What is your protocols for admin of IV NS

[medic417]

The biggest downfall of EMD is that you're essentially making a diagnosis based on a laypersons perception of the incident. Due to poor information given to dispatchers we have been dispatched non emergency to a PNB and we more often get dispatched emergency to someone that cut their finger while making supper. One trigger I know of that will kick out an emergency response is spurting blood, to a lay person that has never seen a real severed artery spurting blood is exactly what they see. Not a perfect system but it usually works pretty well.

ALS vs BLS debate I could go either way and it would depend on the entire setup of your system as to which would work most efficiently but generalizing saying that ALS should always be dispatched first I cannot agree with.

You even state dispatch gets it wrong. So why not err on side of caution and start with an ALS exam. Honestly with the limited "training" basics have they are not qualified to decide whether to allow it to stay basic or needs upgraded.

I have been dispatched many times for welfare check to find someone on deaths door. Had our service used a basic crew patients would have died.

 

[marineman]

Some areas have many BLS crews that can manage a 5 minute response time with fewer ALS crews with an average response time of closer to 15-20 minutes. The way I see it getting any level of care there soon is better than a higher level later.

I will agree with you that in the perfect little world that exists in my head all ambulances would be ALS and we would all have an education that rivals the best R.N. programs in the world but that simply isn't possible in all areas at the current time.

 

[medic417]

Some areas have many BLS crews that can manage a 5 minute response time with fewer ALS crews with an average response time of closer to 15-20 minutes. The way I see it getting any level of care there soon is better than a higher level later.

I will agree with you that in the perfect little world that exists in my head all ambulances would be ALS and we would all have an education that rivals the best R.N. programs in the world but that simply isn't possible in all areas at the current time.

So you are agreeing then that ALS should be first response. I hope that soon it becomes the standard everywhere. I would hate to be some where and my family have a real emergency and only get a BLS response.

 

[marineman]

Yes I agree that ALS should be the only response end of story, however I understand that it's just not possible in all areas right now so I give every system the benefit of the doubt that they're doing the best they can with the hand they've been dealt.

 

[BLSBoy]

Ask Florida and Cali how the all ALS thing went........

 

[marineman]

It's still a flawed system in general in those two states. That's why I do still agree with BLS in the system as it stands but would like to see changes in general that would solidify the system to support an entirely ALS response.

 

[BLSBoy]

The only thing I would like to see is a few more ALS units, and better training for EMTs.

Rare is it that BLS gets on scene, and needs to call for ALS.

 

[medic417]

The only thing I would like to see is a few more ALS units, and better training for EMTs.

Rare is it that BLS gets on scene, and needs to call for ALS.

I would bet it is more often than you realize. BLS providers are not educated enough to determine who needs ALS. If all EMTs upgraded to Paramedic we would not even have a discussion like this.

 

[marineman]

The only thing I would like to see is a few more ALS units, and better training for EMTs.

Rare is it that BLS gets on scene, and needs to call for ALS.

That may be your system but not at all the case across the country. On a BLS unit in Milwaukee if we administer any drug other than O2 we have to call for ALS to transport.

 

[BLSBoy]

I would bet it is more often than you realize. BLS providers are not educated enough to determine who needs ALS. If all EMTs upgraded to Paramedic we would not even have a discussion like this.

Like I said, go to Florida, or Cali, and see how well that went.

 

[BLSBoy]

That may be your system but not at all the case across the country. On a BLS unit in Milwaukee if we administer any drug other than O2 we have to call for ALS to transport.

Then they needed ALS to begin with.

What works in NYC won't work in rural Kansas, won't work in suburban Jersey.

What we have works for us.

Granted, EMTs need a better education, and we could use another ALS unit per county, but other then that, we have pretty damn good EMDs who screen each call well.

 

[medic417]

LOL.

 

[ffemt8978]

Get back on topic....

