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I don't understand how any rational person could even begin to argue that transport mode is anything other than a clinical decision.
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the 100% directionless thread
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I don't understand how any rational person could even begin to argue that transport mode is anything other than a clinical decision.
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The same people that require their ambulances transport every single patient (including BLS stubbed toes) L&S even as the paramedic in the back is requesting cold transport. Rational has nothing to do with it.
NomadicMedic
I know a guy who knows a guy.
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Delaware has a lovely piece of legislation called "fire chief's law" which, in effect, makes the fire command officer el supreme commander of everything on the scene. Everything. Overruling the medics, state police.... Even the governor. Now, why Chaz mentioned does happen, but it's certainly not the rule. There are some medics here who've been a fly in the ointment and will always be overruled by the fire chief. But, in the majority of cases, if the medic tells the chief, "I don't need the helicopter", it's cancelled.
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MrJones
Iconoclast
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We let 'em design our ambulances - might as well let them tell us when we can use them....
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Today we've had two arrests and nothing else. Bodes real well for March.
TransportJockey
Forum Chief
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So what do people know about UMC EMS in Lubbock? One of the medics here is talking it up and it sounds interesting
Well, I know it's in Texas, and thus should be avoided.
TransportJockey
Forum Chief
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Lol my last job before getting drug back to the land of entrapment was in West Texas. .. I didn't completely hate it
Anjel
Forum Angel
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Venting.....
Last night was absolutely horrible. I messed up on a critical care transport we took and didn't get the info that the cath lab needed. And the sending hospital didn't call report like they said.
This lady was 84 shoveling show started having chest pain and enroute to the cardiac facility she went unresponsive so the FD diverted to the smaller hospital 2 miles from the cardiac facility.
We picked her up. She was on a vent, propofol drip and heparin drip. Her dose of propofol was 45mcg/kg/min and she was still waking up trying to talk, and pull out anything she could grab on to. They gave 10mg of versed and she was finally sedated, but her pressure dropped dramatically on the way to the other hospital, and she woke up on the cath lab table.
Just a mess all around. I was exhausted, frustrated, and was made to feel like a complete idiot. Ugh can't wait to come back tonight.
/vent
Last night was absolutely horrible. I messed up on a critical care transport we took and didn't get the info that the cath lab needed. And the sending hospital didn't call report like they said.
This lady was 84 shoveling show started having chest pain and enroute to the cardiac facility she went unresponsive so the FD diverted to the smaller hospital 2 miles from the cardiac facility.
We picked her up. She was on a vent, propofol drip and heparin drip. Her dose of propofol was 45mcg/kg/min and she was still waking up trying to talk, and pull out anything she could grab on to. They gave 10mg of versed and she was finally sedated, but her pressure dropped dramatically on the way to the other hospital, and she woke up on the cath lab table.
Just a mess all around. I was exhausted, frustrated, and was made to feel like a complete idiot. Ugh can't wait to come back tonight.
/vent
I hate calls like those.
Remember, though, it's all the FD's fault. Next time you see them, kick them in the balls.
Actually, it doesn't matter, kicking the FD in the balls is always worth it.
NomadicMedic
I know a guy who knows a guy.
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So, not for nothing, but why is that your fault? Sounds like the sending hospital was behind the 8 ball and you got caught in the undertow. Do you normally transport vented and sedated patients? I'll admit I only did CCT for a year, but I transported these type of patients almost every day. Unstable From the community hospital to Seattle or Tacoma. I found that Diprivan usually wasn't enough to sedate patients effectively during a bumpy ambulance ride. Our medical directors made it a rule that agitated patients would receive a paralytic, sedation and analgesia for the ride, dosed appropriately. If the community hospital didn't provide that package, the medics had standing orders to medicate the patient prior to transport. We were moving to Ketamine when I left, but my choices were Ativan or Versed along with Roc and fentanyl or morphine. Does your service provide additional training for CCT or do they just throw you on the truck and say, "good luck"? It shouldn't be a hurry up and go type of thing. When you're doing a CCT of an unstable patient, you should take as much time as you need to get all the info, the patient squared away and YOURSELF comfortable with the transport. (Or as comfortable as you can be.)
