Call for ALS?

[emtfarva]

Dispatched as: Emotional distress

UOA found 60 y/o f standing outside a store. Pt is CAOx3. Pt's cc is "the world is going to end by nuclear war". Per Tauton fire pt has been calling 911 all day. also per fire Pt has long psych hx with MR. When the Pt was asked what made her feel differently today "it just feels wrong and my ex-husband is out to get me." VS wnl. transported to hosp. At hosp nurse observed that the pt was having AH. I looked at the pt's hx and found no medical problems other than psych.

No als needed here.

 

[ffemt8978]

In todays world we can not say that for sure. With people and packages traveling all over the world we are seeing more and more insects that are not native to the USA. So there is always potential that one could be there. Also even the non poisonous do cause some people to have severe allergic reactions. Again an ALS call.

I was editing my post when you posted this, so if you want you can go back and address the rest of the post.

And while we don't have true scorpion experts on our dept., we have enough local residents who recognized that the scorpion was non-poisonous. In the 50 or so years this community has been here, there has never once been a poisonous scorpion found.

But by your line of reasoning, it should be an ALS assessment just in case it is some obscure problem that is being masked by something else. So if every patient deserves an ALS assessment, shouldn't they be getting the best assessment possible? If so, then every patient needs to be taken to a hospital where a doctor can assess them.

 

[medic417]

Dispatched as: Emontional distress

UOA found 60 y/o f standing outside a store. Pt is CAOx3. Pt's cc is "the world is going to end by nuclear war". Per Tauton fire pt has been calling 911 all day. also per fire Pt has long pysch hx with MR. When the Pt was asked what mad her feel differntly today "it just feels wrong and my ex-husband is out to get me." VS wnl. transported to hosp. At hosp nurse observed that the pt was having AH. I looked at the pt's hx and found no medical problems other than psych.

No als needed here.

I disagree. Her mental state might warrant ALS more than many calls. Plus if extemely emotional what can a basic do. ALS can at least sedate if need be to help her relax. Plus with her mentioning here husband out to get her did you look for signs of abuse. Just because someone crys wolf a million times does not mean that the million and one time is not real. Psych patients actually need even higher level than a Paramedic but since that is not currently available in the field they deserve at minimum an ALS response.

 

[emtfarva]

Prior to EMS arrival you do not know all those facts. Plus who says it was not poisonus are you a scorpion expert? Some scorpions look very similiar to one another one just hurts like heck the other injects some pretty serious poison. So you actually are responding to a possibly serious event so should be ALS responding. Patient is found. And yes a scorpion expert arrives as you do confirms not poisonous. After ALS exam no problem found not even a true sting. So guess what we do not transport regardless of mothers demand.

But ALS was needed to rule out and to be there if it turned out legit. What would a basic crew do if airway closing from the toxins? Call ALS so ALS should have been first response to be safe.

Any PT or Pt's parent that requests they be brought to the Hosp has to be brought to the Hosp. whatever you think it is the law.

 

[Shishkabob]

Why not just call for a doctor to come and assess? I mean, if you want an advanced assessment for EVERY call, might as well go all the way, right?

 

[emtfarva]

I disagree. Her mental state might warrant ALS more than many calls. Plus if extemely emotional what can a basic do. ALS can at least sedate if need be to help her relax. Plus with her mentioning here husband out to get her did you look for signs of abuse. Just because someone crys wolf a million times does not mean that the million and one time is not real. Psych patients actually need even higher level than a Paramedic but since that is not currently available in the field they deserve at minimum an ALS response.

I live and work In MA, ALS can only do what a Basic can do for a psych PT. THEY HAVE NO PROTOCOLS FOR CHEMICAL RESTRAINTS. also her ex-husband was dead, btw.

 

[medic417]

There are no poisonous scorpions in my state, unless they're in a zoo.

And if we had waited for ALS to arrive just to assess this patient, it would have been an hour for them to show up. But you mentioned that you would have not transported the patient, regardless of the mother's demands. Legally, we can't refuse to transport a patient. We can do our best to talk them out of it, but if they insist then they get the ride.

