Comments on: No Transport http://medicscribe.com/2009/10/no-transport/ Peter Canning's EMS Journal Thu, 11 Mar 2010 05:09:48 -0400 http://wordpress.org/?v=2.8.4 hourly 1 By: ben http://medicscribe.com/2009/10/no-transport/comment-page-1/#comment-7807 ben Wed, 04 Nov 2009 23:35:46 +0000 http://streetwatch.wordpress.com/2009/10/29/no-transport#comment-7807 I have worked in London and New Zealand and both EMS services allow assess/treat and release. I can not comprehend a system that expects you to decide what drugs to administer, when to cardiovert, intubate, identify and decompress a tension pnemothorax, etc... but deems you incompetent to decide if little Johnny needs to go to hospital or not for that scratch to his knee. <br />And don't tell me that a nurse at the end of a phone can accurately assess anyone any better.<br />In regard to the recent research stating that EMS services sometimes get it wrong, then we should be increasing training to decrease these occurances. <br />Also remember that nurses, doctors and whole hospitals get it wrong sometimes, so please put it in perspective. I have worked in London and New Zealand and both EMS services allow assess/treat and release. I can not comprehend a system that expects you to decide what drugs to administer, when to cardiovert, intubate, identify and decompress a tension pnemothorax, etc… but deems you incompetent to decide if little Johnny needs to go to hospital or not for that scratch to his knee.
And don't tell me that a nurse at the end of a phone can accurately assess anyone any better.
In regard to the recent research stating that EMS services sometimes get it wrong, then we should be increasing training to decrease these occurances.
Also remember that nurses, doctors and whole hospitals get it wrong sometimes, so please put it in perspective.

]]> By: fiznat http://medicscribe.com/2009/10/no-transport/comment-page-1/#comment-7806 fiznat Mon, 02 Nov 2009 15:15:08 +0000 http://streetwatch.wordpress.com/2009/10/29/no-transport#comment-7806 Prehospital Emergency Care recently published a new article about this concept. It seems that Parmamedics pretty consistently mistake critical and non-critical patients about 10% of the time. Take a look when you get a chance:<br /><br />Prospective Evaluation of an Emergency Medical Services-Administered Alternative Transport Protocol, Prehospital Emergency Care, Volume 13, Issue 4 2009 , pages 432 - 436 <br /><br />Here is the abstract:<br />http://www.informaworld.com/smpp/content~db=all~content=a914291834 Prehospital Emergency Care recently published a new article about this concept. It seems that Parmamedics pretty consistently mistake critical and non-critical patients about 10% of the time. Take a look when you get a chance:

Prospective Evaluation of an Emergency Medical Services-Administered Alternative Transport Protocol, Prehospital Emergency Care, Volume 13, Issue 4 2009 , pages 432 – 436

Here is the abstract:
http://www.informaworld.com/smpp/content~db=all~content=a914291834

]]> By: P http://medicscribe.com/2009/10/no-transport/comment-page-1/#comment-7805 P Sun, 01 Nov 2009 13:45:08 +0000 http://streetwatch.wordpress.com/2009/10/29/no-transport#comment-7805 Thanks for the comments. The US, and then my state, in particular, the legal system and regulations guide much of what we can and can't do.<br /><br />We do have a category I didn't mention which is no injury. If I am called out to a motor vehicle and the police officer tells me there are no injuries, I can clear no patient. But again this is subject to some interpretation. I remember years ago we were called to a minor motor vehicle accident that incolved a 16 year old driver and his 16 year old passengers, and they were not hurt and had not called. Because they were minors, our supervisor said we had to stay with them until their parents came, which tied us up for an hour and they were not even hurt. Today, I might clear that call no injury, no patient, but with the nagging fear I could be sued and lose my license for abandonment.<br /><br />Whether you work commercial or municipal can also influence how you are encouraged to handle calls. A commercial service might emphasize transport to the hospital where a municipal service might encourage you to call a patient's doctor, and do some extended social work, arranging rides to a walk-in etc. You still would need to advise transport X 3 and secure a signature refusing transport. I have done this on occasion working both commercial and municipal, but for liability reasons, it is probably frowned on. Thanks for the comments. The US, and then my state, in particular, the legal system and regulations guide much of what we can and can't do.

