Getting pt. into ambulance

[Explorer127]

Can you have the patient walk into the ambulance if they are able to instead of having to lift them on the stretcher?

For example, a patient who really needs a taxi but calls 911 for something like a toothache, a minor cold, etc...

 

[JPINFV]

Depends on several factors including the patient's condition, local laws, and local protocol.

 

[daedalus]

I would say no. Getting fired, getting sued, getting your license taken are all things that could come from such a silly and stupid thing (I say silly and stupid not in reference to your decision to walk them to the rig, but how small of a deal it really is).

 

[medicdan]

Depends on several factors including the patient's condition, local laws, and local protocol.

I know there are several active members here from Massachusetts, and that leads to the quoting of a lot of MA policies, but MA OEMS has something interesting to say in this case.

A little while ago, MA OEMS posted the most common complaints again EMTs that are reported to OEMS. Walking a patient is number 11 our of 19.

http://www.mass.gov/?pageID=eohhs2t..._emergency_services_p_complaints&csid=Eeohhs2

The problem with walking a patient is the "What-ifs". What if they trip and fall while walking? What if they hit their head while getting into the truck? What if the stress of the walk gives them chest pain they didnt have before? What if they run away? How would you document any of the above?

 

[Scott33]

Can you have the patient walk into the ambulance if they are able to instead of having to lift them on the stretcher?

For example, a patient who really needs a taxi but calls 911 for something like a toothache, a minor cold, etc...

So wait a minute.

Are you saying there are actually places who would advocate "lifting" a toothache onto a stretcher?

There are some arse-backwards systems out there.

If they have legs, no chest pain, SOB, palpatations, weakness, or dizzyness - they walk.

 

[MedicPrincess]

If they have legs, no chest pain, SOB, palpatations, weakness, or dizzyness - they walk.

And there it is.....

What about the little old lady who calls because she just doesnt feel good? Or the pt who was SOB, but now feels fine? Or the ABD pain pt? or the hundreds of others that call us because they have a problem and it is our responsibility to provide them with the best care they can.

The only pts that walk to my ambulance are the ones that meet me at the curb or flat out refuse to get on the stretcher.

And... GASP... Oh the Horrors!!.... I even pick up and carry some of the patients I encounter that would otherwise be able to walk out. Not me alone, obviously. But if I have FD on scene (even if I have to call for them), or between my partner and I, it gets done.

Do you guys take your stretcher into the house with you, or do you go in expecting the patient to walk out to the truck?

If you do have it in there with you, how can you justify to your patient who called you for help, that they cannot get on the stretcher?

 

[MSDeltaFlt]

Yes, walk 'em.

 

[JPINFV]

A little while ago, MA OEMS posted the most common complaints again EMTs that are reported to OEMS. Walking a patient is number 11 our of 19.

http://www.mass.gov/?pageID=eohhs2t..._emergency_services_p_complaints&csid=Eeohhs2

While I'm definitely not an advocate of walking the majority of patients to the ambulance (the only times I can remember having a patient walk into my ambulance is when the patient met us at street. These were normally non-hold psych patients), once again that little quote is someone who obviously has no clue about the field making rules. Yes, there are plenty of patients who should not be walked to the gurney, but again patient location and condition are what's important. Unfortunately, the problem probably is people walking patients who have no business being walked forcing OEMS to issue a fiat. Of course walking a patient to a gurney and walking a patient into a unit are two different things.

Also the majority of my experience isn't in MA.

 

[EMTinNEPA]

Ambulate
Before
Carry



You only get one back. Don't strain it any more than you have to.

 

[Scott33]

And there it is.....

What about the little old lady who calls because she just doesnt feel good? Or the pt who was SOB, but now feels fine? Or the ABD pain pt? or the hundreds of others that call us because they have a problem and it is our responsibility to provide them with the best care they can.

"Best care" should include exercising simple clinical decision making, including whether a patient is able to ambulate a short distance to either the stretcher or the ambulance in the absence of those conditions which may be exacerbated by ambulation.

Next time you carry a broken finger into the ED, see how quick it takes the triage nurse to tell them to hop off the stretcher and walk into triage / fast track. Next time you carry a maternity who is not in active labor, ask the staff at the DR what the next course of treatment will be. Much of it will include lots of ambulating up and down the hallway.

The reason these arse-backwards systems advocate carrying everyone, because they do not trust their providers to make a simple decision by themselves. It is outdated, patronizing, and dangerous to the provider.

I have seen more accidents (and more potential for accidents) with people huffing and puffing trying to get stretchers out of houses, down the steps, and onto the ambulance, than with walking the patient if they are able to

 

[JPINFV]

The reason these arse-backwards systems advocate carrying everyone, because they do not trust their providers to make a simple decision by themselves. It is outdated, patronizing, and dangerous to the provider.

I have seen more accidents (and more potential for accidents) with people huffing and puffing trying to get stretchers out of houses, down the steps, and onto the ambulance, than with walking the patient if they are able to

Too many bad apples spoil the bunch for both accounts.

 

[reaper]

If you have done a complete assessment in the house and are capable of making the decision that they are able to walk out, then walk them out.

Not everyone needs to ride the stretcher. If they have a laceration on their finger, they walk. If they have SOB, they ride. It's very simple.

If you are unable to do a proper assessment, then you need to put everyone on the stretcher, just in case.

 

[Sasha]

We don't walk any patient to the ambulance. Way too many what ifs, too much liability.

At my job, we aren't allowed.

Even when I did my clinicals and the many BS calls we ran on, no one was allowed to walk very far. The stretcher was brought in as close as they could get it, and the patient stood, with assitance or someone there to catch if they started to fall, and pivoted. Only exception were stairs. If the person was light enough they were carried down, if not, they were walked down, one person in front, one person in back.

That's for BS "my big toe has been hurting for six months" calls. Any serious complaint would get stairchaired down the stairs.

Good body mechanics and proper lifting techniques will save your back.

 

[MedicPrincess]

I should clarify then.... The stretcher does not always get brought into the house. Some patients after assessment walk to the stretcher..... some get carried..... some get the stretcher brought to them. Most of them will ride the stretcher to the truck.

I get a little upset at the ones that walk everyone (or a majority) all the way to the truck.

 

[BossyCow]

I'm going to go out on a limb here and say something radical....

"I would assess the patient, make a decision based on my findings, my judgement and using common sense on what I believe to be in the best interest of both the patient's safety and mine"

I know this is a radical departure from some systems but its what I do.

 

[reaper]

Exactly!!!!!!!!!!!!!!!!!!!!!!!!!!

 

[JPINFV]

I'm sorry Bossy, but I think your missing the "contact medical control" step that's required anytime a decision has to be made. h34r:

 

[BossyCow]

I'm sorry Bossy, but I think your missing the "contact medical control" step that's required anytime a decision has to be made. h34r:

ROFL.. yeah.. that would be done only if it were consistant with "make a decision based on my findings, my judgement and using common sense on what I believe to be in the best interest of both the patient's safety and mine"

 

[Scott33]

I'm going to go out on a limb here and say something radical....

"I would assess the patient, make a decision based on my findings, my judgement and using common sense on what I believe to be in the best interest of both the patient's safety and mine"

I know this is a radical departure from some systems but its what I do.

It's perfect!

The "carry all" rule is counterintuitive for both the patient and the provider.

Tail wagging the dog.

 

[Grady_emt]

I'm going to go out on a limb here and say something radical....

"I would assess the patient, make a decision based on my findings, my judgement and using common sense on what I believe to be in the best interest of both the patient's safety and mine"

I know this is a radical departure from some systems but its what I do.

Much more eloquent than how I would have said it.