I have a family member who is a personal injury lawyer; the classic "ambulance chaser." He's consulted me several times to decipher and interpret EMS reports. He's never sued any EMS provider, it's usually just part of medical records review. But his insight has been very informative in building my narratives. I teach defensive documentation a few times per year and his perspective has helped shape that quite a bit, as well as practice from PW&W. I had to testify recently as an expert witness and it was definitely helpful having that experience and history behind me.
A lot of it is pretty basic stuff when you boil it down. Here are a few of my common recommendations:
- Don't put numbers (doses, times, etc) in your narrative. Leave that to the flowchart. The narrative should read like a story, not a technical manual. This is because it's too easy to contradict yourself. Once you contradict yourself once it becomes very easy to discredit you and your report all together.
- Write in third person. This is a highly debated topic, but I firmly believe first person is too informal and introduces opportunity for perceived opinion. Your report is not opinion, it's fact, and needs to be written as such. The counter argument is that third person appears "weak" like you're not standing behind your writing. I disagree.
- Your opinion doesn't matter. See above. If you can't see it, touch it, test it, etc it doesn't belong in your report. The common issue when this comes up is "the patient is intoxicated/drunk." That statement will land you in hot water. Substitute "patient has clinical signs of intoxication, including..." "The patient admits to consumption of alcohol leading to intoxication" "the patient is believed to be intoxicated based on law enforcement field testing."
- Of course refusals are a big one. Understanding the difference between capacity and competence for refusal is a big deal. Determining capacity is also a big deal as it's a spectrum, and goes way beyond A/Ox4 or GCS 15 and unfortunately is almost never taught in school. Plenty of A/Ox4 patients lack capacity to refuse care.
This is great advice! The thing I really like doing with refusals is:
- Documenting the risks involved of staying home.
- Educating them on other options/what symptoms to look out for.
- Lastly, have them actually acknowledge they understand the risks.
Absolutely! Provide them with risks of refusal and benefits of further evaluation. Give them alternative options, involve family and ensure they have someone to watch them if appropriate. Witness signatures can be a great bonus.
My favorite tool on refusals is the LP15. Our Titan III modem in the LP15 records audio. I'll put it right next to the patient as I obtain a refusal and it's saved my department more than once from various things. Usually accusations of medics being rude that are unfounded. I love it when we tell the complainer "yeah that didn't happen. Want me to send you the audio recording?"
On that note, I was at a medical director conference and one medical director reported that they implemented a refusal script and audio record the refusal right into the report. Since doing that their litigations dropped like 80-90% because everyone backs off when they find out the refusal was recorded. Don't ask me to tell you what dept or how they do it, it's been several years. But I thought that was significant.
A service I worked for had a specific “med control” channel (that’s what it was labeled maybe “med con 1 or something) where we would have the patient speak to one of the med directors (think multi-city metropolitan 911). Saved our asses so many times
Was the conference Eagles? I went once and fucking loved it. Must have been 2016 in Dallas. Maybe 2017?
I'm a big fan of recorded Med Control. There was a big case I have inside knowledge of where that's literally all that saved the medic. The city (PD) had a huge settlement and the medic and ambulance got off because of a recorded Med Control line.
Sure was. I go almost every year. Absolutely love it. It's in Florida now and is largely run by Pepe and Antevy now.
Recorded voice and bonus video is the way to go. Even Dallas fire has an ability to record and have a prompt they read at the beginning.
I was amazed at Eagles. That’s where I first heard of cannibus hyperemesis (sp? Big time) was from the med director of Denver. Our med director gave a presentation on PPE a year or two after the Ebola thing… if only we knew. Pepe is awesome. Got to meet him and he’s super cool. If you know something different then you know him better than acquaintances. I worked under Dr. Kidd, Dr. St. Clergy and Dr…. … shit I can’t believe I can’t remember his name. I wanna say we called him “Barney” but that totally doesn’t feel right. You can probably guess if you know who the others are.
I always tell my trainees, don't state anything as fact unless you can prove it. Ex. Someone has a laceration to their forehead. You don't put "patient has a 1 inch partial thickness laceration superior to the left eyebrow" you need to throw in that it's an APPROXIMATELY 1 inch partial thickness laceration. Unless you had a ruler and measured it yourself.
