is a broken arm an ALS or BLS call?

[LonghornMedic]

Thanks for the civil response, Vene. I have no problem with liberal pain management but the "ALS Everything" crowd irks me, especially when this is a thread regarding a fracture of a BLS nature. And the OP was very clear it was BLS.

At the risk of attracting more butt-hurt medics like flies to a bright light, I withdraw my presence from this thread. :usa:

Moot point since the system I live and work in is all ALS. Thank God I don't live in areas with fly cars, intercepts, BLS only, etc. As a sufferer of many a kidney stone, I've been on the receiving end of EMS on more than one occasion. It chills my blood to read some of the responses here. If you have meds, give it. You aren't paying for it. It's there for a reason, so use it. I've had partners over the years, mostly they were real young or older medics who were burned out, who would rarely give pain meds because they were just too lazy(burned out medics) or the "patient can suck it up"(newer young medics). Please, if any of you get to this point in your career.....get out.

Rare is the patient who isn't medicated BEFORE I start immobilizing, splinting and moving. If someone is sitting on a baseball field with a fractured arm, they get medicated right where they are sitting and then we do the rest.

 

[LonghornMedic]

Two things to remember: Your patient could be a drug seeker, or your patient could be an ex addict. Giving drugs to the former of these without evidence they are in pain is bad, and giving meds to the latter of these without helping them make an informed decision is much much worse. All drugs have side effects, and all drugs have aftereffects. Overmedication is one of the bigger medical problems we face in the United States now, better not to compound the problem if you can help it. Be compassionate and make informed treatment decisions based on what a patient needs.

Your not serious are you?

 

[jjesusfreak01]

Your not serious are you?

About what, that overmedication is a problem in the US? That is absolutely true. I'm not saying that it is a problem in pre-hospital medicine, but it is a huge problem nonetheless in general medicine, and I would hate to see it spread to the pre-hospital setting. Just because we only treat patients for a short time doesn't make the interaction any less important in their overall care.

Drug seekers and addicts are also something commonly faced in EMS that we have to be aware of. All i'm advocating is that we use good judgement when injecting people with foreign substances and avoid treating with a "just because we can" methodology. Field IVs are prone to infection at a higher rate than hospital IVs (though it is not a very high rate), so do you want to go before your medical director and defend your starting an IV on an immunocompromised patient so you could give a little pain medication for their stubbed toe? Every invasive treatment on a patient involves inherent risks, and it is often a risk that is warranted, but sometimes it isn't.

 

[medic417]

Many meds are way over prescribed but pain management is way underutilized. Again we have no way to verify. It is their pain treat it.

 

[usalsfyre]

DrParasite

Since you misinterpreted my post, let me explain one final time. You can't feel a patient's pain. If they say the hurting, unless there is obvious behavior to suggest otherwise, I believe them. Very often, the treatment of choice for pain is IV (or IN) opiate medications, in my system it's Fentanyl.

Fentanyl, as reported by surveys of users, gives a poor high, with noticeably less euphoria, ect than other narcotics. It also has a very short half life, meaning a "fix" will likely have less "high" and less duration than whatever their drug of choice is. So given the choice between calling EMS for a crappy high, or obtaining a normal high through buying, stealing or other illegal activities they are likely to go with the normal methods.

Jjesusfreak, listen, this applies in your argument to. Withdrawl HURTS. Users are physically dependent on narcotic medications for normal physiologic function of their bodies. If they don't have it, pain, nausea, vommiting and other illness symptoms honestly appear. Don't believe me, withhold grandma's Vicoden for a day and see what happens. Is this patient somehow less deserving of treatment? Is a patient with the flu not worthy of treatment. Addiction does not make on less human.

The last busy truck I worked I considered "busy" averaged around 16 calls per 24 hours. A busy day was 25+. A large low-income, minority and homeless population and the associated problems with it.

The EMS system IS broken. Ask most people with a real EMS background. Some of us are trying to make it better, MD or no MD. I am extremely fortunate to work for a medical director that believes in aproprite pain management and sedation as needed. These are probably more important to patient care than all the cardiac arrest drugs in the world.

