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October 31, 2007 @ 2:13 pm
———————— I first need to say that I hate these hypothetical and contrived situations. While they are sometimes useful to illustrate a point about no win situations, they seldom give either side a clean cut resolution with which we can live. However, here’s my take on this one: There are two parts to this situation that both need to be addressed separately. Number One: A patient who is CAO X 3 and refuses transport may not be taken against their will without a court order, PERIOD. There isn’t a gray area here. It constitutes kidnapping, unlawful imprisonment, assault and battery, among a whole host of other things. The feelings of the family, nursing home providers, or anyone else are not relevant. If a person is to be transported against their will by court order, I would request a call to dispatch to verify the order and perhaps police/sheriff’s deputy involvement at the scene to back that up.
This is a strong statement of your assessment of the situation over a recorded line (hopefully). If the doctor still presses the issue over the radio/phone. I would ask them to talk directly to the patient. Perhaps there is a medical reason to be transported of which the patient is not aware or needs to have explained. This may resolve the situation and the refusal may go away. If this did not straighten things out, I would still refuse to transport. I would contact a police agency and advise them that the patient is in danger from family members who may try to force the patient to go against their will and I would hand it over to them. This is a mess no matter what you do. I talked to my father about this (he’s an attorney) and his take was that it’s an ethical / legal standoff. It will end badly for everyone and only be decided months or years later by a court decision. He believed based on his understanding of the situation that I am correct. In Maryland protocols, there is a clear process to follow for failure to comply with a physicians online medical order. The key points are made in two places: First: (quoted directly from the Maryland 2007 protocols)
My protocol says:
There are more details on the reporting process but the short version is all will be reviewed by the state EMS director’s office along with the jurisdictional and regional medical directors. Second: (quoted directly from the Maryland 2007 protocols)
Similarly to the first, the case is called in immediately and reviewed by the State EMS Director’s office and all the relevant medical directors. I have highlighted the most important part in the second protocol citation. We both have to agree. If we don’t, the treatment or medication or whatever — DOESN’T HAPPEN! Both situations are clearly listed in the table of contents if you wish to view the entire text. Just follow the pdf links above. In Maryland, we have a statewide protocol that I think helps with these types of situations. Cooler, un-involved heads tend to prevail when a pissing contest starts. ——————– Too long winded for you? Okay, here’s the short answer you can take to the bank on my part: If the patient makes an issue out of the forced transport, you could be arrested for criminal charges or charged with a civil suit. If the doctor decides to make a stink about this and your agency leadership doesn’t want to stand up for you then you might lose your job over it. I, however, would rather lose my job than go to jail. Jamie, the Podmedic October 30, 2007 @ 2:17 pm
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October 29, 2007 @ 8:53 pm
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———————— What do you think? Comment on this article using the comment link below. I’ll be posting my answer to Chris later this week but I want to know your opinion. (Answer now posted Here) Jamie, the Podmedic October 28, 2007 @ 11:00 pm
Welcome to Episode 90
Right click to download this episode or click the little arrow to listen here. A podcast for EMT’s, Paramedics, and other medical providers of all kinds. —————————- MedicCast Listener Deals at GoDaddy.com –
——————————— Link of the Week: The next MedicCast Live! on Wilderness EMS ——————————— Adult Vaccinations for Herpes Zoster (Varicella) Why Flu Spreads in the Winter? ———————————– Tip/Trick of the Week — ARDS (Acute Respiratory Distress Syndrome) ———————————– Med of the Week — Alpha and Beta Effects ———————————– Visit the MedicCast Forums ———————————– Thanks for Supporting the MedicCast! Rate the podcast at iTunes or at EMS Village or Vote at Podcast Alley Visit the MedicCast Store! Get the New MedicCast Newsletter — Sign up now — it’s free! Other Podcasts: MedicCast News, MedicCast Live, and Headliner News Roundup Contact Me! send me a note at podmedic@mac.com ———————————————— Music from the Artist Matthew Ebel — with the song “Nothing” Check out Matthew’s music on his site Or — you can click on the link below to go right to iTunes to check out his music! ————————————– Until next time, Scene safety, BSI! October 26, 2007 @ 6:00 pm
