You Make the Call – MotorDoc

You are dispatched to a reported motorcycle down in a trouble area in your district.  On arrival you find a single motorcycle has impacted the side of a big rig tractor which was turning in front of him.  He is laying supine, helmet removed prior to your arrival and is alert and oriented.

The rider states he was travelling at 20-30 mph and pulled the brakes when he realized he was not going to make it around the truck.  The skid marks leading up to the truck match that story and you begin your assessment.

Deformity to the left clavicle, self splinted and pain on palpation to the left flank are noted with no flail segment noticible on palpation or observation.  No other trauma is noted and the helmet is pristine.

As you begin to cut the leather jacket, after convincing him it will not be a good idea to pull it off considering the injury, he pulls rank.

"Ease up kid, I'm a Doctor.  Just do what I say and I'll be fine."

You pause a moment and consider his statement.  After the first try to move his arm ends in screams, he reluctantly agrees to cut just only the area needed.

As C-spine precautions are applied he bats them away and adds another gem, "I'm not going to Regional Trauma, take me to Saint Farthest."

Saint Farthest is a local ER, most often staffed with a general practitioner doing their rotation.  They have no surgical capabilities and the last time you took a patient there with a decent laceration there was an argument.

 

The patient identifies himself as a trauma doc and doesn't want to bother his co-workers.

He'll agree to the collar and board if you agree to take him to St Farthest.

What do you do?

You make the call.

Read through the comments, the click HERE to see what call I made.

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127 thoughts on “You Make the Call – MotorDoc”

  1. I would call Saint Farthest and inform them of the situation, then i put the pt on the phone with the ER doctor. Hopefully fellow ER doc can change his mind since the facility is obviously not equipped to handle this pt but if he still demands to go I guess I would take him. If I bust out the protocols on him that say to transport to the nearest appropriate facility (im guessing regional trauma?) then he would probably refuse transport anyway and would be within his rights to do so. Then I document document document so that when Saint Farthest transports him out to regional trauma I can show that I tried to take him there in the first place. Doctors and nurses make terrible EMS patients and usually terrible bystanders too!

  2. I would call Saint Farthest and inform them of the situation, then i put the pt on the phone with the ER doctor. Hopefully fellow ER doc can change his mind since the facility is obviously not equipped to handle this pt but if he still demands to go I guess I would take him. If I bust out the protocols on him that say to transport to the nearest appropriate facility (im guessing regional trauma?) then he would probably refuse transport anyway and would be within his rights to do so. Then I document document document so that when Saint Farthest transports him out to regional trauma I can show that I tried to take him there in the first place. Doctors and nurses make terrible EMS patients and usually terrible bystanders too!

  3. I would call Saint Farthest and inform them of the situation, then i put the pt on the phone with the ER doctor. Hopefully fellow ER doc can change his mind since the facility is obviously not equipped to handle this pt but if he still demands to go I guess I would take him. If I bust out the protocols on him that say to transport to the nearest appropriate facility (im guessing regional trauma?) then he would probably refuse transport anyway and would be within his rights to do so. Then I document document document so that when Saint Farthest transports him out to regional trauma I can show that I tried to take him there in the first place. Doctors and nurses make terrible EMS patients and usually terrible bystanders too!

  4. Man, you must have been in my rig in my rig a couple months ago when I had nearly this same scenario….

    In this situation, he would fall under the “rider separated from vehicle” criteria under our trauma activation protocol. So naturally, we would have to take him to our local trauma center. However, being that he is alert and oriented, he DOES have the right to refuse transport to that hospital. The fact that he is a physician has nothing to do with it. He’s a patient at this point, not a doctor.

    I would do my best in this scenario to convince him to allow transport to the trauma center and explain the risks of refusing. Once he stated that he understood the risks and STILL wanted to be transported to St. Furthest, I would have him sign a “Trauma System Refusal Form”, or a standard “AMA” if your system doesn’t use that form. I would probably get a witness signature from a police officer on scene as well.

    When I rolled into St. Furthest, I would let him do all the explaining.

  5. Man, you must have been in my rig in my rig a couple months ago when I had nearly this same scenario….

    In this situation, he would fall under the “rider separated from vehicle” criteria under our trauma activation protocol. So naturally, we would have to take him to our local trauma center. However, being that he is alert and oriented, he DOES have the right to refuse transport to that hospital. The fact that he is a physician has nothing to do with it. He’s a patient at this point, not a doctor.

    I would do my best in this scenario to convince him to allow transport to the trauma center and explain the risks of refusing. Once he stated that he understood the risks and STILL wanted to be transported to St. Furthest, I would have him sign a “Trauma System Refusal Form”, or a standard “AMA” if your system doesn’t use that form. I would probably get a witness signature from a police officer on scene as well.

    When I rolled into St. Furthest, I would let him do all the explaining.

