Tips for BLS transfers- part 2

[pumper12fireman]

So, when I first read the title of the aforementioned thread, I was assuming they were tips for new EMTs on how to make your transfers go as smooth as possible. I was wrong, and I think I'd like to see one on actual patient care tips.


While they may not be exciting or glorious, I have had plenty "oh sh*t" moments in the back of a BLS transfer rig, for the reason that there is no medic there to "save the day"...

1. Be an ADVOCATE for your patient. This includes making the pt. as comfortable as possible. They're getting a bill for this ride, and most will remember how they were treated. This is especially true on a tax-payer based service. In addition, do not be afraid to report elder abuse or crappy living conditions to the proper channels.

2. Pay ATTENTION to your patient. Being lax with vitals or your assessment can lead to big trouble (sedated pts. come to mind). Also, comatose pt.'s can't tell you if they're cold/hot etc., take note of goosebumps, etc...and take care of that as needed.


3. LEARN from your pt.'s conditions. There's tons of good info and trends to notice while going over the paperwork pre-transport (CHFer's edema, COPDer's low pulse SpO2, etc). In addition, you can learn more about definitive care, and more about what happens in hospital, not just prehospital. This goes back to being an advocate for your patient, and making sure they get the best treatment possible.

4. ASSESS your patient. There's plenty of time for a detailed medical assessment when appropriate. You may also pick up something missed by the facility they're being transfered from (nursing homes seem to come to mind..)

I know there's more, everyone feel free to contribute..

Hope this helps any new EMTs..

 

[Airwaygoddess]

The foundation of patient care

Very well said!

 

[whitecrossknight]

Once, as a brand new EMT, I was assigned a transfer involving a patient that had supposedly attempted to commit suicide by taking some rather ineffective pills (don't remember what they were, but it wasn't going to kill him).

Anyway, after getting chewed out throughly by my partner, I learned...never, ever let the suicidal psych off the stretcher.

I got lucky and didn't have anything bad (i.e patient attempting to jump out the door) happen.

 

[KEVD18]

document everything.

 

[TransportJockey]

So, when I first read the title of the aforementioned thread, I was assuming they were tips for new EMTs on how to make your transfers go as smooth as possible. I was wrong, and I think I'd like to see one on actual patient care tips.


While they may not be exciting or glorious, I have had plenty "oh sh*t" moments in the back of a BLS transfer rig, for the reason that there is no medic there to "save the day"...

1. Be an ADVOCATE for your patient. This includes making the pt. as comfortable as possible. They're getting a bill for this ride, and most will remember how they were treated. This is especially true on a tax-payer based service. In addition, do not be afraid to report elder abuse or crappy living conditions to the proper channels.

2. Pay ATTENTION to your patient. Being lax with vitals or your assessment can lead to big trouble (sedated pts. come to mind). Also, comatose pt.'s can't tell you if they're cold/hot etc., take note of goosebumps, etc...and take care of that as needed.


3. LEARN from your pt.'s conditions. There's tons of good info and trends to notice while going over the paperwork pre-transport (CHFer's edema, COPDer's low pulse SpO2, etc). In addition, you can learn more about definitive care, and more about what happens in hospital, not just prehospital. This goes back to being an advocate for your patient, and making sure they get the best treatment possible.

4. ASSESS your patient. There's plenty of time for a detailed medical assessment when appropriate. You may also pick up something missed by the facility they're being transfered from (nursing homes seem to come to mind..)

I know there's more, everyone feel free to contribute..

Hope this helps any new EMTs..

I run a BLS ONLY transport rig out here in ABQ and these tips have served me well.
My favorite still is treat the pt, not the vitals. I've had some patients with BP in the toilet, yet it was normal and I didn't have to go screaming for ILS/ALS support

 

[Airwaygoddess]

Ask questions!

To put in my two cents, just remember that no question is ever stupid, better to ask than not at all.....-_-

 

[BossyCow]

Tips:

Sit next to a male patient instead of in front of him if you are trying to convince him of something.

Know when to take control. When the talking is done and its time to go now.

Pay more attention to the pts symptoms than their emotions. Very often the upset patient is less injured than the calm one. Don't let the anxiety level of the patient set the tone for the call.

Know your protocols! Know your response area. Know your ER. Know your co-workers. In the middle of a trauma code is not the time to find out that the EMT you chose to accompany you in the back of the rig is the one who 'isn't good under pressure'

 

[Granola EMT]

I think this can be one of the most over-looked aspects of the job, however it can be a chance to really make someones day!

One thing I have learned is, DONT be afraid to upgrade to emergent on non emergency transports with updates like " hip pain, low SPO2, low pulse, ect."
Im not saying to upgrade on all of them, but use your gut feeling. I hate walking into train wrecks...

However, if its non emergency, why do they page out at 0400...?
Cant it wait until 0930, or so? LOL

 

[TransportJockey]

However, if its non emergency, why do they page out at 0400...?
Cant it wait until 0930, or so? LOL

No kidding Got my nap at 0230 interrupted

 

[SouthsideEMT]

document everything.

pretty much the most important thing

 

[Code 3]

I think this can be one of the most over-looked aspects of the job, however it can be a chance to really make someones day!

One thing I have learned is, DONT be afraid to upgrade to emergent on non emergency transports with updates like " hip pain, low SPO2, low pulse, ect."
Im not saying to upgrade on all of them, but use your gut feeling. I hate walking into train wrecks...

However, if its non emergency, why do they page out at 0400...?
Cant it wait until 0930, or so? LOL

This is great advice. Skilled nursing facilities are notorious for declining medics and requesting BLS units. My worse case was a patient with O2 sats of < 80% and presenting with full-blown CHF. As soon as this patient got a bed in the ER she was immediately placed on CPAP. There is absolutely nothing wrong with requesting ALS when doing a "routine" transport. Never assume that your patient is okay because you're on an IFT or a downgraded 9-1-1. As cliche as this may sound... expect the unexpected.

 

[WuLabsWuTecH]

This is great advice. Skilled nursing facilities are notorious for declining medics and requesting BLS units. My worse case was a patient with O2 sats of < 80% and presenting with full-blown CHF. As soon as this patient got a bed in the ER she was immediately placed on CPAP. There is absolutely nothing wrong with requesting ALS when doing a "routine" transport. Never assume that your patient is okay because you're on an IFT or a downgraded 9-1-1. As cliche as this may sound... expect the unexpected.

Don't take this the wrong way as I don't mean for this to be a criticism, but a question--Why didn't you plac eher on CPAP yourself? Was it avaliable to you? Or was NRM the best thing you got?

 

[Code 3]

Don't take this the wrong way as I don't mean for this to be a criticism, but a question--Why didn't you plac eher on CPAP yourself? Was it avaliable to you? Or was NRM the best thing you got?

Great question. As of right now, CPAP is not part of our equipment on the ambulance. However, I believe our County is trying to make this a protocol and researching companies that manufacture mobile CPAP machines.