Your opinion of police officers.

Remi

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It’s easy. There are quite a few in EMS who believe they know more than others...
Well, yeah…..of course some folks know more than others.

What is the point of this comment? I don't see how it supports your (demonstrably false, BTW) idea that everyone EMS comes in contact with must be transported to a hospital via ambulance.
 

Phillyrube

Forum Crew Member
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Well, yeah…..of course some folks know more than others.

What is the point of this comment? I don't see how it supports your (demonstrably false, BTW) idea that everyone EMS comes in contact with must be transported to a hospital via ambulance.
Ok, as a cop and a medic, I have had issues on scenes involving school buses. Someone taps the bus from behind, first arriving EMS unit calls for 5 more boxes. Why? Kids can't refuse. Huh? If the kid says he's not hurt, he doesn't need to go to the hospital. I kept pounding that. into new EMTs when I taught. Kid has a complaint of pain, yes, he needs to go. Otherwise, they can wait for mom and dad to arrive (which doesn't take long....dang I hate cell phones).

Had EMS crews ask me to witness refusals. Arrive at an accident scene, ask drivers if they are hurt. No, ok, sign the refusal. There is no need, THEY ARE NOT HURT. Even if they have a visible injury, if you don't touch them, you don't have to do a report and get a refusal. There is no requirement to identify yourself to EMS if they talk to you and you refuse.
 

Tigger

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Ok, as a cop and a medic, I have had issues on scenes involving school buses. Someone taps the bus from behind, first arriving EMS unit calls for 5 more boxes. Why? Kids can't refuse. Huh? If the kid says he's not hurt, he doesn't need to go to the hospital. I kept pounding that. into new EMTs when I taught. Kid has a complaint of pain, yes, he needs to go. Otherwise, they can wait for mom and dad to arrive (which doesn't take long....dang I hate cell phones).

Had EMS crews ask me to witness refusals. Arrive at an accident scene, ask drivers if they are hurt. No, ok, sign the refusal. There is no need, THEY ARE NOT HURT. Even if they have a visible injury, if you don't touch them, you don't have to do a report and get a refusal. There is no requirement to identify yourself to EMS if they talk to you and you refuse.
Perhaps regionally that is acceptable, it is not here.

Regrettably, we must obtain a "release of care" from lift assists and non-injury TAs. It's real easy, get their name and birthday, offer them an evaluation, and have them sign if they say no. Report is only two sentences. If you have a visible injury or complain of anything however, you get an actual refusal done. Obviously if the patient is adamant that you don't assess them that's different but I can't think of a time that anyone said no.

I think there is definitely a liability boogeyman in EMS, but not doing refusals on patients with obvious injuries is...subpar.
 

DrParasite

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Ok, as a cop and a medic, I have had issues on scenes involving school buses. Someone taps the bus from behind, first arriving EMS unit calls for 5 more boxes. Why? Kids can't refuse. Huh? If the kid says he's not hurt, he doesn't need to go to the hospital. I kept pounding that. into new EMTs when I taught. Kid has a complaint of pain, yes, he needs to go. Otherwise, they can wait for mom and dad to arrive (which doesn't take long....dang I hate cell phones).
You are the first EMS unit pulling up to a fully loaded school bus accident, and you don't call for more ambulances, than you and I are going to have a talk, especially of those ambulances are coming from a distance... you can always cancel them if they are't needed, but you have 30 potential patients until proven otherwise. a decent dispatcher should be sending additional resources based on the nature of dispatch, and can down grade once a size up is completed.

However, i do agree with you, if they aren't injured, then you don't need a refusal. don't need a chart. confirm with LE that they aren't injured, so their names go on the LE report as non injured and move on.
Had EMS crews ask me to witness refusals. Arrive at an accident scene, ask drivers if they are hurt. No, ok, sign the refusal. There is no need, THEY ARE NOT HURT.
what do you care? sign the damn paperwork, no need to be a jerk. If they want to write a complete chart, that's their prerogative. put your name and badge number and move on, so they can say they have a witness (even though I try to get a non-LEO be a witness whenever possible, but that's another topic)
Even if they have a visible injury, if you don't touch them, you don't have to do a report and get a refusal. There is no requirement to identify yourself to EMS if they talk to you and you refuse.
Negative ghost rider. If you see a visible injury, and you don't do a chart on them as an injury, than you have failed.

