# Getting pt. into ambulance



## Explorer127 (Jan 7, 2009)

Can you have the patient walk into the ambulance if they are able to instead of having to lift them on the stretcher?

For example, a patient who really needs a taxi but calls 911 for something like a toothache, a minor cold, etc...


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## JPINFV (Jan 7, 2009)

Depends on several factors including the patient's condition, local laws, and local protocol.


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## daedalus (Jan 7, 2009)

I would say no. Getting fired, getting sued, getting your license taken are all things that could come from such a silly and stupid thing (I say silly and stupid not in reference to your decision to walk them to the rig, but how small of a deal it really is).


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## medicdan (Jan 7, 2009)

JPINFV said:


> Depends on several factors including the patient's condition, local laws, and local protocol.



I know there are several active members here from Massachusetts, and that leads to the quoting of a lot of MA policies, but MA OEMS has something interesting to say in this case. 

A little while ago, MA OEMS posted the most common complaints again EMTs that are reported to OEMS. Walking a patient is number 11 our of 19. 

http://www.mass.gov/?pageID=eohhs2t..._emergency_services_p_complaints&csid=Eeohhs2

The problem with walking a patient is the "What-ifs". What if they trip and fall while walking? What if they hit their head while getting into the truck? What if the stress of the walk gives them chest pain they didnt have before? What if they run away? How would you document any of the above?


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## Scott33 (Jan 7, 2009)

Explorer127 said:


> Can you have the patient walk into the ambulance if they are able to instead of having to lift them on the stretcher?
> 
> For example, a patient who really needs a taxi but calls 911 for something like a toothache, a minor cold, etc...




So wait a minute. 

Are you saying there are actually places who would advocate "lifting" a toothache onto a stretcher?

There are some arse-backwards systems out there.

If they have legs, no chest pain, SOB, palpatations, weakness, or dizzyness -  they walk.


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## MedicPrincess (Jan 7, 2009)

Scott33 said:


> If they have legs, no chest pain, SOB, palpatations, weakness, or dizzyness - they walk.


 
And there it is.....  

What about the little old lady who calls because she just doesnt feel good?  Or the pt who was SOB, but now feels fine?  Or the ABD pain pt? or the hundreds of others that call us because they have a problem and it is our responsibility to provide them with the best care they can.

The only pts that walk to my ambulance are the ones that meet me at the curb or flat out refuse to get on the stretcher.  

And... GASP...  Oh the Horrors!!....  I even pick up and carry some of the patients I encounter that would otherwise be able to walk out.  Not me alone, obviously.  But if I have FD on scene (even if I have to call for them), or between my partner and I, it gets done.

Do you guys take your stretcher into the house with you, or do you go in expecting the patient to walk out to the truck?  

If you do have it in there with you, how can you justify to your patient who called you for help, that they cannot get on the stretcher?


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## MSDeltaFlt (Jan 7, 2009)

Yes, walk 'em.


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## JPINFV (Jan 7, 2009)

emt-student said:


> A little while ago, MA OEMS posted the most common complaints again EMTs that are reported to OEMS. Walking a patient is number 11 our of 19.
> 
> http://www.mass.gov/?pageID=eohhs2t..._emergency_services_p_complaints&csid=Eeohhs2


While I'm definitely not an advocate of walking the majority of patients to the ambulance (the only times I can remember having a patient walk into my ambulance is when the patient met us at street. These were normally non-hold psych patients), once again that little quote is someone who obviously has no clue about the field making rules. Yes, there are plenty of patients who should not be walked to the gurney, but again patient location and condition are what's  important. Unfortunately, the problem probably is people walking patients who have no business being walked forcing OEMS to issue a fiat. Of course walking a patient to a gurney and walking a patient into a unit are two different things. 

Also the majority of my experience isn't in MA.


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## EMTinNEPA (Jan 7, 2009)

*A*mbulate
*B*efore
*C*arry



You only get one back.  Don't strain it any more than you have to.


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## Scott33 (Jan 7, 2009)

MedicPrincess said:


> And there it is.....
> 
> What about the little old lady who calls because she just doesnt feel good?  Or the pt who was SOB, but now feels fine?  Or the ABD pain pt? or the hundreds of others that call us because they have a problem and it is our responsibility to provide them with the best care they can.



"Best care" should include exercising simple clinical decision making, including  whether a patient is able to ambulate a short distance to either the stretcher or the ambulance in the absence of those conditions which may be exacerbated by ambulation.

