ER RN Angry & Frustrated!!!

[Ginger35]

Okay, it was a bad 4th of July in the ED this evening. However, what gets my panties in a wad is when I am dealing with other people that want to argue with you when you absolutely, positively know they are in the wrong. Please let me give you the briefing in hopes to get some feedback and get it off the chest for some sleep....

Okay, this has to do with standards of care and patient rights as it pertains to minors.

I work in a small rural community hospital near where I live - but have worked in large level II trauma centers and have all of the certifications TNCC, ENPC, & etc.

Anyways, we had a 16 year old female minor who was a restrained driver that rolled her car multiple times going at highway speeds. Allegedly no LOC. Only complaint is left neck pain. Parents could not be contacted by medics at the scene. Severe damage to this patient's Chevrolet Cavalier to a point you could not tell what it was.

Anyways, medics decide to just put a collar on her and not a board because the patient refused it (keep in mind this is a minor and can not sign a refusal). I questioned this upon patient arrival to the department descretely with patient in the room - but the patient could not hear what I said because she was talking to the respiratory therapist at the same time.

I simply asked why there was no backboard on this patient considering her mechanism of injury and the medics response was because she was up walking at the scene. I simply stated quietly as possible ("guys, this patient should really have a board on) - I did not droan on and left it at that.

Well, when I was done with my nursing assessment - this medic approached me and proceded to rip me a new one stating "that I was setting them up for a law suit" for mentioning this issue infront of the patient. HOWEVER, I mentioned to this medic that if he was sooooooo concerned about a lawsuit that the should have followed standards of care and applied the board.

Luckily, this patient walked away from this MVC essentially unscathed. However, had this patient had say a thoracic spine fracture that did not present itself until after arrival to the ED sometime - I find it hard to believe that this medic could defend this case if neurologic injury was involved because he did not stabilize the spine. Citing that the patient who is a minor refused this abnd "up walking at the scene"

When I was getting yelled at - I kept kool, stood my ground, kept the voice down and trumped his rationale (or shall we say lack of rationale) - which is why I am "fuming" sooooo bad right now.

This medic also came across that he flew with the flight team and on the fire department in some capacity for 25 years - basically coming across like he knew more than I did. Well, come to find out this guy is not even an EMT, Paramedic or Nurse!!! Just a volunteer medic with alleged BLS training.

Now don't get me wrong - I appreciate the help of the EMS around the area. But if care is going to be rendered, it needs to be done correctly. Atleast that is the way I feel. Just because a patient like this is up and walking at the scene - it does not mean that they don't have a spine fracture or other injuries considering this mechanism of injury - OR - Am I missing something here???

Also, I live in the State of Ohio. Do minors involved in MVCs and other emergent conditions have the right to refuse treatment? I mean they can't sign for themselves at all into the hospital, they can not legally sign a contract.....Sooooo how can they pick and choose care issues in this sitation???

I would appreciate feedback from you all.

Sincerely,

Ginger :angryfire

[weetziebat]

Ginger, I certainly don't know the laws in Ohio, but regarding the patient - she definately should have been on a backboard, as well as the collar. Even if she was walking around. We all know patients who walk around with severe injuries.

Imagine he just felt chastised by a nurse. I don't know this guy but do know a lot of EMT/Paramedics who feel they know far more than mere nurses. And if he is not even an EMT,maybe was feeling guilty as well. But, of course, the best defense is a good offense, right?

Personally, I'd let the person in charge of the medic team know what happened and how concerned I was about it. Not to get him 'in trouble' - but to protect the next MVA victim this guy treats. The guy might not listen to you, but he may be more inclined to listen to his boss.

You did good, and all you could have done. Now get a good night's sleep.

[sanctuary, BSN, MSN, RN]

Seems he was a bit touchy, huh? I agree c above, tell his boss. Shock can do all sorts of wonderful things. I've seen people walk on broken legs, walk c fx vertebra, etc. You did good, it is hard to hold your kool when a beligerent person excercises their stupid bone. Fellow needs better supervision, as well as some manners.:icon_hug: :beercuphe Wish i could join you, but I'm at work.

[grammyr]

I have had similar things happen in my small rural ED. Medics brought one lady in who had squat for BP, tachycardic, and that weird funny color we all hate. NO IV. The reasoning: They were 5 minutes out and didn't want to take the time to put one in. My only comment was: People have coded within 5 minutes of the hospital!!!!

[tridil2000, MSN, RN]

i would have said in reply to his

"she was walking at the scene."

"sorry, she's not the educated professional, YOU are and YOU should know better! and any jury would hold you to that!"

[UM Review RN, ASN, RN]

I agree. She could've been walking around with a fractured neck or back. I've known it to happen because a relative of mine broke his neck--2 vertebrae above C5--and walked around for about half an hour trying to get help. Miraculously, he had no paralysis, just a little blood in the spinal fluid. He had to have bone grafts to fix it. (This was back in the 60s.)

So I just took the scenic route to say: You were right; he was wrong. Plot your revenge or go get some sleep.

[emtb2rn, BSN, RN, EMT-B]

As a BLS pre-hospital provider, here's my take:

1) A minor involved in a roll-over mvc with neck pain? Going to the hospital boarded with full c-spine precautions. Can't refuse anything themselves. Period.

