140/80 and you're calling for ALS intercept for hypertensive crisis?

[Martyn]

It doesn't bear repeating. A sign of a great provider is recognizing the need for definitive care over field treatment and getting said patient to that care in the quickest and safest way possible vs waiting around for an ALS truck.

It grates my nerves when EMTs call for ALS and they're within five minutes of the hospital.

And as for paperwork, there has to be certain paperwork in the chart that I need for good continuity of care. Our calls are often more complex than an otherwise healthy person going to the ER for a tummy ache. If it isn't there I need to get the nurses on it sooner rather than later. My partner better have a fresh set of vitals for me when I walk in the room. Eff the stretcher.

Had a patient, BP 78/46 P124 RR18 less than 5 minutes to ER, stuff ALS etc...we scooped and went. Another patient BP 54/P P90 RR16 about 8 minutes from ER...scooped and went. Even in the middle of Tampa we are probably talking about 8-10 minutes for ALS (county) to get on scene. I would much rather think of my patient and go straight to ER than mess about waiting for ALS. And yes I am an EMT-B on a BLS truck.

 

[Martyn]

BTW, last thursday had a BLS 911 non emergency call for hypertension, on scene BP 168/68 P90 RR16 er, sort of er, took him to the wrong hospital. Got written up, suspended a day without pay and put on 90 days probation!!! (Last I heard the patient was still alive though...lol)

 

[DrParasite]

BTW, last thursday had a BLS 911 non emergency call for hypertension, on scene BP 168/68 P90 RR16 er, sort of er, took him to the wrong hospital. Got written up, suspended a day without pay and put on 90 days probation!!! (Last I heard the patient was still alive though...lol)

ummm, not to get off topic, but based on what you just described (assuming no other alarming factors) the patient sounds relatively stable, could have went to the hospital they requested and doesn't sounds like they are imminently unstable or dying (and yes, a RR of 16 isn't too alarming)

maybe your write up and suspension was justified for not following company policy and the patient's wishes?

 

[medicdan]

If you're on a BLS unit an you decide that your pt should be ALS but it's gonna take 20 minutes for an ALS unit to arrive yet your BLS truck is only 15 min code 3, why would you not bring the pt in hot BLS? I have to have this discussion probably once a week with a BLS truck that upgrades a call. Our job is to get the pt to definitive care which is a hospital, not the back of an ALS unit, it don't matter if they arrive ALS or BLS. Things like this need to be considered when calling for an ALS unit. There are very few calls where it is worth the time to wait on ALS if a BLS unit can get the pt to a hospital quicker than the ALS unit you just called will.

I absolutely agree, with one caveat. In every system I've worked in, care quality is measured (either formally or informally) by specific factors-- one of which being whether we request ALS for patients requiring that care. That means that even though the hospital is less than five minutes away, and I know that the patient will probably not benefit from the intercept, but I feel compelled to request it, if nothing else, so I can document that I made the effort.
I just hope that if we end up with an ALS truck the medic has the sense to say "just drive".

 

[Brandon O]

It doesn't bear repeating. A sign of a great provider is recognizing the need for definitive care over field treatment and getting said patient to that care in the quickest and safest way possible vs waiting around for an ALS truck.

It grates my nerves when EMTs call for ALS and they're within five minutes of the hospital.

I think this is actually both appropriate and important (not that the medics always agree) in certain situations -- mostly, when there's a question about the appropriate transport destination, and the medics can help answer it. A couple canonical examples, both of which have happened recently:

1. Sick stroke patient who probably needs a major tertiary facility with neurosurgery, but by protocol would need to go to nearest "stroke center," which is a community hospital that will just end up transferring them out. Medics are intercepted and due to greater leeway in such decisions order transport to the appropriate destination.

2. Chest pain patient, possible MI, a few minutes from a community hospital with no PCI capability. If we scoot over there, by crossing their doors we'll probably add 30-45 minutes to this patient's time until reperfusion in the event they do have a STEMI -- it's not like there will be an immediate 12-lead in the ED followed by us turning around and leaving, they'll go through a lengthy process followed by eventual transfer to the place we should've gone originally. Even if we meet the medics in their parking lot, if they can do the 12-lead, divert us to the right hospital and possibly activate the cath lab from the field, this will be far better for the patient.

Think of the course of care and what the patient needs, that's my motto.

 

[Medic29]

...


All of these 'new' and 'inexperienced' and 'lousy' basics that we complain about now, have the potential to be us in 5, 10 and 20 years. If someone like us doesn't scare them away.

I appreciate this statement

 

[systemet]

I think it's far better to call ALS in a situation where you're uncertain than to not call them, and have the patient suffer as a result.

Any half-decent paramedic should be willing to come and assess a patient for a BLS crew if they're uncertain about it.

No one likes the sense of entitlement and belittlement when it comes from the MDs (fortunately, only from a very small, but very vocal, portion of them). Imitating this doesn't make us better paramedics.

 

[NYMedic828]

Your job as a paramedic isn't just to provide ALS care.

You should always be considering things you can teach to coworkers. If you are with a BLS crew, try and explain what you are doing and get them involved even if it's just holding the patients arm for you. Teach them to spike a bag, review the job with them after. If someone gives you an attitude and isn't willing to learn then you have the right to get frustrated.

Don't get mad or annoyed because people called you and you feel they are incompetent. Instead be part of the solution so they know better next time.

Many EMTs don't actually know the scope of a paramedic and what is actually treatable via ALS

So they called you because they thought they had a diabetic but it was a CVA or they called you for hypertension. Big deal, it's 30 minutes out of your day and that's what you are there for. Everyone makes mistakes from time to time. Cut them some slack and don't forget where you come from.

I remember a job once when I was an EMT up in Harlem. Spanish speaking family, I don't speak Spanish and called ALS because he had an irregular rate. The guys that showed up happened to speak Spanish turned out the guy had a demand pacemaker and the medic was an obnoxious **** about it. It's discouraging and unneccesary.