# Did we do evrything right?



## ilemtbwantn2bTXEMT-P (Apr 25, 2011)

About a month ago my partner and I had a rookie with us doing one of his company required ride alongs. Anyways we got a call to a nursing home for the 59y/o female who fell and was c/o severe hip pain nothing unusual at first. On arrival we found our pt laying in bed screaming in pain, she had a h/x of stoke with left sided paralysis and hypertension when I initially took her B/P it was at the time and still is the most hypertensive I have ever gotten from a pt. it was 190/110 our SOP says ALS at 200 Systolic so we immediately called medical control gave them the other vitals of resps. around 22 and I don't recall  the pulse now, the pain when we asked the pt was a 12/10. Medical control advised us thta the LPN on site could give the pt her B/P meds and to transport to the closest ER. My partner asked the LPN who obliged and after the med was given and we got the LPN's info for the report we quickly transferred the pt to the cot and moved her to the rig. I was driving as my partner was just a few months senior to me he was working with the rookie in the back. I radioed our dispatch of the situation and since we were BLS asked to go Lights/Sirens. They said call our Medical Control we did and gave them a new set of vitals which hadnt changed at all. They we dumbfounded as to why they didnt hear our siren in the background already. So I tell dispatch what control said and then ran emergency to the ER. On arrival at the ER we transferred care to staff, on a side note our closest ER from the scene was a 20minute dirve with Lights/Siren.  On arrival at the ER the B/P hadnt chnaged still. So we go and do our report and all that and then get a cell phone call from our clinical coordinator a Paramedic who is all pissed we ran hot and he flat pout said to us we did it all wrong and that the pian and hypertension were unrelated and redo the report documenting everything. Another note my partner did document everything including that call in total our report narrative was about 5 pages long. So we called our Resource EMS Office and explained everything to them, they weren't happy at all. So we figured it was settled and all would go on fine. No a day or two later our Operations manager chews us both out for goin to our System for what to do after getting chewed out. Everybody except our bosses syas we did the right thing for the patient. Did we? Any feedback on this is greatly appreciated.


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## Sasha (Apr 25, 2011)

Ahhh big text block. It burnsit burns.


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## HotelCo (Apr 25, 2011)

You have to ask permission to go Lights and Sirens? That's a medical decision, not an operation decision.


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## ilemtbwantn2bTXEMT-P (Apr 25, 2011)

HotelCo said:


> You have to ask permission to go Lights and Sirens? That's a medical decision, not an operation decision.



Yep and thats what I said and got myself  chewed out and threatened to be fired, granted that place also got away with only carrying Oxygen and no other medication at all on a BLS Rig.


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## mycrofft (Apr 25, 2011)

*Your question is unclear, return to the Magic Eightball later.*

Naw....
1. Did you do OK clinically? Sure, I guess, especially if the hospital feels likewise since we are not there. 
2. CODE 3: why? What was the "seconds count" nature of your call? What was the risk benefit balance between increased danger driving and pain due to maneuvering, versus getting care for a condition which could result in death or greatly enhanced harm if one or two minutes were not shaved off? (Mileage to hospital?).
3. Were they ok to yell at you for going Code 3: they can yell anytime they want as long as it does not support a labor law violation, they are free to manage, you are free to quit.
4. Five page documentation and going to higher power: be careful not to be violating HHIPA, and weigh whether calling in an airstrike is worth it. The issue will probably just blow over unless you show a pattern of "running hot" (Code 3), but it will take longer now that you pulled the big red lever and got higher levels engaged.


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## EMS49393 (Apr 26, 2011)

I have a problem with this call on a few levels.  Did you assess the hip area?  Did you check the extremity for rotation and shortening?  Does the patient have a history of bone density issues?  They have at least one bone density issue, they are post-menopausal.  Did you SUSPECT a hip fracture secondary to this fall?  For that matter, what caused her to fall?  Did she get dizzy (clue), did she feel faint (another clue), or did she just slip and fall (rule out clue)?

I would have suspected it, and given that she was in pain just laying in bed, I would have immediately called for an ALS upgrade for pain control.  Seriously, it's really one of the only cool tricks we have next to D50, so I welcome any chance to be called out for pain control.  There is a direct correlation between hypertension, tachycardia, and pain.  Control her pain, I bet her blood pressure will begin to fall.

