A Rookies tragic mistake. Paramedics this one is for you

mgr22

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Check out the DAWN and DEFUSE 3 trials, which looked at retrieval presenting 6-24 hours after onset (DEFUSE 3 was 6-16 hrs). It's pretty new stuff, but many of the big academic hospitals are doing it.

Got it, thanks very much!
 

Tigger

Dodges Pucks
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I mean if the story as told is precisely what happened, that's a major hit on the crew's assessment. Never mind the whole "EMTs and paramedics don't diagnose" crap, you still should recognize abnormal neuro findings that are not resolving and that pass that along. And if you frame it as a BS complaint, expect the facility to treat as such. If you want the hospital to believe your interpretation, you better be right or otherwise just stick to the facts.

The treatments that were/were not rendered have minimal bearing here. The fact that this patient was assessed poorly and then passed off poorly is the issue and that's sits mostly on EMS.
 

VFlutter

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One of our local academic stroke centers will do Endovascular up to 24hrs I believe. I think tPA will be falling out of favor with more aggressive retrieval.

I hope that most competent providers realize that age does not preclude any condition.

I had a friend with a similar story, ended up having a spontaneous vertebral artery dissection.
 

rescue1

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I mean if the story as told is precisely what happened, that's a major hit on the crew's assessment. Never mind the whole "EMTs and paramedics don't diagnose" crap, you still should recognize abnormal neuro findings that are not resolving and that pass that along. And if you frame it as a BS complaint, expect the facility to treat as such. If you want the hospital to believe your interpretation, you better be right or otherwise just stick to the facts.

The treatments that were/were not rendered have minimal bearing here. The fact that this patient was assessed poorly and then passed off poorly is the issue and that's sits mostly on EMS.


I agree that this is certainly a major blunder on the EMS side, I just also think there is a significant responsibility that falls on the hospital. Just because EMS says that a patient is fine doesn't mean you can leave a patient unassessed for 4 hours.

If anyone here has worked in an ED before, there is often a surprising difference in what EMS thinks is serious vs who gets actually admitted to the ICU or something similar. I know for me it was pretty eye opening when I saw it from the ED's perspective.

And I also hate the "EMS doesn't diagnose" crap too. Even in the most restrictive system, if you ever picked a protocol to follow then you diagnosed to some level.
 

Tigger

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I agree that this is certainly a major blunder on the EMS side, I just also think there is a significant responsibility that falls on the hospital. Just because EMS says that a patient is fine doesn't mean you can leave a patient unassessed for 4 hours.

If anyone here has worked in an ED before, there is often a surprising difference in what EMS thinks is serious vs who gets actually admitted to the ICU or something similar. I know for me it was pretty eye opening when I saw it from the ED's perspective.

And I also hate the "EMS doesn't diagnose" crap too. Even in the most restrictive system, if you ever picked a protocol to follow then you diagnosed to some level.
Absolutely. I am not entirely sure how these complaints would not be noted in even the most triage assessment. Even when we put patients in the waiting room, they are still triaged pretty quickly and then parked back in the waiting room. I am not familiar with any hospital that lets patients sit in the ED for hours with absolutely no contact by medical staff.
 
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