Lazy EMT'S

[mycrofft]

Back to OP.

Many nurses hate other nurses, as well as techs. Many nurses see techs as a way to move patients (ambulance drivers) and chafe when they stop to stabilize before driving.

It's a cultural thing, and their boss ought to be aware. But he or she might be aware, and be part of that whole thing.

Booger it.

 

[JPINFV]

Yeah, but most EMT's still do it.

The standard of care (what the average person at that level/area does) should not be confused with evidenced based (what the evidence says should be done).

Personally, I feel that "standard of care" should be a dirty word. I don't want to do what the average provider does. I want to do what the evidence says should be done.

 

[JPINFV]

Is it possible that the EMT's in question simply didn't suspect a cardiac origin for the chest pain? Right or wrong, that would probably explain their actions.

When it comes to something like ASA, unless there's a blatantly obvious alternative (patient with PNA coughing up a lung, or taking a baseball bat to the chest), chest pain is cardiac until proven otherwise.

 

[JPINFV]

The standing field treatment protocol for chest pain here, as far as oxygen goes, simply says give oxygen. Not give oxygen prn, or if SpO2 is XX, just give oxygen. So for an EMT-B here, this patient is supposed to be on O2 15LPM NRB since that's how we're trained. Although I suppose if you honestly don't think your patient needs high flow you could give 2L via nasal cannula and still be technically within protocol.

Can I give the patient an FiO2 of 22% and still be compliant with the cookbook-ocol?

 

[JPINFV]

Does anyone know how long it takes for baby aspirin to start working? We carry it but I have literally never seen anyone give it because every station around is within a 10 minute drive of a cardiac center so people say there is no point.

Does it matter? I never got this train of thought. "Well, it won't take effect till after we get to the hospital, so we'll delay it taking effect by even longer because we'll let the hospital deal with it."

 

[rmabrey]

The standard of care (what the average person at that level/area does) should not be confused with evidenced based (what the evidence says should be done).

Personally, I feel that "standard of care" should be a dirty word. I don't want to do what the average provider does. I want to do what the evidence says should be done.

Im in agreement with you. My first post was based on the assumption that the EMT's would follow protocol.

I personally, as an EMT have put exactly one patient on O2 in the last year. Only because I had a gut feeling she would complain and the report would get reviewed (she did and it did).

As a student I reluctantly do it since most medics in my system follow cookbook - ocols, but I argue every time.

 

[Carlos Danger]

When it comes to something like ASA, unless there's a blatantly obvious alternative (patient with PNA coughing up a lung, or taking a baseball bat to the chest), chest pain is cardiac until proven otherwise.

Well, just because you and I and most of the rest of the folks on here know that, doesn't necessarily mean the EMT's in question knew that.

Perhaps the EMT's felt they had GOOD reason to suspect a non-cardiac origin; maybe the patient related an element of her history that didn't make its way to this discussion (i.e., maybe she DID take a baseball bat to the chest the day before). Or maybe the patient said something that led them to believe she had an aspirin hypersensitivity. Or maybe the patient told them that she didn't want to take any medicine. Or maybe you are wrong, and the EMT's were taught that in a young, healthy female, a cardiac origin for chest pain is so unlikely that it should be dismissed as a possibility.

I don't know - obviously I'm just speculating. But there had to be some reason the EMT's in question didn't administer ASA.

 

[Christopher]

There really isn't much excuse for not giving ASA or O2. There are good reasons why that came in BLS. The main one being, hospital is closer than ALS care.

Aspirin is the only one of those two with any evidence to support its routine usage in chest pain.

The other one does not have support for routine usage.

 

[Christopher]

So for an EMT-B here, this patient is supposed to be on O2 15LPM NRB since that's how we're trained. Although I suppose if you honestly don't think your patient needs high flow you could give 2L via nasal cannula and still be technically within protocol.

Good news, many programs no longer teach this nonsense!

