Killing Your Patients

[SeanEddy]

As much as I agree that time is hardly a factor in most disease processes that we encounter, I don't think the public would stand for 20 to 30 minute response times.

They seem to tolerate twice, if not 3 times the wait time for an ER visit. It's our own fault that we built this system around response times and advertised it as such. I would venture out to say at least 80% of our responses don't benefit from a code-3 response.

Only in EMS will you get seen RIGHT NOW regardless of your complaint.

 

[Lifeguards For Life]

They seem to tolerate twice, if not 3 times the wait time for an ER visit. It's our own fault that we built this system around response times and advertised it as such. I would venture out to say at least 80% of our responses don't benefit from a code-3 response.

Only in EMS will you get seen RIGHT NOW regardless of your complaint.

how many of you guy's walk to the rescue/ambulance, or run to the restroom real quick before getting in the rescue?

Do you ever run on scene?

L&S don't save a lot of time in most cases, and in the times when they do save any amount of time, we are maneuvering around still traffic extremely slowly, with the air horns blazing.

I think there is some sort of study/article floating around claiming that the majority of EMS patients are better off being transported in their POV.

 

[sir.shocksalot]

Do you ever run on scene?

Every time. I also kick down the door on every EMS call. Adds dramatic effect and lets the patient know that I am a badass motherf*cker.

 

[usalsfyre]

Every time. I also kick down the door on every EMS call. Adds dramatic effect and lets the patient know that I am a badass motherf*cker.

Running in slow-mo doesn't count though...

 

[DrParasite]

frusemide for CHF

point of information: isn't furosemide/Lasix a standard treatment for CHF?

how many of you guy's walk to the rescue/ambulance, or run to the restroom real quick before getting in the rescue?

Sad/scary part is, I know of systems that will talk a stable and ambulatory patient to the ambulance, and then transport lights and sirens to the hospital, where the person is put into a wheelchair and left in triage.

and the even scarier part is, the justification for doing this is that there are job pending, and they are too busy to transport non-emergency for non-life threats.

 

[Smash]

point of information: isn't furosemide/Lasix a standard treatment for CHF?

I will assume on Browns behalf that he means acute cardiogenic pulmonary edema as opposed to the long term medical management of congestive heart failure.

 

[Smash]

Running in slow-mo doesn't count though...

That's the only way I ever run. Not that I mean to, it just works out that way...

 

[rhan101277]

Administering .3-.5mg 1:1000 epi IVP for suspected anaphylaxis, even though patient has no respiratory component, just hives.

 

[SeanEddy]

Administering .3-.5mg 1:1000 epi IVP for suspected anaphylaxis, even though patient has no respiratory component, just hives.

That's not really a good-faith mistake. That's a result of a poor assessment.

 

[SeanEddy]

I think there is some sort of study/article floating around claiming that the majority of EMS patients are better off being transported in their POV.

Yea it's called 95% of the calls I run not even needing an ambulance, much less a code-3 response. It's pretty ridiculous.

 

[CAOX3]

point of information: isn't furosemide/Lasix a standard treatment for CHF?.

In somee places Im sure it is, not here.

Volume depletion.

At times it can be difficult to differentiate pneumonia, exacerbation COPD and CHF

 

[MrBrown]

Administering .3-.5mg 1:1000 epi IVP for suspected anaphylaxis, even though patient has no respiratory component, just hives.

Um yeah, that dose of such concentrated adrenaline is likely to have a bit of an effect all right

... and yes, that's like super assessment fail, but not as bad as those Los Angeles City Fire Paramedics who gave frusemide to a lady with leg pain because it had to be CHF .... (yes, thats in the literature somewhere, Brown has read it)

 

[Death_By_Sexy]

Wasting time and trying to be the hero onscene during a trauma call, in lieu of extremely rapid transport.

 

[MrBrown]

Wasting time and trying to be the hero onscene during a trauma call, in lieu of extremely rapid transport.

