Is this Advanced Life Support?

[traumateam1]

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.

Thank yooouuu! It's very clear and simple here people. The medics were being lazy and not doing their job. Regardless of "the last 10 people" who cares. It is your job to treat every patient like it's your first of the day. Give them the care they need, not to force them to walk when it's not necessary. If you are making your p.t with a C/C of abd pain walk, when its severe enough to help them (if you don't have a stair chair, and can't fit the stretcher in) than you need a little vacation.

 

[BossyCow]

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.

Genie:
Let me say first, I'm very happy that your husband is doing well. Please understand that the discussion here is only opinions, based on the information we get from your perception of events. I understand that you are trying to be factual and unemotional on the events but the point being made is that without having seen everything, we cannot understand what was factoring into the medics decision to do what they did.

Was one of the medics recently sanctioned for hurting himself while lifting a pt that could have walked? Is the stretcher on the rig they were assigned that day unable to make a tight corner while the one on your neighbor's call was able to make tighter turns? Was your husband's ability to endure the chronic and severe pain of his recent health history causing the medics to underestimate how much pain he was really in?

There are a lot of factors at work and to leap to the conclusion that the medics should have performed differently is one I'm not willing to make. Your husband arrived at the hospital, was stable and able to enter surgery to correct his problem. That is the goal of EMS. He recovered and is doing fine. In our industry, this counts as a win.

As far as the response time, there is no way of knowing if the agency you called was returning from another call or you were attended to by a second out unit because the first unit was out on another call. It is definitely worth calling the agency and discussing it with the management there. At the very least, you may get some information that will help you understand why things went the way they did.

 

[Jon]

Genie,

We all make mistakes... and in our line of work, mistakes can kill people. The stakes can be high. We all make mistakes occasionally... that is why we PRACTICE medicine.

On the same token... I think this call does probably deserve review from the service, and I echo the call of others here for you to contact the service and ask for them to review the call and determine that the care that was provided was adequate and in line with their standards of care.

Good luck, and keep us posted.

 

[EMTDON970]

spoken with the utmost ignorance possible.

well, let me correct myself. anything can go bls, if you want a large percentage of the patients to die or experience significantly increased after effect or defecits when they could have otherwise been spared.

a cardiac arrest has pretty dismal chances overall, but they are better with the earliest als possible.
for the services that utilize prehospital thrombolytics, they are drastically decreasing lasting effects from strokes.

i could go on all night....

im not one of the people that thinks basics are worthless(and those people do exist, even here). but we have to know our place. we cant handle everything. if we could, there would be no medics. there are als calls and bls calls.

Where I work at I have a hospital within 7 minutes away, why wait 10 to 15 minutes for a medic when I can be at the hospital quicker.

I know some worthless EMT's my company employs them :wacko: but I still believe any call can go BLS, whether it should or not is a different story.

 

[reaper]

In a city the size of Pittsburgh I would expect every truck to be ALS. You should not have to wait 10-15 minutes for ALS, They should be first on scene. If you service is sending BLS trucks to emergencies, then they need to rethink being involved in EMS!

 

[Genie]

Thanks for all the replies! Some of them I didn't appreciate at first. Then, I did realize what I might encounter when I call our paramedic division for a review of what happened. I'll be ready because of what I've learned from you.

I could go back over all your comments and come up with more explanations of our situation here, but I don't believe it's necessary. I realize that you all must find it very unbelievable and are trying to come up with good reasons for the paramedics to make my husband walk. I found it unbelievable myself and am kicking myself for allowing it to happen as it did. Instead I feel like a "softy" and feel sorry for those two young men if they are disciplined -- stupid, right?

I keep trying to recall everything I said to the dispatcher that made them determine it would be 20 minutes before an ambulance got to the house. I know I said he was a cancer patient suffering affects of chemo and radiation and I took him in frequently for re-hydration and potassium. Then I said he now had a different pain, a severe pain in his lower right abdomin and was in excrutiating pain just trying to move/roll over in bed. The only question I remember the dispatcher asking was, "How is he breathing?" and I said, "he's breathing very heavy, like it's hard to breath." Then I was told they would be out in 20 minutes, open the front door and remove all pets.

Denver is supposed to have a 6-8 minute response time, so I was surprised at that. They came up without lights or sirens as far as I know. I'll have to ask my neighbors! Anyhow, I wasn't as concerned about that as much as their not carrying him out of the house. Our front walk, hallways, etc. are very accessible – you wouldn't believe all the huge items that have come through here the last 35 years!

Oh well – I'm doing what I said I wouldn't do in my first paragraph – coming up with more explanations – sorry! I guess my next communication is with the paramedic director.

 

[Genie]

One more thing. I called at 1:30 p.m., which is probably an "off" time in Denver. I know that pretty well since I've lived here for 40 years.

 

[ffemt8978]

Genie, please keep us informed of what comes out of this, as it is something that we can all learn from.

 

[MMiz]

First, welcome to EMTLife!

You aren't the typical user we get, so please be understanding if the responses you receive aren't as you expected. It's kind of like having a complaint against a police officer and going to a police officer community, we tend to stick up for our own.

It's almost impossible for us to sit here and give you the response you're looking for. There could be a million and a half reasons why your husband received the treatment he did. If I were you I'd submit an inquiry or complaint in writing, and at the very least ask for a review of the call.

