Did this warrant Lights and Sirens?

[Christopher]

I work for a BLS transport company only. We got an emergency call to go to a nursing home. If you're familiar with the Denver area it's in the area of Federal and Arkansas. C/C was fever. In my rig I get a set of vitals.

BP 150/60
Resp 28
Pulse 144
BGL 448
Temp 107.6 (That's right 107.6)

I double check, then check again, and then again and each time I got 107.x. Ok so my thermometer is F*cked cause the NH reported a temp of 102. We start going normal. I check my temp it's 97.6. I check his again 107.4.

I tell my driver to go faster. We're going to St. Anthony's Medical Center off of Alameda and 2nd. We're driving on Alameda about 1730. It's rush hour still in Denver.

Besides the BP, everything is wrong for this patient (I'm used to working in nursing homes and I see patients with this BP everyday with hypertension).

I had my driver go lights and sirens because even if the resp were normal and the pulse was lower, the temp alone is enough to fry the brain. Some people have told me I did good, others said lights and sirens were not appropriate just drive fast.

Interventions: Undress and turn on air. I'm from SD so I don't yet have my IV cert to cool with fluids and being I'm still new, I forgot to use the ice packs I have available (something I'll be sure to do different next time).

What do you think?

Emergent transport has not been proven to decrease mortality of septic or febrile patients. Recognition of these conditions, however, has been.

Routine is fine for anything not proven to be time sensitive. Even trauma hasn't been shown to benefit from L&S.

Nice and easy ride always wins.

 

[Christopher]

The patient was septic, they needed fluid resus and from what it sounds like an airway. I have no idea how a medic could get BLS from this.

Agreed that the patient requires ALS.

I don't think, however, that if ALS in unavailable in this patient that it warrants an emergent transport. Even if ALS could be available, they would simply be starting Early Goal Directed Therapy (IV's and fluids), which hasn't necessarily been shown to be effective when started in the field without confirmation of sepsis.

 

[bigbaldguy]

I am of the mind that because of the risks involved and the very few times it makes a difference, no call is worthy of lights and sirens.

The only reason it still exists is public expectation and tradition.

There's a lot of truth to this. It does rarely make a difference and the risk generally doesn't balance out but I wouldn't go so far as to say it never makes a difference time wise.

 

[medicdan]

I am of the mind that because of the risks involved and the very few times it makes a difference, no call is worthy of lights and sirens.

The only reason it still exists is public expectation and tradition.

My rationalization for L&S often lies in an expectation that when I arrive at the hospital I will immediately be swarmed by nurses and doctors, or that a critical intervention is to be performed in the first 5 minutes.

It seems utterly pointless to haul a$$ then wait in triage for 10 and be directed to the waiting room or an ignored bed. If I've risks others lives on the transport, I'd better have a good reason.

Maybe my knowledge is limited, but while this patient seems urgent, not emergent, and I doubt a comfortable ride and delay of just a few minutes will make a considerable difference on outcome. I'm all for bringing treatment modalities to the field, but I also just don't like driving L&S unless absolutely necessary.

 

[Aidey]

Agreed that the patient requires ALS.

I don't think, however, that if ALS in unavailable in this patient that it warrants an emergent transport. Even if ALS could be available, they would simply be starting Early Goal Directed Therapy (IV's and fluids), which hasn't necessarily been shown to be effective when started in the field without confirmation of sepsis.

How much confirmation do you need? The diagnosis pretty much danced a jig in a dress while yelling "Here's sepsis! "

 

[Veneficus]

There's a lot of truth to this. It does rarely make a difference and the risk generally doesn't balance out but I wouldn't go so far as to say it never makes a difference time wise.

I think I would describe it as acceptable losses.

The few times it makes a dfference in my mind does not warrant the risks when it doesn't.

To lose a handful of time sensitive patients to stop reading about provider deaths and all the other side effects of lights and siren response and transport, makes perfect sense in my mind.

Particularly when considering the ED is not the definitive care needed, but further delays it.

MI, CVA, and a plethora of surgical emergencies are not helped by ED resuscitation attempts. It is an outdated and misunderstood concept to try to "resuscitate," "stabilize" etc prior to definitive intervention. The very definition of resuscitation is to restore homeostasis, not normalize a bunch of numbers with treatments that could normalize numbers on a corpse in a cadaver lab while delaying the intervention that addresses the reversible lethal pathology.

 

[JeffDHMC]

I am of the mind that because of the risks involved and the very few times it makes a difference, no call is worthy of lights and sirens.

The only reason it still exists is public expectation and tradition.

This.

 

[Christopher]

How much confirmation do you need? The diagnosis pretty much danced a jig in a dress while yelling "Here's sepsis! "

I didn't mean that this patient wasn't septic, just sepsis patients in general are usually not caught by EMS.

 

[bigbaldguy]

I think I would describe it as acceptable losses.

The few times it makes a dfference in my mind does not warrant the risks when it doesn't.

To lose a handful of time sensitive patients to stop reading about provider deaths and all the other side effects of lights and siren response and transport, makes perfect sense in my mind.

