Is this an appropiate reason for Code 3 Transport?

[JPINFV]

Second is because this guy is a prisoner.

Have you ever done a jail transport? Every jail transport I've been on the patient has been handcuffed (handcuff handcuff, not leather restrains) with a guard riding in the back. The fact that the person is an inmate shouldn't change a code 3/code 2 transport decision. I could see it making a difference in destination depending on the ETAs involved, but the jail transports I've done were all to a hospital with a jail ward.

 

[Meursault]

I suggest you both take a look at the studies that have looked at the effect of lights and sirens on transport times. I think you're all in for quite a nasty surprise, especially you Lifeguards.

When I first looked at those studies, I didn't see any with long transport times. They tend to be conducted in urban areas with short response times, and correspondingly find that the minute or so that could be saved is not worth the large risk.

http://www.ncbi.nlm.nih.gov/pubmed/11339726 has moderate transport times, but a very small n. Given that the OP was on a highway, the "rural environment" doesn't apply either.

Is it really that hard to follow more than 30 calls? For that matter, what about pulling MDT data for a quick-and-dirty analysis? /me gets a grant idea...

Oh, right, the topic. Everyone pretty much agrees that the patient's condition deserved emergent transport. I'm not sure that I'd argue that it saved much time, though.

 

[Ridryder911]

I think if going code 3 cuts a 40 minute transport time in half, coupled with a distended rigid abdomen makes a code 3 an appropriate choice.

If one cuts a 40 minute time in half something is wrong. Do some simple math. That would mean doubling your speed, at 40 mph would be 80 and so forth..

Part of the problem is that many assume it saves several minutes when in reality 3-5 is the usual (if driven safely) and maybe 10 minutes. Look at the mph you would have to be save "minutes"...

R/r 911

 

[wyoskibum]

If this was a sudden thing I would definetly do code 3 transport, but it was going on for a few days.

Sure it had been a chronic condition, but something had change to for them to call for an ambulance transport, so now it is an acute episode.

 

[Sasha]

Sure it had been a chronic condition, but something had change to for them to call for an ambulance transport, so now it is an acute episode.

I don't know about prisons, but that is not necessarily true for nursing homes. They may have had that all day, or all week, and they just now got a transport order from the doc.

 

[Lifeguards For Life]

If one cuts a 40 minute time in half something is wrong. Do some simple math. That would mean doubling your speed, at 40 mph would be 80 and so forth..

Part of the problem is that many assume it saves several minutes when in reality 3-5 is the usual (if driven safely) and maybe 10 minutes. Look at the mph you would have to be save "minutes"...

R/r 911

"ER is about 40-45 minutes, on code 3 it cuts it down to about 20-25. Reason being is the 905 freeway is a major border crossing, and the stop lights were all wa" as from the OP.

 

[daedalus]

Disagree Sasha. Just because someone, especially an inmate, says they are in pain doesn't make it so. Wouldn't be my first time dealing with an inmate making up or just exhagerating pain to get out for a little bit.

Having said that, we really can't judge if the pain is legit or not, but pain alone doesn't warrant code 3.

What does warrant it, IMO, is the horrendiously long transport time along with LRQ distension.

Wow. So you do not believe your patients when they tell you they are in pain? Who gave you the right to be the judge of that.

 

[daedalus]

If one cuts a 40 minute time in half something is wrong. Do some simple math. That would mean doubling your speed, at 40 mph would be 80 and so forth..

Part of the problem is that many assume it saves several minutes when in reality 3-5 is the usual (if driven safely) and maybe 10 minutes. Look at the mph you would have to be save "minutes"...

R/r 911

Rid, remember that in california metropolitan areas, extreme back ups at red lights can result in taking an hour just to get a few miles. Lights and sirens have cut transport time in half at my old agency before, when working in downtown Los Angeles.

 

[Shishkabob]

Wow. So you do not believe your patients when they tell you they are in pain? Who gave you the right to be the judge of that.

Re-read what you quoted:


"Having said that, we really can't judge if the pain is legit or not, but pain alone doesn't warrant code 3. "

 

[kittaypie]

i would definitely go code 3 because of the distention and rigidity. also it's better to be safe than sorry. how were his skin signs? he might've been bleeding internally. did the patient mention any trauma? even though it's been going on for a few days, if it were from blunt trauma i'd go with a trauma center.