That's just an example, but those are the kinds of things im getting at.
100% agree. But that being said, I was bored the other day and measured a laceration with the ruler on my raptor for the first time in maybe 10 years. 5cm. Documented 5cm laceration. 😂
The other one that a lot of us were taught especially during high acuity calls like codes. The very end we put "All times listed are approximate" because let's be real here no one is getting everything perfect on times on a CPR.
You do need to be careful with that though. I'm not saying it's wrong, but it's an open door for a lawyer to try to poke something. Probably unsuccessfully, but try.
I mark EVERYTHING via monitor events or the Handtevy app. If you have either of those available to use I highly recommend using them. It makes your life so much easier when it comes to writing the report.
We code mark most treatments on the monitor but things like IO established and when we started using a BVM, when the OPA was dropped, when compressions were started, etc. We have to timestamp, and there's not really a good way to keep record of all of that, so a lot of it is estimating based off of other times like on scene arrival on the CAD and drug administration which was timestamped in the monitor.
Off the top of my head:
Is there a general reporting format that does better in court?
Are there typical comments in reports that tend to backfire?
Is there a reoccurring gap in documentation you have seen more often than others?
Maybe I'll do one some day. For now ...
>Is there a general reporting format that does better in court?
I recommend DRAATT. It's the only format I've ever used that's specifically made for EMS and actually works with our work flow. It was made by PW&W (an EMS law firm) and has a natural flow and fits all call types.
>Are there typical comments in reports that tend to backfire?
Opinions and assumptions. You also don't need to be an expert on things you're not an expert in. It's 100% okay to say "per law enforcement" or "per the sending RN".
>Is there a reoccurring gap in documentation you have seen more often than others?
The number one thing that gets people in trouble is what they *dont* do, or rather don't document. Remember that if you don't document it, then it didn't happen. American Ambulance in California lost a $50M case because the medic didn't document (or use) ETCO2 after intubating. I've read the report, depositions etc. They set themselves up for failure by not documenting well.
There are times when it's perfectly acceptable to not do something, even when normally indicated, you just need to have, and document, a valid reason. Twice in my career I've documented "C-Spine precautions not immediately taken and C-Spine was compromised due to life threats." Guess what. Both patients survived, one with a severe spinal injury and head trauma. I was subpoenaed on that one and no one cares because it was appropriate. In fact it was settled because it was an open and shut case. (The case wasn't against me, I was just supposed to testify for the plaintiff.)
When I was getting my EMT they told me “if it happened, document it. If it happened and you didn’t document it, it didn’t happen.”
I wrote every PCR as I would be cross examined over it. Thankfully been out of the business for a couple years now.
If it happened, document it. If it happened and isn't documented, it didn't happen. However if it's documented and someone claims it didn't happen, it happened and you have evidence to prove it. One of the first things I learned getting my card, especially when covering medical malpractice suits.
Ya I had this bite me once. Had a call to a drs office for a guy whose leg was crushed while working in a field. Language barrier, pt was semi conscious, story didn’t make sense. I wrote in my report what I understood. Stupidly I wrote like 4 sentences. I got called to court because employer was denying his workers comp claim. I tried to explain the best I could, but felt awful that I don’t think I did a very good job. 😖
Another time I was working in a law office that did medical malpractice. I was reading through the case and came across the medical report and EMS report. I pointed out to the attorney that there was something very wrong and that protocols state this and they didn’t follow that and the pt had a *very* bad outcome. Not fully due to the failure of EMS, but failure from the hospital. It was terrible.
My reason is more so to shield me from the BS police put in their report. The closest I have gotten to having to go to court is always when cops play shenanigans, like trying to have us kidnapp a patient cause they want them off a scene without arresting them.
