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???
