ALS Intercept Opinions

[Veneficus]

I saw a couple of posts about it not being the medic's job to educate people.

I thought it was the responsibility of all more qualified providers to help their junior collegues as much as possible?

After all does that not benefit the patient?

Does it not benefit the system?

Without some sort of guidance, if you just "steal" patients over to your rig, how do you improve the decision making capability of when and when not to call ALS?

If you call ALS for everything, there really is no point in having a BLS unit at all. It is just a middleman that has to be paid.

I know some companies think a BLS first response is beneficial, but to whom? Unless the pt actually needs treatment BLS can provide, CPR, AED, epi pen, etc, it really serves no point.

You just wind up with a really small circle of death compared to a first response engine or truck company.

Two terrified little providers waiting on ALS ex machina while taking vital signs and administering high flow o2...

Life and death...

 

[vfpd28pac17]

Moving a little slow here, as I said, I'm a FNG. I will try and answer questions and explain as quickly as possible. That being said, "trying to dodge runs" is not my goal at all. The education I'm talking about is not how you are all taking it, if the EMT-B does not see what interventions the Paramedics are able to use in different situations, how are we supposed to know if ALS would be benefitial to the patient? I've seen basics call for ALS for patients with abdominal pain, stating pain control as the reason. They don't understand ALS cannot give pain control for abdominal pain. It's a matter of getting unneeded ALS requests to STOP. Thus, keeping the ALS unit in service.

 

[Veneficus]

I've seen basics call for ALS for patients with abdominal pain, stating pain control as the reason. They don't understand ALS cannot give pain control for abdominal pain.

Why can't a paramedic give pain medication for abdominal pain?

 

[DPM]

I understand what you're getting at REF education, but that is not the right way to be 'going about things'. You don't want ALS arriving on scene to then tell you that they've been called for the wrong reasons... does that make sense?

 

[vfpd28pac17]

As far as the patient and crew safety goes. Every time a patient is moved on the cot there is a risk of the cot falling over, or patient falling from the cot & those lifting the cot being injured. While I've never dropped a patient and I've not hurt my back lifting a patient, all it takes is ONE time and I'm sure all of these HAVE happened. These things can happen at the ambulance bay of the hospital, why risk it happening in a gas station parking lot? I'm not even going to bring in the busy road way argument. We all know there are risks in this job, my thing is why increase the chances of accident occurrence when unnecessary.

 

[vfpd28pac17]

Why can't a paramedic give pain medication for abdominal pain?

What I've been told, is that the hospital wants the patient to have no pain meds onboard for abdominal pain for examination at the hospital. As I've said, I'm only a B and I'm going off what I've been told and seen happen.

 

[STXmedic]

I've seen basics call for ALS for patients with abdominal pain, stating pain control as the reason. They don't understand ALS cannot give pain control for abdominal pain. It's a matter of getting unneeded ALS requests to STOP. Thus, keeping the ALS unit in service.

I think you just proved Vene's point... However, I'm willing to bet you solidified my point of pointing out the quality of education you'd be getting from these units. Was it one of your paramedics that told you this?

 

[Veneficus]

What I've been told, is that the hospital wants the patient to have no pain meds onboard for abdominal pain for examination at the hospital. As I've said, I'm only a B and I'm going off what I've been told and seen happen.

Where do you work the precambrian time?

Pain in abd exam hasn't been required in easily 20 years. Even less so now with the prevalence of CT.

 

[vfpd28pac17]

I understand what you're getting at REF education, but that is not the right way to be 'going about things'. You don't want ALS arriving on scene to then tell you that they've been called for the wrong reasons... does that make sense?

We are not waiting on scene for ALS, and no it does not make sense for an ALS unit to repeatedly tell you they have been called for incorrect reasons. However, it does make sense to assist in the treatment of a patient and see that ALS does no more than BLS treatment. You will know the next time ALS is not required, and this knowledge can be passed on to the other members of the agency.

 

[vfpd28pac17]

I think you just proved Vene's point... However, I'm willing to bet you solidified my point of pointing out the quality of education you'd be getting from these units. Was it one of your paramedics that told you this?

Being that I've not called an ALS for abdominal pain control since being told this and have not had a problem with the hospitals, I'd say the medic was correct. Just so you understand, these same hospitals ask if we have a line started when bringing patients in with flu symptoms.

 

[Aidey]

Without some sort of guidance, if you just "steal" patients over to your rig, how do you improve the decision making capability of when and when not to call ALS?

You arrange inter-agency classes/training sessions. That way the information can be presented in an organized manner with ample time for questions and scenario practice. That way everyone is on the same page and people aren't going off a lot of opinion instead of actual policy.

On the fly has never been my favorite method of teaching.

 

[Veneficus]

Being that I've not called an ALS for abdominal pain control since being told this and have not had a problem with the hospitals, I'd say the medic was correct. Just so you understand, these same hospitals ask if we have a line started when bringing patients in with flu symptoms.

That is very unfortunate for your patients.

 

[ffemt8978]

We are not waiting on scene for ALS, and no it does not make sense for an ALS unit to repeatedly tell you they have been called for incorrect reasons. However, it does make sense to assist in the treatment of a patient and see that ALS does no more than BLS treatment. You will know the next time ALS is not required, and this knowledge can be passed on to the other members of the agency.

