What do you typically do in a Transport EMT job?

[medicaltransient]

Don't stay too long, you need continue to apply for 911 and er tech jobs as soon as you are hired. If you get stuck there you will be on the 911 no hire black list and you will loose your skills. If you get fired from there or a 911 job you should just quit EMS.

 

[medicaltransient]

The same thing you do in a 911 job, transport... In all honesty, that's the purpose of both, right?

If that's what you think the purpose of EMS is you are very mistaken and obviously have never made a life saving intervention.

 

[Jim37F]

If you get stuck there you will be on the 911 no hire black list

Must be an area specific thing....here considering there's literally somewhere in the neighborhood of 80-100 ambulance companies and only 6 or so do 911 response in LA/OC being "stuck" at a transport only company is pretty much a given. Particularly since here the transport only companies tend to pay a little better than the companies that also do 911..

 

[medicaltransient]

Must be an area specific thing....here considering there's literally somewhere in the neighborhood of 80-100 ambulance companies and only 6 or so do 911 response in LA/OC being "stuck" at a transport only company is pretty much a given. Particularly since here the transport only companies tend to pay a little better than the companies that also do 911..

That sucks man, good luck out there in LA/OC.

 

[Jim37F]

If that's what you think the purpose of EMS is you are very mistaken and obviously have never made a life saving intervention.

I've been an EMT for 2 1/2 years now...6 months BLS IFTs, then 3 months on a CCT IFT unit, then switched companies to where I did BLS IFT and 911 response for about 6 months, and now for the last year or so have been working on the ambulance for a local FD doing ONLY 911 response.....Easily half of all my 911 responses/transports resulted in us doing the exact same thing as the inter facility transports.....code 2 BLS to the requested facility with nothing more intensive than checking vitals...Of the rest where we transported ALS, only a small fraction actually required immediate interventions to prevent loss of life, limb, or eyesight.

So IME yes, every once in a while we do get to play hero and save a life, but those are a very distinct minority for the majority of 911 calls, which in reality, don't really need much more than transport.

 

[medicaltransient]

I've been an EMT for 2 1/2 years now...6 months BLS IFTs, then 3 months on a CCT IFT unit, then switched companies to where I did BLS IFT and 911 response for about 6 months, and now for the last year or so have been working on the ambulance for a local FD doing ONLY 911 response.....Easily half of all my 911 responses/transports resulted in us doing the exact same thing as the inter facility transports.....code 2 BLS to the requested facility with nothing more intensive than checking vitals...Of the rest where we transported ALS, only a small fraction actually required immediate interventions to prevent loss of life, limb, or eyesight.

So IME yes, every once in a while we do get to play hero and save a life, but those are a very distinct minority for the majority of 911 calls, which in reality, don't really need much more than transport.

All those basic calls are important, thats where you form good habits that you will need for the more emergent ones. Some of those basic calls with basic assessment illicit a lot of responsibility.

 

[Lannel]

I'm understanding alot of what I'm learning in class, but one thing I don't understand is... say you're transporting and your patient codes. How do you decide where to take them/if you should pull over and wait for ALS to arrive for backup?

 

[Tigger]

Unless you can see the hospital, you are better off pulling over and working the arrest with your partner and concentrating on great compressions and immediate AED use.

CPR in the back of a moving ambulance is bad.

 

[MonkeyArrow]

This is an area of disagreement that I have between other members of this forum. Especially if you are already en route, upgrade to lights and sirens and get to the closest hospital.

 

[NomadicMedic]

Unless you can see the hospital, you are better off pulling over and working the arrest with your partner and concentrating on great compressions and immediate AED use.

CPR in the back of a moving ambulance is bad.

^^^ This!

 

[PotatoMedic]

This is an area of disagreement that I have between other members of this forum. Especially if you are already en route, upgrade to lights and sirens and get to the closest hospital.

So what intervention(s) is the hospital going to do, that you can't do, that is going to save this persons life?

 

[Tigger]

So what intervention(s) is the hospital going to do, that you can't do, that is going to save this persons life?

If you are BLS and a crew of two and can see the hospital, it's probably worth just getting there so you can have more hands. Other than that, nothing.

This is an area of disagreement that I have between other members of this forum. Especially if you are already en route, upgrade to lights and sirens and get to the closest hospital.

So single rescue CPR in a moving ambulance is what's going to help this patient. Umm no.

 

[PotatoMedic]

If you can see the hospital fine, but if your any distance out no. There is no set of interventions aside from CPR and defibulation that will truly make an impact on a patients survivability. Epi yes improves ROSC rate but does not increase survivability. My guess is the ALPS study is going to show nothing really works and airway can be managed by a opa/NPA or superglotic.

You could make an argument for medics/ hospitals being able to help manage the He's and T's but still the data says early CPR and early defibrillaton is what increases cardiac arrest survival.

 

[Brandon O]

Park, call for ALS, work it. Resist the urge to do "The BLS Punt" -- flooring it for the hospital.

Edit: however, if this sort of thing happens to you a lot, you're either way out in the sticks or you're making some bad triage decisions...

