medicgirl05

First of all, yes I am still employed. Probably because I am one of the only 2 medics they have right now. High employee turnover...wonder why?

I am unsure why we are comparing my situation to that of an emergency call. I think they are two completely different things. If this same scenario had presented as emergent I definetely would have done something different. Also, as I mentioned it was not the patients fault that she had a medical condition causing her to be so heavy and neither is it my fault. I did not refuse her because she was "too fat" but because it was unsafe to transport her.

This is the first transfer I have EVER refused so it isn't like I look for excuses to not do my job. In fact, we stayed at the hospital trying to find an alternative for the patient for an hour and a half. Much longer than the actual transport would have taken.

I also don't like the innuendo that I am giving false information. I do however appreciate the input.

I understand that the risk of a wreck may be low....Do you understand what would happen if there was a wreck? Even a small one? Any idea what I could lose?

Welcome to the City!

We recently had a similar thread that can be found under the category of EMS News. It is called "job interview." There is some great advice there.

My personal experience has been more of a moral/ethical line of questiong...Questions such as-What would you do if your partner was stealing? What would you do if you had a problem with a fellow employee? Do you think it is right to take home a company pen? Those sorts of question...I have also been asked about med doses such as glucose, nitro, and aspirin.

Good luck to you!

I personally think I would have called the supervisor back and had them come to the scene, show them the size of the ambulance etc. If they still want to do the transfer let them take responsibility for the call. I'll drive their truck and they can sit in the back.

This company isn't like a typical private service. It is run by a family and my "boss" dispatches calls to us while doing her normal everyday things. I did measure and the patient width and the clearance of the truck and report that back to her.

Well, I am scheduled to work there tomorrow so we shall see if I still have a job when I show up in the morning. Thanks for all the input!

Wow. Makes me wonder if I have presented myself in a professional light. Thanks for sharing!

Good luck in Mongolia!

The solution was for the service that has transported the patient before to do it again approximately 12 hours after I refused. That was planned before we left. There were a few other factors which I didn't seem relevant to the initial post. One of which was that the receiving facility was holding people over causing them to have OT and wanted things to be done in a hurry. I told my boss I would do the transfer if I could remove the stretcher brackets and she refused. I called her 3 times about it BEFORE I refused transport.

I appreciate the input.

usa, i guess you will never transport another patient then, as their is always the chance of an MVC involving the ambulance. I guess you will never start another IV due to the possibility of infiltration. I guess you will never administer another drug because you may overdose the patient. I guess you will never use a stairchair, as it is too dangerous to transport patients up and down steps. I guess you will never work a wreck in the roadway as there is the chance you could be hit by a car.

So lets put this in a way that even you can understand. Lets change this patients location to her home, and she has just called 911 for chest pain. Are you going to leave her there until the bariatric ambulance can come the next day ? If it is unsafe to transport her non-emergency to a bariatric facility, how is it safe today to transport her to a hospital facility, just because she called 911. Same ambulance, same crew, what you gonna do for her ?

I think an emergency situation would be much different. I do know that she was not going to recieve any treatment in the receiving facility that could not have been done in the hospital.

Patients who weigh in excess of 700lbs pretty much have to be transported on the floor of the ambulance, in most parts of this country, unless you are going to advocate loading them onto an open-bed wrecker somehow. It is obvious that you have never handled this type of transport, so please withhold your opinion when you have no clue what you are talking about.

And yes I read that the OP said the supervisor refused to let them remove the stretcher gear, but I doubt that is the way it really happened. And how do you think the patient felt, when she was refused transport because she is too fat.

Actually that is the complete truth. I have removed the floor brackets at my job working 911 and I know it is not difficult. My boss at the private service did not want them removed because that ambulance was the only one that was not at the mechanic and she was concerned that we would not be able to get the brackets placed correctly right away.

Just for clarification, the patient was large due to a medical illness. It had nothing to do with her being "too fat."

I found myself stuck in an interesting scenario and am curious how others would have handled a similar situation.

