sevenball

We might be getting away from the original question. I think we all agree that to avoid litigation, we should be obtaining signed refusals. My question was, do YOU think it's right if there are no injuries. Not so much "do you think you should document the call?" or "to CYA, should you get a refusal?", but, do you believe that you should have to get a signature if the patient does not have any complaints. Documentation aside, what is your person feelings on the matter. If your service told you tomorrow that it is completely up to you if you want to obtain signatures for refusals, as long as there are no injuries, would you?

Capman, My apologies, when I said "upon your assessment" I meant the assessment of the situation, not the patient. What I should have said was upon your assessment of the scene, and further interviewing the individuals involved, all people claim no injuries, not requesting your services. It's my belief that if you document it as such, there is no liability in that. That being said, I stated before that my particular service shows some leniency in situations like this, but would like to see a refusal signed for every contact. I agree with an earlier post that if you play this game, then you best know beyond a shodow of a doubt, that there is no injuries for sure. In that, I mean the tiny fender bender, all parties ambulatory, clearly no problems. Obviously, if there is any significant mechanism involved, or if something just doesn't settle with you, you want to cover yourself.

there is a difference between getting a signature, and documenting your findings. I'd agree that if you're going to write a good report, it's just as easy to get a signature. Every refusal, regardless of whether or not you got a signature or not, should have superior documentation. However, in the event that you use an electronic PCR, it becomes a gigantic hassle to open up new reports for every patient just to gain a signature. It is far easier to clear with no EMS, and write your report later with your findings.

One of the problems with forums is the inability to look at someones face and hear the inflection in their voices. This line here, if lent to my own interpretation, sounds like you were getting a little heated. If that was not your intention, my apologies. I will give up my first born for reperations. You're correct in saying that I do not intend on using this information to battle my management, I was just curious to see what the rest of the community thought on the situation. Even if I force myself to agree with you, I'd respect yours, and everyone elses opinion regardless on which side of the fence you sit on. Given my earlier posting of the definition of a patient, I believe, that if you don't complain of anything, you aren't a patient at all. If that were the case, I would have to obtain a refusal from everyone I met on the street when I aske them "how are you today?" and they reply, " Crappy, I twisted my ankle a couple of minutes ago". By definition, I have made contact with a pt., even if they say "but I'm fine now, I have no pain".

Don't make this personal Ruff, it was simply a question of opinion. To answer your first question, my service allows flexibilty depending on the situation. As long as there is a piece of paperwork generated to prove that we responded, that is what they require. What they would like to see done is a refusal for every pt. contact, that is what I do, obtain a refusal for every pt. contact. My own opinion on the matter is that if there is no injury, there is no pt. HOWEVER! in this highly litigious society, it would be a risky venture to navigate that tightrope. In the interest of my own career, my opinion is to obtain a refusal, even if in my heart of hearts, I don't even agree with myself.

bus filled with people on their way back from some sight seeing trip. That do gooder bystander sees them involved in a minor... very minor MVC, calls because it's "the right thing to do". Should you get refusals from all of them if there isn't a single injury?

yes, I understand that each service is different, and each service will have their own set of rules, policies and guidlines. I already know what my service has to say on the matter. I was just asking the question for a general opinion on the matter, not as a rule that would dictate my own actions in the field. I am simply curious to see who's opinions match my own. Definition of Patient Patient: A person under health care. The person may be waiting for this care or may be receiving it or may have already received it. There is considerable lack of agreement about the precise meaning of the term "patient." It is diversely defined as, for examples: A person who requires medical care. A person receiving medical or dental care or treatment. A person under a physician's care for a particular disease or condition. A person who is waiting for or undergoing medical treatment and care An individual who is receiving needed professional services that are directed by a licensed practitioner of the healing arts toward maintenance, improvement or protection of health or lessening of illness, disability or pain. (US Centers for Medicare & Medicaid Services) A sick, injured or wounded soldier who receives medical care or treatment from medically trained personnel. (US Army Medical Command) The word "patient" is of interesting origin. It comes from the Latin verb "patior" meaning "to suffer" both in the sense of feeling pain and in the sense of forbearance. Thus, the two uses of the word "patient" -- as a noun denoting "someone who suffers" and as an adjective meaning "to bear with forbearance" -- stem from the same origin. (A patient may be patient or impatient.)