There are many more experienced CCT medics that can weigh in on this... Just sounds like you got caught up in the wave of "we're unprepared, but we're going right now anyway!"
There are many more experienced CCT medics that can weigh in on this... Just sounds like you got caught up in the wave of "we're unprepared, but we're going right now anyway!"
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Dude they didn't put her through an FTO period, I doubt there's anything special for CCT.
That's :censored::censored::censored::censored:ed Anjel I'm sorry. That's bogus on the sending's part and it's even worse that the receiving got in a giddy about it, the sending doc is responsible for that patient until the receiving doc accepts the transfer of care. Yell at the doctor that :censored::censored::censored::censored:ed up or the nurse that didn't call report, don't shoot the messenger.
Anjel
Forum Angel
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I got training on how to turn on the vent that's about it. And no this is only the 4-5 time I have taken a call like this.
The sending facility was in a huge hurry to get her out. They called us priority 1 (L&S) and practically pushed us out the door. Every time I would as a question they would say "don't worry they will have the full report when you get there".
It was a 2 mile transport and I didn't have time to go through paperwork. I didn't ask the patients medical hx or allergies or weight. That's what they were the most angry about. Also I wrote down the dose of the drips but not the drip rate. And our pump was turned off before they had theirs set up. And they didn't know what to run it at. So they were super pissed. And making fun of us as we were leaving.
I just felt like an idiot. I have no idea what I'm doing on those calls.
The sending facility was in a huge hurry to get her out. They called us priority 1 (L&S) and practically pushed us out the door. Every time I would as a question they would say "don't worry they will have the full report when you get there".
It was a 2 mile transport and I didn't have time to go through paperwork. I didn't ask the patients medical hx or allergies or weight. That's what they were the most angry about. Also I wrote down the dose of the drips but not the drip rate. And our pump was turned off before they had theirs set up. And they didn't know what to run it at. So they were super pissed. And making fun of us as we were leaving.
I just felt like an idiot. I have no idea what I'm doing on those calls.
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I love you to death darling but your agency needs a wake up call.
Anjel
Forum Angel
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NomadicMedic
I know a guy who knows a guy.
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Agreed. That is super sketchy. Really, it just sets you up for failure.
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Vent as much as you need to, it is therapeutic (better with a beer) but make sure you also recognize that most of this is on your head, not your company. While the hospital certainly didn't do you any favors, there were plenty of things you could have done to smooth the trip.
45mcg is a pretty low dose for propofol; no wonder she was waking up. And 10mg of versed, in someone who's already having issues with their heart...no wonder her pressure dropped. That's the hospitals fault, but, what did you do to correct this? Are you allowed to adjust the drip rate or provide your own sedation? If so, with what? In the future it's worth "asking" if they want you to give something like fentanyl or ketamine (if you have it) instead of versed for some patients. It may not change things, but your job is still to be a patient advocate.
Her waking up in the cath lab goes squarely on you. Continued sedation is your responsibility; did you have your sedative of choice right there, drawn up and ready to go? If not, why? Why was your propofol drip turned off before theirs was ready? In the future you need to be willing to stand up for the patient and what they need; part of that is making sure that the hospitals equipment is ready to go, and part of that will be telling them how much of a sedative the patient is getting. The staff being pissy because you didn't know the exact drip rate is a bit of a cop-out for them; if they can't figure that out that's a problem. But...if they are using the same concentration of a drug as you that does make it go smoother. Just like bringing a patient into the ER, there will be a lag between your arrival and when the hospitals care will truly start; make sure you are prepared to bridge that gap.
If you have a vent that you are supposed to use it is inexscusable for you to not know how to use it. Doesn't matter if you got little or no official training; it's your responsibility. Find the manual, read and reread it, and go over and over the ventilator until you can use it in your sleep and know how to troubleshoot any problems that come up. Unacceptable to do anything less.
