Shady als calls given to bls. How do you deal?

[NorthCalEMT]

Im in oc and laco and Geez! seems like one shady call after another sometimes, then goes thru a week or so of actual bls calls. I get money is the name of the game for ift companies, and all the blame obviously would fall on the emt, but damn, at least authorize code 3 if vs become worse en route to er for supposed hospital eval. So,my question I wanted to ask what everyone does during those calls... Specifically, how they deal with the nursing home rn's who try and pull the loud, obnoxious or *****ing attitudes when they realize youre onto them? What you say, how you handle, etc? I havr my techniques but i'd like to hear others.

Also, I was wondering... How come ift dispatch/supervisors dont authorize code 3? Does it have something to do with the fact that code 3 would basically mean it should have bern als? I know the rule about transport re: if fire is further to you than it would take to get to nearest hospital u can and should transport.

 

[Aidey]

I have no idea why they don't authorize it, but there is very little evidence that going code has any benefit so don't assume going code 3 would help all that much.

 

[mycrofft]

Hello, thumb-posting police?....

 

[JPINFV]

Im in oc and laco and Geez! seems like one shady call after another sometimes, then goes thru a week or so of actual bls calls. I get money is the name of the game for ift companies, and all the blame obviously would fall on the emt, but damn, at least authorize code 3 if vs become worse en route to er for supposed hospital eval. So,my question I wanted to ask what everyone does during those calls... Specifically, how they deal with the nursing home rn's who try and pull the loud, obnoxious or *****ing attitudes when they realize youre onto them? What you say, how you handle, etc? I havr my techniques but i'd like to hear others.

Simple. Don't engage the SNF RNs. If you need to scoop and run, scoop and run. If you need paramedics, ask to borrow a phone and call 911. You don't have to say who you're calling.

Also, I was wondering... How come ift dispatch/supervisors dont authorize code 3? Does it have something to do with the fact that code 3 would basically mean it should have bern als? I know the rule about transport re: if fire is further to you than it would take to get to nearest hospital u can and should transport.

I've never had to request to transport with lights and sirens. I say when start transporting that I am transporting code 3. There's no request about this. They aren't there, they have not examined the patient, and the responsibly for treatment decisions, which includes transport status, lies with the licensed personnel on scene.

 

[mycrofft]

Once the pt is in your car you are responsible. If your company's guidelines bother you, find another. If particular nurses bother you, work somewhere else.
I'm paraphrasing some of the best advice I was given.

 

[NYMedic828]

Last I checked the decision to go "code" was mine and mine alone based on my interpretation of the patient's current condition and need for definitive care...

 

[DrParasite]

One you leave the SNF, call for ALS. You are the highest level of care assessing the patient. The patient's condition changed from when the nurse was assessing him, and now you need ALS.

call for ALS at the nurses station if you want, but you might deal with a *****y nurse. If you really want to push the nurse's buttons, ask for her first and last name. when she asks why, tell her you want to be able to give the information to the family when they sue her personally for the improper treatment they are providing.

while a company may require a dispatcher to "authorize L&S," it's your truck. if you feel your patient will benefit from L&S, use them. most of the time the notification to dispatch is made for reports and documentation, and to prevent abuse. So if you use them, expect to be called into the bosses office to explain WHY you used them. Many don't want to "authorize" their use due to the potential for liability (and the gross overuse of L&S by responders of all levels), but if you feel it's right, use them; just be prepared to defend your actions.

Lastly, when in doubt, start going to the ER. don't waste time, take the paperwork and run, and do your best to give notification to the ER that you are bringing in an unstable patient.

 

[DesertMedic66]

Simple. Don't engage the SNF RNs. If you need to scoop and run, scoop and run. If you need paramedics, ask to borrow a phone and call 911. You don't have to say who you're calling.



I've never had to request to transport with lights and sirens. I say when start transporting that I am transporting code 3. There's no request about this. They aren't there, they have not examined the patient, and the responsibly for treatment decisions, which includes transport status, lies with the licensed personnel on scene.

Exactly this.