Whatever they discover, we will need to be on our toes in the coming months of the Flu Season as we encounter more individuals with exacerbated respiratory issues in the field. Take some time to bone up on your respiratory protocols. Look over the medical indications or contraindications or cautions for some of your less frequently used drugs like Terbutaline. The time to refresh and review is not with a patient while he’s tanking! October 25, 2007 @ 8:20 am
Just when you think it is safe to work in DC EMS again, another issue crops up — two, actually. A recent trainee death from respiratory distress is questioning the assessment performed by a DC EMS veteran paramedic and has caused her suspension pending investigation. On top of that, the DC Fire and EMS Academy reported a MRSA outbreak among the trainees. I report on this and other EMS news in the most recent episode of the MedicCast News at the Podcaster News Network. Jamie October 24, 2007 @ 2:39 pm
In Day Two of my stress follow-up stories, I found this article from Medicine Net that looks at the a study on the effectiveness of Post Traumatic Stress Disorder (PTSD) treatments. The researchers in the review study looked at other, previous studies on a variety of treatments applied to PTSD patients in an effort to determine the value of each one. What they found, though, was that the original studies themselves were often flawed and untrustworthy. The authors of the recent review commissioned by the Department of Veterans Affairs said that they were unable to effectively test the value of any of the studies and could not say which, if any, were effective treaments. They did point out that they are not saying that the treatments are not effective, just that the studies that looked at their effectiveness in the past are often flawed in their construction and offer uncertain value in their conclusions. This is unfortunate because the Department of Veterans Affairs was hoping to ascertain a definitive advantage of some treatments over others in an effort to better treat those returning from the wars in Iraq and Afghanistan. I would be interested in whether those original studies were (A) funded by federal funds or (B) run by or set up by companies or organizations with a vested interest in a certain outcome? This is definitely one of those — Things That Make You Go Hmmmm. October 23, 2007 @ 3:25 pm
After the great response I received from listeners about the Stress in EMS MedicCast Live Episode, I thought that I should keep an eye out for stress related stories in the news. Low and behold, not one, but two, pop up on my radar almost immediately. The first has to do with a study that has identified a possible genetic link to why some people handle stress better than others. You know what I mean. Why some people become sniveling bowls of jelly (everyone else) at the drop of a pin while others can stand in the middle of a disaster and seemingly hold the world together with their bare hands (us - of course)? I say that with a bit of a humorous tone, but it is a serious topic. Scientists have identified specific neuro-transmitters in the brain that are involved in the sending of messages while under stress. It appears that while some of us are able to suppress excess dopamine production aind inhibit over-response to stress, others exhibit progressive increases of dopamine production and release based on levels of external or perceived stress. This may explain why some of us seem to thrive on stress and can wade through it all day long without perceived effects while the rest of us are wearing our hearts on our sleeves. This discovery may point to more advances in the treatment of depression and anxiety down the road and certainly points to the idea that many of the so-called psych issues we deal with and treat are just manifestations of physiological and chemical differences in our brains. Check out the whole article here. October 22, 2007 @ 9:25 pm
The issue focuses on education in EMS and has a wide variety of articles inside to check out. I provided a column entry on being innovative in planning interactive training that can be found on page 10. Download a copy of the pdf and check out all of the good content. I’m already working on my next piece for the November issue. October 21, 2007 @ 10:45 pm
Welcome to Episode 89
Right click to download this episode or click the little arrow to listen here. A podcast for EMT’s, Paramedics, and other medical providers of all kinds. —————————- MedicCast Listener Deals at GoDaddy.com –
——————————— Link of the Week: Listener Rob’s Diabetes Tattoo Link ——————————— News: Top Hospitals = Better Survival Rates More MRSA Deaths Than AIDS in U.S. Tip/Trick of the Week — Renal Failure Signs and Symptoms ———————————– Med of the Week — I.V. Fluids Review ———————————– Visit the MedicCast Forums ———————————– Thanks for Supporting the MedicCast! Rate the podcast at iTunes or at EMS Village or Vote at Podcast Alley Visit the MedicCast Store! Get the New MedicCast Newsletter — Sign up now — it’s free! Other Podcasts: MedicCast News, MedicCast Live, and Headliner News Roundup Contact Me! send me a note at podmedic@mac.com ———————————————— Music from the Podsafe Music Network by Carlina — How Long Will You Be Gone? ————————————– Until next time, Scene safety, BSI!
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