worried about losing my license

So what exactly is the issue? The words "BLS code 2" means nothing where I am, so I have no idea whether or not what you did(or didn't do) was in fact stupid. You said it was an IFT, so where did you transport this person, and did you report to wherever you brought them that the staff stated they had been "more altered than usual" for the past WEEK?

Also you stated the pt's vitals were stable, but what did your assessment reveal? What was their orientation? Fever? Blood sugar? Lung sounds? Stroke assessment? Pertinent hx? Physical exam? Anything abnormal about their urination? Are they on dialysis?

Did the staff just mention offhand they seemed a little more out of it the past week or was it something they seemed concerned over, since theres no way for you to know what this persons baseline mental status is? Apparently the staff weren't particularly concerned about this mental status change if they never did anything about it or contacted 911, so what has you so concerned?
 
hogwiley said:
So what exactly is the issue? The words "BLS code 2" means nothing where I am, so I have no idea whether or not what you did(or didn't do) was in fact stupid. You said it was an IFT, so where did you transport this person, and did you report to wherever you brought them that the staff stated they had been "more altered than usual" for the past WEEK?

Also you stated the pt's vitals were stable, but what did your assessment reveal? What was their orientation? Fever? Blood sugar? Lung sounds? Stroke assessment? Pertinent hx? Physical exam? Anything abnormal about their urination? Are they on dialysis?

Did the staff just mention offhand they seemed a little more out of it the past week or was it something they seemed concerned over, since theres no way for you to know what this persons baseline mental status is? Apparently the staff weren't particularly concerned about this mental status change if they never did anything about it or contacted 911, so what has you so concerned?
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In LA County, the fd runs als units, and all the ambulances are private bls companies.

Code-3 means priority one, or lights & sirens

Code-2 means priority two, or no lights & sirens.

An ALS transport means the fd paramedics are riding in your bls ambulance

A BLS transport means there is no need for an ALS follow up, and the bls ambulance transports alone.
 
So I gotta ask, what is code 1? Transport in firetruck? :P
 
Grimes said:
So I gotta ask, what is code 1? Transport in firetruck? :P
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Some places use code 3 as lights and sirens, code 2 as lights no sirens and code 1 as no lights no sirens.
 
Grimes said:
So I gotta ask, what is code 1? Transport in firetruck? :p
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Code 3 is lights and siren
Code 2 is no lights and no siren but we have to go directly somewhere
Code 1 is we don't have anywhere we need to go and can do whatever we want haha.
 
DesertEMT66 said:
Code 3 is lights and siren
Code 2 is no lights and no siren but we have to go directly somewhere
Code 1 is we don't have anywhere we need to go and can do whatever we want haha.
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Got it, so y'alls code 1 is essentialling clearing scene, no patient found/pt refusal.
 
Ivan_13 said:
In LA County, the fd runs als units, and all the ambulances are private bls companies.

Code-3 means priority one, or lights & sirens

Code-2 means priority two, or no lights & sirens.

An ALS transport means the fd paramedics are riding in your bls ambulance

A BLS transport means there is no need for an ALS follow up, and the bls ambulance transports alone.
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Ok, so they DID in fact divert to the ER, which is what I figured. So I REALLY don't see what the issue is. Would they really expect them to go lights and sirens to the ER for an IFT where the patient had stable vitals and 911 was never called, for a patient that apparently has some sort of baseline dementia or diminished cognitive functioning, just because staff mentioned oh yeah the patient's mental status has declined a little over the PAST WEEK? What exactly would Paramedics have done en route to the ER that would make ANY difference? The pt was taken to the ER(to be honest many EMTs where I work probably would have just transferred them), so I cant imagine the OP would get in trouble for not calling for ALS or going lights and sirens.

Hell if I had called in a priority 1 and gone lights and sirens to the ER with this patient I would have probably gotten my *** chewed out(or gotten laughed at) when I arrived.
 
And therein lies the magic of LA County: Where every ALS transport is a lights and sirens transport. As it was so eloquently put by a fire medic, "If I'm riding in with you it's an emergency, so we go code 3".
 
Did the person die during transport?
Did they get worse?
Did you willfully act in a way that is contrary to your licensure?
Were you drunk?
Did anybody freak out at the ED?
Do you know ANYBODY who has lost their license before?

If you can answer Yes to any of these, worry. If not, don't.
 
Would three of your peers have done the same thing?
Do you feel you were negligent?
 
LM2015 said:
I guess I'm worried about my documentation. I feel like it looks bad on paper. Is this the kind of stuff county looks at when they audit?
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There are a million reasons why someone could be altered. If it has been going on for a week, which we have to assume because SNF staff reported that, then it's probably not an "emergency." In most counties in California ACUTE altered level of consciousness is ALS criteria. A week is not acute. Do a stroke assessment, if its negative, document as such and carry on.
 
Maybe I have saltiness showing through but...

ER call from SNF? Check.
Dementia patient (normally altered and setting considered, I'm assuming most likely)? Check.
Per SNF, more altered than normal? Check.
Per SNF, ongoing for extended time? Check.

Were any of these phrases, or variations of them, used at any time as well?
- SNF: Not my patient, I don't know.
- SNF: My shift just started.
- SNF: Normal = walking, talking, holding conversations. (In the room, you notice a wheelchair, padded bed railings, patient wearing only t-shirt and diaper, etc.)
- SNF: It's in the paperwork. (When asked about any other pertinent history or info)

Bonus round: Was this on a weekend and/or just after shift change to the night crew?

OP, just asking but are you new to the EMS/IFT? If so, you will soon find comedy, frustration, amazement and possibly fear and sadness in the truth of the above.

It sounds like this was your run of the mill SNF type incident. As long as the patient was stable, vital signs were acceptable (good practice to include recent blood sugar too), you didn't break county or company policy and you didn't leave the patient in worse shape than when you found him, I'd say you're fine. Just be careful with SNFs. Some are fine (perhaps even good, but in my experience that's rare) but most suck. Just make sure you have all the info/report and paperwork you need before putting the patient on your gurney and you should be good. If ALS is needed, though, don't be afraid to make the call.
 
If your situation is all it took to lose your cert there would be a dramatic culling of our ranks.
 
Just from the info you gave I would have done the same thing. First so many places have said that the pt was more altered then normal. Usually it's not true. Atleast in my experience. The wonderful thing about dementia is that they aren't always the same. Let's just say it is this time. It's been going on for a week. Code 2 is fine. An 8 minute transport vs. a 5 minute transport is not making a difference with this pt. Take a sugar, start a line, and document appropriately. The most common problem among elderly altered pt is a uti.
 
STXmedic said:
Perhaps CA doesn't allow BLS to transport acutely altered patients? Is that the issue?
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In my area BLS is only allowed to transport to ALS. We cannot take a patient to the hospital even if we are right across the street. Not really sure why this is in effect.
 
BigBadWolf said:
In my area BLS is only allowed to transport to ALS. We cannot take a patient to the hospital even if we are right across the street. Not really sure why this is in effect.
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That is probably one of the dumbest things i have ever heard
 
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