Treat and Release

[a_shane2_go]

Ultimatley its our call, if patient does not want to go we cant assult him. If we think they should go, encourage and of course if they are not mentally fit to make that decision police time.

The only tricky one seems to be in case of Hypoglycemia. I was reading our policy the other day, our patient must meet all of 8 types of criteria to be signed off, which seems none would unless you stay on scene for a lengthy amount of time. So it seems we must transport all of these cases. I know for other services i worked for i was comfortable if they have multiple incidents as such and family to take care of them afterwards and just needed a snack and not even oral glucose.

[scott33]

I think some people are getting confused with RMA and "treat and release" (per the OP)

The latter would be something along the lines of giving a neb to an asthmatic, and, assuming they feel better and ongoing assessment backs this up, are told by the Ambulance crew they do not need to go to the hospital, follow up with your PMD etc. . Or more so in the case of the ECP, given treatment at home for minor injuries (wound irrigation and suturing) prescription for pain meds / antibiotics etc and...told to follow up with your PMD. A good way to free up beds in an ED.

So in answer to the original question. No Mike, it is highly unlikely to exist to a large degree in the US. Ambulances are to take people to hospitals. ](*,)

[Dustdevil]

What exactly would you do if they didn't go to that ER and either decided to go to a different one, or go home?

[Kaisu]

Dust man you are back!!!!! Thank God! I have missed the crap outta ya. Now I can actually look forward to posting on this site. WE need you. Please don't go away again.

[AnthonyM83]

For those of you who have stricter transport protocols, can you at least present the option to them or ask "Do you want to go to the hospital?"

[Arizonaffcep]

For the service I work PT for, they have a "you call, we haul" mentality. That being said, if a patient wants some treatment but no transport, they get charged for treatment without transport (cost depends on treatment rendered) In the case of a diabetic that got D50, for instance, we must ensure that either they can take care of themselves or someone is there to watch them. If no one is there, then we must actually witness them eating a meal, then we can depart. I've made many a sandwich for many a patient because of it. Which is fine...I prefer not to be called back for what would be called a "rekindle" in the FF world .

[sirduke]

Our protocols cover these type situations, but not completely. Most of the calls we have like that are the Hypoglycemics, who crash and need immediate intervention. Usual scenario goes like this, mama is down with the low sugar, everyone is freaking out, and we arrive. Push D50 or give glucagon and suddenly, mama is back up to normal and refuses to go. Unfortantly, we can't charge unless they ride, and they are aware of this, so we are out of the cost of the trip plus the meds.

Our medical director is working to change this, in the meanwhile, we are supposed to get them in the truck and administer meds enroute, which I am concerned might bite us in the ass. I personally won't delay treatment if the situation warrants immediate intervention.

We are not supposed to but some times do, advise the ones who really don't need an ambulance, of the cost prior to transporting them, and also have a form for them to sign accepting liablitity for the cost should their insurance (yeah right) or Medicaid not pay.

If they refuse when they really need to go, we strongly advise them of the dangers, and make damn sure they are competent to refuse, have them sign a refusal, get it witnessed and then notify dispatch prior to cancelling the call.

Then there is the issue of a family member yelling at you that you "M***********S" are going to take them, when the patient is fully capable of making their own decisions. That one can get interesting.

I've yet to figure out why I always have to be "dat fat cracker MoFugga" when mama be sick...

[mcmikeguy]

In my service, which is private, we can release (we use SOR) just about anyone. I had a buddy of mine SOR a full arrest. The patient was in his 90's and just got his steak at a local restaurant when he went into v-tach. He was successfully defibrillated and on the way the the squad he didn't want to go to hospital, he wanted to finish his steak.

I am more reluctant than that to release a patient. I used to, for instance, SOR diabetics I treated with D50. I kinda got away from that. I thought about it and people don't need much reason to sue anymore. Even if something else happens and you did everything right. I prefer to just get them in the truck and on the way to hospital before I wake them up. Its the easiest thing we do usually, raise a blood sugar. If you are already on the way to the hospital they won't SOR. I would just prefer the doctor to release them.

Some cases I tell them "I can help if they'll come with me to hospital". I do that because I don't want to give a guy NTG then he feels better and less like going to the hospital when he really needs long term treatment and not just relief for now. I keep it BLS o2 v/s monitor, EKG, until I can get him to go.

Less of a factor to me but still in the back of my mind is the company doesn't get paid when I release patients. If they have to spend a lot of money of meds, diesel fuel etc.... and don't get it back that doesn't leave much left for me. God knows that the bosses don't need anymore excuses to not pay me what they should be.

[akroeze]

In my service, which is private, we can release (we use SOR) just about anyone. I had a buddy of mine SOR a full arrest. The patient was in his 90's and just got his steak at a local restaurant when he went into v-tach. He was successfully defibrillated and on the way the the squad he didn't want to go to hospital, he wanted to finish his steak.

:shock:

*opens mouth*

*shuts it*

*opens mouth*

*shuts it*

:shock: