Opinions: Medic Refuses Intercept

[Just Plain Ruff]

This is the real question as far as I am concerned.

You have posted this wanting an "opinion", without giving all the facts for us to form an opinion from.

It should be noted that all the ALS intercept did was 12 lead & MS.

This may be more dramatic if your area had use of prehospital thrombolytics.

Another question.... Do your EMT's have access to a 12 lead monitor?

Since you now have vollies refusing calls..... perhaps it is time for some career/professional positions to open up in your system?

The distance issue was asked or pondered in my second post on this thread.

If the distance of the ALS intercept by this medic was further than the distance that the ambulance was from the hospital then would the patient have benefitted from ALS intercept by the on call medic.

Was the fire department that the emt's used onthis call on the way to the hospital and was it less time to get them there to meet you than it was to get the on call medic.

I know that many times one person may be at the center of the county and you are either at one or the other end. You are heading away from the center of the county (using my service area as a reference our hospital is in the center of the county). You are on the way north to the hospital north and the medic that may be requested will have to drive to catch up to you. Not saying that this is the case but it might be.

The key question to ask here and I think it's the only question right now to ask.

We need the medics side of this. What is his side of the story since all we have are interested 3rd parties and the medic has not spoken.

The key question is this - Did this patient suffer from this medic's refusal to respond?

If the patient did not and the patient did get the care needed then we need to realize that in the end, patient care truly did not suffer.

If the medic was basically in their way on the way to the hospital and the distance was negligible then discipline should ensue. Discipline should ensue either way but the level of discipline should be appropriate.

I'm a patient advocate, I advocate patient rights every single day. If the patient was taken care of and given the same level of care who really cares which person provided the care as long as the care was appropriate and correct.

If it would have taken longer for the medic on call to get to the ems crew than it would have taken for the fire department to get to the patient then closer wins!!!!

[JakeEMTP]

As I said. that was what a friend said. Not my opinion. The reason I bring it up is based on the question of how far away the hospital is? If it's close enough wouldn't it be better for bls and transport asap than wait?

I don't know. I've been on a respiratory distress call less than a mile from the hospital and had one Albuterol nebulised treatment started in the SNF and 125mg of Solumedrol administered before arrival at the hospital. How close do you have to be to do nothing? The parking lot?

While this opinion may not be yours Adam, the individual who spewed this shyte needs to move on.

[mobey]

I don't know. I've been on a respiratory distress call less than a mile from the hospital and had one Albuterol nebulised treatment started in the SNF and 125mg of Solumedrol administered before arrival at the hospital. How close do you have to be to do nothing? The parking lot?

While this opinion may not be yours Adam, the individual who spewed this shyte needs to move on.

LOL

I actually administered epi and ventolin in the ambulance bay when an anaphylaxis walked into our rural hospital through the bay.

[JakeEMTP]

LOL

I actually administered epi and ventolin in the ambulance bay when an anaphylaxis walked into our rural hospital through the bay.

Ha! I guess not even the parking lot. The point is I guess, if you do your job correctly, just taking patients to the hospital w/o providing some sort of intervention if required, really isn't EMS at all.

[Kiwiology]

There was a very simmilar case here where the time to a trauma centre greatly outweighed the time required to get ALS for an intubation (about a 40 minute drive to the hospital, took over two hours to get ALS).

The crew on scene felt an LMA was not adequate enough so they called for an Advanced Paramedic to intubate the patient rather than drop the LMA and leg it to the trauma centre.

Depending on what the case is, if its faster to go to the hospital then thats what I will do.

In THIS particular case playing Monday morning QB I'd take the patient to the hospital.

[RFDMedic3D]

This question is open to anyone who can provide a professional answer. This question involves a small department who utilitizes a paid on call crew with a volunteer back up crew. The situtation I am about give you in an ACTUAL situtation that occured here very recently and I just wanted some input from other medics and EMT's.

Our department was dispatched to a medical call this past week. The c/c from the patient was for CP. A BLS unit responded initially to the call. Upon their arrival they initated patient care in accordance with our protocols. O2 therapy was initated at 15L via NRB. The patient was also give (4) 81mg ASA as per protocol. The patient describe her pain as a dull crushing type pain which radiates into her left arm, left jaw, and back. Patient rated her pain 10/10. NTG gave minimal relief.

The lead EMT on the truck made the determination for ALS intercept. The medic who was scheduled to be on call was notified via cell phone of the situtation and informed that due to the patient's condition, the crew felt that ALS care was required. The medic informed the crew "I'm not responding, I'm spending time with my kids. Just take them to the hospital". When I heard this conversation after the call I was livid for one.

The lead EMT on the truck made the decision to have ALS intercept from a local fire department which operates ALS pumpers. When the medic from the FD got on board our unit, a 12 Lead EKG was obtained and showed elevation in Leads II, III, and AvF. An IV was established, the patient's vitals were WNL. Due to having minimal relief from the NTG, Morphine was administered at 4mg for pain. A copy of the 12 Lead was transmitted to the ER. On arrival of the patient at the facility, the patient was taken immediately to the Cath Lab for placement of a stent.

My opinion is this. The medic who initially refused to provide ALS care on this call even though he was requested is guilty of negligence and breach of duty. This medic was being paid by the department to be available for calls and refused to respond. This medic is also our Deputy Chief. The EMS Chief is investigating this matter internally for now, but the state has also be made aware as has the family of the patient.

