RE: well I have another one for you

October 21, 2008

I think what he's saying is that if you arrive with the patient, the doctor

MUST do an emergency screening exam and stabilize the patient before

transporting. That's the EMTALA law. Violation gets the doc a $50,000 fine.

He

cannot refuse to see the patient if you bring the patient to him.

However, I expect that in your community it would not be healthy for your

employment survival for you to get too crossways with the docs. I fully

understand what you're faced with.

Big towns are one thing; small towns are another. You have to manage to get

along while dealing with idiots. Not an easy task. I do not envy you.

Gene

>

> Are you telling me to ignore the doctor that you are taking the patient to?

>

> I have a

> scenario for you guys> > Respond to a call were someone has been hit in the

> head by a tire. Will he> is airing it up it explodes. You arrive and find a

> 20-25 year old male> sitting with blood clotting in nose laceration to

> bridge of nose and> swelling to the forehead and nose and severe knee pain

> with laceration.> Patient is sitting in chair as we approach the foreman

> tells the patient to> put his head back, we stop that action and take manual

> c-spine the patient> states " what happened to me? " Due to the local hospital

> being level IV and> the nearest level III is 45 miles away we decide to

> airlift. The foreman> immediately states no helicopter! We tell him that

> whatever this young man> has cannot be fixed in our local hospital and that

> it would be best to have> him at a higher level of care as quickly as

> possible he again says no> helicopter and that we are wasting time we have

> the young man c-collared,> spiders, head blocks, backboard moved to unit

> monitors attached IVs> attempted pt begging to be airlifted and foreman

> still refusing helicopter> screaming we been on scene 45 minutes (in reality

> 15 minutes). He even> states that every time you come out here you have to

> airlift(we have been to> this plant 5 times airlifted one with all ribs

> separated from sternum due to> crushing injury from forklift).> > What would

> you do?> > Would you complain?> > And if yes to who?> > This is the highest

> man on the totem pole at this plant so where do you go> from here? Just

> forget it or is this something that can be taken up with> DSHS?> > Debbie> >

>

October 21, 2008

HERESY, BRYAN! Obviously this patient has experienced a significant

mechanism of injury. Therefore he must be fully packaged and transported to

the

Level I trauma center with two 14 gauge IVs running wide open and O2/15lpm/NRB,

CODE 3. Board him standing. Just because you can't SEE his injuries doesn't

mean he doesn't have them. The American College of Surgeons says that he

MUST be severely hurt. Just because he SAYS he isn't hurt doesn't mean he

isn't. Obviously his mental faculties have been severely compromised by his

MOI.

And if you don't take him, the Level 1 can't charge him $8,596.04 for

telling him there's nothing wrong with him. Humpf. , you're never going

to

last in this business unless you learn the basics.

GG

>

> Let me ask this:

>

> A guy wrecks his motorcycle. You evaluate him, find him stable and

> ambulatory, with no apparent injuries. Do you bandage and splint him â€œjust

in case?â€

> No? Then why do you call a helicopter? Same argument.

>

> From: texasems-l@yahoogrotexasem [mailto:texasems-l@yahoogrotexasem] On

> Behalf Of Grayson

> Sent: Tuesday, October 21, 2008 10:29 PM

> To: texasems-l@yahoogrotexasem

> Subject: Re: well I have another one for you

>

> Rotoriasis afflicts more than EMTs, Debbie.

>

> And rural ER Docs tend to get raging cases of it sometimes.

>

> Debbie Fishbeck wrote:

> >

> > Well I have a new one for the masses. We respond to a motorcycle

> > accident dispatch makes it sound terrible we call for Helicopter based

> > on what we are told we arrive and find patient sitting up with officer

> > holding c-spine and we assess and determine despite reports of him

> > traveling anywhere between 50 mph and 80 mph when he wiped out he has

> > asphalt rash on forearm and moderate shoulder pain with no deformity

> > no bloodshed and we call off helicopter. Call report into Level IV

> > hospital and get told you lift him I am the ER doctor and just because

> > you don't see anything does not mean he does not have it so lift him.