  6. Man, you must have been in my rig in my rig a couple months ago when I had nearly this same scenario….

    In this situation, he would fall under the “rider separated from vehicle” criteria under our trauma activation protocol. So naturally, we would have to take him to our local trauma center. However, being that he is alert and oriented, he DOES have the right to refuse transport to that hospital. The fact that he is a physician has nothing to do with it. He’s a patient at this point, not a doctor.

    I would do my best in this scenario to convince him to allow transport to the trauma center and explain the risks of refusing. Once he stated that he understood the risks and STILL wanted to be transported to St. Furthest, I would have him sign a “Trauma System Refusal Form”, or a standard “AMA” if your system doesn’t use that form. I would probably get a witness signature from a police officer on scene as well.

    When I rolled into St. Furthest, I would let him do all the explaining.

  7. Along the lines of other’s… I would actually call Regional Trauma, and confirm with them that they want to see this patient. Again, if need be, put the patient on the phone, and them duke it out MD to MD. I absolutely do not consider my patient to be medical control– or medical direction, so all changes to protocol need to be cleared through online medical control.

  8. Along the lines of other’s… I would actually call Regional Trauma, and confirm with them that they want to see this patient. Again, if need be, put the patient on the phone, and them duke it out MD to MD. I absolutely do not consider my patient to be medical control– or medical direction, so all changes to protocol need to be cleared through online medical control.

  9. Along the lines of other’s… I would actually call Regional Trauma, and confirm with them that they want to see this patient. Again, if need be, put the patient on the phone, and them duke it out MD to MD. I absolutely do not consider my patient to be medical control– or medical direction, so all changes to protocol need to be cleared through online medical control.

  10. “Hey doc, quit bustin’ my balls here. You and I both know you should take a trip to the trauma center. If you’ve got a liver lac or some spleen damage you don’t want to be laying on a gurney at that Band-Aid station with some moonlighting family med resident. We’ll take a short ride, yuck it up with your friends in the trauma bay, and I’ll take you out for a beer for your troubles. How’s that?”

  11. “Hey doc, quit bustin’ my balls here. You and I both know you should take a trip to the trauma center. If you’ve got a liver lac or some spleen damage you don’t want to be laying on a gurney at that Band-Aid station with some moonlighting family med resident. We’ll take a short ride, yuck it up with your friends in the trauma bay, and I’ll take you out for a beer for your troubles. How’s that?”

  12. “Hey doc, quit bustin’ my balls here. You and I both know you should take a trip to the trauma center. If you’ve got a liver lac or some spleen damage you don’t want to be laying on a gurney at that Band-Aid station with some moonlighting family med resident. We’ll take a short ride, yuck it up with your friends in the trauma bay, and I’ll take you out for a beer for your troubles. How’s that?”

  13. MD on scene, directing his own care. Accompanies self to ER. No problemo.
    I wouldn’t call the receiving facility, they’ll be so pre-loaded with WTF factor X if they hear they’re now a trauma center….
    I’d call my field supervisor (RC1, perhaps, ?) to help soothe the irritation.

  14. MD on scene, directing his own care. Accompanies self to ER. No problemo.
    I wouldn’t call the receiving facility, they’ll be so pre-loaded with WTF factor X if they hear they’re now a trauma center….
    I’d call my field supervisor (RC1, perhaps, ?) to help soothe the irritation.

  15. MD on scene, directing his own care. Accompanies self to ER. No problemo.
    I wouldn’t call the receiving facility, they’ll be so pre-loaded with WTF factor X if they hear they’re now a trauma center….
    I’d call my field supervisor (RC1, perhaps, ?) to help soothe the irritation.

    1. Then the hospital documents that the patient was competent at exam and the patient them files a complaint that you kidnapped them and took them somewhere they didn’t want to go. You possibly go to jail, get sued, get your license revoked, get fired, and end up flipping burgers at McDonald’s.

        1. Sued for disobeying the wishes of an patient of adult age and sound mind, making an informed decision about his own health care, who just happens to be [and you could confirm by asking to see his license] an MD, a ‘trauma’ doctor, no less? I dunno……

        2. Taking a person some where against their will is kidnapping. Don’t worry about being sued. Just wonder how long the sentance will be.

          1. I would have to disagree. Taking them somewhere they want to go, just a different version of it is hardly kidnapping. He can goto Regional Trauma or sign out, he’s not being kidnapped if he climbs in and demands a different transport destination. He is welcome to sign out at any time.
            Kidnap is right up there with liability as the most misunderstood terms in EMS.

    1. Then the hospital documents that the patient was competent at exam and the patient them files a complaint that you kidnapped them and took them somewhere they didn’t want to go. You possibly go to jail, get sued, get your license revoked, get fired, and end up flipping burgers at McDonald’s.

