Another of those pesky tough questions

[Just Plain Ruff]

good answer spenac, I've worked in both service styles.

One service we were the only ambulance that was serving the county at the time they called so they are stuck.

the other service style is one that had 11 ambulances running and sometimes there were 5 or more available. They still didn't send another ambulance but sometimes they would send the supervisor or if there was a medic at HQ the supervisor would drive that medic to the scene to transport the patient.

I don't know of a amicable solution to this but you would hope that this doesn't happen very often.

[Yummymedic05]

I was thinking the same as Spenac, the fact is, if they are sitting there arguing about who's taking them in, and wasting time, apparently they don't need an ambulance in the first place. A person with a broken arm can go in POV, and if it was me I'd sign Carlos's refusal form and have a neighbor drive me in.

[Chief1C]

I suppose if the patient had a valid purpose for requesting someone else, I would call for a second unit. I would not want to make someone uncomfortable for calling EMS when they do need our services. I'd certainly make ample note in the PCR of their decision. If no other unit is available, which is a daily occurrence, I would probably have them speak w/ a physician via radio. Convince them to at least accept the more basic care the medic could provide. Still, if they are uncomfortable, I'd request that the patient sign a refusal stating that they refused initial ALS care because of X reasons. That way, we'd be sort of covered in case of future litigation.

[Just Plain Ruff]

That was an excellent point and post CMK I never thought of doing that though.

My line of thinking is that it has to be a valid a truly valid reason to refuse initial parmedic A's services and not just the fact that he didn't provide the narc's or whatever on their last encounter.

[Richard B the EMT]

I am of the primary crew in a district. I have gotten frequent fliers who say, "What, you again?" If the patient or their family request a different crew, for whatever the reason (except as someone else pointed out, a female for a sexual assault), I would advise that there would be a significant, if unspecified, delay in getting backup in, and they were trained to the same level as my partner and myself, by the same trainers. I usually talk them into going.

One exception was, a partner I once worked with, already had a relationship of trust with a particular patient, when I was supposed to be "teching", and my partner driving. Due to the previous relationship, and as the Police would be riding in the back with the patient anyway, that call, my partner and I switched roles for that call.

Play it by ear, on an individual case by case basis.

[paramedicmel]

I agree that you have to look at on a call by call situation. The area that I work in we only staff two ambulances and we are approx 12 miles apart. We have one female per shift so if a female sexual assault happens there can be a female in the back with the patient, and it isn't always going to be a medic. Luckily my FF doesn't have a scanner at her house to know who is working but I think she knows what docs are on duty to give her the narcs she wants! I also agree that if a patient has time to care who is going to be in the back of the ambulance taking care of them then they can get in their POV and drive! By the time the other ambulance gets to their house we would be half way to the hospital. It just blows my mind how some people think they can pick and choose in an emergency. A true emergency means....GET ME TO THE HOSPITAL NOW!!! In the case of Carlos they could always request that someone, a firefighter, drive or a friend rides in the back with them....

Be safe out there!!! :roll:

[Medic26]

No places that I have worked have a policy in place for this type of situation. I suppose that if the patient is requesting someone else than they are not sick enough to be calling in the first place, for MOST situations. We have several frequent flyers that have refused once we showed up they saw who was working or we wouldn't take them to a hospital 20 miles away when we can see the local facility from the scene.

[captainstandup]

Did the folks that didn't want a specific Paramedic follow the steps to report the behavior that caused the animosity? Did they communicate with management about the crew member in writing? Fellow providers and the public can bitch about a myriad of things but until someone has the wherewithal to step up and address the situation in writing forget about it.

Furthermore, how on earth would it be possible to allow anyone to be selective regarding the Paramedic or EMT since it is entirely possible that a person could be injured or become ill anywhere in the community?

If there is a problem crew member it must be documented to provide management with the necessary data to cure the problem.

[iMac]

what about you are in health care yourself and require and ambulance and get a paramedic whom you know couldnt save his own if he depended on it, someone who you know for a fact barely passed the exams to make to where he/she is and you see them arrive on scene?

Always been worried about that situation with myself or my family/friends.

I have had calls where I have been the attending because of the type of call it actually was. Also had a call where I would have been attending and the patient was just being way to creepy and strong and would make the switch with my (much bigger than I, male medic) partner.

Other than that I have not had anyone request another ambulance or someone else to attend nor would I have given them the option in any case.

[captainstandup]

I had a paramedic working for me who was openly gay. This was well known throughout our rural community and it being a rural community in the southeast one would expect some opposition to this guy's lifestyle. We had a Fire Chief that was livid about the fact that this guys was "allowed" to take care of patients. He proceeded to call friends in his community who called other friends who, you get the point. My phone rang of the hook for almost two weeks with citizens raising hell about this guy and how they didn't want him taking care of their children. These folks were calling the town board members and manager it was a mess. From a fair labor standard, civil rights etc perspective there was nothing I could do about this guy possibly responding to these folks residence. I failed to mention this guy was an outstanding employee, educated and probably the most skilled in the service. I finally got fed up with this mess and called the Fire Chief and asked him for his mailing address and that of the town. He inquired as to why to which I replied that this employee was preparing to file a federal civil rights lawsuit against our service, his fire department and town and him as an individual. I also used this tactic when citizens called in, and you know after about another week I didn't receive another call.....

If the clinician provided inappropriate care file the appropriate WRITTEN complaints. If this doesn't work hire an attorney. I would also include the medical director in this situation as he/she is likely more capable of stopping this guy from practicing than the town or county HR folks.