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paramedicmike

Would you stop?

189 posts in this topic

You don't stop, period. No discussion necessary. 8 pages...Whew!! :wink:

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That's how every place I've ever worked at operated. The only time we actually stopped was when my idiot partner nailed someone at an intersection. Any other time, you call it in and keep driving. I feel you are obligated to. But I guess thats just me.

I never said ALS couldn't hand off a BLS pt. That was my point. Transfer to EQUAL or greater medical authority. You could certainly do that.

In New Jersey, we weren't allowed to split, like someone else mentioned, I think from Texas. If we had two ALS pt's, you could begin treatment but you had to call a second ALS unit and transfer to them when they got on scene.

Since you're not allowed to split crews (which would in effect give you two ALS trucks). The only problem is that how can a Paramedic (even if they're only working at BLS level) pass off a pt to a BLS crew?

It's stated in my state protocols that patient care can only be transferred to someone of EQUAL OR HIGHER licensure.

I notice that the parameters that govern the transfer of patient care do not specify or make allowances/exceptions for the level of care given at the time of transfer.

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If I read this correctly, you're saying that the police officer on scene cancelled the responding EMS unit prior to patient contact. I don't see anything legally wrong with that. If anything serious goes down, it all falls on the police officer for cancelling. Am I agreeing with you? I can't tell your stance on the issue from this post.
Yes, that's what happened and the FD was sued, because they took the officer's word. I don't know if I'm forgetting any other details...maybe the officer wasn't the one who originally called. The learning point from the story for us, though, was that they could be successfully sued because they canceled without evaluating the patient and prior to patient contact.

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I never said ALS couldn't hand off a BLS pt. That was my point. Transfer to EQUAL or greater medical authority. You could certainly do that.

Maybe we are running into an issue of semantics. I will attempt to clarify...

An ALS crew assesses (whatever XYZ complaint you can think of) as being within the scope of a BLS provider to take care of. Are you then allowed to transfer care to a BLS ambulance crew? Is the "equal or greater medical authority" mean you as an ALS provider see the patient as? Or is it a "first contact happens to be ALS so regardless of the complaint, I have to hand this patient off to an ALS or ALS+ provider"?

If your system works in a "BLS complaint but ALS first contact, therefore ALS all the way to transfer to the hospital", then that's fine. I disagree with it. I don't think that is an adequate use of resources. But again, I work in a more subjective system.As long as there isn't an active or anticipated ALS treatment plan by an ALS provider, that a BLS provider can't provide, they can be handed off to a BLS provider.

You can quote me on that last one. And of course I'm not talking about a CP that an ALS car is treating as ischemic (when a BLS car can as well), I'm saying a generally benign call.

I don't equate "abandonment" to stopping on accident/flagged down scenes as long as it is reasonable and rational. As long as you are not leaving the patient alone in the back of the ambulance, and as long as your delay will not impede them getting to hospital where emergent tx is needed (in your subjective opinion), I don't necessarily see an issue in stopping.

The whole "stopping is wrong" thing (believe it or not) actually can be a subjective issue. But again, I don't come from a PROTOCOL, PROTOCOL, PROTOCOL, driven system...Guidelines aren't cut and dry...

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Yes, that's what happened and the FD was sued, because they took the officer's word. I don't know if I'm forgetting any other details...maybe the officer wasn't the one who originally called. The learning point from the story for us, though, was that they could be successfully sued because they canceled without evaluating the patient and prior to patient contact.

There is a difference between being cancelled by PD and cancelling yourself because you think the call is b.s. I would never cancel myself!

In the case I stated, the person was arrested and was under the custody of the police officer. If anything happened on his watch, he was responsible.

There have been situations where I've been toned out for motor vehicle collisions with minor injuries, and we would sometimes be cancelled prior to arrival by PD. PD then has to get an RMA ( refusal of medial attention) from the injured person. I know that police filling out RMA's isn't the case in most places. I acknowledge that I'm lucky.

This is an interesting topic and obviously not one that the original thread intended. Has EMS unit cancellations been discussed elsewhere?

Another possible scenario, a BLS unit cancels ALS prior to ALS's patient contact. Is the ALS unit responsible for the patient's outcome if they were cancelled by BLS as they were arriving at the driveway? Wouldn't it be the same as the PD situation ( where PD usually has first responder training and BLS has higher medical training) ?

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Might be. I think the idea is a police officer isn't qualified to decide whether cancellation is needed, he has limited first aid. First responder at best, usually, but most are not even that. I've been through their class. It's very narrow training, CPR, rescue breathing, choking, and GSW procedures, at least where I took it.

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Stirring the pot a bit more, I seem to remember that, per my instructor/co-ordinators at the FDNY EMS Academy, if a crew feels physically threatened after patient contact is initiated, if they leave until the LEOs can restore some semblance of order, and then resume care, they will not be charged with patient abandonment.

I won't make any examples at this time.

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Since you're not allowed to split crews (which would in effect give you two ALS trucks). The only problem is that how can a Paramedic (even if they're only working at BLS level) pass off a pt to a BLS crew?

It's stated in my state protocols that patient care can only be transferred to someone of EQUAL OR HIGHER licensure.

I notice that the parameters that govern the transfer of patient care do not specify or make allowances/exceptions for the level of care given at the time of transfer.

In New Jersey, you could not split. They eventually allowed it under extreme circumstances. IE, accident scene with 2 ALS patients and the second medic unit is 20 minutes away, while the helicopter is 10 minutes away. You cannot operate an ALS unit without two certified paramedics on board. If you did split, I guess technically, you were operating as two units, however, you could stop at another call and treat someone, or just take it upon yourself to start treating a second patient. Especially while enroute to the hospital. You requested a second unit.

On the other note, ALS could in fact hand off a patient to BLS. We were allowed to evaluate the patient fully. We called medical control and informed them that we felt our services were not required. We gave them a full history and report. Either they agreed and BLS transported and we went available, or they disagreed and told us to treat with the IV of life. They called that Triaged to BLS or SNR. (Services not rendered.) Example would be when the local dispatcher calls us for a stroke and it turns out to be a 21 year old with a headache. We could evaluate and traige back to BLS provided everything came back okay during our assessment.

If you were treating an ALS patient, you could only transfer to another medic unit or a registered nurse at the ED.

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Absolutely not.

If you have a Pt. in the compartment, or are on your way to a call, (not including sick-calls or priority 2,) you are obligated by law and SOP to continue providing care to YOUR Pt., else it's considered a form of abandonment.

You raise EOC and inform them that a MVA occurred, and give exact location.

No grey areas, or else you get your company sued.

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If you have a Pt. in the compartment, or are on your way to a call, (not including sick-calls or priority 2,) you are obligated by law and SOP to continue providing care to YOUR Pt., else it's considered a form of abandonment.

Actually, you're wrong. Once you're dispatched to any call, regardless of priority you are committed to that call until rerouted by dispatch. If you don't continue to the call, you have abandoned your patient...even though it may be a low priority patient.

Shane

NREMT-P

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