Next time you carry a broken finger into the ED, see how quick it takes the triage nurse to tell them to hop off the stretcher and walk into triage / fast track. Next time you carry a maternity who is not in active labor, ask the staff at the DR what the next course of treatment will be. Much of it will include lots of ambulating up and down the hallway.

The reason these arse-backwards systems advocate carrying everyone,  because they do not trust their providers to make a simple decision by themselves. It is outdated, patronizing, and dangerous to the provider.

I have seen more accidents (and more potential for accidents) with people huffing and puffing trying to get stretchers out of houses, down the steps, and onto the ambulance, than with walking the patient if they are able to


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## JPINFV (Jan 7, 2009)

Scott33 said:


> The reason these arse-backwards systems advocate carrying everyone,  because they do not trust their providers to make a simple decision by themselves. It is outdated, patronizing, and dangerous to the provider.
> 
> I have seen more accidents (and more potential for accidents) with people huffing and puffing trying to get stretchers out of houses, down the steps, and onto the ambulance, than with walking the patient if they are able to



Too many bad apples spoil the bunch for both accounts.


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## reaper (Jan 7, 2009)

If you have done a complete assessment in the house and are capable of making the decision that they are able to walk out, then walk them out. 

Not everyone needs to ride the stretcher. If they have a laceration on their finger, they walk. If they have SOB, they ride. It's very simple.

If you are unable to do a proper assessment, then you need to put everyone on the stretcher, just in case.


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## Sasha (Jan 7, 2009)

We don't walk any patient to the ambulance. Way too many what ifs, too much liability.

At my job, we aren't allowed.

Even when I did my clinicals and the many BS calls we ran on, no one was allowed to walk very far. The stretcher was brought in as close as they could get it, and the patient stood, with assitance or someone there to catch if they started to fall, and pivoted. Only exception were stairs. If the person was light enough they were carried down, if not, they were walked down, one person in front, one person in back.

That's for BS "my big toe has been hurting for six months" calls. Any serious complaint would get stairchaired down the stairs.

Good body mechanics and proper lifting techniques will save your back.


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## MedicPrincess (Jan 7, 2009)

I should clarify then....  The stretcher does not always get brought into the house.  Some patients after assessment walk to the stretcher..... some get carried..... some get the stretcher brought to them.  Most of them will ride the stretcher to the truck.  

I get a little upset at the ones that walk everyone (or a majority) all the way to the truck.


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## BossyCow (Jan 7, 2009)

I'm going to go out on a limb here and say something radical.... 

"I would assess the patient, make a decision based on my findings, my judgement and using common sense on what I believe to be in the best interest of both the patient's safety and mine"  

I know this is a radical departure from some systems but its what I do.


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## reaper (Jan 7, 2009)

Exactly!!!!!!!!!!!!!!!!!!!!!!!!!!


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## JPINFV (Jan 7, 2009)

I'm sorry Bossy, but I think your missing the "contact medical control" step that's required anytime a decision has to be made. h34r:


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## BossyCow (Jan 7, 2009)

JPINFV said:


> I'm sorry Bossy, but I think your missing the "contact medical control" step that's required anytime a decision has to be made. h34r:



ROFL.. yeah.. that would be done only if it were consistant with "make a decision based on my findings, my judgement and using common sense on what I believe to be in the best interest of both the patient's safety and mine"


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## Scott33 (Jan 7, 2009)

BossyCow said:


> I'm going to go out on a limb here and say something radical....
> 
> "I would assess the patient, make a decision based on my findings, my judgement and using common sense on what I believe to be in the best interest of both the patient's safety and mine"
> 
> I know this is a radical departure from some systems but its what I do.



It's perfect!

The "carry all" rule is counterintuitive for both the patient and the provider.  

Tail wagging the dog.


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## Grady_emt (Jan 7, 2009)

BossyCow said:


> I'm going to go out on a limb here and say something radical....
> 
> "I would assess the patient, make a decision based on my findings, my judgement and using common sense on what I believe to be in the best interest of both the patient's safety and mine"
> 
> I know this is a radical departure from some systems but its what I do.



Much more eloquent than how I would have said it.


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## Explorer127 (Jan 7, 2009)

EMTinNEPA said:


> *A*mbulate
> *B*efore
> *C*arry
> 
> ...



Makes sense to me 

When the pt is in the ER they will be doing plenty of walking.


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## Sasha (Jan 7, 2009)

Explorer127 said:


> Makes sense to me
> 
> When the pt is in the ER they will be doing plenty of walking.



