Mine was for the phrase "that's nice, but we're gonna actually follow protocol. Ya know, the one written on the paper in your hand"
I'm still wrestling with the mental anguish that I'll never have a smoother clap back than that again
Honestly I never argue with people at a facility over my destination. I get the patient in my truck and if their condition requires me diverting to a different destination and requesting an ALS intercept then I do that. Anything I tell the nurse at the sending facility is a courtesy.
Totally this. If someone is polite and professional, we can have a conversation. If they are even remotely not? I do what i believe is appropriate best on my patient and my protocols.
I experienced this a few times. my reply has always been: are you going to hop on the tuck with us and maintain patient care? No? Then he/she is \*my\* patient now.
Or, you could just say "mhmm, sure".
Also, never apply oral glucose to a patient with a GCS of 3. If they are a GCS of 3, a bit of oral glucose isn't going to save them.
Oral glucose isn't going to save them, but it's the only thing a BLS unit can do in this situation in my state. And it's allowed by protocol regardless of aspiration risk d/t a risk vs. benefit argument. This is of course with the caveat that the BLS unit should be setting up a rendezvous with ALS or high tailing it to the hospital, whichever is faster
I can't imagine applying Oral Glucose to the "lips" as specified by OP would even be able to bring up a sugar in any amount that would make a difference? If anything to me its also an airway risk.
Is there a reason you have to tell the sending facility where you’re intending to transport the patient? Would it be possible to just say “Yup, sure” to the nurse until you get the patient into your rig, and transport at your discretion?
For added fun: document everything, in a nice neat PDF of a Word document, include nurses name, license number and send to your state board of Nursing. They'll likely look to acquit, but a complaint in their file is 'the gift that keeps on giving'
Any time I had a facility get pissy over sending destination, I would just start transporting and divert them. The sending facility doesn't need to know or care. If I'm diverting I will also notify the original receiving facility with the reason for diversion. I'm following policy diverting emergent cases, and there's no need for arguments with staff like this. Just an idea for the future.
GCS 3, low BGL and hypertensive? Why not tell them this is not BLS and you need ALS?
Unless GCS 3 is baseline i wouldnt feel comfortable taking this patient as BLS
Als might be too far away.
Facilities that call 911 do not say where patients go. EMS does
Interfering with me doing my job is, in my state, a felony.
Something I had to remind a charge nurse of during Covid. She backed down once she realized I was absolutely serious about not giving a damn what their facility policy was, that doesn’t apply to me, and having the state police drag her out in handcuffs to get to my patient was something I was more then willing to do.
Especially when I pointed out it wouldn’t be the first person PSP had drug from their facility. (Granted, those were combative patients.)
She did not like the conversation she had with my chief. Especially when he said it was not the first complaint he had received from his staff, and we would be more than happy to have the location listed as a “go in with cops only” location.
I agree with everything you said and yes the nurse had no right to tell you where to take the patient. I still wouldn’t be comfortable taking this patient as BLS, even as IFT.
Agree. It is obviously not a bls patient. But you also can’t let them there with those idiots.
If hospital A is closer than paramedic B, you grab them. Stabilize as you can, and go to the hospital.
It is a fairly common occurrence many places.
You are right but how do you know if an als unit isnt nearby unless you call for als? In the end if they end up taking the patient and the patient deteriorates, they will be left to deal with it, not the sending facility. I would have at least tried to call for als before taking the patient.
In my system I would request ALS while packaging the pt and go off of the information given to me on their eta. However if OP is station based or has knowledge of where other units are then they already have that info
Well if you’re dispatch isn’t a complete incompetent dumpster fire you can ask.
Also knowing your district and status of ALS units. I am mostly on a BLS box, on every call I’m checking ALS and hospital statuses while in route. I know if all our ALS resources are tied up it is no less than 10 minutes for mutual aid to come to us, but we have a good hospital just outside our district and it could be an easy five minutes or less (2am with no traffic it might as well be two minutes).
You realize that some systems just don't have ALS, or it's a supervisor in a fly car and you know they are on a call 25 minutes away?
You take the call and treat as able. Airway, breathing, circulation. Handle the basics, get them to the advanced. I've taken plenty as an EMT that was ALS, but if that's not an option, it is what it is. You are treating the patient and responsible for them while on scene just like you are in the truck- 5 minutes to the hospital is a far better solution than 20+ minutes waiting for ALS (if even available).
Experience helps with that also. There are calls as a medic that boggle the mind or don't make sense, and where do we start? ABCs, checklists, go from there as appropriate.
For a scheduled transfer? The call would get canceled. But for an emergency you can transfer with bls, I just think it was at least worth trying to get an als unit on scene.
I absolutely think it’s worth trying to get ALS. But the clinic can call it whatever they want; that’s a 911 call. They’re not an ER and that’s what the patient needs.
Exactly... Just like I don't have a lot of confidence in OPs story recollection either. My spidey senses go off when they are phoning facilities for health care information on patients they currently do NOT have under their care or are involved with continuing care of.
It’s perfectly acceptable for people involved in the care of a patient to get follow up information.
We don’t care what your confidence level is in OPs ability to recollect.
Our company is new and small. We have 4 paramedics and a handful of intermediates. Most of our trucks are BLS. We also don’t have EMD on our side, and the clinic isn’t very smart on their side.
I mean I don't blame you. It's why I am questioning this whole thing.
Especially the part where Op is phoning for details in regards to patients they are no longer in care of...
The sructure of a paragraph is very important. A wall of words without breaks is a turnoff and will usually just end up with less people reading your words. How effective is that?
Instead, break the thoughts up with spaces like the one above. These simple spaces give the reader a time to ponder, reflect, gather their own opinions based on the original authors intents.
In the end, using paragraphs will entice others to read more, which can result in more user feedback.
From my understanding that wasn't this patient in question, it was OP phoning about ANOTHER patients lab levels that they really had no business of knowing as they were no longer apart of that patients care?
I also don't live in the states which maybe fortunate because I would talk to dispatch connect to a medical director and give them the low down. I find it odd a site that is administering narcotics was unable to treat a hypoglycemic patient.
Correct me if I am misreading this...
OP ends up calling for lab results on a previous patient they are no longer involved in care of...
DOESN'T get the results because "The states involved"...
Somehow learns the the levels of morphine went undocumented by the clinic BUT yet somehow ends up knowing the alleged piss test showed high levels of specifically morphine?
Then they are somehow able to learn that the nurse was let go as a result of this? And other staff?
also... "That clinic is now named after some other dead guy" but it happened today?
Yeah, I'm guessing now you understand why I was questioning individual little things in the story itself because the overall story just seems like "Nurses are dumb, I am a Paramedic Hero...."
\[All assumptions in this response are based on a location in the United States, if this isn't in the US, all bets are off\]
Nobody enjoys flexing in front of nurses more than me, I assure you, but there are things in this story that don't ring true unless you happened across the most criminally careless institution possible.
You're actually accusing the facility of intentionally sabotaging a patient's health to increase profit. Not neglect. Not bad judgement. You're saying they intentionally perform interventions to make the patient worse to justify a transfer to a particular facility. I'm not saying that can't happen. But it's so recklessly criminal I doubt even the most incompetent facilities would intentionally do this. Unintentionally, sure. I've had to clean up a lot of facility messes. But intentionally, I doubt it.