        1. Sued for disobeying the wishes of an patient of adult age and sound mind, making an informed decision about his own health care, who just happens to be [and you could confirm by asking to see his license] an MD, a ‘trauma’ doctor, no less? I dunno……

        2. Sued for disobeying the wishes of an patient of adult age and sound mind, making an informed decision about his own health care, who just happens to be [and you could confirm by asking to see his license] an MD, a ‘trauma’ doctor, no less? I dunno……

        3. Taking a person some where against their will is kidnapping. Don’t worry about being sued. Just wonder how long the sentance will be.

          1. I would have to disagree. Taking them somewhere they want to go, just a different version of it is hardly kidnapping. He can goto Regional Trauma or sign out, he’s not being kidnapped if he climbs in and demands a different transport destination. He is welcome to sign out at any time.
            Kidnap is right up there with liability as the most misunderstood terms in EMS.

    2. Then the hospital documents that the patient was competent at exam and the patient them files a complaint that you kidnapped them and took them somewhere they didn’t want to go. You possibly go to jail, get sued, get your license revoked, get fired, and end up flipping burgers at McDonald’s.

  16. Administer Folstein Mini Mental Status Exam (MMSE) to confirm competency to refuse. Make sure that the pt understands the trauma related laws (which should be a no-brainer, no pun intended) and transport per their wishes. The patient, so long as they are competent, can refuse any and all care at their discretion and we are bound by law to take them where they want to go. Inform the hospital, of course, that you told them about the trauma center and the pt is refusing transport to a trauma center. Even if the doctor gets on their and orders a diversion, the patient overrides the doctor. When you get to the hospital, have the patient sign that they refused certain treatments at their own risk. This creates a documentation trail.

    1. I’m not sure a patient can override a diversion via medical control, regardless of their level of medical training. Certainly not in my system, where diversions are controlled by the regional communications center and can only be overridden for rescusitation transports. If only we had a national standard of care…

      1. Depends on the state you are in and the rules and regulations for EMS and state consent law. In the state in which I live, the patient has the absolute right to decide his destination and may override diversion and protocol. The only exception is if he asks to go somewhere quite far away (another city) and the medical director of the service has established in writing that the service will not transport from the scene further than “x” miles.

  17. Administer Folstein Mini Mental Status Exam (MMSE) to confirm competency to refuse. Make sure that the pt understands the trauma related laws (which should be a no-brainer, no pun intended) and transport per their wishes. The patient, so long as they are competent, can refuse any and all care at their discretion and we are bound by law to take them where they want to go. Inform the hospital, of course, that you told them about the trauma center and the pt is refusing transport to a trauma center. Even if the doctor gets on their and orders a diversion, the patient overrides the doctor. When you get to the hospital, have the patient sign that they refused certain treatments at their own risk. This creates a documentation trail.

    1. I’m not sure a patient can override a diversion via medical control, regardless of their level of medical training. Certainly not in my system, where diversions are controlled by the regional communications center and can only be overridden for rescusitation transports. If only we had a national standard of care…

      1. Depends on the state you are in and the rules and regulations for EMS and state consent law. In the state in which I live, the patient has the absolute right to decide his destination and may override diversion and protocol. The only exception is if he asks to go somewhere quite far away (another city) and the medical director of the service has established in writing that the service will not transport from the scene further than “x” miles.

    2. I’m not sure a patient can override a diversion via medical control, regardless of their level of medical training. Certainly not in my system, where diversions are controlled by the regional communications center and can only be overridden for rescusitation transports. If only we had a national standard of care…

  18. Administer Folstein Mini Mental Status Exam (MMSE) to confirm competency to refuse. Make sure that the pt understands the trauma related laws (which should be a no-brainer, no pun intended) and transport per their wishes. The patient, so long as they are competent, can refuse any and all care at their discretion and we are bound by law to take them where they want to go. Inform the hospital, of course, that you told them about the trauma center and the pt is refusing transport to a trauma center. Even if the doctor gets on their and orders a diversion, the patient overrides the doctor. When you get to the hospital, have the patient sign that they refused certain treatments at their own risk. This creates a documentation trail.

  19. In all seriousness, I like Christopher’s answer.. that’d be route number 1.. Route number 2 would be to consult online medical control…

    As for the Kidnapping comment, my Medical Director has always said you’re going to have a much easier job justifying your actions by saying “I felt this guy needed a trauma center for XYZ” than you would saying “He assessed himself, and felt that he didnt need it.”

    The way I see it, when you’re involved in the accident/incident, you lose all ability to properly assess yourself if you’re a trained individual. Its too bad our training couldnt include that lesson…

  20. In all seriousness, I like Christopher’s answer.. that’d be route number 1.. Route number 2 would be to consult online medical control…

    As for the Kidnapping comment, my Medical Director has always said you’re going to have a much easier job justifying your actions by saying “I felt this guy needed a trauma center for XYZ” than you would saying “He assessed himself, and felt that he didnt need it.”

