Why do urban EMS fear on-site treatment?

[Christopher.Collins]

...

If your administration doesn't know or care anything more about medicine than what they learned in their twelve-week paramedic school two decades ago, you can't really expect them to foster a culture of progressive professionalism within their organisation.

Oooooh, I get it. THATS why the first EMS company I worked for sucks so much... its owned by a man who was only an EMT-Basic for maybe a decade, and that was in the caddilac days. I always thought it had something to do with his real-estate and other properties including half the city the EMS company is in being more important.

Im not being sarcastic either. This is a man who orders us to park unused ambulances on the cliff overlooking the city for advertising purposes (NOT PR).

[JTpaintball70]

Meh, ABQ can be both sides of this coin. I'm on internship and had 1 preceptor that wanted to transport right away on everything. My next preceptor was more than ok with me staying on scene to stabilize the patient and get some treatment done on scene. I tend to treat minor stuff on scene before I transport (and definately get some major stuff treated as we get the pt moved, like GSWs).

[FireMedic65]

I have been very rural, and urban in my experiences. That did not change my treatment. It does, however, depend on the patient. If the patient is critical, I am getting them packed up ASAP (not including initial assessment of course). For example, if the patient is feeling weak, having minor difficulty breathing, I am not going to rush them out of their house and into the ambulance. I will treat them in their home and calmly get them packaged up for transport. Now, if they are having crushing chest pain, BP is crap, they look like crap, monitor looks like crap, I am not going to pussy foot around with them. They are load and go. I will treat them en-route.

Now for most cases where your patient is a few blocks from the hospital, personally, I'd like to have my patient going into the ER with SOMETHING done for them, and have it looking like I know what I am doing. During clinicals, I HATED seeing a patient being brought in, and all the EMS crew could tell us was a chief complaint, no medical history, no treatment, not even a good set of vitals. Just "HERE YA GO SEEEE YA!".

I have had a patient, where we were dispatched from the hospital (we were just dropping a patient off) and literally, ACROSS THE STREET from the ER, was the address. We walked across the street, called responding, on scene, at patient, enroute, at hospital, all at the same time. The patient fell over, twisted their ankle, and wanted to see the Dr. We put her on the stair chair, put on an ice pack and roller her across the street.

Why people want to load an go everything, is beyond me.

[MS Medic]

I worked in Jackson, MS for years. We usually ran an average of 8 calls if all were transported (more if not) during 14 hrs of a 12 hr shift. I've had 2 knives pulled on me, fought with a guy trying to pull a gun on me and lost count of the number of psych pts who attacked me. A crew was robbed and shot at while staging at a gas station on a call. Units have been shot at while responding to call and there are certain areas that EMS does not go in w/o police escort for the safety of the crew.

Unofficial common practice there is to treat life threats, move to the truck and do everything else en route. It is the personal safety of the crew that guides this practice and that might be the reason it occurs in other urban settings as well.

[46Young]

I've just discovered this thread, I've read the first page, but I dont' feel like reading through 10 total pages at the moment. I'll do so at a later point.

When I worked in NYC (on 46/53/54 Y, 51V, 51W, 52X, 52W), I would at least do enough for the pt in the residence regarding diagnostics/prophylactics ( such as O2, monitor pulse ox, maybe drop a lock) before going to the bus. I'll of course do more at the residence before removal if the situation warrants, such as an APE, MI, tight asthmatic, hypotensive pt to name a few. I rarely walk someone out to the rig, unless it's obvious that they're in no real distress. I have no problem whatsoever carrying someone down umpteen flights of stairs, also moving the equipment with us every few floors if necessary.

When treating in the residence, I figure out in my head how roughly how far away time wise the hospital is, how much I can get done in that time, and I'll generally halt pt care if appropriate at the point where I know that I can achieve the rest enroute to the hosp. Unless you're literally across the street from the hospital, there's really no excuse for not doing what you need to for the pt before delivery.

We're here to stabilize pts, do damage control, POSSIBLY reverse their condition, not just drive them to the hosp. We're not doing definitive care, but we're not merely a car service either.