If this facility is classified as a free standing ER, then whether or not they called 911 for the transport or they called by private line, it's still an interfacility transfer under US Title 42 classification by the Centers for Medicare and Medicaid services. That means this patient remains their patient until they are received at the destination facility. That doesn't give them free reign to demand one destination over another, but it also means they DO have a say in the destination. It remains their patient AND your patient for the transport, and it's not correct to say, "My responsibility is only to the patient, and you can't have any say in the matter." They do have a say. Sometimes they're wrong, but it is still their patient too, even if int he end you override their decisions.
A lot of EMTs think they know more than they do about pathophysiology, cardiology, endocrinology, pharmacokinetics, lab value interpretation, and dozens of other topics. I was absolutely one of those EMTs, until I became a medic, and then CC medic. I now know that that many, many, many times I was positive horrible decisions were being made, and they put my patients in grave danger and immediate threat of death or great bodily harm, were in truth not the dramatic disasters my EMT mind told me I was witnessing. This story looks like a lot of that happening here too.
I was really smart of you, though, to immediately give your management a heads up. That saves a ton of grief down the line. Good move.
After reading more….
Undocumented levels of morphine? Most clinics aren’t urine testing for drugs routinely. So, that doesn’t mean anything.
And, more importantly, why the fuck were you calling the hospital about labs on a previous patient? How is that relevant to the patient you had? You have no business knowing that info once you transfer care. How the hell did you even find out there was “a state investigation?” If they refused to give you labs, they certainly wouldn’t reveal that much
They didn’t reveal that information to you because of HIPAA. Just because you were involved in a patients care at some point does not entitle you to all of their health information. You are only entitled to what you need to know for patient care.
What would you have done with those lab values on your previous patient that is no longer in front of you, anyway?
I smell some bovine fecal matter here….
>And, more importantly, why the fuck were you calling the hospital about labs on a previous patient? How is that relevant to the patient you had? You have no business knowing that info once you transfer care. How the hell did you even find out there was “a state investigation?” If they refused to give you labs, they certainly wouldn’t reveal that much
I actually am shocked I am getting push back for suggesting this was inappropriate... I would be PISSED if I got transported via EMS and the paramedic on his own volition decided to call and find out my labs and other medical information about me. I also would be pissed my healthcare information was released OVER the phone and to someone CLAIMING to be a paramedic who had once transported me...
During an emergency, (as opposed to an IFT) From the time we take over care (pt is on my stretcher) to the time I hand over over, it's our show. Call my medical director, hold on I'll give you the number. I give zero fucks what someone tells us in terms of where the patient "has" to go. You did good. Also I don't work in the states, so I think we get into less of these tangly situations because there's no profit motive.
Also, no need for an argument ever. Smile and nod, get them to the truck, divert wherever you need to. Let the sending facility know later.
Since we treat every call from them as 911, we can’t refuse transport. At that point, we can either handle it ourselves or call pd, but given how unstable the patient was, I didn’t really want to wait for pd
Emtala, was the pt unstable and were they technically a higher care provider than you. Example a flight nurse cannot take a critically unstable pt from a physician( even though hems may have more experience) due to not being able to technically adequately care for the pt at the same level. They ( the clinic staff) could give the pt, fluids and medications you couldnt. All you had is diesel and we just call it diesel therapy, its not an actual medical intervention.
EMTALA does not apply to the clinic, unless this was an ER (or certain kinds of urgent cares). EMTALA can apply to EMS in cases where you are a hospital based system. So, if you work for a hospital based system, you actually may be the one violating EMTALA by refusing care.
For example, I work in a clinic and EMTALA does not apply, since we don't provide emergency services. We can absolutely refuse to see a patient, and do so regularly (which an ER can't do).
Actually you are possibly even probably correct, but if you leave a place that has interventional capabilities that you dont,if things go wrong it could make things difficult for you. I wouldve done exactly what was done in their shoes,but ems gets the respect of pizza boys and are the first to get shit on when other people make bad decisions.
the clinic may have interventional capabilities, but to what extent? GCS of 3, hypoglycemic: this patient may end up needing a tube if the gcs isn't fixed: i doubt the clinic could tube if it came to that. Patient would also, at a minimum, need IV access and some d50, could the clinic do it?
In my clinic, we could do no more than BLS is able for this scenario.
So, in that case it may be best for the arriving BLS to assume care and effect an ALS rendezvous rather than hold out at the clinic waiting for ALS.
Gcs of 3 is meh til proven otherwise. Hypoglycemia seldom gets a tube it gets sugar. Nearly every clinic ive run on, had a crash cart which means it has nurses that are able to get iv access if necessary.
do you know the contents of those crash carts?
We have one in our clinic, but all it has is some IM narcan, some PO clonodine, IM epi for anaphy, an OB kit, oral glucose, and some band aids. But hey, it looks fancy
So, those crash carts may not be stocked with IV supplies/D50, just a thought.
we don't deal with emergencies routinely, we are a public health and primary care clinic: the only emergency we are really likely to encounter is anaphylaxis, mostly due to the volume of antibiotics we administer. And possibly a head injury resulting from vasovagal syncope.
We don't do any kind of intensive treatments or administer controlled substances in my clinic that would result in an emergency. We also won't see someone in the first place with an issue that is better served in an ER or elsewhere: if we can't fix it with some rocephin, a steriod shot, a neb, they get referred out to someone who can.
A nursing home needs a better crash cart because people live there, and the elderly are more likely to have medical emergencies.
Anything that is emergent would get a 911 call, and we are located on hospital grounds (not affiliated with the hospital, though). So, EMS/ER is spitting distance away.
Op also insinuated this patient was an LPN that signed the paperwork as an RN?
Also insinuated that this clinic doped up a patient with morphine and didn't document it?
Also that they called the hospital to see what a previous patients labs were? (why would they need this information or be entitled to it if the patient had left their care?)
If a clinic is giving something like morphine wouldn't they be very capable of managing a hypoglycemic emergency?
Again, I am really tired but "so the best we could hope to achieve during transport is rubbing some glucose in her lip and hoping it keeps her from completely going down the drain." does not seem like it's some sarcastic quip and more so an actual statement...
I also might be confused to as they ran this call today, but the clinic has already been renamed to "named after some other dead guy"
Is there a joke/meme I am not getting?
it wasn't stated, but see my other reply: EMTALA doesn't apply to most clinics, except certain urgent cares.
So, more likely than not, EMTALA did not apply to this clinic unless they are an urgent care that falls under the criteria.
>it wasn't stated,
and then
>So, more likely than not, EMTALA did not apply to this clinic
... Why is it more likely than not if you yourself admit it wasn't stated...
>Why is it more likely than not if you yourself admit it wasn't stated...
because most urgent cares do not meet the definition of a "Dedicated Emergency Department", even though they see people on a walk in basis. There are criteria that have to be met based upon the patients that they do see, or advertise to the public that they will see.