 

[Christopher]

Does anyone know how long it takes for baby aspirin to start working? We carry it but I have literally never seen anyone give it because every station around is within a 10 minute drive of a cardiac center so people say there is no point.

A number of folks have already made this point, but I'm going to reiterate it because of how important it is...

I really loathe pharmaceutical companies and their studies, but Aspirin is one of the drugs which actually, sincerely, by all evidence known works. It also is cheap and readily available.

The only other pre-hospital intervention for acute coronary symptoms known to improve M&M is an early 12-Lead ECG with activation of a cath lab if indicated.

Aspirin, 12-Lead, and activation if indicated. That is maximally aggressive chest pain therapy by known evidence.

 

[Mariemt]

Many argue about basics doing 12 leads as they can not read them. I have picked up on some things but I feel the best benefit is sending it ahead to be read. The ed can get a read on them before we get there.

 

[patzyboi]

Like most basics here, I was taught to give O2 to almost every patient.
But my instructors emphasized to treat the patient, not the number. If this patient did not have any trouble breathing, whether slight or severe, then they would not need O2. However, O2 may or may not help.

 

[Tigger]

Like most basics here, I was taught to give O2 to almost every patient.
But my instructors emphasized to treat the patient, not the number. If this patient did not have any trouble breathing, whether slight or severe, then they would not need O2. However, O2 may or may not help.

What does the bolded part mean?

 

[rmabrey]

What does the bolded part mean?

Probably referring to the infamous "O2 for pain" or "O2 calms people"

 

[Tigger]

That's what I am guessing. However I am trying to give him the benefit of the doubt before we go down that road.

 

[Hellsbells]

Its a bad idea to have emt b's obtaining 12 leads they cant read, as you cant have an ER physician walking up to the fax to read every 12 lead that is taken, at least not in a busy urban setting.

 

[Medic Tim]

Its a bad idea to have emt b's obtaining 12 leads they cant read, as you cant have an ER physician walking up to the fax to read every 12 lead that is taken, at least not in a busy urban setting.

You can at least use it for trending and changes. Not all places can transmit either.

 

[VFlutter]

You can at least use it for trending and changes. Not all places can transmit either.

+1, an initial prehospital EKG can expedite care regardless if it wasn't read until the patient arrived in the ER. It can mean to difference between a emergent cardiac cath and having the patient sit in the ER with an evolving MI.

 

[Tigger]

Its a bad idea to have emt b's obtaining 12 leads they cant read, as you cant have an ER physician walking up to the fax to read every 12 lead that is taken, at least not in a busy urban setting.

Not every patient needs a 12 lead. I cannot imagine that a physician could not take the time to read 12 leads transmitted from crews with patients presenting ACS symptoms. Would there be a work increase? Yes absolutely, but I don't see it as something that can be overcome, especially by committed STEMI centers.

On a somewhat related note, South Dakota recently finished implementing an AHA Mission: Lifeline grant that saw nearly every agency and non-PCI capable hospital receive cardiac monitors and the needed peripherals to transmit 12 leads. Many of these agencies are volunteer BLS with long transport times. Having med control say "yup it's a STEMI" gets the ball rolling at the receiving facility and also helps to properly utilize alternative transport means (fixed or rotor wing).

 

[Christopher]

Its a bad idea to have emt b's obtaining 12 leads they cant read, as you cant have an ER physician walking up to the fax to read every 12 lead that is taken, at least not in a busy urban setting.

As mentioned, all of SD does EMT 12-Leads, and they do it well.

It is really only a bad idea if you don't like appropriate destinations for patients. Or if you feel like waiting for the paramedics to arrive to have a 12-Lead acquired. If your service can't afford it, that is another story.

But why wouldn't you acquire 12-Leads at first medical contact? (rhetorical, because you should...and I'd rather not hijack this further)

And who cares if nobody overreads it immediately, especially in an urban setting where you've just made the door to ECG negative and transport times are short.