New EMT seeking advice.

LanceCorpsman

LanceCorpsman

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I am current college student and brand new FF/EMT-B for an all volunteer department of maybe 30 people with very limited amount of EMTs with only one ILS c

I wanted to ask some questions and get some opinions from experienced people in regards to BLS.

Whenever I am with another EMT, they are obviously in charge because of their seniority. And I could not have noticed a trend amongst the other EMTs at my department. The trend that I was noticing was the prolonged on-scene time of our unit. When I took my EMT class, I was taught that 10mins was the longest you want to be on scene and that further delay should have a good reason such as extrication.

I would say that the average time on scene for us is anywhere between 15-20 minutes for every single call that I have been to so far. This includes patients with severe chest pain with a cardiac history, as well as calls with breathing problems, diabetic emergencies as well as trauma. I know for a fact that the paid ambulance district in our county is on scene for way less than that (less than 10mins), I hear the "arrived on scene" to "transport to hos" within minutes.

The prolonged scene time is due to the EMTs conducting the full medical assessment and treatments.
For example, I was on a call with a more experienced EMT.
We were dispatched to a call with an elderly female c/o severe chest pain. When we arrived, she was conscious and alert, breathing adequately. And I began my primary survey. She had a weak, and thready pulse. The pulse rate was 180 and she could not move due to the amount of pain. In my opinion, at this point I think we should have loaded the pt and head to the hospital. The hospital is only about 10 mins away going Code 1, 6 mins when code 3.
The EMT conducted a full assessment that included history taking, secondary assessment, interventions, and a full set of V/S, including a 12 lead. Everything in the book. PT also only had a Systolic BP of 80.
We were on scene for a total of 24 mins. The EMT also spent a good 8 minutes or so applying the 12 lead, note that we are both Basics.

Am I wrong to assume that this patient is in pretty bad shape and that we should have taken them to the ER ASAP?

Now, when I am the only EMT on call. I know my lack of experience so my priority is not to hurt the pt and get them to a higher echelon of care as soon as I can. Which happens to be a decent sized medical center with a ER only ten mins away.

I know you aren't supposed to rush things, but moving quick and rushing are two different things. But the scene time seems to take forever.
My final question is if we could start to load and go right after the primary survey. The EMTs here generally don't load the pt on the ambulance till a complete set of V/S are obtained.
 
Everyone has a different style. I don't think 15-20 minutes is unreasonable for most calls.
 
There is no set time limit. I may have calls where I'm on scene 5-10 minutes. Others may be 30-60 minutes. It all depends on the call and what needs to be done.
 
As Aprz stated everyone has their own style for assessment. Some people like to do full assessments and treatments on scene while others like to do them in the back of the ambulance.

The calls themselves also dictate how long we stay on scene. Is it a cardiac arrest? Respiratory arrest? Critical trauma? STEMI? Stroke? Or the more benign calls? Is it going to be a treat and no transport? Or is it someone who really should go to the hospital but doesn't want to?

I think my average on scene time for the non critical call is 15-20 minutes. Critical trauma patients our county wants us off scene in less than 10 minutes.
 
The 10 minute scene time is a rule that primarily applies to trauma. Even then it's situationally dependant. If you're somewhere around 10 minutes away from a trauma center, then a few extra minutes to stabilize a pt is usually acceptable and beneficial to the pt. If you're somewhere where you have a long transport time then a short scene time is appropriate because you have time to treat your pt on the way.

As stated above about medical calls, it varies. If you have the capability to treat the condition on scene then it's usually best to do so.
 
Aprz said:
Everyone has a different style. I don't think 15-20 minutes is unreasonable for most calls.
Click to expand...

A longer scene time isnt an issue if you're an ALS crew, performing interventions to stabilize a patient for transport. But 20 minutes on scene for a CP, with a crew of two basics seems to be excessive.
 
DEmedic said:
But 20 minutes on scene for a CP, with a crew of two basics seems to be excessive.
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I noticed this too but just passed over it because he also mentioned that they performed a 12 lead. Either there is more to that call than mentioned or he's from a place with dramatically different protocols than where I'm from. ECG interpretation is ALS training and EMTs don't carry them here.

On a side note, it is so hard for me to keep from typing in the word Basic rather than EMT.
 
Our protocols state that basics may attach a 12 lead to the pt, usually so the ER knows what isn going on as soon as we walk in.

I notice that everyone is saying certain "styles" and the on scene time of 15-20mins is acceptable.

So is it appropriate if I do the primary survey on scene and conduct the rest in the ambulance en route?
 
LanceCorpsman said:
So is it appropriate if I do the primary survey on scene and conduct the rest in the ambulance en route?
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It varies call to call, but for the most part yes.

Also my average scene time is 15-20 minutes, but that's on a ALS rig.
 
I've never worked in a BLS system but I would figure you'd have a lot of situations where scooping and scooting would be more appropriate than extended scene times simply because you have a limited amount of interventions you can do on scene. It is performing those interventions and correcting the pt medical conditions that should be the reason to have extended scene times.
 
I usually only spend more than 10 minutes on scene of a transportable patient if I'm working a code, intubating a patient, stabilizing an unstable patient prior to moving or have something going on where it makes sense to stay and get things fixed before moving. Like splinting a FX and getting pain meds on board. That's like 10% of all my calls.
 
DEmedic said:
I usually only spend more than 10 minutes on scene of a transportable patient if I'm working a code, intubating a patient, stabilizing an unstable patient prior to moving or have something going on where it makes sense to stay and get things fixed before moving. Like splinting a FX and getting pain meds on board. That's like 10% of all my calls.
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Like you said earlier, not much a BLS unit can do to intervene on behalf of this patient (unless she goes apneic and/or pulseless).

My question is...BLS 12-lead, perform at the bedside for an unstable patient -- or just get going since it is not going to impact en-route care?
 
The answer to that question is highly dependant on your local protocols. Talk to your medical director to see what exactly is expected of you.

As far as running a 12 lead goes, it needed to be done while the pt is sitting still. Movement creates artifact that makes a 12 lead unusable.
 
Like everyone said already, your on-scene time will vary with patient/situation, but the example you provided, an elderly female, pulse in the 180s and weak, pressure in the 80s. You shouldn't be ****ing around on that scene for 24 minutes. You should get an ALS unit in route pronto, unless they can't get there in that 6-10 minutes you can get to the hospital, in that case load and go. I'm curious, what interventions does a basic do on a chest pain call that takes 20+ minutes???
 
DEmedic said:
...and it takes 2 minutes to capture a 12 lead.
Click to expand...

And that includes cutting off the shirt, putting on the stickers and hooking the wires up.
 
In probably over 90% of your calls, the scene time is irrelevant. You could be on scene for 2 hours and it won't change a thing. It's been years (maybe decades now) since I have used the terms primary and secondary so forgive me if they mean something different now. Your primary should take 5 seconds or less on most pts. Are they awake and talking? ABC is pretty much done. I don't really know why you would need to do the majority of the physical exam on scene. The scene time given by the OP for the 80y/o is ridiculous, especially for a BLS crew. This lady needs medical care, whether that be by ALS or the hospital. Don't waste time on scene or waiting for ALS, load and go.
 
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