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

[Hockey]

this job is all about making mistakes and learning from it, its an evidence based medicine. Being new, everything is scary, you're not sure what you're suppose to do in certain scenarios and you're not sure what is the right or wrong thing to do at that time. Everybody makes it, and if you don't, i sure as hell don't want to be your partner or your patient when you do make that mistake.

I don't make mistakes, I'm a Paramedic!

 

[Tigger]

than you haven't been in this field very long.

knowing when ALS is needed or not needed is part of being a good provider.

bring proud of never calling for ALS, or always cancelling ALS, on sick person calls or those borderline cases is a sign that you are a poor provider.

I've called ALS for borderline stuff. I've called for sick patients. and sometimes we both arrive at the same time, and I will say "since you are here, why don't you check them out and throw them on the monitor?" which I only do to medics who treat BLS providers poorly.

and on one borderline call, I had a 40 year old with chest pain, and when the paramedic arrived, her first words were "why are we here???" I told her "because I have a 40 year old man with chest pain, I don't know why. I've ruled out anything I can think of, maybe you want to take a look? " and while he isn't acutely dying, I don't know what the underlying cause is. they assessed and M+T to the hospital with us. and if they released to us oh well, I wanted to make sure there was nothing else going on that I couldn't detect.

for those paramedics that :censored::censored::censored::censored::censored: about getting called for BS, who cares??? you are paid by the hour right? show up, do an assessment, find the patient stable, write a chart and release the patient to BLS to take to the hospital, and go back to your couch or TV.

Ok we get it, you have lots more experience than us. No one here has said that they're proud to have never called for ALS, and I doubt anyone will. I've been working for a year and have called for ALS once. I have no attachment to that number, I've only had one patient where it was clinically and operationally indicated to call.

There is a distinction. 9/10 times the hospital is my ALS. I know, holding someone's hand is not cutting edge medicine, but a lot of time that and a pillow is all that someone's getting for treatment on the way to the hospital. For some of us, it makes a lot more sense to just go to the hospital than try and set up an intercept.

Before you knock us for not having experience and, realize that we don't all work in your system either.

 

[EFDUnit823]

I hate basics. They give other basics a bad name. No wonder most medics dont trust us.

Cool story, where are the dragons? :glare:

 

[Anjel]

Cool story, where are the dragons? :glare:

Ooook? Most basics are not the brightest. And there are exceptions.

How is that an incorrect statement?

 

[mycrofft]

Not to worry.

"Freaking out" repeatedly is a sign the practitioner needs to consider another line of work for their sake and those of their co-workers, the driving public, and their patients. (Never hurts to consider).

When in doubt, call. Know the protocols, and ask about why they have certain parameters (a shortcut to knowing more about physiology sometimes). Get a mentor. And we all went through the excitable stage and will instantly resort to it when it is us, our family, or another loved one that's in trouble...I hope.

 

[Sasha]

Ooook? Most basics are not the brightest. And there are exceptions.

How is that an incorrect statement?

Don't worry love some people are just insecure in their own competence.

 

[mycrofft]

..or over-secure in our self-alleged competence!:blush:

 

[Bullets]

Anyone take the other route? Adhere strictly to the protocols, request ALS for anything that doesnt comply with the strict protocols set by your archaic medical director? Hopefully annoy the MDs until they actually engage field providers and change

 

[Jon]

...As I walk in, the Intermediate is doing paperwork while the EMT is hanging out with the patient. The Intermediate looks perturbed that I was there, saying "I can handle it, I don't know why they sent you". I check out the patient anyhow....

I've never been able to get the hang of the IFT "stand at nurses station and do paperwork for 20 minutes before I see the patient" routine. It drives me bonkers when my partners do it... so I go assess their patient for them. Some of my partners have picked up on that... some are too entrenched to care.

knowing when ALS is needed or not needed is part of being a good provider.

bring proud of never calling for ALS, or always cancelling ALS, on sick person calls or those borderline cases is a sign that you are a poor provider...

While I don't think he was directly adressing anyone in this thread... it bears repeating.

Pretty sure they removed that from the EMT-B curriculum

Too true.

this job is all about making mistakes and learning from it, its an evidence based medicine. Being new, everything is scary, you're not sure what you're suppose to do in certain scenarios and you're not sure what is the right or wrong thing to do at that time. Everybody makes it, and if you don't, i sure as hell don't want to be your partner or your patient when you do make that mistake.