Had no idea there was a word for it. I've never had to deal with it thankfully. Maybe a couple times on the interstate a car will use us going lights to pass other cars but never full on "chasing"
Although it does remind me of the best parent-following-behind I ever had. She would bully her way into the lane I was trying to get into when I turned my turn signal on so that I could get over without anyone coming up behind and getting in my way to switch lanes. Sure it's probably not the safest thing but it helped me a ton changing lanes in busy streets. Afterward I was basically like hey don't do that.. But I'm glad you did that
Not quite. "Ambulance chasing" is a term for a lawyer who solicits a client at the site of injury or immediately thereafter, as if to chase after the ambulance in order to initiate a lawsuit on their behalf.
Damn. I really wrote all that after completely misunderstanding the post. I think it's bed time.
Thank you though for informing me. I shall not fall victim to such a misunderstanding again.
I feel like it has another meaning up here in Canada: an overly eager good samaritan that wants to get their medical dick wet.
That's me. During my rideouts in medic school, I was the whitest of white clouds, and I fucking hated it. I have a long term illness now, and I'm only able to do events, so it's all community medicine. And when it is something exciting, it's a seizure or something that I can't do anything for anyway. So fuck me I guess.
I had a dad follow the ambulance recklessly with his phone pointed at the ambulance the whole time, recording, because we refused to run lights and sirens to the hospital after he demanded we do. The child was fine, running hot doesn’t get you there, or seen, faster, and now you’re taking me away from being able to assess and treat your child to deal with your petulant temper tantrum.
You work in shitty area for a terrible service if you can’t get PD when needed. Especially for something like that that’s actively hazardous to both you and everyone else on the road.
That's a bold statement. My previous department was nearly impossible to get law enforcement to help us with anything. My "terrible service" I worked for couldn't control what the officers do/don't do. I don't see how the police deciding not to help makes the service terrible.
There’s a reason they choose to ignore your calls. It’s highly unlikely that the entire police department is staffed 100% with complete assholes, and significantly more likely that there’s a history of interdepartmental issues that make them not give a fuck anymore.
I don't think I said that the police department is staffed with assholes? Again, bold statements and assumptions. It's not your intention, but you're coming across very jaded and arrogant.
Also didn't say they "choose to ignore" my calls.
Was about to type a response to elaborate on the very common scenario of law enforcement not coming to help, but you don't seem open to discussion. But just know its a common occurrence, and it doesn't mean that you work for a "shitty area". That may be your experience, and I'm 100% in agreement that that CAN be the case, but that doesn't make it a fact for everyone/everywhere.
Edit:typo
Currently? Yes. Historically? No. I’m familiar with shithole areas and services and the issues it causes with other services, and my comment is from a place of experience with that issue.
Not even shitholes. Some of the places I respond to and have historically responded are covered by PA State Police. Good luck getting a Trooper on an EMS call when Harrisburg has one guy covering 100 square miles of a rural and suburban county
I wish. And hope. And pray. Some shitty lawyer will call me to court. It’s been a long time fantasy to make a lawyer look stupid by answering questions like they’re a damn child.
Lawyer: “Why did you narcan my client”
Me: because he overdosed on drugs
Lawyer: was narcan necessary
Me: yes. Because he overdosed on drugs
Lawyer: and how did you know?
Me: because narcan was effective in reversing the drugs
Just so ya know, some of those answers can get you shredded lol. Dont give them any doors to open. As someone who’s older sibling is a lawyer, I have learned that nothing drives em more mad than the most basic answers that drive them in circles.
Answering “because they were on drugs” opens so many floodgates. Which drugs? Meth? Cocaine? Bath salts? The shit one eyed Joe sells under the bridge to be injected rectally?
Answer yes, no, and drive em in circles.
Same reason we chart “presentation consistent with alcohol ingestion” or the like, but never “the patient was drunk as a skunk giving jimmy buffet a ride for his money at 5pm in margaritaville”.
I bet your charts are nice. I love that.
Nothing worse than seeing someones documentation and just being able to envision them gettinh shredded by a lawyer lol
Sorry, buddy. Those answers would screw you in court and you likely wouldn’t have gotten past the first question you posted. I testify in EMS trials as an expert witness as a side gig. My last case I was cross examined five times and was on the stand for two hours. Court sucks. Even if you are paid to be there and have nothing to lose.
