them, they are also welcome to find alternative means like have a friend/family pick them up, use Uber, and sometimes tell them that they could call their PCP or go to urgent care instead. If they end up signing the refusal, I remind them they can call 9-1-1 if they even changed their mind about ambulance transport, even if nothing changed, that's OK to call us. I tell them our ultimate goal is that they are safe and healthy. I definitely encourage them to call 9-1-1 if their condition changes, and I sometimes things to look out for like telling car accident patients that nausea, dizziness, and feeling disoriented could be sign of a brain bleed, and ask them not to wait that out.

It's important that our patients make an informed decision. We shouldn't be so light like "Ah, nothing will happen", but they should know their odds, and it should be up to them if it is worth it to them to chance it, find another means to see a physician, or if they'd rather feel safe paying a lot of money. It think it is absolutely unreasonable to use a lot of fear to convince the patient to spend a lot of money and waste their personal time to go to the hospital when they likely don't need to even go. I think it's OK to tell the patient that there is even a risk of dying, but the way a lot of providers use it, their tone, they make it sound like it is 50/50 rather than like <1% (I don't give statistic, but just that sound like "OK, you are signing here that you know you can die, it is your fault if you die, here you go."). I go over everything and try to help them understand the situation and what can happen. Before I used to do this, I would take patients to the hospital, and we used to dump them in triage/the waiting room. I felt bad. Like I said before, I push to assess everyone involved on scene, full thorough assessment, because my brother didn't get that when he got into an accident, and my brother was genuinely worried that something was wrong with him, but was too scared to call 9-1-1 to look weak/whiny.

Is this wrong? Should I be telling my toe cut patient that I had a couple of days ago he can die so he probably should go to the hospital with us? Should I tell that truck driver whose chief complaint is "shaken up", no complaint of pain, normal vital signs "You can die so you probably should go to the hospital with us." That to me is not truly informed decision making, misleading, and bad paramedicine.
 

DragonClaw

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Are you saying that after the LEOs convinced the pt to go, you'd tell the pt he's low-risk, he might get a big bill, and he'd have to wait a long time at the hospital -- i.e., you'd discourage the pt from being transported?
What's wrong with this if you explain the risks and potential costs ? Seems reasonable to me. Like what Aprz explained. If he's not obviously critical, they may wait awhile in the ER.
 

mgr22

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Aprz, relax. I asked you for clarification because I wasn't sure I was understanding what you were saying. The only misleading thing about my question is the way you chose to quote only a fragment of it.

I'm not suggesting we tell every pt that they need hospitalization. My concern is about encouraging patients NOT to seek definitive care. I think that would be risky.
 

mgr22

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What's wrong with this if you explain the risks and potential costs ? Seems reasonable to me. Like what Aprz explained. If he's not obviously critical, they may wait awhile in the ER.
Here's the potential problem: (1) A pt wants to go to a hospital. (2) An EMT or paramedic convinces the pt not to go to a hospital. (3) The pt subsequently has a bad outcome due to some pre-existing illness or injury. (4) The outcome would have been less bad if the pt were transported to a hospital.

There are different ways of answering patients' questions and making suggestions to them. It is almost always less risky not to say or do anything that discourages a pt from seeking definitive care. The only down side I can think of is a wreck on the way to the hospital, but that would be extremely unlikely during a non-emergent (i.e., no lights and sirens) transport.

This would be just one chapter in a survival guide for people who aren't doctors.
 

DragonClaw

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Here's the potential problem: (1) A pt wants to go to a hospital. (2) An EMT or paramedic convinces the pt not to go to a hospital. (3) The pt subsequently has a bad outcome due to some pre-existing illness or injury. (4) The outcome would have been less bad if the pt were transported to a hospital.

There are different ways of answering patients' questions and making suggestions to them. It is almost always less risky not to say or do anything that discourages a pt from seeking definitive care. The only down side I can think of is a wreck on the way to the hospital, but that would be extremely unlikely during a non-emergent (i.e., no lights and sirens) transport.

This would be just one chapter in a survival guide for people who aren't doctors.
I don't mean specifically convinced them one way or the other, I mean give them my opinion and lay out the facts and let them decide. If they'd rather err on the side of caution, more power to them. I mean, I guess your life is worth more than the ambulance ride cost, for the same time that doesn't mean I'm itching to somebody to make a large financial decision.

And when I say I guess, I'm not really guessing. It is. I was just thinking about it.
 

mgr22

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I don't mean specifically convinced them one way or the other, I mean give them my opinion and lay out the facts and let them decide. If they'd rather err on the side of caution, more power to them. I mean, I guess your life is worth more than the ambulance ride cost, for the same time that doesn't mean I'm itching to somebody to make a large financial decision.

And when I say I guess, I'm not really guessing. It is. I was just thinking about it.
What does "specifically convinced" mean? Is that different from "convinced"? And how might a patient's impression of what you say differ from what you meant?

