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Would you stop?


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#61 tskstorm

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Posted 16 July 2007 - 08:35 PM

So you roll up to an MVA, unknown number of patients, unknown cause, unknown everything.

Hop out of your ambulance grab your stuff, get to the car, you find a male conscious but pinned in by the steering wheel. Vital signs are stable 120/80, 80 bpm, 18 resp reg, ctc normal normal normal, A+0 x 3, GCS of 15, NO C.C. So now this is your patient that your committed too right?

What about the 9 month old who was ejected through the windshield hit the asphalt, rolled into a ditch, vital signs of 70/30, 40 bpm, 8 resp labored, ctc cool pale sweaty, unresponsive, GCS of 8 So i guess we leave this patient at the scene ? and just concentrate on the 30 year old male, because thats our patient we committed too ?


Thats what I'm getting from all of you, once your committed to a patient you can't help any other patient regardless of they're status or priority. We don't triage anymore huh ? Although I might be on a fine line, Once an MVA is witnessed there are 2 patients the one in the back, and the one in the MVA, don't we have a responsibility, to triage, and stabilize all patients while waiting on another unit to back you up and transport 1 patient while we transport the other ?


Duty to Act
In some situations, EMT-Bs have a duty to act. Often
this duty is very clear, such as when you are riding
an ambulance dispatched to a call. Other times—
such as when you are off-duty in another ambulance
district—you may not have a legal duty to act, but
you may be morally obligated to provide care or take
action until EMS arrives. In most cases, for both legal
and moral reasons, it is better to provide care than
not to.

Brady sample chapters online http://www.bradybook.../0130945595.pdf

Also from brady

Abandonment and Negligence
Te rminating care of a patient without making sure the
patient is in the hands of a provider at the same or
higher level of training is considered abandonment.
Negligence is deviation from the accepted standard
of care that results in injury to a patient. There
are four components to a successful negligence action
or lawsuit:
*The EMT-B had a duty to act. This means that the
E M T-B was in a situation through employment,
position in a volunteer squad, or other position
in which the EMT-B is re q u i red to provide care
and . . .
* The EMT-B breached, or failed to perform, that
duty and . . .
* Injuries, which may be physical or psychological,
or damages were inflicted and . . .
* The actions or lack of action caused the injury or
damage.

Another sample http://books.google....IwbiI#PPT121,M1

Read the medical ethics/ legal chapter, while your reading duty to act don't skip negligence. While The arguments here by most is that it is negligent to stop, I think its negligent, and patient abandonment to not stop.
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#62 Ruffmeister Paramedic

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Posted 16 July 2007 - 08:46 PM

I had this exact same situation about 10 years ago.

Picked up a 20 year old woman who fell and sprained her ankle(whine factor of 10/10).

Put her in the unit with my emt attending to her

We drove up on a terrible wreck. Full size pickup into a small toyota cellica at Highway speeds. the celica was crossing the NB highway to get to the SB part of the divided highway.

1 doa in the passenger seat of the toyota(massive open head trauma). 1 critical in the drivers seat
In the truck there was a unconscious male who had suffered massive trauma by not being seat belted.

We radioed dispatch and requested an additional ambulance and fire for extrication as well as a helicopter.

I triaged the passenger and the driver of the truck as black and began to work on the only live guy there.

Our protocols never addressed this type of incident because our unit was the only unit on in the county until a back up crew could be called in and to get the 2nd unit to the scene could take 20-50 minuted due to the winding roads and distance from the station for some calls. So our mandate was to stop and render assistance as long as the patient in the back was being cared for. We really didn't have much choice in the matter.

So before we all say that you are negligent in stopping, put yourself in my shoes at the time of the accident we stopped at. Sure we could have stopped but we were there and it's damned if you stop and damned if you don't

Just for reference, where we were at the first ambulance to get to me after the initial call was 42 minutes. The helicopter was already landed at the time the ambulance got there.
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#63 AnthonyM83

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Posted 16 July 2007 - 09:33 PM

My protocols don't cover an issue that should be common sense. I don't stop nor will I stop if I am occupied. If that was my kid I would sue everyone involved for delaying treatment and transportation thats abandonment. Then I would sue for putting me and my family in jeopardy. Thats negligence, and I would win, protocols or no protocols.

In California, violating protocols, would be against state law. If I had special circumstances, that'd be fine. This scenario would not qualify, as it's exactly what the protocols would have been created for.

Also, my understanding of abandonment is that you must have a duty to act. If protocols say you have a duty to stop (I know yours don't, but you originally said you would keep going even if protocols told you to stop), and then you don't, you're getting into abandonment of driver of the accident.

My whole point is that it might not be 100% clear-cut and it's not a whacker issue.
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#64 Richard B the EMT

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Posted 16 July 2007 - 11:05 PM

I just spoke to one of the paramedics working as a "telemitrist" (in-house title) at FDNY EMS Telemetry Control, which is our On-Line Medical Control office.
In the scenario of carrying a patient, but coming up on a vehicle accident, as per both FDNY and New York State DoH rules, regulations, and protocols (specific passages not noted), an FDNY EMS ambulance WOULD be obligated to stop and investigate, as well as advising the Emergency Medical Dispatch office by radio that they were doing so, and request another ambulance be started out for the MVA (MVC in some areas). 1/2 the crew could initiate care on the scene, the other could continue care of the original patient, while awaiting the second ambulance.
Admittedly, I didn't mention the other stuff from the string, that of the person in the car waving a gun around at the crew, or the shootout that followed, to the telemitrist.
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#65 tskstorm

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Posted 16 July 2007 - 11:57 PM

Admittedly, I didn't mention the other stuff from the string, that of the person in the car waving a gun around at the crew, or the shootout that followed, to the telemitrist.


All that stuff is irrelevant, how was the paramedic driving supposed to know the guy was going to pull the gun ?
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