I'm not responsible for the patient in the ER, so if THEY choose to walk them, they are more than welcome. I'm not getting sued. ^_^


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## Explorer127 (Jan 7, 2009)

Sasha said:


> I'm not responsible for the patient in the ER, so if THEY choose to walk them, they are more than welcome. I'm not getting sued. ^_^



what do you think of having someone with something really minor like a toothache walk?


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## Sasha (Jan 7, 2009)

Like someone stated before. They could trip and fall, hit their head getting in, hurt themselves climbing up and EVERYONE is looking for a reason to sue someone. And it ain't gonna be me.


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## Explorer127 (Jan 7, 2009)

Sasha said:


> Like someone stated before. They could trip and fall, hit their head getting in, hurt themselves climbing up and EVERYONE is looking for a reason to sue someone. And it ain't gonna be me.



True......


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## reaper (Jan 7, 2009)

As stated earlier, Use assessment and common sense in your decision. If you use those and can justify your decision, don't worry about being sued. It does not happen as much as the newer people make you think.

It is more dangerous for the pt to be carried on a stretcher. If it is absolutely not needed, make them walk. If you choose not to let them walk the whole way, then place the stretcher on nice even ground and have them walk to there. It is safer then carrying the stretcher down stairs, when there is no reason for it.

There is a reason why back injuries are so big in EMS. Not everyone needs to be carried. If you assist them the whole way, they will not trip and fall. Again, use your own judgement on your decisions.


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## Scott33 (Jan 7, 2009)

Sasha said:


> Like someone stated before. They could trip and fall, hit their head getting in, hurt themselves climbing up and EVERYONE is looking for a reason to sue someone. And it ain't gonna be me.



Yes, and they could be shot dead in a driveby shooting, a light aircraft could land on their head, or they could be struck by lightening...twice.

I think it is a shame that you are basing your entire approach to prehospital care, on fear. Can you actually provide a reference or a link to any EMT who has been *successfully* sued, after deeming it safe to ambulate a patient to either the stretcher, or the ambulance? 

My guess is it has never happened.


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## Outbac1 (Jan 7, 2009)

Common sense and assessment. Some pts walk. Lifting is part of the job. If we do it right we can "minimize" the potential for injury to ourselves and pts. Injury potential cannot be eliminated. You can be sued either way. If you drop them while they are on a stretcher the lawyers will turn it around and say. "Wouldn't it have been safer to let them walk?" 

  My health is # 1, my partners #2, Allied workers #3, patients and bystanders can fight over who is # 4 or 5. 

  So it comes down to common sense and assessment. Some pts walk.


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## Sasha (Jan 7, 2009)

Scott33 said:


> Yes, and they could be shot dead in a driveby shooting, a light aircraft could land on their head, or they could be struck by lightening...twice.
> 
> I think it is a shame that you are basing your entire approach to prehospital care, on fear. Can you actually provide a reference or a link to any EMT who has been *successfully* sued, after deeming it safe to ambulate a patient to either the stretcher, or the ambulance?
> 
> My guess is it has never happened.



People are sued all the time for people slipping and falling. Hospitals get sued for patients hurting themselves. I'm not taking a chance. 

I'm not basing my patient care on fear. I'm basing how I am going to get the patient into the ambulance not only on the fact America is sue happy, but the fact that my service does not allow for patients to be walked to the ambulance.


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## remote_medic (Jan 7, 2009)

[QUOTE =The problem with walking a patient is the "What-ifs". What if they trip and fall while walking? What if they hit their head while getting into the truck? What if the stress of the walk gives them chest pain they didnt have before? What if they run away? How would you document any of the above?[/QUOTE]


What if I slip, what if I twist my back, what if I drop them?

A lot of what ifs....

My safety first


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## Explorer127 (Jan 7, 2009)

Outbac1 said:


> Common sense and assessment. Some pts walk. Lifting is part of the job. If we do it right we can "minimize" the potential for injury to ourselves and pts. Injury potential cannot be eliminated. You can be sued either way. If you drop them while they are on a stretcher the lawyers will turn it around and say. "Wouldn't it have been safer to let them walk?"
> 
> My health is # 1, my partners #2, Allied workers #3, patients and bystanders can fight over who is # 4 or 5.
> 
> So it comes down to common sense and assessment. Some pts walk.



That's pretty much the reason I asked the question--

I wouldn't want to hurt my back because I attempted to lift someone with a toothache...