But just to make sure that I understand this, you're saying that every patient deserves an ALS assessment to rule out anything because we don't know what we're going to based upon dispatch information. Yet you wouldn't take them to the hospital, so that a definitive diagnosis/rule out can be accomplished using appropriate diagnostic equipment such as labs. I'm curious as to what diagnostic equipment you would have used on this patient that was different than what I had access to at the time.

OOPs my bad I jumped to the conclusion that you knew accurately that the skin was not penetrated. And also I forgot that some toxins can be absorbed through the skin. So yes as a caution might be advisable to transport. But I am allowed to deny transport. In a case like this I would actually just stay on scene with them for a few minutes to observe that no reactions were taking place.

But yes ALS should be dispatched to all calls. Way to many calls for a BP check turn into being full blown acute MI's.

And while a doctor on every ambulance would even be better a properly educated ALS team should be able to treat and release and or determine proper transport location even if only to a local clinic or to the big cardiology hospital. And by doing this we could free up the congestion that is the current USA emergency system.

 

[medic417]

Any PT or Pt's parent that requests they be brought to the Hosp has to be brought to the Hosp. whatever you think it is the law.

Please produce that law. Not your local protocol but that law. I have yet to see any state/federal law that says you must transport all that request it. There are laws that say you can not deny emergency stabilization, but to this point I have seen no law say that you can not deny transport to non emergent patients. I am not going to say it does not exist but I have in all my years have any one produce the law when I ask. I have had several produce protocols but not one law.

 

[Shishkabob]

medic, I'm all for more education, and I want to agree with you, but I can't for one simple reason;

The way you phrase it, and the way you go about it, steps on peoples toes with the assumption that basics don't know anything, when that is just not true.

Please produce that law. Not your local protocol but that law. I have yet to see any state/federal law that says you must transport all that request it.

Just one off the top of my head: Abandonment.

 

[ffemt8978]

Please produce that law. Not your local protocol but that law. I have yet to see any state/federal law that says you must transport all that request it. There are laws that say you can not deny emergency stabilization, but to this point I have seen no law say that you can not deny transport to non emergent patients. I am not going to say it does not exist but I have in all my years have any one produce the law when I ask. I have had several produce protocols but not one law.

I'm still looking for the actual law, but you may want to check out page 408 of this book
http://books.google.com/books?id=uj...C9c&sig=wrB3f1v6ogs8GSFpK_UCodyMMqA#PPA408,M1

It may not be against the law where you live, but not every part of the country has laws concerning EMS-Initiated Refusal of Transport.

 

[medic417]

medic, I'm all for more education, and I want to agree with you, but I can't for one simple reason;

The way you phrase it, and the way you go about it, steps on peoples toes with the assumption that basics don't know anything, when that is just not true.

Just one off the top of my head: Abandonment.

Actually it does not fall under abandonment. Nice try though.

I do apologize if I come accross harshly. My gripe is basics going the other extreme that they know everything. The frustration is a two way street.

 

[Shishkabob]

And mine lays with medics that think they know everything and that are the only ones that can better EMS... guess we're on the same page ^_^


I don't act like I know everything, and I know I don't, but I don't like it when someone bashes my level of education, or in their view lack thereof, simply because of a single certification, and not base it on any of my other education.


THAT is what irks me and why I always jump in these threads. It's not because I think basics should do everything, but because they are making a blanket statement about ALL basics.

 

[medic417]

I'm still looking for the actual law, but you may want to check out page 408 of this book
http://books.google.com/books?id=uj...C9c&sig=wrB3f1v6ogs8GSFpK_UCodyMMqA#PPA408,M1

It may not be against the law where you live, but not every part of the country has laws concerning EMS-Initiated Refusal of Transport.

Yes that is a good read. There is much liability involved in denying patients and even in accepting a patient refusal. And even in my system with the right to deny you have som many checks involved often it is just easier to transport most patients.

As to the law I would just like to see the laws. I have had the law says thrown at me since I first got in EMS yet no one from any state has shown me a law that states I can not deny transport to someone that does not need it. In fact the only laws I have found during research actuall deal with charging patients with 911 abuse for calling for no real reason.

 

[ffemt8978]

And that's the same reason I jump in...blanket statements with absolutes are just an invitation/challenge for me.

Just to be clear, I'm all for an all ALS EMS system nationwide...I just feel that it will never happen because of a variety of factors that nobody wants to address. Things like costs, skills maintenance, proficiency, and CME's aren't being addressed by the "Everyone Needs ALS" group.

