I think the Pt's are getting it in the...........

[letmesleep]

All good points, and some even made me stop and ask myself "why do I care?" In the scenario I mentioned, Pt "1" was cleared on the scene, and Pt "2" did get the LBB with a precautionary line (blah, blah), due to his complaint of lower back pain. Both Pt's were DC'd later that day

I would also say that this is a new thing for our Med Control (the trauma alerts), that begun earlier this year, and maybe it's got to do with being a creature of habit (my weakness). Could be a pride thing, let me explain..........Years ago we had multiple smaller agencies abusing the helicopters, The powers that be (med con) came in and took out their ability to fly based solely on MOI. (foot note: I agree that this is preposterous, MOI should only be a piece of the puzzle.) Now I am seeing this same ER calling these "alerts" based only on MOI for political reasons. Can I save the world? NOPE! And I know this, but it seems as if this might be a contradiction to me and is an unnecessary charge for our Pts.

Ruff, you made a good argument with the CP Pt, and being in 2 different regions this may sound like an argument from me, but it isn't. Here our Pt's get charged for:

BLS- resident

BLS- nonresident

ALS- resident

ALS- nonresident

We are 100% ALS, however if the transport doesn't require ALS skills, the charge becomes BLS. I do understand what your saying to me, and It does make sense (made me see it another way)

And as far as you DUST.........I'll take your minus 5 points.....I got you to respond!

[whit72]

Ruff wrote:

Death of same car occupant

Passenger compartment intrusion of greater than 20 inches

and so forth and so on etc etc.

I understand transporting these people to trauma center. Would you fly them without significant or life threatening injuries? This is where assessment comes in. I don't fly hemodynamically stable patients without significant injury. We have that same criteria in our protocols. This is an excerpt:

The following should be considered in deciding whether to request air medical transport, but are not automatic or absolute criteria.

Mechanism of Injury:

Motor Vehicle Crash

- High speed MVC

- Prolonged extrication > 20 minutes

- Fatality within the same vehicle

- Ejection from vehicle

Pedestrian struck by vehicle and thrown more than 15 feet, or run

over by a vehicle.

Mechanism alone wont get you flown by me. If mechanism along with significant complaint, noted injury or hemodynamically unstable vital signs, will buy you the bird. I don't concern myself with cost or the political bullshit. If I think its warranted that thats how you go. I haven't had a problem in over ten years. If a flight isn't beneficial to the patient then they don't get one.

[Just Plain Ruff]

Whit I totally agree with you. unfortunately our protocols at one service were non-negotiable. MOI alone will get you a bird.

I'd like to have thought for myself but hey, Medical control says to fly due to MOI so I did.

If it was up to me, half the people I flew wouldn't have gotten flown.

[whit72]

Sorry Ruff, now I get it. Wow. That could get expensive.

[flight-lp]

Wow Whit, we agree finally.............

I HATE it when people use the asinine MOI excuse. Ruff, man that sucks that you cannot use your professional assessment abilities to say whether or not a pt. get flown. I'd like to see more air services start to say no to these B.S. pts. After all, its their lives on the line, not the ground crew. Maybe after being told no a couple of times, your med con will rethink that policy......................

[Just Plain Ruff]

actually it was for a service I previously worked for.

[JakeEMTP]

This is our local policy regarding Air Transport. The Medical Director does give us the ability for us to consider calling for EastCare or not.

http://www.greenvillenc.gov/uploadedFiles/...ocols%20v.2.pdf

Also, there is criteria in place to alert the hospital as to the severity of trauma we are bringing in ie: Trauma red, yellow or green.

[whit72]

I have begun to witness this trend in EMS. More and more I hear from new EMTs and medics: Well our protocols state this, and we are not allowed to do this, without this. Its like the human decision making element is being weeded out of EMS. No more assessment, if you find this, then do this. If you see that, then give that. Its quite scary.

Its almost like they would rather have you follow a flow chart. Then assess a patient and make a treatment decision based on your findings. Now I am no brain surgeon, but most of my EMT class if I remember was geared towards assessment, Its like their pumping out non decision making robots. Like they dont want these people to think for themselves cause their afraid of what they might come up with.

