Upgrade or transport?

[Tigger]

You have to remember that not everyone can remain calm in the case of a crashing patient. Even worse would be a rookie who either panics or his adreniline gets the better of him while he/she is behind the wheel.

But i do have to remind myself when reading these things most of you have ETA to the hospital shorter then some of the driveways I go on. And this definatey effects my view and opinions on the Als/bls arguments.

Yes not not everyone will remain calm with a patient circling the drain, but this phenomenon transcends all levels of providers. Being a medic does not make anyone immune to freezing up and making an irrational or reckless care decision.

There are also systems where the ALS/BLS argument barely exists I might add. Not everywhere is the same as your area, some places actually trust their BLS providers to do the patient right by the first goal of EMS--getting the patient to definitive care as safely and comfortably as possible.

 

[d0nk3yk0n9]

Flipping through it, it looks like the BLS protocols only covers major emergencies and nothing else. Also, it makes clear in the intro that the protocols are not an excuse to not use good clinical judgement.

Yeah, I just wanted to make the point that while in some places you get in trouble for realizing that it's a better idea to transport instead of waiting for ALS, in NY the protocols have the idea of using your judgement to make that decision built in.

 

[DownSouthMedic]

I work for a private company who provides BLS transport for the county. My company's protocols say any fall with +LOC is an ALS call. Today we're dispatched to a 61 y/o who fainted and fell. He had +LOC, Hx of head trauma years back, also Hx of seizures. His BP was 150/70 pulse 60. He had a pretty nice sized Lac on the side with previous head trauma. The engine on scene cancelled the rescue and wanted us to transport. We advised that this was an ALS call under our protocols. The crew got pissed. They ended up sending their medic with us. Was it wrong to upgrade or would you have transported? Keep in mind I'm at the BLS level. We were 20 min from the closest ED and traffic was heavy.

Kinda curious what county your in...I'm with a private BLS company as well, we transport for the city and the county, I keep a copy of both departments ALS to BLS protocol in my clipboard..sooo if there's ever a question I can pull out their own protocol..which many of them have never seen. Unfortunately we've had quite a few sketchy calls dropped on us..that's what led me to start carrying the protocols.

 

[Cup of Joe]

Yeah, I just wanted to make the point that while in some places you get in trouble for realizing that it's a better idea to transport instead of waiting for ALS, in NY the protocols have the idea of using your judgement to make that decision built in.

Thats because in highly populated areas, like NYC and Nassau county, you can be at a hospital quicker than you can get an ALS unit to scene. And then there are areas where transporting to the hospital could be 30+ minutes. This is one of the reasons almost every county has either their own set of protocols, or their own revisions to the state-wide protocols.