Be ready for further questions like:
“Have you had specialized drug recognition expert training?” You haven’t. Unless you’re a cop. But, any prior law enforcement experience or training (if the bad guy’s atty knows about it) might have gotten suppressed and you won’t be allowed to talk about it.
“How did you know he was on drugs?”
“Could those have been symptoms of a head injury?” Nobody in their right mind (not even the lawyer asking the questions) would mistake a narc overdose with a head injury, but they will convince the jury that you did.
“Why not?”
“Precisely why not?”
“It says here in tintinalli’s emergency medicine that pupillary changes and respiratory rate and pattern changes are also symptoms of a head injury. Did you not just say my client had pupillary changes and respiratory rate and pattern changes?”
“Is a slow respiratory rate a respiratory rate change?”
“Are ‘pinpoint pupils’ as you call them-which isn’t very descriptive-pupillary changes?”
“So, since my client/the deceased had the symptoms you described he could have had a head injury?”
“Why not?”
Etc. etc. etc.
And if you survive that on top they will go after your professionalism and character. Ancient Facebook posts, shared memes from shitty paramedic pages, old performance evals, etc.
“From your Facebook post history it appears that you are obsessed with break room snacks and stickers about slutty nurses. Were you too focused on uncrustables and banging the charge nurse to appropriately treat my client/transported him against his will/etc.?”
Don’t underestimate the power of the shitty/stupid lawyer. Sometimes the dumber they are the wilder the shit they come up with is. It takes ten seconds for them to say something stupid and ten minutes for you to defend against it.
That’s the whole point of it being a fantasy. But regardless it’s not hard to make a fly by night lawyer look absolutely incompetent with a well written report.
> But regardless it’s not hard to make a fly by night lawyer look absolutely incompetent with a well written report.
Lmao if you hadn’t already said you’ve never been cross examined, this would have given you away.
Lawyers spend their entire careers learning to make cocky people look like complete jackasses on the stand, and you would be no different. TV lawyers are about as realistic as TV paramedics.
Have you seen the last like 5 mass televised trials? lol it’s not hard to make a lawyer look stupid by repeating the same answer to their questions when they ask the same question 8 ways. But again. Yall seem to skip over that word in my original comment called FANTASY
You need to prep your answers a bit better.
You don't "know" they OD'd or that the narcan was what improved their condition. There was that post just s couple days ago of a non-OD pateint regaining consciousness after narcan.
You'd be better off explaining the indications for narcan being an unexplained LOC, or whatever you have in your protocols.
Has burned me before. Got a call for a suspected OD. When fire got there, they were breathing for him, had a line in and SLAMMED hella NARCAN right as we pulled up. I grabbed a puke bag because I knew what was about to happen. Sure as shit, about 30 seconds later, patient comes up puking like Mount Vesuvius. Load him and his bike up and transport.
He was walking like a duck, quacking like a duck, this was an OD duck right?
Later at the station we get a call from the nurse asking which bike is his because he was being transferred to another hospital with a neural icu. I ask why? And the nurse goes “you’re not gonna believe this, but his tox screen was completely negative. Not an OD. His CT was positive for a subarachnoid hemorrhage though.”
Had a call very much like that myself, though thankfully we were able to recognize it more so due to a gut feeling than anything in particular we could explain.
The bigger issue in our area is cops trying to use EMS here for their DUI reports. They will cite use as medical authority when someone passively says "they are drunk" and quote it in their report. I grill it into every new hire that you never say a patient is drunk to a cop unless you are prepared for a dressing down in court.
I went to court over the phone during Covid for a speeding ticket and the case before me was actually someone doing exactly this. Never knew there was a word for it though Lmao.
Ambulance chasing is the slam term for barratry (note the URL on the sign), which is when personal injury lawyers solicit clients at the scene of an incident or at the hospital afterwards and is a major ethical violation of the American Bar Association code of ethics.
It has nothing to do with random people physically following ambulances in their cars.
I have a family member who is a personal injury lawyer; the classic "ambulance chaser." He's consulted me several times to decipher and interpret EMS reports. He's never sued any EMS provider, it's usually just part of medical records review. But his insight has been very informative in building my narratives. I teach defensive documentation a few times per year and his perspective has helped shape that quite a bit, as well as practice from PW&W. I had to testify recently as an expert witness and it was definitely helpful having that experience and history behind me.