 

[tazman7]

The way we do it in our district is, if there is a medical call in a little town near us we will tone out their volunteer firefighters for the call. We will then leave at that same time to go to the call..sometimes they beat us other times they dont. ( I honestly think its a waste of taxpayers dollars to send these clowns out there but thats another topic.) But the problem with this is that there are only a couple emts (if thats what you call them) on their depts and they are guys that went through emt school 40 years ago and think they know everything. So then by the time we get there we basically just push them out of the way and tell them to hold doors open on our way out..

Last call I went on was for a stroke pt. We show up, the whole crew they sent is sitting at the kitchen table having coffee with the mans wife!!!! We look in the bedroom and the man is laying on his bed, barely breathing we sit him up, he cant even remember his name, sob, facial drooping, one sided weakness, you name it he had it...well the guy about died from this stroke he was having... and here you are sending a bls crew that doesnt know adam from eve and they think its a coffee shop...

Thats why i think als needs to be sent, and basics need alot more education.

 

[emtidon]

Oh, where to start. First of all, not every complaint needs an IV. Alot of the time, an asthmatic does need a neb treatment, but nothing else. Why would you start an IV on them? Or what about the peds patient who's mom called because he/she stuck a bead up their nose or might have swallowed a coin? There are plenty of patient's out there that there is no good reason for starting an IV on them. They simply do not need it. Part of the job of a paramedic is knowing when NOT to do something.

As for why some people call for help...Maybe they just want the reassurance that they are doing the right thing. New parents are easily spooked, especially if they haven't spent much time around babies/kids. We've all been on the little old lady (or man) that is just lonely and wants some company, even if it is only for 15-20 minutes. We will never know why some people choose to call EMS, but they do. Just because they pick up the phone, it does not mean that they all need XYZ procedure/treatment.

Well stated and like the quotes

 

[emtidon]

Some areas have many BLS crews that can manage a 5 minute response time with fewer ALS crews with an average response time of closer to 15-20 minutes. The way I see it getting any level of care there soon is better than a higher level later.

I will agree with you that in the perfect little world that exists in my head all ambulances would be ALS and we would all have an education that rivals the best R.N. programs in the world but that simply isn't possible in all areas at the current time.

I live in one of those areas in ND.We are lucky in the fact that most of our crew in my area are I-85 and Paramedic.We also have a Paramedic Quick response unit that gets dispatch on all our calls.I think in most cases the higher the level of response the better the outcome for the patient,as long as they are competent.I would rather see a good emt-b on a call than a not so good I or Paramedic.Because when you get right down to it we all are supposed to go for A B C first and after that its all gravy.

 

[Ridryder911]

Oh, where to start. First of all, not every complaint needs an IV. Alot of the time, an asthmatic does need a neb treatment, but nothing else. Why would you start an IV on them? Or what about the peds patient who's mom called because he/she stuck a bead up their nose or might have swallowed a coin? There are plenty of patient's out there that there is no good reason for starting an IV on them. They simply do not need it. Part of the job of a paramedic is knowing when NOT to do something.

As for why some people call for help...Maybe they just want the reassurance that they are doing the right thing. New parents are easily spooked, especially if they haven't spent much time around babies/kids. We've all been on the little old lady (or man) that is just lonely and wants some company, even if it is only for 15-20 minutes. We will never know why some people choose to call EMS, but they do. Just because they pick up the phone, it does not mean that they all need XYZ procedure/treatment.

Although I agree not every one warrants an IV, I highly suggest an Asthmatic gets one. Ever seen turn bad quickly? Try to get one then. Same, if they have a reaction to the updraft. Sorry, if they get a med, they get at least a lock and a monitor.

If the people call for whatever; then you should do a better assessment. If it is loneliness, then a social worker or adult protection should be notified.

I do agree: Treat you patient, not a protocol and do not make your patient fit a protocol, protocols should fit your patients needs.

Like I said, go to Florida, or Cali, and see how well that went.

Well, see who the primary provider(s) are in those states, and now we can see why it went that way.