Would you ALS or BLS this patient and why?

[Arizonaffcep]

Just on a parenthetical note, has anyone ever heard anyone speaking of their system say, "it doesn't work well for us"?

If it's all you know, it's hard to really be objective about how well it works.

I can honestly say, that the whole system for Tucson Fire is crap, and doesn't work well. I'm not sure how much is the medical director vs. the department dictating it (2nd biggest FF union in the state). It has gotten so bad that when TFD BLS's, say a minor tachycardia (rate less than 110, sinus) we set up for a code, because we don't know if they got a decent assessment by the crew or not. The BLS crews are all scared sh*tless to recontact the hospital for direction because they don't want to be "black balled" by the crews they have to work with day in and day out. I can tell you from personal experience (I started with SW Ambo on the TFD BLS contract) that while I was on the contract, I was BLS's an unconscious unresponsive "drunk," a person with ETOH + who was altered AND was post assault--with a brick to the head, a midshaft femur fracture, and a lady who they WALKED down a flight of stairs and was in septic shock! No BS...

I am a firm believer that if a FD does some transports (TFD does the "ALS" transports), that they should do ALL the transports. My former captain even heard one unit have the GALL to say that transporting to anywhere but the closest hospital is a "drain on the system!" The district I used to work for had only 1 ambo (ALS) for 350 square miles, plus 20 miles of I-10! What happened when we were on a transport?!?! BS! :evil:

[firemed665]

I don't know, its hard to say without actually seeing the wound. However, in any case going ALS even if you don't run a complete trauma protocol on the patient is not going to hurt. I have seen little woulds like that turn into a hemo or pneumo enroute to the ER. If there is any doubt you can always justify hooking a patient up, but try justifying not. Sounds like laziness to me.

[crotchitymedic1986]

IN my humble opinion, any penetrating stab wound to the torso is a load and go, regardless of how stable the vital signs are. So if the first transport unit on the scene was EMTI, then they should have immediately transported and asked for an medic intercept if they felt they needed one. I know that we can argue all day about whether or not this was a cut or a stab wound, and it would be nice to know the size and length of the blade, but as anyone who has been doing this more than 10 years knows (and by the stories that have already been stated here) this is the kind of patient that crashes on you and makes you look like an idiot. If I am reading this right, the ALS fire transport unit deemed it OK, to wait on the scene for a BLS transport unit ? I wouldnt want to be in those medic's shoes if this patient did crash.

[Laura Anne]

:shock:

Just the fact that this call was questioned in regards to ALS or BLS intervention makes me error on the side of the Pt and would therefore ALS it. Gosh darn it!! My crystal ball isn't working lately, so I cannot foresee the extent of the internal damage. :roll: Obviously, depending on the type of call that is presented, depends on if it can be triaged ALS to BLS.

Seriously though, I'd hate to live in a local where union rules, laziness, ill-educated personnel, etc would sway the care of a patient..... OH WAIT, I am living there!! Does anyone else see this as a problem lately? I know, stupid question. :?

[spenac]

Heck if your going to risk lawsuit by BLSing it why not just deny transport all together? I mean if it qualifys as BLS they could be just as well taken by family member to the doctor, save patient money and keep ambulance available for real emergency.

[MedicTroll]

[/font:a0901ccc0f] I have to say I have worked with a system that manned ALS units with one EMT and one Paramedic, who drove to the ED depending on the job. This system was able to put more ALS units on the rode on any given tour, plus gave EMT's better experience going into Paramedic school. It was really a perfect system, bus dispatched to 911 call, crew worked together on scene to eval pt., if BLS job the EMT did the job and paperwork the paramedic drove to ED. If it was an ALS job the Paramedic took the job and did the paperwork. What worked best too was while the Paramedic finish the paperwork the EMT restocked, the Paramedic would double check but down time was less and kept more ALS unit ready and in rotation. In fact most cases everyone had time to get meals before they were up in rotation.

Now before some of you go off the handle and draw your lines in the sandbox, before an EMT could work the ALS unit they had to have time under there belt as well as special training. So an new EMT wouldn't be in an ALS unit.

[Don1977]

You can take ANYTHING BLS.....just not reccomended...

[toutdoors]

ALS due to mechanism of injury. Too many unknowns at this time, unless you have CT and Xray on board the rig (we don't). Stable pt's do deteriorate.

[cynical_as_hell]

being a bls provider i would ALS this patient. Although he is stable and presents no serious problem, the ems provider on scene still needs to take into consideration the possibilty of all potential risks given what the injury is. its always better to side on what's best for the patient.

[defib_wizard]

spenac said

Heck if your going to risk lawsuit by BLSing it why not just deny transport all together? I mean if it qualifys as BLS they could be just as well taken by family member to the doctor, save patient money and keep ambulance available for real emergency.

Or better yet just squirt some bactracin in the wound and tape it with duct tape. Tell the pt to watch it if it turns green or falls of in less than 5 days he can go to the urgent care. If it doesn't fall off within 8 days he needs to bathe more. :shock:

What do you think ? If your gonna screw up go for it and REALLY do it right!