Using EMT Skills off-duty

[cusadiz]

You can still work w/o equipment. Patients walking around != all-ok. Some could be going into shock, some could have a neck injury that's only sore now but has the potential to become worse with aggravation. Stress of the accident may trigger a seizure or cardiac event. If nothing else, it's a great skills review for patient assessment purposes.

 

[NYMedic828]

Some of you guys think wayyyyy too far into your capabilities as a rescue-randy passerby...

Stop, ask if everyone is alright, call 911, sit back and watch the show.

 

[cusadiz]

Some of us enjoy what we do.

 

[NYMedic828]

There's nothing wrong with that, but many people need to learn to slow down and take a step back.

Sometimes doing nothing is better than doing everything.

The best thing you can do is to ensure the response of the appropriate resources to the correct location.

If someone has chest pain, neck pain, ouchies and boo boos what life saving heroics are you going to perform out of your personal vehicle?

 

[Tigger]

You can still work w/o equipment. Patients walking around != all-ok. Some could be going into shock, some could have a neck injury that's only sore now but has the potential to become worse with aggravation. Stress of the accident may trigger a seizure or cardiac event. If nothing else, it's a great skills review for patient assessment purposes.

It's also rather bothersome for the non-serious patient to receive multiple assessments, especially considering that a passing bystander can't really do much with the results of such an assessment.

 

[Christopher]

You can still work w/o equipment. Patients walking around != all-ok. Some could be going into shock, some could have a neck injury that's only sore now but has the potential to become worse with aggravation. Stress of the accident may trigger a seizure or cardiac event. If nothing else, it's a great skills review for patient assessment purposes.

Ambulatory patients, without extremes of age, vital changes, focal neurological deficits, or pain to palpation are fine. F. I. N. E. Even then, patients with whom you have a low index of suspicion and who don't quite meet criteria that end up having an unstable injury are also going to be fine! Occult, unstable spinal injuries which go unimmobilized and end up with deficit are rare! Even less likely is immobilization HELPING.

A review of a fairly liberal clearance protocol found 5 patients (n=504) who "should" have been boarded/collared but were not. Only 1 patient suffered any negative sequelae:

Patient 5 was a 76-year-old man who complained of back pain from the neck through the lumbar region several hours after chiropractic manipulation. He had a past history of a neck fracture 50 years previously. He reported progressive worsening of his pain over weeks, recently requiring the use of a walker. He had been ambulatory before his chiropractic visit that day, but shortly after returning home, he had increased pain and was no longer ambulatory. He was diagnosed with cervical cord dysfunction from a combination of cervical spondylosis, stenosis, degenerative disease, and displacement of an old nonfused unstable C2 fracture. He was treated with laminectomy, dens removal, and fusion from occiput to C4 and was discharged to a nursing home with residual quadriparesis.
...
Patient 5 presents a dilemma because he clearly complained of pain and neurologic dysfunction; however, the question remains whether chiropractic manipulation qualifies as trauma. If considered trauma, this remains a protocol violation. If not, this would become an injury missed by the protocol. We believe that the paramedic should have known to immobilize this patient because he documented an acute inability to ambulate after manipulation. This patient is also concerning because he represents the only patient who had an adverse outcome with residual quadriparesis. However, the extent of neurologic dysfunction did not change between the initial paramedic evaluation and the ED evaluation. Consequently, it seems unlikely that spinal immobilization would have changed the outcome in this situation.
...
Three patients with cervical injuries met none of the protocol criteria for immobilization (patients 2, 3, and 4)...[They] had no neurological deficits.

 

[cusadiz]

If someone has chest pain, neck pain, ouchies and boo boos what life saving heroics are you going to perform out of your personal vehicle?

Chest pain: on-hand to do cpr if necessary.

Neck pain: convince the pt to not move and/or hold c-spine if required.

Ouchies & boo-boos: Tell mommy to kiss it.

No, you're not gonna have the benefit of a full box, but that doesn't mean you can't help if you feel so inclined.

It's also rather bothersome for the non-serious patient to receive multiple assessments, especially considering that a passing bystander can't really do much with the results of such an assessment.

Some people hate attention, some are comforted by it. I don't mean to start a flame war, but OP was asking what he could do to help; telling him to just keep driving by - while certainly an option - wasn't what he was looking for, if I read the original post correctly.

 

[emtCstock]

You can still work w/o equipment. Patients walking around != all-ok. Some could be going into shock, some could have a neck injury that's only sore now but has the potential to become worse with aggravation. Stress of the accident may trigger a seizure or cardiac event. If nothing else, it's a great skills review for patient assessment purposes.

I wasn't implying you can't do anything without equipment, just not much without equipment.

 

[NYMedic828]

Sometimes my friend, the answers you seek may not necessarily be those which you desire.