I think you're missing the bigger picture; that there are risks associated with discussing reasons for not seeking definitive care with patients. That doesn't mean you can't answer questions and it doesn't mean you have to aggressively push the transport option. In my opinion, though, it is safer for you and the patient if you give priority to disclosing the risks of NOT being transported, instead of focusing on the costs and inconvenience of transport. It's a matter of projecting a bias and willingness to see that the patient seeks the best care you have access to, and that the patient understands the risks of not doing so.
 

DragonClaw

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What does "specifically convinced" mean? Is that different from "convinced"? And how might a patient's impression of what you say differ from what you meant?
Specifically convinced (in my mind) is when your goal is to get the patent to transport, just to be sure there's no underlying conditions regarding what they called about, like a brain bleed as one mentioned, and they agree. Like avoiding talking about cost (or not focusing on it).

"Regular" convinced is you present the all the facts (That you reasonably can) and they decide there's enough benefit or evidence, or risk to justify going to the hospital
 

Akulahawk

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Here's my take on this: If a person on scene doesn't want to be assessed, I'll respect that, point out any obvious injuries or facts that lead me to suspect an injury, then tell that person that even if I do an assessment, transport doesn't have to occur. If the person still declines an assessment, that person can still change their mind and request one and still not be transported, or they can be transported to the ED if this is desired.

So what if a cop convinced the truck driver to go to the hospital. If I'm the medic that initially assessed the truck driver, I've probably already done most of the work so another patient care report is all that is needed... I'd have to do one anyway just to indicate that I assessed someone on scene and determined that person isn't a patient so that actually is not much more that I have to do.

Whatever caused the truck driver to change his mind isn't my concern unless it's a sign of injury that wasn't readily apparent earlier. People are generally free to do such things.
 

mgr22

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Specifically convinced (in my mind) is when your goal is to get the patent to transport, just to be sure there's no underlying conditions regarding what they called about, like a brain bleed as one mentioned, and they agree. Like avoiding talking about cost (or not focusing on it).

"Regular" convinced is you present the all the facts (That you reasonably can) and they decide there's enough benefit or evidence, or risk to justify going to the hospital
DragonClaw, the distinction you're making doesn't really address the subtleties of communicating with impressionable patients. You'll learn more about that along the way. Meanwhile, I strongly suggest you consider all that's been presented in this thread you started, and not overlook risk management as a very important part of EMS.

You can offer patients what you feel is an impeccably balanced view of pros and cons and still get in all sorts of trouble because your words weren't interpreted the way you meant them to be.
 

DragonClaw

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It is my considered opinion that, if everybody in public safety would just stay in their lane, we’d all get along much better. Instead, we all think we know how to do the other guys job better than him because we saw it done differently that one time and maybe we benefited from that method, so why dont we try that again...
But... Why? I mean, if you really do have experience wth a field, why ignore it because you're wearing the wrong patch on your sleeve or you drive a different vehicle.

Maybe that's not what you're saying.
 

DragonClaw

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DragonClaw, the distinction you're making doesn't really address the subtleties of communicating with impressionable patients. You'll learn more about that along the way. Meanwhile, I strongly suggest you consider all that's been presented in this thread you started, and not overlook risk management as a very important part of EMS.

You can offer patients what you feel is an impeccably balanced view of pros and cons and still get in all sorts of trouble because your words weren't interpreted the way you meant them to be.

Hmm. I'll certainly mull it over. When I post something, I get a lot more answers that vary than I'd previously imagined. This seems to be a trend. Sometimes things make more sense, sometimes I really have to analyze.

Things are less "by the book" than imagined.
 

DrParasite

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But... Why? I mean, if you really do have experience wth a field, why ignore it because you're wearing the wrong patch on your sleeve or you drive a different vehicle.

Maybe that's not what you're saying.
Because it's not your job? because you might not be right?

The people on the ambulance should be the experts in medical care. the people on the fire truck should be experts in technical rescue and putting out fires. The people in the police car should be experts in enforcing the law. They shouldn't need anyone else to tell them how to do their job.

Is it right for the ambulance people to tell the cops to shut down a road during a T/C? not unless they need that road shut down to do their job, because shutting down a road is a responsibility of PD (although in some places FD can make that call too).

is it right for the fire department to tell EMS that they need to check the patient's BGL, ET02, and make sure they ventilate at 10/minute? no, because EMS should know how to do their job.

Is if right for EMS to tell the cops to arrest someone? what if the EMS person is an off duty cop?

Is it right for PD or EMS to start breaking every window on a house fire, because there is a report of someone inside? Because while your intention might be good, you just made things exponentially worse for both the FD and for that person who is trapped inside.

We all work together (albeit sometimes better than others), but we all have our areas of responsibility, and as professionals, that is our concern. I'm going to worry about my area of responsibility, and because you know how to do your job, I don't need to worry about your areas of responsibility, because that's something you need to handle.
 