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## dsco77 (Jan 7, 2009)

Hi all, i'm new hear but i gotta start somewhere, so here goes. I have just spent the last half hour reading this thread in total disbelief. Don't you have "*crew* & patient safety" over their?, Surely it is safer for both parties to walk, with assistance if necessary, than risk dropping someone during an unnecessary lift. Wouldn't it leave you at more risk of being sued if your perfectly ambulant patient were forced to ride on the stretcher which you then dropped. 
I work as a paramedic in the UK where we have hydraulic tail lifts on all our ambulances, Hydraulicly raising stretchers, electric stair climber chairs,  pat-slides, slide sheets, transfer boards, transfer turn-tables, patient moving & handling belts & light weight carry chairs, but the most useful tool we have to protect out backs is the ability, autonomy & authority to think for our selves. In practice this means that i probably only lift about 20% of my patients, with another 50% being "carried" by lift free equipment & the remaining 30% getting off their backsides & walking & because of this, i will hopefully have a long & healthy career all the way to retirement age.


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## mikie (Jan 7, 2009)

*Jealous!*



dsco77 said:


> I work as a paramedic in the UK where we have hydraulic tail lifts on all our ambulances...electric stair climber chairs...




Only in my wildest dreams would my dept have such a vehicle.  Not to get off topic...do you have any photos of those?


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## dsco77 (Jan 7, 2009)

Assuming i can make this image thing work, this is the kind of thing we use;


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## dsco77 (Jan 7, 2009)

Assuming i can make this image thing work, this is the kind of thing we use;






If not, just google uk ambulance tail lift & you'll get the idea


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## JPINFV (Jan 7, 2009)

dsco77 said:


> Assuming i can make this image thing work, this is the kind of thing we use;



To post an image, the URL has to end in .jpg or .png. For Flicker, you have to right click on the picture and select "view picture." You can use the URL from that page after removing the "?v=0" from the end of the URL.

I am curious, though, isn't it just as much work lifting the gurney all the way to the ground, or do you have automatic or crack style gurneys? Also, is there any specific reason that you have the gurney mounted to the wall instead of using a center mount? It seems like the patient would be really far from the seats in a configuration like that.


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## artman17847 (Jan 7, 2009)

BossyCow said:


> I'm going to go out on a limb here and say something radical....
> 
> "I would assess the patient, make a decision based on my findings, my judgement and using common sense on what I believe to be in the best interest of both the patient's safety and mine"
> 
> I know this is a radical departure from some systems but its what I do.



I couldn't have said it better myself.

If the pt's CC is minor most busy ED's will triage them to the waiting room anyway.


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## KEVD18 (Jan 7, 2009)

In massachusetts, the rules are quite clearly defined. At no time, under any circumstances, are patients to ambulate under their own power with or without assistance or supervision. Never.

Now, that's the protocol. Do I agree with it? No. does it make sense? No. but that's the rule. Failure to abide by this rule extends individual liability to the provider. Not the municipality. Not the, service. The individual provider.

The what if list is astronomical. What if they trip on that craxk in the sidewalk or the ice? What if you trip while assisting them? What if you exacerbate an unknown cardiac or respiratory issue? 

I live and practice in the state in the union where you are most likely to be sued. Every move I make has to be calculated against the liability I face if I screw it up. Not only is it quite clearly spelled out in the treatment protocols, my state issued a separate administrative requirements memo on the matter. There is no room to wiggle on it.

Does that mean that patients never walk? Of course not. Happens all the time. Every provider ive ever met has done it. Does that make it right? Nope. Its still quite clearly against the rules and if/when it goes bad, it can end in disaster for the providers.

Dsco 77: hello and welcome. I don’t know anything about the make up of services in the uk, but here in the states the majority of the ambulances on the road are owned by private for profit companies. It has been my experience that these services rarely spend one penny more than they have to on equipment and supplies, unless the service happens to be owned by someone who likes gadgets and toys. Privates in ma take the list of required equipment the state mandates, may or may not add a few things and call it a day. None of the toys you mentioned are common. It would be great if they were, but its about as likely as prehospital open heart surgery.

I'm not happy with any of this btw, but it’s the way it is.


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## marineman (Jan 7, 2009)

Nice looking rig but I prefer the ones that the rear bumper folds out into a full ramp that comes up to the door. The fancy ones even have a winch up by the head of the cot to save the work of pushing the cot + patient up the hill. Those you can still load/unload in a hurry though on that 1% call. 

