Did this warrant Lights and Sirens?

[Uclabruin103]

I don't know the true validity of this, but I have always been told that SNFs get so many times calling 911 a year before their ratings start to be affected. To avoid this they'll call a BLS car, and if warranted the crew will be the ones that call for ALS.

I've learned to never trust what SNFs tell me. I always get a new set of VS on my own or watch them do things like SpO2, and BGL since we don't have that equipment. Some of the SNFs in the LA area are truly the worst places on earth.

My favorite SNF bs VS are when they gave us a BP of 110/70. I get 60/P, so we expedite the guy the 0.2 miles to the hospital where we're greeted by a nice central line.

As far as L/S goes, I don't hesitate to turn them on if it'll help my patient. I'm also a very conservative code 3 driver, so it's like I'm driving my normal snail pace anyway. If we can respond to a stubbed toe in LA code, then I can transport my sepsis or hypotensive patient code.

 

[Veneficus]

I don't know the true validity of this, but I have always been told that SNFs get so many times calling 911 a year before their ratings start to be affected. To avoid this they'll call a BLS car, and if warranted the crew will be the ones that call for ALS.

I've learned to never trust what SNFs tell me. I always get a new set of VS on my own or watch them do things like SpO2, and BGL since we don't have that equipment. Some of the SNFs in the LA area are truly the worst places on earth.

My favorite SNF bs VS are when they gave us a BP of 110/70. I get 60/P, so we expedite the guy the 0.2 miles to the hospital where we're greeted by a nice central line.

As far as L/S goes, I don't hesitate to turn them on if it'll help my patient. I'm also a very conservative code 3 driver, so it's like I'm driving my normal snail pace anyway. If we can respond to a stubbed toe in LA code, then I can transport my sepsis or hypotensive patient code.

I think something important to remember is that a SNF is not like somebody's private residence.

These patients are there for a reason.

As poor as the quality usually is, a SNF is part of the healthcare system. These patients are being managed by a physician at some level as well as an overworked RN staff.

I agree from the EMS standpoint, the information received is often highly unusable or even misleading.

But If a patient needed transport from one hospital unit to the other, it doesn't really require the person doing the trasport to work this up as a new patient.

The issues are known and being taken care of.

These facilities have become infamous over the years and with good reason. I have found ifyou dig alittle deeper (usually into the chart) you will get much more usable information.

Providers at these facilities are often so focused on their day to day responsibilitiesthat the big picture often escapes them.

SNFs should not be routinely using the 911 system.

 

[Anonymous]

SNFs should not be routinely using the 911 system.

With a concentrated population of chronically ill patients I would say routine use of the 911 system is inevitable.

 

[Meursault]

SNFs should not be routinely using the 911 system.

Alright, but until their staff and their contract providers are able and willing to determine patient acuity and respond appropriately, I'd rather have over-triage and inappropriate system use than long delays in care.

I'm told that, once upon a time, a lot of routine procedures (G-tube and Foley replacement, FFS) were done within SNFs and urgent issues were usually evaluated by the physician before transport. If there were a way to return to that, we could avoid this whole problem and probably deliver better care. I suspect there are too many obstacles.

 

[mommak90]

considering the VS I would most definitely run lights and sirens. Depending on distance/traffic to the hospital I would've called for ALS intercept, but not waste any time just waiting for them. I've seen pts with BLG in the 400's go into DKA, plus that temp.... that temp is just horrid. And seeing as though you are not IV cert yet, I'd say you did a d*** good job and you did make the right decisions. I work for a 911 service now, but I used to work at a BLS only service and I had to make calls like that before.

 

[Veneficus]

Alright, but until their staff and their contract providers are able and willing to determine patient acuity and respond appropriately, I'd rather have over-triage and inappropriate system use than long delays in care.

I'm told that, once upon a time, a lot of routine procedures (G-tube and Foley replacement, FFS) were done within SNFs and urgent issues were usually evaluated by the physician before transport. If there were a way to return to that, we could avoid this whole problem and probably deliver better care. I suspect there are too many obstacles.

Just my opinion, but I think the only obstacle is reimbursement.

I remember the days when SNF did that stuff too. But I have also seen nursing start to return to a more limited role since then also.

 

[rmabrey]

Im late to this game but yes, its obvious sepsis is whats going on. yes it needs to be ALS, No it does not warrant lights and sirens.

 

[Tigger]

SNFs should not be routinely using the 911 system.

