Blood Pressure: ALS v. BLS

IAems said:
If there is a hospital as close to you as you are making it seem, "approximate 40 second drive from the hospital (given the light at the road being green)", the only reason I would call ALS is when I need extra hands.
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My protocols state anything above 210 should be called in to ALS. Their protocols state anything below 220 should not be treated. Obviously there is a disconnect, but I was doing what I have been told to do by the powers that be.
 
sirengirl said:
My protocols state anything above 210 should be called in to ALS. Their protocols state anything below 220 should not be treated. Obviously there is a disconnect, but I was doing what I have been told to do by the powers that be.
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Protocols are made to be broken. They are more like guidelines anyway
 
Our protocols are guidelines, it even says so in the book. We have protocol for protocol deviation as well!

To all BLS providers: What exactly would ALS do to help this patient? (The answer is nothing)
 
Remember that an EKG or any other test for that matter is only going to show what a provider can see. From the information given by the OP, I would have not preformed a 12 lead EKG on a hypertensive patient free of complaint. I would have no pretest suspicion of a ischemic cardiac event underlying the problem so the results would not alter my differential or treatment.

Now, perhaps I am a cardiologist seeing this patient in the clinic. EKG? yes. Lets look for LVH/strain/LBBB and have this on file to compare later. Perhaps will a BP like this LV failure is only a few years away.. But this EKG would not be preformed to rule out "cardiac causes" of hypertension.

EDIT: Field providers should also read the ACEP's new position on treating hypertension in the ED. Basically, dont do it. I think this can be extrapolated into the prehospital setting. See acep . org
 
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For the OP: Don't look at it as Protocols are meant to be broken; but think about it as they are Guidelines:

Your Protocols state that anything over a systolic of 210 needs and ALS consult; but you are closer to the ED than to ALS. Transport, and document why you didn't call for ALS. OR transport, requesting ALS from Dispatch as you mark transporting, and cancel them when you get to the hospital.
Just be prepared to document and back up why you cancelled ALS.

Talk to your Medical Director about changing the protocols: so that if you are closer to the hospital than to ALS that you don't have to wait on scene. He/she may never have thought about that situation; and it seems to happen alot in your area.

Our Medical director in my old area would change protocols on suggestions of the EMS personnel, as long as we did the research to back up the reason that we wanted it done.
 
johnrsemt said:
For the OP:

OR transport, requesting ALS from Dispatch as you mark transporting, and cancel them when you get to the hospital.
Just be prepared to document and back up why you cancelled ALS.
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Don't waist a resource like this, whether that be ALS or BLS resources.

I would be more concerned about why you called ALS, than with why you canceled them.


Ambulances need to be available when people need them, not playing stupid political games.

If basics were tying up ALS trucks like this in my system, this issue would be immediately bought up with both the medical director and fire chief/ supervisor.

Calling ALS with the intent of having them chase you down, just to cancel them is absolutely horrible.

However, never be afraid to call anyone for assistance if you actually need it.
 
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If your less than one minute from the hospital why is this even being debated? When does common sense prevail?

You can drive your patient to definitive care in less than one minute, or wait on -scene for even longer until a Paramedic arrives who will do absolutely nothing to cause a difference in the patient.

As mentioned, protocols are just that, protocols. It is impossible to address every single patient care scenario with protocols. They are guidelines intended to integrate with clinical judgement and decision making. At the end of the day saying, "I was just following protocol" when it obviously wasn't the best choice won't win anyone over or look good in your defense.

If your a new provider and still getting the hang of all of this I definitely understand and its okay. It's experiences like this that we all learn from when starting out and is what helps build decision making skills.
 
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18G said:
If your a new provider and still getting the hang of all of this I definitely understand and its okay.
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Thank you for noticing, this past Sunday was actually my 2-month birthday of being licensed ;)
 
True, ALS would do nothing to treat the BP. I think the concern was regarding the possibility of a CVA or MI and the patient possibly deteriorating. If the transport time was long, then this could be a legitimate concern.

Now, having said that. Numbers alone are nothing without some signs or symptoms to accompany them. I have always said that if you want to treat numbers, go be a mathematician.

Of course, this is not meant to be offensive to the BLS providers. I try not to blame them for being cautious. I think the training requirements for basics is absurd. I think they should do internships - even if not the same length - as paramedics. But then again, I think educational standards for paramedics if embarrassing. But I guess that's another topic for another thread.
 
SeanEddy said:
True, ALS would do nothing to treat the BP. I think the concern was regarding the possibility of a CVA or MI and the patient possibly deteriorating. If the transport time was long, then this could be a legitimate concern.
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Paramedics, in general, can't do much for a CVA either.
 
Lifeguards For Life said:
If the monitor shows a massive MI, but the elderly diabetic patient has no complaints, do you treat the monitor, or the patient?
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I try to treat the patient. Last time I tried to give apsirin and GTN (nitro) to the monitor, my partner looked at me is if I was crazy.
 
JPINFV said:
Paramedics, in general, can't do much for a CVA either.
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True. But it's the field triage and early entry into the proper segment of the healthcare system that makes the difference. If a CVA patient can be recognized in the field and taken straight to a Stroke Center that is much better for the patient. This is in comparison to taking a CVA to a small little hospital who can't handle them.

EMS can't directly resolve the CVA, but the assessment, triage, supportive care, and rapid transport to a facility that can makes a world of difference.
 
18G said:
True. But it's the field triage and early entry into the proper segment of the healthcare system that makes the difference. If a CVA patient can be recognized in the field and taken straight to a Stroke Center that is much better for the patient. This is in comparison to taking a CVA to a small little hospital who can't handle them.

EMS can't directly resolve the CVA, but the assessment, triage, supportive care, and rapid transport to a facility that can makes a world of difference.
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And why exactly can't a BLS unit call a stroke code? They can in SD and have many times...
 
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