Things you've missed

[PRPGfirerescuetech]

Show me a medic with a total scene time of less < 30 minutes on a medical call.... and I show you something they missed or did not perform.

R/r911

30 minutes?

Seems a bit long to me....dont ya think? Even with ALS assessment, initial treatment, interview monitor and vitals...30 minutes is a bit extensive....meh....maybe im wrong.

Ive you said less than 30 minutes of patient interaction, it would make more sense to me i suppose....

[akroeze]

Didn't you ride with an ALS crew? We're not saying that EVERY call should be half an hour on scene. But also please don't think we rely solely on those mnemonics to perform our assessments. The ACR will list those same mnemonics, as that is what the MoH wants to ensure was assessed.

For instance, even though that most calls are medical related, I still perform very throrough and detailed PHYSICAL assessments. No, not the typical "okay, can you squeeze my hands?" thank you!" and then have the gall to document and report that there is no deficits. I'm probably one of the few ACPs in Ontario, who on every respiratory call, will perform a complete physical chest assessment. Have you ever seen an ACP, or PCP for that matter percuss a chest? No. Why not? Beats the heck out of me ... chest percussion to me is as essential as a stethoscope. However, I won't do it in the back of the ambulance, purely because I can't hear as well. Secondly, since I'm disrobing the patient of most of their clothes anyways (and yes, women can leave their bra on) I do it in the privacy of their home, which I guess 'prolongs' my scene time. Also, what about spirometry? I've 'acquired' ( ) a spirometer, and routinely use it on these patients as well. All it takes is a few extra seconds and all I do is ask my local ER nurse for a few of those disposable mouth covers and bingo, another assessment tool. So, this patien is complain of dyspnea, you ausculate and find the lungs are pretty clear, maybe a little shallow, SPO2 is 98% on RA, what would you think? Now, after percussion, I tell you their chest sounds a little dull and their expiratory flow is diminished ... now what do you think?

As well, I really like to sit through my calls and think, absorb what's going on and try and put it all together. How many cranial nerves are you evaluating when you speak to your patient and shine a light in their eye(s)? How many of them aren't you evaluating, what does that tell you, what doesn't that tell you, and more importantly, how does it relate to the patient in front of you?

peace

Nope, didn't ride with ALS. Nearest ALS is about an hour away... this is a BLS only service.

I guess I don't see why what you are saying is specific to ACPs.... I can do those things as a PCP too.

[678 Responding]

Your point is lost. Perhaps you aren't familiar with the terminology though. An ACP is an ALS paramedic. And, as was well explained, it takes an advanced provider longer because he's doing more than taking a pulse, respirations, and blood pressure before transporting. When you have nothing to offer the patient, then yes, you need to get off the scene. But an ACP will in many cases be providing on-scene treatment to the patient instead of making him wait through a ride to the hospital before receiving any care. After all, that is what we are there for. If that takes half an hour, so be it. It still beats waiting until they're seen by a busy ER doctor.

I understand an ACP is an ALS provider, but they arent doctors. There are only so many things you can do on location until you start inventing them. Want a portable lab while you're at it?? There has NEVER been a medical call where I have spent 30+ minutes on scene with ALS personnel. If you can give me a breakdown of an assessment that would take 30+ minutes, that'd be great, because I cant think of many things that should take that long. Any and all ALS I have worked with expect the patient to be on the way to the truck within 10 -15 minutes. You can perform all the assessments you want in the field if there is "nothing seriously wrong", but you know what, if they sit in the ER waiting, they're going to wait anyway until a doctor can get to them and do the same thing over. Sorry, but we assess and treat, not diagnose. Again Lith, this isn't a personal attack or anything, I'm just trying to find justification in it. I'm not the only one that seems that this is a little odd.

[Lithium]

I guess I don't see why what you are saying is specific to ACPs.... I can do those things as a PCP too.

You can, but do you? There's the difference I would think. Plus, were you taught how to properly percuss a chest for instance, or administer a spirometer and understand how to interpret the findings? I wasn't until I took the CCP program ...

678, no worries. However, if you look closely, it seems to me that this is turning into another bls vs als discussion. How do I say this without offending anyone ... Yes, again, if there is a critical error noted in my primary survey, I will initiate rapid transport. However, if not, I'm not going to rush. I should mention as well, that in my area, our average transport time is only 10 minutes without lights and siren usage (and only 9 minutes and 30 seconds with haha), and I'm not a huge fan of performing initial assessments in the ambulance unless our scene prevents patient privacy (ie. shopping mall etc.)

So, as you said, you are not the only one who finds me spending 25 to 30 minutes overall on scene (from arrival to departure) a little much, but as others have pointed out, such as Dust and Rid, they don't see any problems with it as they both understand what is involved.

peace

[akroeze]

You can, but do you? There's the difference I would think. Plus, were you taught how to properly percuss a chest for instance, or administer a spirometer and understand how to interpret the findings? I wasn't until I took the CCP program ...

I give you the spirometer, can't argue that

Chest percussion, we covered it just as in depth in my PCP class as we did in my Nursing class if that helps... I don't know how in depth yours was so that's all I have to compar to.

But your point on that is moot as you yourself point out that you are the only one to your knowledge that actually does it. And regardless... it doesn't take long. So why are you taking so much longer as an ACP than a PCP does? I truly don't see where the extra 14 minutes is coming in.

[Lithium]

I truly don't see where the extra 14 minutes is coming in.

And I guess you won't until you're an ACP yourself.

[akroeze]

And I guess you won't until you're an ACP yourself.

Lovely non-answer there....

Why can't you explain why it is taking so long? What questions are you asking that I wouldn't think of? Cuz I haven't seen any skills listed that take that long...

[Lithium]

I have explained it, you just don't seem to be able to accept what I'm saying.

[MedicMal]

okay I can see this getting more off topic and into an attack fest......

I agree with Lithium, I do think some scene times (not all) can take 25-30 minutes in non-emergent patients. It's one of those things where you want to make sure you assess everything you should so you don't miss something (the original topic of this post).

Lithium, I don't think Akroeze was questioning your assessment skills/techniques, I just think he wants to learn and expand his assessment techniques (at least I hope he wasn't attacking you ) I know I'm very interested if you have any more to add, I'm always looking to better my skills.

Anyways, maybe we should get back on topic!!

MedicMal

[akroeze]

okay I can see this getting more off topic and into an attack fest......

I agree with Lithium, I do think some scene times (not all) can take 25-30 minutes in non-emergent patients. It's one of those things where you want to make sure you assess everything you should so you don't miss something (the original topic of this post).

Lithium, I don't think Akroeze was questioning your assessment skills/techniques, I just think he wants to learn and expand his assessment techniques (at least I hope he wasn't attacking you ) I know I'm very interested if you have any more to add, I'm always looking to better my skills.

Anyways, maybe we should get back on topic!!

MedicMal

I wasn't attacking anyone...

I was genuinely curious what it is an ACP does taht takes so long that a PCP doesn't... and I still don't understand what it is... that's all.