"Stay and play?"

[RedAirplane]

Some topics in other discussions reminded me of this.

When I did my ride along with the ALS 911 provider, most of our calls would follow the same general format: fire is on scene, we get the patient from them, load into the ambulance, spend 15-20 minutes doing an assessment in the ambulance, then drive non-emergent to the hospital.

Is there a reason for that? I realize that those patients weren't emergencies, but it feels like a little bit of a waste to be sitting in an ambulance on a street corner doing a blood pressure and IV access.

My instinct would be to say assess what you need to on scene, and then ongoing assessment enroute.

Is there something I'm missing?

 

[SandpitMedic]

There is more than one way to eat a Reese's.

 

[Akulahawk]

Disclosure: I'm an ER nurse, but I was a working Paramedic once upon a time...

One of the reasons your experience with the 911 folks seemed to follow a set pattern is that the crew likely does things the same way nearly every time they encounter a patient. In the ER, I do the same thing. I do things pretty much the same way every time so that I don't miss something. If I'm getting a "new" patient and I have to do all the triage and initial assessment myself, one of the very first things I do is hook the patient up to the monitor, get that running, get a temp, and start asking questions while I'm doing those other things. It's because I can get those vital signs done quickly and I can refer back to that data as I put the pieces together. It's a pretty rare case that I need to ask the physician to see a patient before I'm done with my initial assessment. In the field, those are the patients that I'll sit on scene long enough to get an airway, do a 12-lead, or start a line, or any combination thereof, and get rolling down the road immediately after that. I'm on scene typically < 8 minutes with those. Most patients don't need me to work on them at Warp III...

In other words, if I'm sitting on scene (not a code), it's probably because I'm doing a more leisurely workup and doing some more in-depth data gathering without freaking-out the patient. Yes, I can do the job while moving, but some tasks are just easier if we're not moving or the engine is at idle or off...

 

[DesertMedic66]

Regardless of what assessment information I am told by the fire department I will always do my own assessment, obtain my own vitals, and double check any treatments they have done. I've been burned by fire once or twice.

I prefer to do everything in the back of the ambulance. It has much better lighting, everything is in close range to my hands, much easier to control the scene, if something happens we can get off scene quick, and I can lock the doors (we have an issue with one of our fire departments who pretty much refuses to let anyone sign out AMA so our solution for now is to cancel them and lock the doors so they have no idea what's going on).

It all depends on the call also. For diabetic issues I will do everything on scene because the majority of our hypoglycemic patients will AMA.

 

[TransportJockey]

Some seizures, especially ones that are very known to us, will also get worked up inside, since they always sign AMA once they come out of postictal. Unless there's a change of course.
Other than that, @DesertMedic66 and @Akulahawk covered it pretty well

 

[EMT2015]

Man, I haven't heard Stay and Play since EMT training.

 

[NomadicMedic]

I think some of this is system dependent. I worked in a system that wanted you to treat in the house and then go, and I worked for another system that got antsy if you were in the house for longer than it took to shove the stretcher inside.

I do like to capture a baseline 12 lead in the quiet, controlled environment of a non moving ambulance though. And I don't care what anyone says, it's easier to start a line when you're NOT bouncing down a dirt road.

 

[akflightmedic]

These "non-emergencies" are exactly where you will define your weaknesses and improve your overall approach to better patient care. Think about it...there is nothing critical identified yet, so there is plenty of time for you to practice many things such as:

1. Patient rapport
2. Team building
3. History gathering
4. Systematic approach to multi tasking and delegating
5. Medication or interesting medical history familiarization


All of these items many are weak on. The skills such as IVs, intubations, EKG application, people can do all day and there is nothing special about them. All the skills I listed above...these are far more important and will get you much further in your career. That is, IF you acknowledge where you are deficient and then endeavor to change, fix or improve it.

Do not wrinkle your nose at such an excellent opportunity like this. Some systems frown upon it and if you happen to be in one where you can take the time to achieve all of this, soak it up now!

Aside from all the benefits above, you will come off as a much more professional and credible provider not only to your colleagues, upper management but also the receiving medical team. This may have its advantages down the road and even if it doesn't, you simply will be a better provider regardless.

 

[RedAirplane]

Being someone with a love of efficiency, the initial reaction was-- this is wasting a resource (the ambulance). If it's not an emergency, the sooner the patient can be handed off to someone else, the less time this unit spends unavailable for calls.

But I totally get it from the patient care perspective.

 

[DesertMedic66]

Being someone with a love of efficiency, the initial reaction was-- this is wasting a resource (the ambulance). If it's not an emergency, the sooner the patient can be handed off to someone else, the less time this unit spends unavailable for calls.

But I totally get it from the patient care perspective.

If you roll into the hospital and don't have a complete patient assessment and a full report to give to the staff you will create some issues.

 

[NYBLS]

Acutely ill patients should be managed where they are found unless safety or space limits that. Before everyone jumps up and down there are some limitations or time sensitive conditions that require more coordination for a shorter on scene time (major trauma, stroke and STEMI).