Particularly when considering the ED is not the definitive care needed, but further delays it.

MI, CVA, and a plethora of surgical emergencies are not helped by ED resuscitation attempts. It is an outdated and misunderstood concept to try to "resuscitate," "stabilize" etc prior to definitive intervention. The very definition of resuscitation is to restore homeostasis, not normalize a bunch of numbers with treatments that could normalize numbers on a corpse in a cadaver lab while delaying the intervention that addresses the reversible lethal pathology.

To many big words for me to understand the whole thing but this is what popped into my head when I tried.

Voilà! In view, a humble vaudevillian veteran, cast vicariously as both victim and villain by the vicissitudes of Fate. This visage, no mere veneer of vanity, is a vestige of the vox populi, now vacant, vanished. However, this valorous visitation of a by-gone vexation, stands vivified and has vowed to vanquish these venal and virulent vermin vanguarding vice and vouchsafing the violently vicious and voracious violation of volition.

 

[Aidey]

In English, more people are hurt/killed in crashes related to lights and sirens then would die if they were never used.

 

[JPINFV]

So number needed to treat is lower than the number needed to harm?

 

[Aidey]

So number needed to treat is lower than the number needed to harm?

Yup. But we have evidence saying the same thing about back boards and look how far that has collectively gotten us.

 

[JPINFV]

Yup. But we have evidence saying the same thing about back boards and look how far that has collectively gotten us.

As a member of my Holy Trinity of EMS?

 

[Aidey]

Back boards, oxygen and lights and sirens...

 

[Anjel]

We have a couple nursing homes that call BLS for everything. Because if they call for ALS they have to call for the fire department.

Unless it is a vent transfer or something like that.

That being said. It is not unusual for us to get on scene and call for an ALS rig.

That is what I would of done. If your service doesn't have ALS, I would call 911 or ask my dispatcher to.

I mean, the guy is alive, you didn't do anything to hurt him. So call it a good days work and move on.

Yes lights and sirens were warranted, but maybe not so much if you could of had ALS there.

The combo of the temp, HR, and BGL would of made me call ALS. Especially since everything about this call screams sepsis.

Did you happen to take another set of vitals? I am interested to see the trending for this patient. Did the HR or BP change at all?

 

[Medic29]

....

Did you happen to take another set of vitals? I am interested to see the trending for this patient. Did the HR or BP change at all?

I took vitals throughout the whole trip. Nothing really changed by anything more than a couple points on any vital. With the exception of getting the temp to 104.

 

[Handsome Robb]

The biggest thing I see here is traffic in downtown Denver at rush hour. Sure the guy probably would have been ok but I've sat in that traffic and it can take forever to get anywhere. I'll play the devil's advocate and ask what happens if you transport this guy routine and he codes while you're sitting in traffic? The provider is going to get hung out to dry. It's a catch 22. I'm not a huge fan of transporting code 3. It's a pain to do from both a driving and a patient care standpoint not to mention the danger for everyone involved along with innocent bystanders and drivers. Unfortunately it's what is expected by the general public in situations like this so it will continue to happen.

How much confirmation do you need? The diagnosis pretty much danced a jig in a dress while yelling "Here's sepsis! "

:rofl: now that's funny!

 

[johnrsemt]

I never said that the patient did not need ALS if they were there; I was trying to say that the patient could have gone BLS if they were what was dispatched; and they were closer to the ED than to ALS.

Re reading my original post; you are all right it read like I was saying that the patient was not that sick and didn't need ALS. and everyone is perfectly justified in thinking that I am too dumb to be a medic

I worked with many, many basics who would wait on scene for 15 minutes because they thought the patient should have gone ALS, when they could see the ED across the street.

Yes this patient presented as a Septic patient; but everyone is knocking the dispatchers for not turning it over to ALS, but no one is thinking that the nurse probably didn't give the dispatcher enough information to know that. The OP noted that the nurses didn't believe their thermometer so they said the patient had a temp of 102.

 

[Veneficus]

So number needed to treat is lower than the number needed to harm?

I wouldn't say it this way.

The total number of patients needed to have one serious enough where the time saved makes a difference (treat) is very high.

But the amount of patients that are transported lights and sirens for the convenience of the providers than patient need is much higher than the population that would recieve medical benefit from it.

Provider or company convenience, is not reason enough in my opinion to justify the risks and negative incidents.

A BLS transfer between home or facilities that takes hours because of traffic is just the price of business. Everytime you add lights and sirens to it, you roll the dice.

Perhaps nothing happens or providers don't realize the wake effects most of the time, but on the day you lose, it will be big.

If you take a gamble often enough, it is just a matter of time before you lose.

 

[JPINFV]

I never said that the patient did not need ALS if they were there; I was trying to say that the patient could have gone BLS if they were what was dispatched; and they were closer to the ED than to ALS.

There are very few patients that still have a pulse where it would be worth waiting for paramedics on scene instead of transporting when transport time is lower. Those are normally patients who need a specialty center and the closest hospital does not offer that specialty.