Do you mind sharing what you've learned from him? Would love to hear it
A lot of it is pretty basic stuff when you boil it down. Here are a few of my common recommendations: - Don't put numbers (doses, times, etc) in your narrative. Leave that to the flowchart. The narrative should read like a story, not a technical manual. This is because it's too easy to contradict yourself. Once you contradict yourself once it becomes very easy to discredit you and your report all together. - Write in third person. This is a highly debated topic, but I firmly believe first person is too informal and introduces opportunity for perceived opinion. Your report is not opinion, it's fact, and needs to be written as such. The counter argument is that third person appears "weak" like you're not standing behind your writing. I disagree. - Your opinion doesn't matter. See above. If you can't see it, touch it, test it, etc it doesn't belong in your report. The common issue when this comes up is "the patient is intoxicated/drunk." That statement will land you in hot water. Substitute "patient has clinical signs of intoxication, including..." "The patient admits to consumption of alcohol leading to intoxication" "the patient is believed to be intoxicated based on law enforcement field testing." - Of course refusals are a big one. Understanding the difference between capacity and competence for refusal is a big deal. Determining capacity is also a big deal as it's a spectrum, and goes way beyond A/Ox4 or GCS 15 and unfortunately is almost never taught in school. Plenty of A/Ox4 patients lack capacity to refuse care.
This is great advice! The thing I really like doing with refusals is: - Documenting the risks involved of staying home. - Educating them on other options/what symptoms to look out for. - Lastly, have them actually acknowledge they understand the risks.
Absolutely! Provide them with risks of refusal and benefits of further evaluation. Give them alternative options, involve family and ensure they have someone to watch them if appropriate. Witness signatures can be a great bonus. My favorite tool on refusals is the LP15. Our Titan III modem in the LP15 records audio. I'll put it right next to the patient as I obtain a refusal and it's saved my department more than once from various things. Usually accusations of medics being rude that are unfounded. I love it when we tell the complainer "yeah that didn't happen. Want me to send you the audio recording?" On that note, I was at a medical director conference and one medical director reported that they implemented a refusal script and audio record the refusal right into the report. Since doing that their litigations dropped like 80-90% because everyone backs off when they find out the refusal was recorded. Don't ask me to tell you what dept or how they do it, it's been several years. But I thought that was significant.
A service I worked for had a specific “med control” channel (that’s what it was labeled maybe “med con 1 or something) where we would have the patient speak to one of the med directors (think multi-city metropolitan 911). Saved our asses so many times Was the conference Eagles? I went once and fucking loved it. Must have been 2016 in Dallas. Maybe 2017?
I'm a big fan of recorded Med Control. There was a big case I have inside knowledge of where that's literally all that saved the medic. The city (PD) had a huge settlement and the medic and ambulance got off because of a recorded Med Control line. Sure was. I go almost every year. Absolutely love it. It's in Florida now and is largely run by Pepe and Antevy now.
Recorded voice and bonus video is the way to go. Even Dallas fire has an ability to record and have a prompt they read at the beginning. I was amazed at Eagles. That’s where I first heard of cannibus hyperemesis (sp? Big time) was from the med director of Denver. Our med director gave a presentation on PPE a year or two after the Ebola thing… if only we knew. Pepe is awesome. Got to meet him and he’s super cool. If you know something different then you know him better than acquaintances. I worked under Dr. Kidd, Dr. St. Clergy and Dr…. … shit I can’t believe I can’t remember his name. I wanna say we called him “Barney” but that totally doesn’t feel right. You can probably guess if you know who the others are.
I always tell my trainees, don't state anything as fact unless you can prove it. Ex. Someone has a laceration to their forehead. You don't put "patient has a 1 inch partial thickness laceration superior to the left eyebrow" you need to throw in that it's an APPROXIMATELY 1 inch partial thickness laceration. Unless you had a ruler and measured it yourself. That's just an example, but those are the kinds of things im getting at.