2) Anyone involved in a roll-over mvc with neck pain? Going to the hospital boarded with full c-spine precautions. If they're over 18, they can refuse medical attention, but we're doing a lot of paperwork documenting what happened and what was said. If I can't convince the patient to be transported, I make sure my refusal witness is a cop.

3) The "medic" you described above has no business being near a patient. I wouldn't want this guy touching me or my family.

4) Patients walking around with vertebral fx's? Yep, seen 'em, especially in the ski patrol setting. Standing takedown is the standard protocol in those cases.

5) You done good.

JMHO

[gonzo1, ASN, RN]

Had a guy about 22 walk into our ER stating his neck hurt after rolling head over heels at a football game. Eventually went to ct (no hurry, nobody thought he could be hurt that bad) turns out he had a burst fracture of c2, oh my god. the ct scanner freaked out. Anyway this guy ended up being flown out to a level 1 center asap. I learned my lesson. The minute anyone tells me their neck hurts and there was a recent accident I immediately put them in a c-collar.

That little girl should have been completely trussed up. She is very lucky. You did the right thing. Be proud and go to bed now. We need you rested so you can continue to do a great job.

[Ginger35]

OMG!!! I really appreciate all of your insights and support!!!

I am so glad that you all responded because I was beginning to feel quite lonely here in rural Ohio.

After creating this thread, I sat down and wrote out the facts that will go on a nursing concern. I plan on forwarding this document to my nursing manager and the director of emerency services. I will also need to send a cc to the CEO and COO because of management being on vacation and may or may not get followed up on.

This may seem like overkill, but similar situations have occurred regarding minors, emergent treatment and consent for treatment in the absence of a minor's parents. I have verbalized concern to my boss in the past - but nothing has been clarified and I keep getting a different story depending on who I am working with (both nursing and medics). I think that it is overdue to have the laws clarified, protocols clarified & etc so that everyone is on the same page regarding these issues. Sticking to the facts, writing a non-emotional (non-angry) case report. I do understand that we all have our "oversights" - however, there was absolutely no need for his behavior in the department. [EVIL][/EVIL] How can problems be corrected if they are not recognized in the first place??? Right???

Regardless of this medics credentials - it seems to me that this is basic medical care in the field and should not have a historical pattern of being overlooked. Had this guy really flown with flight team et al - I know for a fact that they would be taken back at the poor care in this case. (I worked closely as the receiving nurse in the trauma unit on this team). (He doesn't know that *yet*)

What an "orifice"!!!

Ginger

[Medic2RN, BSN, RN, EMT-P]

Yeah Ginger, he was an orifice!!

I also have never heard of a person without ALS certs flying with a flight team. If the guy isn't even an EMT-Basic minimum, then I would not label him a medic. Perhaps a first responder if he even qualifies for that.

The kid should have had the "works" done especially with the mechansim of injury as you described. Let us know what happens with your report. You should document it, you may be saving a patient's life/or mobility in the future. I would be very surprised if his departments QA program did not pick up on it.

Those medics are nasty, loud creatures......

Seriously, there are many of us who act with the utmost respect and professionalism to our patients and other healthcare professionals. The ones who scream and growl with sarcasm make EMS look bad and I apologize for that - EMS people are not ALL uncouth; only the stupid ones.

I hope you got some restful sleep!

[TazziRN, RN]

Okay.....yes, she should have been on a board with FULL precautions because of mechanism. No, she cannot consent or refuse because she is a minor. HOWEVER------if I have a 16-yr-old pt refusing any kind of treatment, I am not going to physically wrestle them into position to do what I need to unless they are altered or 5150. When it comes to a backboard, if she refused it, there would ultimately be more potential damage than just collaring her and bringing her in.

Your other point: the medic's response was wrong and he should have at least attempted to board her. Doesn't matter how she presented on scene. We get lots of MVA victims that were self-extricated and walking on scene who are brought in with full precautions. If that had happened to me, I would have been contacting the field supervisor to make sure that medic got remedial education.

[andhow5, BSN, RN]

Eek!

I can imagine your frustration. I can completely relate, and I must say you seem like you really did a great job at maintaining your professionalism. I would've been livid to have my backside chewed like that, and would've responded in such manner that I probably would've gotten a really long "bad girl note" (write up).

As an ED Trauma RN and an EMT, I can not fathom why this "professional" didn't follow proper protocol... Either education teaches the proper way to care for suspicious spinal injuries!

I don't know why he felt a good defense was to blather on about all of his so-called experience, because, he only made himself look worse, and his so-called resume look suspicious, in my opinion.

I completely agree with emtb2rn - there would've have been every effort made to ensure the patient was completely and properly packaged for transport, and if there was STILL an issue, I would've ensured that the witness to refusal of the LSB was a cop, charted like a fiend, and finished packaging her as best I could (boy, that 6-inch tape sure comes in handy sometimes).

En route to the hospital, the patient would be hearing NON-STOP about adrenaline rushes masking symptoms, occult fractures, paralysis, assorted disabilities, and DEATH as a result of not participating in their own preventative health care. Good old-fashioned scare tactics - mean I know, but sometimes evil is a bit necessary.

Good luck, and go get him. We don't need people like that giving EMS a bad name, and they certainly don't need to be anywhere near patients.