Knowing the BP was that high and not being able to put 2+2 together to figure out it could be a pain related issue, did you do a neuro exam?  A CPSS exam?  What was your reasoning behind calling medical control about her blood pressure being so high?  Just to ask permission to run lights/sirens?

I don't know what state you are in, or what service you work for, but if you were my employee, you wouldn't just get chewed out, you'd get a written reprimand and remedial training.  

Your patient was not a priority patient unless she was exhibiting signs and symptoms of a new onset CVA, STEMI, or some respiratory distress situation that can't be seem to be fixed in the field (like a PE).  I might throw a major trauma in there, but no one can agree on what constitutes an emergent trauma.

If the reason you didn't call for ALS for pain management is because it's against your company policy, then your company sucks.  Pain management and the ability to call ALS when uncomfortable as a BLS provider would be the battle I would pick, not the "getting chewed for running code" battle.


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## ilemtbwantn2bTXEMT-P (Apr 26, 2011)

EMS49393 said:


> I have a problem with this call on a few levels.  Did you assess the hip area?  Did you check the extremity for rotation and shortening?  Does the patient have a history of bone density issues?  They have at least one bone density issue, they are post-menopausal.  Did you SUSPECT a hip fracture secondary to this fall?  For that matter, what caused her to fall?  Did she get dizzy (clue), did she feel faint (another clue), or did she just slip and fall (rule out clue)?
> 
> I would have suspected it, and given that she was in pain just laying in bed, I would have immediately called for an ALS upgrade for pain control.  Seriously, it's really one of the only cool tricks we have next to D50, so I welcome any chance to be called out for pain control.  There is a direct correlation between hypertension, tachycardia, and pain.  Control her pain, I bet her blood pressure will begin to fall.
> 
> ...



It was the compnay policy and system policy to call medical control for an ALS upgrade which we did control said we should just take it, and we would have been fired for calling the nearest ALS from the FD. Believe me the company and its policies sucked and the state that was in was backwards as all heck with EMS, I hated it there, our hands were so tied that unless we were ALS we really couldnt do anything for anyone  we had no AED's and olny carried oxygen on board. We did assess the hip and possiblity of C-Spine  however she was A/Ox1 to begin with due to her H/X of a Stroke. We did do a physical exam though and found no indications of a fracture or where the pain was coming from. The C-Spine factor was further ruined by the fact that the staff at the facility hadn't called us when it first happened but a day later, any type of CSM test would have yeilded really nothing as well the pt had complete left side paralyis from the preivous stroke. On top of that her sister was standing there asking what the heck was going on. Having spent time on ALS rigs with a FD  prior to during and after working at that private I wanted ALS for that but everyone above me said no. I mean any suggestions as far as where to go on that or what to do with that, because eventually I want to attain a Medic License and not be so restrained in some areas on what I can and cant do to help my patient.


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## Chief Complaint (Apr 26, 2011)

ilemtbwantn2bTXEMT-P said:


> It was the compnay policy and system policy to call medical control for an ALS upgrade which we did control said we should just take it, and we would have been fired for calling the nearest ALS from the FD. Believe me the company and its policies sucked and the state that was in was backwards as all heck with EMS, I hated it there, our hands were so tied that unless we were ALS we really couldnt do anything for anyone  *we had no AED's* and olny carried oxygen on board. We did assess the hip and possiblity of C-Spine  however she was A/Ox1 to begin with due to her H/X of a Stroke. We did do a physical exam though and found no indications of a fracture or where the pain was coming from. The C-Spine factor was further ruined by the fact that the staff at the facility hadn't called us when it first happened but a day later, any type of CSM test would have yeilded really nothing as well the pt had complete left side paralyis from the preivous stroke. On top of that her sister was standing there asking what the heck was going on. Having spent time on ALS rigs with a FD  prior to during and after working at that private I wanted ALS for that but everyone above me said no. I mean any suggestions as far as where to go on that or what to do with that, because eventually I want to attain a Medic License and not be so restrained in some areas on what I can and cant do to help my patient.



Whoa, seriously?


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