    The way I see it, when you’re involved in the accident/incident, you lose all ability to properly assess yourself if you’re a trained individual. Its too bad our training couldnt include that lesson…

  21. In all seriousness, I like Christopher’s answer.. that’d be route number 1.. Route number 2 would be to consult online medical control…

    As for the Kidnapping comment, my Medical Director has always said you’re going to have a much easier job justifying your actions by saying “I felt this guy needed a trauma center for XYZ” than you would saying “He assessed himself, and felt that he didnt need it.”

    The way I see it, when you’re involved in the accident/incident, you lose all ability to properly assess yourself if you’re a trained individual. Its too bad our training couldnt include that lesson…

  22. I would probably have to go with hybridmedic. Document, document, document. Let him know “Well, Doc, SOP (standard operating procedure) is the closest trauma center, but since you want to go to St. Furthest, ya gotta sign the form, and then we can go.” Let the ER know that he insisted on going there and his GCS was 15. Again, document, document, document.

  23. I would probably have to go with hybridmedic. Document, document, document. Let him know “Well, Doc, SOP (standard operating procedure) is the closest trauma center, but since you want to go to St. Furthest, ya gotta sign the form, and then we can go.” Let the ER know that he insisted on going there and his GCS was 15. Again, document, document, document.

  24. I would probably have to go with hybridmedic. Document, document, document. Let him know “Well, Doc, SOP (standard operating procedure) is the closest trauma center, but since you want to go to St. Furthest, ya gotta sign the form, and then we can go.” Let the ER know that he insisted on going there and his GCS was 15. Again, document, document, document.

  25. I’m not in EMS anymore but back in my day we always assumed that anyone on scene that said they were a Doctor ment they were a Doctor of Philosophy unless we had seen them wondering around in scrubs somewhere.

    I would have documented with a refusal and through the trauma center. Reminded him that the private ambulance that took him to the trauma center next was going to hit him up for $2000 and took him where he wanted to go.

  26. I’m not in EMS anymore but back in my day we always assumed that anyone on scene that said they were a Doctor ment they were a Doctor of Philosophy unless we had seen them wondering around in scrubs somewhere.

    I would have documented with a refusal and through the trauma center. Reminded him that the private ambulance that took him to the trauma center next was going to hit him up for $2000 and took him where he wanted to go.

  27. I’m not in EMS anymore but back in my day we always assumed that anyone on scene that said they were a Doctor ment they were a Doctor of Philosophy unless we had seen them wondering around in scrubs somewhere.

    I would have documented with a refusal and through the trauma center. Reminded him that the private ambulance that took him to the trauma center next was going to hit him up for $2000 and took him where he wanted to go.

  28. Our stance has been that a person that is competent can do whatever they want to do, incl make their own decisions as to where and how they want to be treated so long as they understand the risk associated with it.

    Of course I say do your assessment, but a patient proven competent can refuse any and all care. All you can do in those cases is present alternatives. I know this from personal experience, and we deal with issues like these without supervision all the time. If they attempt to refuse care you must assess their mental capacity to do so. Score >21? They can decide their own fate.

    1. How does that fit into your destination decision matrix? Can an active STEMI Pt be taken to a non cath facility based on their preference? At what point can you override the person for their own good? Not hypothetical, an actual question.

      1. It has happened before, an active MI transported to a non cath facility. You have to be absolutely clear that going to another hospital will only delay their care and they will die if they don’t do what you say. Rarely does someone not do what you say when you put it in perspective.

        My medical director relayed a story to me one time about a patient that walked into his ED with an active MI and they were going to transfer him out to a cath facility, and he declined any care and signed out AMA. They pleaded with him to stay but he still left. Point being, just because we know that they are endangering themselves by not seeking appropriate care when they should doesn’t mean that if they are competent to decline such care that we can stop them.

        I myself have had a similar situation you describe except the patient wasn’t a physician, and was competent, and wanted to go to one hospital and that facility only. I just told the hospital that I explained the guidelines, recommended a more appropriate facility, they declined and are competent to do so, and we will see you soon.

      2. Why not? The hospital can’t stop an AMI from signing out AMA if they want, cath lab or not. They can’t stop patients from walking into a non-cath lab on their own. Patients are free to make bone head decisions all they want.

        Is it ever right to override a patient’s own decision (provided capacity is present) for their own good? Would you like to be in a hospital and the physician is ordering test, procedures, and medications, but won’t tell you what they are because it’s “for your own good?” More importantly, where do we stop? Ok, sure, the AMI really should go to a cath lab.

        What if Regional Trauma is a hell-hole? How many people would willingly go to King-Drew Medical Center before Joint Commission yanked their accreditation? I’m sure every system has that one hospital that you want to avoid like the plague. Do the EMS providers have a right to haul you there anyways?