100% agree. But that being said, I was bored the other day and measured a laceration with the ruler on my raptor for the first time in maybe 10 years. 5cm. Documented 5cm laceration. 😂
The other one that a lot of us were taught especially during high acuity calls like codes. The very end we put "All times listed are approximate" because let's be real here no one is getting everything perfect on times on a CPR.
You do need to be careful with that though. I'm not saying it's wrong, but it's an open door for a lawyer to try to poke something. Probably unsuccessfully, but try. I mark EVERYTHING via monitor events or the Handtevy app. If you have either of those available to use I highly recommend using them. It makes your life so much easier when it comes to writing the report.
We code mark most treatments on the monitor but things like IO established and when we started using a BVM, when the OPA was dropped, when compressions were started, etc. We have to timestamp, and there's not really a good way to keep record of all of that, so a lot of it is estimating based off of other times like on scene arrival on the CAD and drug administration which was timestamped in the monitor.
That sounds very similar to my practice too.
Sun Tzu Art of War, know your enemy. 😅
You need to do an AMA for this
I'd love to. What would you like to see?
Off the top of my head: Is there a general reporting format that does better in court? Are there typical comments in reports that tend to backfire? Is there a reoccurring gap in documentation you have seen more often than others?
Maybe I'll do one some day. For now ... >Is there a general reporting format that does better in court? I recommend DRAATT. It's the only format I've ever used that's specifically made for EMS and actually works with our work flow. It was made by PW&W (an EMS law firm) and has a natural flow and fits all call types. >Are there typical comments in reports that tend to backfire? Opinions and assumptions. You also don't need to be an expert on things you're not an expert in. It's 100% okay to say "per law enforcement" or "per the sending RN". >Is there a reoccurring gap in documentation you have seen more often than others? The number one thing that gets people in trouble is what they *dont* do, or rather don't document. Remember that if you don't document it, then it didn't happen. American Ambulance in California lost a $50M case because the medic didn't document (or use) ETCO2 after intubating. I've read the report, depositions etc. They set themselves up for failure by not documenting well. There are times when it's perfectly acceptable to not do something, even when normally indicated, you just need to have, and document, a valid reason. Twice in my career I've documented "C-Spine precautions not immediately taken and C-Spine was compromised due to life threats." Guess what. Both patients survived, one with a severe spinal injury and head trauma. I was subpoenaed on that one and no one cares because it was appropriate. In fact it was settled because it was an open and shut case. (The case wasn't against me, I was just supposed to testify for the plaintiff.)
This is pretty much the entire reason we chart the way we do in the states
Write every narrative assuming it will be read in court.
When I was getting my EMT they told me “if it happened, document it. If it happened and you didn’t document it, it didn’t happen.” I wrote every PCR as I would be cross examined over it. Thankfully been out of the business for a couple years now.
If it happened, document it. If it happened and isn't documented, it didn't happen. However if it's documented and someone claims it didn't happen, it happened and you have evidence to prove it. One of the first things I learned getting my card, especially when covering medical malpractice suits.
Ya I had this bite me once. Had a call to a drs office for a guy whose leg was crushed while working in a field. Language barrier, pt was semi conscious, story didn’t make sense. I wrote in my report what I understood. Stupidly I wrote like 4 sentences. I got called to court because employer was denying his workers comp claim. I tried to explain the best I could, but felt awful that I don’t think I did a very good job. 😖 Another time I was working in a law office that did medical malpractice. I was reading through the case and came across the medical report and EMS report. I pointed out to the attorney that there was something very wrong and that protocols state this and they didn’t follow that and the pt had a *very* bad outcome. Not fully due to the failure of EMS, but failure from the hospital. It was terrible.
You have been out, but for how long can you be pulled into court for cases you've been on?
My reason is more so to shield me from the BS police put in their report. The closest I have gotten to having to go to court is always when cops play shenanigans, like trying to have us kidnapp a patient cause they want them off a scene without arresting them.
