Is this Advanced Life Support?

[traumateam1]

Based one the original posters second post on the second page, the medics were in the wrong. Why would you allow a patient to walk 52 feet. And I say allow because wouldn't you try to convince the p/t to take a stair chair ride? Or use the medics as crutches? I think they were just being lazy.
Now for the record could Genie answer a question for me?
Did your husband DEMAND to walk to the door on his own in his underwear?

 

[KEVD18]

Everything can be ALSed. Not everything should be BLSed.

That's my motto.

no, i wouldnt agree with that either.

sure, every call can have an als procedure. but does the call need an als procedure is the question? and if the procedure isnt justified, is it really an als call?

example: suicidal ideations with a plan. pt called 911 for transport to H for voluntary commitment. denies cp, sob, dizziness, nausea, vomiting, pain or discomfort of any kind. denies any substance ingestion. pt is compliant in all regards. pts airway is patent. they are speaking in full sentences. l/s are equal and clear bilaterally. vital signs are stable and within normal limits. no significant findings in any part of the exam.

what als procedures are needed here? they dont need a line. they dont need to be monitored(cardiac) anymore than i do. they dont need to be intubated, vented, paced, medicated, have labs drawn. im literally sitting here racking my brain trying to justify any als procedure here. in fact, this isnt even a bls call. this is a taxi/friends car call, but since health insurance doesnt pay for that, they called the ambulance. but it certainly isnt an als call.

 

[triemal04]

Kev18- Maybe. The fact still remains, he did walk. Unaided. (again, I'm not saying either way if this was right or wrong). Given what the medics on scene saw and were faced with in regards to his location, this may have been warranted. Or may not have been.

Genie- If I've offended you, then I do apologize, that's not my intent at all. But, in this type of situation, with a family member/bystander/whatever who was personally and emotionally involved in the situation and who has no background in mediciene or EMS (I'm guessing here) it's hard to make a full determination of what should or should not have happened based only on that person's statement. My recomendation would be the same as ffemt's; contact Denver Health and file a formal complaint if you feel it was warranted. I will tell you up front that Denver Health is a system with a lot of problems, so you may not get a satisfactory resolution, but if you want, you should definetly try. This next part doesn't apply to you, so you can ignore it.

To EVERYONE- This situation comes up fairly regularly on these type of forums, even though this does not appear to be one of those cases. But it is not uncommon to find someone who is on a fishing expedition for information they can use to sue a particular service because they didn't like the quality of their care, right or wrong. Usually it's fairly obvious from the beginning, other times it takes awhile for things to get clearer. Providing your opinion based on limited information is not the best idea, and can lead to problems for someone else, all due to the fact that YOU did not know what really happened before you spoke up. If you are going to provide an opinion, especially to a layperson who may take what you say as gospel, then you need to be fully informed of really happened, something that is next to impossible on the internet.

 

[triemal04]

Based one the original posters second post on the second page, the medics were in the wrong. Why would you allow a patient to walk 52 feet. And I say allow because wouldn't you try to convince the p/t to take a stair chair ride? Or use the medics as crutches? I think they were just being lazy.
Now for the record could Genie answer a question for me?
Did your husband DEMAND to walk to the door on his own in his underwear?

A patient? Yep. Done it many times and for more than 52 feet. Ordered them to walk that far too. Why? Because not everyone needs a gurney ride for the whole trip. Are you going to put a broken finger from the second floor (or hell, even the first floor) on the gurney/stairchair instead of having them calmly walk to the ambulance?

 

[Genie]

Based one the original posters second post on the second page, the medics were in the wrong. Why would you allow a patient to walk 52 feet. And I say allow because wouldn't you try to convince the p/t to take a stair chair ride? Or use the medics as crutches? I think they were just being lazy.
Now for the record could Genie answer a question for me?
Did your husband DEMAND to walk to the door on his own in his underwear?