For the topic at hand depending on our dispatch information and what we see when we arrive on scene we make our decision for what gear to initially bring in. Sometimes that gear includes the cot or a stairchair and sometimes it doesn't. If we bring the cot sometimes it comes all the way to the patient and sometimes it waits outside the door. I haven't been on any calls yet where they have the patient walk all the way into the ambulance, we have the cot sitting on the ground at the back but I have seen a few that have the patient climb all the way in. Usually the only ones that walk all the way in are also sitting on the bench seat for the government funded taxi ride. No sense in messing up our clean sheets on the cot for some patients.


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## Scott33 (Jan 7, 2009)

KEVD18 said:


> In massachusetts, the rules are quite clearly defined. At no time, under any circumstances, are patients to ambulate under their own power with or without assistance or supervision. Never. Now, that's the protocol. Do I agree with it? No. does it make sense? No. but that's the rule.



You can see the stupidity of this protocol, so the issue isn't with you, but with your system.

It's those who feel the need to defend their county or State's obviously outdates practices (unchanged from the mid 60s) by using a myriad of highly improbable scenarios, which have been spoon-fed to them since EMT school, that I have concerns with. Deep down they know the likes of carrying a "sore thumb" is BS; they just don't want to admit it. 

At least the higher-end providers here seem to be on the same page.

Kev, I know you have to abide by the rules, but on those occasions where you walk an obvious non-critical patient, you are using sound clinical judgement, and there is nothing wrong with that. It's the rule that is wrong.


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## mycrofft (Jan 7, 2009)

*Do as your protocols dictate.*

I've seen (and we have recounted here) instances when EMT's have hurt themselves getting into rigs, and also why it is bad joojoo to seat laypersons in the cab.
You know, why have they not put an extendable ramp ala National Rentals and a small winch into the vehicles?


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## rogersam5 (Jan 8, 2009)

KEVD18 said:


> In massachusetts, the rules are quite clearly defined. At no time, under any circumstances, are patients to ambulate under their own power with or without assistance or supervision. Never.



Oh gee... that's not how we do it....

Out of my maybe 20 pts or so I think I got signed refusals 5 times...out of the remaining 15... I can remember 2 that the medics brought the stretcher in for. All the rest walked to the rig, granted they were escorted as if they were the president but that isn't the point.


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## KEVD18 (Jan 8, 2009)

rogersam5 said:


> Oh gee... that's not how we do it....
> 
> Out of my maybe 20 pts or so I think I got signed refusals 5 times...out of the remaining 15... I can remember 2 that the medics brought the stretcher in for. All the rest walked to the rig, granted they were escorted as if they were the president but that isn't the point.


 
it happens all the time. i never said it didnt. but thats what the books says; and as i said, not following it puts all the liability on you personally. your service can wash its hands of you, as long as they have it in the companies sop that patients dont walk.


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## rogersam5 (Jan 8, 2009)

Lucky for me though the Medics are the ones who choose (They are the transport service, I just treat before they get there) but once they are there, they take over I just help them if they need it and Fire didn't show (its really odd when they do and don't)... its an interesting point you made though about they book, do you have a link to it, I would like to bring it up and see what the leadership says... although the medics also love to clear C-spine in the field and do other weird not book like stuff


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## KEVD18 (Jan 8, 2009)

heres the stp's:

http://www.mass.gov/Eeohhs2/docs/dph/emergency_services/treatment_protocols_704.pdfhttp://www.mass.gov/Eeohhs2/docs/dph/emergency_services/treatment_protocols_appendix_704.pdf

its mentioned once or twice in there. theres an a/r on the matter but i cant seem to locate it at the moment. i'll find it tomorow


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## rogersam5 (Jan 8, 2009)

Wow Thanks!

I am still quite new to this even if I can provide pt care "alone"


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## Veneficus (Jan 8, 2009)

"can you walk?"
"Have you tried?"


back when ships were wood an men were iron, my EMT-B instructor half jokingly said those would be the two most important questions in your EMS career. At the time, I thought he was a callous old dude who probably should just ride the engine. 

If I knew where he was today, I would call and thank him for that wisdom. Back in those days we only had the 2 man cots, so every load was a lift from the lowest position to the rig. (patients weren't as heavy then either) But I have seen more drops, lifts, trips, close calls, and career ending injuries (especially on snow and ice) than could ever justify lifting every patient "just in case."

