Sasha
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I really hope you fly patients because they're critical and you're not risking the flight crew's life because you are unable to deal with a patient long term!
Questions about home medical care
- Thread starter paramedichopeful
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I really hope you fly patients because they're critical and you're not risking the flight crew's life because you are unable to deal with a patient long term!
EMT11KDL
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its due to the long transport times. and only having BLS in my county. In idaho, BLS Crews are not allowed to do IV's so that is a major reason why we fly everyone out.
Shishkabob
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WHat Sasha? Doesn't "every patient deserve an ALS assessment"? Isn't that what you always preach?
ps-- difference between refusing care and going AMA, atleast here.
ps-- difference between refusing care and going AMA, atleast here.
Sasha
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Yeah, everyone does, so provide ground ALS, don't risk the flight teams life for 80% of your calls! Especially when the reason for flying is beause they need an IV!
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EMT11KDL
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but for us to get to ALS ground unit, its going to take min 40 mins. due to the lovely rules that other counties have created about not allowing them to cross the county line. so we have to meet at the line. and that is not including the time that it takes us to get to the patient and on-scene time
Sasha
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Uhhhm so get some ALS units in your service! Not a hard concept!
EMT11KDL
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I wish it was that easy!!! my agency has been saying that for the past 2 years, and yet nothing.
reaper
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Then get someone that can get it done!
Shishkabob
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I was speaking of the bandage thing not the flying thing.
What if the lay rescuer put a TQ on and you refuse to look when the pt goes AMA, they go home release the TQ and get a pulmonary embolism? Good luck explaining tgat one in court.
Wouldn't it be nice to snap a finger and have whatever we need appear? Changing service levels is a process that takes time. It could take 5 years easily to muddle through all the red tape and pre-reqs before beginning ALS transport. When I think about it, IMHO, it is the outlying areas that need ALS more so than populated areas with a locally available ER (or 3!). Population tends to dictate perceived need. Fiscally, I agree. The more humane side does not.
Sasha
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Hey, patient didn't want my treatment! Sorry! Besides I would be more concerned with tissue damage and compartment syndrome than a renegade clot from a TQ!
We can what if it all day! What if after you removed a bandage you were unable to re-control the bleeding and they went all shocky on you? See! There are a million what ifs and many do not practically apply to real life scenarios!
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Shishkabob
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I'd start an iv, load them with NS and get tgem to the hospital.
akflightmedic
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So on an uncontrolled bleed you would keep "loading them with fluid"...what does that accomplish other than eventually replacing their blood with saline?
reaper
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Everyone likes KoolAid!
So on an uncontrolled bleed you would keep "loading them with fluid"...what does that accomplish other than eventually replacing their blood with saline?
The "blood" won't clot the lab machines as easily if the patient survives long enough for one to care about labs.
ResTech
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Most local FD's and EMS station's have to contract and pay for bio-hazard waste removal so some may not like taking the general publics bloody trash. As a lay person, if you have some bloody bandages toss em in your trash can... its not a big deal. If EMS is there, kindly ask them to take them and they more than likely will.
As far as the removing bandages already in place prior to EMS.... if by chance the wound is already dressed and bandaged and a good description of the wound is provided by whoever bandaged it, more than likely Im not gonna undue what they took time to do, cause the patient more discomfort possibly, and break the clot formation and restart the bleeding.
Although, Pennsylvania protocols do allow for removing bandages once if bleeding continues to soak through to make sure direct pressure is being directed right over the laceration.
As far as fluids, unless they are hypotensive (SBP <90) I would start a line KVO (30-60mL/hr) and not "load" them with fluid. The body has a natural mechanism to adapt to low flow states at pressures of 70-80mmHg which is where permissive hypotension comes from. Unless of course the patient has a TBI than you never want to let your patient become hypotensive.
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guardian528
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because someone said something that was just the tiniest bit controversial, and then everyone had to prove that their way is the right way
Hemorrhagic - bio-hazard bags - blood
Neither of you see the connection?
Believe it or not, everything in medicine is not black and white or always comes with a recipe.
There are controversies in many things which is what makes these forums interesting.
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akflightmedic
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Naw, re read mate. Someone said something inaccurate, reminiscent of a very outdated method of thinking/treatment (which we do not follow anymore thanks to evidence based medicine) and then several of the more experienced people chose that moment to provide some education. Sure jokes were made but Linus is a big boy...