When will we stop running code?

[ffemt8978]

In other words my patients won't as they won't even be at hospital yet in many cases.

Ditto. We may not even be on scene in the "Golden Hour", depending upon where they are.

 

[AnthonyM83]

Our dispatchers don't gather information, call takers do though.

This whole grab and run mantra in EMS is ridiculous except in a very few cases.

Let me ask you this, I spent an extra two minutes on scene of a nasty 100 mph motorcycle accident so my partner and I could drop bilateral large bore lines because I wouldn't have had time to do both en route. Total scene time was 14 minutes. Did I do it wrong?

I'm a big fan of load an go. There is a correlation with time to trauma center and survival rates. I tend to emphasize it mainly because our service area has a problem with long scene times with critical traumas.

There definitely might be sometimes you'll decide to get an IV on-scene, because you feel you have a chance then, and he might lose pressure by the time you're en-route, etc etc, but that should me more of an exception.

Also, on-scene, I'd prefer all hands to be working on exposing and getting patient loaded as fast as possible, rather than setting up needles and IV bags. It would take a pretty big exception for me to stay on-scene two minutes for an IV. It's hard to justify how that benefits the patient. Get going, get one en-route, the second at the ER.

And to MedicSB said starting large bore IVs is just a courtesy to the ER, with a critical trauma, it's part of the standard of care to get your vascular access in case the patient needs intervention (whether from you or ER staff). It's not doing it for the ER, it's doing it because the patient requires it.

 

[medic417]

Ditto. We may not even be on scene in the "Golden Hour", depending upon where they are.

Really sucs when the family has to watch someone die waiting for us for hours.

 

[medicsb]

And to MedicSB said starting large bore IVs is just a courtesy to the ER, with a critical trauma, it's part of the standard of care to get your vascular access in case the patient needs intervention (whether from you or ER staff). It's not doing it for the ER, it's doing it because the patient requires it.

I know I didn't explicitly say it but my point is that one shouldn't sacrifice transport time for time to get 2 large bore IVs on scene. If you can get one quickly on scene then great, if you can't then go for it enroute. If you don't get 2 large bores, no big deal, the trauma team is fully capable of doing it themselves. Right now, there's no evidence that the prehospital IV (or 2) makes a difference (remember how the back of a police car has been shown to be just as good as an ambulance, if not better). If it makes a difference, it will be for TBI (via RSI) or pain management for the not-so-critical, less time-sensitive patient. In those cases, a 22g would be adequate most of the time (not that I'd place a 22).

 

[TransportJockey]

Ditto. We may not even be on scene in the "Golden Hour", depending upon where they are.

Assume for us. I love rural EMS for that reason lol

 

[Veneficus]

When they used to preach the golden hour I used to ask why do I even bother trying to help the patient cause they won't be in surgery in an hour or even two.

You must work in the middle of nowhere.

For us dwntown, surgery within 20 minutes of EMS drop off is a normal event. Only because it takes time to set up an OR.

When needed surgical intervention takes place right in the ED.

But aside from the relatively small amount of people who need immediate surgical intervention, there are still toys like blood that help considerably more than normal saline for those who are actually seriously injured.

As well for those with wounds that can be managed nonoperably, like low grade liver lacerations and some stabs and GSWs, knowing and initiating treatment sooner rather than later is just more useful that somebody laying in the street getting a couple of IVs.

For people who live and play where the benefits of society are not available, they can expect to die out there. Tragic perhaps, but predictable.

 

[RocketMedic]

Really sucs when the family has to watch someone die waiting for us for hours.

Meh, living in the sticks has its pros and cons. I personally live within 15 miles of a Level-1 trauma center and within eyesight of a regional hospital.

 

[RocketMedic]

Update: Responding emergent to everything really, really sucks.

 

[Veneficus]

Update: Responding emergent to everything really, really sucks.

I could use some lunch actually, if you're bringing it, lights and sirens are ok.

 

[RocketMedic]

I could use some lunch actually, if you're bringing it, lights and sirens are ok.

"Priority three, hand pain!"

"It's literally down the road. She's waving to us."

"EMERGENCY! ALL CALLS DESERVE AN EMERGENT RESPONSE!"

 

[ffemt8978]

"Priority three, hand pain!"

"It's literally down the road. She's waving to us."

"EMERGENCY! ALL CALLS DESERVE AN EMERGENT RESPONSE!"

Did she injure it while dialing 911? :rofl:

 

[RocketMedic]

Did she injure it while dialing 911? :rofl:

Starcare!

 

[Veneficus]

"Priority three, hand pain!"

"It's literally down the road. She's waving to us."

"EMERGENCY! ALL CALLS DESERVE AN EMERGENT RESPONSE!"

Hey, you never know what she uses that hand for. It could be really an emergency.

 

[Amberlamps916]

I'll throw in my 2 cents. My company didn't have any primary 911 contracts but we would be called in for backup service from time to time. Even though we were entrusted to provide emergency transport, we were never trained to use discretion when it came to driving either code 2 or 3. Now I know common sense plays into discretion at times but seriously, there are some people who don't have it.

For example, I recall one instance where a partner told me that they responded to a 5150 danger to self patient. He told me that they drove code 3 to the hospital because the patient was "suicidal" and it was a true emergency. I guess he didn't factor in the patient being in 4 point restraints into his decision to drive code 3.

I feel that companies should train and aid responders into making the right decision when it comes to driving lights and sirens.

 

[DrParasite]

Even though we were entrusted to provide emergency transport, we were never trained to use discretion when it came to driving either code 2 or 3. Now I know common sense plays into discretion at times but seriously, there are some people who don't have it.

you know, this is a great statement: who among us was actually (formally) trained and educated in the use of discretion for emergency response?

And while common sense might dictate at lot, we all know common sense isn't all that common.