is a broken arm an ALS or BLS call?

[DrParasite]

Very simple question, please do not over think or over analyze:

is a broken radius/ulna, just the arm and nothing else, simple fx, an ALS or BLS call?

ok, follow up: if you are on a A/BLS crew (medic and EMT) would the medic treat, or the EMT (going back to ALS or BLS)?

 

[Simusid]

Bls

My daughter had a very classic Colles' fracture a few years ago when she was about 12. Thinking about her MOI, her mental status, her presentation and subsequent treatment, I cannot think of any way to elevate her case to ALS. YMMV

Now her mom on the other hand... wow! At the mention of possible surgery by the nurse, she nearly passed out.

 

[eveningsky339]

Most of the time, it's a BLS call. However, there have been times where I've called in a fly car for a broken arm. If the patient is experiencing debilitating pain (to the point where we can't get a pulse without the patient screaming), pain meds appear to be in order.

The pain management aspect aside, splinting is a technique that every EMT has in his or her bag of tricks.

 

[EMSLaw]

A closed fracture of the arm with no complications? Sounds like a pretty classic BLS call to me. ALS might be able to do something about the pain, but I don't think they'd give morphine for this sort of thing. One of our medics can chime in, I'm sure.

 

[Shishkabob]

Too many variables for such a simple question.


How was it broken?
What type of pain is the pt experiencing?

 

[JPINFV]

Depends if pain management is needed.

 

[EMSLaw]

Depends if pain management is needed.

I know local protocols can vary on this, but under what circumstances do medics generally give pain medication? I know this is a broad question, but I've seen plenty of people complaining of 10/10 pain from various causes, and have yet to see anyone get narcotics from the medic.

Obviously, NJ is known for its restrictive protocols, but it makes no sense to wait five minutes for medics just to have someone "checked out" with no pain relief, when you might instead be at the hospital in ten minutes. That doesn't do the patient any good, since we are supposed to be, in whatever way we can, alleviating their suffering.

 

[Sasha]

ALS. There is no reason to leave your patient in pain. Medics can splint too. ALS call.

 

[karaya]

A closed fracture of the arm with no complications? Sounds like a pretty classic BLS call to me. ALS might be able to do something about the pain, but I don't think they'd give morphine for this sort of thing. One of our medics can chime in, I'm sure.

Side stepping pain management is an issue that is a constant problem in EMS. Fentanyl is an excellent choice for pain management with it's rapid onset and it does not impact the patient's hemodynamics, GCS or SpO2.

 

[JPINFV]

I know local protocols can vary on this, but under what circumstances do medics generally give pain medication? I know this is a broad question, but I've seen plenty of people complaining of 10/10 pain from various causes, and have yet to see anyone get narcotics from the medic.

Obviously, NJ is known for its restrictive protocols, but it makes no sense to wait five minutes for medics just to have someone "checked out" with no pain relief, when you might instead be at the hospital in ten minutes. That doesn't do the patient any good, since we are supposed to be, in whatever way we can, alleviating their suffering.

Ideally, if the patient is in pain, then pain control should be considered. If the patient is going to receive pain medication in the hospital, then why not start prehospitally? Of course, as with everything else, consider transport vs response times when considering it. That said, it's not like you're going to get to the hospital and hand over care to an ER tech because the 'physician couldn't be bothered.' At the very least, that patient is still going to be treated by a PA or NP, who do have it in their powers to use pharmaceutical pain management.

 

[Epi-do]

Again, like with the drunk patient post, it depends upon the patient. I have no qualms giving pain meds to a patient with a fracture, and most times do. However, I have also had patients refuse pain meds. If that is the case, and they are otherwise ok, then there is nothing wrong, IMO, in letting my basic partner take the patient in. He can do comfort measures just as easily as I can.

 

[Sasha]

Again, like with the drunk patient post, it depends upon the patient. I have no qualms giving pain meds to a patient with a fracture, and most times do. However, I have also had patients refuse pain meds. If that is the case, and they are otherwise ok, then there is nothing wrong, IMO, in letting my basic partner take the patient in. He can do comfort measures just as easily as I can.

