I need someone who's familiar with NYS protocols...

[Catrina]

I've got a couple of questions for those of you who may be familiar with NYS protocols. These questions may be able to be answered by others, as well, so I'd appreciate anyone's input. These involve mostly legal issues, so it may seem nit-picky, but I just want to make sure I do the right thing, as a lawsuit doesn't sound particularly fun. In addition, our instructor is pretty adamant about CYA stuff, and I imagine she's got good reason to be.

1. In an MCI, is it considered abandonment if you leave one pt. to care for a more seriously injured one? Do you have to stick with the first pt. you start caring for? Common sense tells me to care for the more injured, but I want to be sure.

2. If a parent refuses to allow you to care for their critically injured child, what do you do? Obviously, the kid needs care bad, so what are you going to do if the parent refuses to give you consent?

3. If a person legitimately refuses care (i.e. sprained ankle, whatever) do you have to do the whole 'try to convince them to go the hospital' shebang? I should think not, but I want to be sure.

Thanks in advance.

[Weruj1]

1) No it is not. In an MCI you try to identify the most critically injured and then get them to the field hopisptal/treatment area. So if you are triaging then you dont continue on to the treatment area. Also common sense says there will be more patients than repsonders, and it is a treat/triage and on to the next one ........

2)Sticky Wicket here ..........first done some convincing than may have to call the police to keep ANY minor out of harms way

3)Yes ...........when EMS is called no mattter how minor it is your obligation to take them unless, they sign AMA, you transport them, you call a private ambulance, or and this is the best one ............call medical control if it is something simple and get a doctor to agree to send them by perhaps a better means. hows that for choices ?

[kghemtp]

And in some really significant MCI's, the rule of thumb is to open an airway & do nothing more before moving on to the next person. Triage tags might be used to identify those walking wounded, those critical & in need of immediate transport, and those who are dead or presumed dead. MCI's change the rules a little.

About the kiddos... yeah, I'd strenuously urge the parent to have him treated. One might wonder the motive for NOT having his/her child treated, and since we're not involved with investigations, that's where we get the police involved. We shouldn't make assumptions, but there ARE behaviors that raise red flags in our minds.

About non-lifethreatening injuries, I have a couple thoughts. We make the offer to transport someone no matter what. We're glad to do this for you, sir/ma'am/miss. I'm not seeing anything that jumps out at me as lifethreatening, but you have injuries that require medical attention more than I can offer here. You can certainly sign my refusal & go with your friend/family to the hospital, or we can go by ambulance. Now, you KNOW my angle with pain management!! *giggle* When situations aren't critical, we think more about other things like general comfort. Could that broken knee have gone by personal vehicle? Of course. But when we have the option of relieving pain for someone, that's a great option to give our patients. Always push the comfort issue, though I know you might not always be working with a paramedic or CCT.

[Firescueguy]

Ok, here goes....

1) # 1 rule of MCI's -"Do the most good for the most people" - with
that said, what position are you assigned?

If you're the 1st arriving unit or advanced care provider (or the
only guy who isn't freaking out) and are asigned as the triage
officer, then yes you should be rapidly assessing & "tagging" the
pts. Stopping to help one person does no good for the other 10, 20
or however many other pts. there are.

Now if you show up on a later arriving unit & are assigned to
treat a specific pt., then you should treat that pt. You don't
belong deciding that there's another pt. who's more important
(remember sometimes the most seemingly uninjured person is
the one who's the most critical, they just are compensating
until they crash..violently). Stay with YOUR pt. - don't
second guess the triage officer or the chief or whoever...treat
your pt.!! This is a BIG problem I find in EMS...because we
typically operate on our own at "everyday" calls without the
direction of officers unlike the fire service, EMS
providers tend to have that "I'm gonna do what I wanna
do" mentality which in reality equals freelancing which equals
total lack of control on the emergency scene.

2) If you encounter a parent who adamantly refuses to allow you to
treat their child for whatever reason, you need to do the
following:

*Assess the child as best you can - even if it's only looking at
them from across the room - you may be able to see signs of
physical injury or hear things (audible wheezes,
stridor). Look around the house for clues to potential abuse
(dirty clothes all over, animal feces, etc.), mechanism of injury
and just a general impression of how the place is kept. Remember,
we are not here to judge but we are obligated (by law here in
NY) to be observant for any outward signs of abuse.