 

[LonghornMedic]

I guess the answer I would give to the question (since I am the OP after all), if you are an all ALS system, and you have the pain meds available to you, by all means give them. but if you are in a tiered systems, which a lot of the busier systems are, then I wouldn't be requesting a medic simply for pain control, when their skills can be better used treating the chest pain or asthmatic.



and the question isn't do you have difficulty breathing, it's "are you breathing normally." same results occur. but back to the topic at hand....
woooow. I have had patients with a stubbed toe who said their pain was 10/10. ditto a broken swollen finger. or abdominal pain. or a headache. or an ear ache. it's always 10/10 on the pain scale. I guess they needed pain meds, going by your thinkingsee, I guess that shows what type of a provider you are. you let your patient's dictate how you are going to treat them. If I show up to your broken arm, and you tell me you are just going to just lay there screaming in pain until I request ALS and they give you pain meds, I am either going to pull up a chair and wait for your to grow up, tell you "if you want to be treated, you need to let me treat you, or can can just lay there the pain", and if you still don't want me going anywhere near you, I am going to say "sign the RMA," and next time, have the cops and a supervisor respond when you call again. If you are going to let the patient dictate how you are going to treat him (not his condition based on your assessment, his desires), than you are a drug seekers dream medic.

I broke my wrist, my brother broke both his arms due to stupidity (one after the other), and we never called 911. and if I did break my arm, unless it's at a 90 degree angle, I'm probably going to end up walking to the ambulance once it has been splinted and secured in a position of comfort, and that is if I call for an ambulance at all. I might prefer to just drive myself to the ER, or even better, to my PMD's office

What an :censored::censored::censored::censored::censored::censored::censored: you are. It's medics like you who give us all a bad name. Who are you to determine if someone with ABD pain isn't having 10/10 pain? And just because you were "man enough" not to call 911 for your FX wrist doesn't mean that someone else may not need pain control. 10/10 headaches aren't deserving medications? Migraines can be debilitating for some people.


This statement right here tells me exactly what kind of jaded, burned out EMT you are-

If I show up to your broken arm, and you tell me you are just going to just lay there screaming in pain until I request ALS and they give you pain meds, I am either going to pull up a chair and wait for your to grow up, tell you "if you want to be treated, you need to let me treat you, or can can just lay there the pain", and if you still don't want me going anywhere near you, I am going to say "sign the RMA," and next time, have the cops and a supervisor respond when you call again. If you are going to let the patient dictate how you are going to treat him (not his condition based on your assessment, his desires), than you are a drug seekers dream medic.

Guys like you last a couple months where I work. And I work in a busy as hell EMS system. But they expect you to be courteous to the patient. Our "business" is providing care and showing compassion. If one of our Paramedics talked to someone like you say you do, you'd be fired. No joke, you would be out the door. If you tell a homeless guy to go F-off, you're gone. Our Medical Director is big on customer service. The patients are our customers and they deserve the right to excellent pre-hospital care. And we're not even a private service worried about contracts, we're a county run 3rd service with about as much of job security as one can get.

 

[LonghornMedic]

About what, that overmedication is a problem in the US? That is absolutely true. I'm not saying that it is a problem in pre-hospital medicine, but it is a huge problem nonetheless in general medicine, and I would hate to see it spread to the pre-hospital setting. Just because we only treat patients for a short time doesn't make the interaction any less important in their overall care.

Drug seekers and addicts are also something commonly faced in EMS that we have to be aware of. All i'm advocating is that we use good judgement when injecting people with foreign substances and avoid treating with a "just because we can" methodology. Field IVs are prone to infection at a higher rate than hospital IVs (though it is not a very high rate), so do you want to go before your medical director and defend your starting an IV on an immunocompromised patient so you could give a little pain medication for their stubbed toe? Every invasive treatment on a patient involves inherent risks, and it is often a risk that is warranted, but sometimes it isn't.

I've started literally thousands of IV's. I've yet to be called in for a bad one. If you follow proper procedures, you'll be fine. And this whole "stubbed toe" scenario is so stupid. No medic is going to medicate that. But if someone is complaining of severe pain, I'm going to offer and give meds. I'm don't know if the patient is an addict. Maybe he is. Most importantly, maybe he isn't. How would YOU feel if you were in dire pain and some burnout medic responded and treated you like crap and withheld meds and left you in pain? All I have ever worked in is busy EMS systems in large cities. I can only think of a few times where I have encountered chronic 911 abusers looking for pain meds. You and your partner get to know who they are over time. Dispatch notes on the MDT usually will indicate a patient with high risk on it. If I get one I am familiar with and know they are seeking, then I may not give meds. But I have to be pretty darn sure of it before I go around refusing meds because I worry too many people may be addicts.

