What are some things that you have been taught that is total BS?

[HotelCo]

Rule out hypoglycemia...

Basics can do that here.

 

[Veneficus]

Rule out hypoglycemia...

Forgive me, blood glucose has been in the scope since I was an EMT-B, a long long time ago where I am from, but I see your point.

But I wonder about the thinking behind not being able to make the decision to a stroke center.

It would seem that it would be cheaper and more beneficial in places that don't have Basics with glucometers to get them rather than the delays, bills, and logistics of taking a suspected stroke to a nonneuro center.

 

[Veneficus]

if the patient will have to be transferred out immediately for care somewhere else..

That is an oxymoron in medicine.

Imediately transferred usually takes at least an hour usually 2 and that doesn't count the transport time.

 

[katgrl2003]

That is an oxymoron in medicine.

Imediately transferred usually takes at least an hour usually 2 and that doesn't count the transport time.

True, I forgot about that.

 

[Veneficus]

True, I forgot about that.

That also doesn't count the time when the original facility tries to do the $10 million workup for a dx that will be repeated at the stroke center any way because they need specific findings.

the field of EM is really getting under my skin this week.

 

[usalsfyre]

That also doesn't count the time when the original facility tries to do the $10 million workup for a dx that will be repeated at the stroke center any way because they need specific findings.

the field of EM is really getting under my skin this week.

Usually I find this to be less EM docs and more "FM working in the ED".

You know probably better than me EMTALA has more to to with taking an hour or more for transfer than EM specifically.

 

[Veneficus]

Usually I find this to be less EM docs and more "FM working in the ED".

You know probably better than me EMTALA has more to to with taking an hour or more for transfer than EM specifically.

Very true, but it is usually the EM who is ordering all kinds of diagnostics that she can't do anything about no matter what the outcome of them.

 

[johnrsemt]

I wish someone would tell the ED docs that flying is not faster than ground.

Katgrrl and I were at a ED just hanging around outside, went in to use the facilities and raid the fridge; was told by a nurse that they had a patient that they just called a bird for: trauma; multiple fractures. (11mile transport).
we told them that we could get the patient there in under 15 minutes. told no, the patient is too critical to ground transport. They waited 28 minutes from call to helicopter landing; 10 min for crew to come in, the crew took 26 minutes to eval patient, and 11 min for them to load patient on cot to go to bird (they used our cot). 12 minute to take off.
We left there when they took off, and drove to the Level I trauma center, NO L/S; 19 min drive time and was in the ED for 15 minutes when the patient came down off the pad to a bed.
121 minutes for helicopter to transport patient 11 miles (by road). We got there in 19 min without running emergent. But couldn't convince the doctor that we could do it faster

 

[usalsfyre]

Very true, but it is usually the EM who is ordering all kinds of diagnostics that she can't do anything about no matter what the outcome of them.

Billable units man, billable units...

Actually radiologist at one health system put their foot down here, either the patient receives films done to their specs on compliant equipment, or they don want the studies done till they get to the big hospital in the system.

 

[Veneficus]

Billable units man, billable units....

That says it all.

 

[lightsandsirens5]

I've been told that all the time. BLS can only transport to the closest medical center, even if it's just a bandaid station. Baloney. If my patient has s/s of a stroke, I will go the extra 15 minutes to a stroke center. If a medic can meet up with me in that time fine, but if not I'm not diverting.

Hear! Hear! You have no idea how much I get yelled at for suggesting we transport a nasty trauma, (eg. a guy with an arm that got twisted around a tractor PTO) an hour south to a trauma center instead of 20 minutes to a little hole in the wall rural hospital. What the heck is a level IV trauma center going to do for a pt who needs reconstructive surgery on his entire arm. But perish the thought that I would bypass the all important "closest facility."

Or how about when I see STE in two concurrent leads and am ridiculed for even thinking I can decide to head to the cath lab instead of the local ER. Back when I was newer and didn't know that I could do that, I was taught that everything I picked up HAD to go to the local ER. So one day we pick up a chest pain with STE in two leads (don't remember which). I called it, got the level one activated and took this pt to the local ER. Wish I had known that closest facility thing was actually false. I could have had the pt in a cath lab in 90 minutes. Instead, 20 minutes to the little ER, 20 minutes there while they come up with the same conclusion I did, an hour to get ground ALS up and an hour to the cath lab. Yea, somehow 2 hours and 20 minutes is better pt care than 90 minutes. Go figure. :-(

 

[TransportJockey]

Lights, what sucks even more is if your protocols specifically tell you that you MUST transport to the local county facility, even if you're closer to a facility in another state or the Level II two counties over.

 

[usafmedic45]

I wish someone would tell the ED docs that flying is not faster than ground.

We're trying.

 

[usalsfyre]

Lights, what sucks even more is if your protocols specifically tell you that you MUST transport to the local county facility, even if you're closer to a facility in another state or the Level II two counties over.

Usually crap like this is born our of "getting the unit back in service" more than what's appropriate for the patient.

 

[TransportJockey]

Usually crap like this is born our of "getting the unit back in service" more than what's appropriate for the patient.

I confronted the boss about it when I started (especially as I can legally transport into NM since I'm dual certed and my medical director will allow me to work in NM per NMDOH scope), and that's exactly the line I got.

 

[Veneficus]

Usually crap like this is born our of "getting the unit back in service" more than what's appropriate for the patient.

Or a medical director with a financial interest in making sure patients are steered towards their EDs.

I know of one specific instance where this is definately the case. If it happens once, it probably happens more.

 

[usalsfyre]

You don't even really need to be dual certed. As long as the trip originates or ends in the state of licensure or your requested as mutual aid.

This is why I'm glad I work for a larger service. Posting may be a pain in the balls, but having post trucks available does allow for things like transporting to appropriate facilities.

 

[LucidResq]

One of the dispatchers at an old job even tried to tell a medic that we couldn't transport to a stroke center, we had to go to the 'closest appropriate facility', which in her mind, was the hospital a block away.

Puh-lease... as a dispatcher, I can tell you I would probably slap a coworker if they tried to tell a crew where to go or not go. What right does an EMD-trained layperson miles from the patient have telling a paramedic what facility they need to take the patient in front of them to?

Was that an IFT gig?

 

[EMSrush]

I wish someone would tell the ED docs that flying is not faster than ground.

Katgrrl and I were at a ED just hanging around outside, went in to use the facilities and raid the fridge; was told by a nurse that they had a patient that they just called a bird for: trauma; multiple fractures. (11mile transport).
we told them that we could get the patient there in under 15 minutes. told no, the patient is too critical to ground transport. They waited 28 minutes from call to helicopter landing; 10 min for crew to come in, the crew took 26 minutes to eval patient, and 11 min for them to load patient on cot to go to bird (they used our cot). 12 minute to take off.
We left there when they took off, and drove to the Level I trauma center, NO L/S; 19 min drive time and was in the ED for 15 minutes when the patient came down off the pad to a bed.
121 minutes for helicopter to transport patient 11 miles (by road). We got there in 19 min without running emergent. But couldn't convince the doctor that we could do it faster

That's very, very interesting. I've always had my doubts about how much faster an air evac is... hmm....

 

[ffemt8978]

That's very, very interesting. I've always had my doubts about how much faster an air evac is... hmm....

We're an hour from the nearest hospital here, and it is a 30 minute flight for the helo. The only time the helo makes a difference for us is getting a patient to a level 2 trauma center which is 3 hours by ground, or 3.5 hours to a level 1.