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1. emt.dan says:

   July 26, 2012 at 1:13 pm

   Having trouble getting the questions link to work…
   I’m not exactly sure what kind of questions you’re looking for… but something that has been bugging me, at least academically for some time.

   How do you, as a provider, reconcile performing procedures on your patients you know to be futile? Is saying “The book told me so” enough of an excuse for harming patients? Consider the following scenario, and please share your thoughts on whether we’re being deceptive to our patients.

   You arrive on scene to a low-speed MVC, car against pole to find both patients walking around on scene, with your patient complaining of mild neck pain, unclear whether it’s normal for them or not. Your patient has no other medical conditions or complaints, was restrained, and did not lose consciousness. You know the protocol book would call for full spinal immobilization, given the MOI and complaint of pain. Your patient is apprehensive about being immobilized, and you say, “I cannot rule out other injuries, so this is the prudent action”, when pressed, you continue, “If you don’t allow this immobilization, you may suffer additional injury, and could be paralyzed”. Okay, maybe you didn’t say that specifically, but most refusals require us to share that gist. The patient complies, and you have an uneventful transport to the hospital. At triage, the nurse removes the collar, and as soon as you arrive at the bed, a doctor comes over, and after a brief exam, removes the entire board.
   The patient looks back over at you and says, “I thought you told me this was required, and I needed additional screening to make sure I wasn’t injured?!? Why did you subject me to this if you knew it would be removed immediately at the ED?”

   So, Jim, how do you reconcile purposefully deceiving patients, telling them they need a therapy you know will do no good, and may cause harm? Flip flopping between strong language on scene encouraging a treatment, and telling patients at the hospital you knew they didn’t need it? We talk so often about evidence based medicine, but why can’t we move away from even the most basic BLS skills that cause harm?

   Another example: Many ACLS meds, and their known futility. Is saying, “It doesn’t hurt” a legitimate excuse? How about “we don’t know the long term effects”? Would that stand for any new treatment? Why are our old “established” treatments except from evidence based review? Is it okay to say, “well, the evidence for this is reviewed every 5 years, so eventually it will be fixed.”?

   Thanks for your insight, and of course, your contributions to EMS everywhere.

   Dan

   Reply
   • Jim Hoffman says:

     July 26, 2012 at 1:57 pm

     Dan, thanks for the comments and question I will be answering this on the broadcast page today http://emsofficehours.com/wwjd/

     Reply

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