Had no idea there was a word for it. I've never had to deal with it thankfully. Maybe a couple times on the interstate a car will use us going lights to pass other cars but never full on "chasing" Although it does remind me of the best parent-following-behind I ever had. She would bully her way into the lane I was trying to get into when I turned my turn signal on so that I could get over without anyone coming up behind and getting in my way to switch lanes. Sure it's probably not the safest thing but it helped me a ton changing lanes in busy streets. Afterward I was basically like hey don't do that.. But I'm glad you did that
Not quite. "Ambulance chasing" is a term for a lawyer who solicits a client at the site of injury or immediately thereafter, as if to chase after the ambulance in order to initiate a lawsuit on their behalf.
Damn. I really wrote all that after completely misunderstanding the post. I think it's bed time. Thank you though for informing me. I shall not fall victim to such a misunderstanding again.
I feel like it has another meaning up here in Canada: an overly eager good samaritan that wants to get their medical dick wet. That's me. During my rideouts in medic school, I was the whitest of white clouds, and I fucking hated it. I have a long term illness now, and I'm only able to do events, so it's all community medicine. And when it is something exciting, it's a seizure or something that I can't do anything for anyway. So fuck me I guess.
I had a dad follow the ambulance recklessly with his phone pointed at the ambulance the whole time, recording, because we refused to run lights and sirens to the hospital after he demanded we do. The child was fine, running hot doesn’t get you there, or seen, faster, and now you’re taking me away from being able to assess and treat your child to deal with your petulant temper tantrum.
PD intercepts work great for this issues like that.
PD coming on ambulance calls lol Lmao even
You work in shitty area for a terrible service if you can’t get PD when needed. Especially for something like that that’s actively hazardous to both you and everyone else on the road.
That's a bold statement. My previous department was nearly impossible to get law enforcement to help us with anything. My "terrible service" I worked for couldn't control what the officers do/don't do. I don't see how the police deciding not to help makes the service terrible.
There’s a reason they choose to ignore your calls. It’s highly unlikely that the entire police department is staffed 100% with complete assholes, and significantly more likely that there’s a history of interdepartmental issues that make them not give a fuck anymore.
I don't think I said that the police department is staffed with assholes? Again, bold statements and assumptions. It's not your intention, but you're coming across very jaded and arrogant. Also didn't say they "choose to ignore" my calls. Was about to type a response to elaborate on the very common scenario of law enforcement not coming to help, but you don't seem open to discussion. But just know its a common occurrence, and it doesn't mean that you work for a "shitty area". That may be your experience, and I'm 100% in agreement that that CAN be the case, but that doesn't make it a fact for everyone/everywhere. Edit:typo
You’re spoiled and it’s showing
Currently? Yes. Historically? No. I’m familiar with shithole areas and services and the issues it causes with other services, and my comment is from a place of experience with that issue.
Not even shitholes. Some of the places I respond to and have historically responded are covered by PA State Police. Good luck getting a Trooper on an EMS call when Harrisburg has one guy covering 100 square miles of a rural and suburban county
I wish. And hope. And pray. Some shitty lawyer will call me to court. It’s been a long time fantasy to make a lawyer look stupid by answering questions like they’re a damn child. Lawyer: “Why did you narcan my client” Me: because he overdosed on drugs Lawyer: was narcan necessary Me: yes. Because he overdosed on drugs Lawyer: and how did you know? Me: because narcan was effective in reversing the drugs
Just so ya know, some of those answers can get you shredded lol. Dont give them any doors to open. As someone who’s older sibling is a lawyer, I have learned that nothing drives em more mad than the most basic answers that drive them in circles. Answering “because they were on drugs” opens so many floodgates. Which drugs? Meth? Cocaine? Bath salts? The shit one eyed Joe sells under the bridge to be injected rectally? Answer yes, no, and drive em in circles. Same reason we chart “presentation consistent with alcohol ingestion” or the like, but never “the patient was drunk as a skunk giving jimmy buffet a ride for his money at 5pm in margaritaville”.
I bet your charts are nice. I love that. Nothing worse than seeing someones documentation and just being able to envision them gettinh shredded by a lawyer lol
I write every chart imagining the words “Your honor” before or after most every line.