 

[DrParasite]

And this whole "stubbed toe" scenario is so stupid. No medic is going to medicate that. But if someone is complaining of severe pain, I'm going to offer and give meds.

why not? it hurts when you stub your toe, even worse if you slam your hand in the car door. heck, my mom kicked a railroad tie once and broke her toe, would you not give her pain meds? or are you selectively withholding pain meds? [/QUOTE]

What an :censored::censored::censored::censored::censored::censored::censored: you are. It's medics like you who give us all a bad name. Who are you to determine if someone with ABD pain isn't having 10/10 pain? And just because you were "man enough" not to call 911 for your FX wrist doesn't mean that someone else may not need pain control. 10/10 headaches aren't deserving medications? Migraines can be debilitating for some people.

abd pain is different, as in a mirgrane. this is about a broken arm.

out of curiosity, would you give meds for abd pain? most medics I know won't, because they don't know what is causing the pain. not that it isn't painful, only that without knowing the underlying cause, people are hesitant to push pain meds. oh and as for your 10/10 migranes, I'm sure they are painful, but how do you know they aren't a bleed or an undiagnosed head injury? There is a reason doctors run tests and perform an assessment before they start giving pain meds. and contrary to what some people think they have more training and more tools at their disposal before they say "ok lets give some narcotics to take the edge off."

btw, next time I hurt my back, I am going to call for a paramedic unit to give me pain meds. much easier than waiting for the ER to give them to me. after all pain is pain right?

This statement right here tells me exactly what kind of jaded, burned out EMT you are-

If I show up to your broken arm, and you tell me you are just going to just lay there screaming in pain until I request ALS and they give you pain meds, I am either going to pull up a chair and wait for your to grow up, tell you "if you want to be treated, you need to let me treat you, or can can just lay there the pain", and if you still don't want me going anywhere near you, I am going to say "sign the RMA," and next time, have the cops and a supervisor respond when you call again. If you are going to let the patient dictate how you are going to treat him (not his condition based on your assessment, his desires), than you are a drug seekers dream medic.

actually no. That shows that I am going to treat my patient based on my assessment, not on what he wants. I will treat the patient based on my assessment (and yes, his pain complaints is one of those vital signs, one of a larger picture). I will not let the patient bully me (which is exactly what the patient is doing when they say they are not moving until I do something they want to and I don't think they need) into doing something. If following my assessment I determine that medicinal pain management is needed, that is one thing. but no, I do not let the patient demand I do something because they want me to. and if you do, well, I don't really know what to say.

Guys like you last a couple months where I work. And I work in a busy as hell EMS system. But they expect you to be courteous to the patient. Our "business" is providing care and showing compassion. If one of our Paramedics talked to someone like you say you do, you'd be fired. No joke, you would be out the door. If you tell a homeless guy to go F-off, you're gone. Our Medical Director is big on customer service. The patients are our customers and they deserve the right to excellent pre-hospital care. And we're not even a private service worried about contracts, we're a county run 3rd service with about as much of job security as one can get.

I'm pretty sure my system is busier, but that's irrelevant.

I am courteous to all my patients. I won't tell a homeless guy to F-off, nor did I ever say I would (despite what you tried to imply). My operations director as well as my medical director are both big on customer service; however, they both know that the patients should be treated based on what they need, not what they want. They can want morphine, fentynal, and oxycotin, and any other pain med you can name. if it's warranted, then they should (and do) receive it. And still, I have yet to be called into the office for not requesting an ALS unit to provide pain control for a broken arm....

I know this might shock some people, but customer service doesn't mean the customer is always right, but rather doing what is best for the customer.

I guess some places are willing to give the "customer" whatever they want, regardless of if they need it or not. I am curious is the response to the question "why did you give that drug" is "well, the patient demanded that I give it to him, and with customer service, the customer is always right" what would your bosses or the legal system think of it

 

[DrParasite]

btw, the poll says 35% think it's an ALS call, and 65% say BLS.

Maybe the more vocal minority is wrong? and the majority of people (ie, leading in the poll), think BLS is perfectly acceptable, but they don't want to get accused of being harsh jaded EMS providers by a small but vocal providers?

just a thought.

 

[JPINFV]

...alternatively the majority can easily be lacking something that the minority has. Medicine isn't based on a majority vote.

 

[medic417]

We give pain meds for abdominal pain. Only systems that are stuck in the 70's don't.

 

[medicRob]

If you have read your textbooks, you would see that you cannot tell whether a patient's pain is real or not and you are not to withhold medications because you "think" the patient is lying to you.

