Yep...got my degree to know when and where to send a patient who is in trouble, so I send them by my own clinical judgement and the judgement of the paramedics who come as well. I have yet to be wrong!
I mean, if you have someone who is not breathing but has a pulse, you would call 9-11 right away (even with DNR, DNR requires pulseless and apnec..both!!!). So why wouldn't you send someone out that is on their way to being pulseless or apnec? Same rule applies and it is within my scope of practice to make that choice
I have even had times when I have sent in hospice patients for injuries unrealted to their illness.
I had one lady who was on hospice for cancer and got up and fell and hit her head badly on the nightstand and had a large laceration, and complaints of an aching back and hip! I called the hospice nurse and luckily was able to get a return call within a minute! She said "HECK YES!"..and I said "good..they are already on their way...LOL!" It had nothing to do with a natural death by cancer, it was everything to do with the comfort of my patient while this natural death occured...and yes, broken lumbar 2 verts...broken hip...and sutures in the head. They did nothing for the breaks...but we did increase implementitions for pain management so she could die without the added pain from the breaks! That was worth it to me and to my patient who did request to go to the ER (can't deny her that)!
IF you think you must send, then you send. And don't think that it is all your responsiblity, the Paramedic in charge also has medical judgement and will send if they feel it is valid as well
OHHHHHH and always always document your reasons and when you called the MD or answering service! That shows you did try and had to make a clincal judgement on your own!!! That has kept my rear out of one ringer once...I called 9 times and the DOC didn't switch the phones to the answering service and so I had to make my own call...I recorded EVERYTHING I did...and now they don't forget to switch the phone lines! LOL!