Why do urban EMS fear on-site treatment?

[CTXMEDIC]

As someone much wiser than myself told me in response to me "How the HELL are we supposed to get all XYZ done in 5 minutes"... if you're taking 3 sets of vitals, initiating O2, starting an IV, getting a history, initiating interventions and documenting "change" in the 5 minute period it takes to get from the pt's house to the hospital, you're not practicing medicine...

You're just rushing through everything because it's what you're "supposed to do" to remain available for other calls.

I think you can get an awful lot more done and actually do your patient some good if you slow down a bit and initiate some stuff before you get to the truck, or at the very least, in the back of the truck before you get moving.

But that's me.

Wendy

CO EMT-B

If it takes 5min to get to the hospital, why would i sit on scene to 'practice'? It would seem that someone 'wiser' than you is talking out of turn. it would seem youre advocating sitting parked on scene to allow time to 'document changes' 'get 3 sets of vitals' etc. etc. because thats what YOURE supposed to do. you seem to have protocols that have alot of 'musts' in it. you MUST start an IV, you MUST get 3 sets of vitals (why not 2..or 4?) these musts look good to medicare billers but is this whats really in your PATIENTS best interest? Can you please explain your statement to us? Im not going to sit in front of grannys house, 5 min from a hospital, so i can 'practice' on her.

[tamaith]

i see philly medics all the time . since thats where i am from and work . i think it may be a case by case thing all of the stretchers i ve seen have port o2 and i believe heart monitors i could be mistaken though with the heart monitors but i know all of the ones ive seen have o2 on them. and ive seen hundreds of them. i would say out off all the times ive seen medics arrive on scene i think 90 % were a load and go 10% stay and play. but again ive never did ride time with them so i can only say what ive seen.

[Eydawn]

I'm not advocating sitting on scene for 20 minutes. I'm saying trying to get 3 sets of vitals, an IV started, and pharmacological interventions going within 5 minutes while driving in to said hospital is what is *expected* in my system. Does every patient need an IV? No. And I have trouble with that in my own mind... but when hollered at to start IV's...

What I'm saying is that if transport time is only 5 minutes, why are we cramming EVERYTHING the hospital expects us to have done into that time frame? Why not take the extra 5 minutes on scene to begin interventions? Either don't bother, or take the time to do things properly is my feeling. Perhaps once I'm smoother with everything I will feel differently... but I don't think so. For all the good it does to just drive someone in, we could have had them call a taxi and avoided taxing the EMS system...

And that wiser person is NOT talking out of turn, as he has a much better picture of the system I'm in than you do. Sorry...

Wendy

CO EMT-B

[diazapam]

This should be common sense Rx the pt if they are acute if not take your time and Rx where your comfortable , if that happens to be in the back of the ambulance so be it. You are the one that is handling their EMERGENCY wheather it really is or not is up to you with the help of common sense and experience.

[paramedicmike]

You do know it's spelled "diazepam", right?

-be safe

[p3medic]

You do know it's spelled "diazepam", right?

-be safe

LOL :oops:

[DwayneEMTP]

If it takes 5min to get to the hospital, why would i sit on scene to 'practice'? It would seem that someone 'wiser' than you is talking out of turn. it would seem youre advocating sitting parked on scene to allow time to 'document changes' 'get 3 sets of vitals' etc. etc. because thats what YOURE supposed to do. you seem to have protocols that have alot of 'musts' in it. you MUST start an IV, you MUST get 3 sets of vitals (why not 2..or 4?) these musts look good to medicare billers but is this whats really in your PATIENTS best interest? Can you please explain your statement to us? Im not going to sit in front of grannys house, 5 min from a hospital, so i can 'practice' on her.

I think it was me that you believe may have spoken out of turn, so I’ll try and explain.

Two things. First, Wendy was in her FI program at her job when we had this conversation. (I know I’m making a leap that it WAS me, as I can’t think of anyone that would describe me as wise) Some of the medics she worked with demanded that she get full vitals, IV, BGL, assessment and follow up vitals on all patients, regardless of the patients’ needs. They often have very short transport times and she was getting a little nuts because she couldn’t fulfill all of their requirements in the time allowed. I told her not to sweat it, just to simply jump through their silly hoops, as that wasn’t medicine, it was a bullshit kind of hazing. She was being forced to produce a bunch of skills, while still learning those skills, without the necessary time to do so, nor allowed to follow a logical path to choose the interventions she felt were prudent.

