Ruling out MI - Pressing on Patient's Chest

[medicsb]

And the obvious solution is all ambulances be staffed by Paramedics only.

Not really.

 

[medicsb]

By this argument anyone who doesn't get ALS interventions on scene probably can be taken to the hospital by BLS. The vast majority of ALS calls don't get actual ALS treatment (ie meds or fluids or intubation), but as a system we say "patient's with x complaint are still ALS even if all we do is monitor them."

Truthfully, most probably can be taken by BLS if no ALS intervention is found to be warranted by ALS on scene. But, I know that some do develop a need enroute, so there is a degree of over triage to ALS that is warranted, but I think the way it is typically done is not reasonable. It's funny how only about 1 in 5 patients transported actually get any ALS intervention besides VOMIT (vitals, O2, monitor, IV, transport), yet we have ALS sent to every patient in most systems and some others are lining over 50%. Imagine if every CP in your department was sent a cardiologist or every headache, a neurologist, and on and on. That would be even sillier than sending a medic to every call. Why not use the money that would be otherwise used for upgrading every ambulance to ALS for research? Sending a medic to every call and then requiring them to ride in patients with a certain complaint regardless of the assessment shows poor trust of the medics and EMTs and is also incredibly lazy of the medical director (and EMS system in general).

I'm just saying you've got to be careful downgrading patients to BLS. And if someone actually has an ALS type complaint (chest pain, altered mental status, GI bleeding) they should generally be transported by an ALS provider.

Heh, I'd argue that many (maybe the majority) AMS and GI bleeds are totally BLS. For certain, most "strokes" are BLS. But, I'll save those arguments for another thread.

If you've been able to risk stratify them in a very clear way by all means downgrade them. But that shouldn't be done just based on a normal ECG. It should be someone that you could stand in front of your medical director and say "this patient did not need continuous ECG monitoring, there was almost no chance of needing IV medications, and based on our protocols I felt safe having BLS transport."

I've never said anything about basing it solely on a normal ECG. Otherwise, I agree.

 

[mycrofft]

Haha, nothing says a cardiac pt can't have thoracic outlet syndrome or cervical plexus issues. I did, told the MD (new MD) but was ordered to the ED, which blew an afternoon and cost me nearly a grand for neck-originated pain as well as chronic a-fib.


And nothing says a person with chronic or recurrent spinal issues/thoracic outlet syndrome can't have a heart attack.

 

[DrParasite]

Sending a medic to every call and then requiring them to ride in patients with a certain complaint regardless of the assessment shows poor trust of the medics and EMTs and is also incredibly lazy of the medical director (and EMS system in general).

When you finish med school, can this be the title of your first published paper?

Heh, I'd argue that many (maybe the majority) AMS and GI bleeds are totally BLS. For certain, most "strokes" are BLS. But, I'll save those arguments for another thread.

heh, i'd argue that once a BGL is normal on an AMS person, you would be right. ditto a GI bleed that isn't hypotensive. And stokes (without airway compromise) are def BLS.

 

[KellyBracket]

Well, if you go too far down that line of thinking, you end up with the "taxi-cab" model of EMS.

Just an April Fool's joke? Or a serious proposal?

 

[DrParasite]

Well, if you go too far down that line of thinking, you end up with the "taxi-cab" model of EMS.

The truth of the matter is that many people who call 911 requesting an ambulance can go to the ER in a cab with no negative effects.

using the ProQA dispatch criteria, Alpha dispatches are ambulatory, and Bravos are non-ambulatory but not life threatening (or unknown statuses that can be ambulatory). And since we know dispatchers are always 100% accurate :rofl:, we also know that just because it is dispatched as a Charlie or Delta response, doesn't mean it doesn't turn out to be a Alpha patient.

My personal experience (of urban EMS systems) would say that 60% of all EMS calls are either ambulatory, no transports (RMA or cancels), or would suffer no ill effects if they went by POV or taxi to the ER (or their PMD). Another 25% are unable to ambulate to the POV or taxi, but once they are carried out to the ambulance, no intervention is needed until arrival at the ER. The other 15% are either life critical calls or will require ALS interventions, or else the patient will suffer negative consequences. Suburban calls might have a higher percentage of more serious calls due to greater accessibly to doctors offices and high percentage of insured people.

and as for the original topic, just because you have chest pain, doesn't mean you are having an MI, nor are you having ACS. Esp if you are under 35 and showing no other symptoms.

 

[JPINFV]

I think they do, yes. But their training is completely different from a paramedic's education. Paramedics want all of the respect of being "clinicians" without any of the appropriate education and training. You can't have it both ways.

 

[VFlutter]

+100000

 

[usalsfyre]

+100000

I would SERIOUSLY refrain from commenting considering what nursing is trying to do with DNPs.

Glass houses....

 

[VFlutter]

I would SERIOUSLY refrain from commenting considering what nursing is trying to do with DNPs.

Glass houses....

I don't really want to derail this thread but I am inclined to comment. So you want to compare an RN with multiple years of beside experience who has accumulated 8 years of education (4 BSN 2 MSN 2 DNP) trying to advance their clinical scope (along with a profession that as a whole is continuing to advocate increasing education standards) to a medic ,a non degree technician, wanting to be considered a "clinician" with no personal advancement in education and a profession who has little to no interest in raising educational standards? I can loosely see the comparison.

IMHO That RN "playing doctor" has a lot more ground to stand on then the medic.

Regardless, I do not see any reason to "SERIOUSLY refrain from commenting". Does pointing out the supposed flaws in my profession somehow change the facts or discredit my personal opinion? No matter what your opinion is of the DNP moment it does not negate truth of the comment I was agreeing with.

I'll just sit back and continue to throw rocks in my glass house

 

[NomadicMedic]

I'm very close to moving all of these posts and issuing some "thread jacking" infractions. This is the only warning.

This is a "chest pain on palpation" thread. Please keep it on topic and if you choose to discuss nursing, DNP or other items, please start a new thread.

 

[JPINFV]

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