Scenario-4 wheeler accident

[spenac]

Here's my shot in the dark.

A single long bone fracture isn't necessarily a trauma. Any hospital with a orthopedic surgeon can fix it. The only other problem is, how can you be absolutely sure he doesn't have any other injuries? He could have c-spine issues. And if that hospital can't handle those injuries, then we have a problem. But if he is transported to the local hospital of his choice, it's better then nothing. Maybe they can fix his leg, then convince him of the need to be shipped elsewhere.

That said, Id explain the risks of going to XYZ hospital vs. ABC hospital. Then if he still wants to go to XYZ hospital, then that's his wish. Just because he has an injury doesn't mean you can force him to go to the hospital that your 'protocols' says. For example, it is state law that we transport to the only certified stroke center in the area, if pt presents with possible CVA. However, that pt, or their PA, can request the other hospital. They are informed of the ramifications, and must sign a form signifying that they understand that the other hospital cannot properly manage them, and they may die. Then we transport them. Until they are unconscious or confused, then you have no say in where they be transported.

So as has been stated transport per your protocols. Thankfully in my area there are no choices, your stuck going to a bandaid hospital with rent a docs that then decide to ship you to another hospital by air or by ground contract ambulance.

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So as has been stated transport per your protocols. Thankfully in my area there are no choices, your stuck going to a bandaid hospital with rent a docs that then decide to ship you to another hospital by air or by ground contract ambulance.

Well then I feel sorry for anyone that rides in your ambulance.What if it were your family member,would you want them to have sub standard care?

WERE TALKING 5 MILES MORE TO GO TO THE HOSPITAL OF THE PATIENTS CHOOSING.Protocol IS NOT law and is open to much broader interpetation.

[spenac]

Well then I feel sorry for anyone that rides in your ambulance.What if it were your family member,would you want them to have sub standard care?

WERE TALKING 5 MILES MORE TO GO TO THE HOSPITAL OF THE PATIENTS CHOOSING.Protocol IS NOT law and is open to much broader interpetation.

#1 scats comment showed protocol allowed for a way to go to another hospital.

#2 in my area as stated there is no choice because there is only 1 hospital and it's 90 miles to it. In the scenario I would follow procedures to get patient where they want to go.

#3 If my family is serious enough for ambulance I will by pass hospital and meet air ambulance accross street from hospital, I do the same for my patients all the time. Why waste time with the rent a doc. The reason before you ask why not have the helicopter come to location is nearest helicopter or fixed wing takes more than an hour to land at airport next to hospital. I am already at location prior to their arrival. So we cut off time by driving to meet them.

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#1 scats comment showed protocol allowed for a way to go to another hospital.

#2 in my area as stated there is no choice because there is only 1 hospital and it's 90 miles to it. In the scenario I would follow procedures to get patient where they want to go.

#3 If my family is serious enough for ambulance I will by pass hospital and meet air ambulance accross street from hospital, I do the same for my patients all the time. Why waste time with the rent a doc. The reason before you ask why not have the helicopter come to location is nearest helicopter or fixed wing takes more than an hour to land at airport next to hospital. I am already at location prior to their arrival. So we cut off time by driving to meet them.

Then why the comment "im glad they have no choice"?Were not talking about in your neck of the woods what would you do...Were talking:

HOSPITAL A=19 miles away,no trauma,PATIENT OK TO GO THERE

HOSPITAL B=29 miles away,trauma hospital but is know for SUB STANDARD CARE,PATIENT INSISTING HE DOESNT WANT TO GO THERE.

HOSPITAL C=32 miles away,good reputation,PATIENT OK TO GO THERE

Whats the correct choice with a lucid,non emergency patient?Push protocol aside,were talking the human thing to do....

[brentoli]

Is this a scenario, or are you trying to brow beat everyone into agreeing with you?

What do the protocols say. That is what matters. If "B" is the only trauma center, and your protocols say go to hospital "B" that is where we are going. This patient can not be guaranteed to not have an altered mental status. Did you know him before the accident? Your liability rests on the protocols, not on your heart.

[flight-lp]

Then why the comment "im glad they have no choice"?Were not talking about in your neck of the woods what would you do...Were talking:

HOSPITAL A=19 miles away,no trauma,PATIENT OK TO GO THERE

HOSPITAL B=29 miles away,trauma hospital but is know for SUB STANDARD CARE,PATIENT INSISTING HE DOESNT WANT TO GO THERE.

HOSPITAL C=32 miles away,good reputation,PATIENT OK TO GO THERE

Whats the correct choice with a lucid,non emergency patient?Push protocol aside,were talking the human thing to do....

O.k. you are making this harder than it has to be. Go to "C", simple as that. Its only a couple more miles. Some folks have to do exactly as their protocols state. Others have the ability to use some autonomy and a little common sense. Varies by region....................

I hear you use terms like ethical and human. Over time you will learn that these traits have little to do with this industry. It sucks, but quite often these are overruled by such terms as legality and liability. Your compassion is admirable, but you must know exactly where you stand on all of your departmental policies and it would be advisible to follow them or seek other employment. Personal crusades in EMS can be quite destructive to one's career.

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I am the patient....I was taken to a sub standard hospital that mutilated me AFTER I SAT IN THE ER 2 HOURS WITHOUT PAIN MEDS.

Femur fracture did hurt bad but ive got a high tolerance and knew where I didnt want to go.No pain meds were administered by the EMT's,EMT's went 50 mph in the slow lane(which is also the roughest BTW) and didnt run red light's.Hell,they stopped at a red light right in front of the hospital.

