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A Lawyer Speaks Out On Diagnosis

Earlier in the week, I bruised a few widdle feewings on Facebook when I replied in the affirmative to an EMS forum post asking if paramedics diagnose. Quite a few people agreed with me, and a number stubbornly disagreed, and called me everything from "paragod" to "full of myself" to "doctor wannabe" and assured me that I was putting myself on shaky legal ground by diagnosing people, and that I'd definitely get my ass sued for doing it, and the Nomenclature Police would come take my paramedic patch away.

A few folks expressed outrage that I'd rebut these accusations, and that I responded in kind when people attacked me personally, rather than debate the validity of my assertion.

"Hey, it's OUR opinion!" went the refrain of one special flower. "How dare you attack us for expressing an opinion! It's our right to express our opinion, and you're a big bullying poopyhead for disagreeing!"

Well, as the saying goes, you are entitled to your own opinions, but you ain't entitled to your own facts.

After listening to a bunch of EMS guardhouse lawyers opine with tortuously twisted misinterpretation of legal doctrine, and people insisting they were taught that EMTs cannot diagnose, and that only doctors can, I conducted an informal poll here at EMS Today. I asked a couple of respected EMS physicians, "Do paramedics diagnose?"

Their answer was, "If they don't, how can they do their jobs?" They offered the same caveats that I did: a paramedic diagnosis is often rough due to our austere environment and lack of technological capability and advanced education… but it's still a diagnosis.

I asked a room full of EMS educators in the session I taught this morning, "Do you believe EMTs do not diagnose? How many of you teaach that EMTs treat symptoms only?"

Not a single hand went up.

And today in a podcast, I asked nationally respected EMS attorney Steve Wirth, of the law firm Page, Wolfberg and Wirth, a couple of questions:

  1. Do EMTs and medics diagnose?
  2. Are EMTs or medics at any legal risk for using the word "diagnosis," and has any EMT ever been sued for making a diagnosis?

Steve's answers?

  1. "Every patient, every call. How do you do your job without diagnosing? You may call it a field impression or a paramedic diagnosis, but the difference is just semantics."
  2. "Why would they be? It's not a protected word. And plenty of EMTs have been sued for making a misdiagnosis, but the word wasn't at issue – their care and decision-making was. They'd have been just as liable if they called it a 'field impression'."

This is a former paramedic, experienced attorney and consultant who makes his living providing counsel on EMS legal issues.

As I said before, if you think we don't diagnose, you are entitled to your opinion.

But you are not entitled to your own facts. And the fact is, we do diagnose, and we shouldn't be ashamed of saying so.

 

For further reading:

Demystifying Diagnosis

Yes, We Do Diagnose

Comments - Add Yours

  • markmillet

    The problem is EMTs are like kids and their first EMT instructors are like their parents. They take whatever they are told and take it to the bank as a golden rule. Unfortunately, much of the information they have is outdated, incomplete or even flat out wrong. I have seen EMTs get into shouting matches with ER docs about how we dont need to worry about oxygen rates in a COPD patient, well, because you know, thats what their EMT instructor told them. And of course many instructors are telling their students that only physicians can diagnose, which of course they take to the bank as fact, despite how wrong it is. This to me is just further proof why we as a profession need to work towards a more formal, university based education for all levels of providers.

    • Jewish Right Winger

      Mark,
      You nailed it.

      The sad thing is, that while they are taught “X” in school, none want to accept that fact that maybe, just maybe their instructor was wrong, and that they themselves have subsequently been wrong ever since.

      Mike

    • IvyMikeCafe

      Differential diagnoses to a field diagnosis are standard on every call. Can’t treat for a STEMI unless I figure out it’s a STEMI.

      I agree that more rigorous training and
      con-ed are needed for paramedics. Quality assessment is as much art as science, and takes years to master. Medics should be thirsty for new knowledge all of the time.

