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.

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….

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!

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.

(I’m EMT-B with a fire department in Maryland.)

That, my friends, is the up until now elusive “K”.

K, this happens pretty regularly though, correct?

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.