Think of this as the investigation:
Attorney/Supervisor/Dept of Health Investigator: Mr. Rube, was the patient injured?
PhillyRube: He did not complain of any injury
Attorney/Supervisor/Dept of Health Investigator: Sir, that wasn't my question; was he injured?
PhillyRube: He did not complain of any injury when I asked him
Attorney/Supervisor/Dept of Health Investigator: Mr. Rube, multiple witnesses/untrained bystanders state the victim was bleeding, had an obvious arm injury, and was walking around in a daze, with a huge bump on his head. They also said you spoke to said victim briefly, and then walked away without doing anything. So I ask again, why did you fail to even assess this person, that multiple people say was injured?

Regrettably, we must obtain a "release of care" from lift assists and non-injury TAs. It's real easy, get their name and birthday, offer them an evaluation, and have them sign if they say no. Report is only two sentences. If you have a visible injury or complain of anything however, you get an actual refusal done. Obviously if the patient is adamant that you don't assess them that's different but I can't think of a time that anyone said no.
About 10 years ago, I worked for an EMS agency that always did refusals on lift assists, but the in town FD (they sometime performed EMS). So if the request was simply for a life assist, the engine was sent. if the call came in as a fall, an ambulance was sent.

I always followed the rule of "a lift assist is a fall victim," and even if they just need help getting up, a full chart and checking for injuries is done.

a non-injury TC is different; we (EMS) don't go to every TC in our district. That's a law enforcement issue. We go to the ones with injuries, to deal with the injured. So if I (a two person ambulance crew) go to a 4 car fender bender (first person stops, the people behind didn't see him), and all 4 cars have 4 people in them, and only the driver of the first car is injured, am I writing 16 charts? absolutely not; I am writing a chart for the person I assessed. Just the injured people, not everyone.

Is it potentially more liability? I guess in theory..... I mean, if you want to discuss liability, the same argument could be made that EMS should go to every T/C in their district, and get refusals for everyone, just in case.... I would also argue that since you wrote a chart on them, then you have a obligation to complete a full assessment, and document as such, and if you don't, (like that bus accident with 30 kids, for that 4 car fender bender), than the liability is greater if you miss something, because you aren't spending 15 minutes on doing a complete assessment on every patient, even something completely unrelated to the TC vs saying they aren't injured, so you had no obligation to assess them. because they aren't your patient because they have no injuries.
I think there is definitely a liability boogeyman in EMS, but not doing refusals on patients with obvious injuries is...subpar.
agreed
 

Tigger

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Is it potentially more liability? I guess in theory..... I mean, if you want to discuss liability, the same argument could be made that EMS should go to every T/C in their district, and get refusals for everyone, just in case.... I would also argue that since you wrote a chart on them, then you have a obligation to complete a full assessment, and document as such, and if you don't, (like that bus accident with 30 kids, for that 4 car fender bender), than the liability is greater if you miss something, because you aren't spending 15 minutes on doing a complete assessment on every patient, even something completely unrelated to the TC vs saying they aren't injured, so you had no obligation to assess them. because they aren't your patient because they have no injuries.agreed
I think it's a total waste to go about things the way we have to, and we do indeed go to pretty much every TA (silly). These "parties" sign a form stating they were offered an assessment but declined. I think we are relatively protected there, but I am not sure there is much liability in non-injury TAs like our doc thinks.
 

dirtfarmer

Forum Ride Along
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I went out on a ride along (A little farther back) and there was a semi and 2 passenger vehicles involved. They had to extricate one of the drivers (I didn't even see the other car) and the semi went about 40 feet off the road into mud trying to dodge these two cars (apparently).

The driver of the semi was mostly fine, nothing major, but he was shaken about thinking he'd severely injured or killed someone. We'd talked to him and he refused transport.

The other driver couldn't remember much about the incident and had a decent amount of beer cans in the floorboard. He had some pain. He was going to be transported.

We are trying to transport him sooner rather than later and an officer had spoken to the semi driver and apparently convinced him to be transported.

The medics were pretty irritated because they'd already spoken to him and he was "Fine" (Decided on his own to not go, no major obvious injuries) and now they had another person to handle who was less of a priority.

Were they right to be upset (They didn't have a freak out or an argument, more like muttering to themselves)? I think the consensus was that the police had "Overstepped" Their bounds when they already had their hands full.

In my inexperienced opinion, I can see why they'd be upset, but at the same time, see why the police officer would have done so. Some injuries aren't very obvious (Not saying the medics were noobs and I know more than they do), but what would you think of this?
The driver of the semi has a CDL and could be an employee. depending on state it maybe a requirement to get drug and EOH testing asap after involvement with accident.
 

