To ride or not to ride? That is the question

[rescuedylan]

A local rescue department that covers a rock climbing area recently had a highline rescue. I had ran into a member that rides fromtime to time with them and asked about how things went and was good and what needed some work. The one thing that stuck out in my mind that he had said was that the medic was not happy that he was told there will be no riding with the patient. I thought that seems odd to me due to the reason they were there was due to the man having respitory issues. The medic told the officer that he wanted to stay with the patient to asst him with breathing but still the officer refused stating that " he didnt know if the medic could be trusted on the highline"...... I am not one to question outside departments methods but this was just not right to me. A patient that is unable to remove them self due to respitory problems and a medic stating that this patient will need help with breathing and it is denied???

So my question to you is, what are your departments SOGs for medics riding with patients on highlines? It takes no skill to hang, not tuch anything, and tend to your patient. Let me add this, this was a sloped highline, the medic was not going to have to control anything at the basket.

This is not a mountain area company that is in this call. More of a rural area. They may have a high angle rescue 3-4 times a year. My personal thought is I would rather have a medic go with there patient then to have the patient arrive on the otherside DOA. Lets be honest if you think it is too dangerous for your medic to go then why are you sending the patient? Drill with everyone not just your company.

[ProgressiveRescue]

Hmmm... That's odd. During all of our tech rescues a medic or EMT is put in contact with the patient to ensure needed care is given. Our job is to make the unsafe environment safe for us and them to work in. Here's a question though...If your on a rescue team you should be an EMT, so why didn't a member of the team act as the litter attendant? Was it just because ALS care was needed?
Mike

[rescuedylan]

The rescue company was the local volunteer fire dept. The medic is separate. I thought it was odd also.

[ProgressiveRescue]

If the "officer" was a officer on that rescue company maybe he should take part in some friendly retraining. Medics and or EMT's may not be trained in MVX however we put them in a car thats being cut apart at times right? If that officer put one of his members with the victim...a member that could provide the standard of care needed maybe I could see that but to let the victim ride solo....well thats just one bad call.
Mike

[jdcalamia]

The highest trained medical person on scene should have the final say in all aspects of patient care. That person is going to end up being ultimately responsible for the patient's condition and well-being. Legally, Morally, & Ethically. If the medic feels the patient can't make the ride without a provider, no matter what the reason, then the ride shouldn't happen anyother way. That being said, the medic needs to be reasonable and only insist on this when absolutely necessary, no need to put more people at risk then absolutely necessary.

[jdcalamia]

Mike you are absolutely right. The proper standard of care is key, The medic has to make the decisions, however it doesn't mean an EMT can't go for the trip if the medic's rescue qualifications are in question. The worst case scenario in this situation (a respiratory issue) would most likely be an intubated patient, which can easily be handled by an EMT post-intubation. In actuality, in some areas the EMTs may be able to handle the intubation as well.

[KD6708]

In our department, most of the firefighters are EMT-B's so that patient is immediately in contact with medical personnel. If the patient is an ALS patient and requires advanced care, then absolutely that medic should be staying with the patient. Unless this is in a state where the EMT's have advanced airway skills. Then absolutely, an EMT could conceivably provide the standard of care required. But once the paranedics have made patient contact, it's the medics that are ultimately responsible for the patient. Legally, if that patient has a bad outcome due to something that happens during the time that the medic is denied access or an EMT-B is caring for the patient that requires ALS treatment, the medic is the one who is going to hang for it. This patient was having difficulty breathing, if the medic hadn't made patient contact that would be one thing (still probably not the right thing though). But this is a patient that seemed to require advance treatment and that is the job of the medic or the advanced EMT. I feel that in this case, the medic should have been allowed to continue the care they were rendering.*

[PFDSquad47]

What kind of advanced care is the medic going to provide during the trip? Your not starting a line, dropping a tube, administering meds, etc... Placing another rescuer into a situation where if something goes wrong they have no training to help fix is just wrong. Putting a medic with no extrication training in a car that is being cut isnt even close to the same situation. Sounds to me that the medic just wanted to go for a ride. Here, if the patient needed an attendant, that attendant would be a member of the team that is an EMT. If an advanced skill is required it would be done prior to or immediately after the trip, not during.

[ProgressiveRescue]

I can't agree with you on this one. As an example...(and it's happened)If I have a a good MVX and the victim(s) inside the vehicle need ALS treatment or even BLS treatment I most certainly would place a medic or EMT in the vehicle. If your presented with what could become a prolonged operation or a victim that needs care right then and there to say you wouldn't put a victim in contact with medical care is a little off in left field for me. If we had a victim trapped in a trench once the trench is shored and deemed "safe" a medic would be put in the hole to assess and stabilize the patient.
(BAck to the original post) Granted I wasn't there but I would venture to say that the medic probably had the victims medical needs in mind rather than a joy ride on a line system. We're in the business of saving lives and providing the proper and necessary patient care from the start of our operation until we hand the victim off to another agency of higher medical authority. In this case temporary patient care would have been taken over by ALS. To leave a patient even if it's for a 5 min highline ride would be considered medical abandonment.
I can only speak for what goes on here in New Jersey and different states may have different protocols. Just wanted to add my opinion .
Mike Donahue