Divert?

[Summit]

10-50 3pts in rig.
"Let's go that clinic A" (15 miles, closer to trauma center, 80 miles)
"No, they are closed on weekends."
"Great! Then the other one" (15 miles, opposite direction from trauma center)

Radio:
"Clinic B, Ambulance, blah blah inbound with 3pts, details" (1red 2 green)
"Ambulance, negative, we have 2pts at the clinic, divert to clinic C" (50 miles away, opposite direction of trauma center)
"Clinic, I don't think so. You have five beds and we will be there in ten minutes, ambulance out."

 

[Chimpie]

LOL

 

[rescuecpt]

Um, what is this clinic thing of which you speak, and where so that I may avoid being in an area that doesn't have hospitals....

 

[MedicPrincess]

CLINIC??? Tell me can't just drop patients off at the nearest "clinic"?

'Round here, it has to be an Emergency Room for an ambulance to drop off at. Even if they pass 5 Urgent Cares/2 Redi-Meds, and umpteen Dr Offices/Clinics on they way.

 

[TTLWHKR]

The town I grew up in had a doc in the box (urgent care). They would accept ambulance reports over the CB radio, I always tapped in. Now this was extreme rural Montana, so it was nothing odd. When the treated the patient, if they didn't die first, the US Forest Service would airlift them to a Trauma Center somewhere near Missoula.

The thing was, the area was only popular four or five months out of the year. So the DITB was only open May-Sept.

 

[rescuecpt]

I hate the Doc-in-the-boxes around here. They're putzes. We pick up a lot of people from there, and expect the doc to be able to give us history and interventions - nooooo it's always "um, i think she's having a heart attack, no, i don't know her history. no, i didn't do anything for her." Sheesh.

 

[Jon]

Originally posted by rescuecpt@Jun 13 2005, 05:23 PM
I hate the Doc-in-the-boxes around here. They're putzes. We pick up a lot of people from there, and expect the doc to be able to give us history and interventions - nooooo it's always "um, i think she's having a heart attack, no, i don't know her history. no, i didn't do anything for her." Sheesh.

Ummm... isn't "MONA" taught in medical school too? At least the ASA and O2 part?

 

[Summit]

the clinics are our usual destination. they call themselves "medical centers" with "EDs" (usually 2-3 beds, x-ray, insta-lab (tox, treponin, hematocrit), 1 family practice DO or a rentaMD, 1-2 RNs, a tech). they are the infamous "trauma level IV" whatever the heck that means (no OR no surgeons, not even an emergency medicine doctor)

the nearest "real" hospital would be that trauma center 70-80 miles away.

 

[vtemti]

Originally posted by Summit@Jun 13 2005, 07:33 PM
they call themselves "medical centers"

We never tx to the local "Family Medical Center". They always call us when the s*@t hits the fan and they can't handle the situation.

 

[CodeSurfer]

Yeah, the call where they have the PT on NRB at 3 LPM because their protocol is they cant give more than 3 lpm to any patient. :angry:

 

[usafmedic45]

I worked as a respiratory therapist what I would classify as a Level IV Trauma Center when I was doing temporary medical staffing. They were technically supposed to (and I repeat) SUPPOSED to have a doctor in house, but often times the ER doc (actually an FP doc) could found at the same hotel I was staying at, asleep unless there was a patient that "urgently" needed his attention. The docs would be there for shift change, then leave after an hour if there weren't any patients and go back to sleep. We would have to call them and tell to come in if something bad was coming in. Of course, if you ask the hospital there's a doctor on the premises 24-7. Yeah, right. :lol: Heck, I slept most of the nights I worked, all night, on the bed in the "trauma" room.

The nursing staff was made up almost entirely of 'travelers' (temporary staffing agency personnel like myself) so no one was real familiar with the hospital, the only RNs that worked technically directly for the hospital were the house supervisors and maybe a couple others out of the entire hospital.

On at least four occasions during the month I worked there (boy was I glad to get out of there) we had patients crash and/or code and we called the doc in and even after they arrived they just let me (as the RT) run things because they couldn't remember ACLS protocols, etc. :blink: Same went for when we had a patient who needed to be intubated or vented- "Hey Dr. -------, what do you want for vent settings?" Response: "Why are you asking me? You're the RT, you tell me what they need."

