Ambulance Abuse?

[VentMedic]

If there was a nationwide study, with an appropriate sample, that bridged all types of EMS provider systems, I would be more apt to believe the results.

That would also have to include L.A., Orange and San Diego Counties, the AMRs, volunteers and Washington D.C. We could also toss in a couple of counties from Florida like Collier and I'm sure we can find a few other large agencies to add to the mix to offset some of the better ones. Of course you will have good and bad but again why make excuses or believe the 3 - 9 months of training the average U.S. Paramedic is the best.

[HERBIE1]

That would also have to include L.A., Orange and San Diego Counties, the AMRs, volunteers and Washington D.C. We could also toss in a couple of counties from Florida like Collier and I'm sure we can find a few other large agencies to add to the mix to offset some of the better ones. Of course you will have good and bad but again why make excuses or believe the 3 - 9 months of training the average U.S. Paramedic is the best.

As with anything in this business, there are so many variables, it's difficult to make a profession wide declaration like 'The Prehospital recognition of X disease is lacking."

Call volumes, demographics, training, dispatch protocols, level of training of providers, etc- it's hard to make a direct comparison of anything.

[WolfmanHarris]

That would also have to include L.A., Orange and San Diego Counties, the AMRs, volunteers and Washington D.C. We could also toss in a couple of counties from Florida like Collier and I'm sure we can find a few other large agencies to add to the mix to offset some of the better ones. Of course you will have good and bad but again why make excuses or believe the 3 - 9 months of training the average U.S. Paramedic is the best.

That raises an incredibly interesting point. We are very quick to refer back to good systems/providers and saying "while of course if they're going to do the study that way; of course the results suck." But what if we did have a comprehensive, fully stratified study that accurately represented EMS nationwide (US, Canada or wherever)? How discouraging would the results be? Would we find that professional, educated, competent providers were in the minority?

[rock_shoes]

The system in the U.K. also utilizes a nurse in some areas.

I am not anti-education. However, we now have too many in this profession who did not invest but the bare minimum (500 - 1000) hours to become a Paramedic and then have little interest in maintiaining what skills they do have. As well, the areas where the U.S. Paramedics are the weakest or display the least interest is medical issues. If all the patients to triage were trauma or "exciting" then they might show some ambition towards learning more. And yes I do fault the FDs are now making every FF become a Paramedic while utilizing their own PDQ mill or some other 3 month wonder mill. Right now we do have a considerable number of people wearing a Paramedic patch who have no interest in medicine or patient care and will not be the best judge of who deserves medical attention at the ED. It will be more of a "personality contest" rather than something based on a medical assessment. Some fail to put their attitudes in check when they get a call to a familar address or "one of those" neighborhoods with "those kind" of people. Look at the studies with MI patients. There is enough concern out there that some aren't getting assessed or taken seriously because of their gender or race.

I think this is exactly the point Squint was trying to make. Only competent educated professionals should be allowed to "triage" which patients require transport on scene. "Medic Mill" graduates need not apply. Anyone who just happens to wear the patch should be left in the dust while the rest of us strive to be educated, competent, compassionate, professionals.

[crotchitymedic1986]

I would love to see how any medic from any school or employer is going to determine whether or not someone is sufferring from a sickle cell attack ? It can not be done in the absence of labwork. This patient has a legitimate medical condition, and he is not the first to figure out that going to the ER by ambulance usually results in a shorter wait time. Where is the crime in that ?

[tniuqs]

FYI:

Almost all patients with sickle cell anemia have painful episodes (crises), which can last from hours to days. These crises can affect the bones of the back, the long bones, and the chest. Some patients have one episode every few years. Others have many episodes per year. The crises can be severe enough to require a hospital stay.

Common symptoms include:

Attacks of abdominal pain

Bone pain

Breathlessness

Delayed growth and puberty

Fatigue

Fever

Jaundice

Paleness

Rapid heart rate

Ulcers on the lower legs (in adolescents and adults)

Other symptoms include:

Chest pain

Excessive thirst

Frequent urination

Painful and prolonged erection (priapism - occurs in 10 - 40% of men with the disease)

Poor eyesight/blindness

Strokes

Skin ulcers

Exams and Tests Return to top

Tests commonly performed to diagnose and monitor patients with sickle cell anemia include:

Complete blood count (CBC)

Hemoglobin electrophoresis

Sickle cell test

Other tests may include:

Bilirubin

Blood oxygen

CT scan or MRI

Peripheral smear

Serum creatinine

Serum hemoglobin

Serum potassium

Urinary casts or blood in the urine

White blood cell count

Patients with sickle cell disease need ongoing treatment, even when they are not having a painful crisis. They should take supplements of folic acid (essential for producing red blood cells) because red blood cells are turned over so quickly.

The purpose of treatment is to manage and control symptoms, and to limit the frequency of crises.

During a sickle crisis, you may need certain treatments. Painful episodes are treated with pain medicines and by drinking plenty of fluids. It is important to treat the pain. Non-narcotic medications may be effective, but some patients will need narcotics.

Hydroxyurea (Hydrea) is a drug some patients use to reduce the number of pain episodes (including chest pain and difficulty breathing). It does not work for everyone.

Antibiotics and vaccines are given to prevent bacterial infections, which are common in children with sickle cell disease.

Blood transfusions are used to treat a sickle cell crisis. They may also be used on a regular basis to help prevent strokes.