 

[akflightmedic]

Being someone with a love of efficiency, the initial reaction was-- this is wasting a resource (the ambulance). If it's not an emergency, the sooner the patient can be handed off to someone else, the less time this unit spends unavailable for calls.

But is it truly wasting a resource? Until you do a thorough exam, you simply do not know if it was a waste or not. Additionally, think of the entire care continuum...think about the receiving hospital. If you assessed a patient and determined they need to go straight to triage as opposed to back door ER bed, did you not just contribute to the overall efficiency? I think you did...you just made it better for patients you will never see, you just reduced workload on some of your colleagues. It is a team effort.

No offense to you as I am sure you did not intend to sound this way but it almost sounds as if you are saying the call is not worthy of your time as opposed to the wasting of a resource. Just saying it kind of reads that way.

Anyways, stay and play followed by treat and release is the wave of the future...any newbies who do not know this, prepare yourselves.

 

[Flying]

But is it truly wasting a resource? Until you do a thorough exam, you simply do not know if it was a waste or not. Additionally, think of the entire care continuum...think about the receiving hospital. If you assessed a patient and determined they need to go straight to triage as opposed to back door ER bed, did you not just contribute to the overall efficiency? I think you did...you just made it better for patients you will never see, you just reduced workload on some of your colleagues. It is a team effort.

No offense to you as I am sure you did not intend to sound this way but it almost sounds as if you are saying the call is not worthy of your time as opposed to the wasting of a resource. Just saying it kind of reads that way.

Anyways, stay and play followed by treat and release is the wave of the future...any newbies who do not know this, prepare yourselves.

Huge points made here. ak ought to be paid for this advice. We are the ones making the house calls and helping to induct patients into the system.
A good exam for the given situation is paramount. We need to give our own time in doing this work instead of further adding to the ED workload, triage takes time.

 

[RedAirplane]

But is it truly wasting a resource? Until you do a thorough exam, you simply do not know if it was a waste or not. Additionally, think of the entire care continuum...think about the receiving hospital. If you assessed a patient and determined they need to go straight to triage as opposed to back door ER bed, did you not just contribute to the overall efficiency? I think you did...you just made it better for patients you will never see, you just reduced workload on some of your colleagues. It is a team effort.

No offense to you as I am sure you did not intend to sound this way but it almost sounds as if you are saying the call is not worthy of your time as opposed to the wasting of a resource. Just saying it kind of reads that way.

Anyways, stay and play followed by treat and release is the wave of the future...any newbies who do not know this, prepare yourselves.

Excellent point. No I did not mean waste of my time. I truly was looking at overall utilization of resources. You have convinced me that a good assessment is worth the time because of the savings on the other end.

 

[Akulahawk]

Huge points made here. ak ought to be paid for this advice. We are the ones making the house calls and helping to induct patients into the system.
A good exam for the given situation is paramount. We need to give our own time in doing this work instead of further adding to the ED workload, triage takes time.

Speaking as an ER nurse, if we get a good report from a trusted Paramedic, we very well could easily initially triage the patient into a room or into the waiting room. Once that's determined, we'll retriage the patient anyway upon arrival to help ensure that the patient is going to the right place. Truly, stay & do an excellent assessment and report off for a good triage, followed by treat/release is coming especially to the busier places.

 

[Chewy20]

Being someone with a love of efficiency, the initial reaction was-- this is wasting a resource (the ambulance). If it's not an emergency, the sooner the patient can be handed off to someone else, the less time this unit spends unavailable for calls.

But I totally get it from the patient care perspective.

You realize the VAST majority of calls we go to are non-emergent right? So are those a waste of a resource? Maybe, but that's what the job is. Also you're new, so probably haven't hit the point where you want to sit in the hospital as long as possible.

 

[RedAirplane]

You realize the VAST majority of calls we go to are non-emergent right? So are those a waste of a resource? Maybe, but that's what the job is. Also you're new, so probably haven't hit the point where you want to sit in the hospital as long as possible.

See above, the issue of doing a thorough assessment to minimize wasted time in the hospital now makes sense to me.

My background is in Computer Science (with a splash of Economics thrown in there), so I tend to dissect things in terms of efficiency. Even assuming all calls were non-emergency, my ORIGINAL thought was that you could handle more of these non-emergencies with fewer units and fewer crews (and/or have better response times with the same level of staffing) if you could process each call faster. HOWEVER, It does make a lot of sense the time/resources saved at the receiving facility make the detailed assessment worth it.

 

[DesertMedic66]

See above, the issue of doing a thorough assessment to minimize wasted time in the hospital now makes sense to me.

My background is in Computer Science (with a splash of Economics thrown in there), so I tend to dissect things in terms of efficiency. Even assuming all calls were non-emergency, my ORIGINAL thought was that you could handle more of these non-emergencies with fewer units and fewer crews (and/or have better response times with the same level of staffing) if you could process each call faster. HOWEVER, It does make a lot of sense the time/resources saved at the receiving facility make the detailed assessment worth it.

Less crew and more calls is a very easy way to have provider burnout.

 

[RedAirplane]

Less crew and more calls is a very easy way to have provider burnout.

That's another "externality" of the situation to be taken to account.