I agree. I was flabbergasted at what my pain management doctor did an how he treated this patient I brought to him. that is why I reported him with his refusal to treat the patient initially. thank goodness he relented and treated her appropriately in the end and I have to admit that she was treated very very appropriately and tolerated a very rough ride back to our facility with minimal pain as he wrote orders for pain relief on the trip. If she began to exhibit any pain on the trip back she had orders for meds.
Analgesia does not inhibit or prohibit adequate or accurate evaluation of a patient or a patient's pain. It's discouraging to see from this discussion that there are providers out there, specifically the two docs 1EMT-P encountered, who are unaware of this by both literature and direct practice.
I second Dusts comment - from the grave
But couldn't you call the receiving facility and ask them for orders? Tell them that the wussy doc sending the patient won't give orders and the patient needs them
I'll tell a little story
had a patient, history of brittle bone disease, going on a 2 hour transfer for a pain management consult. 2 lane roads all the way, terribly kept up roads.
Was given a 10mg toradol PO pill and 15mg demerol prior to leaving the sending facility(it was the facility I worked at as a hospital based EMS medic). 1 hour prior to leaving she was given this huge dose of meds
20 minutes into the transfer, the roads get the best of her and she starts to cry out in pain.
we are now out in the boonies, no cell service, we are also in the ambulance with the broken antenna so no radio service.
So I go ahead and work via our standing orders for pain, start an IV, give her 25mcg's of fentanyl and some zofran. that does the trick for about an hour. I then dose her again. All the while trying to make contact with the receiving and the sending hospital with NO luck.
When we get there, the pain management doc goes nuts, he says I specifically said no pain meds on the transfer so I could evaluate her pain when she got here. I told him the road condition and how much she was in pain. He in front of the patient said He didn't care and refused to see her. I told him that he would have to discuss that with her physician and that I would be making a complaint to the Missouri Medical Licensing board for his neglecting to treat the patients pain as well as making a complaint to the STATE. (I did this by the way).
He did agree to treat her now that the pain meds were on board for 2 hours and he said he guesses that he could go ahead and see her since she was here. The patients family was really pissed off at the doctor, and myself and my partner were thanked by the family for making the patient as pain free as possible during the drive.
We transferred her back to our hospital with new pain orders from the pain doctor after he saw what this patient had going on, I wrote all this up in my patient care report. Let my EMS medical director know what happened. Our director of nursing reported me to the State bureau of EMS for prescribing medications without a license (I gave med's based on standing orders - he(nursing director) didn't like that we had standing orders for anything). the state came in, investigated, found me without fault since my medical director backed me and my ED nurse manager and EMS supervisor backed me as well due to radio failure and cellular failure.
I told the director that I could have easily have reported this to the State as well due to the poor medication orders given for this patient as we all know that JCAHO and Nursing care everywhere feels that pain control is the new 5th vital sign.
6 months down the road, there were mass layoff's (firings of 8 ER nurses and 6 paramedics - and I was the first to go on the day of the purge). I know why, but hey, it sometimes sucks to be a patient advocate against such shitty nursing/physician care. Tje state did find out about the failure to treat pain but it was a fall out of the complaint I made against the receiving pain physician and hospital she was transferred to, not the place I worked at but I don't believe my hospital was cited for this situation. I do k now that I had to sit with an investigator and my supervisor for about 2 hours going over my run report and the entire transfer. but the investigator was a nice lady and it wasn't too bad.
I contacted the ED Physician, he said to contact the receiving ED Physician which I did three times. Neither Physician wanted to address this patient’s pain. Their reason was they couldn’t assess her if she was medicated. I explained to the Physicians that the patient was in severe pain and that she needed medicated, when I arrived I spoke with the Chief of Trauma and Anesthsia both of which agreed with me that the patient needed medicated and that the ED Docs were both wrong. The patient was given 100 mcg of Fentanyl IV, 4 mg of Zofran IV and an additional dose of Ketamine
I've been in for thirty years and don't have a degree. I started out as a jolly voli FF who went on to get his EMT-A and then finally his P-card.
When I was working overseas, I met a lot (more than a dozen) people who went to overseas schools and obtained their paramedic "degree" who could quote ad nauseum from their P books, but when it came to actually doing hands on in the field, they couldn't do sh*t. There were even some who didn't even know how to change the regulator on a D tank. Some of these guys went to Aussie universities. Some came here. I even had one "degreed" medic asking me how to operate an EZ-IO in the middle of a code. This was after I had already asked him previously if he had any questions about anything.
Granted, these were foreign medics, and not US medics. But they left a very bad taste in my mouth for anyone who feels that a degree makes them better than me and my education through the School of the Street.
I'm sure that, just like anything else nowadays, a requirement will come out making a degree a requirement. It will somehow translate into a good thing for someone. I don't think that it will for those cash-strapped cities that have a majority of of their population on welfare and don't have the economic base to afford a degreed staff, or the rural areas that have no cash base due to being farming areas that have no major industrial tax base. You get away from the urban areas, and the majority of the services are volunteer or paid-on-call. How could they afford these people? The money needs to come from somewhere. How do you pay more, if you can't even afford the basics. Literally.
Just my old, crotchety, non-degreed, two cents worth. 😉😎