A lilttle history about me.Im a PADI master scuba diver trainer,PADI medic 1st aid intructor,and have worked in that profession for 5 years.In that time I have seen many stoke,heart attack,and drowning victims,at least 15.Im no stranger in doing whats right for the patient,esp if theyre LUCID and know whats going on.CALM THE PATIENT!!!!!!!!!!!!!!!!!!!!!

I also suffered a gun shot wound to my other leg 10 years earlier,point blank.EMS did exactly what I wanted and took me to the "good" hospital 30 miles more away.Nothing but good things to say about those guys.

If it werent for the fire and rescue guys almost getting in a fight with the idiot EMT's WHO WERE TRYING TO ROLL ME ON MY BACK AND STRAP ME,I WOULDVE LOST MY LEG.

I KNEW WHAT WAS BEST FOR ME EVEN IF THE EMT"S DIDNT AND MY WISHES WERE REFUSED WITH DISASTOROUS RESULTS.

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ALSO,FYI DOCTORS DONT WANT TO FIX SOMEONE ELSES MISTAKE!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Cant blame em,who wants to get in a big malpractice suite?Luckily,I found a doctor who will fix me out of state in Houston,TX.I had another competant doctor in my home state saying,I dont know why the orig doc made your leg 1.5" to long and I dont know why you cant bend your leg.

I hope and pray none of you ever put anyone in this kind of position.Im sure alot of you know which hospitals you all wouldnt want to go to.

[brentoli]

I am the patient....I was taken to a sub standard hospital that mutilated me AFTER I SAT IN THE ER 2 HOURS WITHOUT PAIN MEDS.

Femur fracture did hurt bad but ive got a high tolerance and knew where I didnt want to go.No pain meds were administered by the EMT's,EMT's went 50 mph in the slow lane(which is also the roughest BTW) and didnt run red light's.Hell,they stopped at a red light right in front of the hospital.

Were they paramedics? Only paramedics have access to narcotics. Did you ask for pain medication? If you weren't critical then there is no reason to risk lives running emergent to the hospital.

A lilttle history about me.Im a PADI master scuba diver trainer,PADI medic 1st aid intructor,and have worked in that profession for 5 years.In that time I have seen many stoke,heart attack,and drowning victims,at least 15.Im no stranger in doing whats right for the patient,esp if theyre LUCID and know whats going on.CALM THE PATIENT!!!!!!!!!!!!!!!!!!!!!

When have you worked in EMS?

I also suffered a gun shot wound to my other leg 10 years earlier,point blank.EMS did exactly what I wanted and took me to the "good" hospital 30 miles more away.Nothing but good things to say about those guys.

Glad to hear you are doing ok.

If it werent for the fire and rescue guys almost getting in a fight with the idiot EMT's WHO WERE TRYING TO ROLL ME ON MY BACK AND STRAP ME,I WOULDVE LOST MY LEG.

I KNEW WHAT WAS BEST FOR ME EVEN IF THE EMT"S DIDNT AND MY WISHES WERE REFUSED WITH DISASTOROUS RESULTS.

How would rolling you on your back be detrimental? You only have a femur fracture? No other fractures? The protocols around here call for a traction splint and immoblization on a long spinal board.

Need more information.

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1#They work for a private ambulance company here that is very big,DIDNT ASK ANYTHING BUT THERE NAMES AND THEY LIED ABOUT EM!!!!!!!!!!!!!!!!I screamed out in pain once and that was when the EMT's pushed me 10" across bumpy ground with roots all over the place(bumpiest ride I took).The 30 mins out of the woods in the back of the truck I didnt scream in pain or cry once,I ALSO TOLD THE EMT's THIS,LUCID,LUCID,LUCID,LUCID..ALSO,HOW CAN YOU BE SO INSISTENT THAT ITS A TRAUMA BUT NOT GIVE PAIN MEDS??????????????????

2#Nope.Common sense tells me that if a patient wants to go to a certain hospital,its there right to die wherever.Document it,have the patient sign it, and its NO PROBLEM.Dont have to be a genius to figure that one out.Or do you???

#3 Im actually not doing OK.Ive got to have a painful surgery and start over becuase some EMT thought he was GOD.Thank god I found a doctor who would address the problem.Thats 2 $50k plus surgeries,alot of people wouldnt be able to get that 2nd surgery because alot of people dont have health ins,luckily,I do.Not to mention the pain,youd have to have it happen to you to understand....The mental anguish from being told youll never walk correctly and your leg will never bend,the pain from a huge cut and peice of metal jammed all in your muscle's.Then the straight up anger when you think how this couldve all been avoided if someone followed your wish's.WHAT WOULD YOU DO IF SOMEONE CRIPPLED YOU OR ONE OF YOUR LOVED ONES?????????????WHAT COULD AFFECT YOUR LIVLY HOOD MORE THAN BEING ABLE TO WALK??????Id rather have my ability to reproduce taken away ANY DAY OF THE WEEK!!!

#4 Closed femur fracture but visible from looking at my skin on the back of my leg.You mean to tell me youd roll a patient onto his fracture thats gouging thru muscle??The EMT's werent even paying that attention,it had to be pointed out by the fire and rescue with them insisting "dont roll him over on the frature"they were just trying to get home for dinner in there town.Fire and Rescue insited on using air bag and strapping me on my side.They saved me and id kiss their feet if I could.

Was also told by an EMT "If you dont let us give you an IV,were gonna throw you in the back of that cop car,take you to jail,and youre gonna go to hospital b anyways"

THIS ISNT STUFF JUST TAUGHT TO THOSE MEDICALLY TRAINED,ITS COMMON SENSE!!!!!!!!!!!!!