Dealing with EMTs

[oscardagrouch]

I am not familiar with the scope of practice in regards to EMTs. My partner at my office wanted one of his patient send to the hospital ( for shortness of breath) and we called EMS for transport.

When the EMTs arrived, they spoke with the patient, asking him some questions and after a few minutes said " it sounds like you have the flu" and decided that the patient does not need to go to the hospital. The patient did not want to go either, so they let him go.

I saw this going on and I informed my partner that they are letting his patient go home and not transporting him. He said "oh, great" and seemed okay with it.

My question is, do EMTs have the ability to make such a decision? Considering a physician seen the patient and recommended that the patient be taken to the emergency room?

Also, how do you deal with EMTs that you do not agree with?

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[deleted87716]

EMS is regulated at the state level, so the laws vary. In most (if not all) states, EMS personnel operate under medical direction. This may be a physician in the employ of the EMS agency, or a physician in the ED at the receiving hospital. In any case, any actions by EMS personnel are ultimately the responsibility of the medical director, including decisions not to transport.

As a former EMT, I can tell you that we would NEVER refuse to transport a patient to the ED if anyone involved felt that they needed to be evaluated, regardless of what we thought. We certainly wouldn't override the decision of a physician.

In the case above, the physician who summoned EMS should've asked to speak with their medical director, IMO.

 

[Vandalia]

The patient did not want to go either, so they let him go.

That is the key phrase. Absent some very unusual circumstances, EMTs cannot kidnap someone. Now, if someone is having an MI and doesn't want to go, they will try their best to convince them, but if they don't want to go, and there is not a very good reason for them to go, then an EMT will likely not push hard to try and change their mind. Your partner's response indicates that he did not view it as a serious issue. My guess was that it was a simply CYA move to show that he provided the opportunity for additional evaluation and if something bad happened the patient made an informed decision. (EDIT: This was based on a literal reading of "oh, great" as indicating that he was glad the patient was not transported to the hospital. However I suppose it is at least equally possible that was sarcasm.)

If the physician AND the patient both wanted hospital transport, then it would be highly inappropriate for the EMTS to refuse, but this did not appear to be the case.

 

[deleted480308]

In the past state I checked the emt cannot refuse transport. They could/would/did however suggest that it might not be necessary and ask the patient if they consent to the trip in a way that influences the patient to say no...

 

[NITRAS]

Seems weird. Why call EMS in the first place? I have a lot of respect for EMT's, but their training is frankly pretty limited.

My 4th year rotation with EMS, basically, patient had to sign to refuse when they were called, regardless of how ridiculous the call. The EMT and paramedics didn't have the medical authority to refuse to transport anyone.

 

[septoplasty]

Not to tag and bash on them, but whenever I've had to call them for transport, they usually give our staff smack.

Just 2 days ago, sent a guy in who ended up having an NSTEMI (no real changes on EKG, except some mild t wave inversion, nothing to compare to), EMT's looked at it and were like.. yeah looks fine to me, dispatching to the radio. Anyways, while I witnessed this, I went and stood there and they basically shut their trap and took the patient w/o mumbling.

Not sure what the deal is (again, not a generalization, I have friends who are EMT's, real nice people).. but from their perspective, I'd rather transport a stable patient from a docs office than have to extricate and transport someone in the back while doing CPR/intubating them, which they are exceptionally well it.