In the house vs. In the ambulance

[Dustdevil]

When I left the field, there was still much debate among medics in the field over whether we should carry all our equipment into scenes and work the patient where we find them, like Johnny and Roy did it, or if everybody should be dragged back to the ambulance before beginning advanced therapy. Interestingly, there was never really any question over the matter in academic circles. They had long ago established the "proper" course of action. Yet, as frequently happens in EMS, a lot of undereducated technicians take it upon themselves to decide that they know better than their instructors and do whatever they want to when they get into the field.

My specific questions are:

• 1. All things being equal, which is your preferred method of operation on an ALS medical run? Why?

2. Does your agency have an SOP covering this? If so, what is it?

3. Did your instructor or school ever tell you which way was the "right" way or the way you should do it?

4. Does everybody in your agency operate the same way, or does the controversy still divide the profession?

Qualifiers: I don't want to hear a bunch of "what ifs." This is not a trick question. It is a simple, straightforward question that does not require any reading into. Your scenario is a safe, uncomplicated medical (not trauma) scene in a well lit suburban home with the ambulance parked close by and fair weather. You are not being rushed by low staffing levels, danger, or a lack of support. And I am asking specifically about ALS intervention, not ABC's.

[akroeze]

Well in our BLS+ system essentially we treat on scene within reason.

For example, severe SOB pt. We would do primary, O2, vitals and start a ventolin treatment on scene. Our protocols state we should initiate transport after the first dose of ventolin with further treatments given enroute.

12 leads done on scene as long as they don't increase on-scene time more than 2 minutes.

IV initiation should not delay initiation of transport

Most of our med protocols involve at least the initial dose started on scene (ie where the pt is found)

[medic001918]

I voted that I typically work my patients in the ambulance. But I also feel the need to clarify and say that I do bring all of my gear into every call with me (bag, O2, monitor). If the patient needs immediate intervention, I'll start working in the house. But if the patient is stable, it's off to the truck where I can work in a more comfortable environment. While I know that you didn't want any "what if's," I felt that the answer needed some qualification since there are times that it's appropriate to work in the house, and other times in the truck.

Shane

FFI/NREMT-P

[kevkei]

All things equal, if time and the patients condition will allow, I like to take them out to the unit. I find that it is my "office", I can let in only who I want, I know where everything is, I can control the temperature and lighting, and if I need to leave in a hurry, you are two steps away.

[nsmedic393]

All things equal, if time and the patients condition will allow, I like to take them out to the unit. I find that it is my "office", I can let in only who I want, I know where everything is, I can control the temperature and lighting, and if I need to leave in a hurry, you are two steps away.

Ditto for me

[Guest]

Allthings equal safe and in order. i like to have first vitals IV and first round intervention and medications done where they are found. Then to the truck and gone. We are a bit backwards here you might say, were are an als service with bls backup. we have only paramedic staff with I and B level Parttime paid on call. so when you call 911 here you get two medics right now. If it is a full code on arrival then the "second out" paid on call team is paged to assist. Once they are onscene then we have three extra sets of hands and a driver so the paramedics are always with the PT. Not saying it is right or wrong just the way we do it

[Ridryder 911]

Returning back to field was some adjustment, that most rather do everything enroute..I prefer to be sure I perform an adequate assessment then perform tx. I has came from the old school of doing everything as much as possible at the scene.

Due to increase weight of equipment, and number of responders at the scene etc..as well as number of responses now, I prefer to tx in my unit. Of course like each call it depends on the circumstances. I prefer to tx. hypoglycemia in the residence.. they can assist to walk to the stretcher etc.. or may even fix a high protein snack and not transport.

Increasing number of responses, causes scene times to be closely monitored as well no available units. gain, each system and each patient unique.

Be safe,

Ridryder 911

[Guest]

I personally take my bag out with me on scene..depending on the situation.If pt is stable I will take a set of vitals on scene and do my pt assessment, hx, etc...and sometimes it turns out to be a pt refusal. If the pt is unstable, we load for transport and hit the road. We are trained to spend less time on scene as possible because of our long transport times. But I do take my bags out with me, sometimes I never get a chance to open them because its a load and go situation.

[AZCEP]

Since through most of my career, my scenes have been more than 40 minutes to the hospital, the only treatment that I will perform on scene is the provision of an airway. Sometimes basic, sometimes advanced, but once air is going in and out, the patient will be moving to a position above some sort of wheels. In the event an aircraft is available they count also.

[Nate]

I voted for treating the patient in the unit.

How I do things:

I carry in our jump bag, front line drugs, and monitor on every patient. Once inside I have everything I need to work a full code for a few minutes until FD can arrive to help lift/load and with CPR. Typically if they are stable and not in cardiac arrest, and are stable like how you have presented us with; I would prefer to load the patient after first round of vitals and assesment.

Why work in the truck?

I don't ever feel safe on a scene unless I'm in my truck. I prefer to work in my truck, I know that sounds odd to some, and normal to others, but that is just how I am. I was always instructed to "do what is best for the patient" and that the ambulance is safer than the scene; but if for some reason it would be better to work them there first, then by all means work them on the scene.

Scene vs. Truck

I think it is more preference. I have worked with people who prefer to remain on the scene in the house and start their IV, get a strip on a stable patient, talk for a while; that is just how they are. Others I know like to get in the truck and spend 10 minutes doing everything; while others prefer to just load and go and do everything in route.

I think it is more style then anything else.