DrParasite

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The driver of the semi has a CDL and could be an employee. depending on state it maybe a requirement to get drug and EOH testing asap after involvement with accident.
and? I am failing to see the coloration....

I don't doubt that the driver will need a drug and ETOH test, and many companies (including many in public safety) require them after any crash.... should it be done at an ER? Meaning, you are going to tie up a bed, or have the guy waiting in triage for hours, and then get a $1200 bill, vs going to Labcorp (or your local drug testing company), paying $200 and being out in like 20 minutes?

Can we agree that if the state or company says he needs a drug and alcohol test after a crash, that he should get it?

Can we also agree that tying up an ambulance, and a hospital bed, dealing with an uninjured person, to complete what is (essentially) an administrative procedure, is an inefficient use of medical resources, as well as an extremely expensive (for someone, whether it be the driver, company or state regulator) way to get a simple piss test completed? And during that ambulances transport (not all of us have 10 minutes transports) of the uninjured driver to an ER, that ambulance is unable to answer any requests for service for people who are actually sick or injured. Can we agree on that?
 

CCCSD

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...”mostly fine, nothing major...” and he doesn’t need a medical evaluation, follow up..? Until you have an MD after your name, NEVER assume.
 

joshrunkle35

Forum Asst. Chief
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...”mostly fine, nothing major...” and he doesn’t need a medical evaluation, follow up..? Until you have an MD after your name, NEVER assume.
Actually, a lot of EMS is based on assumption. We collect data about the patient and then sort through the differential diagnoses for a potential problem, and then assume that the patient has the most likely problem. Occasionally, we choose to rule out something which, if left untreated, could be potentially severe. In this case, we are also making an assumption.

Regardless, if you do not believe in making any assumptions, you should attempt to transport every single patient you encounter. Some people in EMS do this. Other people try to identify and intervene in the potential problem (based on an assumption without a diagnosis), and if they cannot intervene, they transport (or transport is part of the intervention). The difference is that the people who try to transport everything without using any clinical judgement skills are Ambulance Drivers and should be called such. The rest are EMS professionals.
 

DrParasite

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...”mostly fine, nothing major...” and he doesn’t need a medical evaluation, follow up..? Until you have an MD after your name, NEVER assume.
You were a an EMT since the late 70s, and a paramedic in the 80s and early 90s, so I completely understand your points of view; my original EMT class was in the 90s, and I was told the exact same thing. only doctor's diagnose was a common statement (which is crap, as EMT's diagnose patients, and even paramedic lawyers agree that EMTs & Paramedics diagnose), every person with neck and back pain who has a curved spine needs to be strapped to a hard piece of wood or plastic (which we now know is also crap), and NRB's save lives, so regardless of the complaint, everyone gets high flow oxygen, unless they can't tolerate the mask, then they get a N/C (which we discussed on EMTLife in 2011, as well as what is done in class vs real life), because it can't hurt. And our job is to take everyone to the hospital, because we can only do so much in the field. So I get it, old school ways of thinking based on what our instructors told us, and what our old timers told us while we were on the trucks.

It's been 25+ years since you were a paramedic, and I'm guessing almost as long since you have been on an ambulance; things have changed. When are on the ambulance, and you want to transport everyone that is your choice; but when you are wearing a cop uniform, and working full time in LE, and not on an ambulance, it's very likely that you are not up to date with the current EMS literature, current EMS ways of thinking, and current EMS operations That is usually held by the EMS people, as they do this day in and day out. You would get offended if they told you how to do your job, yet, you don't seem to have an issue saying you know how to do their better than they do. But I don't think you are going to change, or admit that you aren't up to date on the latest EMS concepts, so I will wish you good luck in your future endeavours.

BTW, many years ago, I saw an MD clear a patient's C spine. how? he touched their neck, and moved their head, to see where there was pain, and then removed the collar and look them off the board, 2 minutes after we arrived. no Cat scan, no X ray, and all I could think is "wow, why can't we be taught to do that? it looks so simple!" And now look at us: EMS is now starting to clear C-spine in the field, and utilize C spine restrictions with just a collar vs strapping people to a board.
The difference is that the people who try to transport everything without using any clinical judgement skills are Ambulance Drivers and should be called such. The rest are EMS professionals.
You should really rephrase that statement. As a general rule, I transport everyone who wants to be transported. If you call 911 and want to be transported to the ER for BS, than I will do it with a smile on my face. If you are hurt, I am going to recommend you get transported. If you are sick enough to have called 911, I am going to recommend you get transported. However, unless I have a really good reason, I am not going to try to twist anyone's arm to go to the hospital (again, unless I have a really good reason). If you don't want to go, sign here. And if you aren't hurt, or it was a 3rd party caller, or some other weird situation, then you aren't a patient of mine, so I am not going to recommend transport.