The chief has asked for my opinion about this situtation and I informed him the best thing we could do is terminate the individual who refused the call above and hope our agency isn't sued by the family or sanctioned by the state authority. This is not the only call concerning this individual, but one of several. It in my opinion that this individual is a liability to this agency and those that we serve.

What are the opinions of my fellow EMS professionals.....

This is a very confusing and serious request. I havfe read the various responses from the other that have left their input, and would like to now leave mine.

First, you need to clarify, this Medic, was he on the clock, i.e., being paid to respond to calls? If so, under may civil laws he is negligent for not responding. If not then, as an officer of the company, does he have a duty to respond when requested? This again would make him negligent.

I am not sure of what the laws are where you are from, however, I am sure that your squad's legal advisor can give you a better understanding of what constitutes negligence when referring to failure to respond in your area.

Second, what is the certification level of the responding providers? EMT-B, or EMT-Advanced(Intermediate)? I'm assuming the former. If this is so, why wasn't ALS dispatched initially along with the BLS unit? You report the call was dispatched as Chest Pain. This is clearly a call for ALS response.

Finally, someone had mentioned that rapidly transporting the patient to definitive care is always an option. I both agree and disagree with this. If the transport time to the Hospital/ER would be less than the time to meet with an ALS rendezvous, then by all means apply the diesel. If the rendezvous will delay definitive care, transport direct to the ER. However if the rendezvous will not delay getting the patient to definitive care, by all means utilize this for the most positive patient outcome.

I have the greatest respect for the many volunteers out there in both the EMS and Fire Services. We must all remember that some places cannot financially afford to have paid crews around the clock, if at all. As both a career and volunteer provider of both Fire and EMS service, I say to ALL of my fellows, keep up the good work!

[GhostMedic29]

As I said. that was what a friend said. Not my opinion. The reason I bring it up is based on the question of how far away the hospital is? If it's close enough wouldn't it be better for bls and transport asap than wait?

The medic in this situtation was considered "on call" as he was being paid to be on call. Secondly the EMT on the truck made the right decision when requesting ALS intercept. Third as for the dosage of MS @ 4mg, that is OUR state protocol. This medic was negligent in his duty to refuse an ALS intercept from his OWN crew. No he does not have a department issued vehicle with which to respond but when the transporting unit goes by his house....there is no excuse.

This medic has been suspended without pay pending the results of an internal investigation into his actions. It is likely that the state will also investigate his actions as well should our agency forward the results of the investigation to them. No it is NOT this agency's policy to do anything like this medic did. I understand this medic was spending time with his kids but it is HIS responsibility to get his on call shift covered if he can't cover it himself.

No one with this agency was advised that he would be unable to cover his "on call shift". Therefore as far as the department is concerned he is guilty of breach of duty.

[Adam Swartz]

The medic in this situtation was considered "on call" as he was being paid to be on call. Secondly the EMT on the truck made the right decision when requesting ALS intercept. Third as for the dosage of MS @ 4mg, that is OUR state protocol. This medic was negligent in his duty to refuse an ALS intercept from his OWN crew. No he does not have a department issued vehicle with which to respond but when the transporting unit goes by his house....there is no excuse.

This medic has been suspended without pay pending the results of an internal investigation into his actions. It is likely that the state will also investigate his actions as well should our agency forward the results of the investigation to them. No it is NOT this agency's policy to do anything like this medic did. I understand this medic was spending time with his kids but it is HIS responsibility to get his on call shift covered if he can't cover it himself.

No one with this agency was advised that he would be unable to cover his "on call shift". Therefore as far as the department is concerned he is guilty of breach of duty.

How old are his kids? Also was there anybody there to watch the kids? If he left the kids alone depending on age one could face severe punnishment for leaving the kids.

[cosgrojo]

I guess the only question left that I want to know the answer to is... Why didn't he automatically have to respond to this ALS criteria call? Why would he have to wait to be requested by BLS? I believe that this guy shirked his responsibility... but if your system does not require him to respond IMMEDIATELY for ALS criteria calls, then I think you guys have another problem, and the lousy system is partly to blame.

[letmesleep]

If leaving his kids alone is an issue then maybe he should have been more responsible and NOT taken the "duty" for the shift. I also believe that there is some negligent behavior on behalf of this medic for NOT performing his job in this case (based on the info given that is). My question is that we are asking the same type of questions about the distance and time to the hospital, but I am wondering this:

Was the FD ALS intercept made en route, or did this BLS crew sit and wait? Maybe I missed the answer to that question somewhere, but if the crew sat on the scene waiting for the FD to arrive, then isn't there a problem with that? How many times on this site do we get "basics" justifying their worth, but in this case where they recognized an urgent situation, they sat! Why? Does the distance really matter? There are basic trucks/ units/ buses (region specific, pick one) who run 911 calls all the time and "handle" CP calls by realizing and transporting based on their findings.

My point is who cares that this "medic" (and I use the term loosely) refused to respond. I'd like to know why a crew of professionals where on the scene, and didn't just handle the pt once they found out that ALS care was unavailable. As a medic I don't make it my practice to transfer MY CP pts to basic level care, but why take the time to wait (if that was the case). Unless this FD was en route, and could meet them road-side I say they should have just transported.