We do have a category I didn't mention which is no injury. If I am called out to a motor vehicle and the police officer tells me there are no injuries, I can clear no patient. But again this is subject to some interpretation. I remember years ago we were called to a minor motor vehicle accident that incolved a 16 year old driver and his 16 year old passengers, and they were not hurt and had not called. Because they were minors, our supervisor said we had to stay with them until their parents came, which tied us up for an hour and they were not even hurt. Today, I might clear that call no injury, no patient, but with the nagging fear I could be sued and lose my license for abandonment.

Whether you work commercial or municipal can also influence how you are encouraged to handle calls. A commercial service might emphasize transport to the hospital where a municipal service might encourage you to call a patient's doctor, and do some extended social work, arranging rides to a walk-in etc. You still would need to advise transport X 3 and secure a signature refusing transport. I have done this on occasion working both commercial and municipal, but for liability reasons, it is probably frowned on.

]]> By: Anonymous http://medicscribe.com/2009/10/no-transport/comment-page-1/#comment-7804 Anonymous Sat, 31 Oct 2009 16:14:13 +0000 http://streetwatch.wordpress.com/2009/10/29/no-transport#comment-7804 So youre a paramedic but you can't say someone doesn't need hospital? In the uk, any practitioner (technician, paramedic, nurse/para ECP) can leave a patient at home that doesn't need it. In my jurisdiction they can also bypass the ER and refer, either stand alone via the medics or with the patients or out of hours gp, to a medical addmisions ward or other health care provider. This is all without 'medical cobtrol'. Seems you work in a system so frightned of litigation it won't let you do your job, which is a great shame. So youre a paramedic but you can't say someone doesn't need hospital? In the uk, any practitioner (technician, paramedic, nurse/para ECP) can leave a patient at home that doesn't need it. In my jurisdiction they can also bypass the ER and refer, either stand alone via the medics or with the patients or out of hours gp, to a medical addmisions ward or other health care provider. This is all without 'medical cobtrol'. Seems you work in a system so frightned of litigation it won't let you do your job, which is a great shame.

]]> By: TOTWTYTR http://medicscribe.com/2009/10/no-transport/comment-page-1/#comment-7803 TOTWTYTR Fri, 30 Oct 2009 23:18:18 +0000 http://streetwatch.wordpress.com/2009/10/29/no-transport#comment-7803 <i>A woman whose lengthy oxygen cannula was tangled around her so badly that she could not walk without fear of tripping. She wasn't hurt, she just wanted to be untangled.</i><br /><br />We responded to a "Difficulty Breathing" call for a nice lady whose cat had chewed through the tubing on her cannula. We replaced the cannula and she was back in business. No reason for ALS to go, since it was pretty clear from the comments on the call what had happened. <br /><br />Police station calls are a pain in the posterior. It's a game between the prisoners and the police. The prisoners want to go to the hospital because the beds are more comfortable and the food is better. Plus, they think that there's a chance to escape in many cases. <br /><br />The cops don't want the prisoner to go because they have to assign a 2 man unit to watch them. <br /><br />Guess who's in the middle? A woman whose lengthy oxygen cannula was tangled around her so badly that she could not walk without fear of tripping. She wasn't hurt, she just wanted to be untangled.

We responded to a "Difficulty Breathing" call for a nice lady whose cat had chewed through the tubing on her cannula. We replaced the cannula and she was back in business. No reason for ALS to go, since it was pretty clear from the comments on the call what had happened.

Police station calls are a pain in the posterior. It's a game between the prisoners and the police. The prisoners want to go to the hospital because the beds are more comfortable and the food is better. Plus, they think that there's a chance to escape in many cases.

The cops don't want the prisoner to go because they have to assign a 2 man unit to watch them.

Guess who's in the middle?

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