        What about other more cloudy medical decisions? Do EMS providers get to ignore DNR orders because the patient doesn’t look that sick? What about situations where the patient (or parent for a sick kid) has a long term condition and has become a self styled expert on it? Do we ignore their input at all since the all-knowing paramedics know what’s best? Paternalism is a dangerous slippery slope even when the provider-patient relationship is measured in years. However, we’re talking about a situation here where that relationship is measured in minutes, at most in hours.

  29. Our stance has been that a person that is competent can do whatever they want to do, incl make their own decisions as to where and how they want to be treated so long as they understand the risk associated with it.

    Of course I say do your assessment, but a patient proven competent can refuse any and all care. All you can do in those cases is present alternatives. I know this from personal experience, and we deal with issues like these without supervision all the time. If they attempt to refuse care you must assess their mental capacity to do so. Score >21? They can decide their own fate.

    1. How does that fit into your destination decision matrix? Can an active STEMI Pt be taken to a non cath facility based on their preference? At what point can you override the person for their own good? Not hypothetical, an actual question.

      1. It has happened before, an active MI transported to a non cath facility. You have to be absolutely clear that going to another hospital will only delay their care and they will die if they don’t do what you say. Rarely does someone not do what you say when you put it in perspective.

        My medical director relayed a story to me one time about a patient that walked into his ED with an active MI and they were going to transfer him out to a cath facility, and he declined any care and signed out AMA. They pleaded with him to stay but he still left. Point being, just because we know that they are endangering themselves by not seeking appropriate care when they should doesn’t mean that if they are competent to decline such care that we can stop them.

        I myself have had a similar situation you describe except the patient wasn’t a physician, and was competent, and wanted to go to one hospital and that facility only. I just told the hospital that I explained the guidelines, recommended a more appropriate facility, they declined and are competent to do so, and we will see you soon.

      2. It has happened before, an active MI transported to a non cath facility. You have to be absolutely clear that going to another hospital will only delay their care and they will die if they don’t do what you say. Rarely does someone not do what you say when you put it in perspective.

        My medical director relayed a story to me one time about a patient that walked into his ED with an active MI and they were going to transfer him out to a cath facility, and he declined any care and signed out AMA. They pleaded with him to stay but he still left. Point being, just because we know that they are endangering themselves by not seeking appropriate care when they should doesn’t mean that if they are competent to decline such care that we can stop them.

        I myself have had a similar situation you describe except the patient wasn’t a physician, and was competent, and wanted to go to one hospital and that facility only. I just told the hospital that I explained the guidelines, recommended a more appropriate facility, they declined and are competent to do so, and we will see you soon.

      3. Why not? The hospital can’t stop an AMI from signing out AMA if they want, cath lab or not. They can’t stop patients from walking into a non-cath lab on their own. Patients are free to make bone head decisions all they want.

        Is it ever right to override a patient’s own decision (provided capacity is present) for their own good? Would you like to be in a hospital and the physician is ordering test, procedures, and medications, but won’t tell you what they are because it’s “for your own good?” More importantly, where do we stop? Ok, sure, the AMI really should go to a cath lab.

        What if Regional Trauma is a hell-hole? How many people would willingly go to King-Drew Medical Center before Joint Commission yanked their accreditation? I’m sure every system has that one hospital that you want to avoid like the plague. Do the EMS providers have a right to haul you there anyways?

        What about other more cloudy medical decisions? Do EMS providers get to ignore DNR orders because the patient doesn’t look that sick? What about situations where the patient (or parent for a sick kid) has a long term condition and has become a self styled expert on it? Do we ignore their input at all since the all-knowing paramedics know what’s best? Paternalism is a dangerous slippery slope even when the provider-patient relationship is measured in years. However, we’re talking about a situation here where that relationship is measured in minutes, at most in hours.

      4. Why not? The hospital can’t stop an AMI from signing out AMA if they want, cath lab or not. They can’t stop patients from walking into a non-cath lab on their own. Patients are free to make bone head decisions all they want.

        Is it ever right to override a patient’s own decision (provided capacity is present) for their own good? Would you like to be in a hospital and the physician is ordering test, procedures, and medications, but won’t tell you what they are because it’s “for your own good?” More importantly, where do we stop? Ok, sure, the AMI really should go to a cath lab.

        What if Regional Trauma is a hell-hole? How many people would willingly go to King-Drew Medical Center before Joint Commission yanked their accreditation? I’m sure every system has that one hospital that you want to avoid like the plague. Do the EMS providers have a right to haul you there anyways?

        What about other more cloudy medical decisions? Do EMS providers get to ignore DNR orders because the patient doesn’t look that sick? What about situations where the patient (or parent for a sick kid) has a long term condition and has become a self styled expert on it? Do we ignore their input at all since the all-knowing paramedics know what’s best? Paternalism is a dangerous slippery slope even when the provider-patient relationship is measured in years. However, we’re talking about a situation here where that relationship is measured in minutes, at most in hours.

