P_Instructor Posted March 1, 2011 Author Share Posted March 1, 2011 Patience.....concerning your questions.... With the original post, I did leave a lot of info out, so I do apologize for this. Many of the items you mentioned were performed, such as she did not have palpable radial pulses with the initial BP, so this is where other aspects of determing perfusion was obtained, ie. carotid pulses, etc. The patient does use a cane, however mentioned that she has to hold on to furniture to get around the home. No walker with the patient (she has no hx, no rx, no MD - very independant). The patient was continuously monitored for any changes during the contact. The premise for this post was to see if any instructor's out there actually lecture on the geriatrics in detail concerning the multitude of things that could present themselves to the provider, especially the new provider that needs to reflect on only the limited knowledge of their paramedic class, as many do not get the clinical/internship experiences dealing with these unique situations. No patting myself on the back by any means, but I lecture extensively in this field as this is the majority of patients we deal with. The new medic I was working with did come from a different program and really did not understand that pathways that he could investigate on the patient's behalf. Link to comment Share on other sites More sharing options...
crotchitymedic1986 Posted March 3, 2011 Share Posted March 3, 2011 Read up on brain injury from ground level falls for the elderly before you leave another at home. 1 Link to comment Share on other sites More sharing options...
P_Instructor Posted March 3, 2011 Author Share Posted March 3, 2011 Read up on brain injury from ground level falls for the elderly before you leave another at home. Let's discuss the issue presented in my original post. Are you an instructor, and do you instruct in great depth your classes, whether EMT or Paramedic, the geriatric model concerning morals/ethics/ and legal situations? Do you routinely give various examples, situations, and scenarios concerning the same? Trust me or not, I know what is happening or what can happen with the 'ground level falls in elderly'. After a full assessment, both trauma and medical, neurological and cardiovascular, decisions were made and based upon my knowledge and experiences. I will not just 'take em' for the sake of getting the dollar for the company. Taking someone against their wishes when they are fully cognitive can and will create more of a problem down the road. The patient has rights whether 20 years old or 200 years old if they can make their own decisions with sane mind. Here is a decent course for you: http://www.gemssite.com/ Otherwise, you might want to review and take this: http://paramedic.emszone.com/caroline/onlineChapterPretests.cfm?chapter=4&step=2 Don't take this as a bash, but a sensitive view on many geriatric calls that any EMS provider may, and will probably encounter. Link to comment Share on other sites More sharing options...
crotchitymedic1986 Posted March 5, 2011 Share Posted March 5, 2011 I take no offense, and we will always learn more from people we disagree with. If you could not talk her into going, so be it, and I am sure your documentation was very good, but you never answered my question honestly, how long were you on the scene ? What diagnostic tools did you use to ensure the patient was stable enough to be left at home. If the same patient presented to the ER, would an ER doctor release her based on those same simple diagnostic tools you used, or would the doc order some labs and xrays/scans. Link to comment Share on other sites More sharing options...
P_Instructor Posted March 6, 2011 Author Share Posted March 6, 2011 you never answered my question honestly, how long were you on the scene ? What diagnostic tools did you use to ensure the patient was stable enough to be left at home. If the same patient presented to the ER, would an ER doctor release her based on those same simple diagnostic tools you used, or would the doc order some labs and xrays/scans. I was just chiding you anyhow.........to answer your question, full physical and mental exam, stroke screen, EKG, reassessments, questioning, talking with the son from out of state, the friend, entire history (which was limited as she hasn't seen a physician for some time, is on no meds, etc.), talking with DHS........all lasting approximately 45 minutes on scene. As for the latter question, I have yet to see an ER doc not do some type of test whether they agree with you or not. I am sure that blood work would have been done at a minimum. When we left after full explanation of our concerns, she was fully aware of the situation and still refused. This was one of those situations where she did not want to go and knew what she was talking about. Again, the premise for the post was to see if any other instructors actually create scenarios that are similar to this depicting geriatrics/morals/ethics, etc. I do, but again was wondering about others, so I could scratch their brains for more scenarios. Later........... Link to comment Share on other sites More sharing options...