> > We call helicopter back and it takes at least 30 minutes for

> > helicopter to get to us all the while the patient is asking why do I

> > have to be airlifted. I agree that I do not have x-ray vision, but

> > here is where I think helicopter are getting abused. If had blood and

> > guts hanging call a helicopter, if he had head trauma call a

> > helicopter. I think that sometimes we need to look at our patient and

> > say this does not have to go by air. I agree with Gene on the other

> > accident, but we felt he had a head injury and needed to be somewhere

> > that could handle that without delaying his care for over an hour

> > before he was transferred out. The motorcycle person could have gone

> > to local evaluated and if need be transferred, but basically we were

> > told don't bring him here.

> >

> > Bp was normal heart rate a little elevated (mine was elevated more

> > than his) range of motion times 4 alert and oriented to date time

> > place and self.

> >

> > A case of Damned if you do and Damned if you don't.

> >

> > Debbie

> >

> > I have a scenario for you guys

> > >

> > > Respond to a call were someone has been hit in the head by a tire.

> > Will he

> > > is airing it up it explodes. You arrive and find a 20-25 year old male

> > > sitting with blood clotting in nose laceration to bridge of nose and

> > > swelling to the forehead and nose and severe knee pain with laceration.

> > > Patient is sitting in chair as we approach the foreman tells the

> > patient to

> > > put his head back, we stop that action and take manual c-spine the

> > patient

> > > states " what happened to me? " Due to the local hospital being level

> > IV and

> > > the nearest level III is 45 miles away we decide to airlift. The foreman

> > > immediately states no helicopter! We tell him that whatever this

> > young man

> > > has cannot be fixed in our local hospital and that it would be best

> > to have

> > > him at a higher level of care as quickly as possible he again says no

> > > helicopter and that we are wasting time we have the young man

> > c-collared,

> > > spiders, head blocks, backboard moved to unit monitors attached IVs

> > > attempted pt begging to be airlifted and foreman still refusing

> > helicopter

> > > screaming we been on scene 45 minutes (in reality 15 minutes). He even

> > > states that every time you come out here you have to airlift(we have

> > been to

> > > this plant 5 times airlifted one with all ribs separated from

> > sternum due to

> > > crushing injury from forklift).

> > >

> > > What would you do?

> > >

> > > Would you complain?

> > >

> > > And if yes to who?

> > >

> > > This is the highest man on the totem pole at this plant so where do

> > you go

> > > from here? Just forget it or is this something that can be taken up with

> > > DSHS?

> > >

> > > Debbie

> > >

October 21, 2008

Well I have a new one for the masses. We respond to a motorcycle accident

dispatch makes it sound terrible we call for Helicopter based on what we are

told we arrive and find patient sitting up with officer holding c-spine and we

assess and determine despite reports of him traveling anywhere between 50 mph

and 80 mph when he wiped out he has asphalt rash on forearm and moderate

shoulder pain with no deformity no bloodshed and we call off helicopter. Call

report into Level IV hospital and get told you lift him I am the ER doctor and

just because you don't see anything does not mean he does not have it so lift

him. We call helicopter back and it takes at least 30 minutes for helicopter to

get to us all the while the patient is asking why do I have to be airlifted. I

agree that I do not have x-ray vision, but here is where I think helicopter are

getting abused. If had blood and guts hanging call a helicopter, if he had head

trauma call a helicopter. I think that sometimes we need to look at our patient

and say this does not have to go by air. I agree with Gene on the other

accident, but we felt he had a head injury and needed to be somewhere that could

handle that without delaying his care for over an hour before he was transferred

out. The motorcycle person could have gone to local evaluated and if need be

transferred, but basically we were told don't bring him here.

Bp was normal heart rate a little elevated (mine was elevated more than his)

range of motion times 4 alert and oriented to date time place and self.

A case of Damned if you do and Damned if you don't.

Debbie

I have a scenario for you guys

>

> Respond to a call were someone has been hit in the head by a tire. Will he

> is airing it up it explodes. You arrive and find a 20-25 year old male

> sitting with blood clotting in nose laceration to bridge of nose and

> swelling to the forehead and nose and severe knee pain with laceration.

> Patient is sitting in chair as we approach the foreman tells the patient to

> put his head back, we stop that action and take manual c-spine the patient

> states " what happened to me? " Due to the local hospital being level IV and

> the nearest level III is 45 miles away we decide to airlift. The foreman

> immediately states no helicopter! We tell him that whatever this young man

> has cannot be fixed in our local hospital and that it would be best to have

> him at a higher level of care as quickly as possible he again says no

> helicopter and that we are wasting time we have the young man c-collared,

> spiders, head blocks, backboard moved to unit monitors attached IVs

> attempted pt begging to be airlifted and foreman still refusing helicopter

> screaming we been on scene 45 minutes (in reality 15 minutes). He even

> states that every time you come out here you have to airlift(we have been to

> this plant 5 times airlifted one with all ribs separated from sternum due to

> crushing injury from forklift).