One night one of the docs told the RN's before he left (and I quote) "If anything bad happens, listen to him until I get here" (points at me). Of course then we had a code come in (a drive up nonetheless) so I got to play ER doc- reminds me again why I want to become a dentist and not an MD- until the doc finally got back to the hospital about 30 minutes later. By this time, the patient had received at least 6 or 7 rounds of epi, was maxed out on lidocaine, had received amiodarone, had been defibrillated at least 5 times and was in an agonal rhythm- for which we gave two doses of atropine and were trying to pace. Doc walks in, looks at me, goes "How's he doing?" :blink: :unsure: "Great doc." I told him what we had done and that we had seen no improvement, so he goes, "Well then why are you still working on him? Why haven't you pronounced him?" Apparently he didn't realize that none of us could legally do that.

 

[vtemti]

Originally posted by CodeSurfer@Jun 19 2005, 01:05 AM
Yeah, the call where they have the PT on NRB at 3 LPM because their protocol is they cant give more than 3 lpm to any patient. :angry:

They are lucky if they get that. Many times the patient gets O2 because they came with thier own.

 

[Jon]

Originally posted by CodeSurfer@Jun 19 2005, 01:05 AM
Yeah, the call where they have the PT on NRB at 3 LPM because their protocol is they cant give more than 3 lpm to any patient. :angry:

Isn't that a nursing home thing???

 

[Jon]

Originally posted by usafmedic45@Jun 19 2005, 01:32 AM
On at least four occasions during the month I worked there (boy was I glad to get out of there) we had patients crash and/or code and we called the doc in and even after they arrived they just let me (as the RT) run things because they couldn't remember ACLS protocols, etc. :blink: Same went for when we had a patient who needed to be intubated or vented- "Hey Dr. -------, what do you want for vent settings?" Response: "Why are you asking me? You're the RT, you tell me what they need."

I've had some situations like this in my clinicals..... Watching interns try to talk a 3rd year medical student through a rapid trauma assessment..... In the trauma bay... with someone that was obviously trauma-alert criteria....

Jon

 

[TTLWHKR]

Originally posted by MedicStudentJon@Jun 19 2005, 11:20 AM

I've had some situations like this in my clinicals..... Watching interns try to talk a 3rd year medical student through a rapid trauma assessment..... In the trauma bay... with someone that was obviously trauma-alert criteria....

Jon

It's like putting together a toy.

Connect tube A to tube B, put tube C into tube D, Put tube E into Hole one... etc etc. :blink:

 

[CodeSurfer]

Originally posted by vtemti+Jun 19 2005, 10:06 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (vtemti @ Jun 19 2005, 10:06 AM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-CodeSurfer@Jun 19 2005, 01:05 AM
Yeah, the call where they have the PT on NRB at 3 LPM because their protocol is they cant give more than 3 lpm to any patient. :angry:

They are lucky if they get that. Many times the patient gets O2 because they came with thier own. [/b][/quote]
Yeah. I got one today and I really wish I had an O2 sat. Because I bet she was sat'ing at 75 max, it would be nice to know what it actually was. But, treat the patient, not the machine (esp. if you dont have it). Put her up to 5Lpm's and she seemed to pink up a bit.

 

[CodeSurfer]

via N/C just so you dont think I'm completely incompetent

 

[vtemti]

Originally posted by CodeSurfer@Jun 20 2005, 01:43 AM
via N/C just so you dont think I'm completely incompetent

Nah............Would we think that?

We might though, pick up on it and run. :lol:

 

[PArescueEMT]

Originally posted by vtemti+Jun 20 2005, 12:03 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (vtemti @ Jun 20 2005, 12:03 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-CodeSurfer@Jun 20 2005, 01:43 AM
via N/C just so you dont think I'm completely incompetent

Nah............Would we think that?

We might though, pick up on it and run. :lol: [/b][/quote]
but then again... we might just run with this...

 

[TTLWHKR]

Originally posted by PArescueEMT+Jun 21 2005, 03:16 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (PArescueEMT @ Jun 21 2005, 03:16 AM)</td></tr><tr><td id='QUOTE'>

Originally posted by vtemti@Jun 20 2005, 12:03 PM
<!--QuoteBegin-CodeSurfer

@Jun 20 2005, 01:43 AM
via N/C just so you dont think I'm completely incompetent

Nah............Would we think that?

We might though, pick up on it and run. :lol:

but then again... we might just run with this... [/b][/quote]
I knew a woman once who would put trauma patients on 25LPM via Nasal Cannula; so she didn't have to return to base for restocking.. i.e. if she didn't have any masks, etc.