      Medics who get in fights with docs and
      RNs at ERs are idiots. Not professional at all. Professional
      development and ongoing education should mitigate that kind of
      foolishness.

      There is too much variation in the skills and smarts of people with EMT-P certs. A dumb medic gets paid as much as a smart one, and it is the reputation of the dumb medics that overshadows the smart ones, every time.

  • David

    A diagnosis is a part of the patient assessment. If you use the SOAP format on your PCR, then A (assessment) means you need a diagnosis before you proceed to P (plan). Why is that so hard to understand for a lot of people?

  • Too Old To Work

    Nurses go through the same BS, for much the same reason. Which is why the A in SOAPIE stands for Assessment.

    I think the whole thing stemmed from some over sensitive doctors protecting their turf.

    AD, you realize that the root of your problem is arguing with the morons on Facebook, right?

    • Brooks Walsh

      TOTW, I can assure you that most doctors have no idea that the EMS community has these nutty discussions. Heck, WE don’t even diagnose, if you listen to our everyday language. No one ever says “I diagnosed him with pneumonia” – it makes you sound like Dr Borat.

  • http://johnnysgarage.blogspot.com/ Yogi Beaty

    The real reason that there is an “A” in SOAP is that SODP is not pronounceable.

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  • http://cursesfoiledagain2.wordpress.com Jake

    Two words: “field diagnosis”. That pretty well captures the essence of what we do.

  • DocB

    It’s clear that EMTs and Paramedics can make an initial diagnosis, but it is subject to confirmation or rejection by the attending physician or PA.

    • Ambulance_Driver

      Yup.

      As is the NP, PA, or ED Doc’s diagnosis subject to revision or rejection if/when a specialist is consulted.
      It’s a continuum, hopefully with each step refining the diagnosis until it is definitive, and definitive care provided. That does not make the previous steps in the continuum any less a diagnosis.
      Kelly Grayson

      • DocB

        Agreed.

      • Matthew Hansen

        Yeah and I had an MD in a small county town that diagnosed a patient with a-fib w/ RVR until I (paramedic) showed him it was V-Tach with a pulse. We just all need to work together. We all make mistakes, but paramedics do make a diagnosis. We are all a team.

      • Michael Smith

        Our diagnosis is based on what we observe in our pt. we have spent the time at the scene and have seen all of the facts The ER gets the pt. when we have him/her all cleaned up for them. If we did not make a diagnosis in the field and make our discussion on what saw, then we could not administer the care that we need to give.

  • Bill Young

    Mark, you summed it up well. This is part of the problem with moving from a technical education to that of professional education. In order to do so, we need to increase the standards that are required of the EMS educator. To tell a student that “we only treat the symptoms” is ludicrous! That’s chasing the tail that never stops moving and could be deadly for the patient.

    • Patricia Woz

      Especially because several different diagnosis can have similar or the same symptom. That’s why we have the tools and training to know what we are doing, know the differences and make an assessment and plan to treat the diagnosis.

  • Medicman

    Ok here is what I was taught. Paramedics have a differential diagnosis, meaning I have a good idea of what’s going on and can treat appropriately but I also have in the back of my head a couple of other things that the problem could be. Keep in mind if we have no idea of what’s going on using our training and field experience then we are no better than a cook book medic just treating signs and symptoms in some algorithm we learned back in school.

    • Ambulance_Driver

      Actually, all levels of healthcare providers are taught differential diagnoses. Doctors, PAs and nurses form them, too.
      As our experience, education and technological capabilities increase – and mainly experience and education – that list of differentials grows shorter, and the treatment more precise. Often, we can not whittle that list down to one thing, no matter the resources at our disposal.
      But the two most important elements – experience and education – are available to EMS as well.
      If only we’d make use of them.

