Why do urban EMS fear on-site treatment?

[reaper]

Some pt's I will treat on scene and some in the unit. Depends on the situation. I don't like starting IV's in the house, unless they are needed right away.

One thing I can say. In our system, you would be out of a job, if you walked a SOB pt to the ambulance. That is what they make stretchers for! :roll:

[gvandellen]

The call volume was high, I ran roughly 350 calls in 20 days. A lot of BS but we did have a lot of sick patients as well. There were a lot of patients that should have been treated on scene. 13 other students felt the same way. Why aren't we treating these patients quicker? I'm not bashing city style but I'm curious as to why it's gotten like this? Don't get me wrong my preceptor was smart and if I got hurt I'd want him. Good points by everyone though to think about. I just want the best for EMS and for the future students that do their time in Philly.

[WANTYNU]

While I appreciate those who are quick to jump in and say this doesn't happen in their big city, the fact remains that it is a big city culture thing.

This is not a fair nor accurate statement, I’ve heard plenty of stories of folks in rural systems starting treatment on the bus because they have a long transport and they want to get “the wheels turning” asap.

Therefore, I do not believe this “culture thing” is owned solely by urban EMS.

In my mind this (long txp times) presents an even stronger argument to start treatment as early as possible.

It may be more attention is paid to an urban environment simply because transport times are less, and therefore you have to work more quickly if you are to effect patient treatment, so there is a strong temptation to load and go, and let the ER figure it out. In addition, it might appear logical to someone from outside an urban system, that this would be the preferred method directly because of the short transport to the ER, hence the myth.

Another logical argument for the perpetuation of the myth, is folks who do not do something often, are resistant to believe others could or would move quickly and decisively when additional support is close by.

As I stated earlier, the only reason for that action would be if the patient presented with a condition that would not benefit from more time on scene, say a knife sticking out their head…

Lastly, a cautionary tale of walking an SOB, I know of three cases where the crew that did such, ended up delivering a corpse to the ED…

As Always,

Be Safe,

WANTYNU

[spenac]

At my old service we would spend lots of time on scene with all but critical patients. Sometimes we stayed on scene to see if treatment was working and we would release patient to follow up with their Doctor. It made it easier to do many things while still on scene rather than bouncing 90 miles to the hospital. On critical patients we still did a lot on scene but we got on the road much quicker. Patients benefited from better care.

My new job policy is to load and go. Very little done on scene. Of course protocols are limited, so not much you can do anyway. So we load and get the taxi rolling.

[Dustdevil]

This is not a fair nor accurate statement, I’ve heard plenty of stories of folks in rural systems starting treatment on the bus because they have a long transport and they want to get “the wheels turning” asap.

Therefore, I do not believe this “culture thing” is owned solely by urban EMS.

Did I say it was? No. Methinks thou doth protesteth too much.

[spenac]

Methinks thou doth protesteth too much.

MacDust?

[paramedicmike]

Look at it this way. You said you ran 350 calls in 20 days. That's better than 17 calls a shift. How many of those were BS calls? Probably the vast majority of them. Into what kind of mindset do you think that lulls a provider? Probably one that gets people to the ambulance before they start any type of treatment. I'm not saying it's right to let yourself become complacent like that. But you saw what the city was like. Could you imagine keeping up with that kind of volume for years on end?

Knowing Philly, it's probably also a way to figure out who's faking and who's for real.

Also, all those extra units Philly added? Yeah...they're BLS units used to punish FFs. PFD doesn't give a rats arse about EMS. Nor do they care about adequately planning for the city in which they provide services. Combine that with the call volume that you witnessed, does it surprise you they do it that way?

But I digress...

You've got some good insight already. I don't think I'll have more to add. At least not right now. Good luck in your new gig. Delco? Upper Darby? Or down at Crozier? You're certainly not up in Montco or Bucks.

-be safe

[WANTYNU]

Did I say it was? No. Methinks thou doth protesteth too much.

While I appreciate those who are quick to jump in and say this doesn't happen in their big city, the fact remains that it is a big city culture thing.

Well OK, it might be the Vicodin slowing me down (Ok, Ok, and growing up in the 60’s), but I’m pretty sure your quote reads: “the fact remains that it is a big city culture thing.”

Am I wrong to equate Big City (as in my Happy Shining Big Apple) to urban?

After all, we got all the stuff a big city needs: Busses that don’t run on time, Taxi drivers (and EMS) that learned to drive in places where life is cheap, overhead and underground trains, lots of noise, oh ya and a Governor that hires hookers….

Come on that has to qualify as “CULTURE”….

-w

PS, And for the most part we do TREAT our patients BEFORE transport…

[Dustdevil]

Well OK, it might be the Vicodin slowing me down (Ok, Ok, and growing up in the 60’s), but I’m pretty sure your quote reads: “the fact remains that it is a big city culture thing.”

Am I wrong to equate Big City (as in my Happy Shining Big Apple) to urban?

No, but you are wrong to read the word "exclusively" into my statement, since I did not say it.

It just seems you're being a little hypersensitive about this. It's fire based EMS I took a shot at, not urbans.

Have you ever even worked anywhere but NYC to make a comparative judgement? I have worked both and seen it from both sides, and can assure you I am correct.

[WANTYNU]

It just seems you're being a little hypersensitive about this. It's fire based EMS I took a shot at, not urbans.

I still don’t see it, but to be honest my shoulder hurts like a b*tch, I’m distracted by the pittance you get when out on disability, while trying to figure out how to do a better job at marketing, and truly am hypersensitive (not to mention very irritable).

No sense in beating a dead horse.

I concede your point (especially since you were targeting a group that does so much less with so much more…)

Although if I may suggest, please keep to EMS and lay off the Bard. :wink:

Best

-w