He absolutely did not!! They flatly stated to my husband, "We can't carry you out of this bedroom. You'll have to walk out." Outside of the house the paramedic rolled the stretcher up until the sidewalk turned a 90 degree angle towards our 2 steps up to the door. He just plain stopped and said, "I can't take it any further." My neighbor was taken by ambulance to the hospital last year, having abdominal pains. He has the same house design we do and he said he was carried out of the master bedroom.

 

[bstone]

no, i wouldnt agree with that either.

sure, every call can have an als procedure. but does the call need an als procedure is the question? and if the procedure isnt justified, is it really an als call?

example: suicidal ideations with a plan. pt called 911 for transport to H for voluntary commitment. denies cp, sob, dizziness, nausea, vomiting, pain or discomfort of any kind. denies any substance ingestion. pt is compliant in all regards. pts airway is patent. they are speaking in full sentences. l/s are equal and clear bilaterally. vital signs are stable and within normal limits. no significant findings in any part of the exam.

what als procedures are needed here? they dont need a line. they dont need to be monitored(cardiac) anymore than i do. they dont need to be intubated, vented, paced, medicated, have labs drawn. im literally sitting here racking my brain trying to justify any als procedure here. in fact, this isnt even a bls call. this is a taxi/friends car call, but since health insurance doesnt pay for that, they called the ambulance. but it certainly isnt an als call.

You misunderstand. Everything can be ALSed but not everything needs to be. Big difference.

 

[traumateam1]

A patient? Yep. Done it many times and for more than 52 feet. Ordered them to walk that far too. Why? Because not everyone needs a gurney ride for the whole trip. Are you going to put a broken finger from the second floor (or hell, even the first floor) on the gurney/stairchair instead of having them calmly walk to the ambulance?

Are we talking broken finger here or not?

 

[traumateam1]

So based on what Genie is saying here.. they straight up told a p/t with moderate to severe abd pain to WALK to the front door, without taking the time and decency to dress him with pants. So tell your unit chief, or supervisor you made a moderate to severe abd p/t walk >50 feet to the stretcher because you were to lazy to get the stair chair. Yeah we'll see how that one goes over.
Genie: Follow ffemt's advice, best thing you can do.

 

[daedalus]

I agree with triemal...none of us were there, so we're only getting one side of the story. We don't know if the patient insisted on walking rather than being carried, we don't know what his vitals were, there's just too much we don't know.

To the OP: A complaint may or may not be warranted, but I would suggest that you, at a minimum, do the following. Call the ambulance company and ask to speak to the supervisor/manager. Get the name of their medical director, and request that this call be sent in for a QA/QC review by their medical director. Then contact that person, and explain your concerns to them. Request to be kept in the loop on this one.

Actually, this is a great idea. Calling and requesting QA/C and getting the low down from the medical director (a medical doctor) will get you an unbiased and expert opinion, and also get anyone who deserves it in trouble. I echo this idea. Lets not armchair quaterback this crew, guys. Why not let the MD do it so we can keep our hands clean on this one

 

[KEVD18]

Actually, this is a great idea. Calling and requesting QA/C and getting the low down from the medical director (a medical doctor) will get you an unbiased and expert opinion, and also get anyone who deserves it in trouble. I echo this idea. Lets not armchair quaterback this crew, guys. Why not let the MD do it so we can keep our hands clean on this one

that may not be entirely accurate.

in massachusetts, service medical directors are paid employees on the company. sure, its not their main income. quite the opposite, a small fraction of it. now i haven't met a doc yet that would risk their medical license to side with the service just because they were being paid a pittance to do so. but they are on the payroll and therefore there is the possibility that they are susceptible to being influenced in the wrong direction.

 

[Genie]

Broken finger? Re-read my posts and learn. My husband had been through Chemo and Radiation on his middle chest. As a result, the chemo damaged his kidneys and the radiation damaged his esophagus. He is 6 feet tall and down to 120 pounds. He looks like death. He lost all his hair, which was obvious, and we showed paramedics the extension radiation burns and Groshong catheter. His radiation may also have caused heart damage. His kidneys were throwing out all sodium, magnesium and potassium. Just having a low blood pressure, like the paramedics found, does not mean he's all right. We know, from him being re-hydrated frequently, that his blood pressure would be low on laying down and drop lower when being elevated. He was very lucky to never have had a heart attack.

