How do you maintain med drip rates on your truck

[crotchitymedic1986]

I still cant believe that most of the ambulances in the US do not use an IV pump or dial-a-flow type devices for maintaining accurate medication drip rates. Can you imagine being a patient in the ICU and hearing a nurse say, "yes, that looks about like 5mcgs per minute, sure wished we had a pump". In my opinion, "eyeballing" dopamine, is a huge risk to our patients.
So how do you do it at your service ? We find money for all the other pieces of equipment on the truck, why not pumps ?

 

[KEVD18]

heres how i go about it:

before doing any call requiring an infusion, i proceede to have at least thirteen shots of tequila.

then, i blindfold myself and mix the bag by touch.

after starting the iv one handed and hammered, i hook the bag up. i put the drip chamber right next to my head and time it by ear.

i find this method works rather well. of course, im usually pretty banged up from the tequila, so it really doesnt matter much to me.


so, is that enough conflict inspiration for you? if not, paid v. volley is usually good for the type of fight you're lookign for.

 

[remote_medic]

we have pumps for interfacility transports only (not acutally kept on the truck but rather at base). We simply eye ball Dopamine for emerg calls. I haven't had to do this yet and quite frankly don't want to have to.

 

[crotchitymedic1986]

Not trying to start a fight, just trying to improve EMS. There was a time in EMS when we didnt have 12lead, capnography, pulse oximeters, safety needlees, one man stretchers, and about 1/2 the meds in your drug box today. We tend to improfe with time. And just like you look at my generation and say you guys used to stick needles in people's hearts ? The next generation will look at you and say, "You use to hang dopamine on patient without a pump ?"

It is time to improve, if for no other reason : Patient safety.

 

[KEVD18]

Not trying to start a fight

yeah, right.

how is starting a fight on an internet message board going to change things?

in my state, it takes an average of seven years to change a protocol going through a half dozen different committees and review boards. i cant just one day walk in to my bosses office and demand four channel alaris pumps.

every topic you've started to date has been inflammatory. i know a little bit about inflammatory posts, having written one or two myself. get off the soapbox dude. its getting annoying.

 

[crotchitymedic1986]

I beg to differ. My posts may be about controversial subjects, but I have not called anyone a name, or even got into a verbal confrontation with anyone, so I must not be too inflammatory. If you do not like my posts, simply ignore them, you are not mandated to read them, like them, or respond to them.

As far as your 7 year comment, every journey starts with a single step, so why not make that step now, so that you will have the equipment you need in 7 years ? And you do not have to have the most expensive pump out there to get the job done. I assume your service found a way to pay for 12-lead monitors a few years ago, this is no different.

 

[ffemt8978]

I beg to differ. My posts may be about controversial subjects, but I have not called anyone a name, or even got into a verbal confrontation with anyone, so I must not be too inflammatory. If you do not like my posts, simply ignore them, you are not mandated to read them, like them, or respond to them.

As far as your 7 year comment, every journey starts with a single step, so why not make that step now, so that you will have the equipment you need in 7 years ? And you do not have to have the most expensive pump out there to get the job done. I assume your service found a way to pay for 12-lead monitors a few years ago, this is no different.

So how do you propose to pay for all of these "advances" you think we should have? You know, like taking EVERY patient to the hospital to run a full range of tests just to reduce (but not eliminate) a 0.01% fatality rate? Considering Medicare/Medicaid will be insolvent by 2019 at the current rate, I'm genuinely curious about this.

Feel free to start another thread on this, if you want.

 

[KEVD18]

I beg to differ. My posts may be about controversial subjects, but I have not called anyone a name, or even got into a verbal confrontation with anyone, so I must not be too inflammatory. If you do not like my posts, simply ignore them, you are not mandated to read them, like them, or respond to them.