I always prided myself on being able to assess a patient and most of my college education was also directed towards classes that would help improve that. Although my degree will probably take me out of the patient care field. I have learned things in just about every class that I have taken that I can in one way or another use to help me better assess my patients.

The new trucks we have just put in service have electronic BP cuffs, a fancy pulse ox. all this French equipment that allows the provider to just plug the patient in and two minutes later the machines spit out whats wrong with the patient. Its bullshit. When I started we had a twenty year old BP cuff and stethoscope, thats what we relied on. Now these new riders they just want to plug the patient in sit in the tech seat and tell me about all the lives they have saved. I have a cabinet in my truck thats designated just for batteries, everyday I come in and see that cabinet it makes me cringe at what we have become. Don't get me wrong I like technology and the advances we have made, but when some meathead has to take his truck out of service because the batteries in the pulse ox are dead, and he cant confidently assess someones breathing without the flashing red numbers, I get a little pissed off.

I just hope that somewhere down the line we can refocus our attention on the importance of recognition and assessment. Its the best tool we have. It also can never be replaced by something that runs on batteries. Yes we all have fancy little toys, some more then others. However if you cant assess your patient, which I have witnessed is becoming a lost art, then all that equipment isn't worth jack shit.

Whit72<----------- Gets off his soap box, and smashes it into a million pieces.

Sorry for the rant, my regular partner was out yesterday and I had to work with another guy who cant get to an address without plugging in his five-thousand dollar GPS system, it took him longer to plug int the coordinates then it did for me to find it on the good ole ten dollar map. You should have seen this thing you would have thought we were piloting an un-manned space shuttle. I was thinking to myself what this guys reaction would be if I took his overpriced map book and launched it into the bay.

I think I just need sleep, night-night.

Sorry for hijacking the thread.

[letmesleep]

No problem Whit, and I guess this thread for was the start of the real discussion of the DECLINE OF PT CARE BY EMS. The problem I'm seeing is that we have soooooo many newbies out there that use tools such as MOI, and as whit stated, gadgets to assess their pt's.

I have been doing this for a while now and was taught by the "old school" medics that laid the ground work for where I am today. We have the fancy LP12 with the automatic cuff and all the blah, blah crap. but there is still something to be said about taking that BP the old fashion way, and tell if your pt is oxygenating based of their skin color. The tools may allow us to go more indepth, but they are not the tell all.

Here we have a minimal ETA to the ER of 20mins, and in most places up to 45mins. the air transport is typically used for level I traumas, and MI (which is not to say nothing else). I was never so happy years ago to see the MOI taken out of the protocols, and it forced this system to be stronger. It truly bothers me that the hospital staff has reverted back to such an obscene use of this tool.

As far as the cost factor to the pt, well I have always said that I didn't get into this field to "break the bank" for the pt's. I do agree with the statements in this thread to a point, but lets look at the other end of the cost issue too. Would you push transport on somebody who had the Fx index finger after slamming their finger in the car door? I work 24hr shifts, and will transport anyone who demands transport, but they will be informed of a possible cost handed to them, this is our policy. I just feel with this TRAUMA ALERT issue, that the pt's are not getting to make a choice in their own health care (when it is unnecessary), it's just getting forced on them, and WHY? politics/ certs/ pride whatever the reasoning of the hospitals, and whatever the procedure should we have the choice as consumers? Where do we as professionals draw the line of being that advocate?

Damn, talk about a rant!

[Dustdevil]

I have begun to witness this trend in EMS. More and more I hear from new EMTs and medics: Well our protocols state this, and we are not allowed to do this, without this. Its like the human decision making element is being weeded out of EMS. No more assessment, if you find this, then do this. If you see that, then give that. Its quite scary.

I certainly agree with your conclusion, however I'm not so sure about your timeline. I don't think this is anything really new. It seems that a great deal of the country has always been this way. I haven't been seeing systems where the human element is being removed. I have been seeing systems where it was never utilised to begin with. It's always been a cookbook field, for the most part. And really, we have never done anything to convince the medical community that we are worthy of anything more. With three quarters of the EMTs and medics in this country actively fighting against improved educational standards, I wouldn't look for things to get any better in the near future.