Midazzled

My previous comment was a bit rant-y and kinda juvenile. My real issue with pain scales is the way that they get used, and how we are expected to use them. It's not a vital sign. Treat the patient, not the number. Nutella hit the nail on the head.

Not a Nurse, but I hate pain scales. Especially 10 point ones. Both as a patient (I race dirtbikes, which can come with predictable problems) and as a provider. I usually chart a pain number based on what I see, because my agency requires a number. I challenge anyone to make a case that this is more subjective than asking the patient. I treat any acute pain with injury that looks like it needs to be treated, based on how I would want to be treated. Show me some physical findings, and/or physiologic pain response, and I will treat it. I am very generous with acute pain control, much less so with chronic pain that should be being controlled by long term options. Bottom line? There is very little evidence supporting the use of subjective pain scales that has not been funded by sales of opioids.

Medscape has an excellent, easy to read article that pops up when you type "SIMV" into google. I would add that to your list to read in your time off. Ventilators can be very confusing at first, but you will get past that with reading and practice, after which they won't intimidate you so much.

I'm sorry about the negative attitudes you are encountering. You said 911; as far as I know 911 activated patient contacts can only be refused for transport if the patient or proxy refuses. If this is happening otherwise, I would suspect these providers charts are being audited already, but I suggest you fill out incident reports on your end. Edit: prior to frozenmedic's post, I was not aware that some systems allow 911 calls to be deferred to other services. Do these patients wish to go to the hospital, or does the physician want them to go without asking their opinion? What are these patients' complaints?

Edit: I may have misunderstood your post: you say the physician has ordered the patient to go to the hospital? Could the patient be refusing care/transport and the EMT/Paramedics be refusing a kidnapping? From the other side, I am a Paramedic with both a 911 service, and an interfacility service. 1)What is the destination? 2)Is it a 911 service, or a transport service? 3)EMT's or Paramedics? Do you know the difference? (I mean this seriously, not to be abrasive or disrespectful) 4)Is the report you give complete, accurate, and professional? 5)Is the patient clean? 1)destination: I am not taking a sick patient to a nursing home. It makes me super angry when someone tries to trick me into doing this by feeding me inaccurate information. 2) 911 personnel do not usually like picking patients up from hospitals. But, we cannot legally refuse any patient, unless our personal safety is at stake. Transport Medics and EMT's signed up to do interfacility, but can refuse a patient sometimes. 3) EMT's (interfacility type) cannot take some patients, such as those on drips. Paramedics have a broader scope, and can take most or all patients, depending on local rules. 4) report/paperwork: if the paperwork is incorrect, I'll just hang out until it is fixed. Dispatch may send me elsewhere in the meantime. If the medicare transport form says that they are bedbound, when they are not, I still take them, but my documentation will reflect what I see, which may affect reimbursement. When I do interfacility, I expect to get a turnover, including a recent set of vitals. Not ones from 14 hours ago. Old vitals will not cause me to refuse, but it will get more scrutiny. Please do not tell me the respirations are 16 if they are 30, etc. 5) cleanliness: I have no way of cleaning BM's, nor can my agency bill for this. If everytime I get a patient from you the sheets are soaked, I will rapidly think less of you. I still take these patients, some of my friends do not. Bottom line: I will take any patient if the destination is an ED, which is where all of my 911 patients go, anyway. I will also take any patient to an ICU. Its the discharges that I may turn down. Or I will re-route them to an ED, for which the accounting types will hate me. Also, be aware that some EMT's and Paramedics have had bad experiences with nurses. I'm certain this goes both ways. I feel like this relationship is repairable and choose to treat everyone with respect and professionalism, and avoid generalising the attitudes of individuals.