I'm not so much talking about documenting pt. contact. I'm saying should you get a signed refusal? If your pt. doesn't have a complaint of injury, are they considered a patient at all?

Here's a situation for everyone to ponder. You are called to the scene of a MVC. Upon your arrival you find multiple patients all ambulatory and in no apparent distress. Upon your assessment, each individual states that they are unijured and wish no treatment or transport. If you continue to question them as to the nature of injury, for example, you state "You're uninjured, no pain, cuts, scrapes, bumps, bruises, nicks or stiffness?" If they state no to all questions, should you obtain a refusal of care and transport, or should you not classify them as a patient, and document as "no ems needed"?

agreed! When you go into work mode, you can't even look at a patient in that manner. You're there to help, that is your mindset. Nothing more, and nothing less will do.

Holy loaded question batman! Yes, I have. If you're talking about holding hands and allowing a shoulder to cry on. If you're talking about inappropriate touching, no. I think those people who assault their pt.'s should be shot.

Ridryder, Again, you're making an argument for education solely to appease others in the medical field. Make no mistake though, I agree with you. I think a degree makes a well rounded individual. One that can converse with many different social circles. Certainly, holding a degree of any type holds clout among others in the field. My argument is that holding a degree does not make you practice medicine any better. Now before you blow a stack, hear me out. Our field is protocol driven, is it not? Those protocols are in place as a "recipe", as someone already put it, to dictate which treatment we are to administer. In many systems, those protocols do not allow for any tolerance to operate outside of those protocols. Until we can get the protocols to allow freedom, we cannot use the extraneous knowledge gained from our degrees. We may know what the problem is, but do not possess the equipment or medications to treat it. Our knowledge may lead to frustrations, which those of us with higher education hold. Some would say that the reason for not giving us freedom from protocol is the lack of required education, and you may be right. But it will only lead to us chasing our tails. I think we can all agree that holding a higher education makes you a better person, smarter, more quick witted, and I suppose in some cases a better paramedic, but we are still bound by protocols that others give us. The real question is, how do we fix it? How do we make the system work for us? To do what we want it to do?

Calvair, You don't want to go there, trust me. I rode that horse until it was beaten dead, revived and then beaten dead again. I was with you, I felt that basic EMT "experience" was the way to go. I was proven wrong a billion times over. The conclusion that was agreed upon was that education is the key. Nurses and doctors are required in their education to have thousands of pt. contact hours before licensure. That is the difference, which brings us back to our original discussion about the need for education, and more of it. I still stand by my original post that says that a degree doesn't make the medic. I'll agree that a degree may make a better person, a more intelligent person, but in terms of practicioner, I don't see it. Your inability to spell and count to ten may make you look foolish to those around you, but if you can tell me all about the creb cycle, I'll take you seriously. That being said, jsadin said it correct. Can a non-degreed medic be a superb provider? Absolutely. And a degreed medic can be a horrible clinician. This post seems to have two different arguments being applied here. I'm viewing pro-degree posts as the need for education to establish ourselves as professionals. I see anti-degree posts being from individuals seeking acceptance from the EMS community. If it's acceptance from the rest of the medical community that we seek, then yes! a degree should be required. If it's acceptance from the EMS community that you seek, I will pose this question to all degreed, non-degree, and medic-mill individuals: CAN'T WE ALL JUST GET ALONG?!?!

Down in flames ~ The Uninvited

spongebob...... I hope you get crabs....

So you agree that a degree is simply a piece of paper that proves you have "done your time". I'm glad we see eye to eye on this...

that damn doodlebops theme song..... curse my children!!!!!!!!!!!!!!!!!!!!!!

so explain to me why passing english and creative writing classes makes me a better paramedic? I'd rather focus on my paramedic studies, than have to make room for all the other junk that a degree program offers. I am attending college for Emergency Management, only because I want to go higher than field Supervisor, but, I've never had to recite Robert Frost to a pt. in order to revive them. I simply do not see the clinical benefit of a degree. I contend that the only reason to have a degree in Paramedicine (more commonly known as Associates in Science), is to go into management. Is a firefighter worth more if he has a degree? I think not. Every Firefighter I know of, regardless of degree, still attends the fire academy. Same thing that he/she went through in college to obtain their fire science degree. In fact, in the area that I work, Fire departments prefer their recruits NOT to have degrees in their field, and yet, they are still considered to be professional. Two roads diverged in a wood, and I, I took the one less traveled by, and that has made all the difference. ~ Robert Frost

all depends on what you want to do with your medic. do you want to just work the field, then go to a 13 month quick program and get working. If you are looking for a way to climb the ladder into management, alot of companies (and state agencies) require a degree. Choose wisely...

