EMT vs. the law

Robb said:
We're the same as firefite, if we're the standby rig we don't leave unless there's an extraordinary circumstance (read: MCI at the event). We call for a transport unit, either emergent or non-emergent depending on the situation, assess and treat as needed then pass off to the transport unit. We do hundreds of events per year, they pay a lot of money to have either a BLS, ILS or ALS crew on scene. If we leave to transport they no longer are receiving the services they paid for. They can't just pull a 911 unit to staff that event. The crews at that event are dedicated to it and are either solely special event employees or field employees on OT.

A compromised airway is one of the few situations in which time is of the essence. If you can't provide the interventions needed to secure that airway you need to get them to someone that can...quickly. I'm not a fan of transporting code 3 but in the situation you described it's very appropriate. Even though transporting lights and sirens doesn't save much time, in a patient that you cannot oxygenate or ventilate, those few seconds may be the difference between walking away neurologically intact or having neurological deficits including being brain dead...An airway compromise that is bad enough to render the patient unconscious is rapidly progressing towards a cardiac arrest.
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I agree with most all of your post. If you're doing a standby the ambulance is a means to get you and your equipment to the event. It is not supposed to be for transporting a patient to the ED.

I say that, but then there is the above scenario. If you are doing a BLS standby and you have unable to oxygenate/ventilate patient, what's the plan going to be? Hopefully not just sitting there monkeying around with a BVM.

I know I just said that the standby ambulance is not for transport, but in this case it would seem appropriate to violate that rule.

In any case, that's how we do it at my Sports Medicine job. If we pull a player off the ice that needs the hospital NOW, the paramedic crew dedicated to teams is going to transport. Play will not continue until another standby crew arrives.

For less serious patients we will stabilize and package the patient until a "regular" 911 unit arrives for transport and then we will just swap stretchers.
 
Robb said:
I agree... Doesn't sound like an allergic reaction to me at all.



We're the same as firefite, if we're the standby rig we don't leave unless there's an extraordinary circumstance (read: MCI at the event). We call for a transport unit, either emergent or non-emergent depending on the situation, assess and treat as needed then pass off to the transport unit. We do hundreds of events per year, they pay a lot of money to have either a BLS, ILS or ALS crew on scene. If we leave to transport they no longer are receiving the services they paid for. They can't just pull a 911 unit to staff that event. The crews at that event are dedicated to it and are either solely special event employees or field employees on OT.

A compromised airway is one of the few situations in which time is of the essence. If you can't provide the interventions needed to secure that airway you need to get them to someone that can...quickly. I'm not a fan of transporting code 3 but in the situation you described it's very appropriate. Even though transporting lights and sirens doesn't save much time, in a patient that you cannot oxygenate or ventilate, those few seconds may be the difference between walking away neurologically intact or having neurological deficits including being brain dead...An airway compromise that is bad enough to render the patient unconscious is rapidly progressing towards a cardiac arrest.
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I'm fine with the lights and sirens transport if you think it's needed in your area. I know in my area I don't think I would save 30 seconds transporting a couple miles going lights and sirens as opposed to non emergent. I probably would not run code, but then again it would really be situational. I would be more likely to run a airway compromise in code 3 in this situation if the patient was a 9 year old, then if the patient is an elderly adult. Again it really all depends on how quickly I think the patient is going to decompensate to the point of cardiac arrest.
 
Christopher said:
By whose definition of "Obviously"? That is a bizarre notion to me.
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In some states the EMT basic can administer oxygen...can assist with nitro if the patient has it, can give the patient asprin if they patient can take it themselves, and can assist with the patients epi pen....and that is pretty much it....activated charcoal too I think but yeah...thats it...
 
Rialaigh said:
In some states the EMT basic can administer oxygen...can assist with nitro if the patient has it, can give the patient asprin if they patient can take it themselves, and can assist with the patients epi pen....and that is pretty much it....activated charcoal too I think but yeah...thats it...
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Florida also lets EMTs give glucose gel, oooh...
 
Or here in Colorado, EMTs with IV certs can give Narcan and D50. Nebulized Albuterol is available as well. I haven't heard of anywhere that allows Benadryl by BLS.
 
chaz90 said:
Or here in Colorado, EMTs with IV certs can give Narcan and D50. Nebulized Albuterol is available as well. I haven't heard of anywhere that allows Benadryl by BLS.
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Besides which, this guy needs IV benadryl. Not a BLS skill anywhere I've heard of. We have a level of EMT, EMT-Enhanced, in VA that would be able to give IV benadryl, but I don't know of a single Enhanced provider who would appropriately recognize and feel confident treating a dystonic reaction.

I'm not convinced it's a big enough emergency to merit the standby truck doing the transport. We usually save that for the honest-to-goodness life threats.

I would just do whatever is required to get a transport truck.
 
Rialaigh said:
I'm fine with the lights and sirens transport if you think it's needed in your area. I know in my area I don't think I would save 30 seconds transporting a couple miles going lights and sirens as opposed to non emergent. I probably would not run code, but then again it would really be situational. I would be more likely to run a airway compromise in code 3 in this situation if the patient was a 9 year old, then if the patient is an elderly adult. Again it really all depends on how quickly I think the patient is going to decompensate to the point of cardiac arrest.
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If your patient has a compromised airway, then the patient has a comprised airway and they need advanced care now, regardless of age.
 
Tigger said:
If your patient has a compromised airway, then the patient has a comprised airway and they need advanced care now, regardless of age.
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Age would make a big difference in how quickly this patient will crash, and how bad the crash will be when it happens. If I can get them to the hospital before they crash running non emergent than I will.
 
Rialaigh said:
Age would make a big difference in how quickly this patient will crash, and how bad the crash will be when it happens. If I can get them to the hospital before they crash running non emergent than I will.
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What kind of crash are we talking about here? Just wondering. In my experience, dystonia is a terribly uncomfortable, but completely non-life threatening condition.
 
abckidsmom said:
What kind of crash are we talking about here? Just wondering. In my experience, dystonia is a terribly uncomfortable, but completely non-life threatening condition.
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I was thinking airway failure due to allergic reaction. Either way I would be really bummed standing by an event as a non transport BLS....
 
I am not sure of what the protocols are where you are from, but here in New Jersey an ambulance is an ambulance in the eyes of the state. An IFT that generally only does standby's is the same as a 911 that only does 911. Both have the same requirements for staffing and equipment. If one munic. has a contract for 911 service, that does not mean an IFT can not perform an emergent transport. Many times these events and also certain facilities have contracts with an EMS provider. If dispatch was sending a noncontracted ambulance for an actuall 911 dialed called that would be different. No reason you can not due the transport.

In both the department I work for and volunteer for, we staff an ambulance for all events through the township. If transport is required, it depends on the situation. If the patient is stable and can wait the 5 minutes (or less) for an additional ambulance to do the transport, the standby ambulance will stay and start treatment. If the patient is critical, the standby ambulance will do the transport and the duty rig will cover the standby.
 
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