Emergency response back to Hospital

[Dustdevil]

Exactly! Now, if he had reqested that you run hot, and you did not, then he might have a legitimate beef. The onus is on him as the responsible medic. I would report him on all counts. I would report him for hostile behaviour (for which he should be immediately fired, no questions asked). I would report him for poor medical judgement (for which he should be immediately fired, no questions asked). And I would report him for not communicating with you regarding patient care (for which he should be immediately fired, no questions asked).

But now, the one thing that has been bothering me since the original post is, what is your definition of a "stable" patient. What exactly did you see that made him "stable?" The term "stable" is SERIOUSLY misused in EMS by people who really have not the slightest idea if their patient is "stable" or not. Can you clarify your observations and rationale for us?

[Mediclcems]

Sounds like your partner has a case of "Ricky Rescue". SHOOT HIM!!!!!!

[JakeEMTP]

Your partner has a classic case of whackerdom!

I see where your partner wasn't sure what was going on and you considered the pt to be stable, yet you were driving. A more appropriate finding would be " within normal limits " for V/S. Everyone would be different. If the pt's airway was not compromised or he was not showing signs of a MI, then running with L & S is totally contraindicated. Since there is a radio in the back of the ambulance, they should have contacted the hospital with the results of their assessment if they were truly concerned with pt care, and let them decide whether to run L & S or not. You partner obviously watches to many " Paramedics " episodes or is it " Saved! " now?

Wait, you would have been at the ED before you most likely had had a MD on the other end. Scratch that. :wink:

[FireGuard69]

Vitals somewhere in neighborhood of 132/90, HR 84, R 16

No pain

Walked to ambulance, said dizzyness had lessoned, not as nauseous.

Not bad at all, IMO

[CoyoteMedic]

Studies have shown that running to the hospital code 3 (L&S for your northern folks ), it increases the chance of a MVA involving that unit 10 fold. When your pt has a clear airway, is breathing on his own, has a good pulse, and is not complaining of any serious signs or has any serious symptoms (Hypotension, Chest Pain, SOB, Altered Mental status), where is the point in endangering yourself, your partner, the pt, or the general public? The entire point of EMS is to do whats good for the Pt. Granted N/V is a s/s of a MI, but there are alot of other factors out there that even a EMT-B can use to find out if the pt is actully having a MI. If your partner is this unsure of himself with regards to field clinical impression, then whats best for the pt is for him to find another job.

Everyone else on here has given some sort of example, so why not...

this weekend I was working as a 3rd person on a rig. Two medics and a EMT-B, I was the secondary medic. We were called out for a ALOC at a apartment complex with about a 25 min travel time to the nearest hospital. We get there, its a pt who hasn't been responding all day (its late afternoon), and has had snoring resp per the wife. She put him on her bi-pap last night because he had been having trouble breathing at night. On assessment his BP was WNL, but his pulse was elevated. Fire already had him on O2 by the time we got there, we get him loaded up, sinus on the monitor, shallow resp at 24, L/S congested. He wouldn't talk, but followed very simple basic commands. Get'em in the elevator to down to the rig, and I noticed his pupils were pinpoint. The gent had a cardiac hx, and his meds confirmed this, but no narcs were noted in his meds. Well, he really didn't meet our local protocol for narcan, so the primary medic instructed the EMT-B to start to the hospital code 3. We got a line in him, and after talking it over, the primary gave him a mg of wake up juice because we desided his resp were not adiquate. Go figure. His pupils go from about 1 mm to about 4 mm within seconds, and he starts talking to us.

Had the narcan not worked, you bet we would have kept going code 3 because we have a altered mental status with a unknown cause. But since he came around and stabalized respitory wise, where need is there to continue code 3? There's not. So we down graded, and coasted in.

My 2.8725165761 cents

EDIT: BTW, accu check was WNL

[Dustdevil]

Vitals somewhere in neighborhood of 132/90, HR 84, R 16

No pain

Walked to ambulance, said dizzyness had lessoned, not as nauseous.

