Rural Scene Times

[systemet]

But again, having spent nearly all of my time as a provider in rural or remote areas, my opinions almost certainly wouldn't hold in an urban environment. But if you have the time to improve a patient before stressing them, and can do so without queering system status, what is the down side really?

I think this depends a lot on the culture and the medical direction in a given urban system, as well. For example, in one of the urban systems I worked in, it was unacceptable to transport a potentially cardiac patient without a scene 12-lead. This was a pre-requisite for giving NTG to rule out RVI, and if STEMI was found, resulted in field lysis or ER bypass to cathlab. A 20 minute or greater scene time on an MI while faxing a 12-lead, drawing up meds, consulting with a doctor, and making the decision as to where the patient was going was common, and encouraged.

I think we all probably agree that very few patients are acutely time-sensitive. If you're not saving time-to-reperfusion in the field, then all your STEMIs have to fall into that box. A small percentage of CVA patients that are potentially eligible for thrombolytics fall in there, if you have receiving centers capable of doing this (not always a possibility in rural regions without CT). Maybe a few more that are potential neurosurg candidates. Penetrating trauma to the core / neck. Breech presentations / unusual deliveries. Post-partum hemorrhage. Potentially surgical abdomens. The TAAs/AAAs.

Beyond that very small percentage of calls, most things don't need to be rushed.

I would say that a major difference in an urban center, is you often have the option to take your patient to a well-equipped facility that has specialty ICUs and a wide range of surgical capabilities. It makes it a little easier to hold off on some decisions. If the indication for intubating a sick patient is borderline, but you can put them in front of an ER fellow in 10-15 minutes, often you make the decision not to pull the trigger, because you know you can get them better care fast. This sometimes gets perceived as poor care from outside, but I think it's often in line with the patient's best interests (not to suggest that there aren't lazy or substandard practitioners everywhere).

If you're transporting to a small community center 3 hours from an urban center, and there's maybe not going to be a physician on site because they're being called in from home, there's no surgical capability, you're lucky if they have much for blood, and maybe the physician you're getting has next to zero EM training / experience, then there's a different set of variables to consider. Often that patient isn't getting to a high level of care for a couple of hours, and you may be managing them in the "ER" long after you arrive. In that environment, if you're pretty sure the patient's going to get intubated, and you're pretty sure it's going to be you doing it anyway, then it makes sense to do it early.

[1EMT-P]

I have to agree with Dwayne on this one, moving & transporting patients can be stressful. If we can decrease their anxiety, improve their condition & make them more comfortable before we go enroute to the hospital then we should do that. There is a difference between working in a rural system with long transport times versus working in an urban system with short transport times.

[BrandonDrew87]

Yo, I work in a very rural part of northwest Florida and my TX times are from 30-3hr depending on facility. I like you often find my self on scene for 20 plus minutes... The other day i was on scene for 45... My coworkers often heckle me, but by god, we have really aggressive protocols and lots of neat drugs and I wanna see what they do! I recommend taking your time on scene for two reasons. 1. You cant get another call while your on one. 2. The worse that can happen is they code, then its really easy. lol.

[paramedicmike]

It's your first post. Welcome.

Are you saying you treat your patient because you want to see what certain drugs do versus doing what's best for your patient?

What are Texas times?

There are many parts of your post that would benefit from proper punctuation. This part in particular comes to mind:

I like you often...

[Richard B the EMT]

I would let CUPS be your guide on any and all calls, in regards to "Stay and Play" vs. "Load n Go".

Reminder, or information to those in training: CUPS=CPR in Progress (or Critical), Unstable, Potentially Unstable, and Stable.

[BrandonDrew87]

@ParamedicMike

TX refers to transfer, or transport. Sorry for the confusion.

To clarify, I like spending more time on scene to see if my treatments are gonna to be beneficial for the pt, If not I still have a second set of hands (my emt) to take vitals, assist with procedures, and or draw up meds.

It may not be a healthy habit but last year I had a PT in border line unstable Vtach. Got a line and amiodarone on the pump. Got enroute to the hospital. While enroute I was putting the pads on the PT (just in case) I looked down and my line had infiltrated... Luckily I was able to pop in an EJ. Since then Ive been weary about having everything right before bouncing down the road.

[paramedicmike]

That makes much more sense. Thank you for the clarification.

[cwilliams17]

I work for a department that has stations 5 minutes from hospital to about 30, and volunteer for a department that has an hour plus transport time. With both agencies I aim to keep scene time less than 10 minutes. It's just something I've always done since I've been in ems. It takes a short amount of time to gather the information needed to make a transport decision.

[DFIB]

My coworkers often heckle me, but by god, we have really aggressive protocols and lots of neat drugs and I wanna see what they do!

You might want to try consulting a PDR or taking a pharmacology class instead of "seeing what they do" on your patients.

The worse that can happen is they code, then its really easy. lol.

I really fail to see the humor.

[Richard B the EMT]

I concur with it needing perhaps only 10 minutes to make your CUPS status determination, which then becomes basis for the "Load & Go" versus "Stay and Play" decision. That should be on any call, whether across the street from the ER, or 5 hours at full Emergency status due to no helo available.