My favorite quote on this, when precepting N00B's:
Good judgment comes from experience, and experience comes from bad judgment. (I can't find a definitive cite for the quote).

Anyone take the other route? Adhere strictly to the protocols, request ALS for anything that doesnt comply with the strict protocols set by your archaic medical director? Hopefully annoy the MDs until they actually engage field providers and change

I've worked with EMT's that do that. It's annoying, for a bunch of reasons.

 

[Aidey]

Jon, I never make contact with the patient until staff know we are there. I don't spend 20 minutes doing paperwork, but if the RN isn't available I'll work on the paperwork until she is.

It might seem strange, but there have been more than several times where it has saved my butt because of pissed off family, cranky patients etc. An oddly large number of nursing home staff don't tell patients they are being sent out until the last second. It is always fun having a 90 yo tell you you're crazy and not taking them anywhere because staff never gave them the heads up that they were being sent in for their fever of 90 degrees.

 

[firecoins]

I've never been able to get the hang of the IFT "stand at nurses station and do paperwork for 20 minutes before I see the patient" routine. It drives me bonkers when my partners do it... so I go assess their patient for them. Some of my partners have picked up on that... some are too entrenched to care.

I expect my EMT-B to be assessing the patient while I stand at the RN's desk doing paperwork, asking the RNs for report. Can't stand when I turn around see my EMT prepping the cot and he doesn't have vitals.

 

[Aidey]

Jon, I never make contact with the patient until staff know we are there. I don't spend 20 minutes doing paperwork, but if the RN isn't available I'll work on the paperwork until she is.

It might seem strange, but there have been more than several times where it has saved my butt because of pissed off family, cranky patients etc. An oddly large number of nursing home staff don't tell patients they are being sent out until the last second. It is always fun having a 90 yo tell you you're crazy and not taking them anywhere because staff never gave them the heads up that they were being sent in for their fever of 90 degrees.

That is supposed to be fever of 99 degrees.

 

[Sasha]

I've never been able to get the hang of the IFT "stand at nurses station and do paperwork for 20 minutes before I see the patient" routine. It drives me bonkers when my partners do it... so I go assess their patient for them. Some of my partners have picked up on that... some are too entrenched to care.


While I don't think he was directly adressing anyone in this thread... it bears repeating.


Too true.



My favorite quote on this, when precepting N00B's:
Good judgment comes from experience, and experience comes from bad judgment. (I can't find a definitive cite for the quote).



I've worked with EMT's that do that. It's annoying, for a bunch of reasons.

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.

 

[Sasha]

Jon, I never make contact with the patient until staff know we are there. I don't spend 20 minutes doing paperwork, but if the RN isn't available I'll work on the paperwork until she is.

It might seem strange, but there have been more than several times where it has saved my butt because of pissed off family, cranky patients etc. An oddly large number of nursing home staff don't tell patients they are being sent out until the last second. It is always fun having a 90 yo tell you you're crazy and not taking them anywhere because staff never gave them the heads up that they were being sent in for their fever of 90 degrees.

Or combative patients.

Nothing like going in
Me: "hi I'm sasha blahblahblah"
Patient: *whack*

 

[EMTHokie]

Basics that get worried/freak out due to HR of 140-160 while running a fever of 104F. Oh wait that was me, until someone sat down and educated me about things like that.

If someone doesn't mind, can you explain to a new EMT why this isn't an ALS issue? Just so I don't do the same

 

[exodus]

If someone doesn't mind, can you explain to a new EMT why this isn't an ALS issue? Just so I don't do the same

Because sepsis is a BLS call, right?

 

[EMTHokie]

Because sepsis is a BLS call, right?

Yeah, I guess so as long as there aren't any extenuating circumstances.

So in this case, monitor vitals, put on O2 and transport?

 

[exodus]

Yeah, I guess so as long as there aren't any extenuating circumstances.

So in this case, monitor vitals, put on O2 and transport?

I was using sarcasm h34r:

 

[EMTHokie]

I was using sarcasm h34r:

Yeah, missed that one :sad:

 

[iPhonemedic]

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.