Martyn
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Sorry JP, they are available online only thru secure portal, obvoiusly can't send link but any you want to know about I can cut/paste etc (private ambulance company, need I say more?)
Forgot oxygen
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the_negro_puppy
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Not every patient needs oxygen, and odds are if you "forgot" it, they probably didn't need in the first place. Someone that needs oxygen is generally fairly obvious, and it's not going to take the reading of a pulse ox to make that decision.
JPINFV
Gadfly
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The problem is that it's a "I know it when I see it" thing. For something like this, however, what I would really be looking for is what the introduction to the protocol book says. Generally that's where you'll get whether it's written with "This is the bible of EMS that should be followed without question," vs "These generally should be followed because they're right, but you know... sometimes patients don't read the rule book." Similarly, what does the "Airway Management Protocol" say? That's what's referred to, and three times no less. I highly doubt that the protocol wants you to start oxygen therapy three separate times on the same patient.
bstone
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Repeat after me: O2, IV, Monitor. Those three things need to be done on basically every call. Repeat those three things and it'll become second nature.
JPINFV
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The only thing that has to be done on every call is an assessment. Supplemental O2, IV, and a monitor are definitely not needed on basically every call.
bstone
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An assessment must be preformed. O2, IV, Monitor have to be initiated.
JPINFV
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Why does supplemental oxygen, intravenous access, and a monitor must be "initiated" on basically every call?
Is every patient in the ED on supplemental oxygen?
Is every patient in the ED on a cardiac monitor?
Is every patient in the ED have an IV started?
If the answer is "no" to any of those questions, what's the difference? Are EMS providers simply too stupid to decide if supplemental oxygen is needed?
bstone
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Welcome to the field of Emergency Medical Services. O2, IV, Monitor are essential on basically every call. Not every call, but basically every call. Going for a ride in my ambulance? I'm going to put you on a NC, 3 lead, and start a 20 gauge.
adamjh3
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So the lady with isolated extremity trauma I transported today needed oxygen, an IV and a cardiac monitor?
Why?
bstone
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She definitely did.
JPINFV
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JPINFV
Gadfly
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With what medical justification? The indication for supplemental oxygen is not "ambulance." Are you saying you're incapable of determining who needs supplemental oxygen with any sort of reasonable accuracy?
bstone
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lol:rofl:
adamjh3
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Okay, lady with 2/10 pain in that isolated extremity.
My point was that one shouldn't perform a treatment without medical necessity.
Bstone, you elected to answer only the first part of my question. You've already clearly stated that every single patient you encounter gets your little blanket of treatments and skills, what's your rationale for it?
My point was that one shouldn't perform a treatment without medical necessity.
Bstone, you elected to answer only the first part of my question. You've already clearly stated that every single patient you encounter gets your little blanket of treatments and skills, what's your rationale for it?
bstone
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If you'd like to quote me accurately then I'd be happy to reply. Until then I'll be sleeping. Goodnight.
adamjh3
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Um... What? Your answer was one sentence. I want to know your justification for your answer. Avoiding the question doesn't make your argument stronger. Nor does laughing at other wholly appropriate questions make you right.
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How is EMS supposed to become a profession when this attitude is employed? Using these sort of blanket treatments is not a good way for providers to prove that they are capable of making sound and independent clinical decisions.
As an aside, when I was transported in an ILS ambulance over the winter with suspected lumbar fractures following a significant fall I was given none of these, as none could possibly be construed as indicated. My vitals were fine and I was in no respiratory distress. If you had tried to initiate any of the above three I would have protested mightily since a) they would not do anything to help me b) they require manipulation of the patient, and when you're in pain sometimes all you want to do is lie there and c) they cost money.
Unless you're giving a medication or fluid I see no reason to start an IV unless you have a significant worry that the patient is going to rapidly become unstable.
the_negro_puppy
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What Grade A baloney. Treatment and interventions should be based on assessment and clinical judgement. I don't start IVs unless I am going to give something through it, or have a likely need to do so. Many procedures come with their own risks and performing them on every patient exposes people to them unnecessarily. While many of my patients get a 3 lead ECG, I wont be doing one on a 15 y.o with an isolated colles fracture. Our oxygen protocols have changed in so that we don't even give it to anyone with Sp02 > 93% bar a few circumstances.
The sooner EMS moves away from cookbook pre-hospital care the better.
The sooner EMS moves away from cookbook pre-hospital care the better.
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But I.V's save lives! :sad:
Not knocking intermediates, but I think a lot of people who have such a minimally expanded scope try to excercise it as much as possible. And they get away with it, because its hard to ding someone if it isn't truly harmful to the patient. You can always use your "I was airing on the side of benefit to the patient" get out of jail free card.
Not knocking intermediates, but I think a lot of people who have such a minimally expanded scope try to excercise it as much as possible. And they get away with it, because its hard to ding someone if it isn't truly harmful to the patient. You can always use your "I was airing on the side of benefit to the patient" get out of jail free card.
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