Getting pt. into ambulance

Do as your protocols dictate.

I've seen (and we have recounted here) instances when EMT's have hurt themselves getting into rigs, and also why it is bad joojoo to seat laypersons in the cab.
You know, why have they not put an extendable ramp ala National Rentals and a small winch into the vehicles?
 
KEVD18 said:
In massachusetts, the rules are quite clearly defined. At no time, under any circumstances, are patients to ambulate under their own power with or without assistance or supervision. Never.
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Oh gee... that's not how we do it....

Out of my maybe 20 pts or so I think I got signed refusals 5 times...out of the remaining 15... I can remember 2 that the medics brought the stretcher in for. All the rest walked to the rig, granted they were escorted as if they were the president but that isn't the point.
 
rogersam5 said:
Oh gee... that's not how we do it....

Out of my maybe 20 pts or so I think I got signed refusals 5 times...out of the remaining 15... I can remember 2 that the medics brought the stretcher in for. All the rest walked to the rig, granted they were escorted as if they were the president but that isn't the point.
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it happens all the time. i never said it didnt. but thats what the books says; and as i said, not following it puts all the liability on you personally. your service can wash its hands of you, as long as they have it in the companies sop that patients dont walk.
 
Lucky for me though the Medics are the ones who choose (They are the transport service, I just treat before they get there) but once they are there, they take over I just help them if they need it and Fire didn't show (its really odd when they do and don't)... its an interesting point you made though about they book, do you have a link to it, I would like to bring it up and see what the leadership says... although the medics also love to clear C-spine in the field and do other weird not book like stuff
 
Wow Thanks!

I am still quite new to this even if I can provide pt care "alone"
 
"can you walk?"
"Have you tried?"


back when ships were wood an men were iron, my EMT-B instructor half jokingly said those would be the two most important questions in your EMS career. At the time, I thought he was a callous old dude who probably should just ride the engine.

If I knew where he was today, I would call and thank him for that wisdom. Back in those days we only had the 2 man cots, so every load was a lift from the lowest position to the rig. (patients weren't as heavy then either) But I have seen more drops, lifts, trips, close calls, and career ending injuries (especially on snow and ice) than could ever justify lifting every patient "just in case."

As said here many times:
Your Safety
Clinical judgement

Need to be your decision makers. I doubt anyone reading this forum works at a place where disability provides a decent life. You can get another job if you are fired, you can get another job if you are sued. Try with an injury, especially to the back. Besides, I doubt the pro bono Dewey, Cheatum, and Howe lawyers would waste their precious time on suing an individual paramedic or EMT. "Agents, officers, and employees of..." sounds far more appealing from a personaly injury suit (money) stand point.

Think a lawyer wants 33% of what can be collected from the assets an EMS worker makes?

Besides that's what insurance is for. I think it is like trying to be too careful. Things always go wrong when you do that.

I have no doubt occasionally things will go wrong. Conditions missed, under triaged, over triaged, etc. Life is not perfect. Besides we could go on about the medical benefits of avoiding the "victim" mentality in patients and the benefits of early reentry into normal activity. That is why you never here the phrase "stay in bed for x days or until you feel better" anymore.

As for me I will stand in court anyday and answer the question:
"Why did you make the patient ambulate?"

"For the health and safety for all involved."

Rules are just guidlines.
 
I've seen some bad ones. I saw the Chicago Fire Dept ambulance having an obvious 9 month pregnant woman in labor walk out the back of the rig and into the ER. She was in a TON of pain and had to be helped down the ambulance. I couldn't believe my eyes and wanted to give them a piece of my mind.

I've had people tell me they were forced to walk to the cot or up into the rig with leg injuries, when in severe pain, after being in fights and feeling dizzy, etc.

I make my patients get on the cot, even when they are only needing a ride home from dialysis and are waiting for us, standing, in the lobby.
 
In New Zealand, a large % of our patients walk to the ambulance if they are able. Of course there are cases where they can't...
and we do have to look at things like SOB and Chest pain.

No offence, but know wonder you have so many issues with back and knee problems of EMS staff ,if your protocol is having to lift every patient!

Cheers Enjoynz
 
I agree with joy.. Happens a lot here too.. When able a patiënt can walk to the ambulance by himself, I can not really see the point in getting every patiënt into the ambulance by stretcher.
 
BossyCow said:
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.
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I agree and it best describes what I do.
 
dsco77 said:
Assuming i can make this image thing work, this is the kind of thing we use;

2443354269
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It's like an ambulance, a semi, and a wheelchair van had an illegitimate child. :wacko:
 
Remember manual handling course,

IF possible eliminate move, if not possible reduce. You do not move/lift if you do not have to.

If they are capible of getting in on their own steam off with them,
 
does anyone other than myself notice that most of the EMS agences not in the US, which also have higher educational standards, advocate patient walks?

We seriously need to take more pages out of their book.
 
Maybe because elsewhere they recognise that there biggest asset are their staff & they are no good to them if they are unable to work due to long term back pain. Also, in the US you talk a lot about the fear of getting sued, fair enough, but surely, if you the staff sustain a debilitating injury during the course of your duties, you too could sue your system for failing to protect you from foreseeable & therefore avoidable harm.
 
If they are ambulatory, I'll often have them walk a short distance WITH ASSISTANCE to the stretcher... that might be out their front door and/or down a few steps.

If they are calling 911 for something silly... like "I've got a 1cm laceration to my hand" and they are sober enough to walk... they will often end up on the bench seat with a seatbelt on.


In regards to the OP's question - YES... B.S. complaints sometimes walk to the truck, and they sometimes end up on the bench seat.

I try to avoid walking chest pain/resp. diff. patients. Sometimes you need to for a short distance, but I do what I can to minimize it.
 
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bstone said:
I've seen some bad ones. I saw the Chicago Fire Dept ambulance having an obvious 9 month pregnant woman in labor walk out the back of the rig and into the ER. She was in a TON of pain and had to be helped down the ambulance. I couldn't believe my eyes and wanted to give them a piece of my mind.

.
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Don't jump too quickly on this one. I spent most of my labors walking. In many cases being upright and walking is more comfortable for a woman in labor than the traditional lying down on her back. For some, lying down increases labor time, decreases the efficiency of the contractions and can be a lot more painful. The woman you mentioned may have requested/demanded to be allowed to walk.
 
Scout said:
Remember manual handling course,

IF possible eliminate move, if not possible reduce. You do not move/lift if you do not have to.

If they are capible of getting in on their own steam off with them,
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It's great to see that there is someone else on this site that has done a Manual Handling course, Scout!
This course should be added to very EMT-B course, I'm surprised it hasn't!
Here are a couple of links for you to look at, if you have not heard of this course before!

http://www.hse.gov.uk/contact/faqs/manualhandling.htm
http://www.solutionstraining.co.uk/equipment.aspx

Cheers Enjoynz
 
BossyCow said:
Don't jump too quickly on this one. I spent most of my labors walking. In many cases being upright and walking is more comfortable for a woman in labor than the traditional lying down on her back. For some, lying down increases labor time, decreases the efficiency of the contractions and can be a lot more painful. The woman you mentioned may have requested/demanded to be allowed to walk.
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Well said BC.

Once again someone has assumed that someone in labor is unable to walk. Was the head presenting? Had the waters even broke?

Those who would willingly carry maternity calls would benefit greatly from a rotation or two in L&D, where you will see expectant Moms ambulating up and down the hallway ad nauseum. Gravity is a good way to expedite things along.

By default, maternities should be walked, unless there are extenuating circumstances. Again, all down to clinical judgement and the ability to do a little more than just scoop and run.
 
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