Of Chaos and Ethics, thoughts please!

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Specializes in Education, Acute, Med/Surg, Tele, etc.

A horrible car crash involving three cars happened near my home the other day. One of the cars caught fire and paramedics were able to pull on of the men from the burning car and saved his life (the driver did not make it sadly and died there). One of the other cars had significant injury to the driver and passengers requiring life flight teams and quick transport by ambulance. The third car, supposedly the one that caused this crash had two in it...a man driving and his teen daughter. They were bumped around a bit, but no real significant injury.

Okay, these things happen...but when I talked to a friend paramedic who was on the scene, well...an ethical dilemma came forth and slapped me in the face, making me question myself and what as a medic I would have done or felt!

You see, paramedics were indeed injured pulling the man from the burning car, and will get the Medal of Valor. All the paramedics were male except one female who was busy tending to another patient in the second car. The car that caused all this (not sure how it happened), had the man and daughter whom were of the Muslim faith. They declined treatment twice, signing the refusal. Then all the sudden the man wanted his daughter checked by paramedics but refused any male to do it! So the female on duty had to leave her critical patient and tend to the daughter who only had a scratch or two.

My blood started boiling at the story :angryfire ! Signed refusal x 2, he caused the accident that killed one person, burned another, injured EMS, caused three more critical patients...and now demands a female paramedic to check his stable daughter?!?!? I was furious!!!!!!!

Then I thought about it...although I feel that given a non emergent situation a patients rights to a female medic for a female patient is very valid, and we should do our best to accommodate for our patients...NO MATTER the religion! But in a chaotic mess like this...to demand such things after two SIGNED refusals was going wayyyyyy out of line! I am happy they did accommodate, but what about the right of that critical patient she was tending??? Didn't that person certainly have the right to her attention instead of having her change patients and have to report things when seconds counted???

I was very upset at myself for thinking this way:idea::nono: ...I always am an advocate for patients rights and accommodating for patients. Then I realized...it wouldn't have mattered to me if the father was any religion or faith...and that helped me a bit since I really strive to provide religious and spritual needs for all my patients (I feared I was being bias...which after careful thought thank goodness...I was not, but it scared me! I am overly sensitive to that!) . I came to the conclusion that in non-emergent situations accommodation within reason and safety is totally good, but in emergent situations when accommodation puts patients at risk or is unsafe...it isn't rational or right!

Please express your thoughts on the matter! This one is a tough one for me...stuck between my wish to help patients, and demands on us medics that go more than a situation should allow for... I believe in always striving for the patient, but I think in this case, bless those paramedic's hearts...it was more than what was necessary given the chaos!

I don't wish to cause any upset, so please just your thoughts...and all thoughts are appreciated by me and respected by me! Makes me think...and I really want to think about this from many perspectives!

Thank you!

TRIAGERN

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Specializes in Maternal - Child Health.

Why would ANY paramedic leave a CRITICAL patient to tend to a STABLE patient under any circumstances?

To me, that is the issue. Not one of gender, initial refusal of care, or fault in causing the accident.

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In situations like this don't they triage (no pun!) the injured? Would she even let the male medic do a basic assessment of her to determine this? If there was no one else to assume care of the female medics pt while she tends to the female injured, I don't see how they can accomodate her without harming the other injured pt?

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We had sort of a similar situation a few months ago. In our area, there are only a few OB/GYN practices within a 30 mile or so radius. A muslim patient presented to our triage area. Her husband said a male could not examine her, only a female. The nursing staff did the VE and the male doc spoke to her. He was peeved, however, as he believed that the patient did not fully comprehend that had there been an emergent situation, like that patient had presented imminently ready to deliver, he could not get a female physician to stand in for him. As it was, pt came back a few weeks later for a scheduled c/s w/ one of his female partners. Culturally sensitive care is sometimes difficult to provide.

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Specializes in Emergency & Trauma/Adult ICU.

"Culturally-sensitive" care is an admirable goal, but I don't believe this goal overrides basic principles of triage/prioritization of care in an emergent situation.

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"Culturally-sensitive" care is an admirable goal, but I don't believe this goal overrides basic principles of triage/prioritization of care in an emergent situation.

Very well said! Am emergent situation demands medical personnel give/prioritiize their attention and care, to the injured victims first. If other individuals cannot/will not understand, and want immediate attention, they can call a taxi, and be taken to the nearest "doc in the box", and have their care provided there.