  • Mike Smith

    Thank you thank you! I have fought the thought that we do not diagnose in the field for years. My standard reply is, “How is your protocol set up, is it chest pain, diaphoresis, nausea and fear of impending doom? Or is it worded AMI, chest pain rule out AMI or just MI? Most students then reply yes the later, but we cant say we diagnose! Why? Because that’s the law! Not sure where they get this, I see nothing in the Ohio Revised Code making a word or an act of patient care illegal! Thank you for putting this out, sharing it with my students as i type!
    Mike Smith

  • PARAMEDIC70002

    I think we are misdirecting our outrage. The better topic is, “diffential diagnoses,” since we truly are unable to diagnose complicated medical complaints without the knowledge and experience of Physician training, labs, and radiology. Certainly EMS diagnoses and treats many emergent complaints that we have been trained to recognize, however only a Physician can ultimately put the stamp of approval on that diagnosis to the exclusion of all other possibilities (and quite often they get it wrong as well, but don’t tell anybody! Ssshhh…).

    • Ambulance_Driver

      We’re arguing semantics.

      Whether you call it a clinical impression or a paramedic diagnosis or a presumptive diagnosis or a SPWAG (super paramedic wild-assed guess)…
      It. Is. Still. A. Diagnosis.

      Just because it is broad does not mean it is not a diagnosis.

      Just because it has not (yet) been confirmed by appropriate tests does not mean it is not a diagnosis. In fact, doctors are taught to make the diagnosis based on H&P, and then order ONLY the minimum tests necessary to confirm the diagnosis.
      Just because it may be refined (or disproven) by a person further up the hierarchy, does not mean it is not a diagnosis.
      And while we’re arguing semantics, let me point out that “differential diagnoses” are a list of things that could also be the problem.
      DiagnosES, as in plural. The only time we should be saying “differential diagnosIS” is when there is only ONE other thing it could be.
      Personally, I don’t care what we call it, as long as we a) aren’t saying silly shit like insisting we only treat symptoms without any deeper thought processes, and b) don’t assign some special quasi-legal meaning to the word as if it were owned solely by doctors, and we’ll get sued or have the Nomenclature Police confiscate our EMT cards if we dare utter it.

      • PeriMedic

        Agreed. This idea that the only person who can claim the unmodified “DIAGNOSIS” is the final doctor who sees the patient is ridiculous. My father got a DIAGNOSIS and because of it, got treated for the wrong illness and died of liver failure. (As a side note, while in EMT-I/99 school, as the instructor told me that if I observed ascites, it was a sign of liver failure, I immediately felt unmitigated hate for my dad’s incompetent physician).

        IMO, if we want to be precise, everyone is making a differential diagnosis: weighing the evidence for what it can’t or can be with what you know now. Just hopefully, the last person to treat has gotten it right.

        Oh, and a friend of mine had spinal surgery for a pinched nerve. After opening him up, the surgeon discovered no pinched nerve, but a cracked vertebra that did not show-up in xrays. So much for that DIAGNOSIS.

  • Cyndy Armstrong

    making a differential diagnoses is something we are taught to do in order to hopefully begin with the proper treatment but, without x-rays, ct’s, bloodwork, mri’s ultrasounds etc. I am not capable of walking into a hospital and tell the triage nurse and then the Dr that this patient has a Triple A or he hasn’t had a stroke, he is just drunk or, not having the information that this patient had a car accident a few days ago, I can’t tell the Dr he has a hematoma in his brain….differential diagnoses-yes, definite diagnoses-no

    • Ambulance_Driver

      Toe-may-toe, toe-mah-toe.

      We’re arguing semantics here. Doctors and nurses form differential diagnoses as well, and often cannot form definitive ones.
      Same as us, only with more tools.

      • Cyndy Armstrong

        exactly, initially Docs come up with differential diagnosis but, they then have the “tools” that we do not to hopefully be capable of pinning it down to a diagnoses without the “differential”…in all of this the only word that should be added to what we can do is “differential”. Something as simple as a broken wrist we can likely differentially diagnose but with so many bones in a wrist it takes a Dr and an x-ray to diagnose which bone is broken

  • voice of reason

    Why are these folks not looking at this as a process. Its like cops when they come upon a scene and determine what “crime” they are investigating. None of that means that it can’t change or evolve dependent on new facts or evidence. I’m sure that an EMT’s diagnosis is just the start of a process that will change and evolve over the course of treatment. It doesn’t make anyone more important than anyone else – except those egomaniacs that need constant validation.