 

[medic417]

And mine lays with medics that think they know everything and that are the only ones that can better EMS... guess we're on the same page ^_^


I don't act like I know everything, and I know I don't, but I don't like it when someone bashes my level of education, or in their view lack thereof, simply because of a single certification, and not base it on any of my other education.


THAT is what irks me and why I always jump in these threads. It's not because I think basics should do everything, but because they are making a blanket statement about ALL basics.

Linuss the majority of basics have no medical training besides the two week course, no matter how long it is stretched out. Yes there a few that have degrees in other fields. And there are even fewer still that have degrees or certifications in other medical fields.

And as someone else pointed out many Paramedics from diploma mills actually are not very educated but it is still a lot more than the 2 week basic course. Diploma mills need to be closed but certain groups are fighting to keep them open and to keep all education at a minimum and fast.

In a perfect world the basic would only be a first responder to assist Paramedics on scene with lifting andpackaging patients. It would also allow the basic to be the third member of a dual paramedic crew while getting their paramedic degree.

Linuss I was a basic many years and considered to be one of the best by all that worked with me. I was the partner that the Paramedics wanted as I could handle my responsibilitys and because I to was educated besides my basic I could assist them and even be ahead of them preparing what they needed next. So yes I did get offended when talked down about. But Now I really see how much I was lacking and even how many patients suffered as often as a basic I was the highest level of care available. I never applied for a job as a basic. I was pursued by those that knew me and based on reputation. That still goes now at the higher level.

Again sorry if I seem harsh. I just want to get people to start thinking and to put patients first not our egos. And sadly that means patients deserve at least one Paramedic to respond as they in the largere scheme know more medicaly than the basics so are more likely to catch a problem that a basic could miss.

 

[BossyCow]

I would dearly love to have ALS available for all patients. But it's not a reality for me in the forseeable future. I am by protocol told to call for ALS support on all altered LOC, chest pain, ABD pain and multi-system trauma calls. About 50% of the time I call for ALS support the ALS rig is unavailable or not able to meet with us in under 45 minutes to an hour.

With a critical pt we apply a bolus of diesel therapy and hope an ALS unit breaks free from their current call or transport soon enough to meet up with us enroute. Since the area covered by our ALS system isn't able to afford a decent medic coverage, they often double up on calls, with ALS transports to Seattle hospitals, it often leaves us without an ALS rig available to meet our pt.

In the meantime, we give o2, assist with neb treatments, we can combi-tube, start an IV, splint fxs, control bleeding, and get the pt to the ER.

Is this limited? You betcha! Is it probably inadequate for the needs of many of our pts? Certainly! But it is reality for many of us. So regardless of 'should' we have ALS, we don't. This is the system in which many of us live and work. So telling us that we should do something that is completely and totally a wish list is pointless. Unless you are going to pass me that magic wand of unlimited funding or the cloak of universal ALS availability.. could we just answer the question of the original poster about what the protocols are?

 

[medic417]

Actually this thread has evolved into a great discussion that gets everyones passions into play and gets all to start thinking regardless of level.

 

[BossyCow]

Actually this thread has evolved into a great discussion that gets everyones passions into play and gets all to start thinking regardless of level.

Sure, and instead of providing information for those of us without the option of ALS support, or with limited ALS response, it seques into an 'ALS for everyone' chest thumping session. Pointless... if you want to participate in one of those... there are a bazillion threads already dedicated to that point. But to take a thread in the BLS section of the forum and use it to toot that same tired old horn that is nothing but a pipe dream to many of us, is really tiresome, boring and repetitive.

 

[medic417]

Sure, and instead of providing information for those of us without the option of ALS support, or with limited ALS response, it seques into an 'ALS for everyone' chest thumping session. Pointless... if you want to participate in one of those... there are a bazillion threads already dedicated to that point. But to take a thread in the BLS section of the forum and use it to toot that same tired old horn that is nothing but a pipe dream to many of us, is really tiresome, boring and repetitive.

Actually Bossy I have provided many ideas to you in the past and you griped at me everytime. So I refuse to be drawn into that with you. Have a nice day.

 

[Shishkabob]

Aww man you edited it :sad:

Always ruining my fun!