is a broken arm an ALS or BLS call?

[RedBlanketRunner]

Female in her 70's fell getting out of a vehicle in the parking lots of the hospital. ER nurse came on scene and took charge. Woman lying on her side, left forearm extended laterally behind her back. Nurse relocated the arm to the front. An artery was lacerated and one of the major nerves partially severed. Humerus head had broken off.
BLS or ALS, at least have the sense to immobilize in place, not play ortho doc.

 

[medichopeful]

Since we have some new people here, would anyone like to contribute their opinion to this thread (and vote in the poll)?

Sure, I’ll contribute.

All broken bones are ALS for me, unless they refuse pain meds. If they refuse meds, I may still ride it in because they might change their mind.

If I got requested by a BLS crew for a broken bone, or pain meds/comfort meds in general, I would have absolutely zero issue with it, and would actually commend them for doing that.

 

[DesertMedic66]

Sure, I’ll contribute.

All broken bones are ALS for me, unless they refuse pain meds. If they refuse meds, I may still ride it in because they might change their mind.

If I got requested by a BLS crew for a broken bone, or pain meds/comfort meds in general, I would have absolutely zero issue with it, and would actually commend them for doing that.

This. All day and everyday. Pain medications are one of the things that can actually help a patient feel much better. If they refuse pain meds or are not having any pain from the fracture then I am OK with them going BLS.

 

[E tank]

Female in her 70's fell getting out of a vehicle in the parking lots of the hospital. ER nurse came on scene and took charge. Woman lying on her side, left forearm extended laterally behind her back. Nurse relocated the arm to the front. An artery was lacerated and one of the major nerves partially severed. Humerus head had broken off.
BLS or ALS, at least have the sense to immobilize in place, not play ortho doc.

What if the hand was pulseless as presented?

 

[Phillyrube]

The pain management aspect aside, splinting is a technique that every EMT has in his or her bag of tricks.

Only if the splint has velcro. I dont think they teach real splinting anymore...

 

[CCCSD]

I do.

 

[Ensihoitaja]

Our EMTs can give 100 mcg of IV fentanyl, so unless someone's in a lot of pain or there's something weird going on there's no reason to make it ALS.

 

[DesertMedic66]

Our EMTs can give 100 mcg of IV fentanyl, so unless someone's in a lot of pain or there's something weird going on there's no reason to make it ALS.

In that case BLS is more than appropriate. Our EMTs aren’t even trusted with oral glucose

 

[Peak]

Since we have some new people here, would anyone like to contribute their opinion to this thread (and vote in the poll)?

A simple fracture can go be driven in POV like the majority that present to clinic or the ED.

 

[Peak]

Our EMTs can give 100 mcg of IV fentanyl, so unless someone's in a lot of pain or there's something weird going on there's no reason to make it ALS.

To be transparent the majority of the busses are double medic, and there aren’t any BLS only crews except for the detox can, correct?

 

[DragonClaw]

Extreme situation aside.

If I broke my arm I'd just drive myself to the hospital. Or I'd drive the pt (assuming I'm off duty)

If I was on duty I'd give them an informed option. They're stable and it hurts but you won't like this bill. If you can't grit the pain, call an uber or a friend.

I broke my ankle and had I not been at the hospital already(and on duty) I'd have driven myself probably.

 

[FiremanMike]

Our EMTs can give 100 mcg of IV fentanyl, so unless someone's in a lot of pain or there's something weird going on there's no reason to make it ALS.

Is this in America? Who starts the IV?

 

[hometownmedic5]

Any of you medics out there who think patients only deserve analgesia if you have bones sticking out or 90% burns etc can pick your favorite cheek and pucker up. I have nothing but loathing and disdain for each and every one of you. Try a little humanity on for size. Administering narcotic analgesia isn't launching the space shuttle. It's ten minutes of extra paperwork. Boo Hoo. What kind of sick thrill do you people get sitting there watching someone writhe around in pain, often fighting some sort of anxiety causing restrictions and general stress?

FFS, do your job. I'm not saying every patient with "10/10" atraumatic back pain off and on for forever gets dosed every time they call. This isn't that. Just about any patient not waving a bright red "I'm drug seeking" flag is going to get the benefit of the doubt from me. Of course, I'm a paramedic who spun their motorcycle into the interstate at just under the speed of light and laid their incredulously while the medic made up a lie about why he didn't want to medicate me. No joke. I asked, he said "well..", looked at his watch, and then out the window to estimate time to destination. I worked with a medic a number of years ago who, in complete seriousness told me there was no situation he could conceive in which he'd administer narcotics. None.

 

[Peak]

Any of you medics out there who think patients only deserve analgesia if you have bones sticking out or 90% burns etc can pick your favorite cheek and pucker up. I have nothing but loathing and disdain for each and every one of you. Try a little humanity on for size. Administering narcotic analgesia isn't launching the space shuttle. It's ten minutes of extra paperwork. Boo Hoo. What kind of sick thrill do you people get sitting there watching someone writhe around in pain, often fighting some sort of anxiety causing restrictions and general stress?

