Fatal Ambulance Accident under Investigation in Utah

[Arctickat]

4) a guy who amputated his atm

Did he get the card back?

[BushyFromOz]

Did he get the card back?

[Kiwiology]

Typing on teh android for the fail - he amputated his arm

[BillKaneEMT]

Just finished a 24 and we actually had a L&S transport. spO2-72%, sinus tach, hr-132, resp-41. That was after albuterol and on 10lpm non rebreather at the nursing home. My (medic) partner concluded it was "get him to the ER right the f*#$ now" time. I've never actually seen anyone with that low an spO2 on a non rebreather with high flow. Hell, I've never seen anyone that low on room air. They just started giving me ALS shifts recently though, bls wouldn't get that call. Fortunately the hospital was about 5 miles away so we got the pt there fast and they immediately hooked him to a BiPAP which seemed to help. Last night was strange all around. Most off yesterday we had a few calls, just transport stuff. Then last night we got slammed with like 6 calls in a row starting at 23:30 or so. Very strange. But again, 5 of those "emergency" calls were completed without a flash of light or a hint of siren.

Like I said, if you use them you better be able to supply a good reason for doing so in your report. At least for my service.

[jonas salk]

In four years I have seen only four people returned on a priority one

1) an anterior infarct who was crook

2) a young girl post seizure who was very unconscious

3) post cardiac arrest

4) a guy who amputated his atm

In the 1000+ hours I've worked already this year, I think i've done 4 code 4 returns.

I was talking to a friend from paramedic school and she was saying her service (in eastern ontario), any patient who gets SR of any kind is an automatic 4 return. Personally i found that insane, but each service has their own formal and informal P&P I suppose.

[BEorP]

In the 1000+ hours I've worked already this year, I think i've done 4 code 4 returns.

I was talking to a friend from paramedic school and she was saying her service (in eastern ontario), any patient who gets SR of any kind is an automatic 4 return. Personally i found that insane, but each service has their own formal and informal P&P I suppose.

I would question whether this is truly a formal policy. It seems like in many services, things simply become accepted as the way things are done. Sometimes this is so strong that people will refer to a policy, but if you go digging you will find that none actually exists.

Certainly, the social pressures alone (without any formal policy) can still be quite strong. I am guilty of turning the lights on to call it a code 4 return with a chest pain patient when we're literally three blocks from the hospital. Why? Because it is the accepted practice at that service and to deviate from that would have either ruffled the feathers of my partner, the service, or the base hospital, despite there being no explicit policy requiring a code 4 return for all CTAS 2 patients. I know that that is not a good reason for a professional paramedic to do something that carries a degree of risk, but I have gotten to the point where I try to avoid conflict sometimes rather than trying to initiate change.

[jonas salk]

I would question whether this is truly a formal policy. It seems like in many services, things simply become accepted as the way things are done. Sometimes this is so strong that people will refer to a policy, but if you go digging you will find that none actually exists.

Certainly, the social pressures alone (without any formal policy) can still be quite strong. I am guilty of turning the lights on to call it a code 4 return with a chest pain patient when we're literally three blocks from the hospital. Why? Because it is the accepted practice at that service and to deviate from that would have either ruffled the feathers of my partner, the service, or the base hospital, despite there being no explicit policy requiring a code 4 return for all CTAS 2 patients. I know that that is not a good reason for a professional paramedic to do something that carries a degree of risk, but I have gotten to the point where I try to avoid conflict sometimes rather than trying to initiate change.

Yeah I'm certain it's not an official policy (hence the 'informal' part of the statement lol). The culture of my service is one where we rarely return code 4, whereas other services are on the other side of pendulum.

[WolfmanHarris]

For awhile there was a push from management (well the QA Sup) at my local service for Code 4 return on all CTAS 2 patients. The crews fought and fought, resisted and refused and eventually it was dropped with the BS CYA remark of: "fine but you could wear it as a result."

Where I work there's no policy at all. Code 4 return is entirely crews discretion and I've never had anyone question it. As a service, culturally we very rarely transport Code 4. CTAS 1, STEMI's and CVA's and non-STEMI ischemic CP's are usually it.

Code 4 response is at our discretion to but we tend to error on following dispatch since we've all been burned before. My last call of my last shift was a possible UTI, Code 4 due to drowsy. Arrived to find Pt GCS 5 x24 hrs, per-arrest. She was DNR but by moving quick and getting her in she was able to get BIPAP before she arrested and did end up being weaned and survived fr at least a few days. Extreme case certainly but I prefer arriving in a timely manner just to be sure.

I also had a big disagreement with a colleague on transporting active labour Code 4. I refuse in the case of uncomplicated labour. If we need to deliver we need to deliver but it's not worth the risk. He expressed not wanting to deliver in the Ambulance as justification. I pointed to the almost regular cases of unassisted home and side of the road births and that even contractions 2mins apart may be hours from delivery.

[Arctickat]

I think that over the last few decades attitudes have shifted and peer pressure have slowly become the driving force behind appropriate L/S transport. The suits may try to impose policies and procedures regarding L/S but the street medic will never respect such oversight because the suits aren't in the trenches, and it's "real" down here. 30 years ago we probably transported 4 times as many patients with L/S as we do now. My favorite concept that I stress to my students is that if you're transporting with L/S then you are incompetent in providing patient care. They eventually understand that if their L/S are on, then they do not have the competence or confidence in themselves to take care of the patient's needs. This isn't a slam at them, but that they need to recognise the limitations of their training. If they're transporting a patient that they should be able to treat and stabilise competently given their training and scope, then there shouldn't be any reason for them to use L/S. If the patient requires further treatment beyond what the medic is capable of providing to stabilise the patient, then L/S are warranted.

I'm reminded of a call I did about 25 years ago to the UAH in Edmonton. We were transporting a femur fracture for definitive care when my partner pokes his head up front and tells me he's lost the pedal pulse and can't get it back, we still had an hour to go in the trip so I completed the transport with L/S. The ER staff heard our sirens and when the triage nurse found out it was for a femur fracture she yelled across the ER to the rest of the staff, "Femur fracture, Sirens unnecessary!" before letting us give her a complete report. I suppose this was an attempt to embarrass me, which worked quite well. Then it was her turn when my partner gave a report to the receiving nurse and mentioned the lack of a distal pulse.

[BEorP]

Code 4 response is at our discretion to but we tend to error on following dispatch since we've all been burned before.

Is this a formal policy at your service for your response priority to be at your discretion or just something that is tolerated?