    • Ambulance_Driver

      EXACTLY what I’ve been saying.

  • DrKen

    In Texas, it’s called practicing medicine without a license, and it’s a felony. I am a physician who has taught paramedics for 20 years. Some of the most brilliant medical thinkers I have ever met are paramedics. Also, some of the most arrogant, misguided, misinformed, ignorant wastes of oxygen I’ve ever worked with are paramedics. The problem is that pare docs are TRAINED, as opposed to being EDUCATED. Teach them that 2+2+2=6 and when they’ve got that memorized, give them 2+2 and all they know is that if they had one more 2 they could make 6. That is why they operate under specific protocols….if THIS…..then THAT. That isn’t making a diagnosis. Yep, they know the terms, but that still isn’t making a diagnosis. They compile a list of signs and symptoms and plug them into the protocols, which GIVES them the diagnosis. Just because they have the protocols memorized doesn’t equate to a de novo diagnosis. To sway from those protocols is malpractice and is civally and criminally punishable. I have a good friend who is a former paramedic and ER nurse who is now a physician. He is appalled at his own lack of understanding of what he was doing prior to going to medical school. 100 years as a paramedic doesn’t make a doctor. Sorry to burst your bubble. You can reply with all of your eloquence and zeal…..you’re still speaking from a position of ignorance if you haven’t seen first hand the depth of understanding of things that are unknown by ALL paramedics that are second nature to a junior medical student.

    • Ambulance_Driver

      At no point did I ever equate paramedic education, no matter how extensive, with the education provided in medical school, nor did I insinuate that street experience is even a pale substitute for that medical school education.
      Do not put words in my mouth.

      As to your assertion that a paramedic making a diagnosis constitutes practicing medicine without a license, and thus a felony, I will respond to you in the same way I would when anyone else makes a baseless assertion:
      Prove it.

      When someone defends a medical practice of dubious benefit, I expect to see relevant research cited to back it up.
      So until you can show me in the Texas legal code where a) the word “diagnosis” is legally defined and who exclusively may use it, and b) how a paramedic doing so is “practicing medicine without a license,” and c) the case number and court where such a case was tried…
      … you have only supplied us with anecdote, not data.

      And until you can do that, you can reply with all of your eloquence and zeal, but you’re still speaking from a position of ignorance.
      Personally, I prefer to listen to the EMS lawyers and physicians who say otherwise, a number of whom, it should be noted, practice law and medicine in your state.

    • Ambulance_Driver

      And one other thing: while I agree with you on the low state of EMS education in general, your experience with it, even 20+ years of direct involvement, does not make you an expert on EMS education.
      In other words, doctor, you may “train” monkey-see, monkey-do paramedics, but I can assure that in many other places, they are “educated,” and use critical thinking.
      Certainly not a medical school education, but an education nonetheless.

    • @dannyjonz

      It is no surprise to me that there is such ignorance out there as to the education and scope of paramedics in healthcare. We’ve done a deplorable job of representing our profession. I’m in paramedic school now and am going through the process of advancing my knowledge. Granted when I graduate I will not be a physician, but the endless readings and essays indicate to me that I am not being trained as a protocol monkey, but rather educated to understand my patient’s disease process and the comorbidities that add to the complexity of my diagnosis. My textbooks aren’t written by paramedics and only one of them is specific to paramedicine. If I am expected to read and know Bates’ Guide to Physical Examination and History Taking, how is that different than the med student who is required to know the same material? I’m not arguing that we have the same level of education, but I would argue that your understanding of my educational path is misinformed. But, maybe you’re right… I can’t spend anymore time on this discussion as I’m preparing for two of my final exams on Wednesday. Wish me luck!