Other treatments for complications may include:

Dialysis or kidney transplant for kidney disease

Drug rehabilitation and counseling for psychological complications

Gallbladder removal (if you have gallstone disease)

Hip replacement for avascular necrosis of the hip

Irrigation or surgery for persistent, painful erections (priapism)

Surgery for eye problems

Wound care, zinc oxide, or surgery for leg ulcers

Bone marrow transplants can cure sickle cell anemia. However, transplants have many risks, including infection, rejection, and graft-vs-host disease. They are not an option for most patients. Also, sickle cell anemia patients are often unable to find suitable donors.

Sickle cell anemia can cause great stress to the patient and family members. Joining a support group where members share common experiences and problems can relieve this stress.

See: Sickle cell anemia - support group

In the past, sickle-cell patients often died from organ failure between ages 20 and 40. Thanks to a better understanding and management of the disease, today patients can live into their 50s or beyond.

Causes of death include organ failure and infection. Some people with the disease experience minor, brief, infrequent episodes. Others experience severe, long-term, frequent episodes with many complications.

Acute chest syndrome

Anemia

Blindness/vision impairment

Brain and nervous system (neurologic) symptoms and stroke

Death

Disease of many body systems (kidney, liver, lung)

Drug (narcotic) abuse

Erectile dysfunction (as a result of priapism)

Gallstones

Hemolytic crisis

Infection, including pneumonia, gallbladder inflammation (cholecystitis), bone infection (osteomyelitis), and urinary tract infection

Joint destruction

Leg sores (ulcers)

Loss of function in the spleen

Parvovirus B19 infection, leading to low red blood cell production (aplastic crisis)

Splenic sequestration syndrome

Tissue death in the kidney

When to Contact a Medical Professional

Call your health care provider if you have:

Painful crises

Any symptoms of infection (fever, body aches, headache, fatigue)

Sickle cell anemia can only occur when two people who carry sickle cell trait have a child together. Genetic counseling is recommended for all carriers of sickle cell trait. About 1 in 12 African Americans has sickle cell trait. It is possible to diagnose sickle cell anemia during pregnancy.

You can prevent sickling of red blood cells by:

Getting enough fluids

Getting enough oxygen

Quickly treating infections

Have physical exams every 3 - 6 months to ensure that you are getting enough nutrition and activity, and that you are receiving the proper vaccinations. Regular eye exams are also recommended.

PREVENTING INFECTIONS

People with sickle cell anemia need to keep their immunizations up to date, including Haemophilus influenza, pneumococcal, meningococcal, hepatitis B, and influenza.

Some patients may receive antibiotics to prevent infections.

PREVENTING CRISES

Parents should encourage children with sickle cell anemia to lead normal lives.

To reduce sickle cell crises, take the following precautions:

To prevent oxygen loss, avoid:

Demanding physical activity (especially if the spleen is enlarged)

Emotional stress

Environments with low oxygen (high altitudes, non-pressurized airplane flights)

Smoking

Known sources of infection.

To make sure you're getting enough fluids:

Avoid too much exposure to the sun

Have fluids on hand, both at home and away

Recognize signs of dehydration

To avoid infection:

Consider having the child wear a Medic Alert bracelet

Have the child vaccinated as recommended by the health care provider

Share the above information with teachers and other caretakers, when necessary

Be aware of the effects that chronic, life-threatening illnesses can have on siblings, marriages, parents, and the child.

Lee MT, Piomelli S, Granger S, et al. Stroke Prevention Trial in Sickle Cell Anemia (STOP): extended follow-up and final results. Blood. Aug 1, 2006;108(3):847-52.

Just my 2 cents but there is abuse and there is legitimate use, using this patient as a poster boy EPIC FAIL.

Correct me if I am wrong, but P02s must drop below 50 mmhg to sickle this equates to skin saturations of (fill in the blank)

cheers

Edited August 2, 2009 by tniuqs

[spenac]

he is not the first to figure out that going to the ER by ambulance usually results in a shorter wait time. Where is the crime in that ?

Should be a crime to use the ambulance just to get in faster.

[WolfmanHarris]

Should be a crime to use the ambulance just to get in faster.

Thank-god for "offload to waiting room policy." If you're a CTAS 4 or 5 patient, able to ambulate or sit in a wheelchair and can be left to care for yourself, you can take the Ambulance to hospital, but you will find yourself offloaded to the waiting room same as if you came by cab. Not to mention I will if called for, check the "not medically necessary" box on the form and hopefully so will the MD giving you the full $350.00 bill rather then the usual $45.00 co-pay.

[Dustdevil]

Not to mention I will if called for, check the "not medically necessary" box on the form and hopefully so will the MD giving you the full $350.00 bill rather then the usual $45.00 co-pay.

Liar. Everyone knows healthcare is free in Canadia.

[VentMedic]

Should be a crime to use the ambulance just to get in faster.

If you ever felt the same pain that someone in a sickle cell crisis is experiencing, to them that is an emergency. Fortunately most on this forum are blessed with good health and may not or hopefully will never experience a disorder or debilitating disease to where they do understand where some of their patients are coming from. As well, many feel like they have nothing else or no alternative and the disease has consumed their whole life which each day consisting of trying to find some comfort. This doesn't just apply to adults but to children also but many young children have other coping mechanisms like just shutting down and withdrawing.

Sickle cell is no joke and several patients have already been on ventilators. Each time they get that feeling of shortness of breath they may remember their last ICU stay. Granted many do just need their labs monitored and medications adjusted but I would hate to tell the one that is developing acute chest syndrome to call a cab.

Edited August 3, 2009 by VentMedic