When will we stop running code?

[medic17]

Did you read any of the other posts? The point is, private ambulance companies respond emergent to calls where there is already an EMT on site, who is managing patient care and HAS NOT called for ALS. They do this ONLY to meet time requirements in the contract. That is simply dangerous and reckless.

I have no issue with first responders making a hot initial response if the dispatch criteria warrants. i.e., a reported cardiac arrest or severe respiratory difficulty. I also have no problem with medics making a response to an emergent ALS call, if the dispatch criteria is met.

Yes but it should be illegal to go hot for any reason that i did not mention.

 

[Handsome Robb]

Yes but it should be illegal to go hot for any reason that i did not mention.

You should look up Emergency Medical Dispatching.

We go cold to headaches and "sick people" all day long. Hell, I want cold to a chest pain call the other day. Albeit he was 18 and had no other symptoms.

Who made your word law?

 

[Tigger]

You should look up Emergency Medical Dispatching.

We go cold to headaches and "sick people" all day long. Hell, I want cold to a chest pain call the other day. Albeit he was 18 and had no other symptoms.

Who made your word law?

As it should be. It is not possible for only certain "conditions" to determine the priority of a response. Certain signs and symptoms (as you note) trigger the dispatcher to assign a priority.

It would be foolish for a field provider to make their own priority determination based on what information dispatch has given them as more often than not the responding unit is not necessarily getting the whole picture.

 

[mpena]

And then spend 5+ minutes before unloading the pt once at the hospital.

We have priority dispatch. We run hot to about 60% of our calls. Most of them do not require a hot responce. I can count on one hand the number of times I have gone to the hospital hot this year. We have some crews that go hot for just about everything. It has been my experience that ppl who run code for everything are not comfortable in their assessment/skills or are new.[/

Please, enlighten us..

 

[Medic Tim]

Please, enlighten us..

What do you want to hear? do you disagree?

I have worked for different companies in different countries and my experiences were similar. Providers who for whatever reason are not confidentcomfortable assessing pt usually go code for the slightest thing. With experience , time, and education some become more comfortable with their role and abilities. There are also those that have the notion that driving code is safer and saves time. Instead of addressing the needs of the pt they rush to the hospital with minimal assessment and treatment.

I am sure other peoples experiences are different than mine but I know others have had the same/similar experience.

 

[medic17]

What do you want to hear? do you disagree?

I have worked for different companies in different countries and my experiences were similar. Providers who for whatever reason are not confidentcomfortable assessing pt usually go code for the slightest thing. With experience , time, and education some become more comfortable with their role and abilities. There are also those that have the notion that driving code is safer and saves time. Instead of addressing the needs of the pt they rush to the hospital with minimal assessment and treatment.

I am sure other peoples experiences are different than mine but I know others have had the same/similar experience.

In my EMS we have protocol to keep time in the field to a minimum. Unless we can diagnose the sickness (or no sickness sometimes) we transport and do the second survey in the rig (although this is not always the case and much is left to the highest ranking medic to decide) . I remember a call i witnessed before i got licensed for 38 y/o F chest pain and difficulty breathing no history of lung or heart problem. The EMT at the seen measured VS all normal and transported. (It turned out to be a vary Mysterious case. The doc said panic attack but 4 months later she was diagnosed with a severe psychiatric condition and sent to a mental hospital. Left with 100% disability.)

 

[medic17]

You should look up Emergency Medical Dispatching.

We go cold to headaches and "sick people" all day long. Hell, I want cold to a chest pain call the other day. Albeit he was 18 and had no other symptoms.

Who made your word law?

It is up to the dispatcher to try to get all the picture but if there is no clear picture we respond hot. The example you mentioned is not a hot case.

 

[Handsome Robb]

It is up to the dispatcher to try to get all the picture but if there is no clear picture we respond hot. The example you mentioned is not a hot case.

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?

 

[RocketMedic]

In my EMS we have protocol to keep time in the field to a minimum. Unless we can diagnose the sickness (or no sickness sometimes) we transport and do the second survey in the rig (although this is not always the case and much is left to the highest ranking medic to decide) . I remember a call i witnessed before i got licensed for 38 y/o F chest pain and difficulty breathing no history of lung or heart problem. The EMT at the seen measured VS all normal and transported. (It turned out to be a vary Mysterious case. The doc said panic attack but 4 months later she was diagnosed with a severe psychiatric condition and sent to a mental hospital. Left with 100% disability.)

$15/hour. (seen = scene, very, mysterious need not be capitalized.) Writing is one of my pet peeves, and it helps you to communicate ideas when you use correct punctuation.


This is a perfect example of poor education, folks (not to pick on you, medic17.) Even with an active, severe medical or psychiatric emergency, the vast majority of our patients are not actively dying, nor are they going to benefit from emergent transport. Unless those assessment findings detect an emergent life threat that can literally kill/disable them in minutes and your transport time will be impacted by L/S, the only thing you did for that patient was to place her and yourselves at risk where there need be none.
We've all done it, either due to inexperience, ignorance or procedure. It's done every day. That doesn't make it right.

 

[Jon]

What do you want to hear? do you disagree?

