Conflict on Dual Medic Units

[firemedic05]

I haven't killed anyone either, but I don't do IV, monitor, finger stick on every patient. Well it may work for you, is it always appropriate for the patient? I prefer to make decisions about interventions based on a need, rather than a routine or practice. It does more for my patient to prevent them from having things done to them without a need, and also forces me to do a thorough assessment in order to determine that need. How would you feel if you were getting charged when you went to the doctor's office and they applied a "blanket" set of tests/interventions to you without a need? Not every patient that you come into contact with requires those interventions.

I'm not posting to pick on you. But I would like to know more about why you perform those interventions for everyone? Just because you haven't "killed anyone," doesn't make it the right thing to do.

Shane

NREMT-P

My standing orders for the intervention of an Intravenous line cover a pretty broad spectrum of patients and I quote "Make two attempt at IV access if the patient has reported volume loss, signs of shock, has any new mental or physical deficit, has a documented metabolic imbalance, has a new systemic complaint, has new or uncontrolled pain, or has a condition that may require emergency medication." I also know that every hospital in my area, draws blood to do a CBC on most all of the patients. So, they are going to get intravenous access, usually either way. Most nurses are glad that I have started a line because they can in turn, start a salinelok' and get their blood work. I have not in 5 years had to many patients that didn't fall in one of these categories in my standing orders. I know that most medics do nothing for psych evaluation patients but I will always do a blood sugar on a psych patient because they could be Bi-polar or Schizophrenic but be acting strange because their blood sugar is low. That is something that I can correct and stop their brain from starving for sugar. So, have I done ECG, IV, and Glucometer on every patient, probably not but for the most part if I am following my standing orders then most every patient should at least come in with a saline lock. BTW I have found some medics, when they don't think they can get the IV, they will justify that the patient doesn't need one and to that I say don't be lazy, do your job. There has been at least two times or more that I had a perfectly stable patient crash. One had a stroke and one on the printed out strips on scene showed nothing but NSR and had a MI en route. In those two cases, I was glad that I didn't second guess the "need" for Intravenous access.

Brad

AASP

NREMT-P

Certified Professional Firefighter

[medic001918]

Whatever works for you to justify your intervention not only to yourself, but your medical control. If you want to say that a medic is lazy for not putting an IV in every patient, whether it's a saline lock, or a running line...that's okay as well.

You say that the hospital is usually going to draw blood from the patient and that they can now just put a saline lock in. Let's ask if you're doing your patient a favor by gaining IV access (that you're not going to use) only to have them get stuck again at the hospital for blood? Now rather than saving your patient an IV stick, you've added another one.

Most of us can somehow rationalize making most any patient an ALS patient. But is it always prudent? Or always best for the patient's needs? We have all had stable patients crash. It happens. And I think most paramedic protocols have a broad guideline for obtaining IV access. But just because it's in your protocol doesn't mean that it's the best thing to do. There is a place for "routine ALS," but not on every patient that we come into contact with. Just because a patient may fit a generally written, broad scope protocol; it doesn't mean that they should have the full protocol applied. They're more guideline's than absolutes.

Shane

NREMT-P

[Scaramedic]

I have always and always will view protocols as what we CAN do, not always what we SHOULD do. Following protocol to the letter is not the intent of any Medical Director I have worked with. Notice I said worked with, Paramedics and MD's should work together. Medics should not be Igorian slaves to the Medical Director or his/her protocols. I doubt many MD's would disagree with this.

Just because you can start an IV or place a patient on oxygen or a monitor does not always mean you should. If you work under protocols that state you must do AB & C to each patient your protocols suck.

LMAO at five years.

Peace,

Marty

[akroeze]

A physician is qualified to start an IV on patients. Therefore every time a GP sees a patient in their office they should start an IV because they can, otherwise they are being lazy. I mean, patients suddenly have an MI when they are seeing their doctor so they must really wish that they had started a line in advance.

[Scaramedic]

You right Akroeze, in fact the Dr should place a chest tube, tracheotomy, foley, and a rectal tube on any patient. Especially firefighters getting physicals.

Peace,

Marty

[akroeze]

You right Akroeze, in fact the Dr should place a chest tube, tracheotomy, foley, and a rectal tube on any patient. Especially firefighters getting physicals.

Peace,

Marty

And before anyone asks why a rectal tube, it's a breathing tube for the ones with their heads up there

[Dustdevil]

GO BIG OR GO HOME!

[AnthonyM83]

Eh, I could take him...

(I actually happen to work out at his old gym)

[CBEMT]

My standing orders for the intervention of an Intravenous line cover a pretty broad spectrum of patients and I quote "Make two attempt at IV access if the patient has reported volume loss, signs of shock, has any new mental or physical deficit, has a documented metabolic imbalance, has a new systemic complaint, has new or uncontrolled pain, or has a condition that may require emergency medication."

Oh. So you're a CCP (Cookbook Care Provider).

Thank you for clearing that up.

[firemedic05]

Oh. So you're a CCP (Cookbook Care Provider).

Sure, that's what I am and your the Savior to the world I guess.

Thank you for clearing that up.