We know from being often in cancer treatment that there are many normal-looking people receiving treatment. Radiation to the mid-chest can cause heart and lung problems 4-6 months, even a year after treatment. It's rare, but it is apparently happening to my husband.

Back to the main issue though. He was having severe right-side obdominal pain and that's what we called the ambulance for. We gave history of my husband to the dispatcher and paramedics but thought the paramedics were the ones to assess him, not us. We shut up, stood back and followed their orders -- walk.

I will follow through with your advice to have this reviewed. I have scared many relatives and friends, telling them what happened. I know they would feel better if there were consequences for the actions of these paramedics and they feel they can trust most paramedics.

 

[KEVD18]

genie: you're confused. the broken finger thing was a side comment about another type of call we see a lot.

 

[Bosco578]

Broken finger? Re-read my posts and learn. My husband had been through Chemo and Radiation on his middle chest. As a result, the chemo damaged his kidneys and the radiation damaged his esophagus. He is 6 feet tall and down to 120 pounds. He looks like death. He lost all his hair, which was obvious, and we showed paramedics the extension radiation burns and Groshong catheter. His radiation may also have caused heart damage. His kidneys were throwing out all sodium, magnesium and potassium. Just having a low blood pressure, like the paramedics found, does not mean he's all right. We know, from him being re-hydrated frequently, that his blood pressure would be low on laying down and drop lower when being elevated. He was very lucky to never have had a heart attack.

We know from being often in cancer treatment that there are many normal-looking people receiving treatment. Radiation to the mid-chest can cause heart and lung problems 4-6 months, even a year after treatment. It's rare, but it is apparently happening to my husband.

Back to the main issue though. He was having severe right-side obdominal pain and that's what we called the ambulance for. We gave history of my husband to the dispatcher and paramedics but thought the paramedics were the ones to assess him, not us. We shut up, stood back and followed their orders -- walk.

I will follow through with your advice to have this reviewed. I have scared many relatives and friends, telling them what happened. I know they would feel better if there were consequences for the actions of these paramedics and they feel they can trust most paramedics.

Glad you feel better. Hope you find closure on this issue. Sorry to hear you have "scared many relatives and friends" with your tale of woe. File as many complaints as needed to make you feel better. Best of luck.

 

[Guardian]

I've had cancer patients with abdominal pain walk to the stretcher. I've taken 20 mins to get on scene. I've started an IV and billed the patient for ALS.

You love your husband and want him to be treated like a king. We don't love your husband and treat him like the other 10 people in similar conditions we saw that night. Thus, nothing we do is ever going to be good enough. Because you love your husband, you most likely overreacted. He most likely did not need to be carried from his bed. The real world dictates we make judgments based on our vast previous experience in dealing with people in you husband's condition. We are usually much more accurate than family members when making those judgments because of our experience and lack of emotional involvement. While you saw an emergency, the paramedics most likely more accurately saw a routine call with relatively minor discomfort.

You mentioned that you and your husband did what you'll were ordered to do (walk). Generally speaking, paramedics can't order anyone to do anything. I would encourage you and your husband to request more assistance next time. Your husband has the real power because only he really understands how bad it hurts and he could have refused to walk or requested something to cover himself up with. Tell your husband to not be afraid to take a little more of the initiative next time. If he refused to walk, they would have carried him out. I hope this helps with any future paramedic contacts.

 

[triemal04]

So based on what Genie is saying here.. they straight up told a p/t with moderate to severe abd pain to WALK to the front door, without taking the time and decency to dress him with pants. So tell your unit chief, or supervisor you made a moderate to severe abd p/t walk >50 feet to the stretcher because you were to lazy to get the stair chair. Yeah we'll see how that one goes over.
Genie: Follow ffemt's advice, best thing you can do.

Well...yes, yes I have done that. And will do that again. And again. And again. And you know what? Never had any problems come from doing that. Not from my partners, not from anybody that I work with at any level.

