Patch Posted June 18, 2006 Share Posted June 18, 2006 Opinions Please. Please bear with me on this. I would like to know how the professionals feel about a scenario I was involved in. I work in a casino with AED and O2. I am AED/ BCLS provider. Also, Certified EMR. Pt was 47 y/o male, overweight, with History of asthma ( 2 years previous, was prescribed Bronchiodialator once), CC is Chest pain with shortness of breath, feels dizzy, weak, and has numb hands and feet. Appears in distress, looks anxious, deep inhalations but seems effective. First contact was not me. Supervisor let Pt move on own from sitting on a bench to a wheelchair, transport to our 1st Aid room without O2. Super gave O2 about 10 mins after contact, even though I arrived at scene with AED and O2 after 2mins of initial contact. Non- Re breather at 6LPM. Bag not inflated. No vitals taken. Super kept telling me "he's fine, there's no problem". So I leave at the instruction of my on duty Super. After about 10 mins of O2, Super and Pt walk back to hotel to Pt's room. While walking Pt begins to feel dizzy/ weak, pain comes back, real hard to breath now. Again I attend with AED and O2 to find Pt sitting on a couch in our hallway entrance. He looks scared and is inhaling very deeply. Also, Pt had a spacey look in his eyes, kind of a surprised look. Against my Super's wishes, I quickly asses Pt and Pt tells me ( in a rushed manner with quick words), Chest pain feels burning, pressure in center of chest, "ow-ee", about 3-4 on 10 scale, not radiating, no pain else were. Breathing is harder to do now than at first contact. Pt's wife tells me this happened a week previous and a week and a half before that. Almost any time Pt is physically exerted, especially in hot weather. I give O2 at 15 Lpm with Non-Re breather. Pulse - 82Bpm - regular and strong, Breathing - 16 Resp. per min - big deep inspirations, relaxed on exhale. Skin warm, diaphoretic, red. ( first contact Pt looked Pale). Good even strength in hands and feet. Eyes equal and react to light, 3mm. NKA. I convinced the Pt to let the EMS have a look at him as I don't have the equipment to properly asses the event. Pt agrees and Fire is there in 3 mins, Ambulance arrives in 5mins. The super stated to 911 that this is non-emergent and that the EMS need not arrive lights and sirens. EMS on scene, they do their thing and Pt is loaded and gone in about 10 mins. Link to comment Share on other sites More sharing options...
nsmedic393 Posted June 19, 2006 Share Posted June 19, 2006 Your supervisor is an idiot. Period. Link to comment Share on other sites More sharing options...
RaceMedic Posted June 19, 2006 Share Posted June 19, 2006 Agreed... super should have his ass removed!!!! you were in the right and EMS should have been notified on first contact and c/o chest pain. Link to comment Share on other sites More sharing options...
whit72 Posted June 19, 2006 Share Posted June 19, 2006 Patch wrote Non- Re breather at 6LPM. Bag not inflated. No vitals taken Sure he dosent work in a nursing home. If your gut tells you somthing its probably leading you in the right direction. You made the correct one to step in for the benefit of your pt. strong work. Link to comment Share on other sites More sharing options...
albemt Posted June 19, 2006 Share Posted June 19, 2006 you need to go to your supervisors boss and discuss this with him. You were hired there as the Medical response person right??? Well if you are hired there as such then you are responsible for treatment. If your not aloud to assess and treat people there then what were you hired for? Link to comment Share on other sites More sharing options...
Patch Posted June 19, 2006 Author Share Posted June 19, 2006 We have only had AED's for about 3 years. I was hired over 8 years ago. Primarily Security duties with what seems to be second thought to medical. We have all the plans in the world for fire and the staff and resources, but the medical response is still uncoordinated. It has always been hit or miss. I obtained my EMR certificate on my own, but they have an education assistance program and was reimbursed because of the relation to my job. It just seems to be the 'Hear no evil, see no evil', and 'Don't rock the boat' mentality. Super is 55+ y/o, employed for 12+ years, military medical training and instructor background, teaches for St. John's. I am 25-30 y/o, 8 years with company, no background, except EMR in Dec. 2004, (lots of first aid and CPR training all my life though). I guess basically it didn't feel right and I knew the event was being mishandled in an unprofessional way. I noticed things like no BSI, no vitals taken, no O2 for Pt difficulty breathing, no EMS activation upon C/O chest pain with history of similar past events so, I just kind of politely (to the Pt) took over. I also felt concerned about responsibilities as a licensed AED provider and the implications of the Pt deteriorating after my Super. sends him on his merry way out the door, (which is what the Super. is supposed to consider). I don't feel bad or anything like that. I want opinions to know if what I did seems done out of professional deductions or did I go over the top with the whole event? And yes, I am a professional. A professional who is practicing medicine at my level of education. Bike riding and repair is my hobby. Link to comment Share on other sites More sharing options...
ncmedic309 Posted June 19, 2006 Share Posted June 19, 2006 I would like to know your supervisors justification for not involving ALS care much earlier in the situation, what was he waiting for? Link to comment Share on other sites More sharing options...
Patch Posted June 19, 2006 Author Share Posted June 19, 2006 I won't comment on what some one may be thinking. But I know as fact that if I had not intervened EMS would not have been called. It has been stated over and over by Supervisors that unless the Pt requests an ambulance, or the on-duty supervisor requests EMS, EMS will not be called. Personally, I have yet to encounter a situation were I request EMS and it has not been done, but there are a lot of ego's and power trippers at all levels of Management. The idea of calling an ambulance for someone who may not be able to give consent or for someone who obviously needs attention but does not directly ask for EMS is lost on these people here. I believe, if a Pt needs ALS and doesn't want it, I feel they can tell that to the EMS Responders themselves rather than it be on my head that it was obviously needed but was not done. The primary concern for the Security dept is to protect the assets, employees, and guests. Liability anyone? Link to comment Share on other sites More sharing options...
EMT City Administrator Posted June 20, 2006 Share Posted June 20, 2006 Title modified for clarity Post moved to more appropriate category. Link to comment Share on other sites More sharing options...
itku2er Posted June 20, 2006 Share Posted June 20, 2006 Patch wrote Non- Re breather at 6LPM. Bag not inflated. No vitals taken Sure he dosent work in a nursing home. If your gut tells you somthing its probably leading you in the right direction. You made the correct one to step in for the benefit of your pt. strong work. Patch I hate to to say this to you but ..........to make a generalized statement like that is just wrong.....i dont go around making statements about your skills so dont go judging me cause i work at a NH......it is stupid comments like that that make it hard for us nurses that actually know what we are doing to get a break .........not all nursing home nurses are dumb.... now umm your supervisor needs to go back and learn basic O2 administration rules.......gezzz........ just my 2 cents worth..... Terri Link to comment Share on other sites More sharing options...
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