is a broken arm an ALS or BLS call?
- Thread starter DrParasite
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I'm with everyone else--it's a basic call unless pain management is needed.
This opinion's left me in pain a few too many times. I have a lot of drug allergies, and have occasionally been in too much pain to do more than semi-coherently refuse everything I'm allergic to and ask for something I'm not. Even after indicating allergies, I've had providers tell me I must not be in serious pain or I'd take whatever they gave me.
This opinion's left me in pain a few too many times. I have a lot of drug allergies, and have occasionally been in too much pain to do more than semi-coherently refuse everything I'm allergic to and ask for something I'm not. Even after indicating allergies, I've had providers tell me I must not be in serious pain or I'd take whatever they gave me.
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Why? Do you believe all of your patients are drug seekers?
ITA. There are a lot of things I can't take and I just plain do not like having drugs in my body. I've rejected many many pain meds in many different situations. Though mostly my providers are just distressed to see me in pain and a bit confused, they aren't mean about it. As soon as I explain away my reasoning they nod their heads and go about their business. I have been fortunate in that aspect.
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You seem to contradict yourself. In one thread you responded to call in ALS, "Fracture can be very painful and uncomfortable. No point in making them suffer." And yet, here you state let the patient suffer.
Epi-do
I see dead people
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Yes, I know you were responding to a specific question regarding a tiered system during the busy part of the day, but seriously? We can only run one call at a time, and if your patient can benefit from analgesics, get them for him/her. With this thought pattern you are trying to play the odds game. What are the odds of another run coming out and that run being a more serious patient than the one that I have?
You don't need to be worrying about the "potential" patients that may call while you are tending to a fracture. You need to worry about the patient you have. What happens when that more serious run doesn't go out and your patient has now needlessly suffered because you decided the patient that doesn't even exist is more deserving of the medic and their care than the real patient that is in front of you?
The system will deal with whatever comes its way. As a whole, EMS sucks at pain management. As a whole, we need to do better at using analgesics, when warranted. Treat the patient you have, not the one that the next crew might get.
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Excellent points!
medichopeful
Flight RN/Paramedic
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Yes, I realize that. But this was in response to this question from Linuss:
All I'm saying is that, if the area is very busy and there are not very many medics, I would rather keep the medics out on the road to respond to a more serious call than a broken arm. Yes, pain relief is a VERY important thing. I never said it wasn't. Rather, I am saying that if it comes down to either taking ALS away from somebody who may not survive without it, or letting somebody be in pain for a little bit, I would choose the first option.
Now, this is NOT something that I would want to do. It's a lose-lose situation. If you choose one option, somebody will get pain relief, but somebody else may die because they were stuck with a BLS crew. On the other hand, somebody may get an ALS crew, but somebody else may be in pain. It's not an easy situation.
medichopeful
Flight RN/Paramedic
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As Karaya said, excellent points.
Yes, I would LOVE to have my patient get pain management ASAP. I would not want them to suffer in the least. When I was responding to the theoretical question, I was thinking about the situation that is around where I go to school: very few ALS trucks to cover a few towns, at least one of which is a fairly good-sized city. If there is a day where the ALS units keep getting called for serious problems (cardiac, respiratory, etc.), than I would say there is a good chance that they will continue to be busy. Someone with a broken arm can wait, at least for a bit.
Now remember, the question Linuss posed had a very short transport time (around 5 minutes). If there was a long transport time, I would be more likely to call for ALS.
I would call for ALS in a heartbeat for pain management. The only time I wouldn't would be when resources were stretched thin. If need be, somebody with pain can survive for 5 minutes. Somebody who absolutely needs ALS may not be able to.
It's not an easy situation, and it's not one to take lightly. Also, my answer is very situational dependent.
This wouldn't be a question if every truck had at least 1 paramedic on it.
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Just remember that in a system with tiered response, if the medics give pain medication, they have treated the patient and have to ride the call in, especially if they have started an IV (since BLS can't transport a patient, generally, with an active IV).
So, by the time they treat, ride to the hospital, report, and get back in service, the time is longer than five minutes.
