EMS Office Hours

You know, a lot of things in EMS just don’t make sense. Spinal immobilization, continued use of Lidocaine, Lasix, Epi the list can go on. I suppose we do these things for a variety of reasons. Following protocols, job security, going along to get along etc.

One thing that has been really buttering my biscuit these days is this whole patient signature thing. This idea that having the patient sign the privacy form, billing form, no fault form etc. clarifies why they are in the ambulance. To me if they are in the ambulance it “implies” they want to be there. If they can’t sign because they are unconscious etc. it still “implies” they want to be there and having me or a nurse sign that they couldn’t sign is ridiculous.

Shouldn’t our documentation be enough to state why they were transported. How we found them, their complaints, our findings and treatments. Isn’t that all enough to warrant the need for an ambulance? Why do we subject patients to signing unfamiliar forms and computer screens when they are in duress. Chest pain, difficulty breathing, trauma and otherwise. “Oh excuse me sir, I know you are having chest pain and your 12 lead is showing a STEMI but can you allow me stop everything I am doing to save your life and direct your attention to my billing form.”

“Ma’am I know you are immobilized to a flat board with a stiff collar on your neck and although this alone should be enough of unnecessary treatment, can you sign this no fault form while on your back unable to move your head and in a most uncomfortable position”

My personal favorite. The 80-90 year old patient who can barely see, has arthritis and is being asked to use a computer screen and stylus… (what’s a stylus) to sign their name. Now press hard, don’t let your hand rest on the screen, no lets try again, oh wait, that’s good enough, I know it looks nothing like your signature….. ”UNCLE!!”

“What” you say, “most patients can sign”? They aren’t in duress or in precarious positions not to sign? Maybe these patients should be going by some other means to the hospital. Perhaps they should be signing before you transport, that in your opinion they don’t require an emergency transport and that they may be required to pay the ambulance bill themselves.

Sure some patients need the ambulance and they most likely can also sign. But why is that part of the deal? Shouldn’t our assessment, care and documentation of it all assure the need for ambulance transport?

Now there are those who will say that it only takes a few minutes to get a signature. Its not a big deal, its part of the job and on and on. While this may be true at the root of it all, requiring these signatures has evolved in EMS from not needing them, to sometimes needing them to needing them is mandatory, patient condition be damned.

To me, the fact that the patient is in the ambulance accepting transport and treatment as I document the same on my report implies they want to be there and agree to being transported. I don’t know about you but I have not seen ambulances driving around snatching people off the street and taking them to emergency rooms against their will. But I guess if they did, as long as they got a signature somehow it would be OK.