Time spent on scene

neoclassicaljazz

neoclassicaljazz

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I was wondering, if you are on the scene with a patient that you know is going to the hospital and the hospital is a good ways away (20-25min), are you going to take the time to get vitals and all that on the scene or just get them in the ambulance and transport as soon as possible? Lets say its a non-emergency transport though.
 
Yep. I get at least one set of vitals before the patient is on my gurney.
 
I'm in no rush. I'll do whatever I need to do on scene, then have a nice, relaxed, safe ride in.
 
Unless the patient walks out to the ambulance or is an a hazardous area / position I always try to do my vitals and assessment first.

Our standard on scene time here would be around 20 minutes. We take our time to be thorough with assessment and treatment, because we have so many different hospitals for different conditions we need to have a working dx first.
 
I'll also do what I can on scene and do the rest while on the road. While I don't like to sit on scene, I know that some things are just simply easier to accomplish while on scene. I'm going to do my initial assessment, vitals, and so on while on scene. Even with scoop and run cases, I will do enough assessment/patient care that's necessary on scene and leave most quickly, because you have to know that the patient's that bad off to initiate ye olde scoop & run.
 
Thanks for the replies. I'm pretty new but we usually get some vitals and all that before we get the patient into the ambulance and I was wondering if this was common or if others would rather just get them into the ambulance and do all of that on the way to the hospital.
 
Personally the only vitals I get on scene, (unless we're going to do some type of treatment i.e albuterol, adenosine ect.) is the pt's pulse quality and their respirations. I pretty much answer the question, sick? or not sick? and do they need something right now, on scene. If not, I like having my on scene time as short as possible.
 
First, a quick caveat. Your assessment starts when you can first see the patient. Sick patients, in general, look sick. I don't need a hard number to see if the patient is breathing too fast or too slow.

So, for patients who don't look acutely sick:

Non-emergent IFTs (i.e. direct admits): Not really. I'll try to get a set of V/S before we leave, but it's not holding up the show.

Non-emergent 'emergency' calls (i.e. going to the ED): Full assessment on scene the vast majority of the time, but it's situation dependent.
 
To a point and with exceptions, the sicker the patient, the more time that should be spent to assess and initiate treatment.
 
If its not life threatening and a 20 min transport? I'll get my vitals and an assessment on scene and another set before calling in about 5 to 10 min out.

If the patient is in really bad shape, I do what I have to ABCS on scene, and the rest in the back. I will get bp before taking off to get a good reading. ALS is going to want to know vitals enroute if we were to intercept.
 
medicsb said:
To a point and with exceptions, the sicker the patient, the more time that should be spent to assess and initiate treatment.
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I agree to the with exceptions portion of your post. Each patient is definatly situation dependent.

I think whether I treat or not on scene has more to do with how fast we can get the pt in the ambulance. if it's quick, and they're sick, i'm not gonna fiddle fart on scene. I'm gonna do it all on the fly. if they're sick and it's gonna take some effort to get them out, i'm gonna spend a little time stablizing them.
 
Unless the Pt. is in need of immediate treatment we just load them up then hook them up to the Lifepack. To qualify this though, most of our calls are nursing home calls. Nurse gets a low pulse? 911. Pt has "severe stomach ache" 911. General rule, if they can be driven to the hospital in a car, then we do everything en-route. Nearest hospital is 25 min away.
 
For me it depends on the clinical presentation. Does the patient need me to begin care where I found him/her? Then yes, I'll get vitals right then and there and begin treatment as condition, presentation, environment dictate. Some houses we go to don't have lights, or airconditioning and it's just not feasible unless they're dead or dying.

The goal is to begin care as soon as possible. To take the ER to the patient within your scope of practice.

There is a difference between being FedEx with a lightbar and being a prehospital practitioner.
 
medicsb said:
To a point and with exceptions, the sicker the patient, the more time that should be spent to assess and initiate treatment.
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For a paramedic crew, yes. For an EMT crew, I respectfully disagree.
 
PoeticInjustice said:
I'm in no rush. I'll do whatever I need to do on scene, then have a nice, relaxed, safe ride in.
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Glad I'm not the only one. Generally spend 15-20 minutes on scene.

Unless there's a reason I need to be off scene quickly I get everything in place before the wheels roll. There are exceptions to that though, a 30+ minute transport being one of them but a lot still gets done before we move.
 
It's fluid. Am I less than 10 minutes to the hospital? Do I need to perform interventions prior to moving? Is the PT going to be a difficult IV?

All of those may cause me to spend a little more time on scene.
 
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When im a medic student, the patient dictates my scene time. If I cant do anything to make the trip more comfortable, if its life threatening, or if the patient is annoying, ill do what I can on the way.

Otherwise ill play a bit
 
I don't do crap on scene, with very few exceptions (e.g. 12-lead if warranted, cardiac arrest). And honestly that is double so for sick patients. Generally first question out of my mouth is "do you want to go to the hospital?" If the answer is yes I get them on the cot heading to the medic while I ask my questions. And any interventions are done in route.
 
JPINFV said:
For a paramedic crew, yes. For an EMT crew, I respectfully disagree.
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Yeah, I suppose I should have been more specific. But, for an EMT crew, the scene time for BLS should probably have little variation as there is less to do in terms of assessment and treatment. Cardiac arrest should probably produce some of the longer scene times.
 
medicsb said:
Yeah, I suppose I should have been more specific. But, for an EMT crew, the scene time for BLS should probably have little variation as there is less to do in terms of assessment and treatment.
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I disagree again. For the stable or questionable patient, spending a little time on scene is understandable, especially if at a SNF where being able to mine the chart for a few minutes can be helpful.

For the acutely unstable patient not in arrest, I don't see why the EMT crew should be doing anything more than getting a report, slapping on a NRB, and moving towards the ambulance. The lack of treatment options limits the utility of any on-scene assessment once the decision is made that the patient is critical.
 
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