Do you ever feel annoyed?

[ERDoc]

Yup, sounds like a patellar dislocation. I'm not doubting it was an MD or DO, but it doesn't mean they were trained in Emergency Medicine. An EM trained doctor would have hit you with some propofol, reduced it, immobilized it and had you on your way before an orthopod would have made it to the hospital.

[Inthecity]

Yeah definitely no propofol for me. That would have been nice instead of suffering for like 1.5 hour between the time I dislocated it, got to the hospital and orthopedic finally came. The morphine did take the edge off though. So what is the difference between knee and patella? Patella is just the knee cap and the knee is the entire knee gets dislocated? And all this time I thought my knee was dislocated.

[croaker260]

Yup, sounds like a patellar dislocation. I'm not doubting it was an MD or DO, but it doesn't mean they were trained in Emergency Medicine. An EM trained doctor would have hit you with some propofol, reduced it, immobilized it and had you on your way before an orthopod would have made it to the hospital.

Just to point out, since we in EMS tend to get the patient within 15 minutes of the injury, I would say that 99% of the time IMHO, we never sedate at all, the reduction is quick and minimally painful, it remains a BLS call, and the patient then goes in via POV to the ER for follow up.

By the time an ER doc gets to the patient, orders the propofol, and meets what ever institutional requirements for conscious sedation his hospital requires......it is easily 45 plus minutes after the call, and by then you likely need sedation to reduce the injury.

Not bashing you at all Doc, just providing a little different perspective.

Edited April 14, 2012 by croaker260

[ERDoc]

No bashing at all. I was just commenting on what happened to the OP. Usually when you guys get there, they are still feeling the adrenaline rush and it can go pretty well.

[Kiwiology]

By the time an ER doc gets to the patient, orders the propofol, and meets what ever institutional requirements for conscious sedation his hospital requires......it is easily 45 plus minutes after the call, and by then you likely need sedation to reduce the injury.

45 minutes? do you have to call down the acute anaesthetic registrar or something?

[HERBIE1]

That sounds like a PATELLAR dislocation, not a true KNEE dislocation, and yes we see them. We have a protocol for Patellar reduction, and depending on the time frame involved, frequently treat and release them.

True KNEE dislocations are a different matter, and are limb threatening. TRUST ME, you would know the difference.

For my fellow EMS'ers out there.....Here is the link to our protocol for this. http://www.adaweb.ne...7I%3d&tabid=798

It's times like this when I am truly disgusted at how backwards and out of date our EMS system is. Field reduction of a patellar disclocation, and then not transporting??? Wow.

Maybe we'll see that here in 30 years-long after I'm worm food.

May I ask how long your transport times are, Croaker?

[croaker260]

It's times like this when I am truly disgusted at how backwards and out of date our EMS system is. Field reduction of a patellar disclocation, and then not transporting??? Wow.

Maybe we'll see that here in 30 years-long after I'm worm food.

May I ask how long your transport times are, Croaker?

Well, we have a mix of urban, suburban, and rural, with occasional frontier when we respond out of county or forr our Tech Rescue team. Plus huge difference between winter and summer here.

The following is "off the cuff" as I dont have our yearly report readily available.... Typically (say 90% of calls) our transport times vary between 5 and 30 minutes. I dont know the average, but I am guessing 15-20 min mark. that can double in the winter. Depends on the unit though.

So...not really all that long. But remember, it is mandatory for the patient to go in for evaluation, just not by ambulance.

Edited April 15, 2012 by croaker260

[HERBIE1]

Well, we have a mix of urban, suburban, and rural, with occasional frontier when we respond out of county or forr our Tech Rescue team. Plus huge difference between winter and summer here.

The following is "off the cuff" as I dont have our yearly report readily available.... Typically (say 90% of calls) our transport times vary between 5 and 30 minutes. I dont know the average, but I am guessing 15-20 min mark. that can double in the winter. Depends on the unit though.

So...not really all that long. But remember, it is mandatory for the patient to go in for evaluation, just not by ambulance.

Thanks for the info.

That's what I was afraid of. Just confirms the fact that our system is still stuck in the dark ages.

The only glimmer of hope I have is that we have had a recent influx of young medical directors in the area, and they do seem to be open to more progressive/aggressive prehospital care, and seem to be more hands on, vs letting the nurses run the show. The old school medical directors delegated far too much authority and control to the nurse coordinators.

Now if we only can get rid of some of the old school ER nurse coordinators who seem to still harbor animosity towards EMS workers, things may change.

[Chief1C]

Do you know what annoys the piss out of me? Patients who make me look like an idiot; and providers that don't recognize "Pain" as something that needs to be treated.

Take Patient A. Patient A has a fracture, and both Patients A's vitals, and their demeanor points to them being in a significant amount of pain. 10/10. Patient A is trying to be strong, but crying through it. Patient A had no significant mechanism, and no other injuries, and probably could have gone POV. But Patient A's parent called 911, because Patient A appeared to have a syncopal episode, while splinting the fracture.

EMT A calls an ALS unit, to manage Patient A's pain. What does patient A do when the paramedic gets on board? Patient A is suddenly pain free, and doesn't know what EMT A is talking about. Then, after the ALS unit releases care to BLS... Patient A is crying again, and in severe pain. EMT A wanted to scream "if you didn't want help, what the fuck did you call us for", but didn't. Thought it probably increased EMT A's BP ten fold.

Then, you have Patient B. Patient B is in a severe amount of pain, and is a hospice patient with a certain form of Cancer in the abdomen, and Patient B is dying. Patient B told the hospice nurse to shove it up her backside, and decided that since there were no meds to help, that 9-1-1 was the best choice. Patient B is okay with death, but would rather not lay in bed, in agony. Patient B is clearly shocky, and vitals show it; Patient B is in tears, and gripping EMT A's hand, screaming like there is no tomorrow - which there might not be. ALS boards, and won't give the patient any meds for abdominal pain... Because abdo pain is too hard to diagnose.. and releases care. EMT A calls medical command, and states the obvious, that the patient doesn't need a diagnosis, the patient needs pain management. Which brings Paramedic B... another ALS unit, who gives the patient enough MS, so that EMT A can feel his fingers again.

Those are the sort of things that annoy me.

[Asysin2leads]

Croaker, I've said plenty on my feelings on reducing injury without analgesia. A patellar dislocation is incredibly painful. Reducing it is very painful as well. Continuing the practice may put your service at the risk of liability. I know you're not the one making the decisions, but that practice needs to change.