As said here many times:
Your Safety
Clinical judgement 

Need to be your decision makers. I doubt anyone reading this forum works at a place where disability provides a decent life. You can get another job if you are fired, you can get another job if you are sued. Try with an injury, especially to the back. Besides, I doubt the pro bono Dewey, Cheatum, and Howe lawyers would waste their precious time on suing an individual paramedic or EMT. "Agents, officers, and employees of..." sounds far more appealing from a personaly injury suit (money) stand point. 

Think a lawyer wants 33% of what can be collected from the assets an EMS worker makes?

Besides that's what insurance is for. I think it is like trying to be too careful. Things always go wrong when you do that.

I have no doubt occasionally things will go wrong. Conditions missed, under triaged, over triaged, etc. Life is not perfect. Besides we could go on about the medical benefits of avoiding the "victim" mentality in patients and the benefits of early reentry into normal activity. That is why you never here the phrase "stay in bed for x days or until you feel better" anymore.

As for me I will stand in court anyday and answer the question:
"Why did you make the patient ambulate?"

"For the health and safety for all involved."

Rules are just guidlines.


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## bstone (Jan 8, 2009)

I've seen some bad ones. I saw the Chicago Fire Dept ambulance having an obvious 9 month pregnant woman in labor walk out the back of the rig and into the ER. She was in a TON of pain and had to be helped down the ambulance. I couldn't believe my eyes and wanted to give them a piece of my mind.

I've had people tell me they were forced to walk to the cot or up into the rig with leg injuries, when in severe pain, after being in fights and feeling dizzy, etc. 

I make my patients get on the cot, even when they are only needing a ride home from dialysis and are waiting for us, standing, in the lobby.


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## JPINFV (Jan 8, 2009)

KEVD18 said:


> heres the stp's:
> 
> http://www.mass.gov/Eeohhs2/docs/dph/emergency_services/treatment_protocols_704.pdfhttp://www.mass.gov/Eeohhs2/docs/dph/emergency_services/treatment_protocols_appendix_704.pdf
> 
> its mentioned once or twice in there. theres an a/r on the matter but i cant seem to locate it at the moment. i'll find it tomorow


Talking about this page? Number 11. 
http://www.mass.gov/?pageID=eohhs2t..._emergency_services_p_complaints&csid=Eeohhs2


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## enjoynz (Jan 8, 2009)

In New Zealand, a large % of our patients walk to the ambulance if they are able. Of course there are cases where they can't...
and we do have to look at things like SOB and Chest pain.

No offence, but know wonder you have so many issues with back and knee problems of EMS staff ,if your protocol is having to lift every patient!

Cheers Enjoynz


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## Belgian EMT/nurse (Jan 8, 2009)

I agree with joy.. Happens a lot here too.. When able a patiënt can walk to the ambulance by himself, I can not really see the point in getting every patiënt into the ambulance by stretcher.


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## firecoins (Jan 8, 2009)

BossyCow said:


> I'm going to go out on a limb here and say something radical....
> 
> "I would assess the patient, make a decision based on my findings, my judgement and using common sense on what I believe to be in the best interest of both the patient's safety and mine"
> 
> I know this is a radical departure from some systems but its what I do.



I agree and it best describes what I do.


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## EMTinNEPA (Jan 8, 2009)

dsco77 said:


> Assuming i can make this image thing work, this is the kind of thing we use;



It's like an ambulance, a semi, and a wheelchair van had an illegitimate child. :wacko:


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## Scout (Jan 8, 2009)

Remember manual handling course, 

IF possible eliminate move, if not possible reduce. You do not move/lift if you do not have to.

If they are capible of getting in on their own steam off with them,


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## Veneficus (Jan 8, 2009)

does anyone other than myself notice that most of the EMS agences not in the US, which also have higher educational standards, advocate patient walks?

We seriously need to take more pages out of their book.


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## dsco77 (Jan 8, 2009)

Maybe because elsewhere they recognise that there biggest asset are their staff & they are no good to them if they are unable to work due to long term back pain. Also, in the US you talk a lot about the fear of getting sued, fair enough, but surely, if you the staff sustain a debilitating injury during the course of your duties, you too could sue your system for failing to protect you from foreseeable & therefore avoidable harm.


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## Jon (Jan 8, 2009)

If they are ambulatory, I'll often have them walk a short distance WITH ASSISTANCE to the stretcher... that might be out their front door and/or down a few steps.

If they are calling 911 for something silly... like "I've got a 1cm laceration to my hand" and they are sober enough to walk... they will often end up on the bench seat with a seatbelt on.


In regards to the OP's question - YES... B.S. complaints sometimes walk to the truck, and they sometimes end up on the bench seat.

