Wednesday, January 25

To Haul or Not to Haul - Should the Complexity of a Refusal Influence Transport?

Recently overheard was a conversation between 2 Paramedics, both proactive about their Profession, discussing a complicated patient.

It wasn't the assessment that was complicated.

It wasn't the indicated treatment, or lack thereof, that was complicated.

It was how they were going to document their findings and whether simply transporting would eliminate liability.

You know me, I had to get involved.

The patient had a syncopal episode onboard a flight of about 4 1/2 hours.  Meaning that for 3 1/2 hours the patient has been asymptomatic and "feels fine, I just fell asleep."

Patient has in their possession prescription medications for a knee injury, an odor of alcohol (yes, they served her after her "episode") but speaks in clear sentences and meets criteria to be able to make her own medical decisions.

Pretty straight forward refusal in 57 of 58 Counties in California, even for an EMT-B in many places.  Not us, we need a MD consult for the witnessed syncopal.  I know, 1969 called, they want their policy back.

Medic 1 isn't comfortable documenting a witnessed syncopal with meds and ETOH on board on a refusal and recommends in the future talking the patient into hospital to "eliminate liability."

When pressed to explain exactly how that happens Medic 1 was unable to do so, as many are.

When we complete our assessments and figure out which 35 year old box our patient fits into it is our duty as health care providers to also assess what is in the patient's best interests moving forward.  We are no longer in a "Go, No Go" EMS world.  Uber and Lyft have replaced spotty taxi resources in most communities, meaning we can get someone to a clinic, MD or ER in a recorded fashion.  When appropriate.  Hence the assessment.


We are spoiled at my station because we have a MD staffed clinic most hours of most days and I can get a wheel chair to take someone there in under 10 minutes.  But expand that concept out and you have that ability as well.

It goes back to the patient having to prove to me they're well enough to stay where they are, but where they are can now be moved.  Do you follow?


Imagine being able to document in your PCR your assessment findings, indications and treatments, establishing the patient's ability to refuse, then the name, car description and destination of the person refusing transport.  I've done it often and goes to show we literally did everything we could.

"That's just adding liability, Justin, transport is the only true way to avoid being sued."

For what, exactly?

Imagine getting a phone call that the patient you talked into transport is challenging your clinical judgment that transport was necessary.  The Anchors never warned us of this did they?

Talking someone into the ED in an ambulance simply to make for what you think is easier documentation is misguided, dangerous and wrong.  All you've done is gone outside your mandate and introduced a new element into the liability matrix: coercion.

"He told me I needed to go and the Doctor said I didn't!" is a complaint your billing department gets far more often than they'll admit.

Stop making transport decisions based on how hard your head will hurt documenting the alternate.

Do the right thing, write down what you did, nothing can go wrong.

Saturday, January 21

Crossover Show - Ep 91 - ACLU cameras

In this episode, MC and the HM jump headfirst into the ACLU Washington DC PD body camera issue and somehow end up talking about CCTV, the First Amendment and why this kerfuffle is much ado about nothing.

MC is giving a speech from a teleprompter and HM is reading a manifesto about technology called You Are Not a Gadget.

Rate us on iTunes and don’t forget to become a patron of the arts by supporting the show at

Be sure to text “DebtFree” to 66866 to get info about MC’s course he’s been talking about, like, forever.


Sunday, January 15

Tip of the Helmet - Bj's Brewhouse

Hi internet.

Bet you thought I was dead.

Nope, just lurking.


Had to pass along another tip of the Helmet I ran across this weekend on a family trip.

Up to Sacramento, CA for the Irish Dance Competition for the Jrs (Feis they call it. Pronounced fesh) and we need to get some dinner.  A few miles from the host hotel is a restaurant we know and love BJ's Brewhouse.  Good food, good beer and even if there is a playoff football game on it won't be crazy busy.

I like their beer selection and there's always a new brew or two of theirs I haven't tried yet.

As I was eyeing the menu I came across a special promotion: Buy a Hero a Beer.

You know I'm all about that!

Here's how it works:

You goto the website HERE and complete the form.  They need your name, email and Department affiliation.

Moments later your email has a discount code the waitress will apply towards a free beer.  All you have to do is show ID or a business card to prove you're in the disciplines.

Then it is super easy to have the server add a beer to the list in your name for the next hero to wander in.


The website will let you know if there are any beers available at your chosen location.  When I looked it up there were 4 beers available.  I took one, I left one, so it was right back to 4.


Love the program BJ's!  Here's a tip of the helmet!

And if you get a moment, maybe swap out the French firefighters on your page for some of the local boys?  Thanks!