O2 admin in cases of ETOH and AMS

[MrBrown]

MrBrown, in the US care is very fragmented, and each department or region treats their ambulance service differently. I believe the company Jon is describing working for is ONLY BLS, that is, they do not have authorization from the state to provide ALS-level care, and when they employ paramedics, they do so understanding they have a BLS SOP.

Ah nationalisation how I love thee ^_^

Every vehicle here has the same equipment, so, if an Intensive Care Paramedic jumps onboard all he has to take is his ICP bag which has his airway gear and drug roll. A vehicle crewed by two Technicians will have at least one IV kit, for example, even though they cannot use it per-se.

I did have a look at the PA Ambo licensing manualhttp://www.portal.state.pa.us/portal/server.pt?open=18&objID=445337&mode=2 and it looks like the only difference is in the equipment carried, which, is really the same here as an Intensive Care Paramedic will carry intubation gear (for example) whereas a vehicle crewed by say, a Paramedic and a Technician will not.

Not to judge a system I have no experience in, but, it does seem a little odd to me.

 

[46Young]

It is the mentality behind the "ALS" and "BLS" that has made EMS here so ridiculous.

If a doctor places a nasal cannula on a patient does that make it "BLS" even if the patient is headed for the ICU? If the patient is brought in by "BLS" does that make them less sick because less or no "ALS" procedures were done on them? If a BLS truck brings in an acute stroke patient does that make the patient less sick? If an ALS truck rushes a patient in cardiac arrest to the ED that they have not established any "ALS" interventions on, is that patient "BLS" and less sick?

In the U.S. we tend to get more hung up on labeling the patient by a skill or procedure rather than the knowledge of the provider or the actual patient care where assessment is concerned or whether that patient might actually be sick. If the Paramedic does not see where they can or want to do a "skill" the patient becomes "BLS". Thus, it is then assumed the patient is "less sick".

We can take a severely injured trauma patient as an example since the BLS vs ALS is argued. The fact that only "BLS" procedures are done does not make that patient less sick. It should be the fact that an ALS assessment determined less is best rather than stay and play. Either way the patient needs Advanced Patient Care regardless of whether it is initiated in the field or in the ED. They may not need "ALS" skills but they are entitled to an assessment by someone capable of determining if immediate intervention is required and one that can do that procedure be it "BLS" or "ALS".

Where I work now, virtually every unit its a medic unit. So, there's no "BLS or ALS", just the crew's assessment and treatments. When I worked in NYC , there were both BLS and ALS units. If the BLS assesses the pt and determines that their limited diagnostic capabilities are inadequate for the pt, then they will call for ALS. As medics, our PCR's had a section for treatment codes. The first code, every time, is "ALS Assessment", regardless of the pt's condition. "BLSing or ALSing" a pt is more to say if the pt required any interventions that BLS would not be able to provide. This is after proper diagnostics, such as pulse ox, ECG, 12 lead, BGL, and a paramedic level physical assessment/interview, of course.

If the paramedic level was entry level, BLS and ALS categories would be unnecessary.

Bottom line, when we, the double medic unit in the city would advise the pt is BLS, that means that the we decided that the pt didn't require any further Tx under ALS protocols other than those diagnostics already provided. In the city, when giving a note to the hosp, we would say "ALS in progress" rather than "ALS established" if interventions were in progress. As far as what interventions were established were left intentionally vague, as the medics need to work, not answer a plethora of questions during transit. The advised R/O along with the pt's mental status, vitals and general condition would suggest the actual "ALS" established or in progress. That's how it works in NY. Also, the stubbed toe wouldn't require a 12 and a BGL, and the diff breather with significant Hx needs more than air and chair.

I don't understand why some ED's need to know every detail during transit (when we need to work and also watch the pt), when they've already been advised of the pt condition, suspected Dx, diagnostics, interventions, and applicable reassessments. That's what the pt transfer portion of the call is for.

 

[MrBrown]

If the paramedic level was entry level, BLS and ALS categories would be unnecessary.

