Severe pain + 2mg of Morphine = severe pain.

- Rogue Medic

Witness – Hall paramedic ‘abandoned’ stroke victim

 

I don’t know what things are like in Bakersfield, but they do not seem to be good for cooperation between the police and EMS.

What should we do if we suspect a medical emergency, but the police do not consider it to be a medical emergency?
 

According to Blankenheim, all paramedics must be well-versed and well-trained in state law, which ultimately gives authority over patient care to the top-ranking medical personnel at an accident scene.[1]

 

A person working as an expert witness who claims that all paramedics should be explaining the law to the police? Maybe he put it a bit differently, but I wonder what he would say about the kind of informed consent that should be provided for every stable patient prior to spinal immobilization – We have no reason to believe this works, and a lot of reasons to believe that this will harm you, but this is to protect us from your lawyers.

Is the person a patient?

What do we do if the police do not agree?

Is the highest ranking EMS provider in charge of the patient if the police say that there is no medical emergency, hence no patient?

EMS and police give conflicting accounts of events, but this kind of police/EMS disagreement is something that does happen.

The description of the patient does not suggest that he would even be able to stand for a field sobriety test. Where I am, if the police bring someone to jail in that condition, this may present an opportunity to sit and squirm in front of management.
 

Even if police are resistant to releasing the patient into the care of emergency workers — as Dumont testified earlier in the trial — Dumont should have insisted, or asked for assistance from higher authorities, such as the on-duty ER doctor at the hospital, a watch commander at the police department or another authority.[1]

 

That may be what matters most to the jury. there are other people the paramedic could have called for assistance in attempting to persuade police that this is a patient who needs transport by ambulance, but that appears not to have been done.
 

In his earlier testimony, Dumont said he has always operated on the assumption that the person at the scene “with a badge and a gun” has ultimate authority. And he testified that Payne insisted that she would transport Harb in her patrol car, and that Dumont needed to move his ambulance because it was blocking her exit.[1]

 

That would make it difficult to call for assistance in resolving the issue. If the police are saying, We are transporting now. You have to move your ambulance. There is not much ability to involve a medical command doctor, or a sargeant.
 

But there appears to be a clear dispute about the facts between his version of the incident and Payne’s, who apparently testified in a deposition that Dumont indicated Harb’s vital signs were normal and that he didn’t need to be transported via ambulance.[1]

 

Normal vital signs do not mean much of anything. We should not use the word normal in medicine.

What are the normal vital signs for the patient?

If the patient is drunk, what are the normal vital signs for that patient when he is drunk?

Why does anyone assume that we know what normal is?

This trial is far from over, but it does raise a lot of questions about how we handle disagreement between different agencies about patient care, or about who is a patient.

Do we wait until the next day, and then assume that the lack of a phone call from management means that we did the right thing.

We regularly get away with doing the wrong thing. When there is no obvious bad outcome, we seem to assume that we did the right thing, rather than realize that we do not know the outcome. We are dangerous when we make these assumptions. we are more dangerous when we apply them to patients.
 

Image credit.
 

Those are not specific, but they are only some of the signs of a stroke. They are the parts of the Cincinnati Stroke Scale.

The best known mimic of stroke is hypoglycemia, which looks a lot like being drunk. Or is it the other way around? Sometimes it can be difficult to tell.

What parts of the assessment clearly differentiate between having a stroke and being drunk?

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Footnotes:

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[1] Witness: Hall paramedic ‘abandoned’ stroke victim
Wednesday, Nov 28 2012 06:49 PM
By Steven Mayer Californian staff writer
Bakersfield Californian.com
Article

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Comments

  1. Obviously, there’s way too much missing for us to really know what happened; but since that would lead to a boring reply, I’ll happily speculate. :-)

    In California, at least where I’ve worked and had my EMT/medic education, we are taught that the ultimate authority on-scene in the case of disputes is with local law enforcement. The way I’ve understood that is that if the cop really wants to be a martinet, s/he can retain custody of the patient/suspect and punish the medic depending on how the medic interferes with that. The cop will certainly sit and squirm like hell in front of his/her superiors if s/he can’t justify ignoring a licensed medical professional; but the cop does have that right.

    In practice, that means that if a patient is in police custody, I have the police officer sign (with badge number) any AMA form. Their prisoner, their (legal) responsibility. Depending on the patient’s condition, I may go some length up the chain of command; but ultimately the cop (or his/her superiors) has the final say.

    I partly disagree about the usefulness of “normal”. IMHO, “normal” is the range for a given vital sign in a healthy individual at rest. From there, we should look at the difference between “normal” and the patient’s vital sign and correlate both with the patient’s known history and the trends in subsequent vital signs. “Normal” is overused, but we need to start somewhere with our assessments.

    There are two pieces of evidence that are absolutely needed to make any sort of informed comment on this case: the PCR, and the police dash camera (with audio). Without those, we’re relying on the hearsay of 5 year old memories.

  2. Mpatk:

    I partly disagree about the usefulness of “normal”. IMHO, “normal” is the range for a given vital sign in a healthy individual at rest. From there, we should look at the difference between “normal” and the patient’s vital sign and correlate both with the patient’s known history and the trends in subsequent vital signs. “Normal” is overused, but we need to start somewhere with our assessments.

    I’m doing to disagree with you on that. Even in a “healthy” pt normal has variances. While my resting heart rate is in the low 70′s, an extremely fit individual has a resting heart rate of half that. They’re “normal” at 36BPM, while if I’m at 36BPM you’d need some Atropine handy. Plenty of people that are healthy average a temp in the 96 range.. 98.9 degrees for them is a sign of illness, other healthy people 98.9 is a normal finding.
    Same can be said for BGL’s, BP’s, etc.
    Plenty of healthy people fall outside a range for the general population.

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