 

[Amberlamps916]

Welcome to BLS IFT. It happens. Learn to adapt to it, err on the side of caution, and above all have the patient's best interest be your main priority. It wastes time, like JP said, to sit around arguing with the nurses. Most of them think you're just a on call taxi service that will obey all commands because that's what your company's marketers/management promised them. Nothing will change that belief, trust me. They'll sit there and pull the "Well the Doctor said pt needs to go to this hospital 40 miles away BLS blah blah blah. Bottom line, limit your on scene time.

On a side note, today I found out some interesting information about the recently shut down Medlife ambulance is being investigated for. Apparently, a BLS unit was dispatched from VAN NUYS to a snf in PASADENA for, get this, "POSSIBLE CVA (Ok to go BLS). You would assume that even though they decided to make this call BLS, at least they would have the EMTs transport the patient to the designated stroke center exactly 1 Mile away from the snf. But no, patient was to be transported to an URGENT CARE 14 miles away.
Upon arrival of the EMTs, they told the facility prior to patient contact that they would be going to the stroke center, regardless of what the doctor who hadn't even seen the patient's presentation said. The nurse told them they can't do that and called the charge nurse. And can you guess what the patient presented as? Left sided facial droop with weak grips and pulls with inability to speak. After getting the patient on the gurney, the charge nurse came with the operations manager of MEDLIFE AMBULANCE on the phone telling the EMTs that if they didn't transport the patient to the URGENT CARE, they would be out of a job. They told him he couldn't do that and transported the patient to the stroke center. They didn't get fired but got written up for "spending too long on scene".

Apparently both those EMTs reported MEDLIFE AMBULANCE and the snf. Is it any coincidence that the company was shut down soon after? My point is that if you do the right thing, have all your bases covered and be a patient advocate, you can help in getting the companies and facilities that try to pull this kind of crap into the spotlight!
Good job for being a concerned EMT. We need more of those out there! Keep your head up.

 

[fbemt]

most likely Brighton Convalescent. Absolute worst nurses, never had any clue what was up with the pt.

 

[Amberlamps916]

Not sure. The guy who told me about it didn't say where it was. Is that on convalescent row off Fair Oaks? Lol

 

[Jon]

Interesting posts.

When I worked BLS IFT, we'd get sent on some shady runs. Usually the fastest option was to scoop and run. I didn't call for ALS often (because it really delayed more than it helped).

Now I work for a company that requires dispatch document Code 3 response/transport. Especially as a medic, no one questions it, but I better have a good reason.

Every once in a while I'll run hot TO a facility. Usually after calling and getting a good report. Biggest one is the LTAC vent facilities we serve. Even if 911 can get there a little quicker, they have no vent, and no CCT experience - so it's better if we take it.

Usually all I have to do is key up dispatch w/ siren on and they get the message.

 

[Anjel]

If I need ALS for whatever call, I get on my cell, call dispatch, and ALS shows up within ten minutes.

I've only had to do this a handful of times, but it is usually because when I call the ER with my report they request and intercept.

I've never gone code with a pt to the ER, unless again the receiving hospital orders it.

What happens to my patient is my responsibility and my choices. Dispatch doesn't dictate what happens on my truck.

 

[firecoins]

Always used my cell to call ALS when I worked BLS IFT. RN at the SNF does not make the decision.

 

[mycrofft]

Used to be, convalescent facilities would call ambulances to transport people they were sure were dying to shift statistics off them. A couple times we revived them enroute with basic EMT skills like running an oxygen mask at over 2 LPM.

 

[Ewok Jerky]

As others have said, its my call (and it happens on my cell or radio in the back of the truck).

If a nurse is causing a problem on scene I smile, say thankyou, and bounce. Once we are out the door its my Pt and I decide the most appropriate facility and priority. Forget the "best interest of the Pt", if you act like a jerk to a facility, you will get in trouble with the boss. Remember, the facility, not the Pt, is your customer.

*not saying the best interest of the Pt is not your most important prioirty, but you can still act professionally while on scene, if you want to keep your job*

 

[TheLocalMedic]

Oh man, reading this thread brings back so many memories from my first BLS IFT job!