Please elaborate because this is a potential super-mega-hella-king sized-value meal-US EMS fail right here.

 

[Foxbat]

Please elaborate because this is a potential super-mega-hella-king sized-value meal-US EMS fail right here.

What's interesting is that I heard Russian EMS providers (physicians and physician assistants mostly) often criticizing US EMS precisely for "load and go" approach for life-threatening conditions, including major trauma. They basically say "paramedics over there are trying to transport unstable patients rather than stabilize them on scene, so their patients end up dying en route or shortly after arrival".

 

[mycrofft]

Know when to boogie and where to.

Until ambulances have operating rooms, labs, and diagnostics beyond basically EKG, stethoscope, BP cuff and a couple others (yes, I simplify, but not too much), there are cases where if you get bogged down trying to resuscitate when the trouble is out of your league, your delay will make demise more likely. Like, any STAT belly, obstetric emergencies, intracranial bleeds, dissecting aortas...the list goes on and on.

On a simpler note, how about strapping on the oxygen mask then something occludes the line or the oxygen runs out and you fail to notice? "Non-rebreather" gains a whole new depth of meaning there.

 

[DrParasite]

What's interesting is that I heard Russian EMS providers (physicians and physician assistants mostly) often criticizing US EMS precisely for "load and go" approach for life-threatening conditions, including major trauma. They basically say "paramedics over there are trying to transport unstable patients rather than stabilize them on scene, so their patients end up dying en route or shortly after arrival".

You are comparing apples to pears....

a physicians and a physician assistant can do more than a paramedic. can a paramedic insert a chest tube? can a physician?

the load and go approach is used because in the majority of multi system traumas, the patient needs a trauma center, for both the assessment tools and the trauma surgeons to fix the problems.

there is only so much you can do in the ambulance. a hospital ER has more staff, more interventions, and more diagnostic tools than a paramedic does in the back an ambulance.

truly sick people need an ER (and all the support that comes with it), not a paramedic. the latter can only do so much in a short amount of time, the former is better suited to both treat and long term manage the patient

 

[MrBrown]

Brown wonders how much of "load and go" is underassessment and overtriage.

 

[Akulahawk]

You are comparing apples to pears....

a physicians and a physician assistant can do more than a paramedic. can a paramedic insert a chest tube? can a physician?

the load and go approach is used because in the majority of multi system traumas, the patient needs a trauma center, for both the assessment tools and the trauma surgeons to fix the problems.

there is only so much you can do in the ambulance. a hospital ER has more staff, more interventions, and more diagnostic tools than a paramedic does in the back an ambulance.

truly sick people need an ER (and all the support that comes with it), not a paramedic. the latter can only do so much in a short amount of time, the former is better suited to both treat and long term manage the patient

While a Physician and a PA will undoubtedly have more education than a Paramedic will... Trauma victims need a surgeon, an OR and enough hands to make sure that everything is ready to support the patient. Last time I checked, an ambulance makes for a poor OR and generally lack enough trained hands to do the job well (let alone have sufficient supplies of, well, everything because you'd have to be ready for any surgical need...)

Truly sick people do need an ER. Why? All the support/resources available. An ambulance doesn't (yet) have the ability to do portable X-ray and doesn't have a CT scanner. While there is bedside lab equipment out and about in the world, a much better lab capability is available to the ER. There are Pharmacy services available there too. An ambulance can stock only so much.

"Stay and play" vs "load and go" is a very old argument that does need to be rehashed every so often to make sure that those patients that should be stabilized on scene, are while the patients that need transport urgently should get it... regardless of who is staffing the ambulance.

Delete the Paramedic vs MD/PA stuff and a good argument was made by DrParasite about the limitations of ambulances.

 

[the_negro_puppy]

I will assume on Browns behalf that he means acute cardiogenic pulmonary edema as opposed to the long term medical management of congestive heart failure.

I am confused. I have seen lasix/frusemide used to treat cardiogenic APO and as a prescribed diuretic in CCF/CHF patients.