reaper

OK, answer this then:

Why isnt there any lividity in the leg/foot that is hanging off the bed ? If blood has started pooling in one spot in the patient's back, why isnt it pooling in the lowest hanging part of the body as well ---- Oh i know, right after he arrested, all the blood in that leg rushed to that one spot in the back.

DDDDUUUUUUUUUUUUUUUUHHHHHHHHHHHHHHH !!!!!!!!!!!!

I checked for rigor, there is no rigor. The pt brother arrives on scene and says I don't want anything done for him, Your not going to take him and do cpr. So My partner talks to him. The pt has no dnr and the brother doesn't have power of attorney. I put the monitor on and its asystole in all three leads. The pt is warm to the touch. My partner and I roll the pt to check for lividity, there is a tiny tiny amount starting between his shoulder blades, and some minor mottleing, on his leg that was hanging off his bed.

Are you reading any of these posts? :shock:

How are statistics preventing it?

We deal with pt care in the car, while FD extricates.

For other rescues, we all share them. If it is a High angle rescue and the pt is injured, then I am usually the first one down to them. While I provide care, FD will set up for retrieval.

We happen to have a great county ERT team involving EMS,FD,and SO. We have different specialized teams and they will be called out as needed.

Because the pt knew you would think it was a bruise and try to resurrect him?

And the point of all of this is?

We could look at every profession and find the same.

How many:

LEO crashes

Bus driver crashes

Trucking crashes

FD crashes

The list could go on and on.

If you drive in any profession there will be crashes. IT happens! :roll:

I would have worked it, you have no legal standing not too. For all you know, brother has been pumping him full of antifreeze for the past several days.

You did not mention the patient's age ????

How about signs of death? :roll:

Yeah, I noticed that!

Guess he thinks that none of us can drive?

She wanted to flirt with the medics? :wink:

no offence bro, but what they do for their bread doesn't change my treatment. treating hem diferently is asking to make a stuff up. if they want to refuse treatment thats fine, but after i do my job. no matter how "tough" these "real men" are, i bet they'll have no quamls about suing anyone who treats them "differently" and misses an injury.

It should not change your treatment! It should change your approach to that treatment.

Like I stated before, if this was a professional rodeo, being sued would be the least of my worries! Real cowboys don't follow the "sue everybody mentality"!

The problem is where you are at. Rodeo in Aussie land is still considered back woods and have not been setup in a professional matter.

Here in the states you do have your little backwoods rodeos that are a joke. The Pro rodeos are all governed by the PRCA and have rules they must follow. Medical care is a high priority for them.

Riders are in a whole different world, to any pt you have had to deal with. The pros do this for a living and know their bodies and the problems they have. These guys walk around with injuries and pain that would put a normal person in the ICU. This is just a way of life for them. Most medical providers do not know how to deal with them, so they get frustrated. I rode pro for 17 years, so I know how to relate to these Pt's. It just takes a way of reasoning with them, to get them to understand.

Hopefully one day, you will get to work a real rodeo and you will see how fun they can be to work at. You just can't expect to treat them like regular Pt's!

I can feel the slide already! :shock:

Why all the secrecy? Do you not work for a county service? If so, your protocols should be public knowledge and full access!

Sounds to me that there needs to be some changes in the way your county manages EMS!

I work a county with a population of over 500k. We run between 15-19 trucks. We do not deny transport to anyone and still manage to cover the county just fine.

For what you have described as your "guidelines" on this. There is no way I would be caught dead, tied up in that system. Because when the poop hits the rotors, everyone is going to get hit by it!

I hope their was sarcasm in that post, somewhere!

A problem with claiming asystole as a reason for not working a patient is under current ACLS guidelines, which many protocols use, asystole is to be worked. You do not shock it but you do CPR, EPI, etc.

If this patients relative that has not seen her for 75 years comes out of the woodwork and takes you to court and you say only sign of death was no pulse and asystole on monitor you just lost as current guidelines say work it.

Some services no longer print a strip because asystole is not criteria that counts as death.

?Do I agree? No but that is what is considered standard of care in court so better make sure you meet standard of care.

Each service should have a set protocol in place. Not all MD's follow ACLS guidelines. They are just that "Guidelines", they are not set in stone standard of care. There are many MD's that will adjust protocols a little here and there.

Ours states, downtime of 10 minutes or more, without CPR being preformed PTA and asystole on the monitor. We do not have to work them. This is for witnessed arrest, where down time is verified. If down time is unknown, they we look for other signs of death.

This has been the standard at the last 3 services I have worked at, in two different states.

I have my protocols and my MD behind my decision not to work it. I am pretty well covered there!

I always stay calm on a call. My old partner used to make fun of me, because she thought nothing affected me.

Then she picked up on a tick that I have. We could have the worst call and I was as calm as could be, just doing the job. Then she noticed my right leg shaking. So from then on, she knew a call was serious if she saw the leg shaking.

I guess all my adrenaline just pools in that leg! The rest of me is as cool as ice and my right leg will be going 90 mph.

Dang I think he is close to what I ran last month!

Asystole on the monitor in 3 leads, not witnessed arrest, no CPR in progress prior to arrival, and down for 10 minutes. = NOT WORKED!

Only in my mind!

Does that count? :shock:

Ok, I do not agree with having a supervisor overseeing my refusals. I always try and talk pt's into going to the ED, if they need to.

On that note. The last service I worked did have a slightly different refusal policy. Any refusal we did, we had to call a supervisor or dispatch on the radio. We would them switch over to an extra tac channel we had and we would give them a refusal report over the radio.

This was not asking for permission to refuse that pt and the supervisor never talked to the pt. All this was for was to have a recorded record of the report for liability reasons. The only reason we would call a supervisor is so they could acknowledge hearing the report clearly.

I had no problem with that system, as it did CYA. If a question came up, they could pull the tape on it.

Are you saying that in all of 2008, your service has not had a single patient death from someone who "refused" EMS transport ? And all I can do is use logic and reasoning as EMS is not required to report these incidents like hospitals are, so there are no "real statistics to use", but if you google phrases like

EMTs blamed for death

Paramedics blamed for death

EMS sued over patient death

You will see this is not an isolated problem, but in your heart you already know that, as everyone in this room has heard a story about a similar call in their region (if not their service).

Those are the key words there. Someone is always going to try and lay the blame on someone else. The pt may have refused AMA. Then they die! Of course the family is going to try and blame the last people to examine them. This does not mean that the provider did anything wrong or negligent. That is just human nature, to blame someone else for the problem.

That is right. The medic on scene is in charge and does not need someone to look after them.

There are plenty of supervisors in EMS that are great supervisors. This does not mean they are better medics then the one on the truck. Hell, some are poor medics, but good at management!

What makes you think that a supervisor is any better of a medic then the one on scene?

This is the most ludicrous idea I have heard in a while.

I guess we need to hire a supervisor for every truck! :roll:

It just blows me away that RN instructors can teach this program when very, very few have ever actually run a code nor ever intubated anyone ... sheesh.

Flash box ? Funny thing that's a BLS skill set ? I even had one bystander tell me we were not following 30:2 with an intubated patient ... hmmmm.

Last course I was on a senario was presented ... Pulmonary Emboli .. The RN instructor told the student that "Coarse Rhonchi" heard over the affected side .. I quietly protested to the MD oveseer and it was never corrected ..... OMG shock and awe.

Because they set the standards ?

cheers

We should be pushing for better standards in medicine. This is not just a Paramedic problem. I have been in ACLS and PALS classes with Rn's and Dr's that had no clue what was going on. This is something that should be pushed in all the fields.