Mess Ups..

We were dispatched to a pt having difficulty breathing. We get there and we find out pt sitting on a toilet. She's not having difficulty breathing, but is only able to say her birthdate, nothing else. AND she can't move her left arm. First thing we figure is that maybe she stroked out on the toilet, she was 70-something, so a CVA wasn't out of the question. We move her to the stretcher, but when my partner slides her hand out from where she had been holding the pt's left side, there was a liquid covering the glove, almost bloody, but not blood. We lift up the shirt and see sores, so now we have NO clue what's going on. We transport lights and sirens, simply because we have no idea what we're dealing with; our patch to the was so vague that they had no idea what they were to expect. While in the truck, we smell death, both of us are dry heaving for the entire ride. When we get to the ER and cut the pt's shirt off, we find a HUGE area of necrotic tissue, involving the pt's left breast and extending across her side to her back. It even when subcutaneously into her arm, destroying the limb. They figure that it was a cancer that was ignored, leading to the state we found her in.

So, moral of the story. Don't worry if you don't know or if your ideas about what the pt has chage, ours is an inexact science. We're not doctors, it's not our job to fully diagnose. And if you really don't know what's going on, drive fast or call for back up.
 
Couple of things. Driving fast NEVER saves lives, rather endangers them!
The fluid you were in contact probably was serosanguinous fluid from the necrosed tissue or else was from gangrene. One has to be careful on gaseous gangrene. Did you place BSI (gown, mask, eye wear on?)

Why did you not expose the patient and see what you had than rather "run" with them to the ER? If it was blood or a sucking chest wound, would you had found it? As well, where you not taught to "expose injuries" for examination? Place sterile dressings on open wounds?

You are right it is not an exact science, but it is a form of health care and part of our job and responsibility is to examine for wounds, treat appropriately and transport safely.. and what warranted L & S?

I am sure it was smelly, most rotting tissue does.. but, that is part of the job.

Yes, ED has a responsibility, but so does EMS.

R/r 911
 
You're so very right, but ours was a slightly special situationl; we were less than a minute from the hospital, so we wanted to get her there rather than to stay and specifically diagnose everything.
And what warranted L&S was the fact that, between myself, my partner, and a number of fire-medics on scene, our combined years of experience told us something was totally amiss and that this woman was in serious condition. She was actually taken to the OR immediately after we brought her in and I don't think she made it.
 
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recognizing a condition like CVA and immediately transporting is good.

Thinking something is beyond your capabilities and rushing to the hospital is never good. EMS was invented to stop this practice.
 
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Has anyone ever missed a pt's [SIZE=-1]fentanl patch[/SIZE]? We did, and the hospital caught it during their initial intake exam. Simply removing the patch seemed to solve a lot of problems.

Edit: Change nitro to [SIZE=-1]fentanyl.[/SIZE]
 
Guardian said:
recognizing a condition like CVA and immediately transporting is good.

Thinking something is beyond your capabilities and rushing to the hospital is never good. EMS was invented to stop this practice.
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I disagree...

Knowing something is beyond your capabilites and rushing to the hospital is how the American EMS system is supposed to work. European systems "stay and play" in the field, with an MD, for extended time periods, and do a decent amount of treat and release. We go to the ED. We don't play around with trauma patients in the field.. we get to a trauma center.

I would say that "I've got no freaking clue" shouldn't be used often... but in a case like this... where everyone was scratching their heads and wasn't sure what was going on... well... high-flow diesel is sometimes the only treatment modality that makes sense.
 
Jon said:
I disagree...

Knowing something is beyond your capabilites and rushing to the hospital is how the American EMS system is supposed to work. European systems "stay and play" in the field, with an MD, for extended time periods, and do a decent amount of treat and release. We go to the ED. We don't play around with trauma patients in the field.. we get to a trauma center.

I would say that "I've got no freaking clue" shouldn't be used often... but in a case like this... where everyone was scratching their heads and wasn't sure what was going on... well... high-flow diesel is sometimes the only treatment modality that makes sense.
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Here's a challenge, give me one example of something where I can't do a full assessment and stabilize (which is sometimes just ruling out life threats and/or preventing other injuries) in field and I'll reconsider your point.

Do we do a full assessment and stabilize trauma pts?...yes
Do we do a full assessment and stabilize flesh eating disease victims...yes


No matter how strange or weird a person's condition may be, we should always do a full systematic assessment and treat appropriately based on condition. With the call TCERT described earlier, I would not have even gone emergent.

Nothing is beyond our capabilities to deal with and treat appropriately.
 
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Guardian said:
Here's a challenge, give me one example of something where I can't do a full assessment and stabilize (which is sometimes just ruling out life threats and/or preventing other injuries) in field and I'll reconsider your point.

Do we do a full assessment and stabilize trauma pts?...yes
Do we do a full assessment and stabilize flesh eating disease victims...yes


No matter how strange or weird a person's condition may be, we should always do a full systematic assessment and treat appropriately based on condition. With the call TCERT described earlier, I would not have even gone emergent.

Nothing is beyond our capabilities to deal with and treat appropriately.
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I agree that we should do a full assessment... TCERT didn't really do that.

However, what can be done prehosptially for a paitent like that, espicially at the BLS level? Nothing, really, except O2. The patient is in shock (septic shock) and is exhibiting an altered mental status. Yes... a full assesment should be conducted, and the patient should be rapidly transported to the closest appropriate facility (which is 1 minute away). Proximity of ED negates the need for prehospital ALS if not already onscene (because you can be in the ED before ALS gets set up).

However, what can BLS do for that patient? High-flow O2, assist respirations/cirulation if needed, control major bleeding if needed, bandage wounds if time permits, and do a decent assessment so that the ED has a decent picure on what

And relistically, with that short a distance to the ED.... the lights aren't going to buy you any time... except for merging in and out of traffic... so I'd probably transport emergently just because the call meets ALS criteria and the hosptial is your nearest ALS.

I guess, Guardian, that we agree on this.... but our phrasing is different... I'm just saying that although we should do a full assesment... there are often things that are above our ability to fix, and that require transport.
 
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I guess I need to make something else clear. Every single one of our medic trucks were being used on an MVC turned MCI. We were told by dispatch when we were sent to the call that we had no ALS backup, and if our patient warranted advanced care, to take them immediately to the hospital.

As for L&S, Jon is exactly right in determining our use of emergency tactics; we weren't far away, but people ignore emergency vehicles in Hartford unless you have L&S, which is fine under normal circumstances, but ours were not. Fire even cleared the main intersections for us until we got closer to the ED.
 
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