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Is EMS still stuck in the "you call, we haul, that's all" mindset?

EMS1.com News

February 28, 2013


EMS News in Focus
by Art Hsieh

Is EMS still stuck in the "you call, we haul, that's all" mindset?

The challenge is that patients are humans, with a countless number of variables to identify and sort

By Art Hsieh

The investigation into this case is just beginning; we know about what happened for some time, especially since a lawsuit appears likely. This report highlights the ongoing concern that refusal of transport by EMS is a risky procedure.

There is no doubt we learn a lot while in training. Couple that with a few thousand patient contacts and we might feel confident in our ability to determine whether the patient is healthy enough to be left on scene.

The challenge is that patients are humans, with a countless number of variables to identify and sort. It's not possible to be able to recognize all of them, not even for a physician.

When you consider that the doc has access to a variety of testing methods and about 10 times the training and education of a paramedic, it becomes apparent that we are poorly trained and equipped to conduct such assessments.

In addition, while changes in healthcare delivery might provide the average EMS provider options in transport decisions, at this time those avenues are pretty limited.

For better or worse, EMS continues to be rooted in the paradigm of "you call, we haul, that's all" mindset.

Dramatic changes to that model are sorely needed, but so too is the need to be properly trained and educated.

About the author

EMS1 Editor in Chief Art Hsieh, MA, NREMT-P currently teaches at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. In the profession since 1982, Art has worked as a line medic and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a published textbook author, has presented at conferences nationwide, and continues to provide patient care at a rural hospital-based ALS system. Contact Art at Art.Hsieh@ems1.com.
Comments
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True North Group True North Group Thursday, February 28, 2013 7:43:54 PM The majority of lawsuits against EMS providers, other than for motor-vehicle accidents, arise out of patient refusals and other situations in which EMS fails to transport a patient who suffers a further medical emergency resulting in death or disability. Some of these cases are unavoidable, typically occurring where patients refuse care despite the best efforts of providers to convince patients to accept treatment and transport. Others, however, arise from a failure to follow protocol, an inadequate assessment or over-confidence regarding the capacity of providers to determine the presence of serious medical emergencies. As in so many areas of EMS, there is a pressing need to develop an evidence-based approach to “no transport” decisions. Unfortunately, very little research has been published on this topic. Training of EMS providers in managing “no transports” is inadequate as well, often based on traditional practice rather than sound medico-legal principles. Given the proper tools, EMS providers can effectively address patient refusals and related situations, while delivering excellent patient care and avoiding liability. Eric Jaeger, NREMT-P, BS, JD. @EMSLegal on Twitter. TrueNorthGroup.org

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