No one is telling anyone not to do the righteous thing and help if the situation presents itself. We are stating that the harsh truth is that more often than not there is nothing you can do, and that which you can do may not be beneficial.

 

[usalsfyre]

I'm going to guess your fairly new at this.

You can still work w/o equipment.

In a very, very limited way

Patients walking around != all-ok.

Generally yes.

Some could be going into shock,

Even on an ambulance I don't have blood and surgical control of internal hemorrhage so what is the off-duty responder going to do?

some could have a neck injury that's only sore now but has the potential to become worse with aggravation.

Conscious people generally do a VERY good job of protecting a true neck injury. Look up self-splinting

Stress of the accident may trigger a seizure

The DEA frowns on carrying benzos around...

or cardiac event.

I guess you could hand them some aspirin

If nothing else, it's a great skills review for patient assessment purposes.

They may not appreciate being skills practice.

Sometimes the best thing to do is let the people who are empowered handle the situation. We have a very limited tool box as it is, further limited when off duty. The honest truth is doing things off-duty is often more about making you feel good than true help to the situation.

 

[usalsfyre]

Some people hate attention, some are comforted by it. I don't mean to start a flame war, but OP was asking what he could do to help; telling him to just keep driving by - while certainly an option - wasn't what he was looking for, if I read the original post correctly.

Just because it's not what he was looking for doesn't mean its not the right answer

 

[Veneficus]

The DEA frowns on carrying benzos around...

Not to mention state medical boards.

There is also that pesky little caviat about practicing medicine without a license being a felony.

 

[cusadiz]

You guys take the fun out of everything!

 

[NYMedic828]

Sorry :blush:

 

[nocoderob]

If you really feel the pressing need to stop, I suggest walking up, if the scene is safe which they generally never are, and advising that you have called 911. I wouldn't want some stranger claiming to be an EMT pawing my family members in an attempt to assess them and surely others feel the same way.

More than likely this desire will pass, young Padawan

 

[CANDawg]

There is also that pesky little caviat about practicing medicine without a license being a felony.

Even further reason medics should be a self regulated profession rather than operating under a doctor's medical license. Some jurisdictions are moving this way, but alas.

That said, the amount of apathy in this thread is astounding. Yes, off duty w/o complex supplies, you can't do much. But not being able to do much does not equal not being able to do anything. If so, there would be no such thing as basic first aid.

If you want to call 911 and keep driving, that's your call. But telling someone that wants to help that they should do the same is rude and immature. Yes, you're limited in what you can do, but that alone is not excuse enough not to help someone.

 

[bahnrokt]

Even on an ambulance I don't have blood and surgical control of internal hemorrhage so what is the off-duty responder going to do?

Triage. Figuring out that somone is going down hill fast gives Ricky Rescuer the chance to relay this information to dispatch and get appropriate resources moving faster. Maybe they only had a BLS responding as an aplha and now know to upgrate to delta and get als or life flight en route. Getting that pt into a trauma er 10,15,20 min sooner makes a big difference.

 

[Aidey]

Since when was Ricky Rescue able to accurately triage a group of people without grossly over-triaging them? The last thing we need are more people landing helicopters on interstates because someone has pain from the seat belt.

 

[EMDispatch]

As a refresher for some, and an FYI for others:

In 911 dispatch, we ideally would like answers about:
1. Exact Location
2. Number of Patients
3. Entrapment
4. Hazards

Generally I can't get even a quarter of that from callers.

Obviosuly scene safety is the top priority, but if you can stop and get that information, you are doing about the best service possible for responders and victims. If you can't stop, do a scene size-up as you drive by. While doing that size-up try to think about the answers for those 4 areas.

 

[usalsfyre]

Even further reason medics should be a self regulated profession rather than operating under a doctor's medical license. Some jurisdictions are moving this way, but alas.

Nurses are a self regulated profession, yet they don't have the authority to practice medicine either (leaving aside the advanced practice debate for now)

That said, the amount of apathy in this thread is astounding. Yes, off duty w/o complex supplies, you can't do much. But not being able to do much does not equal not being able to do anything. If so, there would be no such thing as basic first aid.

It's not apathy. Its just the realization the returns are not worth the investment. There is quite literally nothing I can do in the majority of cases except stand there and look like a jackwagon while making myself a gigantic target for Suzy Cellphone and her minivan.

If you want to call 911 and keep driving, that's your call. But telling someone that wants to help that they should do the same is rude and immature. Yes, you're limited in what you can do, but that alone is not excuse enough not to help someone.

Except you represent me in some form or fashion (professionally) and I may be the one who has to deal with the fact that you have now convinced a totally uninjured party to be transported "just in case" and that not doing "x" intervention is malpractice (and yes, I've had this happen on multiple occasions).