I try to avoid walking chest pain/resp. diff. patients. Sometimes you need to for a short distance, but I do what I can to minimize it.


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## BossyCow (Jan 8, 2009)

bstone said:


> I've seen some bad ones. I saw the Chicago Fire Dept ambulance having an obvious 9 month pregnant woman in labor walk out the back of the rig and into the ER. She was in a TON of pain and had to be helped down the ambulance. I couldn't believe my eyes and wanted to give them a piece of my mind.
> 
> .



Don't jump too quickly on this one. I spent most of my labors walking. In many cases being upright and walking is more comfortable for a woman in labor than the traditional lying down on her back. For some, lying down increases labor time, decreases the efficiency of the contractions and can be a lot more painful. The woman you mentioned may have requested/demanded to be allowed to walk.


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## enjoynz (Jan 8, 2009)

Scout said:


> Remember manual handling course,
> 
> IF possible eliminate move, if not possible reduce. You do not move/lift if you do not have to.
> 
> If they are capible of getting in on their own steam off with them,


It's great to see that there is someone else on this site that has done a Manual Handling course, Scout!
This course should be added to very EMT-B course, I'm surprised it hasn't!
Here are a couple of links for you to look at, if you have not heard of this course before!

http://www.hse.gov.uk/contact/faqs/manualhandling.htm
http://www.solutionstraining.co.uk/equipment.aspx

Cheers Enjoynz


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## Scott33 (Jan 8, 2009)

BossyCow said:


> Don't jump too quickly on this one. I spent most of my labors walking. In many cases being upright and walking is more comfortable for a woman in labor than the traditional lying down on her back. For some, lying down increases labor time, decreases the efficiency of the contractions and can be a lot more painful. The woman you mentioned may have requested/demanded to be allowed to walk.



Well said BC.

Once again someone has assumed that someone in labor is unable to walk. Was the head presenting? Had the waters even broke? 

Those who would willingly carry maternity calls would benefit greatly from a rotation or two in L&D, where you will see expectant Moms ambulating up and down the hallway ad nauseum. Gravity is a good way to expedite things along.

By default, maternities should be walked, unless there are extenuating circumstances. Again, all down to clinical judgement and the ability to do a little more than just scoop and run.


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## Scott33 (Jan 8, 2009)

Veneficus said:


> does anyone other than myself notice that most of the EMS agences not in the US, which also have higher educational standards, advocate patient walks?
> 
> We seriously need to take more pages out of their book.



Yes, when it comes to moving and handling, the US is stuck in the mid 60's. 

Also hindered by the brainwashed who can't see beyond their own departments prehistoric policies.


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## Sasha (Jan 8, 2009)

Scott33 said:


> Yes, when it comes to moving and handling, the US is stuck in the mid 60's.
> 
> Also hindered by the brainwashed who can't see beyond their own departments prehistoric policies.



Not "brainwashed", people who don't care to lose their jobs because of their own lazyness or that of coworkers.

You see, a lot of companies, when you don't follow their policies, will fire you. Getting fired from one EMS job in my area kind of kills you for the rest of the few EMS services in the area.


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## Scott33 (Jan 8, 2009)

Sasha said:


> Not "brainwashed", people who don't care to lose their jobs because of their own lazyness or that of coworkers.



Oh so it's lazyness now, having made a clinical decision to ambulate a stable patient?

Let's be under no disillusion here, as an EMT-B, your 120 hours of training has not even scratched the surface of emergency medical care. Perhaps you should look at the other posts on this thread by your more senior colleagues and actually see where we are coming from.

Your system obviously doesn't care about their employees. It's a pity you can't see that.


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## Sasha (Jan 8, 2009)

Scott33 said:


> Oh so it's lazyness now, having made a clinical decision to ambulate a stable patient?
> 
> Let's be under no disillusion here, as an EMT-B, your 120 hours of training has not even scratched the surface of emergency medical care. Perhaps you should look at the other posts on this thread by your more senior colleagues and actually see where we are coming from.
> 
> Your system obviously doesn't care about their employees. It's a pity you can't see that.



Almost done with medic school, thanks. And my EMT class was more than 120 hours.

I see where they are coming from, it boils down to the fact they don't want to take the stretcher out and put it back in for what they deem a BS, no real complaint call. Do you see where I'm coming from? The fact that it's against company policy? This is no life or death decision here, it's not going to hurt them to get on the stretcher.


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## Grady_emt (Jan 8, 2009)

Sasha said:


> it's not going to hurt them to get on the stretcher.




