Street EMS vs. Transport

[Sasha]

sitting behind the pt during transport

I will unashamedly admit that I sit in the airway chair during most transports unless I NEED to be at the patients side for a procedure/treatment.

I work in a vanbulance, the walls are curved, my transports span anywhere between 5 minutes to 5 hours. Sitting with your back curved constantly really hurts and makes me cranky, and I can do my job effectively from the airway chair most times.

 

[himynameismj]

I work in a vanbulance too. I'm 6 ft. 2. I always sit next to the patient. There's a reason dialysis centers have a lot of 911 calls. Dialysis is brutal on the body and those pt's are unstable. Just saying, it's gonna suck when you find out that post-dialysis nap was a silent arrest and you're 20 minutes too late.

 

[TransportJockey]

I work in a vanbulance too. I'm 6 ft. 2. I always sit next to the patient. There's a reason dialysis centers have a lot of 911 calls. Dialysis is brutal on the body and those pt's are unstable. Just saying, it's gonna suck when you find out that post-dialysis nap was a silent arrest and you're 20 minutes too late.

That is why if I have a long transport with a patient, they are at the minimum hooked up to SPo2 monitoring. You are more than welcome to risk you back in an accident, but I side with Sasha on this one. I sit in the airway chair, belted in, as much as possible. I value my life pretty heavily, and want to have the best chance out there of walking away if we get in an accident

 

[usalsfyre]

Examples include letting patients walk down the steps, walk long distances, doing rapid extrications for non-critical pt's (not using the KED), "forgetting" you have something called a scoop stretcher, "forgetting" you have a backboard for elder fall victims

Show me where ANY kind of spinal immobilization has made a difference in outcomes. Unless I find something hinky on assesment, I rarely board patients, and the KED sits quitely gathering dust in a compartment where it belongs. Most of the time more movement occurs when placing the patient in a KED than a smooth, controled move to a board (if a board is even needed).

taking the nursing home's vitals instead of your own and calling it a base,

The NH or hospital vitals may be important clues in what's going on. Look at trends, not individual numbers

sitting behind the pt during transport

I try to sit cotside on my criticals, but look at ambulance safety issues to see why I don't dog anyone for sitting in the airway seat.

avoiding the splint of a fx, etc. This is stupid stuff. Practicing "Street EMS" makes you crap, so my answer is.. do things the way the book says so. Your partner may look at you like you're WASTING HIS / HER TIME, but the truth is you're saving his *** from liability. LEARN PT ASSESSMENT.

Your right, learn assesment. Along with that, don't take EMS textbooks as dogma. ALOT of what we do is complete and utter crap with no scientific base behind it other than some guy saying "yeah that seems like a good idea" or a salesman selling his product. Street EMS may be an an excuse to be lazy, but "limiting your liability" is often an excuse to do useless/painful/harmful stuff to patients because people are too set in thier ways to look at current practices.

 

[usalsfyre]

I work in a vanbulance too. I'm 6 ft. 2. I always sit next to the patient. There's a reason dialysis centers have a lot of 911 calls. Dialysis is brutal on the body and those pt's are unstable. Just saying, it's gonna suck when you find out that post-dialysis nap was a silent arrest and you're 20 minutes too late.

If these patients are truly unstable, then why are they being discharged HOME? Dialysis is a safe procedure, done daily. If people were dropping like flies post-dialysis, don't you think someone woulda noticed?

 

[Shishkabob]

If the situation warrants me sitting on the bench, I'll sit on the bench, such as giving a med. However, most of the things I do, even ALS level monitoring with an EKG, can be done from the captains seat, and so that's where I spend most of my time, belted in.

 

[46Young]

Oh damn, here comes the soap box. "Street EMS" is literally a figment of some lazy crap EMT's imagination. The reason we have "Street EMS" is because most of today's EMS students think they're doctors post-initial training and refuse to actually learn the book right. That book was written by doctors. People who after all is said and done, have endured thousands of more hours than us in training. You should be appreciative that doctor's even took the time to recognize our importance back in the mid-60's which allowed us to grow. If you learn that book right (Especially Pt Assessment), you will be way ahead of your peers. If you are doing EMS in general, you need to be the best you can be. Learning that book is just a starting point in being the best that you can be. Follow up training involves CEU's on what you identify as your weak points, and continually practicing skills. "Street EMS" is literally a way of saying "I could be held accountable if something goes wrong here, but it makes my life easier". Examples include letting patients walk down the steps, walk long distances, doing rapid extrications for non-critical pt's (not using the KED), "forgetting" you have something called a scoop stretcher, "forgetting" you have a backboard for elder fall victims, taking the nursing home's vitals instead of your own and calling it a base, sitting behind the pt during transport, avoiding the splint of a fx, etc. This is stupid stuff. Practicing "Street EMS" makes you crap, so my answer is.. do things the way the book says so. Your partner may look at you like you're WASTING HIS / HER TIME, but the truth is you're saving his *** from liability. LEARN PT ASSESSMENT.

It would appear that you didn't read posts #2-4 on this thread. It was clarified that the OP was asking about 911 (street EMS) vs IFT (transport). What you're referring to is being lazy and/or burnt out, and that happens in both 911 and IFT. I don't understand the point of your post.