Hospitals are often in a hurry, especially with "unstable" or "critical" patients (ie the ones they aren't equipped to deal with). Make sure you take the time that's needed to find out the information you need; history of present illness, meds given prior, meds currently being given, reaction to those meds, vent settings (if applicable), current vitals (including labwork if applicable), past history, allergies, plan at the receiving hospital. If you need to be a little firm to get that then do so. But, pick your battles. Sometimes it may be easier to load the patient and then take a few minutes before leaving to find the needed info in their paperwork. Once they are in your truck they are your responsibility; if you need to know something, take the time to find it. You just found out the hard way that someone may not actually call report, if they do the report might not get to the right people, or it may not contain the right info. Be ready to fill in the details.
All to often hospitals get so focused on getting the patient out that they neglect both the patient's care, and what will happen at the receiving facility. Your job is not just to take them from point A to B, but to properly treat them in between, and make sure the transition is as smooth as possible.
So...take it as a learning experience. Maybe write down what didn't go well and what could have been done to make it better. If this is a rarer type of call for you, I'd consider having a written plan for the things you NEED to know, the things you NEED to do, and one for the things that are nice to know and do. Until you've got more experience it'll help a lot.
45mcg is a pretty low dose for propofol; no wonder she was waking up. And 10mg of versed, in someone who's already having issues with their heart...no wonder her pressure dropped. That's the hospitals fault, but, what did you do to correct this? Are you allowed to adjust the drip rate or provide your own sedation? If so, with what? In the future it's worth "asking" if they want you to give something like fentanyl or ketamine (if you have it) instead of versed for some patients. It may not change things, but your job is still to be a patient advocate.
Her waking up in the cath lab goes squarely on you. Continued sedation is your responsibility; did you have your sedative of choice right there, drawn up and ready to go? If not, why? Why was your propofol drip turned off before theirs was ready? In the future you need to be willing to stand up for the patient and what they need; part of that is making sure that the hospitals equipment is ready to go, and part of that will be telling them how much of a sedative the patient is getting. The staff being pissy because you didn't know the exact drip rate is a bit of a cop-out for them; if they can't figure that out that's a problem. But...if they are using the same concentration of a drug as you that does make it go smoother. Just like bringing a patient into the ER, there will be a lag between your arrival and when the hospitals care will truly start; make sure you are prepared to bridge that gap.
If you have a vent that you are supposed to use it is inexscusable for you to not know how to use it. Doesn't matter if you got little or no official training; it's your responsibility. Find the manual, read and reread it, and go over and over the ventilator until you can use it in your sleep and know how to troubleshoot any problems that come up. Unacceptable to do anything less.
Hospitals are often in a hurry, especially with "unstable" or "critical" patients (ie the ones they aren't equipped to deal with). Make sure you take the time that's needed to find out the information you need; history of present illness, meds given prior, meds currently being given, reaction to those meds, vent settings (if applicable), current vitals (including labwork if applicable), past history, allergies, plan at the receiving hospital. If you need to be a little firm to get that then do so. But, pick your battles. Sometimes it may be easier to load the patient and then take a few minutes before leaving to find the needed info in their paperwork. Once they are in your truck they are your responsibility; if you need to know something, take the time to find it. You just found out the hard way that someone may not actually call report, if they do the report might not get to the right people, or it may not contain the right info. Be ready to fill in the details.
All to often hospitals get so focused on getting the patient out that they neglect both the patient's care, and what will happen at the receiving facility. Your job is not just to take them from point A to B, but to properly treat them in between, and make sure the transition is as smooth as possible.
So...take it as a learning experience. Maybe write down what didn't go well and what could have been done to make it better. If this is a rarer type of call for you, I'd consider having a written plan for the things you NEED to know, the things you NEED to do, and one for the things that are nice to know and do. Until you've got more experience it'll help a lot.