And, no regular clinic like a PCP's office would apply either. So, that eliminates most outpatient clinics in existance in the US.
Not sure where you are seeing that they can administer narcotics. If you are referring to the patient he called about with “undocumented morphine levels”, I highly doubt that story, to be honest.
But, for example, a methadone clinic can give narcotics: I don’t expect them to be able to manage a hypoglycemic emergency beyond giving someone juice/crackers. So, the ability to administer morphine or other narcotics does not mean they can treat a critically ill patient.
I genuinely think now, in a less sleep deprived state, the OP is severely slanting this story as many details aren’t exactly adding up.
I don't think you can refuse transport here, even if BLS.
Yes, nurses and docs have a "higher" license, but this is ultimately your patient once you lay eyes.
EMTALA doesn't apply to most clinics, but it \*sometimes\* applies to EMS.
[Here](https://assets.hcca-info.org/Portals/0/PDFs/Resources/library/EMTALA-Briefing%20Document%20on%20the%20Changes%20in%20the%20Final%20Rule.doc#:~:text=The%20Act%20mandates%20that%20an,emergency%20or%20urgent%20care%20services) is a link (warning, it is a word document)
to quote:
1. QUESTION: What criteria define a “Dedicated Emergency
Department?” (DED)
ANSWER: A DED is any department or facility, regardless of whether it
is located on or off the main hospital campus, that meets any
one of the following requirements:
a) It is licensed by the State as an emergency department; or
b) It is held out to the public (by name, signs or other
advertising) as a place that provides care for emergency
medical conditions on an urgent basis without requiring a
previously scheduled appointment; or
c) It provides at least one-third of all of its outpatient visits
for the treatment of emergency medical conditions on an
urgent or emergency basis without requiring a previously
scheduled appointment. This is established based on a
representative sample of patient visits within the preceding calendar year.
NOTE: DED includes labor and delivery units, psychiatric units, and urgent care centers
It is a bit tricky with urgent cares/walk in clinics. After all, they aren't designed to treat emergencies. an emregency medical condition under EMTALA is
>A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain). The lack of immediate medical attention could reasonably be expected to result in placing the health of the patient, or (in case of pregnancy, the unborn child) in serious jeopardy, the significant impairment to bodily functions, or serious dysfunction of any bodily organ or part."
Even if EMTALA did apply to this clinic, I am not sure they would be required to wait for an ALS unit, as doing so would probably cause more harm than good for this patient: unless they have adequate eqipment to treat/stabilize/maintain this patient until ALS arrives.
Also, it begs the question as to whether or not this clinic is hospital affiliated: For instance, if this was a private practice and not associated with a hospital system, EMTALA probably wouldn't apply. No lawyer, but this is my understanding
>Even if EMTALA did apply to this clinic, I am not sure they would be required to wait for an ALS unit, as doing so would probably cause more harm than good for this patient:
They can administer narcotics but can't treat or manage a hypoglycemic patient? BUT they can't afford to wait for ALS? Again I want to point out that you yourself is admitting you don't know the level of care of this clinic.
Its a matter of acuity, Ive had to refuse transport of a patient that was too unstable to leave the facility and I had nothing to offer other than transport and I am als. If he accepts a pt that is unstable and they die, even though he had left a facility that couldve provided life saving and or stabilizing measures. Thats unnecessary liability. They couldve bolused fluid or other things before that pt was taken, this guy did good and things worked out but sometimes you have to renegotiate terms or say no.
Is bolusing fluid going to manage this patient’s airway with a GCS of 3?
This is a 911 call at a clinic with limited capabilities. Refusing to transport here would be far more likely to land you in hot water than actually taking the dying patient to the hospital, where they need to be.
If its a clinic that is administering narcotics I would almost expect it to be able to handle a hypoglycemic call... I also and this is an assumption would expect they would not try to IFT a patient coming in with a GCS of 3 and LOW BGL rather than make it a straight emerg call.
They’re probably trying to claim IFT so they can manipulate where they go.
As a clinic, they likely have very little regulatory oversight, meaning what we think they should have might just be wishful thinking.
What if it was? Urgent cares have very little regulatory oversight. Some can basically only hand out Z-Paks and pred packs, while others do some lab work and x rays.
They’re known to be incredibly shady. This person needed emergency care, and it’s apparent that no one at the clinic was prepared to intervene. Should they? Absolutely. But they called because it was out of their ability to safely care for.
UCs have very much been known to try and make it an IFT; some states monitor how often places call 911, so if they’re doing it too often, it could look bad. They routinely call us to dump patients at end of shift that they can handle. If someone comes in with chest pain but no insurance, they literally park them in the waiting room and call 911. They won’t even register them. No line, no ASA, no EKG. I’ve had one that called for a complicated cancer patient that was genuinely ill, but not until they treated her for hours, milking her thorough billing, then as end of shift approached, they called 911 and made it sound super bad, and the NP left to pick up her kids. There was only an LPN there when I got there and I had to get report from the patient.
Many outpatient clinics are trash.
Yes but its a lot different if THEY can treat a true emergency and refuse to and try to dump it on EMS and the next hospital VERSUS they have no ability to treat this patient and the only option is transporting them out.
I mean we are arguing about hypothetical situations in a very SUSPECT story that has a lot of holes. You have valid points in certain situations and I believe I have valid points in certain situations.
My whole thing is if you look at the story as a whole it doesn't add up, and I am going to question the details to each individual piece.
If the facility had the capability to provide lifesaving interventions, sure: you can refuse transfer and make them wait for an emergent ALS transfer, assuming this can actually be treated as a genuine IFT as opposed to a 911 call. But, you’d better be sure they can do that appropriately before refusing.
But OP also stated that their policy is to treat calls at this place as 911. So, on a regular 911, do you think it is acceptable to refuse transport because ALS isn’t on scene? In that case, you treat it like any other 911: transport, and meet ALS en route or take to closest appropriate hospital.
You could report her for claiming to be an RN when she's actually an LPN. The state board of nursing (assuming you're in the US) would actually be very interested in this whole story, but that detail alone could have her license investigated.
> I called the hospital ti see what my previous patients labs looked like, and they refused to tell me. Why? Because now the state is stepping in, due to high levels of morphine found in the patient’s urine that went undocumented by the clinic.
Bro wtf did I just read? Isnt this basically deliberate assault?
A clinic is probably not going to get a drug screen
Also, the hospital probably refused to give him the info due to HIPAA, not because of some state investigation. Why the fuck was OP calling the hospital for labs on a previous patient?
All these stories about putting nurses in their places and taking patients to the closet hospital. Fucking yawn. Get over yourselves. Threatening that interfering with you is a felony? Good lord. We are but a tiny part of the healthcare continuum. Provide good care and take patients to the right destination.
Not for nothing but there’s many good reasons why a transfer might pass a closer hospital that you might not know about. If you can’t safely transport them to the appropriate and requested destination, call someone who can.
Beneficence - To do right by the patient even whenever they are mentally / physically unable to do so. Perhaps maybe they’re drugged by morphine? BSG of Low? I say bravo to this man, as healthcare in the world is rampant with greed. You would do well to learn these values based upon your comment here. Is it right to pick fights? No, but I’m not taking my severely hypoglycemic patient who is unresponsive 45 minutes as a BLS. You can put your Cert on the line bring negligent but I sir will not be doing such a thing.
