How do you manage medication drips

[medic_texas]

It's all about money however Rid is right, if they use a pump you can charge the higher rate for specialty transport. A lot of hospitals may lend out a pump for your service to use for transfers but for 911, I'm guessing you would have to buy a pump.

When I was the DO of a service I bought some refurbed AED's and LP 11's, they worked great, had a warranty, and it was way cheaper than most other places.

My license/certifications is what keeps me eating so.... I'll protect them

[CBEMT]

Ok so what do I do when I encounter a post-arrest patient who need dopamine but I don't have a pump because it isn't standard here? Do I refuse the dopamine and lose my liscence because I didn't do the minimum care expected of me?

We still haven't answered the man's question, beyond

You should talk to your director and medical director about having pumps to accurately infuse your medications because that is the suggestion by the drug companies.

That's great. It still doesn't help him today/tomorrow/etc when he gets sent for a transfer involving a med that should be on a pump. He can refuse, and lose his job, or take the patient, do the best he can, and risk a lawsuit.

[akroeze]

We still haven't answered the man's question, beyond

That's great. It still doesn't help him today/tomorrow/etc when he gets sent for a transfer involving a med that should be on a pump. He can refuse, and lose his job, or take the patient, do the best he can, and risk a lawsuit.

Or the non-interfacility option of I just raised the dead on this guy and he is hypotensive and my standards allow for dopamine but I don't have a pump. I could not give this guy the dope and just get him to the hospital... but there will be hell to pay after.

[FireMedic65]

I would refuse to transport the patient due to not having the proper capabilites to do so. If like medic_texas said, the hospital might let you borrow the pump for the transport. It's not like you are going to steal it.

[akroeze]

I would refuse to transport the patient due to not having the proper capabilites to do so. If like medic_texas said, the hospital might let you borrow the pump for the transport. It's not like you are going to steal it.

Perhaps you did not see my post right above yours. Are you suggesting that if I have a patient who I have just resuscitated in their living room and they are hypotensive and I want to start dopamine on them I should in fact refuse to transport this patient??

My protocols state I should be starting a dopamine drip if they remain hypotensive after a fluid challenge post resuscitation but I do not have a pump as throughout Ontario it is not the accepted standard.

[VentMedic]

QUOTE (FireEMT177959 @ Apr 18 2009, 07:00 PM)

I would refuse to transport the patient due to not having the proper capabilites to do so. If like medic_texas said, the hospital might let you borrow the pump for the transport. It's not like you are going to steal it.

Perhaps you did not see my post right above yours. Are you suggesting that if I have a patient who I have just resuscitated in their living room and they are hypotensive and I want to start dopamine on them I should in fact refuse to transport this patient??

My protocols state I should be starting a dopamine drip if they remain hypotensive after a fluid challenge post resuscitation but I do not have a pump as throughout Ontario it is not the accepted standard.

akroeze, I believe the key word here is hospital.

IFT transports should be held to a level of higher expectation. No hospital should ever allow their equipment to be loaned out to anyone if they do not have some idea about that person's knowledge of that equipment and even then it is a huge liability. Anytime hospital equipment that is providing some form of life support either meds or ventilation, a member of the hospital staff should accompany. Too often some do not know what they don't know and assume an IV pump is just a couple of buttons. Thus, when they can not get the pump restarted during transport, they end up diverting to another facility because the med is not running or their "eyeball" technique ran too much med and dire consequences have occurred. Receiving hospitals do take note of these muck ups and eventually file a complaint against the sending facility if it happens too often. Those with the higher licenses should have known better.

Also, if this occurs during an ED transfer, the sending hospital may have to answer to EMTALA regulations as to why they allowed a poorly prepared team without proper equipment transfer a patient. That is a huge offense and again those with the higher licenses should have known better since obviously by some of the comments here, some Paramedics don't.

[akroeze]

I totally agree, and there is no way we'd ever take someone on any kind of drip IFT without an escort. We aren't allowed to.

[fireflymedic]

Okay - here is my thought - it is much more concerning to think about wrong drug dosages as opposed to oxygen - yet we ensure that we have regulators, but we can scrimp and save on meds which require much more precise delivery and we can't break down and figure out a way to get some refurbed pumps? Come on that is a joke. Yes I hear it now, regulators and cheaper and oxygen does require precise delivery (okay then please explain to me why the mills are still saying everything gets 15 L via NRB). I'm simply stating that for the stupidity of the arguement.

I often sit back and wonder what really is the problem behind EMS. Is it truly that we can't get paid - there are some services that have great reimbursement rates and do fine, what is it that they are doing that the others aren't? Perhaps because EMS directors should have a mix of both EMS and business experience before being placed in a director's position. They should understand what is needed, but also what is required. We spend money on things that are nice, but not required, and by all means if you have the money, buy it, but if you don't prioritize and yes, pumps should be a priority. However, that would require some medics to alter their training. Have to learn to deal with problems and yes, troubleshoot if required. In addition, there is the requirement of still being able to count drips if necessary if your pump fails (remember doing those calculations during medic class you thought you would never need again and that micro drip set that's collecting dust?)

I was suprised recently when a nearby service polled on what they thought was the most important purchase. EZ IO drills, an easy lift cot, or IV pumps - the winner was the easy lift cot. Sad. Needed yes, a luxury, yes, but not in the same class.