FFS, do your job. I'm not saying every patient with "10/10" atraumatic back pain off and on for forever gets dosed every time they call. This isn't that. Just about any patient not waving a bright red "I'm drug seeking" flag is going to get the benefit of the doubt from me. Of course, I'm a paramedic who spun their motorcycle into the interstate at just under the speed of light and laid their incredulously while the medic made up a lie about why he didn't want to medicate me. No joke. I asked, he said "well..", looked at his watch, and then out the window to estimate time to destination. I worked with a medic a number of years ago who, in complete seriousness told me there was no situation he could conceive in which he'd administer narcotics. None.

I beg to differ. A simple, union, fracture with intact CMS does not warrant intervention beyond a splint and non-opioid pain management. There are is a lot of literature that shows non-opioid pain management to be just as effective.

I think that there is an important distinction between withholding opioids versus treating with the correct analgesic therapy (which is often not an opioid).

 

[FiremanMike]

Any of you medics out there who think patients only deserve analgesia if you have bones sticking out or 90% burns etc can pick your favorite cheek and pucker up. I have nothing but loathing and disdain for each and every one of you. Try a little humanity on for size. Administering narcotic analgesia isn't launching the space shuttle. It's ten minutes of extra paperwork. Boo Hoo. What kind of sick thrill do you people get sitting there watching someone writhe around in pain, often fighting some sort of anxiety causing restrictions and general stress?

FFS, do your job. I'm not saying every patient with "10/10" atraumatic back pain off and on for forever gets dosed every time they call. This isn't that. Just about any patient not waving a bright red "I'm drug seeking" flag is going to get the benefit of the doubt from me. Of course, I'm a paramedic who spun their motorcycle into the interstate at just under the speed of light and laid their incredulously while the medic made up a lie about why he didn't want to medicate me. No joke. I asked, he said "well..", looked at his watch, and then out the window to estimate time to destination. I worked with a medic a number of years ago who, in complete seriousness told me there was no situation he could conceive in which he'd administer narcotics. None.

While there are certainly medics who are generally lazy about giving narcs because they are lazy, there are also those of us knee deep in the opiate crisis who are evaluating each case individually to decide if it's worth the risk of introducing the patient to the joys of opium intoxication.

Have I given opiates to fractures? Yes.. Do I give opiates to all fractures? No.. If that means you loathe and disdain me, I'm ok with it.

Pain should have never been made a vital sign.

 

[DrParasite]

I'm not saying every patient with "10/10" atraumatic back pain off and on for forever gets dosed every time they call.

as someone who has had 10/10 atraumatic back pain off and on forever, I can say when it's hurting, and I can't move, I would love some pain meds.

Of course, I'm a paramedic who spun their motorcycle into the interstate at just under the speed of light and laid their incredulously while the medic made up a lie about why he didn't want to medicate me. No joke. I asked, he said "well..", looked at his watch, and then out the window to estimate time to destination.

and you filed a formal complaint with his agency, and demanded corrective action be taken against this medic, because he was not acting in the best interests of his patient, nor was he following the current standard of care... right? if you didn't, then you seem to be a keyboard commando, who is more than willing to judge and complain about people online, but when an actual wrong occurs, you don't do a thing to actually rectify the situation.

I worked with a medic a number of years ago who, in complete seriousness told me there was no situation he could conceive in which he'd administer narcotics. None.

If I had been in your position, I would have driven back to the station, and told my manager that I refuse to work with someone who clearly has no business being on an ambulance. That person should be stripped of their certification and terminated. I am not saying that all pain should be treated by narcotics (in fact, I think quite the opposite), but to refuse to give narcs under any circumstances? Nope, I'm not working with a provider like that.

And i think everyone should read from page 1 to the current one, to see that many of the opinions are identical to what is being said now.

oh, and @Phillyrube, we teach every student how to splint in my EMT class. I am usually the evaluator, and all of my students know that I don't care how pretty it is, as long as it actually immobilizes the injury.

 

[Aprz]

I'll frequently give Morphine even if I don't suspect fracture. It's easy to do and pain is pain. Who cares about 5-10 mg Morphine as long as I didn't use it on myself or steal, right?

I'll sometimes give the call to an EMT if the patient insist on not having any pain management. If it looks bad to me and the transport isn't just down the street, I'll retain the call just in case.

We carry intravenous Tylenol/Ofirmev for patients who Morphine is contraindicated in, an alternative if they don't want Morphine, orif their pain isn't severe. Works well.

 

[mgr22]

I'll frequently give Morphine even if I don't suspect fracture. It's easy to do and pain is pain. Who cares about 5-10 mg Morphine as long as I didn't use it on myself or steal, right?

I'm guessing you don't mean this the way it sounds to me, which is that morphine is benign except for its analgesic properties. I agree pain shouldn't be ignored, but nausea and allergic reactions are two reasons I wouldn't give it casually.

 

[Bullets]

I think that there is an important distinction between withholding opioids versus treating with the correct analgesic therapy (which is often not an opioid).

This is why we are emphasising microdosing of ketamine as an alternative to opiates

 

[RocketMedic]

Pain medication is humane, safe, and generally appropriate.