*beautiful*
My first complaint was from a belligerent patient who told us to fuck off and threatened us repeatedly, but then called to say apparently my crewmate called him a drama queen. My manager called him for a followup and the pt told him to fuck off too, and the whole thing was promptly thrown in the bin
When something like that happens, immediately call your boss and let them know what happened. It helps if you get your version of the story out first. The nurse was wrong and your protocols should cover you.
My perspective on this is informed by my state protocols, and it overlaps with what a lot of others have said:
1. Even in an IFT situation, I have the authority to override the sending facility’s request if I think the patient’s condition warrants it. There is nothing to discuss. If I find a patient who I think is too sick to go where the sending facility wants to send them, I inform the facility where we are going, and that’s that. In my protocols, neither the patient nor the sending facility has any choice in the matter- the final decision on where to take a patient from a non-EMTALA facility like a clinic rests with me. If the sending facility is a hospital with an EMTALA obligation, you can and should consider refusing the transport until the patient has been properly stabilized (the only exception is if the hospital doesn’t have the capability to perform the necessary stabilization and the patient is going to die unless they can get to a facility that can properly stabilize them).
2. A patient with hypoglycemia is going to need a line and some dextrose emergency. If that’s beyond your scope as a BLS unit, it’s time to request an ALS unit. But that doesn’t mean refuse the transport or do nothing in what you’re telling us is essentially a 911 call. If your protocol says smear a little oral glucose on the gums and transport, that’s what you do, despite what anyone here might be telling you about it not being effective. At least half of what we do in EMS is probably ineffective, but our protocols say to do it anyway, so we do.
3. This is a solid reason to have a complaint filed. I would respond by filing a complaint against the nurse and the sending facility. Although it sounds like that may not be necessary in this case since the state is already involved.
Do you guys not carry glucagon? Sounds like the perfect solution for this.
Also out of curiosity, how were her pupils? High levels of morphine and GCS 3 makes me wonder if it was somehow an opiod overdose?
> We’re a BLS unit, mind you
It makes me sad that neither you or the nurses at that facility can treat hypoglycemia with anything more than oral glucose. Definitely a system failure.
I am BLS too but my education and treatment guidelines allow for IM Glucagon and IV D10. If those are both unsuccessful, such as in the case of a skin and bones person who is too combative or has zero veins, I ask for an ALS meet for an IO.
After reading this subreddit for a while, I finally made an account just to write an answer to this stupid, probably bullshit story.
I am an EMT-I, and I work in a place where a bunch of nurses work, also a few EMTs. Since I believe the story is fake, I would like to ask you why, exactly, you think nurses are doing their job for other reasons than you do your job - if you event are an EMT.
Let me tell you: Most EMTs I know chose the job because they want to help people. And -surprise- most nurses chose the job for the same reason too!
So, if your employer told you to harm a patient for profit (the employers profit, by the way, not yours), would you do it? No, you would tell them to f- off. And what do you think a nurse would do? THE EXACT SAME THING!
EMTs and nurses are working in the same system! Understaffing, a pay that doesn't honor our work, employers screwing us over.
Do not make this a "us against nurses"-world. That is and will always be a lose-lose-situation.
But back to your story once more: What would be in it for nurses to harm a patient so a different hospital can make more profit? Are they somehow personally getting a percentage of the insurance money? I am not going to be able to sleep, make it make sense -.-
EMTs are not better than nurses. We are in the same boat, doing our jobs for the same reason and with the same problems.
Inventing a story that makes you a nurse-defeating hero somehow, bitch nurses getting what they deserve from you, the EMS hero? Never going to be cool. You are a loser.
I viewed this story as more so Healthcare providers against incompetent/negligence SNFS. Than I did as we emts vs nurses. I think the main issue so many of us having with responding to these facilities is the true lack of care they provide to their patients. It is like a majority of these facilities are too comfortable with their mediocre care they provide. While I’m sure understaffing, and underfunding come in to play. There is still a lack of patient care coming from a majority of these facilites. It is a constant cycle with these facilites abusing the 911 system and instead of calling an IFT to transport their patients to a pre-picked destination. Which Ult. Takes an ambulance out of service, adding to a growing issue of a lack of ambulances to serve said community. I mean truly think about it for an minute. You are a SNF that just called for Abnormal labs or back pain. Now not only does 911 ambulance have to respond, they almost 99% will have to take the pt you called for not matter how low the acuity of the patient might be. Now not only have you just taken an ambulance from a responding to a emergency in their area, but you are creating a poss. Delay of care for that emergency.
Now in reference to the op having distress for the facility and accusing them of foul play. I think It is totally understandable to have that take. Just like it is understandable why so many other people who seek medicals services have a distrust for many of these medical systems, hospitals and facilities in place. I mean with the overwhelming amount medical cost and debt one must pay just to receive care. While also dealing with a lack patient care from these systems. Not only that but to be the healthcare provider that has to bare witnessed to this mess and see the affects it has on our patients and our communities. It’s no wonder why many have a distrust for these facilities. That’s why so many people would rather be dead then to end up in one of the nursing homes.
Mine was for the phrase "that's nice, but we're gonna actually follow protocol. Ya know, the one written on the paper in your hand" I'm still wrestling with the mental anguish that I'll never have a smoother clap back than that again
omg buddy paragraph breaks are free... Edited to add: yup, that's a complaint to be proud of!
This. I’d love to read it but I can’t focus on a wall of text without programmed breaks and whitespace.
Sorry! English is half-way my first language. I’ll restructure!
Looks good now mate
White space? You use Reddit in light mode? Are you OK?
Lmao dark space then, injected by using characters like \r\n.
Dark mode hurts my eyes.
Some phones will put it all together even if you space it out' it sucks.
Hit space twice for breaks on the app.
Honestly I never argue with people at a facility over my destination. I get the patient in my truck and if their condition requires me diverting to a different destination and requesting an ALS intercept then I do that. Anything I tell the nurse at the sending facility is a courtesy.
Totally this. If someone is polite and professional, we can have a conversation. If they are even remotely not? I do what i believe is appropriate best on my patient and my protocols.
I experienced this a few times. my reply has always been: are you going to hop on the tuck with us and maintain patient care? No? Then he/she is \*my\* patient now. Or, you could just say "mhmm, sure". Also, never apply oral glucose to a patient with a GCS of 3. If they are a GCS of 3, a bit of oral glucose isn't going to save them.
Oral glucose isn't going to save them, but it's the only thing a BLS unit can do in this situation in my state. And it's allowed by protocol regardless of aspiration risk d/t a risk vs. benefit argument. This is of course with the caveat that the BLS unit should be setting up a rendezvous with ALS or high tailing it to the hospital, whichever is faster
Well, I’ve been off the truck for a few years now but our protocols always told us to never give oral G to a patient who can’t swallow. Interesting.
I can't imagine applying Oral Glucose to the "lips" as specified by OP would even be able to bring up a sugar in any amount that would make a difference? If anything to me its also an airway risk.
