Emergency response back to Hospital

[1EMT-P]

Do they have a lights & siren protocol where you work? We had a protocol that covered when we could use lights & siren...

[Michael]

If I hear another amateur parroting that tired old cop-out "we don't diagnose," my head is going to explode. :?

Dx: Incipient pre-detonating cranial borborygmus originating in anticipated exposure to recurring audiomimetically dillentante, psittaciformogenically lethargic, geriatric pseudo-deontology.

Howzat?

[Niftymedi911]

Well, first of all if nausea / vomiting were the c/c why are EMT's running the call? Now given wether BLS or ALS we are all together, but if there is an ALS agency able to transport like stated. They should have been dispatched to the scene. Mind you it says in EMT-B textbooks if its a ALS call, call an ALS unit to transport. If I was on a BLS truck, I wouldn't of moved until ALS got there. We as EMT's dont have the medical knowledge medic's have. Why would you take a priority 2 ALS call in the first place??? Likewise first response is probably gonna be BLS to being with.

Per our protocol's any nausea/vomiting with abdominal pn is a priority 2, IV with 250 bolus of NS, and Phenergan at the correct dosage PRN, ECG, any further symptomatic treatment and montior vitals enroute. We have all standing orders. We dont have to call for medical direction, just a telemetry report letting them know we are enroute. Anyway, in the case of running 10-18 (L&S) If your the driver you have absolutely no right to decide wether 18 or 18X (- L&S)is warranted. The medic attending makes the call reguardless of stability. I ALWAYS ask before I roll away from the scene. In fact per our SOG, thats the way it should be done.

Now, the medic should have spoken up if he wanted different. Talking about afterwards isnt the best thing. It just lets the fact simmer and blow up worse. Now, the medic being at your throat is also dead wrong. If it was SO IMPORTANT you had to go 10-18, then why the hell did he not speak up when you started transport at 10-18X, so you could make the change to 10-18??

We rarely run 18 to facilities. Priority 1's are the pretty much the exception. Trauma Alerts, Stroke Alerts, OB p/t's in labor, Airway Alerts ( Intubation in the field requiring Etomidate, Succ's and Diprivan), Active Seizure p/t's ( status Epliticus), severe hypotension from GI Bleeds, pretty much anyone who is suffereing from CTDRTF syndrome. (Circuling the drain, ready to flush)

[flight-lp]

Well, first of all if nausea / vomiting were the c/c why are EMT's running the call? Now given wether BLS or ALS we are all together, but if there is an ALS agency able to transport like stated. They should have been dispatched to the scene. Mind you it says in EMT-B textbooks if its a ALS call, call an ALS unit to transport. If I was on a BLS truck, I wouldn't of moved until ALS got there. We as EMT's dont have the medical knowledge medic's have. Why would you take a priority 2 ALS call in the first place??? Likewise first response is probably gonna be BLS to being with.

It is a BLS truck, that is why. Why would you sit and wait for ALS when the hospital is 3-4 minutes away? Why not just transport to the hospital. If they puke, give them an emesis bag or basin. Honestly, I fail to see the significant events transpiring that call for a delay to wait for an ALS unit. Now granted it would be optimal to have a Paramedic on the truck, but unfortunately thats not always the case. So with that in mind they have to do what they can with the resources and knowledge that they are equipped with, its called improvision. You can't just throw your hands in the air and say "we aren't going to take this patient" or "why didn't an ALS unit take this call". Deal with the situation at hand.

Also, since the " EMT books" call for ALS on an ALS call, does that mean we can call a nurse for nursing home calls??

(Sorry Rid / Dust / etc.........Had to take a jab) Throw your book out the window and use some practical hands on common sense, it will get you further down the road in this career........

We rarely run 18 to facilities. Priority 1's are the pretty much the exception. Trauma Alerts, Stroke Alerts, OB p/t's in labor, Airway Alerts ( Intubation in the field requiring Etomidate, Succ's and Diprivan), Active Seizure p/t's ( status Epliticus), severe hypotension from GI Bleeds, pretty much anyone who is suffereing from CTDRTF syndrome. (Circuling the drain, ready to flush)

Diprivan?? For RSI?? In the field??