And I certainly don’t advocate sitting in front of grandma’s house if I’m five minutes from the hospital, I advocate sitting IN grandma’s house until I’ve improved her condition if I’m able to do so. The distance to the hospital makes no difference to me.

Breathing problems? I’ve ‘done harm’ if I have fire or my crew move her, jostle her around, make her anxious, before improving her condition. Cardiac? Ditto. Fall with broken limbs/hip? Line, O2, pain management, proper stabilization, before even considering movement to the ambulance. Isn’t that why we did all the silly book learnin’?

I’m curious, with the exception of significant trauma, why the relative closeness to the hospital matters? How would that change your treatment?

The only times I’ve ever just picked up an ran was on major trauma, twice, both less than a block from the ER doors. All other major traumas I moved my ass you can be sure, as I'm a believer in the Platinum 10, but on those two I simply strapped them to a board, monitored the airway and ran to the ER. I can’t think of a single time that I’ve moved a medical patient before making every realistic (read 'logical based on likelihood of short term success') effort to improve their condition. Because moving them, in my limited experience, is sure as hell going to retard it.

I like to imagine that the ‘medic’ in my dearly earned title is short for medicine.

Dwayne

[spenac]

I think it was me that you believe may have spoken out of turn, so I’ll try and explain.

Two things. First, Wendy was in her FI program at her job when we had this conversation. (I know I’m making a leap that it WAS me, as I can’t think of anyone that would describe me as wise) Some of the medics she worked with demanded that she get full vitals, IV, BGL, assessment and follow up vitals on all patients, regardless of the patients’ needs. They often have very short transport times and she was getting a little nuts because she couldn’t fulfill all of their requirements in the time allowed. I told her not to sweat it, just to simply jump through their silly hoops, as that wasn’t medicine, it was a bullshit kind of hazing. She was being forced to produce a bunch of skills, while still learning those skills, without the necessary time to do so, nor allowed to follow a logical path to choose the interventions she felt were prudent.

And I certainly don’t advocate sitting in front of grandma’s house if I’m five minutes from the hospital, I advocate sitting IN grandma’s house until I’ve improved her condition if I’m able to do so. The distance to the hospital makes no difference to me.

Breathing problems? I’ve ‘done harm’ if I have fire or my crew move her, jostle her around, make her anxious, before improving her condition. Cardiac? Ditto. Fall with broken limbs/hip? Line, O2, pain management, proper stabilization, before even considering movement to the ambulance. Isn’t that why we did all the silly book learnin’?

I’m curious, with the exception of significant trauma, why the relative closeness to the hospital matters? How would that change your treatment?

The only times I’ve ever just picked up an ran was on major trauma, twice, both less than a block from the ER doors. All other major traumas I moved my ass you can be sure, as I'm a believer in the Platinum 10, but on those two I simply strapped them to a board, monitored the airway and ran to the ER. I can’t think of a single time that I’ve moved a medical patient before making every realistic (read 'logical based on likelihood of short term success') effort to improve their condition. Because moving them, in my limited experience, is sure as hell going to retard it.

I like to imagine that the ‘medic’ in my dearly earned title is short for medicine.

Dwayne

Good answer. I am a firm believer in doing things like pain management prior to moving them.

[CTXMEDIC]

I agree with ya dwayne. what i dont agree with is sitting there just to 'do stuff' because it looks good on paper or the hospital (seriously?) expects you to do it. I do whats in my patients best interest. if moving em is going to hurt, we're going to sit there until i get an analgesic on board, if they cant breathe, they will be by the time we leave. Im sure everyone here would do the same thing. doing it just cuz some guy in a suit and a 2 o'clock T-time expects you to is B.S. I think we have some great nurses at our hospitals and i value their opinions. where the line for me is, i dont tell em how to do their jobs and they dont tell us how to do ours. working a patient in a dark house with one other guy is alot different than a fully staffed and equipped ER.

As for somebody hazing Wendy? Thats fine with me, just keep it away from patient care.

[Eydawn]

Thanks. I don't know how much of a response I can muster to that...

Wendy

CO EMT-B