No, but if you hurt yourself while lifting said finger pain on the stretcher, then drop the stretcher, then they will get hurt.   It's a very situation dependent thing to say weather you walk them out or don't, but if you have a minor complaint and are ambulatory, you're most likely gonnna walk out.


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## Scott33 (Jan 8, 2009)

Sasha said:


> it's not going to hurt them to get on the stretcher.



True (unless they are dropped...has happened), but eventually it is going to hurt the provider. it's the repetition of lifting which will cause the problem sooner or later, and look at all the senior EMS providers out there, many of whom are suffering from chronic back pain, and popping pills just to get through their day. Do their employers care? Nope, because the employee is the biggest throw-away commodity out there. 

Take your medic class (and good luck with it), are you allowed to do any of the lifting as a student? I know I wasn't, even for the genuine cardiac calls.Why? Because I had no insurance under the system I was riding for, just a general umbrella policy for the school. 

So the "lift all" is nothing to do with doing the right thing for the patient, and all to do with the EMS system covering their arse from litigation. If they could have the means to wrap the patient in cotton wool and seal it with clingfilm for transport purposes, believe me, they would be doing it. 

That means, if the provider wishes to engage their brain and do what is best for both provider and patient, they should not be put down for it. 

Sometimes stupid rules and regulations need to be bent a little.


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## Sasha (Jan 8, 2009)

Grady_emt said:


> No, but if you hurt yourself while lifting said finger pain on the stretcher, then drop the stretcher, then they will get hurt.   It's a very situation dependent thing to say weather you walk them out or don't, but if you have a minor complaint and are ambulatory, you're most likely gonnna walk out.



Unless, like here, it's against company policy. Then you're kinda foolish to walk them out.


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## reaper (Jan 8, 2009)

Sasha,

If it is your company policy, then that is fine and you must abide by it. Don't come here saying people are lazy because they let a perfectly capable pt walk to the stretcher or truck. When you have more then a year in the business you will see that your back and health are not worth carrying someone that is capable of walking. I would suspect that being on an IFT, that every pt you see needs to be on a stretcher. That is not always the case in 911 service.


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## Sasha (Jan 8, 2009)

reaper said:


> Sasha,
> 
> If it is your company policy, then that is fine and you must abide by it. Don't come here saying people are lazy because they let a perfectly capable pt walk to the stretcher or truck. When you have more then a year in the business you will see that your back and health are not worth carrying someone that is capable of walking. I would suspect that being on an IFT, that every pt you see needs to be on a stretcher. That is not always the case in 911 service.



Actually, you'd be suprised. a good number of them don't require a stretcher, are able to walk, yet the RN calls for ambulance transport anyway.


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## reaper (Jan 8, 2009)

Then that could be Medicare or insurance fraud? They need a medical necessity form signed by a Dr. to require ambulance transport to be paid. If they can walk, where is the necessity?


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## Scott33 (Jan 8, 2009)

reaper said:


> I would suspect that being on an IFT, that every pt you see needs to be on a stretcher. That is not always the case in 911 service.



Oh now I get it.  

Yes, a little different from 911


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## JPINFV (Jan 8, 2009)

reaper said:


> Then that could be Medicare or insurance fraud? They need a medical necessity form signed by a Dr. to require ambulance transport to be paid. If they can walk, where is the necessity?



To be fair, if the patient can't stand and transfer from a bed to a wheelchair by themselves then it's covered under medicare. So if the patient requires someone to help hold them as they stand and pivot, then a necessity is there. Then, of course, there's the patient's who need monitoring, on oxygen, hip precautions, watching due to psychatric conditions, and a bunch of other non-mobility related issues.


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## Sasha (Jan 8, 2009)

reaper said:


> Then that could be Medicare or insurance fraud? They need a medical necessity form signed by a Dr. to require ambulance transport to be paid. If they can walk, where is the necessity?



Beats me. We have a CMN that's attached to our reports that can be signed by a doctor, RN, or discharge planner. They're supposed to tick whatever box applies to that patient, if they don't tick a box, and it's not obvious like bilateral AKA or chronic confusion, then the form gets turned in with an unticked box and we let billing figure it out.


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## RESQ_5_1 (Jan 8, 2009)

Our Paramedic actually injured his Cervical Vertebrae lifting a pt. Due to the style in which he was lifting, his trapezius put lateral stress on his 5th cervical and caused a hairline fracture. That was over 2 years ago and he still does rehab with the occasional sick day call-in.


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