    • Ambulance Chaser

      Dr. Ken:

      Providing legal opinions and interpreting the law without being admitted to the bar is practicing law without a license. I should know as I am both an attorney and a paramedic, licensed to practice both in Texas.

      I look forward to seeing you provide statutory and/or case law references to back your assertions, which I believe are incorrect. Some of the worst interpretations of the law I have ever read have come from physicians who think that a single class on medical-legal issues qualifies them to interpret and understand the nuances of the law. (Sort of like what you’re accusing of paramedics, it seems.) My income tax professor in law school said that he made a very nice living on saving physicians who thought they understood the Internal Revenue Code.

      In short, I don’t believe that there’s a prohibition on paramedics making a diagnosis. I believe that your opinion and interpretation of the law isn’t supported by current Texas law. As for your allegations of malpractice as well as civil and criminal liability, I look forward to reading and critiquing your legal reasoning.

      On a personal note, I’d be interested to find out where you taught paramedics for 20+ years. If you’ve been feeding them this incorrect information about diagnosis and legal liabilities, you too may have committed malpractice.

    • Ambulance Chaser

      Isn’t there something ironic about a physician warning us of the dangers of uneducated or undereducated providers “practicing medicine” when the same physician provides legal opinions without the benefit of law school?

    • GHS

      Dear Dr. Ken, I hope you will accept my comments in the spirit of bonhomie and an collegiality with which they are humbly tendered.

      Any students that may have had the misfortune to have been in your classes over the last 20 or so years are owed both an apology and a full refund for any tuition they might have paid.

      You have done them a disservice by treating them as dogs, or perhaps parrots, to be trained to blindly treat patients without understanding what they were doing or, more importantly, why.

      It is blatantly obvious that you have no respect for any paramedics that you have worked with. Although I would posit that you never once, for one second, thought of working along side them, but thought of them as “those ambulance guys”.

      In my 35 years working full time in one of the better EMS systems in this country (not my judgement, but that of others), I was privileged to work with many physicians. That includes many board certified EM physicians, professors of surgery, medicine, and the founder and first chair of the School of Emergency Medicine at a well known medical school.

      The relationship that my fellow paramedics and I had with these doctors was such that we were on a first name basis with most of them. Never once did I hear from them as I sat in classrooms that they were “training” us. Rather, they were educating us and expected us to understand the underlying theories for the protocols that we used.

      We were allowed to deviate from protocol when needed, as long as we could justify and document our rationale.

      Never once did any of them talk to us about “practicing medicine without a license” or any such twaddle.

      Paramedics make decisions and diagnoses on every call, there is no other way to work as a paramedic and help patients. I’ve seen the type of paramedics that you describe and they are OK until they find a patient that is off script. Then they invariably do the wrong thing and often harm the patient.

      Any well educated paramedic is likely to do a better job in an emergency than most physicians, especially those who are not trained in emergency medicine.

      Please oh great holder of medical knowledge, do yourself and EMS a favor and take up Radiology or perhaps Psychiatry. We’ll all be better off.

    • PeriMedic

      Your assertions about protocols are the exact opposite as in the Commonwealth of Virginia. Many of our regions have rewritten our protocols to be less specific and more general specifically to encourage more educated, situationally appropriate, independent thought when deciding on treatment for our patients. (Maybe we should debate the word “patient”. If we are just robots following a programmed response, we should call them “experimental subjects”.

      It even says that just because a treatment is mentioned, it is not required to do it, not is is required to do treatments in the order listed. We are to treat the patient as we determine is in the patients’ best interest.

      I am certainly glad, at this moment, to practice paramedicine in VA and not TX. I’ve dealt with some jerk ED doctors in my time, but usually because they expected MORE from us, not less.

