"Keep on-scene time < 20 minutes for medical"

[mycrofft]

Actually, that reference wasn't far off from my follow-up question. I wanted to first see if anyone had heard of the "20-minute limit" for medical calls, and if this was promulgated by textbooks or culture. Apparently, the un-written culture seems to play a larger role.

I think I can anticipate the responses to my follow-up question:

Is there a perception that cardiac arrests should have a 20-minute on-scene time?

Allegedly/apparently it is the minimumthreashold for a resuscitation attempt in the UK, if the article I sent is to be believed. Any Brits, Scots etc want to comment on that?

 

[chaz90]

Are you talking about 10 minutes at the patient side? That is a little more reasonable... but if you mean total scene time, there are countless calls (depending on your area, maybe most of them) where you can eat up most of that just getting in and getting the patient out, leaving no time for anything but a scoop and screw. (That includes no time for assessing the patient and figuring out what care they need and how they're going to get it, which is kinda our job.) Good way to freak them out too.

Yeah, we'll go with just bedside time for that 10 minutes. Absolutely assess the patient before scooping, and if the patient needs to take his/her time moving for whatever reason, no problem! The mention of difficult extrication was meant to apply to moving from wherever the patient is far more often than actual vehicle extrication post MVA, so I imagined that time as being added on and necessary for the call.

 

[Brandon O]

The trouble is that scene times are universally recorded, whereas time-of-patient-contact is only sometimes noted (depending on your system) and I don't think I've ever heard of someone recording time-beginning-to-leave-place-of-patient-contact-en-route-to-ambulance. So "scene time" is often confounded with this, as is probably happening in this thread.

KellyBracket: I believe in Mass 20 minutes is the minimum to work a code before ceasing resuscitation. Nothing to do with scene time though.

 

[mycrofft]

I made sure I ALWAYS integrated times into the narrative, and the arrival and access times right up front.

 

[Brandon O]

I made sure I ALWAYS integrated times into the narrative, and the arrival and access times right up front.

And exit time? (See, there's not even a name for it...)

 

[NomadicMedic]

Yes, but it's pretty easy to see your patient contact times when you look at the strip on the monitor. Using code stat software, you can watch the entire progress of a call from the moment you turn on the monitor (which is usually when you arrive at the patient, right?) to the point where you disconnect the patient from the monitor and they are turned over to the hospital staff. Correlate those times with the CAD times and you'll have a very accurate picture of scene dwell time vs transport time.

 

[NomadicMedic]

If someone really wanted to do a study, it would be very simple to program an event marker in the lifepak for "end of scene dwell time". You could instruct your medics to hit that marker when the patient is loaded onto the cot, and then after a year of data collection, perform a retrospective study looking at mortality based on scene time.


I'm kidding… But I'm kind of not.

 

[Brandon O]

Hard to imagine it'd tell you much more than scene time alone does, though. It'd remove entrance/extrication time as a confounding variable, but one presumes those are fairly random factors that should cancel out anyway in any large study, unless it's true that sick people tend to be on the top floor ^_^

This stuff seems like it's mostly for the sake of training purposes (at best) and punitive CQI (at worst).

 

[Medic Tim]

My last job we had a pt contact and pt loaded time. We manually entered them know our pcr while all the other times were tracked by medic Center (dispatch)

 

[Brandon O]

My last job we had a pt contact and pt loaded time. We manually entered them know our pcr while all the other times were tracked by medic Center (dispatch)

That's interesting. Patient loaded = into the truck, I assume? Or fully packaged and you're leaving the scene to head that way?

 

[Medic Tim]

That's interesting. Patient loaded = into the truck, I assume? Or fully packaged and you're leaving the scene to head that way?

At pt was called when we made visual/ verbal contact. Pt loaded was called once the stretcher was locked into position in the truck .

The company want to track our time it took us to get to the pt. ad time time we sat on scene with the pt loaded.

 

[Brandon O]

At pt was called when we made visual/ verbal contact. Pt loaded was called once the stretcher was locked into position in the truck .

The company want to track our time it took us to get to the pt. ad time time we sat on scene with the pt loaded.

Oh, I see. That's a very ALS thing to track (some of y'all love to sit there in your office...)

Bet that encouraged people to get more done at the bedside before loading though, eh?

 

[Medic Tim]

Some managers got upset if we were loaded for more than 5 minutes. Qi/qi didn't. Our managers are mostly of the old school load and go while giving everyone 100 o2 and on a backboard.
Keep in mind it was a BLS service ( about AEMT).

We would get people having 30 min plus scene times with over 10 min load times... Then drive code to the hospital , 10 mins down the highway.


This got people to smarten up a bit.

 

[Rialaigh]

If the patient is walking and "looks well" scene time is about 2 minutes. There is nothing I will do for well looking ambulatory patients that will improve viability by staying on scene period...I can ask questions do what I need in a 10-15 minute transport to the hospital, most of our transports are 20 plus. No reason for me to hangout on scene, doesn't benefit me, doesn't benefit well patients, doesn't benefit the county or potential other patients.

Those benefiting from CPAP generally benefit from longer scene times. Any type of trauma can be pain medicated and moved in under 10-15 minutes I would think. Even chest pains I can get an EKG on and 4 asprin them up in a couple minutes and we can talk and IV and medicate on the way to the hospital....

 

[mycrofft]

And exit time? (See, there's not even a name for it...)

Yeah sure did. "10-8, 10-19". Or "left scene in service".

 

[mycrofft]

Some managers got upset if we were loaded for more than 5 minutes. Qi/qi didn't. Our managers are mostly of the old school load and go while giving everyone 100 o2 and on a backboard.
Keep in mind it was a BLS service ( about AEMT).

We would get people having 30 min plus scene times with over 10 min load times... Then drive code to the hospital , 10 mins down the highway.


This got people to smarten up a bit.

Talk about stay and play.
Or "Single combat with Death"

 

[Brandon O]

Yeah sure did. "10-8, 10-19". Or "left scene in service".

I'm talking about the time you've got the patient packaged up and you're leaving wherever you found them (bedroom, etc) for the truck. (Although I suppose you could also argue it should be the time when you stop doing mediciney stuff and start doing extricationy stuff like moving them to your stairchair. Gosh, this is complicated...)

 

[mycrofft]

I'm talking about the time you've got the patient packaged up and you're leaving wherever you found them (bedroom, etc) for the truck. (Although I suppose you could also argue it should be the time when you stop doing mediciney stuff and start doing extricationy stuff like moving them to your stairchair. Gosh, this is complicated...)

Yeah, that's what I'm talking about. Ditto leaving the patient after a 4-15 (fight) or man-down at the jail. If I'm going on the stand, I'm going with my whereabouts recorded if only by me.