Long Transports

[mikie]

I'm in a semi-urban/residential county, often transport of times of 5-10min.

I'm wondering for those transport time is 20+ minutes. Lets say your pt in completely stable (conscious, alert, oriented, etc), other than vitals, history, assessment, treatments, what do you talk about?

The news? Sports?

Just wondering,

Thanks!

 

[Airwaygoddess]

Patients

Patients will give let you know if they want to talk, talking about family, local town news and such. Sometimes the patients welcome the peace of not talking but do appreciate you as the person being there.

 

[ffemt8978]

Or you can spend the time getting a better/more detailed history on your patient.

And for the record, around here 20 minutes would be considered a short transport time to an ALS intercept.

 

[mikie]

Or you can spend the time getting a better/more detailed history on your patient.

Oh of course! But one can ask so many questions!

 

[BossyCow]

yeah.. but who among us hasn't asked the questions only to have the nurse ask the same question in the ER and get a totally different answer???? I ask the same question a bunch of different ways... "So ever had anything like this happen before?" "Ever felt pain like this before?" "Ever been to the doctor for pain here before?" "When was the last time you saw a doctor and what was that for?"

Amazing how you can get that... "Oh yeah.. there was this one time when I had something like this happen and they said I had .. diver.. something itis.. but this can't be that!"

I've never run out of things to talk about with my patients. I have had some that were less communicative than others but most of them like some sort of interaction, keeps their mind off the scary voice in their heads.

 

[skyemt]

yeah.. but who among us hasn't asked the questions only to have the nurse ask the same question in the ER and get a totally different answer???? I ask the same question a bunch of different ways... "So ever had anything like this happen before?" "Ever felt pain like this before?" "Ever been to the doctor for pain here before?" "When was the last time you saw a doctor and what was that for?"

Amazing how you can get that... "Oh yeah.. there was this one time when I had something like this happen and they said I had .. diver.. something itis.. but this can't be that!"

I've never run out of things to talk about with my patients. I have had some that were less communicative than others but most of them like some sort of interaction, keeps their mind off the scary voice in their heads.

that has happened to me as well... however, rather than a source of complaint, i feel like i needed to do a better job getting the history...

if a patient acts that way, i think it means i either did not ask the questions in the right way, that the patient understands... or... i did not gain the trust of the patient, which is also a big deal...

either way, it is on us, not the patient... means we could have done a better job... means that to me anyway...

 

[LucidResq]

Because a rescue can potentially end in a freakishly long transport in the litter, it's been suggested to me to remember to ask patients if they're comfortable, if the temp is ok, if they need to go potty, if they're hungry/thirsty, and if they would like to call family or anything.

Granted this is not really conversation and SAR carry-outs are pretty different from ambulance transports, but it's good to remember to ask a few ?s to ensure the patient is comfortable.

 

[KEVD18]

i don't know anything about transports in emergency situations over 10min. in my service area you can throw a rock in any direction and it will bounce off three hospitals. even if you need a specialty H and your coming from the other end of the city in rush hour traffic your not looking at much more than 15min.

now as far as routine transfers, i have done my share of long hauls. my record is 9hrs 1 way(interstate transfer). sometimes they want to talk. i had a two hour discussion about the motor in the ambulance with a patient once. he was a retired diesel mechanic. some don't want to talk at all. some just don't want to talk to me. i go by the patient.

 

[mikie]

i
now as far as routine transfers, i have done my share of long hauls. my record is 9hrs 1 way(interstate transfer). sometimes they want to talk.

Whoa! And this was ground tx? What was the pt needing a 9hr taxi ride for? :huh:


(just kidding about the taxi part...)

 

[KEVD18]

anybody who has done any contract work for the va system can attest to the fact that they dont care how long the ride is or what level of care( from none to als) is required during the ride. they just send em where they need to go.

example: in augusta maine theres is a va hospital(togus vamc). in boston ma, there are two(jamaica plain and west roxbury). jpva is a speciality day clinic. togus is a general hospital. togus will send patients down for procedures and then they'll go back up. thats 4 hours each way and they do it all the time. they have sent patients down "als" with nothing more than a line running at kvo. no meds, no airway/cardia monitoring.

now i believe that our veterens deserve the best care we can offer them. but i spent 2.5yrs working for a private that was contracted by the boston va system. i have seen millions of dollars wasted by giving people a ride in the ambulance when they should have been in a chair car or most commonly a cab.

 

[VentMedic]

anybody who has done any contract work for the va system can attest to the fact that they dont care how long the ride is or what level of care( from none to als) is required during the ride. they just send em where they need to go.

example: in augusta maine theres is a va hospital(togus vamc). in boston ma, there are two(jamaica plain and west roxbury). jpva is a speciality day clinic. togus is a general hospital. togus will send patients down for procedures and then they'll go back up. thats 4 hours each way and they do it all the time. they have sent patients down "als" with nothing more than a line running at kvo. no meds, no airway/cardia monitoring.

now i believe that our veterens deserve the best care we can offer them. but i spent 2.5yrs working for a private that was contracted by the boston va system. i have seen millions of dollars wasted by giving people a ride in the ambulance when they should have been in a chair car or most commonly a cab.