    2. How does that fit into your destination decision matrix? Can an active STEMI Pt be taken to a non cath facility based on their preference? At what point can you override the person for their own good? Not hypothetical, an actual question.

  30. Our stance has been that a person that is competent can do whatever they want to do, incl make their own decisions as to where and how they want to be treated so long as they understand the risk associated with it.

    Of course I say do your assessment, but a patient proven competent can refuse any and all care. All you can do in those cases is present alternatives. I know this from personal experience, and we deal with issues like these without supervision all the time. If they attempt to refuse care you must assess their mental capacity to do so. Score >21? They can decide their own fate.

  31. Amazing how many people will let themselves get walked all over in the name of the almighty god CYA.

    Treat the patient, not their (hypothetical) lawyer. I can assure you, the conversation will go something like this:

    Patient: I want to sue my EMT!
    Lawyer: Why?
    Patient: I crashed my motorcycle wanted to go to St. Farthest, but s/he took me to Regional Trauma instead!
    Lawyer: I see. Well, according to these protocols I found online, the EMTs are supposed to take motorcycle crashes to Regional Trauma. Based on your location, it was also much closer than St. Farthest. What was your reason for wanting to go to St. Farthest?
    Patient: I work at Regional Trauma and didn’t want to bother my coworkers.
    Lawyer: *click*

    1. Gee, up here in Maine, a lawyer would never, ever hang up on a potential client, no matter how stupid the suit. After all, lawyers get paid by the hour, regardless of whether they’re successful or not. Not to mention that suing the local EMS system would generate all sorts of additional potential clients (“they didn’t transport me to my choice of hospitals, either… even though I live north of Bangor, I wanted to go to Mass General… figured I’d catch the Celtics after I got my Oxy refilled”)

    2. So you aren’t willing to transport the patient to a non-trauma emergency department, but are willing to let him sign out AMA because you aren’t willing to transport him to a non-trauma emergency department?

        1. I felt it was implied based on the hypothetical situation being the lawyer can’t sue and providers being “walked on.” I agree that the chance of being sued is no where near what people make it out to be, but that doesn’t mean he should be taken to the trauma center regardless of his wishes.

  32. Amazing how many people will let themselves get walked all over in the name of the almighty god CYA.

    Treat the patient, not their (hypothetical) lawyer. I can assure you, the conversation will go something like this:

    Patient: I want to sue my EMT!
    Lawyer: Why?
    Patient: I crashed my motorcycle wanted to go to St. Farthest, but s/he took me to Regional Trauma instead!
    Lawyer: I see. Well, according to these protocols I found online, the EMTs are supposed to take motorcycle crashes to Regional Trauma. Based on your location, it was also much closer than St. Farthest. What was your reason for wanting to go to St. Farthest?
    Patient: I work at Regional Trauma and didn’t want to bother my coworkers.
    Lawyer: *click*

    1. Gee, up here in Maine, a lawyer would never, ever hang up on a potential client, no matter how stupid the suit. After all, lawyers get paid by the hour, regardless of whether they’re successful or not. Not to mention that suing the local EMS system would generate all sorts of additional potential clients (“they didn’t transport me to my choice of hospitals, either… even though I live north of Bangor, I wanted to go to Mass General… figured I’d catch the Celtics after I got my Oxy refilled”)

    2. Gee, up here in Maine, a lawyer would never, ever hang up on a potential client, no matter how stupid the suit. After all, lawyers get paid by the hour, regardless of whether they’re successful or not. Not to mention that suing the local EMS system would generate all sorts of additional potential clients (“they didn’t transport me to my choice of hospitals, either… even though I live north of Bangor, I wanted to go to Mass General… figured I’d catch the Celtics after I got my Oxy refilled”)

    3. So you aren’t willing to transport the patient to a non-trauma emergency department, but are willing to let him sign out AMA because you aren’t willing to transport him to a non-trauma emergency department?

        1. I felt it was implied based on the hypothetical situation being the lawyer can’t sue and providers being “walked on.” I agree that the chance of being sued is no where near what people make it out to be, but that doesn’t mean he should be taken to the trauma center regardless of his wishes.

        2. I felt it was implied based on the hypothetical situation being the lawyer can’t sue and providers being “walked on.” I agree that the chance of being sued is no where near what people make it out to be, but that doesn’t mean he should be taken to the trauma center regardless of his wishes.

    4. So you aren’t willing to transport the patient to a non-trauma emergency department, but are willing to let him sign out AMA because you aren’t willing to transport him to a non-trauma emergency department?