I have worked for different companies in different countries and my experiences were similar. Providers who for whatever reason are not confidentcomfortable assessing pt usually go code for the slightest thing. With experience , time, and education some become more comfortable with their role and abilities. There are also those that have the notion that driving code is safer and saves time. Instead of addressing the needs of the pt they rush to the hospital with minimal assessment and treatment.

I am sure other peoples experiences are different than mine but I know others have had the same/similar experience.

I tend to use lights far more during transport at my rural/suburban job than my suburban or suburban/urban jobs. When every hospital is 15-20 minutes away, I'm a fan of "getting there" sometimes, especially if there really isn't anything I can do for the patient.

As to the comment of "5 minutes in the back before you unload" - It's always bugged me when I see medics that will sit at a scene and camp out in the truck for 5-10 minutes (when the hospital is 5 minutes away) or futz around in the back at the hospital. If you can't get it done, don't do it, and don't let a nurse browbeat you because she has to do her job and start an IV and draw bloods. I try to spend as little time camped on a scene as possible - if the patient truly needs IV meds, I might get a line, but we're moving as soon as it's secured.

Jon

 

[Veneficus]

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 wouldn't say wrong, but not a good idea.

So you have 2 IV lines? So what?

Serious trauma does benefit by grab and run.

 

[medicsb]

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 tend to agree that "load and go" is wayyy over-rated. In most cases, taking an extra 5 minutes to get everything in order is not a bad idea. I generally think it's fine if scene time is ≤ 20 minutes. But, for severe trauma, it is best to keep it short as possible. The 2 large bore IVs should be thought of as a courtesy to the hospital and not a requirement. My general approach was get any IV (even if just a 20g) as soon as the patient was loaded as it would usually take a minute or 2 for equipment to be loaded and for the EMT to get in the driver's seat. I'd use that interval to get an IV and then go for a 16 or 14 enroute.

If all you get is a 20g, it can still be used for meds. If the patient really needs blood/fluid, the trauma team should be able to throw in a 8.5 fr CVC pretty easily.

 

[RocketMedic]

I'll delay onscene to secure an airway, but generally, IVs aren't on my short list for serious trauma.

 

[TransportJockey]

I'll delay onscene to secure an airway, but generally, IVs aren't on my short list for serious trauma.

Same here, especially with my long transport times. Although half the time I will just throw in an MLA and call it good.

 

[medic417]

I wouldn't say wrong, but not a good idea.

So you have 2 IV lines? So what?

Serious trauma does benefit by grab and run.

I tend to agree that "load and go" is wayyy over-rated. In most cases, taking an extra 5 minutes to get everything in order is not a bad idea. I generally think it's fine if scene time is ≤ 20 minutes. But, for severe trauma, it is best to keep it short as possible. The 2 large bore IVs should be thought of as a courtesy to the hospital and not a requirement. My general approach was get any IV (even if just a 20g) as soon as the patient was loaded as it would usually take a minute or 2 for equipment to be loaded and for the EMT to get in the driver's seat. I'd use that interval to get an IV and then go for a 16 or 14 enroute.

If all you get is a 20g, it can still be used for meds. If the patient really needs blood/fluid, the trauma team should be able to throw in a 8.5 fr CVC pretty easily.

I'll delay onscene to secure an airway, but generally, IVs aren't on my short list for serious trauma.

Same here, especially with my long transport times. Although half the time I will just throw in an MLA and call it good.

Exactly because we don't want them to die because we missed the golden hour.:rofl:

 

[TransportJockey]

Exactly because we don't want them to die because we missed the golden hour.:rofl:

Lol even if I do nothing on scene I miss that fictional golden hour. I just have plenty of time to do everything en route... And then some.

 

[medic417]

Lol even if I do nothing on scene I miss that fictional golden hour. I just have plenty of time to do everything en route... And then some.

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.

 

[VFlutter]

On a side note: I was downtown yesterday walking around for school when a multi-alarm fire was paged out. I ended up seeing 3 STLFD Fire trucks and 2 ambulances from various stations going to the scene and all of them did a horrible job of clearing intersections. The one firetruck was going ~35 mph through a red light with no attempt to slow down or check for oncoming traffic with almost resulted in an accident. It was insane.


Reminds me of this crash that happened a while ago.

http://www.youtube.com/watch?v=3jAmoXl8fws&feature=plcp

 

[AnthonyM83]

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.

I've definitely seen them in surgery within that time.

What do you want to hear? do you disagree?

I have worked for different companies in different countries and my experiences were similar. Providers who for whatever reason are not confidentcomfortable assessing pt usually go code for the slightest thing. With experience , time, and education some become more comfortable with their role and abilities.

I've only worked in systems were responding code 2 or code 3 is pre-decided by EMD and protocols, not at discretion of ambulance....still, I haven't noticed a correlation between poor assessment skills and wanting to go faster. The determinant to wanting to get to the call faster usually has to do with age and newness level and excitability.

Now, wanting to transport code 3 TO the hospital, does seem to have some correlation with confidence in TREATMENT skills (which is also based on assessment).


Also, might be different in some areas, but around the busy areas here, going code 3 isn't about rushing to get to the call. It's just a routine driving to cut response times by 10 to 30 minutes...it's not unusual to see the attendant sleeping or reading the paper on the way there (not that that's appropriate). Lights/Sirens does NOT equal HaulAss.

 

[medic417]

I've definitely seen them in surgery within that time.

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