The difference there is there is ALS and BLS on your truck. Many areas run BLS ambulances with ALS flycars or ambulances. If anything changes, you guys can simply switch. not possible in a BLS truck.

 

[karaya]

...but I've seen plenty of people complaining of 10/10 pain from various causes, and have yet to see anyone get narcotics from the medic.

JPINFV is right on about pain management pre-hospital. Even if you wait a few minutes for ALS, that is a few minutes earlier that the patient will begin to feel the effects of the pain management drug. You experiencing medics not giving any pain management to 10/10 patients is a tremendous problem in EMS today. I travel throughout the U.S. riding with various EMS providers and I unfortunately see this all the time. From my observations, this is due to lazy, uncaring medics who don't want to fool with the narcotic paperwork afterwards. A terrible shame!

 

[Aidey]

ALS. There is no reason to leave your patient in pain. Medics can splint too. ALS call.

This. I tend to be on the more liberal side when considering pain meds. If the injury warrants it, I will let the patient know I can give them something for the pain, and see what they want and go from there. Some patients it is a given you are going to have to give them pain meds just to move them, but like someone else mentioned, I have had people refuse them too.

 

[EMSLaw]

JPINFV is right on about pain management pre-hospital. Even if you wait a few minutes for ALS, that is a few minutes earlier that the patient will begin to feel the effects of the pain management drug. You experiencing medics not giving any pain management to 10/10 patients is a tremendous problem in EMS today. I travel throughout the U.S. riding with various EMS providers and I unfortunately see this all the time. From my observations, this is due to lazy, uncaring medics who don't want to fool with the narcotic paperwork afterwards. A terrible shame!

It's interesting, since before I started in EMS, I thought that one of the benefits to paramedics was that they /did/ have access to pain medicine. It does have an impact on your transport decision (not the ultimate outcome, obviously, but whether you wait for medics) if the only pain relief the patient will receive is at the hospital.

 

[Shishkabob]

Now here's an interesting question:

Say you're in a tiered system with medics in fly cars.

Do you take an ALS resource off the road during a busy day to provide ~5min of pain relief for a broken arm? Or do you keep the medic out for something else happening?

 

[Medic744]

It really depends on alot of variables but when I offer pain managment to my pts I dont start with the narcotics unless the injury warrants it. Our first line analgesic is Toradol. We rarely give Morphine, we rarely even hint at having it on the truck to give. In my opinion when you are in true horrible pain you will take anything that is meant to ease it. When you refuse the NSAID and starting demanding the Demerol and an exact dose (actually had that pt) then its for sure "This is what I have to give you otherwise I dont have anything."

 

[medichopeful]

Technically, it is a call that a BLS crew can treat. So in that aspect, it is a BLS call.

However, I would want to have ALS on scene to ease the suffering of the patient. Fracture can be very painful and uncomfortable. No point in making them suffer.

 

[medichopeful]

Now here's an interesting question:

Say you're in a tiered system with medics in fly cars.

Do you take an ALS resource off the road during a busy day to provide ~5min of pain relief for a broken arm? Or do you keep the medic out for something else happening?

Keep the medic out. I would only call for them on this call if it wasn't going to put anybodies life in danger. I would rather have my patient suffer than another patient die. I don't mean that to sound cold.

 

[Jon]

Most of the time, it's a BLS call. However, there have been times where I've called in a fly car for a broken arm. If the patient is experiencing debilitating pain (to the point where we can't get a pulse without the patient screaming), pain meds appear to be in order.

The pain management aspect aside, splinting is a technique that every EMT has in his or her bag of tricks.

If I was in a MICU setting (Medic/EMT truck), it would probably be a BLS call. If the pain was significant, I'd ALS it, and per PA protocol (6003, isolated extremity trauma), can give pretty liberal doses of Fentanyl, MS, or Nitrous without needing to call for orders.