Not bad at all, IMO

Not bad, but what made them "stable?"

It takes more than one set of vitals to determine stability.

[FireGuard69]

With a C/C that had lessoned, CAO x3, and in no obvious distress. Had somehting happened to change that, you bet you ass I would have lit it up, but why risk it?

[kgrescue447]

OK I'm a newbie here so forgive me and don't yell at me for putting my 2 cents in . i am an EMT -b i volunteer at a county squad with a 45 min transport with no lights or siren . in my squad it is up to the provider how we respond to the hosp. if i was like 3 min from the hosp i would have said to drive like normal.

but this guy's issue probably just wanted to hear the sirens :shock: . but in a case like this it's hard to say how i would have handled it (not being there) . you did give us the vitals . seem pretty stable but like i was taught we don't deem a pt stable.what if a bls provider picks up a pt with hx of hypertension and her b/p is 118-72 just for saying and she tells you that is way to low to her norm .OK so i start to think what is the prob .just because 120/80 is the text book version of a b-p doesn't mean that a higher or lower b-p is bad in my opinion. once again i am new hear and i love this place just by the forums i read and all the good stuff i could learn ya'll have a good day and be safe

[JPINFV]

OK I'm a newbie here so forgive me and don't yell at me for putting my 2 cents in . i am an EMT -b i volunteer at a county squad with a 45 min transport with no lights or siren .

Just a pet peeve of mine. If you're willing to participate, be willing to take critisism. It's how we learn. Sure, some people can be a little harsher then others, but ignorance (not knowning better, please don't take that as an insult. Everyone is ignorant of something) is not an excuse. The fact that it is your opinion, you're a volunteer, or your a basic doesn't make what you say immune. Same would go if you were quoting a medical study, as a paid paramedic.

in my squad it is up to the provider how we respond to the hosp. if i was like 3 min from the hosp i would have said to drive like normal.

but this guy's issue probably just wanted to hear the sirens :shock: . but in a case like this it's hard to say how i would have handled it (not being there) . you did give us the vitals . seem pretty stable but like i was taught we don't deem a pt stable.what if a bls provider picks up a pt with hx of hypertension and her b/p is 118-72 just for saying and she tells you that is way to low to her norm .OK so i start to think what is the prob .just because 120/80 is the text book version of a b-p doesn't mean that a higher or lower b-p is bad in my opinion. once again i am new hear and i love this place just by the forums i read and all the good stuff i could learn ya'll have a good day and be safe

No offense, but this "we can't decide this or that" is poppycock. We decide every day if a patient is stable enough to warrent or not warrent emergency (code 3, L/S, what ever you want to call it) transfer. I bet your intructor also warned you against using specific words to describe the situation because it could be considered "diagnosing" too. Ohh, and if you want to know more about blood pressures, look up "mean arterial pressure."

[Lithium]

I was driving, and since the pt was, in my opinion, stable, I elected to not go to the hospital Lights and Siren.

Well, I think I solved your little dilemna right there. You were driving, therefore your partner was the one attending correct? This means that he or she is ultimately responsible for patient care, which would include return priority and destination. Since you 'assumed' this patient was stable (I'm not going to get into the argument of whether the patient was or was not, that's not the issue) you decided to take it easy back to the hospital. Your partner, on the other hand, believed the patient warranted an expedited trip.

What this amounts to in my opinion, is a lack of communication between you and your partner. A simple "what return would you like?" to your partner, and there is no doubt where their head is at, at that moment. You may certainly disagree, but that is the time to dispute it, not afterwards. If the patient truly was stable, then rationally explain this to your partner. Perhaps, the patient began develloping chest pain or something else you were not aware of and he didn't mention it. All I'm saying is that I've made it a habit to ask my partner before leaving the scene, and to keep me updated on the way in. Again, failure to communicate!

peace