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

[KellyBracket]

"Do not spend more than 20 minutes on scene for a medical call."

Has anyone heard of this? Better yet, anybody have a reference to a textbook or article that describes this teaching?

 

[mycrofft]

From experience, if it is a purely medical call, two thoughts.

If they are so bad it takes over 20 min, they are not as likely to make it due to presenting acuity.

If you are there for over 20 min, you may be target fixated and need to get that pt in pronto for definitive care before the shock cascade, well, cascades.

Depends upon which end you are working on for emphasis.

Null and void when extrication and bad addressees are involved.

No source, sorry.

 

[emt11]

Our target on scene time is 10 minutes, whether trauma or medical. Of course it's really more of a suggestion but that's what all the big wigs around here say. We can always find a reason or two for being delayed on scene.

 

[Medic Tim]

For medical I usually start treatment where the pt is found. If there is something I can do I usually don't delay it.

 

[Jon]

"Do not spend more than 20 minutes on scene for a medical call."

Has anyone heard of this? Better yet, anybody have a reference to a textbook or article that describes this teaching?

I've heard this... often in line with the "10 minute scene time" for trauma patients.

I'm gonna go out on a limb and say it's pure dogma, with no evidence behind it.

 

[medicsb]

I'm gonna go out on a limb and say it's pure dogma, with no evidence behind it.

I'll second that it's dogma.

Depending on the situation, I think it's more prudent to spend time stabilizing than extricating the patient and running to the ambulance.

 

[NomadicMedic]

The kind of dogma that made it all the way to protocols. The DE protocol for trauma is very clear on the 10 minute scene time.

 

[the_negro_puppy]

We have no time limits.

If I go to a suspected cardiac chest pain, I will give aspirin, GTN, start and IV , 12 lead and possibly even morphine before loading.

 

[KingCountyMedic]

I've heard of it. Do I buy into it? NOPE. I'll stay on scene with a medicine patient as long as I need to. Moving fast on a STEMI can save lives while moving fast on a sick resp patient can kill 'em. I'll get out the camping gear on a bad CHF call! I'd rather spend 45 minutes to an hour treating a patient on scene and having them speak full sentences back to me as opposed to just dropping a tube.

 

[NomadicMedic]

I've heard of it. Do I buy into it? NOPE. I'll stay on scene with a medicine patient as long as I need to. Moving fast on a STEMI can save lives while moving fast on a sick resp patient can kill 'em. I'll get out the camping gear on a bad CHF call! I'd rather spend 45 minutes to an hour treating a patient on scene and having them speak full sentences back to me as opposed to just dropping a tube.

Are you guys using CPAP yet?

 

[Sublime]

I believe this rule has nothing to do with patient care and everything to do with freeing up ambulances to get back on the system.

 

[STXmedic]

We have target scene times for Alert patients. As for general medical patients needing to be transported within 20, never heard of it. I don't even pay attention to the time. If they're in immediate need of attention, I'm going to address their issues on scene if possible. If they're in no immediate distress, I'm in even less of a hurry. I'd say I average 20-30min on scene for most patients.

 

[mycrofft]

We have no time limits.

If I go to a suspected cardiac chest pain, I will give aspirin, GTN, start and IV , 12 lead and possibly even morphine before loading.

This has everything to do with level of training and emphasis on primary health (ANZAC) versus auto accidents and heart attacks USA).

Also:
KingCountyMedic "I've heard of it. Do I buy into it? NOPE. I'll stay on scene with a medicine patient as long as I need to. Moving fast on a STEMI can save lives while moving fast on a sick resp patient can kill 'em. I'll get out the camping gear on a bad CHF call! I'd rather spend 45 minutes to an hour treating a patient on scene and having them speak full sentences back to me as opposed to just dropping a tube. "

Yes, but knowing the tipping point after which you will look up and say "God, why didn't I load and go ten minutes ago?" can pass really fast and quiet-like. THAT is a medical art versus hard and fast protocol, like the ten-minute rule.

 

[RebelAngel]

It's been beaten into our head to be en route to hospital in 10 minutes for medical or trauma, unless scene calls for an extrication. In my ride alongs, which all but one have been medical, only one of five we've been on our way in 10 minutes.

