Speak out against triage?

[vquintessence]

This is aimed at dual response systems, and I'll admit this is kind of a dumb poll, but I'm curious nonetheless. How often do you get triaged something you don't feel comfortable with and why/what are those instances. I'm not talking blatant negligence either, but for example: Pleuretic CP, N/V, etc.

 

[medic417]

If you are not comfortable with it you should not take it. That is why I hate the two seperate responses. The ALS can decide hey its BLS and leave but if the BLS is not comfortable so what according to many. Should always have a Paramedic on every ambulance then if the BLS patient turns ALS just switch whos driving.

 

[boingo]

Why are they not comfortable? If they aren't they should say something. EMT's can and do take people to the hospital. Not everyone will benefit from an ALS transport.

 

[medic417]

Why are they not comfortable? If they aren't they should say something. EMT's can and do take people to the hospital. Not everyone will benefit from an ALS transport.

But if a BLS feels more care could be done and they accept the step down to bls they have not done what is right for the patient.

While not all calls end up being ALS all patients deserve the opportunity to have ALS if they go down hill.

 

[Sasha]

Not everyone will benefit from an ALS transport.

But everyone can benefit from an ALS assesment. Just because they called for a stubbed toe doesn't mean there isn't something else going on.

How often do you get triaged something you don't feel comfortable with and why/what are those instances

This problem could be eliminated with a medic on every truck.

 

[BossyCow]

This problem could be eliminated with a medic on every truck.

And a chicken in every pot, two cars in every garage, cradle to the grave healthcare and education for all, honest politicians in DC, ethics in the used car industry and a cell phone plan I can count on.... ah.. the wish list!

 

[medic417]

And a chicken in every pot, two cars in every garage, cradle to the grave healthcare and education for all, honest politicians in DC, ethics in the used car industry and a cell phone plan I can count on.... ah.. the wish list!

Dreams do come true.

 

[PapaBear434]

We had ALS dump a woman with abdominal pain 10/10 on us (a BLS truck) a few weeks back. Woman reported that she had an aortic dissection previously, and it felt exactly like this.

Turns out that she DID have just that. Doctor said it extended down past her iliac crest, and looked like a peeled banana.

Granted, there wasn't a terrible lot the Medic could have done for this, but if she would have crashed out in the back of the truck on the way to the hospital I imagine they could have did a hell of a lot more than we could back there.

We should have insisted that he come along, but I was new and stupid. Won't happen again, I assure you.

 

[BossyCow]

Dreams do come true.

ROFL yeah, but so far clicking my heels together and repeating "I do believe in ALS, I do believe in ALS, I do believe in ALS, I do believe in ALS," hasn't helped! Maybe I need to get some ruby slippers.

 

[PapaBear434]

ROFL yeah, but so far clicking my heels together and repeating "I do believe in ALS, I do believe in ALS, I do believe in ALS, I do believe in ALS," hasn't helped! Maybe I need to get some ruby slippers.

Oh, those would be awful for EMS work. Get some ruby steel toes, maybe. Much safer.

 

[boingo]

Why is it that the systems with a medic on every truck tend to be the same systems with poor intubation success rates and cardiac arrest survival? LA has medics on all their fire trucks, yet the survival rate for OOH cardiac arrest is piss poor. Should patients be inappropriately downgraded to BLS? No. There should be a robust QA/QI program in place to ensure its done properly, after a proper assesment, however putting medics in every truck for every stubbed toe does nothing to improve patient outcomes.

 

[medic417]

Why is it that the systems with a medic on every truck tend to be the same systems with poor intubation success rates and cardiac arrest survival? LA has medics on all their fire trucks, yet the survival rate for OOH cardiac arrest is piss poor. Should patients be inappropriately downgraded to BLS? No. There should be a robust QA/QI program in place to ensure its done properly, after a proper assesment, however putting medics in every truck for every stubbed toe does nothing to improve patient outcomes.

LA is a bad example of a bad example. That system is just broken. When a system does not allow their Paramedics to interpet EKG that should tell you there are problems.

Haveing properly educated Parmedics on every ambulance common sense says would improve patient outcomes.

 

[AJ Hidell]

ROFL yeah, but so far clicking my heels together and repeating "I do believe in ALS, I do believe in ALS, I do believe in ALS, I do believe in ALS," hasn't helped! Maybe I need to get some ruby slippers.

So you suggest that we simply accept that things suck, that there is nothing we can do about it, and that we should not even try to improve things? Doesn't sound like a real plan to me.

 

[AJ Hidell]

Why is it that the systems with a medic on every truck tend to be the same systems with poor intubation success rates and cardiac arrest survival?

Mostly because those systems are typically fire-based and inadequately educated.

 

[daedalus]

LA is a bad example of a bad example. That system is just broken. When a system does not allow their Paramedics to interpet EKG that should tell you there are problems.

Haveing properly educated Parmedics on every ambulance common sense says would improve patient outcomes.

AMEN!
Los Angeles = EMS stone age. Actually, at least paramedics in the stone age probably cared about there patients! That is even too much to say of Los Angeles "Fire medics".

 

[vquintessence]

Prologue:Please... no more ALS vs BLS discussion in this thread, it's already infected a good deal of the threads lately. We all know where most stand. h34r:

Well Papabear, thanks for providing the only post. It's good to hear the woman didn't crash on you. Why did the medics triage a woman in horrendous pain? I'm curious the story they gave you and how they wrote their PCR. Why did you & your partner go along with it at the time?

Others please add your triage stories! I know you've got em! Quick, before the thread codes. :sad:

 

[Sapphyre]

sorry, VQ, I've already posted my one inappropriate triage story elsewhere on this site. Not going to post it again.

 

[AJ Hidell]

The most common mis-triage I see is in nursing home patients. Dispatch seems to lower the priority level of nursing home patients at least one level below what they would prioritize any other citizen. Consequently, units respond with less urgency, and without the benefit of first responders. I can't count the number of times I have ended up with a critical or otherwise labor intensive patient in a nursing home that needed me faster than I got there, and with no extra hands to help me out.

 

[EMT007]

Granted, there wasn't a terrible lot the Medic could have done for this, but if she would have crashed out in the back of the truck on the way to the hospital I imagine they could have did a hell of a lot more than we could back there.

If she had crashed on the way to the hospital, there isn't jack squat an MD could have done

And Los Angeles doesn't have a medic on every truck, although that is their goal over the next few years. But yes, they are far from progessive.

As for the topic at hand, we don't really have any problems with triage. We have an excellent working relationship with the medics in our area. We tend to be comfortable with a lot, but the medics are always willing to take anything we say "hey, I'm not super comfortable with this one - can you take it?"

Works out well for us

 

[PapaBear434]

The most common mis-triage I see is in nursing home patients. Dispatch seems to lower the priority level of nursing home patients at least one level below what they would prioritize any other citizen. Consequently, units respond with less urgency, and without the benefit of first responders. I can't count the number of times I have ended up with a critical or otherwise labor intensive patient in a nursing home that needed me faster than I got there, and with no extra hands to help me out.

I've had that, as well as the flip side. How many times have you arrived at a nursing home to have them tell you that their BP is 120/78, pulse is 82, and so on... Only to have NONE of those vitals actually be anywhere NEAR what they really are?

I love made up turnovers. Especially when they call for a "general illness." In other words: "We took the night shift for an easy gig, and this sick old codger that needs vitals checked every twenty minutes really cuts into my Harly-Quinn novel time. Let's just call the Rescue Squad and let them take him to the ER."