 

[himynameismj]

Why does everyone keep saying that the EMT textbook is not written by doctors? The most frequently published textbook, "Transportation of the Sick and Injured" (AAOS) was written by Dr. Eugene Nagel and colleagues. It has been edited multiple times since initial publication, but the fundamentals were in fact written by a doctor.

And as for riding the Captain's seat, I guess it comes down to preference but I do feel as pt advocates, making them feel like a person and not a job is important. I understand, multiple pt's are senile and beyond conversation but still, how professional is texting behind them? And as for anyone who is transporting an ALS pt in the emergency setting (originated from a 9-1-1 call), sitting behind them is completely unprofessional. I don't care how much flack I catch for that statement.

 

[JPINFV]

1. The profession has supposively evolved past ambulance drivers who load, go, and provide an NRB to every single patient as they race to the hospital.

2. Care to compare the first edition to the current edition?

3. To be honest, in current times I'd argue that a bunch of orthopedic surgeons are writing a book targeting a field outside of their speciality. EMS isn't about trauma anymore.

4. So because 1 physician was involved that physician speaks for all physicians?

 

[himynameismj]

Not at all, but I'm clarifying the book was indeed, written by a doctor. Multiple posts said it wasn't. Obviously, multiple edits probably make today's version look like a separate book all together. And absolutely no, one physician does not represent the entire bunch, however a little respect should be given (at the least, know his name) to the doctor who saw hope in our field.

 

[TransportJockey]

And as for riding the Captain's seat, I guess it comes down to preference but I do feel as pt advocates, making them feel like a person and not a job is important. I understand, multiple pt's are senile and beyond conversation but still, how professional is texting behind them? And as for anyone who is transporting an ALS pt in the emergency setting (originated from a 9-1-1 call), sitting behind them is completely unprofessional. I don't care how much flack I catch for that statement.

ALS pt in the emergency setting? Funny I don't think a tubed pt that you're bagging is going to care one way or the other (which by definition is an ALS emergent call).
I've sat airway on long distance transports every time, even if the patient is perfectly with it, not just senile. I don't text usually I'm charting, and still talking to the patient. I explain to them that while they are strapped in and safe, if I'm sitting on the bench it's less safe for me than if I was riding in the captains chair.. They usually understand.

 

[himynameismj]

We share different views, obviously. I'm going to continue to acknowledge my patients.

 

[TransportJockey]

We share different views, obviously. I'm going to continue to acknowledge my patients.

That we do. And keep in mind I keep talking and having a running dialog with my patients the entire way. I just like being able to walk away from an accident if one happened while I'm attending.

 

[JPINFV]

And as for riding the Captain's seat, I guess it comes down to preference but I do feel as pt advocates, making them feel like a person and not a job is important. I understand, multiple pt's are senile and beyond conversation but still, how professional is texting behind them? And as for anyone who is transporting an ALS pt in the emergency setting (originated from a 9-1-1 call), sitting behind them is completely unprofessional. I don't care how much flack I catch for that statement.

If you text in the back of my ambulance with a patient on board I'll write an incident report. I don't care how new or old you are.

Why is it unprofessional for paramedics in the 911 setting? Does the emergency physician sit in the same room as the patient for the entire time the patient is in the ER?

 

[LonghornMedic]

We share different views, obviously. I'm going to continue to acknowledge my patients.

Obviously you have not seen the multitude of ambulance crash test videos with crash test dummies flying forward and impacting cabinets at even low to moderate speeds. Or maybe you haven't seen the inside of the patient compartment after an MVA with crap strewn everywhere. Unless that patient requires me to be constantly providing patient care, I move to the airway seat and buckle in. In no way does it affect patient care and most importantly....it keeps me safe. I'm guess I'm just selfish in wanting to go home safe and sound after every shift.

 

[MrBrown]

Why does everyone keep saying that the EMT textbook is not written by doctors? The most frequently published textbook, "Transportation of the Sick and Injured" (AAOS) was written by Dr. Eugene Nagel and colleagues. It has been edited multiple times since initial publication, but the fundamentals were in fact written by a doctor.

Um, wasn't "Emergency Transportation of the Sick and Injured" written by Nancy L. Caronline MD on behalf of the American College of Orthopaedic Surgeons?

We here in New Zealand threw out using the Prehospital Emergency Care textbook because it was absolute rubbish.

Just because something is written by a doctor does not make it correct. If the consortium of physicans wouldn't cop so much flak from the shortsighted Paramedic/EMT student who just wants to learn the minimum possible and not all that "hard stuff" the books would be ten times as thick.

 

[himynameismj]

"Emergency in the Streets" is Nancy L. Caroline, M.D. She wrote the Paramedic Book.

 

[JPINFV]

Isn't that the one with Sidney Sinus because cardiology is too complicated?

 

[himynameismj]

I'm not sure, haven't hit that chapter yet. I'm reading "Cardiology Made Ridiculously Simple".

 

[MrBrown]

The problem with medicine is that it cannot be made "ridiciously simple"

How in the bloody hell you can expect to produce competent medical professionals without even requiring a basic chemistry or anatomy/physiology class is beyond me.

Perhaps that is why you get all these hillariously silly concepts and notions that try to boil everything down for the lowest common denominator.

I am not arguing that everybody will have various methodologies of learning but rather teaching silly concepts like Sidney Sinus and how lidocaine numbs the heart just drives me crazy.