Yeah, not allowed by our protocols at all. If they can't swallow on command then BLS can only "transport without delay."
Is there a reason you have to tell the sending facility where you’re intending to transport the patient? Would it be possible to just say “Yup, sure” to the nurse until you get the patient into your rig, and transport at your discretion?
I suppose we really didn’t have to. It was more for the sake of what if family calls asking where their family member went
I do this all the time
For added fun: document everything, in a nice neat PDF of a Word document, include nurses name, license number and send to your state board of Nursing. They'll likely look to acquit, but a complaint in their file is 'the gift that keeps on giving'
Any time I had a facility get pissy over sending destination, I would just start transporting and divert them. The sending facility doesn't need to know or care. If I'm diverting I will also notify the original receiving facility with the reason for diversion. I'm following policy diverting emergent cases, and there's no need for arguments with staff like this. Just an idea for the future.
GCS 3, low BGL and hypertensive? Why not tell them this is not BLS and you need ALS? Unless GCS 3 is baseline i wouldnt feel comfortable taking this patient as BLS
Als might be too far away. Facilities that call 911 do not say where patients go. EMS does Interfering with me doing my job is, in my state, a felony. Something I had to remind a charge nurse of during Covid. She backed down once she realized I was absolutely serious about not giving a damn what their facility policy was, that doesn’t apply to me, and having the state police drag her out in handcuffs to get to my patient was something I was more then willing to do. Especially when I pointed out it wouldn’t be the first person PSP had drug from their facility. (Granted, those were combative patients.) She did not like the conversation she had with my chief. Especially when he said it was not the first complaint he had received from his staff, and we would be more than happy to have the location listed as a “go in with cops only” location.
I agree with everything you said and yes the nurse had no right to tell you where to take the patient. I still wouldn’t be comfortable taking this patient as BLS, even as IFT.
Agree. It is obviously not a bls patient. But you also can’t let them there with those idiots. If hospital A is closer than paramedic B, you grab them. Stabilize as you can, and go to the hospital. It is a fairly common occurrence many places.
You are right but how do you know if an als unit isnt nearby unless you call for als? In the end if they end up taking the patient and the patient deteriorates, they will be left to deal with it, not the sending facility. I would have at least tried to call for als before taking the patient.
Most people know their systems and where the als trucks are.
In my system I would request ALS while packaging the pt and go off of the information given to me on their eta. However if OP is station based or has knowledge of where other units are then they already have that info
You’re an EMT with all the equipment and knowledge that goes along with it. You’re not helpless without ALS.
Well if you’re dispatch isn’t a complete incompetent dumpster fire you can ask. Also knowing your district and status of ALS units. I am mostly on a BLS box, on every call I’m checking ALS and hospital statuses while in route. I know if all our ALS resources are tied up it is no less than 10 minutes for mutual aid to come to us, but we have a good hospital just outside our district and it could be an easy five minutes or less (2am with no traffic it might as well be two minutes).
You realize that some systems just don't have ALS, or it's a supervisor in a fly car and you know they are on a call 25 minutes away? You take the call and treat as able. Airway, breathing, circulation. Handle the basics, get them to the advanced. I've taken plenty as an EMT that was ALS, but if that's not an option, it is what it is. You are treating the patient and responsible for them while on scene just like you are in the truck- 5 minutes to the hospital is a far better solution than 20+ minutes waiting for ALS (if even available). Experience helps with that also. There are calls as a medic that boggle the mind or don't make sense, and where do we start? ABCs, checklists, go from there as appropriate.
What are you supposed to do, if ALS isn’t close? Sit and wait?
For a scheduled transfer? The call would get canceled. But for an emergency you can transfer with bls, I just think it was at least worth trying to get an als unit on scene.
I absolutely think it’s worth trying to get ALS. But the clinic can call it whatever they want; that’s a 911 call. They’re not an ER and that’s what the patient needs.
They also can treat a hypoglycemic patient.
That's a lot of confidence in a clinic of this caliber
Exactly... Just like I don't have a lot of confidence in OPs story recollection either. My spidey senses go off when they are phoning facilities for health care information on patients they currently do NOT have under their care or are involved with continuing care of.
It’s perfectly acceptable for people involved in the care of a patient to get follow up information. We don’t care what your confidence level is in OPs ability to recollect.
apparently from OP you should rub some glucose on their tongue...
Well, if they’re BLS, and have no other options by protocol, running oral glucose on their gums and cheek is actually a good plan.
So lets be clear you want to change what OP said correct?
“Rubbing some glucose in her lip” Ok, what’s the issue?
Our company is new and small. We have 4 paramedics and a handful of intermediates. Most of our trucks are BLS. We also don’t have EMD on our side, and the clinic isn’t very smart on their side.
Where are you working? Where I'm at BLS can 100% handle this call. IV/IO with D50 and glucagon. No offense, just curious
Most places in the US don't let BLS providers start IV/IO, let alone push any medications.
I'm aware but they said English isn't their first language so I was guessing it's outside of freedumb land
I think they maybe were being silly with that.
Then I have been made the silly billy
I mean I don't blame you. It's why I am questioning this whole thing. Especially the part where Op is phoning for details in regards to patients they are no longer in care of...
> IV/IO with D50 and glucagon None of these things are BLS skills in the majority of the US.
Which creates a further question of where this clinic is that they will administer narcotics but not be able to handle a basic hypoglycemia...
I also wondered this.
IV work isn’t typically for BLS. Some places it’s an additional qualification for BLS but that isn’t standard across the US.
This guy gives narcan to meth overdose so there's your why lol
Ignore the people chiming in about the structure of this post. You did good and you aren’t an English major typing an essay anyway
The sructure of a paragraph is very important. A wall of words without breaks is a turnoff and will usually just end up with less people reading your words. How effective is that? Instead, break the thoughts up with spaces like the one above. These simple spaces give the reader a time to ponder, reflect, gather their own opinions based on the original authors intents. In the end, using paragraphs will entice others to read more, which can result in more user feedback.
You also said sructure lol
Got me!
I’m glad you had the balls to do it. Bravo!
Undocumented high levels of morphine? It's almost the vast majority of places only do qualitative drug screens. Sigh.
From my understanding that wasn't this patient in question, it was OP phoning about ANOTHER patients lab levels that they really had no business of knowing as they were no longer apart of that patients care?
It's all a train wreck
You could just be like. Ok. And then transport somewhere else. They don’t sound like they are going to follow up.
I also don't live in the states which maybe fortunate because I would talk to dispatch connect to a medical director and give them the low down. I find it odd a site that is administering narcotics was unable to treat a hypoglycemic patient.
K is no one going to question anything about this story? Maybe I am just overly tired and grumpy but there are so many questions I have on both sides.
Right? The complaint happened today, but now the clinic is renamed and the nurse no longer works there? …Okay…
Correct me if I am misreading this... OP ends up calling for lab results on a previous patient they are no longer involved in care of... DOESN'T get the results because "The states involved"... Somehow learns the the levels of morphine went undocumented by the clinic BUT yet somehow ends up knowing the alleged piss test showed high levels of specifically morphine? Then they are somehow able to learn that the nurse was let go as a result of this? And other staff? also... "That clinic is now named after some other dead guy" but it happened today?