As for the long response time, you really need to speak with the EMS provider to see what that was the case. A typical emergency response time in most systems is 8-9 minutes, while a typical non-emergency response is 15-20 minutes. Please understand that your definition of an emergency differs from our version. It's up to the dispatcher to determine the dispatch priority of a call. We've arrived on normal (non lights/sirens) calls to find a patient in cardiac arrest. Clearly there was a breakdown in communication. I've arrived on calls for a gunshot wound victim that were really a jammed finger. It's really the dispatcher's responsibility to take the information and dispatch the unit.

I'd hate to say it, but some of my partners in EMS like to see the patients walk whenever possible. It's an absolutely pain trying to maneuver the 100 lb bulky cot through doorways and up and down porches. The truth is, that's it's our job to transport the patient in the safest, healthiest manner possible, which may not have been a stretcher in your case. If I'm unable to put the patient on the stretcher I then use our stair chair or we carry the patient out to the cot with our arms.

It's important that you advocate for your husband's health and well being, which I think can best be served by contacting the service and asking for a review of the call. I've typed out multiple paragraphs where I analyze why your response took so long, and all of them are valid reasons, but I'm really not in a position to rationalize or justify another persons actions. That's what a Quality Improvement committee is for.

I sincerely with you the best of luck, and wish your husband all the best.

 

[KEVD18]

Where I work at I have a hospital within 7 minutes away, why wait 10 to 15 minutes for a medic when I can be at the hospital quicker.

I know some worthless EMT's my company employs them :wacko: but I still believe any call can go BLS, whether it should or not is a different story.

by that logic sir, any call can go by yellow cab.

as far as time, yes you have to weigh the time to the H against the time it would take the medics to arrive and decide whther its better to wtay and play or load and go an intercept enroute. this is NOT the same as "every call can go bls". this is "in this situation, waiting for als would harm more than help".

its not worth arguing over. i dont agree with you in any way, but i'll agree to disagree

 

[KEVD18]

In a city the size of Pittsburgh I would expect every truck to be ALS. You should not have to wait 10-15 minutes for ALS, They should be first on scene. If you service is sending BLS trucks to emergencies, then they need to rethink being involved in EMS!

be careful here. thats a really broad statement.

putting R/r's "every 911 call deserves an als assesment" aside from the moment, there are bls emergencies. in some places, they far out number the true als emergencies. true here meaning the call actually required and als procedure, not a call where als interventions were done "because we can".

in the city of boston, there are only 6 medic trucks on during normal days. during special events(4-JUL etc) they might put up an additional -p truck, but normally just the 6. they are complemented by 16 bls trucks that run the majority of the calls. they have a tiered system where a bls truck will be dispatched to teh minor emergencies. if it is classafied as requiring als, they two truck the call. major traumas etc get als, bls and a div chief. fire respond to maybe 30% of the calls.

while i dont really like the system, it works. they answer over 100k calls a year, with upwards of 70k transports. it may not be pretty(you can easily expect to hit 10 calls in 8 hours on a slow day.

you cant paint every city with the same brush.

 

[reaper]

Sorry, But any major city should have an all ALS service. This means at least one medic on every truck. They are doing the pt no could to have to wait for an ALS intercept. In the Rural areas and smaller towns, they may not have a choice due to funding. Any city the size of Pittsburgh and Boston should not allow an EMS service that is jeopardizing the citizens that pay all those huge tax bills.

You don't see the FD sending out explorers to fires, telling them to call for the FF's if it's needed. Why should the Pt's have to wait on care in a big modern city?

I understand that not all calls are ALS. But, do you want your family to be that call that did need need it and they send a BLS truck out? We are in the game of "What if's". You must be prepared for the worst and hope for the best!

 

[KEVD18]

Sorry, But any major city should have an all ALS service. This means at least one medic on every truck. They are doing the pt no could to have to wait for an ALS intercept. In the Rural areas and smaller towns, they may not have a choice due to funding. Any city the size of Pittsburgh and Boston should not allow an EMS service that is jeopardizing the citizens that pay all those huge tax bills.

You don't see the FD sending out explorers to fires, telling them to call for the FF's if it's needed. Why should the Pt's have to wait on care in a big modern city?

I understand that not all calls are ALS. But, do you want your family to be that call that did need need it and they send a BLS truck out? We are in the game of "What if's". You must be prepared for the worst and hope for the best!

yep. sending basics to the sub acute left toe pain x 3 weeks is significantly jeopardizing the patient safety. btw, thats an actual call that i personally worked in boston. person called 911 because they had stubbed their toe three weeks prior and it hadnt stopped hurting yet.

tell me, what would you have done at the als level for that call? are you really advocating line, labs, XII lead, and pain management for a toe stubbed three weeks.

the plain facts of the matter are there are als calls and bls calls. quite frankly, it is true that most "bls emergency" calls are more suited for a taxi. but id much rather have a bls crew tied up on that call than an als unit in your all als service.

have you ever been bringing out the dead? its a fdny paramedic movie from the early 90's. theres one seen where the get sent to such and such a location for the neighborhood famous drunk home less guy. john goodman is complaining that "one of these days, we're going to get a cardiac and the only medics are going to be taking care of mr. rowe".

in your all als system, the truck that should be handling that code will be coming from the next district because the primary for that area is hauling drunks to detox(a call i have done hundred of in boston). tell me sir, do we have that extra 3 minutes in the case of say a foreign body airway obstruction? NO!

there is a place in even the busiest urban 911 setting for bls trucks.

 

[mycrofft]

This thread is becomng incredible.

..............

 

[ffemt8978]

Since the OP has gotten the information she was looking for, let's not let this turn into another BLS vs ALS debate.