Carl Ashman Posted March 12, 2011 Share Posted March 12, 2011 I don't see a need for either medical control or my supervisor in this situation, as it truly is relatively straight forward if you've been taught critical thinking skills. I think that this thread is an awesome idea. As I've said many times in the past, I believe the vast majority of my most difficult decisions have been moral/ethical, not medical. And I don't think that I see a lot of this being taught, and very seldom see it practiced. I think we need a forum just for moral/ethical scenarios. When I state that the above scenario is relatively straight forward what I mean is that if I begin at the beginning, the fact that I am there not to cover my ass, but to be a patient advocate, then forcing this woman out of her house if she's mentating properly is going to be so far down on my list of possible options that it's unlikely that I will ever get there. She has a support system in place and is healthy enough to choose to rely on it instead of going to the hospital. Educate her and the neighbor to watch the bruises as they can become a significant health risk in a pt of this age, help her to the bathroom, get her comfy, make sure her telephone is within reach, remind her that I would like nothing more than to come over and help again if she needs it, and then document the shit out the call in case something goes sideways. Easy, right? I'm not sure at what point MC or a supervisor would have become useful unless I believed her to be significantly damaged and I couldn't change her mind about transport. Great thread. It would be fun if everyone posted their 'weird' calls, right? So we can flex our brains a little bit down this logic path. Dwayne Finally someone who turns this call around to see it in perspective. Of course this lady doesn't need to go to hospital (where, at her age, she would signifcantly be at risk from all soorts of hospital-based pathogens), she needs helping up and a cup of tea. And some help and advice to the carers about preventing falls. Yes, even in this case, there is a role for preventative medicine. Carl. Link to comment Share on other sites More sharing options...
DwayneEMTP Posted March 12, 2011 Share Posted March 12, 2011 Bless you Crotchity, but I can't for the life of me figure out where you became so perfectly qualified as a life adviser that you feel comfortable forcing people to accept help against their will? And old woman wants to stay home but based on your superman skills you are able to know what's best for her and force her into the hospital ... This isn't loving and caring brother...it's cover your ass medicine. Love says you protect her...you are only protecting yourself here. She's got nearly a century of falling down and knowing how it feels...leave her alone man.... A couple of kids get layed..you report them when they've chosen not to report themselves. Scar them now, likely scar them later, but at least you've covered your ass. This isn't loving "protect the children' medicine, as even the new, young medics see where this is going to get ugly..this is scared medicine. You preach doing good medicine, but both of the above decisions are protocol-monkey crap. You just simply can't justify them in a real world application in these scenarios as explained. I get the feeling that you are a really intelligent provider..I'm not sure if it's your "everyone should give me everything I want and do what I say because I'm black" attitude or something else...but even you are truly not smart enough to know what is best for everyone. Dwayne Link to comment Share on other sites More sharing options...
Richard B the EMT Posted March 13, 2011 Share Posted March 13, 2011 So what happens when OLMC denies the RMA? Do they issue paperwork to put the patient on a medical hold? Who carries out the paperwork if the patient adamantly refuses? Do you do everything necessary including taking the pt using force into the ambulance? Do police get involved at place the patient in their custody? Not saying you are wrong here, just honestly trying to understand what happens if the OLMC says the pt cannot refuse. (sorry to hijack the thread) When OLMC is contacted, no matter what the transport decision ends up being, the contact is documented on the call report, with the doctor's ID number on that call report. I know they ask for information from the crews, as to badge numbers, unit radio ID, and the call report's number. If the patient is to go into "protective custody", the NYPD does almost everything but move the carry chair or stretcher. Link to comment Share on other sites More sharing options...
NYCEMS9115 Posted April 21, 2011 Share Posted April 21, 2011 I had a pt who had attempted suicide by taking too many painkillers, but it wasn't enough to actually kill him due to his tolerance. He became irate to the point of telling our ALS provider on the call to get out of his home and not to come near him again because the ALS provider said similar to what you did and started giving orders. One of our volunteer Basics who's a minister was able to convince the man to let us take him in, get him checked out, and get him counseling simply by treating him with kindness and showing concern for his well being. It was a lesson in non-pressure for me. How did you know it wasn't enough to kill him? How did you know his tolerance? Was the Police there? Link to comment Share on other sites More sharing options...
Richard B the EMT Posted April 21, 2011 Share Posted April 21, 2011 I forgot one detail on my last posting: OLMC has the Medic channels on radio and the telephone lines taped as further documentation. Link to comment Share on other sites More sharing options...
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