I got a call from a paramedic at 1 in the a.m. this morning. She works for an ambulance service that responds as a second tier to the fire department, and transports any patients that the firemedic deems is not serious enough for them to handle. The call went like this:
“I need your help. My supervisor won’t answer the phone, and I don’t know how to handle this. I am on scene of a single vehicle rollover that shattered a telephone pole, and the driver is a 26 year old female who woke up in the grass and didn’t remember the crash, or how she got out of the vehicle. She states that she had a single glass of wine, is otherwise appropriate, and is refusing medical care and transport. She states that she doesn’t want to be on a backboard or have a C collar. Her vitals are: HR 162, BP 126/78, RR 16. The fire department allowed her to sign a refusal, but I don’t think that’s right. The other medics here from the fire department are telling me that I’m being too much like a “rookie.” What should I do? She is in SVT, and had an accident.”
The first thing that you need to know is that this particular medic only got her license 4 months ago. She is a very bright woman, but has no experience. I advised her to talk the lady into going, and if there was no other way, agree to not immobilize her if she agrees to go, and just document that she refused being immobilized. I also told her that she was not likely dealing with SVT, the patient was likely bleeding internally, was in compensated shock, and getting her to the trauma center was a high priority.
Enroute to the hospital, the woman began complaining of abdominal pain, and her abdomen became rigid and distended. It turns out that she had some significant bleeding.
Medics: This is one of the dumbest refusals I’ve heard of a medic taking. Lazy medics make me angry. Make fun of the new medic for confusing shock and SVT all you want, but at least she was smart enough to know what a sick patient looks like.

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nadaclue · August 4, 2012 at 2:24 am

Good on that medic. When I saw the P rate, I figured internals.

Good that she had you to bother, I suppose you precepted her. She was trained well when her gut told her to overrule supposed experience, she did. A good gut is what makes an excellent medic. I've trained/precepted hundreds of them and flunked many.

I hereby award her with the "Mighty Missile Wo(Man) award of Steel. Great catch. Good medic. The kind of medic I’d consider for my crews I think.

I've thought long and hard on the Firemedics. I was a QA coordinator and Fire Captain of EMS. Managed two privates as well. Never got sued in 34 years in EMS, 32 as ALS.

Not enough info is provided regarding time the Fire guys checked the pt out or whether they knew her current VS.

HOWEVER, any patient with a high trauma event score, loss of memory of the incident, unknown extrication and the fact that she was outside the vehicle: MUST GO TO HOSPITAL, even with 5150 form if necessary.

The Fire medics were negligent and if they were on my crew, they would get 30 days off without pay as a first offense with one year probation, demoted from Paramedic for negligence if on probation. Lucky those fuccers don't work for me.

Her dilemma is difficult, New medic, doesn't want to make waves, Fire Medics and Privates usually don't get along that well (unless they're hot).

Answer: I don't have enough info to make the call BUT, She should be advised to NEVER trust anything this department does until they earn her trust, NOTHING. Recheck everything. Fire medics get their and think their shiite don't stink. Yeah, well, I had incompetent medics and we got rid of one and retrained a few others with weekly testing. They’re still shaky, but not as much as they were.
I think she should file an incident report with her management. The Fiiremedics certainly would. Public vs Private breeds contempt anyway so she’s got nothing to lose and covers her ass. This is coming from EMS commander, BTW. EMS is a hard but exciting life. Make a stand. Of course, you know her situation better than I so I won’t go much further. The IR is not going to earn points but neither is getting her butt in a sling because she listened to incompetent medics.

I feel for her but she bucked up and saved a life. Good for her.

Divemedic · August 4, 2012 at 3:05 am

Sadly, the patient expired. It turns out she had a ruptured spleen, a lacerated liver, and a ruptured abdominal aorta. She bled out at the trauma center. There is an investigation.

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