Already treated in Mexico - What Would You Do?

[PRPGfirerescuetech]

You have contradicted yourself several times since the beginning of this post.

Protocols are designed for medics who cant think on their own. Good luck with your protocol driven "monkey see-monkey do" future.

The mother may have no concern for her childs well being, however I was addressing your ptotocol which stipulates "no medical complaint" (your words).

The scenario you have presented is a violation of the protocol as you have defined them, regardless of the mothers "no concern".

Everyone in this post has gotten far too tied into the immigration status of the mother. This holds NO bearing on the care of the child.

1. No EMT or Medic in the US is adequately educated to the level appropriate to determine a need for transport. We arent adequately educated in many things, and feel free to peruse the thousands of posts on this topic. Your "professionalism" or feelings of "competency" aside...your education is NOT adequate enough to make this decision while avoiding liability.

2. Since you mentioned so frequently this discussion "ignoring protocols it should be restated that your protocol actually allows for flexibility for determining transport, and requires both medics to agree not to transport someone. That means if you do the right thing and transport, you havent broken these magical protocols you continue to spout about.

Finally, I find it interesting that you continue to spout about these protocols of a "mindless" nature which seem to be ironclad in your view. Yet you call me a mindless ambulance driver for saying that you need to transport everything.

So, im mindless for knowling the huge liability for refusing transport and stating the truth, and your the intelligent medic for blindly following protocols?

Get bent.

This is simple. Your ignoring the patient. Regardless of the purpose of the mothers initiation of 911, you have a US citizen with a reported medical complaint and incomplete medical care, and a mother who is requesting the patient be transported to a medical facility. We have a responsibility to this child.

[spenac]

Oh dear......

Spenac,

I do feel your pain due to the fact that I, too had lived temporarily on a border town over in Southern California. I do not think we had established a protocol stating the denial of care due to no need for EMS intervention....at least not while I was there(5yrs prior). Perhaps things have changed and if so, I apologize. I am only going to comment on what we did as EMS providers when I was out west. Also, where I was, we had a hospital approx <10miles from the border town checkpoint.

***El Centro Regional Medical Center, Cali.***Gold Cross Ambulance, Imperial Co., Cali.***

There were certain situations where EMS was called to the Customs check point on the border for transfer of care from the Mexican EMS ambulance. In this case, there was no issue that I was aware of in reference to the status of the patients' nationality or their parents' if the patient was a minor. If the BPA found them and they claimed an injury/illness(which happened often as a scapegoat from detention), then we took them without question due to the verbal complaint noted and/or obvious injury/illness presented.

Now, if a patient was already in town/US soil and wanted medical care, then I see no reason for denying transport. Unfortunately, in this scenario, the parent has to make the medical decision for her child. Perhaps she's using her child to help her own personal situation, but I would not want to be the EMS provider who attempted to state this in a court room. Err on the side of what is best for the patient......that's what I would do.

Are we aiding the illegal immigrant into the states? Technically, she is already here approx 50miles, correct? And the child is an American citizen, therefore giving the mother the right as the legal guardian to accompany her. It's kinda like the pregnant illegal mothers who walk to the check points fully in labor, water broke and all, just to give birth over in the states, making their child an American and also giving them the legal right to stay. :roll:

Basically I'd transport the patient and mother. If BPA has an issue with the passing of the mother thru their check point, let them make the legal decision. If there is an alternative you can give the mother, such as a taxi voucher, a phone call to another relative/friend/etc.....let her do this so you can stay in the local for your community and any other 911 calls.

Thank for well thought out Professional response maybe that will keep me from my going back to ranting. Actually this occurs within a mile of the border. This child in the scenario is one of the babys you speak of. Mother wants a way past the check point 50 miles inland. If the child actually had a need that required transport we would hall her right away with the mother, no problem with that. Child has legal family they have already taken her out of the USA and back today and are happy to take the child again this one point that is being missed by many and maybe I should find a way to reword is "You then ask them is there some other concern for the childs well being that has caused them to want to have child taken by ambulance. The reply is "no concern" but that the mother cannot pass the Border Patrol checkpoint because the mother is illegally in the USA."

I should not have used the is there some other concern maybe if I just asked the first question of what is the reason for your 911 call and then had her reply

" "no concern" but that the mother cannot pass the Border Patrol checkpoint because the mother is illegally in the USA."

We do not worry about a persons legal status we are not law enforcement, if there is a real or even a decently faked emergeny we transport. We deny very few as yes there is to much at risk to be wrong. Again the reason for this denial is mothers only reason for ambulance is being illegal per her.