 

[SanDiegoEmt7]

Exodus, From the State prison you are speaking of the transport time is fairly fixed if you're taking the 125 (which is the shortest route) since you spend the entire time on the freeway and drive on the 905 for about a quarter of a mile.

The trauma center you speak of is about the same distance, hence the reason Mercy Air is usually called for any serious traumas.

I would base the decision solely off whether you felt the patient needed ALS, since medics can get there in about 10-15 min. Not to mention, they have ALS capabilities at the Prison and they could provide a higher level of care while he waited for ALS transport, rather than 40 min. in a BLS ambulance.

Can you give us some vitals?

 

[Sasha]

Can you give us some vitals?

Thank you! I hate when people give "Vitals WNL" WNL for whom? Mosby? Grady? Bledsoe? This patient?

 

[SanDiegoEmt7]

Thank you! I hate when people give "Vitals WNL" WNL for whom? Mosby? Grady? Bledsoe? This patient?

Haha, Hey imagine the benefits a trend of vitals could provide!!

 

[SanDiegoEmt7]

Wow. So you do not believe your patients when they tell you they are in pain? Who gave you the right to be the judge of that.

These prisoners have a tendency to exaggerate because the conditions at the hospital are more favorable than their normal accommodations.

 

[SanDiegoEmt7]

Rid, remember that in california metropolitan areas, extreme back ups at red lights can result in taking an hour just to get a few miles. Lights and sirens have cut transport time in half at my old agency before, when working in downtown Los Angeles.

But this call was at night, with a transport that is 97% freeway driving

 

[SanDiegoEmt7]

Last night I got dispatched to a prison Code 3 for an inmate for extreme abd pain. Non-Radiating splitting pain, 10/10 and this guy has been shot before, he said this is worse. Entire left side hurts him on palpation, and LRQ is rigid and distended. Secondary showed distal edema, and extreme scrotum edema. He's on lasix for that, but it hasn't been working. And has no hx of CHF.

If this was a sudden thing I would definetly do code 3 transport, but it was going on for a few days. Main reason I upgraded is because of the extreme pain he was in - he cried... - and the distension and rigidity. Also our code 2 transport from this place to the approved (We have to go to a certain one unless it's critical) ER is about 40-45 minutes, on code 3 it cuts it down to about 20-25. Reason being is the 905 freeway is a major border crossing, and the stop lights were all way backed up.

Nobody said anything about it to me, but I was wondering, other than those complaints, the VS were wnl.

I didn't see that the first time around. Glad to see you erred on the side of caution. I hear too many stories about basics transporting SOB with CP, or the like just because they wanted to transport a "cool" call, never mind they can't actually help the person.

 

[exodus]

I don't remember specific vitals but they were stable and normal for this patient. We go 805-> 15 -> 8, it's the quickest way to Alvarado (where all prisoners go)


Looking at the map now online, 125 -> 8 may have been quicker. I'm not sure how the Toll Roads work with Ambulances I'll ask when i come in tomorrow.

Edit: And like I said, It's not cutting down because of speed, it's because it gets me through the lights quicker. And even at 10-11pm 905 is BUSY

 

[daedalus]

These prisoners have a tendency to exaggerate because the conditions at the hospital are more favorable than their normal accommodations.

Is it your job to judge the merit of the patient's chief complaint, or is it your job to take them to the hospital while keeping an open mind. I suggest you review the medical ethics found in your EMT book.

 

[SanDiegoEmt7]

I don't remember specific vitals but they were stable and normal for this patient. We go 805-> 15 -> 8, it's the quickest way to Alvarado (where all prisoners go)


Looking at the map now online, 125 -> 8 may have been quicker. I'm not sure how the Toll Roads work with Ambulances I'll ask when i come in tomorrow.

Edit: And like I said, It's not cutting down because of speed, it's because it gets me through the lights quicker. And even at 10-11pm 905 is BUSY

Toll Roads are free for ambulances, you just drive through the the quick pass lanes with no booths. It's a lot better route that way you bypass that 4 miles of lights.

 

[SanDiegoEmt7]

Is it your job to judge the merit of the patient's chief complaint, or is it your job to take them to the hospital while keeping an open mind. I suggest you review the medical ethics found in your EMT book.

I am aware that did not read well, and I never treat one patient different than the next nor is it my job to argue the validity of their complaint. I only meant the comment in regards to why a private BLS ambulance gets called out there for these type of calls, rather than ALS from the start.