*Calmly (and this can be hard with a kid who's hurt & a parent who
won't let you near them ) explain to the parent that you just
want to help..you're not here to judge them, you just want to
help THEIR child...keep reminding them this is THEIR child, the
one they love, the one they care about (supposedly). This will
probably work in most situations. Not every parent who says "stay
away from my child" is an abuser, they may just be one
of those people who doesn't handle emergencies well especially
when it's their kid.

*Explain EVERYTHING you are going to do or want to do to their
child from why you're touching them (palpating) to what the BP
cuff is going to do. Explain EVERYTHING to them in simple terms,
not medical terminology...telling a parent "your child has a
mild epistaxis" sounds a lot worse than "your child has a little
nosebleed & we're going to care of it". If you are going to
provide some form of care, get the parent INVOLVED..be it holding
the NRB mask for blow-by O2 or applying direct pressure. They
feel that they are helping THEIR child & that THEY are back in
control of the situation. Of course (and this should go without
saying), if you've got perform a specialized skill such as
ventilating the pt. or holding C-spine, this is NOT the time to
have mom or dad helping out!!

*While this is going on, have another crew member quietly step
outside the house & request your local PD. DON'T have the new
guy or the hyper guy get on the radio in front of the parent &
say "yeah, we need the cops 'cause this lady is nuts"...not good
pscychological first aid!!

*This kinda belongs up at the beginning - # 1 rule of EMS - protect
the rescuer - if the situation becomes hostile, leave the premises
and return to the safety of your ambulance. If it becomes
necessary to leave the scene due to a threat, then LEAVE!! Notify
your dispatcher OVER THE RADIO (so it's taped) of the situation,
the need for PD immediately AND where you will be staging (a block
or two away is good, just be sure to notify dispatch). As the
issue of CYA was addressed, do just that...report it on the radio
& document it on your PCR (you'll probably need a continuation
form) - EVERYTHING...pt's condition (physical signs/symptoms,
audible sounds - wheezes), condition of the home, child, even the
parent, what you tried to do,what they wouldn't let you do,
document EVERYTHING 'cause when you are on that witness stand,
you want to be able to recreate that situation in your mind
detail by detail just by reading your comments on the PCR.

*Provided it's safe & mom isn't chasing you with a meat cleaver,
then the other big thing you need to do is "pass the buck"..you
either want an ALS provider to the scene or even better, pick up
the phone & call your local medical control. After you've
explained all the options & treatment plans to the parent, the
medical control MD will then speak to them & try to convince
them. Most of the time, the MD's can convince the parent..they
feel the dr. knows best so they listen to him/her.

Now I know this ****es all of us off, we're all like "oh sure, she
listened to the MD, what am I nothing just 'cause I'm an
EMT??!!" We've all had that reaction but remember what do most
people know about us as EMS providers? We come in their houses
wearing funny looking gear, saying all kinds of fancy words they
don't understand & then we load them into a box on wheels & take
them to the hospital. And let's face it not everyone is EMS always
presents themselves as "professionals" (regardless of whether or not
you get a paycheck, I've been both paid & "vollie" and there
are "goobers" in every EMS service)

Nobody sees the hundreds of hrs. of school we all go thru & you
can't see someone putting all the "pieces of the puzzle" together
in their head when they'e treating a pt. Some people know what
EMT's (& above) do, but most don't..I've been a technician for 13
yrs. now since I was 18, the last 9 yrs. as an ALS provider &
people STILL to this day will say to me "oh, you're an ambulance
driver??" :eek: :mad: :rolleyes:

And once again as a reminder...DOCUMENT, DOCUMENT, DOCUMENT!!!!!

3) Ok, quickly on this last one, follow your local protocols,
assess the pt., treat them as much as you can & if they are not
experiencing a life threatening emergency and are mentally
competent enough to refuse treatment/transport, then let them
sign the refusal, get it witnessed (preferably by PD but this
doesn't always work out) & DOCUMENT everything. Don't make a
HUGE deal out of a guy who is A & O x 3, sprained his ankle &
wants to just put his leg up & rest!!

WHEW, my fingers are tired!! Now I know this reply was rather long winded but hey, you asked for answers & I hope my insight will help you one day on a call. Good luck with the rest of your class, keep your eyes/ears open and mouth shut (unless you have a question - then ask!!) and you'll do fine as an EMT.

Stay Safe. :) ;)