      • Ambulance_Driver

        Texas allows service medical directors a great deal of leeway in determining the scope of care their EMTs provide. There is a statewide scope of practice, but it is ultimately a baseline. The medical director can allow his EMTs to exceed it if he is willing to asse the liability.

        This allows progressive medical directors in Texas to develop some really stellar EMS systems rendering top-notch, cutting-edge care.

        Of course, it also allows systems full of the kind of medics Dr. Kenneth Wilgers trains.

    • StreetMEDICINE

      Dr Ken,

      I don’t know where you work, or who your medics are, or what have you, but let’s look at it this way: paramedics are not “practicing medicine without a license.” Every paramedic in every service the world over works under the same general principle: we operate under our medical director’s license, who, as it happens, is an MD. Now, if you are uncomfortable with our relationship, please feel free to remove yourself from this awkward situation. We are extensions of the medical director. He (or she) has to be comfortable with the medics and EMTs that are working under his license to make the clinical decision (e.g. field impression, diagnosis, whatever) based on the signs, symptoms, evaluation with different techniques such as ECG, recognition of lung sounds, etc. to make the right call at the right time to pick the right course of treatment. We all use the same basic assessment skills that MDs and RNs use to evaluate the patient at triage in an ED and from there make a treatment plan and follow it. Protocols are the guidelines that we follow that our approving physician feels comfortable extending from his (or her) license to our hands.

      That being said, my medical control trusts our medics. He (and his colleagues) allow us free reign to treat as we see fit if we can justify it based on clinical evaluation of a patient (diagnostics) or with online medical control, the key thing being that I don’t call and ask, “What do you want me to do?” I tell the attending what I have and what I want to do, just like a consultation. And 9 times out of 10, the orders are given based off what I see and describe. I am told time and time again, “I can’t see or evaluate the patient, so I trust your decision.” As you can see, this is not monkey see, monkey do. This is evaluation, plan and treatment as seen fit by the paramedic.

      As for your comment on your friend’s lack of understanding, I can see where medical school is a lot different than being a paramedic. My wife is a medical student. I help her study for her knowledge based exams. There is a lot that we don’t know and would be hard for us to learn in the field, seeing as we don’t do advanced diagnostics such as blood work, CTs, MRIs, XRs, EEGs, biopsies, etc. But when it comes to clinical reasoning exams, she and her classmates continue to discuss with me the patient’s clinical findings, exams, etc and are surprised when I use similar assessment techniques that they are taught. I do spinal clearance in the field. I determine if a patient needs to have an airway secured or not. I determine if that chest pain is a possible STEMI or a possible broken rib and treat accordingly. You do not look at my findings and tell me what to do for each patient.

      My point is, do not assume that because the medics you have taught, err… excuse me… TRAINED, can’t figure out that 2+2=4 because they don’t understand pertinent negatives, means that all of us are unable to make a clinical diagnosis in the field based on our experience and resources to adequately treat and begin the path to resolution of medical issues en route to your ivory tower of a hospital.

      Please think more of the people that are working under your license as a medical director (if that is what you actually are). We do diagnose in the field. Working diagnoses, but diagnoses all the same.

  • Je Casse Des Choses

    EMS does NOT diagnose patients, at least not as a stand alone. Just as EMS does not prescribe medications, but rather administers them in a very limited capacity on standing orders and medical direction. EMS is part of a larger diagnostic system (process) utilizing an initial assessment. One might say that EMS is not even the beginning of that process. The patient diagnosis (process) is usually initiated by the patients themselves or bystanders (callers) witnessing an event/incident.
    The very idea of EMS as a stand alone diagnostic practice is a completely misguided (albeit well intentioned) concept. The correct view is easily reflected in the EMS system’s ‘chain of care’, i.e. >call > EMS Responders (protocol interventions) > ED mitigating care > increasing levels of care (from tech to RN to Surgical, etc.) > hospital admittance/release > long term care options & specialists.
    EMS Responders are part of that system, with patient care, assessment, transport & management into the system. The EMS contact is limited in time and scope (to the provider’s level and patient needs) and concludes with patient care being transferred to higher medical care.
    Please realize that attorneys will twist and scrutinize a word, like diagnose and them manipulate it to mean something far more bastardized than the genuine intent of its use. Do EMTs diagnose? Yes in the kind of partial truth that is skewed to suit the meaning desired, much the same as saying that gas a makes a car go, while true it certainly does not run on gas alone. But in the whole truth EMTs and other care providers within the system are merely part of the diagnostic process, one purpose of which is to provide redundancy as well as diverse diagnosis. And thus we can adapt for changes in condition and new findings that yield better and more complete diagnosis in patients over time.