Don't forget that before "Medic" In your title comes, "PARA" meaning, "in a secondary or accessory capacity".

Also in response to earlier posts, we treat patients based on our clinical findings. This is not Cookbook medicine or "One size fits all".

 

[LonghornMedic]

I'm pretty sure my system is busier, but that's irrelevant.

Unless your agency or company is handling over 110,000 EMS 911 only calls a year, you have me beat. Considering there isn't even a city remotely the same size as where I work in NJ, I doubt it.

 

[LonghornMedic]

We give pain meds for abdominal pain. Only systems that are stuck in the 70's don't.

Exactly. We also give meds for patients with a history of migraines. Not sure what kind of back @sswards systems some people work in.

 

[lampnyter]

i think that pain deffinitly determines whether you give pain meds but if people are saying a broken arm is an ALS call then what is a BLS call? Some people make it seem like everything is an ALS.

 

[medic417]

i think that pain deffinitly determines whether you give pain meds but if people are saying a broken arm is an ALS call then what is a BLS call? Some people make it seem like everything is an ALS.

Everything has the potential to be ALS so it should have a ALS response.

 

[MrBrown]

The American obsession with ALS vs BLS is laughable and utterly ridiculous.

That is not a reflection on individual providers or systems and should not be taken as such but as an overarching concept it has all but been abandoned in other countries as it is outdated and not found anywhere else in medicine.

Lets see, if you go to the ER you get seen by a doctor (eventually) and have access to a Consultant physician, if you go to the dentist you get seen by a dentist, and so on. But in the US, if you call an ambulance you might get a 120 hour wonder who can take your blood pressure and give you some oxygen. If ALS turns up they might be able to give you 5 or 10mg of morphine and then have to call the doctor to ask for more, which might get denied. If your pain does not respond to traditional narcotic analgesia you probably won't get combination analgesia such as morphine+midazolam or ketamine, dilaudid, nubain/foratol or even bloody methoxyflurane/entonox so guess what you're out of luck.

By saying oh so and so is a BLS call it really does show the limited scope of American EMS' thinking and reflects a lack of appreciation for wider concepts in medicine and international trends within EMS. It also highlights the poor quality of knowledge being given to providers generally because it is so limited.

Its depressing that after nearly fifty years the American system still advocates a basis of "limited training" with "medical direction" as being acceptable (EMS Agenda for the Futures words not mine)

 

[TransportJockey]

The American obsession with ALS vs BLS is laughable and utterly ridiculous.

That is not a reflection on individual providers or systems and should not be taken as such but as an overarching concept it has all but been abandoned in other countries as it is outdated and not found anywhere else in medicine.

Lets see, if you go to the ER you get seen by a doctor (eventually) and have access to a Consultant physician, if you go to the dentist you get seen by a dentist, and so on. But in the US, if you call an ambulance you might get a 120 hour wonder who can take your blood pressure and give you some oxygen. If ALS turns up they might be able to give you 5 or 10mg of morphine and then have to call the doctor to ask for more, which might get denied. If your pain does not respond to traditional narcotic analgesia you probably won't get combination analgesia such as morphine+midazolam or ketamine, dilaudid, nubain/foratol or even bloody methoxyflurane/entonox so guess what you're out of luck.

By saying oh so and so is a BLS call it really does show the limited scope of American EMS' thinking and reflects a lack of appreciation for wider concepts in medicine and international trends within EMS. It also highlights the poor quality of knowledge being given to providers generally because it is so limited.

Its depressing that after nearly fifty years the American system still advocates a basis of "limited training" with "medical direction" as being acceptable (EMS Agenda for the Futures words not mine)

Too bad there's a large body that helps control EMS that is against a lot of improvements since it would increase education times

 

[Akulahawk]

There are other ways to treat pain than IV pain meds. Is a simple broken arm an ALS call? Maybe. Maybe Not. Then again, I don't try to blot out your pain. I want to make you comfortable, and your pain tolerable, but not completely gone. Why? I want you to remember to keep still... If you're still moving around because it no longer hurts, you risk further damage to all the structures in the area of the Fx. Of those, I worry most about neurovascular damage...

 

[MrBrown]

Too bad there's a large body that helps control EMS that is against a lot of improvements since it would increase education times

You could just say the IAFF/IAFC/volunteers/Parathinktheyare's/Medicfighters.

They probably know who they are anyway