I was working for a private transfer service and my supervisor called and told me to take the stretcher out of the truck before heading to a local hospital for a transfer. She said the patient wighed more than our stretcher allowed so we would be transporting her on the hospital provided mattress. She advised that the hospital would provide the man power needed to get the patient in the ambulance and the receiving facility would help get the patient out. From the beginning I was not comfortable with this but I decided to go with it. When we got to the floor I went to see the patient before accepting care of the patient. The patient was very wide on the bottom half. I asked my supervisor if we could remove the stretcher brackets, but she said no. I asked the patient if she could tolerate laying on her side, she said no. I went and measured the ambulance and the patient and the patient was about 6 inches too wide. We talked about using pillows to prevent the stretcher mount from injuirng her and she was very willing to do that. Then we discussed getting her in the ambulance with the mount in the way. She said it wasn't an issue for the other private service to transfer her as they just slid her in. Hospital staff advised that service was unable to tranport her today but would have a unit in the morning. I refused the transfer for multiple reasons. I did not want the liability of the transfer. I was genuinely afraid of injuring the patient. The patient was being transferred to a rehab center so there was no issue of her not getting the level of care needed. I decided that waiting for an ambulance service better able to serve was the best thing for the patient. My supervisor was not happy, obviously. I am curious as to what others think? Suggestions for the future?

I keep cinnamon flavored gun and chewing it usually distracts from smells. Only one situation that didn't work and I used Vicks. Old guy laying in the contents of his colostemy bag for at least three days in the TX summer with the HEATER on! It was horribly rank.

You're local ERs suck.

No argument there. Most of the ER docs are rent a docs. When we fly out multi system trauma pain management is one of the first things dealt with. If we don't medicate the flight crew will so we figure why wait for their arrival. Only pain med we currently carry is Morphine. We had been using Nubain but it got removed after multiple ass chewings from ER docs. We are currently rewriting protocols to carry Toradol. Unfortunately my supervisor is more of the opinion that less intervention is better, so we don't carry many pain meds..

Why are your protocols written like that, have you researched the rational?

The exception to the abdominal pain is if we are fairly sure of what is causing the pain. For example, someone with previous history of kidney stones and no recent trauma we could medicate. None of the local ER's approve of medicating abdominal pain because they say it interferes with their exam. Other than that I haven't researched it much. On a patient by patient basis I can do pretty much what I want with online medical control so I don't worry much about the protocols, as trying to change such things are like pulling teeth around here!

Also how does the clinicals defer from riding the bus?

When you are doing clinicals you have more knowledge than riding the truck as a basic. You also have more skills you are able to perform. The entire thinking process from a Basic to a Paramedic changes because of all the new things wyou are able to do. So in my opinion, clinical time is much more valuable than working as a basic. Plus as a clinical student you are supervised so you have the freedom to make your own calls but you have the safety net of someone who can guide you.

Edited due to posting issues.

Our protocols don't allow for pain management if there is an altered level of consciousness or for abdominal pain. Other than that we are pretty much allowed to medicate what we choose. We also have great medical directors who are always a phone call away, so if I am unsure if I can medicate I can make a phone call. She usually lets me do what I think is right.

I did medicate a bilateral calcaneous fracture with a pelvic fracture that the nurses gave me some grief about, but I stand by the desicion. If my patient is in pain and I can fix it I am going to try!

Is he on meds to prevent the SVT? We have a pre-teen patient who has episodes of SVT when she is noncompliant with her meds due to family that would rather smoke coarettes than buy her the meds. Her SVT always happens around 7PM which I've never thought about before...She is otherwise asymptomatic. Complains of her chest feeling "funny" but denies pain. I'm wondering if it may be a similar situation?

Is he on meds to prevent the SVT? We have a pre-teen patient who has episodes of SVT when she is noncompliant with her meds due to family that would rather smoke coarettes than buy her the meds. Her SVT always happens around 7PM which I've never thought about before...She is otherwise asymptomatic. Complains of her chest feeling "funny" but denies pain. I'm wondering if it may be a similar situation?

Usually in the summer months we try to keep some gatorade in the truck for hydration, especially lately with all the fire standbys we have been going to. It is pretty funny that here we try to find snacks that no one else will eat. Mostly if you keep fruit or yogurt you are in the clear, but if you keep cookies or something yummy everyone else will help themselves.

It's hard when someone's loved one dies of apparent natural causes, but when we choose not to work a suicide their emotions are doubly or triply (not sure if that a word or not) screwed as they get to add the, 'what did I do so wrong as to make them kill themselves' to the 'how did I not see this coming!' thoughts and then churn it up with their grieving.