 

[STXmedic]

It's been beaten into our head to be en route to hospital in 10 minutes for medical or trauma, unless scene calls for an extrication. In my ride alongs, which all but one have been medical, only one of five we've been on our way in 10 minutes.

Do your instructors give you a rationale behind this?

 

[TheLocalMedic]

I move fast on traumas, strokes and STEMIs because there really isn't all that much that I can do for them. I am not a surgeon, nor do I have a CT, tPA of the ability to perform angioplasty in my ambulance. Everything that needs to be done for these patients that I can provide can be done en route to the ED.

Most other calls though are a different story. Breathers, CHFers in particular, may warrant a longer scene time while I initiate treatment immediately to get them stabilized before moving them. Had a pretty sick CHF patient the other night that we stayed on scene with for nearly 30 minutes while we got CPAP and an in-line neb running. Result was that by the time we made it to the ED she was talking in full sentences and looked about a thousand percent better. Even had a nurse roll her eyes and give me the whole, "you guys just put CPAP on everyone, don't you?" even though I tried to explain how this woman was fixin' to go toes up before we got there.

 

[NomadicMedic]

Honestly, I find 20 minutes is about the right amount of time to start treatment and get the patient out of the house and rollin' toward the hospital. But, I'm certainly not adverse to staying longer if needed...

But that damn 10 minute rule for trauma. They're sticklers on that.

 

[Ridryder911]

I have (for decades) attempted in research trying to find any lit and specifics on scene time... I have found none. Sure, there are tons of literature about reducing scene time for trauma.

I believe it is this is one of those.... "this is the way we do it "... stigma with no real justification and evidence. Alike what many have decribed, I think this is for status management and of course reducing scene time as little as possible.

There is a happy middle between load and go and stay and play.. I much rather for Paramedics to have a true understanding of what an emergency is and the value of expediting, and to do a thorough H & P with a readable ECG and patent IV.

Not everything has to be rushed, and not every incident is time sensitive; alike everything else.. it's not black and white and the usage of common sense is best used.

R/r 911

 

[Carlos Danger]

"Significant mechanism of injury = impending death".
"Moving a trauma patient without full immobilization = instant paraplegia".
"More than 10 min on scene with a trauma = you just caused your patient's death". ("Unless you are waiting for the helicopter......the helicopter saves all".)
"Rapid transport = life saved"

These axioms originated in a time where a person who summoned EMS was much more likely to actually have a life threatening injury or illness, when a badly smashed up car really did indicate a decent possibility of severe injury, when we didn't have the benefit of decades of EM/EMS research, when there wasn't a hospital on every street corner, and perhaps most importantly, when EMS providers could offer very little aside from transport, anyway.

"This patient might die soon + we can't do much but drive + the hospital is far + traffic is light = LOAD & GO, and DRIVE FAST!!" Most on this forum are probably far too young to remember when that actually kind of made good sense.

Obviously, things have changed. We now have pulse oximeters, EKG's, CPAP, ventilators, drugs, defibrillators/pacers, airway devices, and a fair amount of research to guide us in how to use it all.

Still, when you are dealing with a sick patient, I think there is something to be said for the general idea of expeditiously getting them to a place that has much more diagnostic and treatment resources and expertise than we do. If things can be done just as well during transport as before, I think most of the time it is probably most prudent to do them then.

I am not aware of any reason to endorse a hard and fast "20 minute rule", but I also think that just because there isn't a ton of data proving that short scene times improve outcomes doesn't mean that we should assume it's good for patients to take our sweet time on scene.

 

[mycrofft]

Of for four axioms, I think most were written by bored management stuck at the desk. The fourth neglected the part about the curative properties of lights and sirens.

As for the last, there is anecdotal evidence that very prompt transport of some cases (such as police tossing GSW victims into patrol cars and dashing to close-by hospitals) may yield some benefit versus staying on-scene when it will take prompt surgical work to save the pt if it can be done at all. But nothing scientific that I can find. :huh:

I would think that if severe blood loss has occurred and you aren't carrying some type O in a ref rig, and with recent findings about the conflict between maintaining a viable BP and diluting blood to the point it doesn't clot or carry O2, those would also benefit form considering leaving early rather than late.

Hate to be in the control group for THAT.