[Ridryder 911]

Throw your book out the window and use some practical hands on common sense, it will get you further down the road in this career........

Wow ! A new concept ..........it's called thinking!

R/r 911

[Niftymedi911]

Yep, we have a RSI program called Crash Airway Management.

If we are on scene of a p/t who needs an airway but has a gag reflex we use the Etomidate and the succ's to put the p/t under then keep the p/t sedated using a diprivan drip to the hospital. We have 2 helicopters in our fleet if any pri 1 is outside of 15 min transport we send Medstar 1 or 2 depending on availablity. If you would like a copy of our medical protocols I will be happy to leave the website address at the end of my post.

I'm also sorry about what I said earlier, flight-lp kind of made me realize what I wrote. Your exactly right many agencies make do with what they got. We are kind of spoiled here in Lee County, FL we have 33 ALS 911 response 24 hr units 4 12 hr ALS interafcility and 911 response trucks, and almost every fire/rescue district is ALS non-transport, we are not metroized, we have 22 independant fire districts in the county. We are the sole transport provider for Lee County. We also make pretty good money for what we do. Medic's start at 52,000 a year. EMT's at 38,000 a year. So I would like to retract what I said about calling an ALS unit, it wasn't very necessary for me to add my 2 cents. And your right common sense does go a long way......

I'm always on an ALS truck so I dont have the experience of being on a BLS truck so from my point of view I said was only b/c of the lack of experience on a BLS truck.

Anyway, here is that copy of the address for our medical protocols:

[web]www.lee-ems.com[/web]

[Coop]

Egad. I used to live in Ft. Misery --I mean, Ft. Myers. Heh. Small world. I'm actually wearing a T-shirt from Ft. Myers right now --Medicine Man Music.

This has been said countless other ways, but I think you did the right thing. If you were that close to the hospital, going in hot wouldn't have saved you much --if any-- time. It sounds to me as though your colleague may be upset more that you usurped what he believed was his authority --which is _his_ flipping problem.

Best,

--Coop

[Dustdevil]

Per our protocol's any nausea/vomiting with abdominal pn is a priority 2, IV with 250 bolus of NS, and Phenergan at the correct dosage PRN, ECG, any further symptomatic treatment and montior vitals enroute. We have all standing orders.

Bummer. Sorry to hear that you guys work in such a restrictive system. That's inevitable in a state that is dominated by fire EMS though.

Anyway, in the case of running 10-18 (L&S) If your the driver you have absolutely no right to decide wether 18 or 18X (- L&S)is warranted. The medic attending makes the call reguardless of stability. I ALWAYS ask before I roll away from the scene. In fact per our SOG, thats the way it should be done.

Minus five for using codes in conversation. Nobody knows what that means, and it makes you sound like a wanker.

If it was SO IMPORTANT you had to go 10-18, then why the hell did he not speak up when you started transport at 10-18X, so you could make the change to 10-18??

Excellent point, despite the inappropriate use of codes. That is indeed the bottom line.

[hfdff422]

Tell your partner to take an EVOC course! And if he is so unsure of his abilities in regards to patient care an assesment that he felt the L+S was reasonable, then tell him to take a refresher course! He must be one of those 71% EMT's who is afraid to spend some time with their patients and actually do some work.

As for the communication issue, I hate it when someone assumes how and where we are going. The ambulance better not move until I say it moves. If you start driving before I tell you to, I will "correct" you after the run. Of course that does not involve yelling.

Kgrescue- If you are not sure if you want to advance or not after six years, please do EMS a favor and find some other ego stroke. Be the best you can be, or don't do it. This business really is life and death. Being satisfied with in-service is not going to score you any points. I personally completed my in-service time 3 months after my book came (it is a 2 year book), as in-service requirements are a joke.