Now, when I worked for Charleston County EMS, they were all about the scoop and run. My FTO said to me "Hell boy, what are we gonna do for em? Our job is just to take 'em to the hospital, where they can actually do something." WTF?

Finally, here in Fairfax County, many of our units are double medic, along with the engine medic for ALS call types. Most Lt's insist on doing a quick assessment, 12, vitals/O2 for most pt's, then doing everything else indicated in the bus onscene before leaving for the hosp. On several occasions I've had arguments with my medic officer making us stay onscene to get a line before leaving - for a legit trauma! On more than a few occasions I just sit and stare at the pt while we leave for the hosp, maybe assessing for improvements and such, having done everything already.

I can see having the engine medic square you away before departure if you're the lone medic on a one and one, but then again you can take them along for a serious pt and get a lot done while in transit. I'm lucky that the regular officer at my station thinks like I do - txp to the hosp at the earliest opportunity provided everything indicated for the pt will get done.

Having said that, things do go fairly quickly onscene with 2-3 medics and a few BLS getting things done in a rapid fashion. It sounds like a cluster****, but it's not. Everyone knows their role, and things typically go smoothly and rapidly. It works really well here.

[Siffaliss]

Yeah, too much to read now so I'll read it all later ...

It's not that urban services fear onsite treatment, you have it wrong there. Since we're urban and full time ALS, there is a lot of staying and playing done when feasible due to the additional resources that go along with an EMT-P. Because the call volume is much higher, I know that I prefer to travel light into a call when possible because if I don't, it would be too much wear and tear on myself and my partner. We bring what we need to when we need to. And when feasible for the patient causing them no further harm, it's Airway, Breathing, Can you walk? With the additional volume you just can't carry every single person. (However there have been nights where everyone has been carried ...)

And yeah, due to the increased volume there is an increased risk of violence against EMS. I won't go in if it's not safe and police haven't arrived yet. Sure I want to help, but it's not my emergency and not worth getting killed over and leaving my daughter without a mother.

Edited November 3, 2009 by Siffaliss

[scott33]

Now, when I worked for Charleston County EMS, they were all about the scoop and run. My FTO said to me "Hell boy, what are we gonna do for em? Our job is just to take 'em to the hospital, where they can actually do something." WTF?

That old chestnut! This gets my back up and unfortunately, appears to be a very common philosophy. Is it any wonder we are often used as a taxi service? We can't really blame the public for abusing the 911 system, when the above-mentioned providers are encouraging it.

[JakeEMTP]

Now, when I worked for Charleston County EMS, they were all about the scoop and run. My FTO said to me "Hell boy, what are we gonna do for em? Our job is just to take 'em to the hospital, where they can actually do something." WTF?

Well damn. I thought about applying to Charleston County when I move to SC next year (hopefully). Now though, I think I'll stick with Horry County or Florence County. Since I'm going to be in Conway SC, I could do with either or work for Brunswick County in NC. Decisions, decisions. Charleston County doesn't sound like anything I'd be interested in. Edited November 3, 2009 by JakeEMTP

[Mateo_1387]

Well damn. I thought about applying to Charleston County when I move to SC next year (hopefully). Now though, I think I'll stick with Horry County or Florence County. Since I'm going to be in Conway SC, I could do with either or work for Brunswick County in NC. Decisions, decisions. Charleston County doesn't sound like anything I'd be interested in.

You still owe me that beer before you move.

[46Young]

Well damn. I thought about applying to Charleston County when I move to SC next year (hopefully). Now though, I think I'll stick with Horry County or Florence County. Since I'm going to be in Conway SC, I could do with either or work for Brunswick County in NC. Decisions, decisions. Charleston County doesn't sound like anything I'd be interested in.

http://www.emtlife.c...unty+ems&page=3 post # 28

http://www.emtlife.com/showthread.php?t=14118&highlight=charleston+county+ems this thread as well

Edited November 4, 2009 by 46Young