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You start off by saying, “The incident you refer to is disgraceful and if that is the norm it is outrageous.” but then you say, “Our paramedics were loathe to have a person sign a release if they truly believed they needed medical care but the base stations doctor was not required for the patient to sign the release.” Which leads me to believe that you have witnessed some events vaguely similar to what I described. In our town the powers overseeing our EMS program felt that we were letting to many patients sign AMAs (Against Medical Advice) forms, so the protocol was changed years ago that requires us to call a a doctor for any AMA. We can have them sign a ROR (Release of Responsibility) without a doctor's permission.

The system is designed to be paint by the numbers so that it limits the City's liability. We have fairly strict guidelines which different people still interpret in different ways. Some paramedics want to transport everyone who meets their very liberal interpretation of the protocol and some want to “turf” (get everyone to sign an ROR and get back to the station for dinner). Most of us like to treat everyone the way that we would want to be treated ourselves. Unfortunately there are also those who think that they know the best for everyone whether it is a strict interpretation of our policies and procedures or not and who will use every trick in the book to impose their will on others.

But I can tell you that this business can be very tricky. Recently we had a situation where a person had taken too much of her prescription meds and was acting incoherent. The persons spouse said that under no circumstances was the person to be transported because the last time this had happened it cost them $8000 and they didn't have medical insurance and they were in a very bad financial situation. We all felt very sorry for the couple, but in the field there was no way to determine that this was not a life threatening situation. Until we got her in the back of the rescue unit and gave her medication we could not rule out that the patient was not having a stroke. After the call I told the paramedic that I admired the way he handled the situation very much because he did not try to manipulate the spouse in any way, but he stuck to his guns in what was actually the best interest of the patient. The spouse was still very upset but agreed to meet us at the hospital.

The situation I described in the previous post was not referring to a particular motor vehicle accident. But it was very similar to previous situations that I have witnessed. I have literally seen a fender bender turned into a Mass Casualty Incident where multiple people were transported none of whom were seriously injured. I work with mostly people who act in a professional way and can take a little criticism. I am not shy about sharing my observations. I have a big problem with people who exaggerate and lie, but it is a very common occurrence. I have been doing this for a long time and I have seen many other departments in action also. People tend to filter and interpret their experiences and most seem to think a “little white lie” is OK if they know it is in the patient’s best interest.