Does this mean that each person needed to be carried? That what I did was detrimental? That each really had pain? That some weren't drug seekers? That there weren't other circumstances involved that dictated my course of action? I'm not saying, and you don't know. Why? Because you weren't there.

Is this getting clear yet?

 

[daedalus]

I admit, I have asked plenty of patients to walk to the gurney. If my back goes out at my age, I will never be able to continue my career in paramedicine, which means I will no longer be able to be of service to people the way I want to be. If I ever suspected that walking may be detrimental to the patient's condition, I would have assisted or carried them to the gurney. However, I do teach new EMTs that you cannot risk your back just because an obese patient does not want to walk because they are "lazy" or something to that extent.

I doubt that this is the situation here, your husband being so thin due to the treatment for his cancer. Again, I encourage you to ask the ambulance service to review the call with their QC team. My comments above are meant for the professional debate over assisting patients to gurneys.

 

[Bosco578]

I've had cancer patients with abdominal pain walk to the stretcher. I've taken 20 mins to get on scene. I've started an IV and billed the patient for ALS.

You love your husband and want him to be treated like a king. We don't love your husband and treat him like the other 10 people in similar conditions we saw that night. Thus, nothing we do is ever going to be good enough. Because you love your husband, you most likely overreacted. He most likely did not need to be carried from his bed. The real world dictates we make judgments based on our vast previous experience in dealing with people in you husband's condition. We are usually much more accurate than family members when making those judgments because of our experience and lack of emotional involvement. While you saw an emergency, the paramedics most likely more accurately saw a routine call with relatively minor discomfort.

You mentioned that you and your husband did what you'll were ordered to do (walk). Generally speaking, paramedics can't order anyone to do anything. I would encourage you and your husband to request more assistance next time. Your husband has the real power because only he really understands how bad it hurts and he could have refused to walk or requested something to cover himself up with. Tell your husband to not be afraid to take a little more of the initiative next time. If he refused to walk, they would have carried him out. I hope this helps with any future paramedic contacts.

This hits the nail. Well said.

 

[yowzer]

he shouldnt have been made to walk. if they couldnt get the stretcher in, they should have used a stair chair.

It's possible they didn't have a stair chair.... When I worked on an ambulance, we didn't have any such beast, just these horrid canvas bucket things with handholds -- assuming it hadn't been lost somewhere. Or we'd use a scoop or backboard, but those tight 90 degree turns into narrow hallways are only slightly less awkward with those than a cot. A couple of times we sat someone down in a sturdy kitchen chair and carried that.

In general, though, if it's a case of walk or carry and the patient is physically able to walk, they're footing it. I'm sure we all know people out on disability with back injuries. Do you want to be another?

Sounds like this guy should have had someone at his side to lean on/assist, though. There are ways and then there are ways of walking someone to the cot.

 

[Flight-LP]

I really cannot believe some of the responses I am reading. If you use proper lifting mechanics, you will not injure your back. C'mon, we are talking about a 120ish pound man. Every one of us should be able to carry him unassisted, much less with 2 people. Many State's, Texas for instance, requires an ability to lift a particular weight. Can't do it? Then you are not fit to perform your job description. Simple as that. An excuse is all it is. All of this "you are just like the other 10 people we have seen" and the "if they can, they will walk" is B.S.

STOP BEING LAZY AND DO YOUR JOB!

Put a little thought and care into your patients, it won't kill you, you will still get a paycheck, and I don't know, maybe it will make you feel good about doing the right thing instead of being self-centered. If its a problem, then maybe you need a vacation...............

It is so easy to say that he should have refused to walk. The general impression that most get is that EMS will do the right thing for their patient. The pt. and / or family called for assistance, nothing more should be required. the rest is in YOUR hands.

Genie, I agree with the aforementioned opinions that you should contact the agency's QA department and follow up. I am sorry for your experience, I wish you and your husband well..............

 

[firecoins]

deleted my comment by posting a non sensical comment.