Again thank you for the professional reply.

[spenac]

You have contradicted yourself several times since the beginning of this post.

Protocols are designed for medics who cant think on their own. Good luck with your protocol driven "monkey see-monkey do" future.

The mother may have no concern for her childs well being, however I was addressing your ptotocol which stipulates "no medical complaint" (your words).

The scenario you have presented is a violation of the protocol as you have defined them, regardless of the mothers "no concern".

Everyone in this post has gotten far too tied into the immigration status of the mother. This holds NO bearing on the care of the child.

1. No EMT or Medic in the US is adequately educated to the level appropriate to determine a need for transport. We arent adequately educated in many things, and feel free to peruse the thousands of posts on this topic. Your "professionalism" or feelings of "competency" aside...your education is NOT adequate enough to make this decision while avoiding liability.

2. Since you mentioned so frequently this discussion "ignoring protocols it should be restated that your protocol actually allows for flexibility for determining transport, and requires both medics to agree not to transport someone. That means if you do the right thing and transport, you havent broken these magical protocols you continue to spout about.

Finally, I find it interesting that you continue to spout about these protocols of a "mindless" nature which seem to be ironclad in your view. Yet you call me a mindless ambulance driver for saying that you need to transport everything.

So, im mindless for knowling the huge liability for refusing transport and stating the truth, and your the intelligent medic for blindly following protocols?

Get bent.

This is simple. Your ignoring the patient. Regardless of the purpose of the mothers initiation of 911, you have a US citizen with a reported medical complaint and incomplete medical care, and a mother who is requesting the patient be transported to a medical facility. We have a responsibility to this child.

You have me there, yes I have to live by a protocol, but a protocol requires you to use your education to even know where to begin. We have very progressive protocols. Thankfully as I have mentioned elsewhere it does allow us to think a little rather than none. I will not argue a point that is already been discussed to death it is obvious that we work in different environments and have to operate in the way that our medical directors deem best. I will continue to work from my part of the world for people to view us as professionals and I hope you do from yours.

[PRPGfirerescuetech]

Ill accept that.

Professionalism is the ultimate goal, your 100% right.

Please understand that much of my frustration comes from a poor educational standard across the US which ill prepares any of us for what we are facing daily.

From your posts prior, and posts today, you present yourself as a well spoken and intelligent EMS provider. I look forward to further debates with you.

[spenac]

Ill accept that.

Professionalism is the ultimate goal, your 100% right.

Please understand that much of my frustration comes from a poor educational standard across the US which ill prepares any of us for what we are facing daily.

From your posts prior, and posts today, you present yourself as a well spoken and intelligent EMS provider. I look forward to further debates with you.

Thanks, enjoyed it to. I actually do have a lot of respect for medics in the city's. Your minds and bodies have to run constant, I get most times a 90 mile drive or ride back home to unwind, but you guys go pick up drop off and pick up again again again. The endless running and from what others post sadly many are not a real emergency and then still always geared for the real one. I actually envy sometimes the thought of not being alone to make the critical decisions based on a few pages of paper and knowing there is no help for more than an hour and no one to call for advice. But it also makes me work to continue my education because we are years if not decades from getting a hospital in our immediate area so it will continue to be up to those of us in EMS to provide the best care we can. It is rewarding and in some ways more difficult at the same time on the long transports. We have time to learn about our patients, their family's, their pet's, their beliefs etc. But that also makes it harder to deal with knowing they are about to die but you hope at least by being there with them you brought them some comfort. Often times the ones that were not dieing (which is most as most really just need the doctor not the ambulance or ER) will see us in town and introduce their family's to us, give us hugs or a warm hand shake. You know like everyone I have a lot I can gripe about but really I could not see doing EMS any where else. And I can not see leaving EMS.

The hardest part is making changes to become more Professional. There is no one size fits all. Education is vital I agree but is not all that is needed. I see many ways it could be improved here but if I required those same changes in your area might make it worse there. And if you go with what benefits the majority, the people in areas like I serve lose.

[certguy]

This is interesting , 1 point I think that's been missed is ; Is the child a U.S. citizen ? If she was born here before the law changed , yes . In San Diego , where I used to work , we often went into Mexico to transport americans out , but , there was an organization called the bi - national health council that coordinated all transports out . In my mind , I'd definitely question the need for an ambulance , but I would refer this to them to determine if there's a genuine need and go from there . She definitely doesn't need an ALS rig though .