Or an honest question actually… On behalf of my Superstar Partner, K.
Let’s say you are a Paramedic. Or an EMT on an ALS truck. You show up on the scene, assess the patient, do a 12 lead, determine it’s a BLS run after patient contact. You tell the fire truck to call for a BLS truck and leave the scene. BEFORE the BLS truck shows up.
Is that abandonment?
I’m pretty sure I know the answer, and I’m pretty sure that K knows the answer as well. Feel free to chime in with your thoughts.
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I’m just guessing here. I’m not an EMT yet. I think it might be abandonment if the firefighters on scene are not EMTs. Also the BLS truck crew would need the ALS crew’s report.
The firefighters on the scene may or may not be EMT-B’s. They could be First Responders. I think. Let me double check with K to be sure.
It sounds like abandonment to me. However, I don’t know how y’all do it in the field.
In a hospital though? Big no-no.
I would say a huge no-no, and it wouldn’t be worth my license. Also, my thought is if you were concerned enough to do a 12-lead in the first place, the ALS ambulance should just continue with transport. If your system works in a different way, the medic should absolutly stay with that patient until the BLS ambulance arrives. The “just in case” factor. Is there a reason the ALS crew couldn’t transport?
Just my two cents.
Yup its abandonment unless the crew you are releasing to is at the same level, unless your protocols allow for downgrading of patient care.
If one of the FFs is the same level as the unit being requested, and they concur with your assessment, then no. However, you initiated an ALS assessment, EKG which could, in some circles, be met with “Why a 12 lead and not just 3?”
If it was me, I’d wait for the BLS team to also make sure they concur.
It’s abandonment. The EMTs are responsible for the patient once they started care and can’t walk away until they’re relieved.
While I don’t know how it works in your state, it works that way across the board in NY for anyone who provides medical assistance. For example if I, as Joe Citizen, start CPR on someone I’m responsible for that person until an EMT or someone else comes in and takes over care. If I stop CPR and walk away, I can be charged with homicide (Depending on the DA) and I am liable for the person’s death in civil court.
If the firefighters are not EMTs, it’s abandonment.
Even then, it’s shitty patient care. When the transport truck arrives, the patient report winds up getting filtered through another layer of caregivers.
Also, what was the 12 lead for? What was the patient’s complaint?
IMHO it is abandonment – in every system I worked in applying a 12-lead was considered to be an ALS intervention. Besides, a 12-lead can only rule in and event, not rule it out. If you thought the patient needed that much of a look (protocol or gut feeling) then the patent gets a medic for the ride to the ED.
But then if the medic in question actually walked away from a patient he/she did a 12-lead on then handing off to a CFR or BLS provider might actually be transferring care to a higher level….
-A
Yes, it’s abandonment.
And besides the legal issue, how do you know nothing will change before the BLS crew arrives?
I’m sure you know this. :-)
It might be a little different if the firefighters ARE a BLS crew… but that will depend on where you are and who they are. Around here, the career dept are all EMTs, but most volunteers are not. I think you can’t leave a patient with CFRs, if they need to be transported. If they are EMT-Bs… let me think about that a second.
It still seems odd, whether it’s technically abandonment or not. I’m having a hard time imagining it happening, unless there was an MCI or something that really needed every ALS provider.
I know if I were the patient, I would not be happy. If I called 911 and needed to be transported, I would expect the ambulance that showed up to do the job.
The FF’s that were left with the patient are EMT’s.
Let me check with Super Star Partner for the rest of the details…
unless at least one of the firefighters is an EMT, then yeah, I think it’s abandonment. Abandonment as I learned it is if you leave your patient without transferring care to a person with equal or higher training as long as care was warranted (ie, if you get a signed refusal, then walking away its not abandonment because more care was not warranted) The fact that the call was downgraded to BLS means that BLS providers needed to be present. If the firefighters are at the MRT/First Responder level, I dont know if that counts. I don’t think it does. Maybe??
At least they were EMTs but the whole situation kind of freaks me out. I agree with the question of “why the 12 lead instead of the regular ECG?” And they should make sure that the BLS crew is comfortable taking over care of the patient.
Quick answer, yes its abandonment. If a paramedic is on scene doing ALS level skills i.e. it required a 12 lead then it probably should stay an ALS level call. I just read about a crew that left a chest pain at home without doing a 12 lead and told the patient to take Maalox.. yes he was dead within hours at his home. It depends on the protocols or SOP for that service regarding BLS hand off. The only service that I worked for that did this was wicked small and both ambulances were generally on scene together but when we weren’t I still had to wait for another crew from an ambulance to arrive before leaving. What were the extenuating circumstances? Was there an emergency call that the crew needed to take care of or were they just being lazy and wanted to go back to the house. Was fire ok with staying with the patient until another truck arrived ( I would lay big money on this being a HUGE NO)? Any way you cut it, it doesn’t make the service look good to anyone.
