Ambulance/Paramedic procedure

I did trauma surgery for a couple years, such that the ones the paramedics thought should or knew they needed to go to the trauma unit where ones that I saw. I guess that's the opposite of what you want. However they will check ABC's. Airway, Breathing and Circulation.

Airway- Do they have any trouble protecting the airway, such as hematoma deviating the trachea, sinus or throat bleeding risking blood draining into the lungs, are they drooling a lot, tongue swollen (basically mechanical reasons that might interfere with breathing, not just now but a chance of it over the next couple days)...

Breathing- Are they having any problems like short of breath, hyperventilating, do their breath sounds sound equal on both sides, are both sides of their chest expanding equally, is their pulse oxymetry normal without supplemental oxygen...

Circulation- they'll check vital signs to be sure that they are stable over time (I don't know what their parameters were for discharge to home in terms of how long they'd wait before making the call that they don't need to go to the hospital) do their limbs look like they are getting supplied with adequate oxygen, are pulses good at all extremities

Any competent patient can refuse treatment, so the paramedics will also probably do a mental status check on anyone refusing to go to the hospital and if they fail, then they go to the hospital. Are they orieted to person, place time and situation? Who are you? Where are you? What is the date? What happened here?

Like I said, I only saw the ones that failed somewhere along the way and went to the hospital. I'm sure a paramedic will wander by and have a longer explaination for how someone would "pass".

if a medic is called to a scene he/she is obligated to bring the patient in unless the patient refuses treatment- particularly if a pt has head/facial injuries-

But as George said, any compitent person can refuse treatment- if he does they need to sign a release form that releases the medic from any legal responsability if the injuries should prove life threatening-

Keep in mind unless this is a triage situation, a medic can not diagnose- while they have protocols to follow that aid them, they are not doctors and they can not diagnose an injury or illness-

As Shea said, an EMT/paramedic is not a doctor. Nor do we have x-ray vision.

Facial injuries bleed. A lot. Some of the skull and facial bones are rather delicate. Brain injuries don't show a lot of signs, but you know when someone has been hit in the face, the brain has suffered some level of trauma from the back and forth motion. We're going to recommend transport. We know what we don't know.

Being kicked in the stomach can lead to ruptured internal organs. These won't show any signs for a while. We're going to recommend transport. We know what we don't know.

Preference is you go rather than not. If you're obviously completely uninjured, then okay. But your patient is obviously injured. Now the kid who gets his finger caught in the chain of his bicycle, he's the type we don't transport (Yeah, I got a call for that.) But the person who calls us at 3 AM goes, even if they decide by the time we get there they're not sick. (You wake me at that time of the day for nothing? I don't think so. You're going.)

Technically, we have to advise patients of their right to refuse transport. It's amazing how often I can forget that little fact. In your scenario I'm not going to mention it. Why confuse a patient by giving them a choice? Further, the police is going to be leaning on us transporting. If he started the fight, he either gets to ride with the friendly guys with the red lights and hope there's a cute nurse at the other end, or he gets the bracelets and the blue light special. If he's the victim, the police are going to want the increased consequences of having to go to the hospital.

We're going to force him into being a macho jackass about refusing. EMTs are cautious individuals who hate the paperwork involved when a patient refuses treatment and then dies. Let the doctors deal with that crap -- that's why they get the big bucks.

When a patient signs off refusing treatment, it doesn't mean they are healthy. It just means they're too dumb to realize they should go. You're most likely not to transport on auto calls, where the call is automatic such as for a car accident or in a school (school nurses call for the dumbest reasons -- they should know more than we do). Or something like a "lift assist."

Fights are not automatic calls and your patient is going to have to fight not to go.

Best of luck,

Jim Clark-Dawe

I ended up having to arrest a pedestrian accident victim. He had an obvious broken leg, was lying in the middle of the street and refused to go with the paramedics. He couldn't get up and intended to crawl home from where he was. I gave him his choices. He got arrested and once he was under my authority, the EMT's took him bodily. He screamed all during the process getting the crowd riled up, but that's the way it goes some days.

Kate_Sherwood said:

What did you arrest him for? (like, what charge, not 'why'?)

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Stupidity?

Kate_Sherwood said:

I have a character who's been beaten badly enough that an ambulance is called, but I'd rather that he didn't actually go to the hospital.

I know I've seen paramedics on the news, etc. treating people at the scene. I assume that the paramedics then make a judgement call about whether the person needs more treatment (at a hospital) or can be sent away without further care. Is this correct?

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Yes ... within the parameters set by their supervising physicians and/or state law, they can. The butt-covering phrase, "make sure to check with your family doctor" is always said.

Assuming that it is, what criteria would the paramedics be using to decide whether my character needs to go to the hospital? He's been hit in the face several times, and then kicked a few times, but he never lost consciousness.

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Around here, he'd be going to the hospital to be checked (X-ray, CAT scan or MRI) for internal injuries and head trauma unless he refused. The ER could "treat and release" if they wanted.

He doesn't want to go to the hospital, but I don't want him to be a macho jackass about it, so I'm looking to hurt him as bad as I can without making it totally stupid of him to refuse to go to the hospital.

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Hit in the face, kicked in the head, and kicked/punched in the gut are all going to make the EMTs want to take him in for a better look, because they are the kinds of damage that can indicate internal injuries.

Plenty of people refuse ... the EMTs just have them sign a refusal, and tell them to make tracks to the ER if signs of head injury or internal bleeding show up.

Kate_Sherwood said:

What did you arrest him for? (like, what charge, not 'why'?)

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Obstructing traffic?

People refuse treatment all of the time, even ones that are seriously injured. I once worked a wreck where the patient was partially scalped and tried to convince me that he didn't need to go to the hospital. Yet, the lady that hadn't had a bowel movement in 2 days called 911 and we had to transport her to her hospital of choice 40 minutes away. Sigh...

Anyhow, a lot of times, men that have been in fights, or injured with power tools, or otherwise bleeding will refuse to go - it will usually be the girlfriend or wife (or police) that calls the ambulance, but the patient is confident they don't need to go to the ER. I've had countless guys tell me that they will just "put butterfly strips" on their wounds, so you could go that route. And don't forget the refusal!

Good luck!

In Ireland a paramedic can treat at teh scene and not have to take the patient to hospital. I think it's different for head injuries etc though.

You don't have to be a macho jerk to refuse transport around here as long as the medics don't have reason to think you've got serious injuries. It pretty much goes like this (especially if you don't have insurance).

Medic: "Do you want to go to the hospital?"
Patient: "No."
Medic: *holds out clipboard* "Sign here"

Sources: Personal experience and the fact I have a police monitor set to the med channels, through which I hear multiple patient refusals every day. I've heard plenty of assault victims (mostly meaning drunk guys who've gotten into fights) refuse medical transport. The medics really don't care unless they think you're dying, and even then it's difficult for them to transport against a patient's will. They have to get authorization from their own command and get the police involved (I've heard them actually do this a grand total of once in the past year, for a person they genuinely thought might bleed to death if they didn't). I've gotten the impression that the medics understand most people without insurance truly can't afford hospital bills for something that won't kill them*.

*This might be different in a country like Canada with free health care. I'm in the US.