If you've worked BLS, then you've undoubtedly run into this situations many times. Here's a few of my pointers:

* Remember that your job is mostly about customer service, and the nursing staff are also customers, so play nice with EVERYONE no matter how frustrating they are

* I always smile and nod a lot, which goes a long way towards making the "*****y" nurses ease up a little

* Keep nodding an smiling as you completely ignore what "the doctor wanted" and make up your own mind as to whether it's faster to get an ALS unit there or just take the pt directly to hospital

* Nod and smile some more as the nurse freaks out on you and then explain that you understand their concerns but that you're just "following the rules" and doing what needs to be done

* If they threaten you or call your company, just nod and smile some more, but state that you don't have time to rationalize or debate with them, and start getting ready to take the pt

* If you decide it's faster for you to transport, then just get on your horse and ride. YOU decide if you want to roll code 3, but generally it really doesn't save you much time and it does put you at much higher risk of an accident. This holds especially true for BLS companies where most employees don't have a lot of experience driving code 3!

 

[Tigger]

We go priority to SNFs and other healthcare facilities all the time. The facilities we contract with call us before 911 9/10 times, we have EMD and enough units to match (if not exceed) the city's response time. We also have ALS units with vents, which none of the 911 services around here have.

Once on scene it's like any other call. If we need ALS, we'll call from the floor and then get moving and intercept on the way or go straight to the ED if it's faster. If the provider in back wants to go to the ED emergent, then we do it. I rarely do this and kindly encourage my partners not too, but at the end of the day the transport priority is solely at the crew's discretion.

 

[leoemt]

Welcome to BLS IFT. It happens. Learn to adapt to it, err on the side of caution, and above all have the patient's best interest be your main priority. It wastes time, like JP said, to sit around arguing with the nurses. Most of them think you're just a on call taxi service that will obey all commands because that's what your company's marketers/management promised them. Nothing will change that belief, trust me. They'll sit there and pull the "Well the Doctor said pt needs to go to this hospital 40 miles away BLS blah blah blah. Bottom line, limit your on scene time.

On a side note, today I found out some interesting information about the recently shut down Medlife ambulance is being investigated for. Apparently, a BLS unit was dispatched from VAN NUYS to a snf in PASADENA for, get this, "POSSIBLE CVA (Ok to go BLS). You would assume that even though they decided to make this call BLS, at least they would have the EMTs transport the patient to the designated stroke center exactly 1 Mile away from the snf. But no, patient was to be transported to an URGENT CARE 14 miles away.
Upon arrival of the EMTs, they told the facility prior to patient contact that they would be going to the stroke center, regardless of what the doctor who hadn't even seen the patient's presentation said. The nurse told them they can't do that and called the charge nurse. And can you guess what the patient presented as? Left sided facial droop with weak grips and pulls with inability to speak. After getting the patient on the gurney, the charge nurse came with the operations manager of MEDLIFE AMBULANCE on the phone telling the EMTs that if they didn't transport the patient to the URGENT CARE, they would be out of a job. They told him he couldn't do that and transported the patient to the stroke center. They didn't get fired but got written up for "spending too long on scene".

Apparently both those EMTs reported MEDLIFE AMBULANCE and the snf. Is it any coincidence that the company was shut down soon after? My point is that if you do the right thing, have all your bases covered and be a patient advocate, you can help in getting the companies and facilities that try to pull this kind of crap into the spotlight!
Good job for being a concerned EMT. We need more of those out there! Keep your head up.

CVA's are BLS here unless they have airway compromise. Nothing ALS is going to do for a CVA - they need a Stroke center ASAP. ALS is going to delay the time it takes patient to get to definitive care.

To answer your question - if you need ALS then call them. If you need to run priority then do so. The goal is to get the patient to definitive care using what is in the patients best interest. If ALS would be in their best interest then get them.

 

[exodus]

CVA's are BLS here unless they have airway compromise. Nothing ALS is going to do for a CVA - they need a Stroke center ASAP. ALS is going to delay the time it takes patient to get to definitive care.

To answer your question - if you need ALS then call them. If you need to run priority then do so. The goal is to get the patient to definitive care using what is in the patients best interest. If ALS would be in their best interest then get them.

What they probably need is 911, not a private company though.