Passion is not measured in the amount of dollars you get paid, rather the force that drives you to excel. To question ones passion is to say that you have gained an intimate view, and have a deep knowledge into another persons psyche. So, to me, this posting is solely to invoke argument. If it's validation from the EMS community you seek, you have it. To enter into a field with little or no pay, and even less acknowledgement, is validation that you are passionate about your work. Kudos, carry on regardless of your compensation.

dust devil, I fear that you mistaken my confidence for cockiness. that is not my intention at all. I just happen to hate when those emt's of which you speak, endanger other compitent emt's ability to function to our full potential. You and I both claim to be able to determine with great accuracy the need for trauma alerts and helicopters. There must be something to your claim however, because we've gotten out butts chewed out for calling a helicopter in without transporting them to the hospital first. Now if what I know about helicopter crews is correct, they need all the pertinent information before accepting a mission. However, our hospitals seem to believe that we cannot accurately assess our pt.'s and determine that need. So clearly, somewhere along the way we've messed up as a profession and have created an evironment that does not foster faith in our abilities, and thats a shame.

vent: "A trauma center will have most of the essential personnel inhouse to get the party started. By the time the necessary tests are done, all players should be in place if needed. On a busy shift in a trauma center, resources can be stretched thin by unfounded "Trauma Alerts". Think of it as all those ambulance calls that you don't believe warrant an ALS Rescue but you must respond because someone called 911. Not every call requires a trauma surgeon and 6 other team members immediately at bedside. Many of these team members are leaving the bedsides of other critically ill patients only to find the "Trauma Alert" patient has no immediate distress and will probably be triaged to the general ED for the rest of their workup." Makes total sense. I often use that argument when going on what I would consider "useless" runs. It's nice to see that when using this forum, a strong argument can pull out multiple points of view never before thought of. I still stand by the point that I know how to call a trauma alert, and that my gut tells me alot about a sick person, but hey, thats just me. Perhaps they should change the trauma alert criteria to trauma "alert" meaning I'm bringing in a potential surgical candidate, and a trauma "stat" which means call me in the world. Thats the way we used to do it in my region in Mass. It seemed to work out alot better.

My apologies ruffems, In my little peabrain, the world does not exist beyond the confines of my own bandage shears. When I said industry wide, I meant my own state. Clearly, destroying trauma notifications for the entire country would have devastating effects on our pt.'s I agree that there are certain hospitals and certain client bases that rely heavily on early trauma notification to allow their teams to get ready. I also agree with some of the early posts that there are some services, and more narrow, some providers, that have no business calling trauma alerts. I am simply stating that it's an overreaction of some beaurocrats to pull the ability to call trauma alerts, and I for one was offended that my call was discounted and judgment piled up with all those who have poor judgment.

I never said that I don't make mistakes, all I said is that when it comes to my gut, I've never been wrong. Thats not arrogance, it's fact. I've been plenty wrong when treating my pt.'s. I had a 26 year old kid that I put money on the fact (based on clinical findings, not gut) that he had pneumonia. Turns out he was in failure. WHO KNEW? I've been plenty wrong, just not when listening to my gut, we should all listen to our instincts, thats why we have them.

I agree with you. I never said I call because it made sense. I said sometimes i call because I have a gut feeling, and I've never been wrong. I know that not everyone has that ability. Its the same ability most of us have when we walk into the room and can say with certainty that the pt. is "sick" or "not sick". I told you that I cannot show you numbers. I'm sure that I can research and find it, but off the top of my head, I cannot find a research paper that supports my claims. The only thing that I can offer you is my stance that we as providers should be given the benefit of the doubt that we know what we are doing out there, and if we don't (and there are many of them too) then we as providers should be creating a training environment to bring us up to speed. I think that pulling the plug on the trauma alert system is too punitive and throws us back to the days of calling med control to drop an aspirin.