    • Ambulance_Driver

      Who ever said EMTs diagnose as a stand-alone process?

      I haven’t, and neither has anyone else in these discussions.

      All along, I’ve said that diagnosis is refined as the patient moves along the continuum of care as education level and confirmatory lab and imaging capability increases. It may start out broad, rough and rudimentary with EMS because of our lesser formal education and austere environment, and hopefully is refined to something definitive along the care continuum.
      And sometimes, the only person who gets to make the definitive diagnosis is the pathologist.
      Never did I say that a paramedic’s diagnosis stands alone. That’s just silly.
      Kelly Grayson

      • Je Casse Des Choses

        Not that anyone said, but that the question somewhat implies a singular diagnoses. The idea that EMS providers become liable to diagnosis is to say that their diagnosis (or misdiagnosis) is infallible and stands alone. I might have buried my larger point here though, it is not what EMS does but what attorneys do, in semantics that is at issue to my mind. Look at the question of a person (i.e. a patient) who does not understand the process. That becomes the problem, (and) attorneys use that misguided and misunderstood purpose of diagnosis as a stand alone ‘fact’ in presenting against EMS providers. I am simply asserting that we (EMS) initiate the diagnostic process from the medical system stand point, and the very question “How do you do your job without diagnosing?” it the very sort of manipulation of terms i mean. Calling it ‘semantics’ and changing the parameters, does not change the reality of the job. It is the same as saying we (EMS) do not give a medical assessment in opinion, but rather in impression by observed condition and response to symptoms. A lot of liability and EMS legal issues are generated by unrealistic expectations of EMS providers by the public (something that is certainly not isolated to EMS.) Attorneys appear in cases with what seems a pathological manipulation of terms to further confuse the issue (misunderstood purpose) and assign blame to individuals for misdiagnosis. The (simple) truth is that EMS has a patient for a very short time and lack advanced diagnostic capabilities, but the general public does not know this or expect a realistic level of care. The General public mentality is that 911 will solve problems infallibly and instantly. Something that legal action (attorneys) perpetuate in presenting cases that do not deal with actual care practices.

  • Matthew Hansen

    We have a patient with difficulty breathing. Can we through both COPD and CHF medications at them without getting in trouble? No! We must make a diagnosis and treat appropriately or we can kill our patients. You cannot give Lasix for suspected CHF? No it must be absolute CHF. Same with any drug we carry: Can you give Lidocane for suspected V-Tach? No, it must be absolute V-Tach. Can you give adenosine for suspected SVT? No, it must be absolute SVT.

    • Ambulance_Driver

      Not necessarily, but I see your point.

  • Garrett Kajmowicz

    I’ve always viewed it as a difference between “diagnosis” and “Diagnosis”.
    The first is involved in any medical field which involves patients.
    The second is legal term which requires MD (or similar) and a really expensive insurance policy.
    Avoiding the word “diagnosis” to avoid giving people the idea that you’re giving them a “Diagnosis” is probably a good idea to keep the paperwork to a minimum, however.

  • PeriMedic

    We could do some serious damage if we don’t diagnose, but only treat symptoms. Ours is an initial diagnosis, not the final one.

  • PeriMedic

    Question: With the increased push for paramedics treating and releasing, and doing community medicine, are we looking at paramedics being the final diagnosticians?

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