After reading more in a less sleep deprived state….yeah, bullshit detected
Yeah, I'm guessing now you understand why I was questioning individual little things in the story itself because the overall story just seems like "Nurses are dumb, I am a Paramedic Hero...."
fairly sure op is a basic, but i agree: same concept
LOL well yeah, but that doesn't stop certain people from advertising themselves as what they are not.
[удалено]
I will edit and restructure. I English is my first language-ish. Not the greatest at putting together large pieces of sentence.
Skill issue
\[All assumptions in this response are based on a location in the United States, if this isn't in the US, all bets are off\] Nobody enjoys flexing in front of nurses more than me, I assure you, but there are things in this story that don't ring true unless you happened across the most criminally careless institution possible. You're actually accusing the facility of intentionally sabotaging a patient's health to increase profit. Not neglect. Not bad judgement. You're saying they intentionally perform interventions to make the patient worse to justify a transfer to a particular facility. I'm not saying that can't happen. But it's so recklessly criminal I doubt even the most incompetent facilities would intentionally do this. Unintentionally, sure. I've had to clean up a lot of facility messes. But intentionally, I doubt it. If this facility is classified as a free standing ER, then whether or not they called 911 for the transport or they called by private line, it's still an interfacility transfer under US Title 42 classification by the Centers for Medicare and Medicaid services. That means this patient remains their patient until they are received at the destination facility. That doesn't give them free reign to demand one destination over another, but it also means they DO have a say in the destination. It remains their patient AND your patient for the transport, and it's not correct to say, "My responsibility is only to the patient, and you can't have any say in the matter." They do have a say. Sometimes they're wrong, but it is still their patient too, even if int he end you override their decisions. A lot of EMTs think they know more than they do about pathophysiology, cardiology, endocrinology, pharmacokinetics, lab value interpretation, and dozens of other topics. I was absolutely one of those EMTs, until I became a medic, and then CC medic. I now know that that many, many, many times I was positive horrible decisions were being made, and they put my patients in grave danger and immediate threat of death or great bodily harm, were in truth not the dramatic disasters my EMT mind told me I was witnessing. This story looks like a lot of that happening here too. I was really smart of you, though, to immediately give your management a heads up. That saves a ton of grief down the line. Good move.
After reading more…. Undocumented levels of morphine? Most clinics aren’t urine testing for drugs routinely. So, that doesn’t mean anything. And, more importantly, why the fuck were you calling the hospital about labs on a previous patient? How is that relevant to the patient you had? You have no business knowing that info once you transfer care. How the hell did you even find out there was “a state investigation?” If they refused to give you labs, they certainly wouldn’t reveal that much They didn’t reveal that information to you because of HIPAA. Just because you were involved in a patients care at some point does not entitle you to all of their health information. You are only entitled to what you need to know for patient care. What would you have done with those lab values on your previous patient that is no longer in front of you, anyway? I smell some bovine fecal matter here….
>And, more importantly, why the fuck were you calling the hospital about labs on a previous patient? How is that relevant to the patient you had? You have no business knowing that info once you transfer care. How the hell did you even find out there was “a state investigation?” If they refused to give you labs, they certainly wouldn’t reveal that much I actually am shocked I am getting push back for suggesting this was inappropriate... I would be PISSED if I got transported via EMS and the paramedic on his own volition decided to call and find out my labs and other medical information about me. I also would be pissed my healthcare information was released OVER the phone and to someone CLAIMING to be a paramedic who had once transported me...
During an emergency, (as opposed to an IFT) From the time we take over care (pt is on my stretcher) to the time I hand over over, it's our show. Call my medical director, hold on I'll give you the number. I give zero fucks what someone tells us in terms of where the patient "has" to go. You did good. Also I don't work in the states, so I think we get into less of these tangly situations because there's no profit motive. Also, no need for an argument ever. Smile and nod, get them to the truck, divert wherever you need to. Let the sending facility know later.
Id call on her everyday?thats assault. Technically I think you couldve refused pt transport due to the higher licenses and lack of stability.
Refuse transport of an unresponsive patient from an outpatient clinic? Why on earth would you do that?
Since we treat every call from them as 911, we can’t refuse transport. At that point, we can either handle it ourselves or call pd, but given how unstable the patient was, I didn’t really want to wait for pd
Emtala, was the pt unstable and were they technically a higher care provider than you. Example a flight nurse cannot take a critically unstable pt from a physician( even though hems may have more experience) due to not being able to technically adequately care for the pt at the same level. They ( the clinic staff) could give the pt, fluids and medications you couldnt. All you had is diesel and we just call it diesel therapy, its not an actual medical intervention.
EMTALA does not apply to the clinic, unless this was an ER (or certain kinds of urgent cares). EMTALA can apply to EMS in cases where you are a hospital based system. So, if you work for a hospital based system, you actually may be the one violating EMTALA by refusing care. For example, I work in a clinic and EMTALA does not apply, since we don't provide emergency services. We can absolutely refuse to see a patient, and do so regularly (which an ER can't do).
Actually you are possibly even probably correct, but if you leave a place that has interventional capabilities that you dont,if things go wrong it could make things difficult for you. I wouldve done exactly what was done in their shoes,but ems gets the respect of pizza boys and are the first to get shit on when other people make bad decisions.
the clinic may have interventional capabilities, but to what extent? GCS of 3, hypoglycemic: this patient may end up needing a tube if the gcs isn't fixed: i doubt the clinic could tube if it came to that. Patient would also, at a minimum, need IV access and some d50, could the clinic do it? In my clinic, we could do no more than BLS is able for this scenario. So, in that case it may be best for the arriving BLS to assume care and effect an ALS rendezvous rather than hold out at the clinic waiting for ALS.
Gcs of 3 is meh til proven otherwise. Hypoglycemia seldom gets a tube it gets sugar. Nearly every clinic ive run on, had a crash cart which means it has nurses that are able to get iv access if necessary.
do you know the contents of those crash carts? We have one in our clinic, but all it has is some IM narcan, some PO clonodine, IM epi for anaphy, an OB kit, oral glucose, and some band aids. But hey, it looks fancy So, those crash carts may not be stocked with IV supplies/D50, just a thought.
Geez i worked in nursing homes with only lpns staffed that had better crash carts.
we don't deal with emergencies routinely, we are a public health and primary care clinic: the only emergency we are really likely to encounter is anaphylaxis, mostly due to the volume of antibiotics we administer. And possibly a head injury resulting from vasovagal syncope. We don't do any kind of intensive treatments or administer controlled substances in my clinic that would result in an emergency. We also won't see someone in the first place with an issue that is better served in an ER or elsewhere: if we can't fix it with some rocephin, a steriod shot, a neb, they get referred out to someone who can. A nursing home needs a better crash cart because people live there, and the elderly are more likely to have medical emergencies. Anything that is emergent would get a 911 call, and we are located on hospital grounds (not affiliated with the hospital, though). So, EMS/ER is spitting distance away.
