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Arrest at clinic
Ok I got a question for you guys. Was called to the clinic for SOB 30ish male whiteout of lungs with pneumonia and when pt was moved to stretcher pt went into respiratory then cardiac arrest. When you have an arrest at a clinic do you usually take one of the doctors with you if they want to go? What about the tube? If the lead doctor in clinic wants to perform the tube before you roll do you let them or what do you do? I know a doc can maintain patient care if they are willing to go with you and assume liability for pt but unsure about the tube. I had never had a doc want to get involved in the code much less intubate so I was curious as to what ya'll might do in same situation.
Replies to This Discussion
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Permalink Reply by Joe Stoltz on
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I would think that if care is transferred to an EMS level of care that could perform intubation then it would be OK for the doctor to shoot the tube first. If it happened here, and the doc tubed the person then expected a BLS ambulance to transport I don't think we could until an I/CC/P level tech got there to assume care with the tube.
Very interesting question and it will be interesting to see others' ideas.
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Permalink Reply by Chief Terry Mills (Ret) on
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We had this question come up when we had a call where the Doctor on scene initiated care and did ride in. Now laws may and will very from area to area, but this is what we were told by the State Dept. of Health & Hospitals, " An advanced level Medical Practitioner, ie; Physician, RN, Physician's Assistant(under medical direction) being properly certified and accredited, may decide to retain control of care but must acknowledge to responding Emergency medical personnel that they are maintaining responsibility for care. It is required that the Responding Emergency Unit obtain the Medical Practitioner's signature and State ID number on the run report in the attending medics block and note in "Remarks Section" Care Continued By Initial Medical Practitioner" . We have had this happen only 1 time since. I would think that the attending practitioner would be allowed to perform any reasonable procedure to his/her level of care with regards to the scene, situation and available equipment. Just my interpretation.
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Permalink Reply by Matt Barker on
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If they want to "drop" a tube, then they can ride to the Hospital. In my dept. only our personnel can perform ALS skills. If a Dr. is on scene, and wants to "get in there" or wants things done differently, then he/she has to take over PT care
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Permalink Reply by Jessica Shrewsbury on
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Everyone is pretty much saying the same thing, and I agree. If the Doc wants to play, he gets to go the whole way. Obviously there is a lot of organization going on at a code. While all of that is happening, you could probably make quick contact with medical control. They would be able to tell you what should be done, which would take all of the pressure off of your shoulders. I have had to do that in a couple of really shady situations.
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Permalink Reply by Bambi on
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here, if the dr wants to do it, let him do it, but explain that if he does it, he is coming with you.. he is higher on the food chain than ems... if he wants to go, the more hands to help, the better!!! that is unless he is incompetent, but if he was, hopefully he wouldnt be a dr!!!
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Permalink Reply by Engineco913 on
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As we were trained to do, the highest trained personnel on scene (doctor in this case) would be the primary care giver until you load them in the bus. Once the patient is in the bus, you and your EMS squad would be in command until the hospital where the doctors would take over again. Especially in the case of a Cardiac Arrest, its better to have more hands than not, but under no circumstance does a doctor do a ride along UNLESS it is in your SOP. If you get in a wreck enroute to the ER who covers the doctor? Don't think for 1 minute they wouldn't sue the living hell out of the ambulance driver, crew and organization.
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Permalink Reply by Engineer Ulfrik on
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Don't think too many doctors would be willing to intubate & then pass pt care over for transport. I've gone on cardiac arrests at nursing homes where there's been a DR. on scene & he was doing no more than CPR. I would think that may lead to an abandonment issue.
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Permalink Reply by Ryan on
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If a Dr. or RN or whatever approaches you on scene and wants to take control, I suggest you just get on the phone with your own Medical Control. yeah the doctor or RN is there but you are in charge. dont be afraid to tell the doctor in the field to back off, and if there's a problem get right on the phone with your medical control.
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Permalink Reply by medic69 on
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i go with what ryan said. i had that and it does get crazy when the pt goes into arrest and luckily we had a rider with us so i was calling our med control as we were rolling the guy out and med control told us if dr intubated the he goes with make sure to get HIS signature put in the comments and get all his info that is required by law also and make him understand that he is the one that maintains the tube. since then once a month we have con-ed classes about it for all the new people so they know what to do. i think it all depends on your smos and med control. even though the dr will be there hes going in your ambo and your name will be on that run report . i hope that helps you out :)
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Permalink Reply by Tricia Loskot on
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the whole "higher level of care" thing is what gets me on this. i mean, if the doc starts cardiac care, you would think he'd have to ride in bc obviously we are nowhere near his level of care! but if he doesn't start care and it's already been turned over to you, i don't know if he could do anything without riding in. hmmm.....
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