But, that being said, I agree you should treat the patient in front of you and not wonder about the "what-ifs". My only concern would be tying up an ALS unit if they really couldn't do anything, for example if the patient's only ALS-level complaint was pain and the medics were unable or unwilling to give analgesics. Since that's been my experience (and we've discussed why this is bad, but it's the way things are in this neck of the woods, apparently), I'd be more inclined to ride the call in BLS.
So, by the time they treat, ride to the hospital, report, and get back in service, the time is longer than five minutes.
But, that being said, I agree you should treat the patient in front of you and not wonder about the "what-ifs". My only concern would be tying up an ALS unit if they really couldn't do anything, for example if the patient's only ALS-level complaint was pain and the medics were unable or unwilling to give analgesics. Since that's been my experience (and we've discussed why this is bad, but it's the way things are in this neck of the woods, apparently), I'd be more inclined to ride the call in BLS.
JPINFV
Gadfly
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So? It's not like the ambulance reaches the hospital and the patient immediately gets pain control.
Medic744
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Idont believe all my pts are drug seekers, but I am highly suspicious of the ones who are "allergic" to everything but one specific narcotic and demand that one and refuse all others even if they don't claim an "allergy" to it.
Medic744
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But they can tell you are in pain, there's a difference between that situation and one where a pt is laughing, joking and moving the ext. or the injured area and not complaining until you remind them that they are supposed to be hurt and then the Oscar winning performance comes out.
The reason of "they don't get pain meds as soon as they get to the ED" is a prime reason of giving Pain management on the street. If you don't, not only are you delaying pain relief for transport, they then have to wait at the ED for relief.
Our job is to treat the patient that we have NOW; not the one we may have in 10 minutes.
If it was you or a family member; wouldn't you want the pain gone?
My old medical director told us that the reason that they were slow about changing our protocols was that we didn't use what we had. Pain manage-ment is prime example: when we went from having to call in for pain control to having the written protocols to give relief (1st by Morphine, then Fentanyl) for any pain, (Including head and abdominal); our usage of Narcotics dropped 30% the first year. Too many medics were 'afraid' of using something that they had been using for years, they just didn't have to call in anymore.
If it is available, use it; patients call us for help and relief, why is it so hard for us to give it to them.
If you are worried about someone becoming addicted to Narcotics from Prehospital: there is an ongoing study (if I can find the info I will add it later): at the University of Chicago for the last 4 or 5 years on people that came into the ED with prehospital pain management in place. they are over 10,000 people so far: they have had 3 (not 3%) patients become addicted; and they all stayed in the hospital for at least 2 weeks. that is good odds in our favor.
someone mentioned that the person may be a drug seeker: So what? the next cardiac symptom patient may not be having a MI; but we still treat it as such. if a patient says they are in pain: treat it. not our job to judge. if a patient tells you that they are allergic to certain drugs, believe them. they may have developed the allergy recently. If I have a patient that tells me that they have allergies to Toradol and have to have Fentanyl. I will give them Fentanyl. I trust my patient, even if they are a frequent flyer and I remember their past history. what if it changes? My allergies have changed over the years.
In my old service I had the reputation of being 'too liberal' with pain meds: but everyone coworker that ever told me that also told me that they wanted me as their medic if they were hurt. Had a supervisor go to our medical director to tell him how liberal I was: I was told by the MD to double what I was using after that.
Our job is to treat the patient that we have NOW; not the one we may have in 10 minutes.
If it was you or a family member; wouldn't you want the pain gone?
My old medical director told us that the reason that they were slow about changing our protocols was that we didn't use what we had. Pain manage-ment is prime example: when we went from having to call in for pain control to having the written protocols to give relief (1st by Morphine, then Fentanyl) for any pain, (Including head and abdominal); our usage of Narcotics dropped 30% the first year. Too many medics were 'afraid' of using something that they had been using for years, they just didn't have to call in anymore.
If it is available, use it; patients call us for help and relief, why is it so hard for us to give it to them.
