Discussion in 'EMS Talk' started by EpiEMS, Jan 4, 2017.
Plus, you gotta bill!
Could you actually bill for it though when it is not indicated?
Sure, every policy is put into place because somebody, at some point, screwed up. So, they need to make a rule about it.
FWIW, my last dept was a fan of the theory "Well we've got both an EMT and a Paramedic in back with an ALS patient, and if they're starting a line, before you toss that flash chamber of blood into the sharps container, even with a 5 min transport, someone is gonna have a spare 30 seconds without something more pressing to do, might as well get a drop of it on a test strip since we have roughly a million of those, don't have to do anything extra to the patient and won't change their billing, so why not?"
The current ALS dept I run with, not so much. In fact, come to think of it, I'm not sure I've ever actually seen them use blood from an IV stick for a BSG, always been a finger stick with a lancet, and they're a lot more in line with what @captaindepth is saying. Not necessarily saying they're stingy per say about getting a sugar, but it has resulted a couple times in us walking into an ER BLS and the nurse ends up asking us what the patients sugar is and all we can say "ALS never got one" since it's out of the BLS scope to use a lancet here
We have fields for all of the various "measurements" and vital signs in our PCRs but I believe the only required ones (in order to upload the report) is a physical exam section, BP (x1), Pulse (x1), RR (x1), and a GCS. We don't have automatic blood pressure cuffs so we all do manual pressures on every patient. I get at east two on almost every patient I transport, one at the beginning of the call and one before arriving at the ED. I will usually trend BPs and pulse rates on moderately - significantly ill patients and get around 3 or 4 sets. I only use the pulse oximetry for patients with a respiratory complaint/symptom or are critically ill. Very rarely will I just throw it on without a good reason.
Where I work we really stress history gathering and physical exams and wanting good solid reasonings behind our decisions. Its a cultural thing. Not to say I havent been burned before but but I think it strengthens our abilities to accurately assess and treat patients.
@Gurby The reasoning behind my decisions is not in an effort to be defensive or antagonistic but to show the ER staff that I have thought about the patients presentation and assessed them to the point where I feel comfortable in what I did vs. didn't do while with the patient.
Is this done intentionally by your service? In this day and age we've become all too spoiled with automatic blood pressures; I'm no different.
This being said, I think it's kind of cool and when I work ground shifts if I still keep the BP cuff in the alley of the ambulance. I've chuckled at the new kid that asked if I wanted an extra BP, and when I said "yes", they brought a spare disposable NIBP cuff.
It really is a lost art. If my spidey senses don't trust the NIBP, the patient isn't matching what it's saying, or anything in between, I auscultate or palpate one. And sometimes I just do it to keep up with the skill itself.
There is a 911 service near me that requires the first BP to be ascultated or palpated. After that they can use NIBP. I really think I'm going to try to make that my practice.
We don't have any NIBP's on our ambulances, except the ones on the fire medic's Zoll X-Series. So unless we're patching the patient up on the 4 or 12 lead we'll get a manual, but if we are patching up the leads they don't really seem bothered if you throw on the NIBP cuff, but it seems even then half and half of our guys who grab a manual vs NIBP.
Now virtually every single one of our hospitals require us to grab a complete set of vitals on their machine as part of triage. Those are all machines that do NIBP, pulse ox and pulse, and temperature in one, so usually the driver puts those on and runs the machine while the attendant starts talking to triage and registration.
Yes it is intentional, we have LP 15s which are obviously capable of using the NIBP automated cuffs but we purposefully don't have them on the ambulances. We carry a variety of sized cuffs and it is understood that our EMTS and paramedics all know how to use them. I have never used automated cuffs and actually really enjoy taking blood pressures. I think there is a lot of information to be gathered from hearing the rate and quality of a persons pulse while auscultating their pressure. On every* patient I introduce myself and ask them if I may feel their wrist for a pulse, again a lot of information can be gathered in that 20-30 second time frame.
Well there you go, @EpiEMS. I think @captaindepth just brought the initial question to your thread full circle.
Only for patients with an LMA or ETT. No use of sidestream ETCO2 because of cost.
@VentMonkey, this thread has gotten pretty epistemological - and I dig it!
Sounds like ALS In Yakima. That was SOP there.
+1 for the play on words regarding your name.
+2 for the big word of the day.
Question that occurred to me today while getting a set of vital signs....anyone mandating VS must be even numbers?
I remember in EMT school they always told us that because BP Cuff gages are marked in even that if we documented an odd number (157 over 97 for example) they'd say we made up a number (or something along those lines, I forget exactly what they said as that was 4 years ago now lol).
So anyway, say for that example BP, say it was obtained via NIBP monitor, I've still seen a few (not all) guys document as 158/98, but I've never had a problem putting an odd number in myself.....anyone else run into something similar where vitals "must be even numbers"?
I don't think it's a huge deal, unless we're talking about completely balking numbers.
FWIW Jim, I believe you and I went to the same EMT school, and think it's kinda funny they still preach that. Old habits die hard, and I stilled abide by the even numbers rule.
If I use the NIBP to chart a BLS patients vittles I typically upload them and document as such, otherwise an auscultated set gets even numbers from me.
Aside from a beat by beat A-line, the numbers aren't anywhere nearly as accurate anyhow. I do from time to time still enjoy palpating one, documenting the systolic, then comparing it to the ED's to see if I am still within my ~10 mmHg range; usually I still am.
I was told that in EMT school, which was dumb I thought. It's literally 1 number different than what I am going to tell you, who gives a damn? At this point, I do it out of habit, but I don't think it is a huge deal to do either.
It depends. If I'm documenting a manual pressure, the numbers must be even as the gauge is marked in even numbers.
If I'm documenting an NIBP, the machine is capable of displaying odd integers, so an odd result is possible and thus should be documented as such.
every patient should get a rectal temperature.
And a guaiac.
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