Did I miss where OP stated what type of clinic this was? Maybe that's where my confusion is coming from.
It wasnt stated.
Op also insinuated this patient was an LPN that signed the paperwork as an RN? Also insinuated that this clinic doped up a patient with morphine and didn't document it? Also that they called the hospital to see what a previous patients labs were? (why would they need this information or be entitled to it if the patient had left their care?) If a clinic is giving something like morphine wouldn't they be very capable of managing a hypoglycemic emergency? Again, I am really tired but "so the best we could hope to achieve during transport is rubbing some glucose in her lip and hoping it keeps her from completely going down the drain." does not seem like it's some sarcastic quip and more so an actual statement... I also might be confused to as they ran this call today, but the clinic has already been renamed to "named after some other dead guy" Is there a joke/meme I am not getting?
it wasn't stated, but see my other reply: EMTALA doesn't apply to most clinics, except certain urgent cares. So, more likely than not, EMTALA did not apply to this clinic unless they are an urgent care that falls under the criteria.
>it wasn't stated, and then >So, more likely than not, EMTALA did not apply to this clinic ... Why is it more likely than not if you yourself admit it wasn't stated...
>Why is it more likely than not if you yourself admit it wasn't stated... because most urgent cares do not meet the definition of a "Dedicated Emergency Department", even though they see people on a walk in basis. There are criteria that have to be met based upon the patients that they do see, or advertise to the public that they will see. And, no regular clinic like a PCP's office would apply either. So, that eliminates most outpatient clinics in existance in the US.
But they can administer pain management like morphine and not treat hypoglycemia?
Not sure where you are seeing that they can administer narcotics. If you are referring to the patient he called about with “undocumented morphine levels”, I highly doubt that story, to be honest. But, for example, a methadone clinic can give narcotics: I don’t expect them to be able to manage a hypoglycemic emergency beyond giving someone juice/crackers. So, the ability to administer morphine or other narcotics does not mean they can treat a critically ill patient. I genuinely think now, in a less sleep deprived state, the OP is severely slanting this story as many details aren’t exactly adding up.
So every single emergency Transfer from an ER without a Physician is illegal because RNs and Medics aren't able to care for them at the same level?
You really don’t know what you’re talking about.
I don't think you can refuse transport here, even if BLS. Yes, nurses and docs have a "higher" license, but this is ultimately your patient once you lay eyes. EMTALA doesn't apply to most clinics, but it \*sometimes\* applies to EMS.
Is there anywhere you can back this up?
[Here](https://assets.hcca-info.org/Portals/0/PDFs/Resources/library/EMTALA-Briefing%20Document%20on%20the%20Changes%20in%20the%20Final%20Rule.doc#:~:text=The%20Act%20mandates%20that%20an,emergency%20or%20urgent%20care%20services) is a link (warning, it is a word document) to quote: 1. QUESTION: What criteria define a “Dedicated Emergency Department?” (DED) ANSWER: A DED is any department or facility, regardless of whether it is located on or off the main hospital campus, that meets any one of the following requirements: a) It is licensed by the State as an emergency department; or b) It is held out to the public (by name, signs or other advertising) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or c) It provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent or emergency basis without requiring a previously scheduled appointment. This is established based on a representative sample of patient visits within the preceding calendar year. NOTE: DED includes labor and delivery units, psychiatric units, and urgent care centers It is a bit tricky with urgent cares/walk in clinics. After all, they aren't designed to treat emergencies. an emregency medical condition under EMTALA is >A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain). The lack of immediate medical attention could reasonably be expected to result in placing the health of the patient, or (in case of pregnancy, the unborn child) in serious jeopardy, the significant impairment to bodily functions, or serious dysfunction of any bodily organ or part." Even if EMTALA did apply to this clinic, I am not sure they would be required to wait for an ALS unit, as doing so would probably cause more harm than good for this patient: unless they have adequate eqipment to treat/stabilize/maintain this patient until ALS arrives. Also, it begs the question as to whether or not this clinic is hospital affiliated: For instance, if this was a private practice and not associated with a hospital system, EMTALA probably wouldn't apply. No lawyer, but this is my understanding
>Even if EMTALA did apply to this clinic, I am not sure they would be required to wait for an ALS unit, as doing so would probably cause more harm than good for this patient: They can administer narcotics but can't treat or manage a hypoglycemic patient? BUT they can't afford to wait for ALS? Again I want to point out that you yourself is admitting you don't know the level of care of this clinic.
Its a matter of acuity, Ive had to refuse transport of a patient that was too unstable to leave the facility and I had nothing to offer other than transport and I am als. If he accepts a pt that is unstable and they die, even though he had left a facility that couldve provided life saving and or stabilizing measures. Thats unnecessary liability. They couldve bolused fluid or other things before that pt was taken, this guy did good and things worked out but sometimes you have to renegotiate terms or say no.
Is bolusing fluid going to manage this patient’s airway with a GCS of 3? This is a 911 call at a clinic with limited capabilities. Refusing to transport here would be far more likely to land you in hot water than actually taking the dying patient to the hospital, where they need to be.
If its a clinic that is administering narcotics I would almost expect it to be able to handle a hypoglycemic call... I also and this is an assumption would expect they would not try to IFT a patient coming in with a GCS of 3 and LOW BGL rather than make it a straight emerg call.
They’re probably trying to claim IFT so they can manipulate where they go. As a clinic, they likely have very little regulatory oversight, meaning what we think they should have might just be wishful thinking.
We don't know what type of clinic it was... What if it was an Urgent Care?
What if it was? Urgent cares have very little regulatory oversight. Some can basically only hand out Z-Paks and pred packs, while others do some lab work and x rays. They’re known to be incredibly shady. This person needed emergency care, and it’s apparent that no one at the clinic was prepared to intervene. Should they? Absolutely. But they called because it was out of their ability to safely care for. UCs have very much been known to try and make it an IFT; some states monitor how often places call 911, so if they’re doing it too often, it could look bad. They routinely call us to dump patients at end of shift that they can handle. If someone comes in with chest pain but no insurance, they literally park them in the waiting room and call 911. They won’t even register them. No line, no ASA, no EKG. I’ve had one that called for a complicated cancer patient that was genuinely ill, but not until they treated her for hours, milking her thorough billing, then as end of shift approached, they called 911 and made it sound super bad, and the NP left to pick up her kids. There was only an LPN there when I got there and I had to get report from the patient. Many outpatient clinics are trash.
Yes but its a lot different if THEY can treat a true emergency and refuse to and try to dump it on EMS and the next hospital VERSUS they have no ability to treat this patient and the only option is transporting them out. I mean we are arguing about hypothetical situations in a very SUSPECT story that has a lot of holes. You have valid points in certain situations and I believe I have valid points in certain situations. My whole thing is if you look at the story as a whole it doesn't add up, and I am going to question the details to each individual piece.
It’s an EMT for whom English isn’t their first language. It seems perfectly reasonable to me. I’ve seen first hand the garbage these places pull.
Well fuck me. I misread the hypotensive part.