Sounds like a plan

when giving a note to the hosp, we would say "ALS in progress" rather than "ALS established" if interventions were in progress. As far as what interventions were established were left intentionally vague, as the medics need to work, not answer a plethora of questions during transit.

Does the hospital actually care about what you've done for the patient or understand the difference? I think the hospital staff here are a little niave about what an Officers' skill set is but that's not thier fault!

Here a radio message to the hospital is very brief; it is specifically directed to report only abnormal routine vital signs or non-standard treatment.

Example might be "City 3 bringing to you a 63 year old male, moderately short of breath speaking 3-4 words of breath, extremely wheezy, has not responded well to salbutamol, saturation is 91%, status two (unstable), be with you in 6 minutes"

 

[JPINFV]

It really depends. For example the base hospital report (the one filled out by the RN manning the radio) is essentially the same as the paramedic PCR. For base hospital contact calls (essentially any real emergency), the form is supposed to be filled out completely, even if it means that the paramedic calls the base hospital after turning over care to finish reporting the information.

http://ochealthinfo.com/docs/medical/ems/P&P/390.10.pdf

 

[FLEMTP]

Sounds like a plan



Does the hospital actually care about what you've done for the patient or understand the difference? I think the hospital staff here are a little niave about what an Officers' skill set is but that's not thier fault!

Here a radio message to the hospital is very brief; it is specifically directed to report only abnormal routine vital signs or non-standard treatment.

Example might be "City 3 bringing to you a 63 year old male, moderately short of breath speaking 3-4 words of breath, extremely wheezy, has not responded well to salbutamol, saturation is 91%, status two (unstable), be with you in 6 minutes"

I keep my reports short sweet and to the point... just like yours posted above... here we call the ER directly to give report.. and we dont have to ever ask for orders.. all of our protocols are standing orders for anything we do.. meds or procedures... and those ER nurses are just too busy to wait for you to tell them every med.. every allergy and what the patient had for breakfast last tuesday

 

[Jon]

Ah nationalisation how I love thee ^_^

Every vehicle here has the same equipment, so, if an Intensive Care Paramedic jumps onboard all he has to take is his ICP bag which has his airway gear and drug roll. A vehicle crewed by two Technicians will have at least one IV kit, for example, even though they cannot use it per-se....
Not to judge a system I have no experience in, but, it does seem a little odd to me.

Mr. Brown - Exactly right. Remember how I said that your system was much LESS confusing than ours?

All "my" ALS gear is actually my employers, and is shared among all employees. The transport job I have works somehow like yours does - when I'm on the truck, I pull all the ALS gear out of a closet and use it for the shift, and if I'm not relived by a medic, it gets locked up again. Lots of schlepping when I'm the 2nd daytime medic.

I currently spend at least 16 hours a week on a BLS truck to pay my "rent" - I live in an apartment at a BLS company and my roommates and I trade time on the truck for rent. Not a bad deal for all involved. It's allowed them to still be staffed by all volunteers from 6p-6a all week.

...Here a radio message to the hospital is very brief; it is specifically directed to report only abnormal routine vital signs or non-standard treatment.

Example might be "City 3 bringing to you a 63 year old male, moderately short of breath speaking 3-4 words of breath, extremely wheezy, has not responded well to salbutamol, saturation is 91%, status two (unstable), be with you in 6 minutes"

Nice. We need to call in for orders for some things, but not every call requires a command call.

It really depends. For example the base hospital report (the one filled out by the RN manning the radio) is essentially the same as the paramedic PCR. For base hospital contact calls (essentially any real emergency), the form is supposed to be filled out completely, even if it means that the paramedic calls the base hospital after turning over care to finish reporting the information.

http://ochealthinfo.com/docs/medical/ems/P&P/390.10.pdf

JP - Has anything changed since Emergency! in CA?
Has it changed for the BETTER?

 

[JPINFV]

I never really enjoyed Emergency (I watched 3/4s of the pilot), but from what I've heard... no.