A persons religious beliefs do not give them the right to overide/demand treatment. Triage/prioritizing principles were developed to assure that accident victims are cared for in a manner that will ensure their survival and limit disability caused by their injuries. This is another example of "politically correctness", that is way over blown, and given too much weight in treatment decisions in hospitals and it now seems, in the arena of emergency situations. JMHO

Linda Gusch, RN, BSN, CCRN

Spokane, Washington

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Specializes in Education, Acute, Med/Surg, Tele, etc.

From what I heard about the switch is that two paramedics (not basics) the female and a male were working on the critical patient with a reserve set of Paramedic/EMT basic on scene for back up...so the switch was somewhat possible...and the paramedics felt at the time that is was better that the girl get looked at despite her fathers probelms then not...

So the switch was made, but I don't think that was fair!

I guess my hubby (paramedic) made that mindset clear to me when he said "better to be judged by 12 peers than 6 paulbearers"...in essence, better to accomidate by the rules set forth to us about patient rights, then to risk a death if you can...considering the teen girl may have had internal injury or other unseen probelms at that time (they didn't know at that time...turned out to be very minor!) best to side on caution and go by the father's expectations and actually assess her...the other patient was covered...just a total pain and..well to me, unecessary action!!!!!

I don't care where you are, if you need immediate help to save your life...or even the presumption...you don't go barking wishes...you take what you are given and go with it! Sorry..that kind of probelm is best (if not totally unwanted but ya know) taken care of in Hospital than on a rainy day on the side of a road with one person dead, a car in flames..and two life fights trying to land!

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Specializes in Education, Acute, Med/Surg, Tele, etc.

Keep those thought comming! YOu guys are great!

I guess we have to give paramedics a lot of credit knowing their field and what they can do dispite the chaos to accomidate patient requests! I don't think I would be so inclined in an emergency setting like that because I don't experience that...much!

I mean...give me a day from heck and have some patient demand something like that...I will admit I do accomidate, but with that gritting teeth grin! To do it in a chatoic situation...my hat off to you!

Thank goodness only one death in that mess...that I guess shows how wonderful the EMS was (and police and fire too!!!!!). Sad there was one loss...but wow, could have been more if it weren't for professional medics and support...given the attention to one persons request no less!

I am spoiled in my area...darn good EMS here, and I am so proud to know them and can call them my friends and collegues! (even though I am RN...LOL!).

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Here's a thought....what would daddy have done for his little girl if she had shown some sign of injury and nothing but male emergency responders were available? Could happen..so will he let her bleed to death internally. Or drive her to the hospital himself and wait for a female doc to be available? There has to be some sense of judgment used here. Sorry about the kid, but at this very moment the other victim seems to be the priority. Until symptoms/signs change to make me think different, daddy's little girl will just have to take a number. I'd love to know that I could be the squeaky wheel and walk in with my daughter and make her a priority because of religion. However, that's not the way emergency care and triaging works. If you're looking for customer service, I'm sure I can find an 800# for you. Otherwise either grab an ambu bag and help, or get out of my way and let me do my job.

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Specializes in Education, Acute, Med/Surg, Tele, etc.

Tl...I am 100% behind your answer...

Why did thinking about it bother me...that is the gist...my gut says..."ummmmm hi ya...but situation doesn 't allow for this right now! SO be treated or sign your third and FINAL refusal and quit wasting my time!"

Guess it gets wierd when there is a different race or religion envolved...but NOT in emergencies kiddos!

part of me feels bad about even thinking that way...but sorry...the majority says this is total utter BS!

Keep em comming please!!!!!!!!!!

OH btw...I will see the female paramedic today!!!!!! SO I will copy this and give it to her....because she really is having a hard time with this...more so than I! Your support is sooooooo loved!

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darn, such madness...

undoubtedly you always tend to the most critical first. life holds more value than religious taboos. of course it's preferable to accommodate one's religious values but in a life and death situation, clearly sustaining one's life holds more priority.

a male para could have done non-invasive interventions on the dtr: checking airway, breath sounds, palpating abd, neuro signs, rom ...the father wasn't too worried when he refused care x 2.

maybe running it by the e.r. chief might qualm any doubts.

customer service is not the priority. what a mess.

leslie

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Specializes in Public Health, DEI.

I don't think in this situation the signed refusals or the reason for the request that only a female look after his daughter is relevant. In emergency situations, standard of care is to triage. As this man didn't want a male medic to attend his daughter, she will just have to wait until a female is available, the same way she would have to wait in an emergency room. Too bad, so sad. End of story IMHO.

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