 

[MonkeyArrow]

Ugh. Really don't want to get into it again. But ok, here we go. First of all, everything assumes short, urban transport times. Waiting for an ambulance to arrive at the side of the road to help you takes what, 7-10 minutes. Driving to the hospital takes what, 7-15 minutes. Waiting for that extra set of hands, you have two providers trying to do CPR and manage the airway, while also working the defibrillator. It takes two people to get a good seal on the BVM, plus you need one to do compressions. Yes, CPR does suffer in a moving ambulance but eventually, doing CPR with 1-2 people waiting for that second ambulance will tire you out too, also regarding the quality of compressions administered.

Instead of waiting and watching compression efficacy decrease, drive to the hospital and watch compression efficacy decrease. That way, you have more hands to help, with a marginally longer time vs that of the second ambo arriving. In the hospital, you have many more hands to help, and is generally a better place to facilitate resuscitation. No one here should be arguing that an ED offers less than the back of your ambulance.

In my ED, we do cath lab with CPR in progress, ECMO, etc. Yes, not every ED has these things. However, you would be hard pressed to find a department with the aforementioned assumptions not to have an ultrasound unit (PE) and thrombolytics to lyse the patient, access to multi-disciplinary specialities who can correct reversible causes of death, the ability to start drips and push medications and perform maneuvers that you simply cannot do in the field (who paces over VFib in the field).

 

[triemal04]

I hope you realize that you are contradicting yourself. A lot.

You think it takes 2 people to get an effective seal on a BVM...so you'll just haul butt to the hospital with one person doing compressions and ventilations...hmmm.

You say (correctly) that CPR will tire out 1-2 people...so you'll just haul butt to the hospital with one person doing compressions and ventilations...hmmm.

You imply that having 2 people try to provide ventilations, compressions and defibrillation is a bad thing...so you'll just haul butt to the hospital with one person doing compressions and ventilations...hmmm.

You say (correctly again) that the quality of CPR suffers in a moving vehicle...but you still want to move and negate the effectiveness of one of two interventions that we know works...hmmm.

Do you think that having 7-10 minutes of innefective compressions will be negated by possibly effective compressions when you reach the hospital?

I'd seriously suggest you stop and think this one through.

 

[MonkeyArrow]

I hope you realize that you are contradicting yourself. A lot.

You think it takes 2 people to get an effective seal on a BVM...so you'll just haul butt to the hospital with one person doing compressions and ventilations...hmmm.

You say (correctly) that CPR will tire out 1-2 people...so you'll just haul butt to the hospital with one person doing compressions and ventilations...hmmm.

You imply that having 2 people try to provide ventilations, compressions and defibrillation is a bad thing...so you'll just haul butt to the hospital with one person doing compressions and ventilations...hmmm.

You say (correctly again) that the quality of CPR suffers in a moving vehicle...but you still want to move and negate the effectiveness of one of two interventions that we know works...hmmm.

Do you think that having 7-10 minutes of innefective compressions will be negated by possibly effective compressions when you reach the hospital?

I'd seriously suggest you stop and think this one through.

No. What I am saying is that by staying on scene with 2 people or leaving with 1, the quality of resuscitation suffers nevertheless. Therefore, if the quality of resuscitation will suffer anyways, I will opt to get the patient to a higher level of care.

 

[Brandon O]

At least do a few rounds while you're in the best possible time to get ROSC. All you need to do is push and zap and rotate if need be. Hell, you can get the police to come help if you want.

 

[Chewy20]

No. What I am saying is that by staying on scene with 2 people or leaving with 1, the quality of resuscitation suffers nevertheless. Therefore, if the quality of resuscitation will suffer anyways, I will opt to get the patient to a higher level of care.

It's actually pretty simple, person has a much better chance if you pull over and immediately shock if applicable and start quality chest compressions. That is the most important thing in an arrest. 1 or 2 people can handle CPR for 10-15 mins until (we all have done it is school) another unit to get there.

If nothing else think of this, an IFT unit encounters a code en route (BLS or ALS rig) it is more than likely their first time seeing an arrest, and this being after not using their skills what so ever since they finished school. I do not want that person up front driving with all the "excitement" in their head. Could get everyone in the box killed. Nor would I want my family member receiving subpar performance and missing treatments because the medic in the back is freaking out on a code by himself being tossed around at the same time. No bueno, if you have the pt in mind, you pull over. My opinion but it seems pretty common sense. UNLESS you are a BLS unit and can throw a rock at the ED then sure go for it.

I was at the ED not to long ago and a private ALS transfer agency (wont say who) came screaming into the parking lot with someone who coded on the way in, my partner and others jumped in the back to help because they were both freaking out and said they have been doing one man CPR, ventilations, and looking at monitor for the past 15-20 mins, are you kidding me? All the while driving through a county with 40+ ALS units in stations. Pt did not make it. Could or could not be because of his care given to him since we know cardiac arrests are hard to get back in first place, but I can tell you the care he received certainly did not help.

 

[triemal04]

No. What I am saying is that by staying on scene with 2 people or leaving with 1, the quality of resuscitation suffers nevertheless. Therefore, if the quality of resuscitation will suffer anyways, I will opt to get the patient to a higher level of care.

Actually, the quality of CPR, when done by two people, should be just fine for long enough to get extra hands on scene (in the urban setting you mentioned). If it isn't that is more of a problem with the providers than anything, and should be corrected with remedial training.

The quality of CPR done by one person, in a moving vehicle will be next to worthless. The only way to fix that is to stop moving and gets more hands.