As far as your 7 year comment, every journey starts with a single step, so why not make that step now, so that you will have the equipment you need in 7 years ? And you do not have to have the most expensive pump out there to get the job done. I assume your service found a way to pay for 12-lead monitors a few years ago, this is no different.

every truck ive worked on had pumps. i have just found that tequila bottles are easier to work with a lower failure rate

 

[crotchitymedic1986]

Well first of all, I am not so full of myself to assume that I am right about everything, or that everyone should do it my way. I am merely asking questions. But to answer your question, I dont think that "cost" should be the primary gauge for deciding to do what is right. If it is the right thing to do, then we need to find a way to do it, regardless of price.

But I have not mandated that you spend a fortune either. For instance, on the patient refusal front, I think I have a solution that is low cost or no cost:

Instead of transporting everyone (as you suggested), why not just make it mandatory for a supervisor or a 911 operator to talk to the patient on a recorded phone line, and ask the patient, "are you refusing EMS transport at this time ?" If the patient is truly refusing AMA, and says "yes" on the recorded line, then you have even more proof to back up your claim that you tried everything. But it the patient hadnt refused, then he would say, no I am not refusing, they told me I didnt need to go, then you have corrected the lazy medic's mistake.

I mean how many refusals do you get in a shift ? I think a supervisor could make those calls (if you are a bigger/busier service, then you probably have layers of supervisors who could do it). Doesnt cost you a thing, unless you dont have unlimited calls on your cell package. And think of what it could save you.

 

[ffemt8978]

Well first of all, I am not so full of myself to assume that I am right about everything, or that everyone should do it my way. I am merely asking questions. But to answer your question, I dont think that "cost" should be the primary gauge for deciding to do what is right. If it is the right thing to do, then we need to find a way to do it, regardless of price.

But I have not mandated that you spend a fortune either. For instance, on the patient refusal front, I think I have a solution that is low cost or no cost:

Instead of transporting everyone (as you suggested), why not just make it mandatory for a supervisor or a 911 operator to talk to the patient on a recorded phone line, and ask the patient, "are you refusing EMS transport at this time ?" If the patient is truly refusing AMA, and says "yes" on the recorded line, then you have even more proof to back up your claim that you tried everything. But it the patient hadnt refused, then he would say, no I am not refusing, they told me I didnt need to go, then you have corrected the lazy medic's mistake.

I mean how many refusals do you get in a shift ? I think a supervisor could make those calls (if you are a bigger/busier service, then you probably have layers of supervisors who could do it). Doesnt cost you a thing, unless you dont have unlimited calls on your cell package. And think of what it could save you.

Hmm...that's not what you said here...

This is why i am against leaving patients at home, until the day we have the ability to do labs and xray. Which isnt to say you did anything wrong, but there is just no way to rule out every possible diagnosis with the limited tools we have.

Think about it this way: A 14 year old girl comes to the ER for dyspnea, after breaking up with her boyfriend. She is obvioulsy hypeventilating, and everyone knows it, and treats her accordingly. But they will not discharge her until they do a blood gas to confirm hyperventilation. If the ER doc will not discharge her without supporting lab work, I do not understand why we feel so comfortable to not transport this same patient to the ER.

So which is it? And not every service has a supervisor you can call...unless you call medical control for EVERY refusal. If you're referring to your agencies supervisors and not med control, keep in mind that not everyone gets promoted to a supervisory level because they are good at EMS or medicine.

Around here, we use our clinical judgement, training, and experience and if we have any thoughts that the patient should go to the hospital but they still refuse, we call medical control.

 

[crotchitymedic1986]

Now, how do we pay for the pumps ?

1. You could use dial-a-flows. We can argue over their accuracy, but it is more accurate than an eyeball.

2. Maybe you start with one reconditioned pump on the supervisor's vehicle if you have one. Or on one truck.

3. Maybe the hospital will sell or donate their old ones to you.

4. Maybe you do some fund raising.

5. Maybe you can apply for a grant.

We dont know what possibilities are there, until we make the first steps. Many times in my career, the conversation started with "we cant afford that", but somehow, someway, we always found a way to get what we needed.