Yes. I have been to many suicides, as both a basic and a medic, and it still amazes me the extremes of emotion that are experienced by family. People react very differently and you just never know how the conversation will go.

But patient wise, though I don't have a particular moment in mind, it would have to be while explaining to the family of a patient that I've chosen not to 'work' (is that like saying 'breathing treatment?') that their loved one is dead, and beyond any help that anyone can provide.

Edited for spelling only.

I believe this is the absolute hardest thing I have had to do. It is a balancing act to keep you emotions where they need to be. These moments are what stick in my mind from such calls. Plus I was never really prepared for how to do it, and it hasn't gotten any easier with experience.

The example that comes to mind is dehydration. Symptoms of dehydration are tachycardia and hypotension. I'm sure there are more examples but this is all that pops into my mind.

Yeah, depending on the arrhythmia and if you know what you're listening for. It's way easier to EKG that stuff, though.

This being said, why would you want to do listen for an arrhythmia? If a patient has an arrhythmia, you should be hooking them up and getting them ready for a shock (not sitting and listening for abnormalities in their heart beat). If you don't have a defibrillator, you probably should be doing compressions, not listening for abnormalities in their heart beat.

So yes, theoretically you can, although there's no practical reason to do this.

EDIT: Grammar.

Do you know the definition of arrhhythmia SD? Any abnormal heart rhythm. Don't chew the poor kid out for wanting to listen to them...I have never shocked or done compressions on many arrhythmias; including A-fib and the occasional PVC.

Nerd-yes occasionally you can hear an arrhythmia. A-fib has an irregular beat which you can usually hear. Now I wouldn't document an irregular rhythm from auscultation, as I don't know how precise it would be without special training.

The only dumb question is the one that goes unasked.

Yeah, that's something I always thought was crazy about most scenarios in school. If your patient appears fine, they are going to die no matter what you do, and if they are certainly going to die, your miracle intervention saves them. In my experience nearly all of our really critical patients fall somewhere in the middle and end up being a balancing act.

Sounds like a tough call...

Dwayne

All the scenarios I ran in school the patient either was fixed after 2 or 3 interventions or they died. I never thought I would work so hard on a patient for nothing... They just don't tell you about the hard parts, or maybe I missed that particular class...

I recently had a patient that we eneded up defibrillating 14 times. V-fib over and over again. Used all my available meds. Treatment and transport time was one hour and a half and we got a pulse back once. I was so sick of V-fib that I pleaded for a different rhythmof any type. We finally got a PEA at a rate of about 30. They called her after twenty more minutes in the ER. She was STILL in PEA. They never EVER told me of any such scenario in school. It got to the point where my partner and I were completely out of ideas and all we could do was CPR. ER doc had never seen such a persistent V-fib either.

You'd just better be damn sure you know what you're doing. You will never have any credibility again if you pull that stunt and you're wrong. Plus you'll have to live with yourself after.

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Exactly! That's why I can't do it as often as I'd like! :-)

Hi Grady! I'm also from Texas. Gotta love it! :-)

I'm curious, do you already have work lined out, my curiosity is because I am currently exploring the idea of working overseas/offshore and all the companies I've looked at require experience at the paramedic level....What company are you going with? Thanks!

I know how frustrating such a situation is...

I get very agitated when a patient has the nerve to say "I only called y'all so I don't have to wait to be seen". I, however, don't change my treatment of said patient other than when we get to the ER I may kindly inform the nursing staff the patient could be triaged before room assignment...They usually get the hint that the patient isn't "emergent" but that lets them make the final determination if the patient can be sent to the waiting room. Most of the nurses we deal with on a regular basis will proceed to tell the patient the purpose of 911 and EMS, clearing us from getting dinged with "refusing to transport."

The bad part-patients who do not need ambulances are the majority of our calls, so I've pretty much just learned to deal with it. Only time it really sucks is when both of our ambulances are on BS calls and something serious gets toned out. It takes an hour for mutual aid to respond to our county; and a typical call for us, with transport times, takes 2 hours...

I think one of the most important things I had when I started off was a list of all the area ER codes. When I started it seemed as though everyone just assumed I knew the codes and were frustrated when I asked. We have 5 ER's that we go to and every one has a different code.

When I started I carried all sorts of things...Now I carry trauma shears, a field guide, and pens. I find that pretty much does the trick for me.