>

> What would you do?

>

> Would you complain?

>

> And if yes to who?

>

> This is the highest man on the totem pole at this plant so where do you go

> from here? Just forget it or is this something that can be taken up with

> DSHS?

>

> Debbie

>

October 21, 2008

Rotoriasis afflicts more than EMTs, Debbie.

And rural ER Docs tend to get raging cases of it sometimes.

Debbie Fishbeck wrote:

>

> Well I have a new one for the masses. We respond to a motorcycle

> accident dispatch makes it sound terrible we call for Helicopter based

> on what we are told we arrive and find patient sitting up with officer

> holding c-spine and we assess and determine despite reports of him

> traveling anywhere between 50 mph and 80 mph when he wiped out he has

> asphalt rash on forearm and moderate shoulder pain with no deformity

> no bloodshed and we call off helicopter. Call report into Level IV

> hospital and get told you lift him I am the ER doctor and just because

> you don't see anything does not mean he does not have it so lift him.

> We call helicopter back and it takes at least 30 minutes for

> helicopter to get to us all the while the patient is asking why do I

> have to be airlifted. I agree that I do not have x-ray vision, but

> here is where I think helicopter are getting abused. If had blood and

> guts hanging call a helicopter, if he had head trauma call a

> helicopter. I think that sometimes we need to look at our patient and

> say this does not have to go by air. I agree with Gene on the other

> accident, but we felt he had a head injury and needed to be somewhere

> that could handle that without delaying his care for over an hour

> before he was transferred out. The motorcycle person could have gone

> to local evaluated and if need be transferred, but basically we were

> told don't bring him here.

>

> Bp was normal heart rate a little elevated (mine was elevated more

> than his) range of motion times 4 alert and oriented to date time

> place and self.

>

> A case of Damned if you do and Damned if you don't.

>

> Debbie

>

> I have a scenario for you guys

> >

> > Respond to a call were someone has been hit in the head by a tire.

> Will he

> > is airing it up it explodes. You arrive and find a 20-25 year old male

> > sitting with blood clotting in nose laceration to bridge of nose and

> > swelling to the forehead and nose and severe knee pain with laceration.

> > Patient is sitting in chair as we approach the foreman tells the

> patient to

> > put his head back, we stop that action and take manual c-spine the

> patient

> > states " what happened to me? " Due to the local hospital being level

> IV and

> > the nearest level III is 45 miles away we decide to airlift. The foreman

> > immediately states no helicopter! We tell him that whatever this

> young man

> > has cannot be fixed in our local hospital and that it would be best

> to have

> > him at a higher level of care as quickly as possible he again says no

> > helicopter and that we are wasting time we have the young man

> c-collared,

> > spiders, head blocks, backboard moved to unit monitors attached IVs

> > attempted pt begging to be airlifted and foreman still refusing

> helicopter

> > screaming we been on scene 45 minutes (in reality 15 minutes). He even

> > states that every time you come out here you have to airlift(we have

> been to

> > this plant 5 times airlifted one with all ribs separated from

> sternum due to

> > crushing injury from forklift).

> >

> > What would you do?

> >

> > Would you complain?

> >

> > And if yes to who?

> >

> > This is the highest man on the totem pole at this plant so where do

> you go

> > from here? Just forget it or is this something that can be taken up with

> > DSHS?

> >

> > Debbie

> >

October 21, 2008

While I am not a legal expert, nor do I play one on TV, I would think unless he

is affiliated with your EMS service in some way the ER doc can not refuse to

take the patient. I think that would be a EMTALA violation. You might need to

take a step back and look at your ability to control the scene and manage

outside factors. I am not saying you are a bad medic or can't handle it, but it

does seem you let to many outside influences affect your patient care decisions.

You should consider what the patient wants, what's in the patients best interest

and what your protocols dictate. Use your best judgment and stop worrying about

foremen and lazy ER docs.

Vondran EMT-P

To: texasems-l@...: lcambulance@...: Tue, 21 Oct

2008 22:16:15 -0500Subject: RE: well I have another one for you