  33. Amazing how many people will let themselves get walked all over in the name of the almighty god CYA.

    Treat the patient, not their (hypothetical) lawyer. I can assure you, the conversation will go something like this:

    Patient: I want to sue my EMT!
    Lawyer: Why?
    Patient: I crashed my motorcycle wanted to go to St. Farthest, but s/he took me to Regional Trauma instead!
    Lawyer: I see. Well, according to these protocols I found online, the EMTs are supposed to take motorcycle crashes to Regional Trauma. Based on your location, it was also much closer than St. Farthest. What was your reason for wanting to go to St. Farthest?
    Patient: I work at Regional Trauma and didn’t want to bother my coworkers.
    Lawyer: *click*

  34. Why does he need a Trauma Center? He barely meets mechanism criteria and has no anatomical or physiological indicators (where I work triage by mechanism only is STRONGLY discouraged – the Trauma Staff will turf to the regular ER – Trauma activations require both injury and/or abnormal vital signs)
    In reality St. Farthest will put his clavicle in a sling, arrange next day follow up with an orthopod for possible surgery and, if his chest and abdomen CT are clear, send him home with a Vicodin prescription. Even if they find something on CT they can ship him out – he’ll feel a fool having delayed but he is a grown-up and clearly had capacity to make informed consent on his preference to not go to Regional Trauma.

      1. Yep…still bopping around in that pretty nifty ship of mine (…possession is 9/10ths of the law!) On my own now though, Trillian kind of “let herself go” and left me. Actually not quiete alone – forgot about the bloody android, didn’t I?

        ……..ooops! ……………time for my meds

  35. Why does he need a Trauma Center? He barely meets mechanism criteria and has no anatomical or physiological indicators (where I work triage by mechanism only is STRONGLY discouraged – the Trauma Staff will turf to the regular ER – Trauma activations require both injury and/or abnormal vital signs)
    In reality St. Farthest will put his clavicle in a sling, arrange next day follow up with an orthopod for possible surgery and, if his chest and abdomen CT are clear, send him home with a Vicodin prescription. Even if they find something on CT they can ship him out – he’ll feel a fool having delayed but he is a grown-up and clearly had capacity to make informed consent on his preference to not go to Regional Trauma.

      1. Yep…still bopping around in that pretty nifty ship of mine (…possession is 9/10ths of the law!) On my own now though, Trillian kind of “let herself go” and left me. Actually not quiete alone – forgot about the bloody android, didn’t I?

        ……..ooops! ……………time for my meds

      2. Yep…still bopping around in that pretty nifty ship of mine (…possession is 9/10ths of the law!) On my own now though, Trillian kind of “let herself go” and left me. Actually not quiete alone – forgot about the bloody android, didn’t I?

        ……..ooops! ……………time for my meds

  36. Why does he need a Trauma Center? He barely meets mechanism criteria and has no anatomical or physiological indicators (where I work triage by mechanism only is STRONGLY discouraged – the Trauma Staff will turf to the regular ER – Trauma activations require both injury and/or abnormal vital signs)
    In reality St. Farthest will put his clavicle in a sling, arrange next day follow up with an orthopod for possible surgery and, if his chest and abdomen CT are clear, send him home with a Vicodin prescription. Even if they find something on CT they can ship him out – he’ll feel a fool having delayed but he is a grown-up and clearly had capacity to make informed consent on his preference to not go to Regional Trauma.

  37. If you’re dead set on the trauma center, then go for the counter offer:

    “Are you willing to go to Regional Trauma if we don’t immobilize you?”

    Patient goes to trauma center and there’s no hocus pocus immobilization done (where, again, are the studies showing immobilization prevents secondary spinal injury?) and the patient is spared additional back pain and skin integrity problems.

  38. If you’re dead set on the trauma center, then go for the counter offer:

    “Are you willing to go to Regional Trauma if we don’t immobilize you?”

    Patient goes to trauma center and there’s no hocus pocus immobilization done (where, again, are the studies showing immobilization prevents secondary spinal injury?) and the patient is spared additional back pain and skin integrity problems.

  39. If you’re dead set on the trauma center, then go for the counter offer:

    “Are you willing to go to Regional Trauma if we don’t immobilize you?”

    Patient goes to trauma center and there’s no hocus pocus immobilization done (where, again, are the studies showing immobilization prevents secondary spinal injury?) and the patient is spared additional back pain and skin integrity problems.

  40. The rider would seem to meet criteria to be a trauma patient in my system as well. In PA, we are all about “destination based command” and one must call a trauma center for command re: trauma patients.

    If the patient is CAOx4 and truly understands the risks of refusal, I’ll call command at Regional Trauma and have their command doc actually talk to my patient after I paint the picture.

    Then MotorDoc either agrees to go to Regional Trauma, or his refusal is documented on a recorded line.

    Why is it that healthcare providers make the worst patients?

  41. The rider would seem to meet criteria to be a trauma patient in my system as well. In PA, we are all about “destination based command” and one must call a trauma center for command re: trauma patients.

    If the patient is CAOx4 and truly understands the risks of refusal, I’ll call command at Regional Trauma and have their command doc actually talk to my patient after I paint the picture.