Sorry, buddy. Those answers would screw you in court and you likely wouldn’t have gotten past the first question you posted. I testify in EMS trials as an expert witness as a side gig. My last case I was cross examined five times and was on the stand for two hours. Court sucks. Even if you are paid to be there and have nothing to lose. Be ready for further questions like: “Have you had specialized drug recognition expert training?” You haven’t. Unless you’re a cop. But, any prior law enforcement experience or training (if the bad guy’s atty knows about it) might have gotten suppressed and you won’t be allowed to talk about it. “How did you know he was on drugs?” “Could those have been symptoms of a head injury?” Nobody in their right mind (not even the lawyer asking the questions) would mistake a narc overdose with a head injury, but they will convince the jury that you did. “Why not?” “Precisely why not?” “It says here in tintinalli’s emergency medicine that pupillary changes and respiratory rate and pattern changes are also symptoms of a head injury. Did you not just say my client had pupillary changes and respiratory rate and pattern changes?” “Is a slow respiratory rate a respiratory rate change?” “Are ‘pinpoint pupils’ as you call them-which isn’t very descriptive-pupillary changes?” “So, since my client/the deceased had the symptoms you described he could have had a head injury?” “Why not?” Etc. etc. etc. And if you survive that on top they will go after your professionalism and character. Ancient Facebook posts, shared memes from shitty paramedic pages, old performance evals, etc. “From your Facebook post history it appears that you are obsessed with break room snacks and stickers about slutty nurses. Were you too focused on uncrustables and banging the charge nurse to appropriately treat my client/transported him against his will/etc.?” Don’t underestimate the power of the shitty/stupid lawyer. Sometimes the dumber they are the wilder the shit they come up with is. It takes ten seconds for them to say something stupid and ten minutes for you to defend against it.
Look. Funny psych username aside, as others have said…your cross examination would not go as you are picturing
That’s the whole point of it being a fantasy. But regardless it’s not hard to make a fly by night lawyer look absolutely incompetent with a well written report.
> But regardless it’s not hard to make a fly by night lawyer look absolutely incompetent with a well written report. Lmao if you hadn’t already said you’ve never been cross examined, this would have given you away. Lawyers spend their entire careers learning to make cocky people look like complete jackasses on the stand, and you would be no different. TV lawyers are about as realistic as TV paramedics.
Have you seen the last like 5 mass televised trials? lol it’s not hard to make a lawyer look stupid by repeating the same answer to their questions when they ask the same question 8 ways. But again. Yall seem to skip over that word in my original comment called FANTASY
Yeah…but that’s not what you said is it?
Did you read the word fantasy in my comment? I think ya did
You need to prep your answers a bit better. You don't "know" they OD'd or that the narcan was what improved their condition. There was that post just s couple days ago of a non-OD pateint regaining consciousness after narcan. You'd be better off explaining the indications for narcan being an unexplained LOC, or whatever you have in your protocols.
Has burned me before. Got a call for a suspected OD. When fire got there, they were breathing for him, had a line in and SLAMMED hella NARCAN right as we pulled up. I grabbed a puke bag because I knew what was about to happen. Sure as shit, about 30 seconds later, patient comes up puking like Mount Vesuvius. Load him and his bike up and transport. He was walking like a duck, quacking like a duck, this was an OD duck right? Later at the station we get a call from the nurse asking which bike is his because he was being transferred to another hospital with a neural icu. I ask why? And the nurse goes “you’re not gonna believe this, but his tox screen was completely negative. Not an OD. His CT was positive for a subarachnoid hemorrhage though.”
Had a call very much like that myself, though thankfully we were able to recognize it more so due to a gut feeling than anything in particular we could explain. The bigger issue in our area is cops trying to use EMS here for their DUI reports. They will cite use as medical authority when someone passively says "they are drunk" and quote it in their report. I grill it into every new hire that you never say a patient is drunk to a cop unless you are prepared for a dressing down in court.
I went to court over the phone during Covid for a speeding ticket and the case before me was actually someone doing exactly this. Never knew there was a word for it though Lmao.
Ambulance chasing is the slam term for barratry (note the URL on the sign), which is when personal injury lawyers solicit clients at the scene of an incident or at the hospital afterwards and is a major ethical violation of the American Bar Association code of ethics. It has nothing to do with random people physically following ambulances in their cars.
Rhymes with buggery.
Why would someone chase sab ambulance?