You're heading down a slippery slope there. Just because ALS may not be required for a patient doesn't mean the next one with similar symptoms won't require ALS. The ALS unit may pick up on symptoms you didn't, or maybe the patient's history will affect their decision.

And then taking that knowledge/experience and spreading it around third hand to the other members of your agency by saying, "I had a patient with X symptoms that didn't require ALS, so the next time you see X symptoms there is no need for you to call ALS" is a sure fire way to get in trouble.

 

[STXmedic]

Being that I've not called an ALS for abdominal pain control since being told this and have not had a problem with the hospitals, I'd say the medic was correct. Just so you understand, these same hospitals ask if we have a line started when bringing patients in with flu symptoms.

I regret to inform you the medic was incorrect. Unfortunately, that's a lot of medic's mentalities. Getting them to provide ANY pain control is like pulling teeth.

I fail to see how abdominal pain control and IVs in flu patients correlate...

 

[Veneficus]

I regret to inform you the medic was incorrect. Unfortunately, that's a lot of medic's mentalities. Getting them to provide ANY pain control is like pulling teeth

I didn't want to take such a strong stance.

I know there are still some old school doctors out there that actually like to use abd pain as a diagnostic feature.

It is possible that in his area, protocol actually dictates no pain control for abd pain.

At the same time there might be docs in the hospital lamenting how bad the EMS care is that they are not giving pain control for abd pain.

I would specifically look at the ALS protocol. I would not even ask the doc in the ED, because if it is opinion it will change with the provider.

I fail to see how abdominal pain control and IVs in flu patients correlate...

Dehydration exacerbates flu symptoms. IV therapy helps. (in my opinion a bit over kill in most cases, but easier for the provider than oral rehydration)

 

[vfpd28pac17]

I regret to inform you the medic was incorrect. Unfortunately, that's a lot of medic's mentalities. Getting them to provide ANY pain control is like pulling teeth.

I fail to see how abdominal pain control and IVs in flu patients correlate...

I was trying to show that the hospital's act as though all patients ought to have ALS transport, and if they aren't having a fit over not giving pain meds for abdominal pain the medic was probably correct.

 

[Veneficus]

I was trying to show that the hospital's act as though all patients ought to have ALS transport, and if they aren't having a fit over not giving pain meds for abdominal pain the medic was probably correct.

So how do you know the hospital staff is just not quietly thinking that the local EMS provides substandard care?

Most doctors I know don't get bent out of shape enough over such things to actually spend time trying to change EMS practice.

If I were you I would really look for the protocol, only then can you be sure.

If it really does stipulate no pain management for abd pain, I would take it up with the medical director.

I would be hesitant about taking somebody's word on this because not giving analgesia for abd pain is a very old practice and not the current teaching.

 

[STXmedic]

It seems more common that the nurses want the convenience of it already being there than them thinking everybody is an ALS patient.

And just because the hospital isn't *****ing that something wasn't done does not mean that it shouldn't have been. They may not know what capabilities the ambulance has, or may already have a low opinion of the providers and expect no more.

 

[vfpd28pac17]

So how do you know the hospital staff is just not quietly thinking that the local EMS provides substandard care?

Most doctors I know don't get bent out of shape enough over such things to actually spend time trying to change EMS practice.

If I were you I would really look for the protocol, only then can you be sure.

If it really does stipulate no pain management for abd pain, I would take it up with the medical director.

I would be hesitant about taking somebody's word on this because not giving analgesia for abd pain is a very old practice and not the current teaching.

If I could trust our protocols I wouldn't even be on here with this question. Our protocols state under - Transfer of care during In-field Service Level Upgrades.

"1) Safety will be emphasized throughout the intercept and transfer of care.
2) Patient transport should not be unreasonably delayed.
3) If at all possible, the patient should not be transferred from ambulance-to-ambulance except for extenuating circumstances.
4) The higher level personnel with proper equipment shall board the transporting vehicle and oversee patient care with the assistance of the requesting agency's personnel.
5) The transporting ambulance will, at that point, become temporarily, and only during the duration of the transport, a higher level of vehicle.
6) The ambulance returning to the hospital that has no patient on board will do so without the use of emergency lights or sirens."

 

[Veneficus]

If I could trust our protocols I wouldn't even be on here with this question. Our protocols state under - Transfer of care during In-field Service Level Upgrades.

"1) Safety will be emphasized throughout the intercept and transfer of care.
2) Patient transport should not be unreasonably delayed.
3) If at all possible, the patient should not be transferred from ambulance-to-ambulance except for extenuating circumstances.
4) The higher level personnel with proper equipment shall board the transporting vehicle and oversee patient care with the assistance of the requesting agency's personnel.
5) The transporting ambulance will, at that point, become temporarily, and only during the duration of the transport, a higher level of vehicle.
6) The ambulance returning to the hospital that has no patient on board will do so without the use of emergency lights or sirens."

What does this have to do with pain management for abd complaints?

Edit: I think it very clearly states how intercepts are to be handled. Bolded part is specific and support by subsequent lines.
These statements leave no ambiguity at all.