Agreed but if you are in Los Angeles, a lot of these hospitals that are close by are more like band aid stations. We had a Dr intubate a pt because he was saturating at 94%. Yup, you read that correct.
"ICU Level Care on the Street" Salt Lake City Program going to put Doctors on ambulances
- Thread starter johnrsemt
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Lot's of reasons besides oxygenation to intubate someone. More to the story?
CarSevenFour
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Sounds like the old "Hospital on Wheels," "Specialized Cardiac Care Unit," and "Dedicated neo-natal Ambulance." They were usually 1970s gas guzzlers sporting the "Latest Lifesaving Equipment" a physician, nurse, driver, etc. all packed into a rig the size of a motorhome, and shortly fizzled because they were personnel intensive and could never run enough calls to keep a specialty unit such as this in service. The MD on wheels is kind of a retro-idea going back to NYC-EMS horse-drawn rigs running out of Bellevue having an ambulance physician, usually an intern, handle the role- later delegated to a first-aid trained "attendant" in most later ambulance services.
CarSevenFour
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In the area where I responded, the city was huge, but hospitals were generally a 5-7 minute run in many cases. That's why EMT "scoop and run" made sense in dense cities. Lots of hospitals to choose from and you're already arriving at the ER before an ALS unit could even be onscene. In Heavy Rescue traffic accidents or runs where immediate amputation is necessary for extrication, it would be great to have a surgeon onscene with you, especially if an ALS unit is not available. I agree that in areas where the closest hospital is 20 minutes away, Code-3, and the patient is circling the drain, you could justify having an MD onscene with the ambulance or responding in a quick response unit. It's interesting that we're rehashing many of the same topics over the decades, I ran around in ambulances from 1973 to 2012 and it's like Ol' Yogi said, "It's deja vu all over again."
CCCSD
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An MD on the scene could also provide prophylactic vaccinations.
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Just last week I had a patient who had great SpO2 numbers... like 96% and above... but we intubated. Why? The pCO2 was in the 100's and patient was getting very drowsy. (And going downhill too quickly for a BiPAP trial.)
CarSevenFour
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That's why it's up to the crew to know which hospitals are appropriate. For instance, you don't take major trauma to a "doc in the box" or a minimally equipped hospital. That's NOT what I was referring to. You bypass the lower levels of care and go straight to the closest trauma center or major hospital that can handle your patient properly. To do otherwise would likely cost you your job.
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Inadequate oxygenation is only one of many indications for intubation and mechanical ventilation. As often as possible we should intubate BEFORE the sats drop into the toilet.
To put I another way: If the only time you place a tube is when the sats are low, then you have no idea what you are doing and are certainly in no position to judge the competence of others.