    Then MotorDoc either agrees to go to Regional Trauma, or his refusal is documented on a recorded line.

    Why is it that healthcare providers make the worst patients?

  42. The rider would seem to meet criteria to be a trauma patient in my system as well. In PA, we are all about “destination based command” and one must call a trauma center for command re: trauma patients.

    If the patient is CAOx4 and truly understands the risks of refusal, I’ll call command at Regional Trauma and have their command doc actually talk to my patient after I paint the picture.

    Then MotorDoc either agrees to go to Regional Trauma, or his refusal is documented on a recorded line.

    Why is it that healthcare providers make the worst patients?

  43. Christopher, I think you nailed this one. I would be tempted to say that any person not agreeing to your deal would be in no way a competent adult. If this did not work; however, I would most likely “honor” his wishes and take him to the “clinic” only after trying most all of the above options. On the other hand I think this is the exact reason why we have the Darwin awards…

  44. Christopher, I think you nailed this one. I would be tempted to say that any person not agreeing to your deal would be in no way a competent adult. If this did not work; however, I would most likely “honor” his wishes and take him to the “clinic” only after trying most all of the above options. On the other hand I think this is the exact reason why we have the Darwin awards…

  45. Christopher, I think you nailed this one. I would be tempted to say that any person not agreeing to your deal would be in no way a competent adult. If this did not work; however, I would most likely “honor” his wishes and take him to the “clinic” only after trying most all of the above options. On the other hand I think this is the exact reason why we have the Darwin awards…

  46. first thing i think is MOI and go to regional trauma. Thats how my FD operates anything with an MOI like that and those presenting problem is going to the closest trauma center

  47. first thing i think is MOI and go to regional trauma. Thats how my FD operates anything with an MOI like that and those presenting problem is going to the closest trauma center

  48. first thing i think is MOI and go to regional trauma. Thats how my FD operates anything with an MOI like that and those presenting problem is going to the closest trauma center

  49. No brainer, here. alert and oriented? Not impaired by drugs or etoh? Take him to the band-aid station of his choice. They can sort it out, there.

  50. No brainer, here. alert and oriented? Not impaired by drugs or etoh? Take him to the band-aid station of his choice. They can sort it out, there.

  51. No brainer, here. alert and oriented? Not impaired by drugs or etoh? Take him to the band-aid station of his choice. They can sort it out, there.

  52. Call the trauma center and have the doc there talk to them. If he still wants to sign AMA, let him.

    ….Or slam in 20mg of MS and 10mg of Versed for “pain control” and once he’s out of it transport him to the hospital. (I’m kidding…..mostly)

  53. Call the trauma center and have the doc there talk to them. If he still wants to sign AMA, let him.

    ….Or slam in 20mg of MS and 10mg of Versed for “pain control” and once he’s out of it transport him to the hospital. (I’m kidding…..mostly)

  54. Call the trauma center and have the doc there talk to them. If he still wants to sign AMA, let him.

    ….Or slam in 20mg of MS and 10mg of Versed for “pain control” and once he’s out of it transport him to the hospital. (I’m kidding…..mostly)

  55. Hmmm… I remember this patient. What stuck in my mind was that he self diagnosed a fractured rib saying that he was an Emergency Department Attending Physician at a Level I Trauma Center in a nearby locale and he was insistent on not going to the local Level I Trauma Center because he felt that he did not merit the amount of attention at the RTC but felt more comfortable going to a closer hospital where his friends worked. Let’s be fair to the local ED, they are a good volume ED with Board Certified Emergency Attendings.

  56. Hmmm… I remember this patient. What stuck in my mind was that he self diagnosed a fractured rib saying that he was an Emergency Department Attending Physician at a Level I Trauma Center in a nearby locale and he was insistent on not going to the local Level I Trauma Center because he felt that he did not merit the amount of attention at the RTC but felt more comfortable going to a closer hospital where his friends worked. Let’s be fair to the local ED, they are a good volume ED with Board Certified Emergency Attendings.

  57. Hmmm… I remember this patient. What stuck in my mind was that he self diagnosed a fractured rib saying that he was an Emergency Department Attending Physician at a Level I Trauma Center in a nearby locale and he was insistent on not going to the local Level I Trauma Center because he felt that he did not merit the amount of attention at the RTC but felt more comfortable going to a closer hospital where his friends worked. Let’s be fair to the local ED, they are a good volume ED with Board Certified Emergency Attendings.

  58. well for me that is simple follow your protocol and when you call your medical command advise them of the pt choice and have your medical command make the call on where to take the pt. as for him saying he a doc that has no impact on your choices when you tell him what wrong you can use common medical terms he or she is just a well informed patient

  59. well for me that is simple follow your protocol and when you call your medical command advise them of the pt choice and have your medical command make the call on where to take the pt. as for him saying he a doc that has no impact on your choices when you tell him what wrong you can use common medical terms he or she is just a well informed patient

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