If you are worried about someone becoming addicted to Narcotics from Prehospital: there is an ongoing study (if I can find the info I will add it later): at the University of Chicago for the last 4 or 5 years on people that came into the ED with prehospital pain management in place. they are over 10,000 people so far: they have had 3 (not 3%) patients become addicted; and they all stayed in the hospital for at least 2 weeks. that is good odds in our favor.
someone mentioned that the person may be a drug seeker: So what? the next cardiac symptom patient may not be having a MI; but we still treat it as such. if a patient says they are in pain: treat it. not our job to judge. if a patient tells you that they are allergic to certain drugs, believe them. they may have developed the allergy recently. If I have a patient that tells me that they have allergies to Toradol and have to have Fentanyl. I will give them Fentanyl. I trust my patient, even if they are a frequent flyer and I remember their past history. what if it changes? My allergies have changed over the years.
In my old service I had the reputation of being 'too liberal' with pain meds: but everyone coworker that ever told me that also told me that they wanted me as their medic if they were hurt. Had a supervisor go to our medical director to tell him how liberal I was: I was told by the MD to double what I was using after that.
Smash
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A lot of good answers. If the patient requires pain relief they get pain relief. If this means ALS intercept then so be it. Resourcing is not my concern, treating patients is and I won't provide substandard treatment to cover for my service providing substandard coverage.
Epi-do's quote sums it up perfectly.
Pain relief is something that is recognized as being done extemely poorly in emergency care (both pre- and in hospital) and yet it is one of the most important things we can do for our patients. Failure to treat pain in the field leads to ongoing failure to treat pain in hospital (they take cues from us) and leads to a greatly increased likelihood of the patient developing chronic pain disorders.
Johnrsemt raises some very good points about some if the myths of prehospital pain relief. We need to be ever vigilant about poviding appropriate care and that includes pain relief.
Epi-do's quote sums it up perfectly.
Pain relief is something that is recognized as being done extemely poorly in emergency care (both pre- and in hospital) and yet it is one of the most important things we can do for our patients. Failure to treat pain in the field leads to ongoing failure to treat pain in hospital (they take cues from us) and leads to a greatly increased likelihood of the patient developing chronic pain disorders.
Johnrsemt raises some very good points about some if the myths of prehospital pain relief. We need to be ever vigilant about poviding appropriate care and that includes pain relief.
Dominion
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Without reading the other posts I say BLS until proven otherwise.
medichopeful
Flight RN/Paramedic
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Somebody brought up the idea of it being a family member. If it was my family member, I would definitely want them to have pain management.
I thought about it after I posted my last post, and I can see that yes, I was wrong. Unless there is some major catastrophe (plane crash, etc.), or I knew for a fact that ALS would be needed by somebody else soon, I think I would request ALS for pain management. But like I said, it would be situation dependent.
This is exactly how this site should work. Somebody should post a question, and people should give their input. Everybody should be open to other's suggestions, comments, etc.. I know for a fact that I learned something from this thread. So to those who were conversing with me, thanks!
I thought about it after I posted my last post, and I can see that yes, I was wrong. Unless there is some major catastrophe (plane crash, etc.), or I knew for a fact that ALS would be needed by somebody else soon, I think I would request ALS for pain management. But like I said, it would be situation dependent.
This is exactly how this site should work. Somebody should post a question, and people should give their input. Everybody should be open to other's suggestions, comments, etc.. I know for a fact that I learned something from this thread. So to those who were conversing with me, thanks!
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Well, unfortunately, my home county generally does not treat for pain management. That being said, with ski patrol, an uncomplicated ulna/radius break is regularly treated as splint to POV transport, without pain management for 30+ minute transportation times. You usually won't see ALS here unless there is significant Loss of Consciousness, bilateral femur fx, acute chest px with suspected cardiac origin, decompensated shock, respiratory distress to failure, or some other extreme... While I don't particularly agree with that, we play the hand we're dealt. While I am currently practicing in the famous "King County" and our paramedics are phenomenal, I do think that we need an intermediate level of care that would allow minor interventions, including being able to treat for pain management.
Dominion
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Our intermediates (and as I suspect most EMT-I's) are not allowed to do pain management. Technically we have pain management protocols which are paramedic specific but my service doesn't carry pain meds.
When you get into pain management with the meds and assessment that goes along with it, you need to be advanced in your education and skills. You do not need to be an EMT with a couple extra tricks in your bag by way of a few hours of extra training which is essentially what the Intermediate level is.