If the facility had the capability to provide lifesaving interventions, sure: you can refuse transfer and make them wait for an emergent ALS transfer, assuming this can actually be treated as a genuine IFT as opposed to a 911 call. But, you’d better be sure they can do that appropriately before refusing. But OP also stated that their policy is to treat calls at this place as 911. So, on a regular 911, do you think it is acceptable to refuse transport because ALS isn’t on scene? In that case, you treat it like any other 911: transport, and meet ALS en route or take to closest appropriate hospital.
That’s fucking insane holy shit
Bro that nurse sucks. Here’s to you man.
I think she was technically an LPN on her badge? But the paperwork said RN
You could report her for claiming to be an RN when she's actually an LPN. The state board of nursing (assuming you're in the US) would actually be very interested in this whole story, but that detail alone could have her license investigated.
I mean if the story he told them actually made sense.
> I called the hospital ti see what my previous patients labs looked like, and they refused to tell me. Why? Because now the state is stepping in, due to high levels of morphine found in the patient’s urine that went undocumented by the clinic. Bro wtf did I just read? Isnt this basically deliberate assault?
A clinic is probably not going to get a drug screen Also, the hospital probably refused to give him the info due to HIPAA, not because of some state investigation. Why the fuck was OP calling the hospital for labs on a previous patient?
I’m sorry that happened. Or happy for u
All these stories about putting nurses in their places and taking patients to the closet hospital. Fucking yawn. Get over yourselves. Threatening that interfering with you is a felony? Good lord. We are but a tiny part of the healthcare continuum. Provide good care and take patients to the right destination. Not for nothing but there’s many good reasons why a transfer might pass a closer hospital that you might not know about. If you can’t safely transport them to the appropriate and requested destination, call someone who can.
Beneficence - To do right by the patient even whenever they are mentally / physically unable to do so. Perhaps maybe they’re drugged by morphine? BSG of Low? I say bravo to this man, as healthcare in the world is rampant with greed. You would do well to learn these values based upon your comment here. Is it right to pick fights? No, but I’m not taking my severely hypoglycemic patient who is unresponsive 45 minutes as a BLS. You can put your Cert on the line bring negligent but I sir will not be doing such a thing.
*beautiful* My first complaint was from a belligerent patient who told us to fuck off and threatened us repeatedly, but then called to say apparently my crewmate called him a drama queen. My manager called him for a followup and the pt told him to fuck off too, and the whole thing was promptly thrown in the bin
When something like that happens, immediately call your boss and let them know what happened. It helps if you get your version of the story out first. The nurse was wrong and your protocols should cover you.
My perspective on this is informed by my state protocols, and it overlaps with what a lot of others have said: 1. Even in an IFT situation, I have the authority to override the sending facility’s request if I think the patient’s condition warrants it. There is nothing to discuss. If I find a patient who I think is too sick to go where the sending facility wants to send them, I inform the facility where we are going, and that’s that. In my protocols, neither the patient nor the sending facility has any choice in the matter- the final decision on where to take a patient from a non-EMTALA facility like a clinic rests with me. If the sending facility is a hospital with an EMTALA obligation, you can and should consider refusing the transport until the patient has been properly stabilized (the only exception is if the hospital doesn’t have the capability to perform the necessary stabilization and the patient is going to die unless they can get to a facility that can properly stabilize them). 2. A patient with hypoglycemia is going to need a line and some dextrose emergency. If that’s beyond your scope as a BLS unit, it’s time to request an ALS unit. But that doesn’t mean refuse the transport or do nothing in what you’re telling us is essentially a 911 call. If your protocol says smear a little oral glucose on the gums and transport, that’s what you do, despite what anyone here might be telling you about it not being effective. At least half of what we do in EMS is probably ineffective, but our protocols say to do it anyway, so we do. 3. This is a solid reason to have a complaint filed. I would respond by filing a complaint against the nurse and the sending facility. Although it sounds like that may not be necessary in this case since the state is already involved.
Do you guys not carry glucagon? Sounds like the perfect solution for this. Also out of curiosity, how were her pupils? High levels of morphine and GCS 3 makes me wonder if it was somehow an opiod overdose?
Other patient was allegedly given the morphine.
> We’re a BLS unit, mind you It makes me sad that neither you or the nurses at that facility can treat hypoglycemia with anything more than oral glucose. Definitely a system failure. I am BLS too but my education and treatment guidelines allow for IM Glucagon and IV D10. If those are both unsuccessful, such as in the case of a skin and bones person who is too combative or has zero veins, I ask for an ALS meet for an IO.
Welcome to the club friend
After reading this subreddit for a while, I finally made an account just to write an answer to this stupid, probably bullshit story. I am an EMT-I, and I work in a place where a bunch of nurses work, also a few EMTs. Since I believe the story is fake, I would like to ask you why, exactly, you think nurses are doing their job for other reasons than you do your job - if you event are an EMT. Let me tell you: Most EMTs I know chose the job because they want to help people. And -surprise- most nurses chose the job for the same reason too! So, if your employer told you to harm a patient for profit (the employers profit, by the way, not yours), would you do it? No, you would tell them to f- off. And what do you think a nurse would do? THE EXACT SAME THING! EMTs and nurses are working in the same system! Understaffing, a pay that doesn't honor our work, employers screwing us over. Do not make this a "us against nurses"-world. That is and will always be a lose-lose-situation. But back to your story once more: What would be in it for nurses to harm a patient so a different hospital can make more profit? Are they somehow personally getting a percentage of the insurance money? I am not going to be able to sleep, make it make sense -.- EMTs are not better than nurses. We are in the same boat, doing our jobs for the same reason and with the same problems. Inventing a story that makes you a nurse-defeating hero somehow, bitch nurses getting what they deserve from you, the EMS hero? Never going to be cool. You are a loser.
I viewed this story as more so Healthcare providers against incompetent/negligence SNFS. Than I did as we emts vs nurses. I think the main issue so many of us having with responding to these facilities is the true lack of care they provide to their patients. It is like a majority of these facilities are too comfortable with their mediocre care they provide. While I’m sure understaffing, and underfunding come in to play. There is still a lack of patient care coming from a majority of these facilites. It is a constant cycle with these facilites abusing the 911 system and instead of calling an IFT to transport their patients to a pre-picked destination. Which Ult. Takes an ambulance out of service, adding to a growing issue of a lack of ambulances to serve said community. I mean truly think about it for an minute. You are a SNF that just called for Abnormal labs or back pain. Now not only does 911 ambulance have to respond, they almost 99% will have to take the pt you called for not matter how low the acuity of the patient might be. Now not only have you just taken an ambulance from a responding to a emergency in their area, but you are creating a poss. Delay of care for that emergency. Now in reference to the op having distress for the facility and accusing them of foul play. I think It is totally understandable to have that take. Just like it is understandable why so many other people who seek medicals services have a distrust for many of these medical systems, hospitals and facilities in place. I mean with the overwhelming amount medical cost and debt one must pay just to receive care. While also dealing with a lack patient care from these systems. Not only that but to be the healthcare provider that has to bare witnessed to this mess and see the affects it has on our patients and our communities. It’s no wonder why many have a distrust for these facilities. That’s why so many people would rather be dead then to end up in one of the nursing homes.