Then again, maybe an IV pump is not the most important piece of equipment that your service needs. You may still be waiting on 12Lead or certain medications. My point is that whatever you shouldnt give up just because you think you cant afford it.

 

[Sasha]

2. Maybe you start with one reconditioned pump on the supervisor's vehicle if you have one. Or on one truck.

So everytime a truck needs a drip they have to call a super or THAT truck and delay treatment until that truck or super can get to them? What if more than one truck needs it at a time?

3. Maybe the hospital will sell or donate their old ones to you.

That's a liability. Technically if something went wrong with the pump, the hospital could be sued.

4. Maybe you do some fund raising.

Some company's have enough trouble getting their employees to show up, much less show up to something extracurricular such as a bake sale or begging for money.

5. Maybe you can apply for a grant.

Good luck with that.

 

[crotchitymedic1986]

Both statements are accurate: In the absence of lab and xray, I am against the individual medic being able to talk people out of going to the hospital. The solution I proposed solves that problem. I am not worried about the patient who actually refuses AMA, I am concerned about the patient who should be transported, but is talked out of transport, and then dies hours later.

And as far as the .01%, we hope that is the real number, but we have no idea. It could be 20% for all we know (actually there was a study performed by AMR that showed for every 100 patients who refused, you would have 7 hospital admissions, 2 ICU admissions, and 1 death).

 

[crotchitymedic1986]

So everytime a truck needs a drip they have to call a super or THAT truck and delay treatment until that truck or super can get to them? What if more than one truck needs it at a time.

That's a liability. Technically if something went wrong with the pump, the hospital could be sued.


Some company's have enough trouble getting their employees to show up, much less show up to something extracurricular such as a bake sale or begging for money.


Good luck with that.

1. Supervisors typically respond to arrests and critical calls. It may not be the best solution, but it may be the best solution for right now. Maybe you can only afford to buy one pump per budget year.

2. That is incorrect, once they have donated or sold them to you, they have no ownership or liability.

3. Employee performance will rise or fall to the expectation level that leadership and the other employees have set. This is not a slam against your service, but if your greatest accomplishment is that all the warm bodies showed up for work today, then you have bigger problems than IV pumps, your service needs to dust off its mission statement and change the culture.

 

[remote_medic]

And as far as the .01%, we hope that is the real number, but we have no idea. It could be 20% for all we know (actually there was a study performed by AMR that showed for every 100 patients who refused, you would have 7 hospital admissions, 2 ICU admissions, and 1 death).

Source?

ABC (extra characters to meet the 10 character minimum to make a post)

 

[crotchitymedic1986]

source for what ????????????

 

[ffemt8978]

source for what ????????????

The AMR study you cited.

 

[crotchitymedic1986]

That is the source: American Medical Response. I worked there when they did it back in the 90s. I doubt you can link it on the web, as that is not the kind of information a private, for profit service, would want floating on the web. It was an internal CQI project, but I am sure that anyone that still works there can get you a copy of it, as they frequently preached about it in every new employee orientation.

 

[Sasha]

That is the source: American Medical Response. I worked there when they did it back in the 90s. I doubt you can link it on the web, as that is not the kind of information a private, for profit service, would want floating on the web. It was an internal CQI project, but I am sure that anyone that still works there can get you a copy of it, as they frequently preached about it in every new employee orientation.

So it's a study that only YOU saw? That's a real good proof, love. Real good proof.

 

[crotchitymedic1986]

No, everyone that worked there saw it -- and it is a pretty big company. And if you did the math, you realize that makes it more like a 1% failure rate instead of .01% failure rate. A 1-2% failure rate is pretty much universal across all industries, so I see no reason to believe that we wouldnt have a 1% failure rate. I bet everyone in this room knows about a case that a medic totally screwed up in 2008, even if it didnt result in a death. Do you really think that we are 100% perfect in every EMS agency in the USA ?

But like I said, even 1 preventable death is 1 too many.