Now if you ask me my opinion, I will gladly provide it to you, based on the findings of my assessment. Do I think you need to go? maybe, maybe not. I will always recommend it (mostly for liability reasons, but also because my supervisor makes money on transports, not on refusals), but at the end of the day, it's the patient's decision if they want to go to the hospital, not mine. If they want to go, lets go, if not, well, patients have the right to make stupid decisions about their health.
 

DragonClaw

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Kind of random, but if someone calls 911, you or otherwise, and you give O2 or glucose or even Epi or something, and then they refuse transport, do they still get billed?
 

chriscemt

Forum Lieutenant
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Kind of random, but if someone calls 911, you or otherwise, and you give O2 or glucose or even Epi or something, and then they refuse transport, do they still get billed?
Short answer is yes. Long answer is kinda murky because at a certain point getting billed for something is only relevant for those that pay their bills.
 

DragonClaw

Forum Lieutenant
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Short answer is yes. Long answer is kinda murky because at a certain point getting billed for something is only relevant for those that pay their bills.
How do you know if they've paid their bills? And does that really matter? It's not like you'd arrive to the home of a frequent flyer and say "Sorry man, you're delinquent in your bills. Wish I could help you, but you know. Rules."
 

joshrunkle35

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You should really rephrase that statement. As a general rule, I transport everyone who wants to be transported. If you call 911 and want to be transported to the ER for BS, than I will do it with a smile on my face. If you are hurt, I am going to recommend you get transported. If you are sick enough to have called 911, I am going to recommend you get transported. However, unless I have a really good reason, I am not going to try to twist anyone's arm to go to the hospital (again, unless I have a really good reason). If you don't want to go, sign here. And if you aren't hurt, or it was a 3rd party caller, or some other weird situation, then you aren't a patient of mine, so I am not going to recommend transport.

Now if you ask me my opinion, I will gladly provide it to you, based on the findings of my assessment. Do I think you need to go? maybe, maybe not. I will always recommend it (mostly for liability reasons, but also because my supervisor makes money on transports, not on refusals), but at the end of the day, it's the patient's decision if they want to go to the hospital, not mine. If they want to go, lets go, if not, well, patients have the right to make stupid decisions about their health.
If you start by saying, “XYZ EMS...Are you the person who called? Do you want to go to the hospital?”

If so, you are an Ambulance Driver. You intend to either transport or not transport, and treatment is secondary.

If you start by saying, “XYZ EMS...Hi, I’m [your name here]. I’m a [provider level]. What’s going on? Oh, gosh, sorry to hear that. Let me check you out/ask questions...with what it sounds like, I think you should probably go to the hospital.”

If you do this, transport is an option that it part of your EMS treatment. If so, you are an EMS provider.

In the first example, you are trying to get them to care. In the second example, you are a part of the care team trying to get them access to expanded care levels.
 

DragonClaw

Forum Lieutenant
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If you start by saying, “XYZ EMS...Are you the person who called? Do you want to go to the hospital?”

If so, you are an Ambulance Driver. You intend to either transport or not transport, and treatment is secondary.

If you start by saying, “XYZ EMS...Hi, I’m [your name here]. I’m a [provider level]. What’s going on? Oh, gosh, sorry to hear that. Let me check you out/ask questions...with what it sounds like, I think you should probably go to the hospital.”

If you do this, transport is an option that it part of your EMS treatment. If so, you are an EMS provider.

In the first example, you are trying to get them to care. In the second example, you are a part of the care team trying to get them access to expanded care levels.
I seriously doubt he's showing up and already expecting to transport before even a general impression or primary assessment. Who does that?

I think it's more the latter, erring on the side of caution. Correct me if I'm wrong, Parasite. I mean, if someone is adamant there's something wrong, who am I to say there's not? I can guess, maybe even pretty well, but even if they look fine, vitals are good, there's a lot we can't diagnose or possibly know.
 

DrParasite

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Kind of random, but if someone calls 911, you or otherwise, and you give O2 or glucose or even Epi or something, and then they refuse transport, do they still get billed?
Short answer is, depends on the agency. Longer answer: Some will only bill for ALS post treat refusals, some will only bill for BLS post treat refusals, some don't bill for any thing they don't transport on. It all depends on the individual agency.
 