Do the FF’s have access to all the tools found on an ambulance? If not, that’s bad.
I agree with the thought that if there was enough there to do a 12-lead, it probably should stay an ALS call.
So many if’s and’s and but’s to really pass judgement, but from face value, I would say EEK!
Ouch, I’m not even part of that world and it sounds like abandonment??
Not good to leave ANY patient at ANY time like that?
Not really in the patient’s best interest I would think.
Without a doubt. These guys should be reported. Js
The call came in as a chest pain. Upon arrival find a 60 ish man sitting up. Says his pain isn’t as bad now. He is a poor historian due to dementia and mild mental retardation living in public housing with an obvious limited income. According to person in the apartment with him who is not much better says he fell down the stairs about 15-30 min ago. The medics I am with perform a 12 lead and do a full assessment. They determine that the patient is stable and ask the FFs (who are all basics) to call for a private BLS ambulance Code 2.
My understanding is that once you take patient care you are responsible for patient care and cant give it to a lower level. Almost every BLS run for a private company had a paramedic there at one point who left. This has led to BLS squads getting ALS patients. Like an eclamptic patient or a patient who complains of chest pain (with cardiac history)after BLS arrival and the medic refuses to do a further assessment.
I feel that it constitutes abandonment and felt that as we packed up and left. But as a lowly clinical student my opinion would not matter. My opinion as a private Basic also doesn’t matter, which has been been proven multipe times.
*points to above comment*
That, my friends, is the up until now elusive “K”.
K, this happens pretty regularly though, correct?
Almost every time a basic ambulance is called for, a medic has done a full assessment and then left. Also, there might be a medic firefighter on scene but don’t dare disagree that is a basic transport and you would be fired for rejecting the run. Or my favorite in the case of our boss say your medic. The exception is when they automatically send a basic squad based on the nature of the call. This does happen quite often and sometimes they will actually call a medic squad but it has to be bad.
I’m not law smart enough to know if it was abandonment… but if an ALS provider ever treats one of my family members like that, I’d be PISSED.
(I’m EMT-B with a fire department in Maryland.)
Superstar Partner,
Abandonment is defined as the unilateral termination of patient care before ensuring that care can be continued on a level commensurate with the patient’s needs.
You can indeed hand off patient care to a lower level, if that lower level of care is all the patient needs.
Otherwise, triage in multiple patient scenes would never work. Tiered response systems would be illegal. And handing over our patient in the ER would be illegal as well, because that patient is likely not going to have an MD or RN sitting at bedside, 14 inches away, like they do in our rig.
Sometimes, they may even go to the waiting room for a few hours of fluorescent light therapy before they get brought back to a room.
That said, if the assessing ALS crew felt the need to do a 12 lead EKG, that’s a big clue right there that they shouldn’t have handed the patient off to a BLS crew. Something in their minds indicated the need for that 12 lead.
Totally, 100% irregardless of the abandonment issue (as it pertains to leaving the scene), this is just epically shitty care. I want their cards. NOW.
Trauma with chest pain- especially with a mental handicap/poor historian patient- would be a Level 2 trauma activation at my trauma center. Unless the first arriving transport crew was BLS, the patient better be coming in ALS, and since the patient is not completely oriented and can reliably deny neck or back pain, he better be boarded too.
That said, if the assessing ALS crew felt the need to do a 12 lead EKG, that’s a big clue right there that they shouldn’t have handed the patient off to a BLS crew. Something in their minds indicated the need for that 12 lead.
Which, to me, points out exactly how mind-numbingly incompetent this crew was. Why were they even bothering with a 12-lead? There is NO MEDICAL COMPLAINT here!
Before reading any of the comments – triaging a patient to a BLS crew in this situation is abandonment. Maybe not necessarily in the strict sense, but if an ALS-level provider initiates any sort of intervention (even a non-invasive one like a 12-lead) that is at their level of skill, they need to continue providing care.
Think about the ramifications if an ALS crew triaged a patient to a BLS crew after this and the patient boxed on the BLS crew. It would be bad indeed. Licenses would be lost, lives would be ruined, and the patient would likely be dead.
Regardless of any of the legal issues involved, I wouldn’t triage a patient like this anyway; I’d want to do things the right way. Plus, I wouldn’t want something like this on my conscience.
Now – I’ll go read the comments….
Another problem is this patients mental status. “Difficult assesment” comes to mind. IF they don’t know their name, they don’t know whats wrong… goes the saying.
You can downgrade care, if your state and/or protocol allow. Our protocol requires the signature of a nurse or doctor to release care. That means I can’t drop to a BLS truck (which we don’t have). If we had them… the protocol might change.