Agreed, they are generally a burden on the municipally provided EMS service in terms of call volume. However, some change needs to happen within the private EMS world before this can really happen. If the private companies are using dispatchers that only send units to calls and can't EMD callers, that is an issue. Even if the company does not have in-house ALS, the dispatcher should be able to generally determine the acuity of the call. If the company is only BLS, the dispatchers need to have the ability to send or request ALS themselves rather than relying on a BLS ambulance to respond, arrive, and assess, only to say "too sick" and then spend time needlessly waiting for ALS (in any fashion including intercepts). Most of the time, if the patient needs a medic, they've needed one from the onset of the call and an effort should be made to provide it.

 

[Akulahawk]

Patients can't normally be transported out of a SNF unless it's truly an emergency, thus 911... so the Nursing staff has to assess and refer to a physician who then writes an order for the transfer. This can take HOURS. So, what should have been a relatively easy, smooth, no-worries transfer ends up being a 911 call because the patient has started to decompensate or they get the order, call an ambulance for the transfer, and that crew is no longer appropriate because things changed and the info that generated the transfer hasn't been valid for a long time.

 

[Cindigo]

Nice job.

Also, validation that I am in no way ready to be on call with a driver that has no medical training and is difficult to understand. They've been pushing me ("Nothing gonna happen. You be fine") and I will continue to refuse.....unless of course you want to be on call with me.

I'm all for confidence and trial by fire but holy mother I've only had my state cert. for three weeks!

 

[Medic29]

Nice job.

Also, validation that I am in no way ready to be on call with a driver that has no medical training and is difficult to understand. They've been pushing me ("Nothing gonna happen. You be fine") and I will continue to refuse.....unless of course you want to be on call with me.

I'm all for confidence and trial by fire but holy mother I've only had my state cert. for three weeks!

You just have to request to work with me. Completely understandable about the only driver part. Until you are confident you can run these "emergencies" on your own, keep telling him no unless he pairs you with an EMT instead a driver. Then take the opportunity to learn from us. It's amazing when we get these calls and we're an EMT/EMT crew. We both get in the back, help each other out before one of us gets out to go. Not that easy when you're in a Driver/EMT crew. We'll go over some things in the morning when we get to the office. 4am! Be ready!! lol

 

[Cindigo]

Thanks dude. Hope I didn't come off as negative. I appreciate the opportunities it's just with my comfort zone being really pushed and the 5 million degree temperatures for the last two weeks I feel a little overwhelmed.

I was talking to a long time RN that works at the VA at a get together I went to yesterday. She was saying that she never worries about the newbie nurses that are nervous and have their doubts, she's nervous about the ones that don't. The more I learn, the more I see that I have to learn. On calm days, that's exciting. On days that I don't sleep well or eat like crap or just get into my head too much....it doesn't seem all that exciting.

Probably text book normal

 

[Medic29]

Thanks dude. Hope I didn't come off as negative. I appreciate the opportunities it's just with my comfort zone being really pushed and the 5 million degree temperatures for the last two weeks I feel a little overwhelmed.

I was talking to a long time RN that works at the VA at a get together I went to yesterday. She was saying that she never worries about the newbie nurses that are nervous and have their doubts, she's nervous about the ones that don't. The more I learn, the more I see that I have to learn. On calm days, that's exciting. On days that I don't sleep well or eat like crap or just get into my head too much....it doesn't seem all that exciting.

Probably text book normal

If you piss me off tomorrow I'm gonna toss you out the back. I'll be nice and have you buckled to the cot! So eat breakfast and you're gonna nap after our first call lol. Make sure to bring lots of water also or I'll buy you a few at the gas station

 

[JPINFV]

If you piss me off tomorrow I'm gonna toss you out the back. I'll be nice and have you buckled to the cot! So eat breakfast and you're gonna nap after our first call lol. Make sure to bring lots of water also or I'll buy you a few at the gas station

[YOUTUBE]http://www.youtube.com/watch?v=MsQH7PFrI04[/YOUTUBE]

 

[Tigger]

Patients can't normally be transported out of a SNF unless it's truly an emergency, thus 911... so the Nursing staff has to assess and refer to a physician who then writes an order for the transfer. This can take HOURS. So, what should have been a relatively easy, smooth, no-worries transfer ends up being a 911 call because the patient has started to decompensate or they get the order, call an ambulance for the transfer, and that crew is no longer appropriate because things changed and the info that generated the transfer hasn't been valid for a long time.

At least where I am we do non-physician ordered emergency transfers fairly frequently on both the ALS and BLS side. Our crews will respond to SNFs to work codes, though I am not sure if it's supposed to be taken that far. I'd still maintain that we provide a higher level of service than the city often does given dispatch's propensity to sending medics and quicker response times in many cases. This is company specific of course.

 

[Cindigo]

If you piss me off tomorrow I'm gonna toss you out the back. I'll be nice and have you buckled to the cot! So eat breakfast and you're gonna nap after our first call lol. Make sure to bring lots of water also or I'll buy you a few at the gas station

and I live to ride another day.