Walking Patients to the Ambulance

[DFIB]

That`s exactly what we were talking about beforehand.

It`s all a matter of ass-covering vs. clinical judgement/valiable need.

Although I see the reasons for those moves and true enough, I have never worked in your region under the condition of everyone suing everybody and anything over ridiculous bullshit - still, you gotta take it as it is: being safe facing legal (reasonable or not) liability. It has nothing to do with "giving them your best service" or best patient-care if you carry them around if they don`t need it.

I kinda agree except I would place emphasis on the other part of the post. The part about where I am going to avoid as many hazards for my patient as I can. If giving them a push ride is less hazardous and more practical, that will be my choice. In the end I can't just say "sorry you fell on the way to the ambulance mate" or risking injury while walking some dude to the truck.

[Vorenus]

I kinda agree except I would place emphasis on the other part of the post. The part about where I am going to avoid as many hazards for my patient as I can. If giving them a push ride is less hazardous and more practical, that will be my choice. In the end I can't just say "sorry you fell on the way to the ambulance mate" or risking injury while walking some dude to the truck.

I can see your point.

Still, in my opinion, if there`s no medical reason for not letting them walk, it`s really just fantasizing about the worst possible outcome of a situation, which has per se nothing to do with a practical treatment plan.

Following that point, we`re back at "every patient is carried".

[J306]

I'm curious as to how long you've been in EMS. If you've mentioned it previously I either missed it of have since forgotten.

While I appreciate the position you're taking, you're going to find that you're going to encounter many patients who don't either need or deserve to be transported on the stretcher. This doesn't imply a lack of professionalism on your part. It represents a fact of life and will become a practical part of your life in EMS.

This isn't coming from a disgruntled, back injured old timer. This is from someone who has seen too many back injuries from people who do everything right in terms of lifting yet wind up flat on their back with debilitating back injuries.

I've been in EMS for about two and a half years and just got accepted into school for ACP starting in September.

On my first year of my career I worked in a northern reserve community where the terrain was very challenging and houses had missing stairs and endless amounts of obstacles in the yards. We had no stair chair, scoop stretcher, FD, or backup unit to help lift for the more difficult and barriatric pt's. I found myself having a lot more of my patients walk if possible than I would now in my city job with FD responding to all of our code 4 calls and with a stairchair on our main unit.

The point was made that your geography has a lot to do on how frequent and to what extent you lift patients and with that in mind it makes a lot of sense why there would be such a contrast of opinions on this topic.

[DFIB]

I can see your point.

Still, in my opinion, if there`s no medical reason for not letting them walk, it`s really just fantasizing about the worst possible outcome of a situation, which has per se nothing to do with a practical treatment plan.

Following that point, we`re back at "every patient is carried".

I guess I fantasize a lot!

[mobey]

I need to see/hear a medical reason for them not to walk (always with assistance btw).

At risk of sounding like a "grumpy old guy", I give medical care at many levels.... but I am not a wet-nurse, I do not carry my patients thinking it is some superior care.

I assist each patient to the level that they require it, sometimes they need a little encouragement to get thier drunk ass off the curb and walk, sometimes a stable yet frail elderly patient gets carried so they don't injure themselves.

That is how it should be though, a case by case basis. If you are generalizing treatment of your patients, you are behind the 8-ball.

[J306]

That is how it should be though, a case by case basis. If you are generalizing treatment of your patients, you are behind the 8-ball.

Well, I generally believe that patients should be treated/transported in a way which will preserve their dignity and reduce the risk of further injury or unnecessary exertion which could worsen their condition. I would agree that anybody in EMS who has a generalized tx plan before even assessing their patient has a long way to go.

[ambodriver]

I'm a big fan of the walk to the ambulance, unless the extertion from the walk will make the pt. worse off. Or if an injury prevents walking or (safe walking).

I do work in a high volume inner city area though, if that means much.

[LegendaryPunk]

Aside from patient safety and a potential diagnostic tool, there are other factors I consider as well.

I had one patient with difficulty breathing who was arguing with me about needing to go to the hospital. Eventually, he came up with the excuse that he didn’t want to scare his wife and kids by having them see him being wheeled away in a stretcher. Ordinarily I don’t like to make people with difficulty breathing exert themselves, but it was a short walk, and it got him into the ambulance. Obviously this did nothing to improve his condition at the time, but it let him keep a bit of his dignity, and helped gain some patient rapport, making him more willing to work with me from that point forward.

I’ve also walked patients who I probably should have put on a stretch because it meant less time spent on scene. Rather than working with a couple different contraptions and navigating a house with tight corners, I’ll have the patient walk so we can be en route to the hospital within five minutes instead of twenty. These were situations when I saw the patient and thought, “this guy is sick and needs to get to a hospital NOW.” If I have time to stay and play on scene I have no problem putting patient comfort higher on my list of priorities and giving them a full ride to the ambulance. This also does not apply to trauma calls.

Generally though, it’s just based on my initial diagnosis of how sick they are. If the patient is borderline between sick / not sick, I will just ask them; if it isn’t a life or death decision, I’m perfectly happy to let the patient make their own (informed) decisions about optional treatments.

[DwayneEMTP]

Man, great discussion...

I think it most likely boils down to the cost/benefit discussions that we've had with a couple of our favorite posters.

It can be seen many ways. If you're in a system where there are a ton of whackers that walk nearly everyone out of laziness, your c/b scale may be tipped simply because you feel better for showing yourself that you're not one of them.

Or if your experience has been that Grandmother/father nearly always seems to somehow bang their shin on the coffee table that's still 4 feet away from then, then perhaps you're happier wheeling them whenever you can.

If, as has been mentioned, you know many strong, healthy people with injured backs despite being professional and conscientious, then walking is a no brainer for you.

Maybe you're doing 15 calls in a 12hr shift in a place where nearly all patients are hard to get to, then carrying everyone has got to seem insane I'm thinking.

For the professional, it will always boil down to cost/benefit I think, but what tips your scales will likely be different for all.

For the whacker, cost/benefit will likely never be as important as convenience, so I'm guessing that this is the persona that Bieber was more than likely looking for protocol advice on.

Dwayne