AZCEP Posted December 23, 2006 Share Posted December 23, 2006 The descriptor wasn't added. Similar to the 0-10 scale for pain. 1 being your average healthy adult human, SICK being, well, death warmed over. Better? Link to comment Share on other sites More sharing options...
nsmedic393 Posted December 23, 2006 Share Posted December 23, 2006 This thread has provoked the hamsters in my head to do some serious running... While i have stated previously that I am not opposed to bending the rules, the things that I am willing to do that bend the rules are things that the medic has been educated in, but not necessarily allowed to do. I don't believe people should be doing procedures that they have not been educated on or even seen done. To do such a thing, in my opinion, is dangerous and stupid. If i could make the analogy of fixing a car.....I would change my own oil because I have seen it done, read about it in books and am fairly certain it would not make my car blow up... I would not say attempt to fix my engine with a mechanic giving me directions over the phone because I am not reasonably sure that the outcome would be positive. All that being said, how many people here would be comfortable doing a procedure that they know nothing about. For the basics- If the online doc told you to intubate or decompress the chest or even start an IV would you??? For the ALS providers lets use the previously mentioned example of a traumatic arrest of a patient who is 8 months pregnant. Would you perform a c-section with instruction from the online doc even though you have no formal education in how to do it? I'm just trying to guage where people think the line is. What is an acceptable deviation in protocol and where do you draw the line and just say no? Link to comment Share on other sites More sharing options...
Doczilla Posted December 23, 2006 Author Share Posted December 23, 2006 Sick. Not simply feeling bad, but in real danger of a bad outcome if untreated. Sometimes SICK is evident in the vital signs, or the rhythm, or the lung sounds. Very often, it's not simply one variable that you can put your finger on, but a "feeling" that you have just on walking in the room and laying eyes on them. Despite the warnings we all receive about patients with potentially fatal disease that is lurking out of sight, most folks that are really in danger clue into these little instincts of ours. 'zilla Link to comment Share on other sites More sharing options...
jwraider Posted December 23, 2006 Share Posted December 23, 2006 Thanks guys I swear I even saw it (SICK) on a test question (may have been my class final or NREMT). I figured it was that simple. 1 Reason why a BLS provider may be more apt to go along with the physician is they know less and look to the doctors and medics for guidance more often and are used to listening to them? Did that make any sense? heh For example a Basic gets that order and thinks to themselves "Well this doctor must know what he is doing (in regards to protocols on top of the procedure) while a Medic who has been through more schooling and been around longer may not go along with it. Link to comment Share on other sites More sharing options...
Asysin2leads Posted December 23, 2006 Share Posted December 23, 2006 For me, what it would come down to was how comfortable I was with my own abilities and what my relationship with the doctor was like. If he would be willing to guide me through it, and I knew the doctor and had a great working relationship with him, I probably would. When you talk about ethics and morals in this context, you really are asking whether it is ethically superior to always follow the rules or to not. There are many people out there, the police officer or soldier being a great example who would say "It doesn't matter what I think, it doesn't matter what is good in this situation, these are rules and as a member of society or a member of a profession, we are duty bound to follow them." We can come up with a great many excuses to justify our behavior when we break the law or break the rules, but honestly, when it comes down to it, breaking the law is breaking the law. Its wrong, always, end of story. Sure, you can bring up civil disobedience or whatever, but that is a different case. So, someone could make a great case in saying "If she dies, she dies, people die all the time, she had a medical condition that could not be treated in the field under existing protocol, and she succumbed. It happens all the time, every day, there is no reason to go above and beyond your scope of practice just because you think it might work." So, when I say I probably would, its because of my own personality, not because I think there it is ethically superior, but because of my own problems in dealing with the fact that I am not applying skill and knowledge that I possess to help someone who is dying. I, personally, could not live with myself if I didn't. I know it would be wrong, I know that I would not be doing anyone except maybe the patient a service, and I would do it anyway. Link to comment Share on other sites More sharing options...
akroeze Posted December 23, 2006 Share Posted December 23, 2006 You make a very good point Asys. I was somewhat thinking along those lines myself. There can be a very compelling arguement for "If they wanted us to be able to do this, they would train us to." Link to comment Share on other sites More sharing options...
Doczilla Posted December 23, 2006 Author Share Posted December 23, 2006 When you talk about ethics and morals in this context, you really are asking whether it is ethically superior to always follow the rules or to not. There are many people out there, the police officer or soldier being a great example who would say "It doesn't matter what I think, it doesn't matter what is good in this situation, these are rules and as a member of society or a member of a profession, we are duty bound to follow them." We can come up with a great many excuses to justify our behavior when we break the law or break the rules, but honestly, when it comes down to it, breaking the law is breaking the law. Its wrong, always, end of story. Sure, you can bring up civil disobedience or whatever, but that is a different case. Asys brings up some good points here. Actually, everyone has brought up good points, and this has become a very interesting discussion. There is no right answer here, and hearing the thought process of various providers is the point. Now here I come to throw a wrench into the works... You are given this order by the physician. It is a lawful order, one that is appropriate to the patient's condition. The physician fully understands the patient's condition and diagnosis, and has given an order that represents, at least from his perspective, the standard of care. As a prehospital provider you work under the license of a physician, and technically are following orders in the form of protocol. You are now being given a direct online order by a licensed physician, one that your medical director allows to give online orders. Can you refuse it? 'zilla Link to comment Share on other sites More sharing options...
AZCEP Posted December 23, 2006 Share Posted December 23, 2006 Just as performing the procedure has to be justifiable to the "reasonable man", so would refusing to do it. Inappropriate orders are given all the time, and following clarification, are either withdrawn or reaffirmed. D50 or bicarb down the ETT, for example. Yes, I've received them, and no, I did not follow the given order. Too often we get caught in the trap of thinking that we have to do what we are told. When it is obviously wrong, we have to be smart enough to realize it. Link to comment Share on other sites More sharing options...
bassnmedic Posted December 23, 2006 Share Posted December 23, 2006 Doc, I am unfamiliar with the legalities of refusing to do said direct online order. With that being said and the facts that I am untrained in that particular procedure and the fact that it is outside my scope of practice, I would say I'd have to take my chances with refusing to do the centesis. As a paramedic I fully recognize the fact that the patient is in dire need of it and could die without it, I just can't see myself doing it and accidentally messing up and killing her. Take care and stay safe, Todd Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted December 24, 2006 Share Posted December 24, 2006 I have had the opportunity to refuse a doctors order but only when the patient has refused. for example Morphine for pain when the patient refused it I let the physician know so I really didn't refuse the order. There has been one time when I refused an order by a base station physician. I was told by a physician to transport a patient(pediatric overdose). I told the physician that this patients parents were refusing to be transported by ambulance but they would go to the hospital on their own. The physician told me "NO, I said transport the patient, do you have a problem with that" and I said, "No I do not but they are refusing to go by ambulance and I will not take them" She then replied "I am giving you a direct order to transport the patient to the ER by ambulance and if you do not then I will have your license" I then replied "Well I'm not transporting the patient against the families wishes" and I did not. The phsyician made a huge stink, she went to my ambulance management and filed a complaint. In the end I was vindicated by our medical director and my management due to refusing this order. The child was taken by her parents to the nearest er, she checked out without issue and was discharged from the ED 3 hours after she got there. I'm sure if the outcome was different then it would have been a different story but it all was well. I felt totally in the right on this one and would do it again if I felt the order was wrong. Even though they are doctor's doesn't mean they are not always right. Link to comment Share on other sites More sharing options...
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