DrParasite

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If you start by saying, “XYZ EMS...Are you the person who called? Do you want to go to the hospital?”

If so, you are an Ambulance Driver. You intend to either transport or not transport, and treatment is secondary.
To be perfectly honest, it all depends. If I pull up to a scene, and the patient presents with a stab wound to the abdomen, that's pretty much all I am going to ask (might not even bother asking if they are the person who called). I can do most of my assessment and treatment enroute to the hospital. If I have a patient who is in obvious respiratory distress, who is sitting on the porch, same thing; I know my limitations, and unless I can definitively solve the issue on scene (such as a hypoglycemic diabetic), I'm going to start moving towards my truck and not stay and play with a sick patient, who needs more help than prehospital interventions can provide. Can I perform some interventions? sure. Can I perform those interventions on the way to the ER? well, in MICU, M stands for mobile....

We went to an ortho doctors office for a chest pains patient, and instead of it being the patient from the office, it was her 40 something year old husband. He looked like ****. I think I asked him for his name, and his medical history (5 previous MIs), and then said which hospital did he want to go to, and off we went. He needed a cardiologist to evaluate him, and fix the issues, nothing I was going to do was going to have any impact.

If they look sick, I'm going to assume they are sick, and start making my way to the truck.
If you start by saying, “XYZ EMS...Hi, I’m [your name here]. I’m a [provider level]. What’s going on? Oh, gosh, sorry to hear that. Let me check you out/ask questions...with what it sounds like, I think you should probably go to the hospital.”

If you do this, transport is an option that it part of your EMS treatment. If so, you are an EMS provider.
Sure, on a stable patient, absolutely. We can set up camp, ask questions, take our time because the patient is stable, so there is no need to rush. Maybe we do some interventions, maybe they help or maybe they don't. If it takes us longer than 30 minutes to get to the ER, no worries, the patient isn't actively dying.
In the first example, you are trying to get them to care. In the second example, you are a part of the care team trying to get them access to expanded care levels.
Agree to disagree. Just because you are transporting them doesn't mean you aren't still treating and assessing them.

The longer I've been in EMS, the more I realize that there are many situations where nothing I do prehospitally is going to matter in the long term (see the post by @rescue1 in another thread on ALS vs BLS), especially when it comes to time critical stuff. ALS or BLS, it doesn't matter, sometimes the best thing we can do is identify the sick patient, and get them to the hospital so a doctor can work their magic.

I know I might be old school in this regard, but I can perform the bulk of my assessments and interventions in the back of a moving ambulance, driving down to road. Have I told my partner "get me to the ER as fast as you can, I don't care about the bumps just don't crash!" absolutely. On an ambulance going to a sick person call found patient is having a new onset CVA, as we loaded him into the ambulance, started actively seizing, and when we arrived at the ER, put him on the monitor, and guess what, he's having an MI. Would staying and playing have benefited this patient at all? no way.

If that makes me an ambulance driver, because I don't believe in wasting time on scene when dealing with sick patients, when I can't correct those issues on the scene, well, I guess that's what I am. I can live with that.
 

johnrsemt

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With the accident scene with multiple vehicles and few or only 1 patient: my PT job had that problem last week. We had 2 crews/trucks on duty.
Closest backup trucks are 110 miles away (from 2 different directions). Closest hospital is 110 miles away also.

My truck was coming back from a ground transport to a hospital, and was still 95 miles out when the accidents got toned out. All single vehicle accidents: 7 slide offs, and 5 rollovers: in a 150 yards of freeway both directions. Quick hail storm dropped about 2 inches of hail (small stones) speed limit is 80mph, and pretty much everyone that had their cruise set slid or rolled. 19 miles from EMS station, 17 miles from Fire Station. Fire Dept. is First Responders.
Fire gets there 1st, along with PD, and reports to ambulance responding that they seem to have 1 patient that is severely injured; a few others that are shaken up, but all but the one are walking around ok.
Crew gets there in 20 minutes, check out 3, and concentrate on the one that had gone from answering all questions correctly to being confused: BP dropped from 150/80 to 90/50. and HR from 90 to 150. They loaded and headed 40 miles to meet a helicopter.

We increased our returning speed and got there almost an hour later, and all the slide offs were gone, 1 tow service was pulling them out. Rollovers people were gone with the police back to town. 1 guy we talked to said everyone else decided they were seriously hurt after they saw how bad the 1 person was. Which surprised us. We went on to town and talked to the police officer and he said everyone was fine and waiting for rides from family and friends and knew to call 911 if needed.
 
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