My longest was Miami VA to Montgomery, AL VA. Yeah, there were smoking breaks for the patient.

 

[BossyCow]

that has happened to me as well... however, rather than a source of complaint, i feel like i needed to do a better job getting the history...

if a patient acts that way, i think it means i either did not ask the questions in the right way, that the patient understands... or... i did not gain the trust of the patient, which is also a big deal...

either way, it is on us, not the patient... means we could have done a better job... means that to me anyway...

Who was complaining? I actually enjoy the adventure.

I don't take it personally when the pt witholds some piece of the puzzle until the nurse asks them, nor do I feel like if I ask the question 'in the right way' that the pt will always give me the information I need. There is a reason why every patient gets asked every question 100 different times, 100 different ways, because its the only way to minimize the surprises. I don't think we can ever eliminate them entirely.. where would be the fun in that???

 

[Arkymedic]

My longest was Miami VA to Montgomery, AL VA. Yeah, there were smoking breaks for the patient.

My longest ones have been: Dodge City, KS, Sevier, LA, Memphis, TN, and Dallas, TX. I also had one turn into 28 hrs but that is including an EMSA medic sending me home the wrong way, the unit running off the road in whiteout conditions with nowhere to go and a big CF of a night. It was reaaaaaaaaal fun. As far as VA I have drove 3 hrs into OK from AR to get the pt then take them to Fayetteville which is 5 hrs from there because OK VA did not have a single bed available anywhere.

 

[MedicPrincess]

Did Pensacola, Fl to Cinncinati, Oh trns. Was on deck for a P'cola to Upstate New York, but we got our flight division to take it.....I was really looking forward to that one!!

Our service, in addition to the 911 contract for the county, has a ground transport and an air transport division. We'll take anybody, anywhere they want to go in the world, so long as the $$$ is there to pay for it....

But, on an emergency transport, I generally use the time for a more detailed history. You'd be surprised how much comes to a pt as your talking. I've had them suddenly "remember" they had cancer 2 years ago, and OH YEA, there was that MI....ect.

Since we have a lot of tourists, we do quite a few "taxi rides" as people don't have a vehicle/know the way/want to bother to ask directions. Generally, those are BLS patients, and my EMT will tech on those. She is so very thorough, and enjoys the time to "practice" her detailed physical exams.

 

[Firesurfer75]

Talk the same things as you would with anyone else! When it gets too dry I usually hit the jump seat and do paperwork, checking on them periodically.

 

[paramedix]

Talk the same things as you would with anyone else! When it gets too dry I usually hit the jump seat and do paperwork, checking on them periodically.

I wish we had transport times of 5 to 10 minutes... I suppose it depends where in town you are and what time of the day. I the (un)lucky one, most of my patients always love talking... at least I know they maintain there airway.

I also take the jump seat and enjoy the ride. I can easily talk to the patient if needed.

 

[mikie]

So why are some of your patients needing this multi-state transports (obviously to another facitility, I'm just inquiring as their choice of EMS)? I'm just assuming they're via ambulance...

Thanks! Some great stuff here!

 

[CFRBryan347768]

Because a rescue can potentially end in a freakishly long transport in the litter, it's been suggested to me to remember to ask patients if they're comfortable, if the temp is ok, if they need to go potty, if they're hungry/thirsty, and if they would like to call family or anything.

Granted this is not really conversation and SAR carry-outs are pretty different from ambulance transports, but it's good to remember to ask a few ?s to ensure the patient is comfortable.

and if they say their hungry, than what?

 

[VentMedic]

So why are some of your patients needing this multi-state transports (obviously to another facitility, I'm just inquiring as their choice of EMS)? I'm just assuming they're via ambulance...

Thanks! Some great stuff here!

The VA system used to transport between various facilities for different services and long term placement. Several VA facilities have convalescent centers attached to them. Some veterans also wanted to be transferred closer to their family if they had become disabled or needed an extended recovery period after a lengthy illness. Now, the funds are lean in the VA system so the vets may be SOL for some services and at the mercy of the system for other services.

 

[KEVD18]

The VA system used to transport between various facilities for different services and long term placement. Several VA facilities have convalescent centers attached to them. Some veterans also wanted to be transferred closer to their family if they had become disabled or needed an extended recovery period after a lengthy illness. Now, the funds are lean in the VA system so the vets may be SOL for some services and at the mercy of the system for other services.

as of last year, i would have to say i disagree. the va system was at that time still flagrantly wasting money with reckless abandon. but i havent worked for that service in about a year