What Gets ALS?

[DrParasite]

I know we've sent a few out to triage with locks on. As long as you're not actively giving meds through it, why not?

and the response is:

For whatever reason its a big deal when patients walk out with an IV still in though

We used to send the cops and EMS to pull the IV lock; I suspect it was due to hospital liability, but I always wondered what would happen if the patient refused to let us touch him and refused to let the cops in the door......

 

[DesertMedic66]

It becomes an issue for the hospital when a patient of theirs walks out of the hospital with an IV still in place. It's happened around here. Hospital will contact LEO who will search for the party and bring them back to the ED to have the IV pulled.

 

[MonkeyArrow]

It becomes an issue for the hospital when a patient of theirs walks out of the hospital with an IV still in place. It's happened around here. Hospital will contact LEO who will search for the party and bring them back to the ED to have the IV pulled.

Huh. Never heard of that here. We routinely line and lab people while in the waiting room. Sometimes, we even get IV antibiotics or fluids running in the waiting room. The attitude here is if they want to leave, let them leave. But I guess we haven't been burned before...

 

[agregularguy]

Never heard of that here either. Interesting.

 

[DesertMedic66]

Huh. Never heard of that here. We routinely line and lab people while in the waiting room. Sometimes, we even get IV antibiotics or fluids running in the waiting room. The attitude here is if they want to leave, let them leave. But I guess we haven't been burned before...

For all of our hospitals here there is a separate area in the lobby that is usually behind a locked door where patients get lab draws/IV fluids/antibiotics. Those are not done in the lobby seats with everyone around with the ability to walk out of the hospital at any time, which is where we place patients when we drop them off.

 

[luke_31]

The IV thing is to cover the hospital in the event the patient is a drug user and decides they want to mainline a hit though the IV. If it's no longer there when the patient leaves the hospital isn't liable if the patient later dies of an overdose

 

[NomadicMedic]

While I was doing paramedic clinicals in Tacoma, we had a patient cone in, ostensibly in sickle cell crisis. I started his line and fluids. He went outside to smoke a cigarette and eloped. He was found unresponsive a short time later, overdosed, behind a gas station, with a syringe attached to his IV catheter.

 

[medicsb]

I place locks in patients that "I" feel (IMO) would benefit from not just my meds, but perhaps an ED bed, lab work, or even a quicker "treat and street", or admission that much sooner.

My experience is that prehospital IV makes no difference in length of stay. At least one small study demonstrated such: https://www.ncbi.nlm.nih.gov/pubmed/9799021. If it is a sick patient, then yes, an IV can save us time for initiating treatment.

 

[RocketMedic]

My experience is that prehospital IV makes no difference in length of stay. At least one small study demonstrated such: https://www.ncbi.nlm.nih.gov/pubmed/9799021. If it is a sick patient, then yes, an IV can save us time for initiating treatment.

I think that judging acuity by who gets an IV is an incomplete measurement. Plenty of patients don't need IV access for transport, and it likely doesn't matter a whole lot when they get it, but it is also an expectation of ALS in many communities that we initiate care prior to arrival at a hospital. For example, DKA- it probably doesn't matter when IV access is started and fluid starts flowing on a 10-15 minute transport.