DragonClaw

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Because it's not your job? because you might not be right?

The people on the ambulance should be the experts in medical care. the people on the fire truck should be experts in technical rescue and putting out fires. The people in the police car should be experts in enforcing the law. They shouldn't need anyone else to tell them how to do their job.

Is it right for the ambulance people to tell the cops to shut down a road during a T/C? not unless they need that road shut down to do their job, because shutting down a road is a responsibility of PD (although in some places FD can make that call too).

is it right for the fire department to tell EMS that they need to check the patient's BGL, ET02, and make sure they ventilate at 10/minute? no, because EMS should know how to do their job.

Is if right for EMS to tell the cops to arrest someone? what if the EMS person is an off duty cop?

Is it right for PD or EMS to start breaking every window on a house fire, because there is a report of someone inside? Because while your intention might be good, you just made things exponentially worse for both the FD and for that person who is trapped inside.

We all work together (albeit sometimes better than others), but we all have our areas of responsibility, and as professionals, that is our concern. I'm going to worry about my area of responsibility, and because you know how to do your job, I don't need to worry about your areas of responsibility, because that's something you need to handle.
I don't mean like that. I mean, say you're a medic who became a cop. Assuming you keep everything certified (don't know time constraints of that), if you are first on scene, you are probaby better equipped to be able to assesses the patient or help small issues. I'm not saying you start an IV or you do anything or there. I'm saying if you have valid experience and credentials, why should that be ignored? Maybe your answer is the same.

If you're out in public, not on a shift and someone drops in front of you, you're probaby not going to scream and run around like you don't know what you're doing.

Your duties may change with the uniform, but it doesn't reduce your training or experience, you know?
 

DrParasite

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I think your misinterpreting what I'm saying....

If you are a medic who becomes a cop, and your first on scene and you want to use your medical knowledge to help the person, go for it. nothing wrong with that at all (other than your LEO duties are not being performed because your doing medical stuff, but whatever).

Once the medical people show up, it's their show; they are the medical experts, and what they say goes, because it's their responsibility. But that also means if they say something, or discuss something with the patient, it's unprofessional to go behind their back to convince the patient to make another decision.

Am I going to be annoyed? sure, for about 30 seconds. Because at the end of the day, if the patient wants to go to the hospital, it's my job to take them.
If you're out in public, not on a shift and someone drops in front of you, you're probably not going to scream and run around like you don't know what you're doing.
Hopefully not. do what you can, including making sure someone calls 911. But when the ambulance people get there, you step back and let them do their job.

let's say you see a building on fire, and you call 911 and start banging on doors to get people out, since you're an off duty firefighter. When the FD shows up, are you going to start telling them what to do? stretch a line here, hook up to the hydrant, ladder the roof..... or should you step back and let them do their jobs, because it's their fire to put out?

No one is reducing your training or experience, however your role and responsibility should be taken into account. Before they get there, you can do whatever you want. Once the appropriate AHJ shows up, it's their ball, and they can use it as they determine.
 

DragonClaw

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I think your misinterpreting what I'm saying....

If you are a medic who becomes a cop, and your first on scene and you want to use your medical knowledge to help the person, go for it. nothing wrong with that at all (other than your LEO duties are not being performed because your doing medical stuff, but whatever).

Once the medical people show up, it's their show; they are the medical experts, and what they say goes, because it's their responsibility. But that also means if they say something, or discuss something with the patient, it's unprofessional to go behind their back to convince the patient to make another decision.

Am I going to be annoyed? sure, for about 30 seconds. Because at the end of the day, if the patient wants to go to the hospital, it's my job to take them.Hopefully not. do what you can, including making sure someone calls 911. But when the ambulance people get there, you step back and let them do their job.

let's say you see a building on fire, and you call 911 and start banging on doors to get people out, since you're an off duty firefighter. When the FD shows up, are you going to start telling them what to do? stretch a line here, hook up to the hydrant, ladder the roof..... or should you step back and let them do their jobs, because it's their fire to put out?

No one is reducing your training or experience, however your role and responsibility should be taken into account. Before they get there, you can do whatever you want. Once the appropriate AHJ shows up, it's their ball, and they can use it as they determine.
Full agreement. Do what you can, then hand the scene over to whoever is now in charge and step back.
 

johnrsemt

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Also remember the stress that the Truck Driver was under from seeing the wreck, even if he wasn't directly involved in it; or was but wasn't the cause of it. What happens when the adrenaline wears off and he realizes he has chest pain from the stress?
In our area had a truck driver involved in a wreck with minor damage to his truck but the tractor needed to be towed because the metal was forced into the front tire, so he refused transport and waited for the heavy tow to show up. When they showed up they called 911 back because the driver was unresponsive. He was dead. Massive MI.
 
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