PatrickW

In no particular order... Activated Charcoal Glucagon Epi 1:10 Epi 1:1 Atropine Furosemide Lidocaine Procainamide D50W Sodium Bicarbonate Magnesium Sulfate Dopamine Amiodarone Albuterol Naloxone Solu-Medrol Adenosine Thiamine Terbutaline Diphenhydramine Morphine Midazolam Lorazapam Etomidate Succinylcholine NTG Spray ASA Oxygen Normal Saline D5W

What does your physical assessment involve if the pt has no complaints? Detailed head to toe? What do you tell them the risks of refusing transport are for someone with no complaints? What do you tell them when they ask why you, the healthcare provider, think they should let you transport them? Since they are a pt, what does your treatment and transport of them usually consist of? Do you call for a second ambulance while you work the full arrest? I agree they need emotional support, however if they do not have a medical complaint or ask for EMS for themselves we aren't going to transport them as a patient. I don't know that they won't have pain later, and I don't know that they won't contact some lawyer. What I do know is that the person did not request EMS or want EMS, they claimed that they did not need EMS because they were not injured, and I will document that. Is there some case that you can cite where leaving someone with no apparent injury who stated they don't need EMS was considered abandonment, or are you just trying to use scare tactics? I don't know about your system, but taking a truck (or however many it would take to do a whole school bus full of kids) puts a major strain on the entire system and delays response times for true emergencies from people who want EMS. Yes, there is harm done.

How does a refusal only take a few minutes for you? Do you not take two sets of vital signs? Is the refusal you're obtaining just a signature, or is it an informed refusal following advising the patient of the risks involved with refusing (which I'm not sure what they are for someone who says they aren't hurt or ill and don't need EMS)?

Of course I can't be sure that there isn't anything wrong with them, but I can't thoroughly assess everyone that is involved with any call. How do I know that the family member of the full arrest I'm working isn't going to stroke out from the hypertension associated with the event? If they don't ask for us and they don't want us, I'm not going to sit there and do a detailed history and physical, including vital signs, and then suggest that they be taken to the hospital regardless of my findings. I can't police the community for illness and injury, assessing everyone I come across or everyone involved in an event I'm called for. If I get called to an MVA and a pedestrian jumped out of the way to avoid it, do I need to get a refusal from them if I ask them if they're ok? How about a school bus that brakes quickly, one patient complaining of neck pain. I have to obtain histories, physicals, and refusals from all the other children and their parents? That's ridiculous. The 911 service I work for does have a transport policy, and we are able to treat and release some patients if they do not meet our transport criteria and both crew members are comfortable doing so. "You call, we haul" is ridiculous.

The replies here really puzzle me. In the hypothetical situation of an MVA with no injuries, what would the people with no injuries be refusing? Transport for no injuries? Is that implying that you, as the healthcare provider, are suggesting that these people be transported to an ER, even though they have no complaints? In my system, a refusal means that the patient meets transport criteria and the patient should be transported to an ER. To obtain a refusal, we have to inform the patient of the possible consequences of refusing transport (for example, for neck pain we would warn them that if they have a spinal injury and refuse transport, they could become paralyzed and die), and by signing the refusal they acknowledge that they accept these possible consequences to refuse. I can't imagine doing a refusal on someone who has no complaints. What would I tell them the refusal means? With few exceptions, anyone who denies injuries on an MVA is not a patient. They are a person involved in an MVA who isn't hurt and doesn't need EMS. There would have to be extenuating circumstances for me to assess someone who claims they aren't hurt and don't need an ambulance, and tell them that they need to go to the hospital.

Most dispatch centers record all phone calls (obviously), so if your dispatch center has the ability to forward phone calls, you can call the dispatch center and ask to be put through to the hospital. If anything comes up, the recording can be pulled.

Well, that's a relief!

Well, I don't think there are different scopes of practice for EMT-Bs on a BLS-only truck vs. EMT-Bs working with EMT-Ps, and I didn't know you were arguing for one. If you'll notice, in the scenario I posted, I stated only objective criteria. That scenario is from a call I was on, and all I stated was the facts of what happened. BGL low, symptoms, BGL brought up, no symptoms. Make of that what you will, but no where did I state that the low BGL was the only issue and no where did I state that the patient should not be transported. With such a condescending, holier-than-thou attitude I don't understand how you can expect people to not be offended by your posts. I understand you're passionate, however I don't think too many adults would agree that name-calling, insulting intelligence, and a general condescending attitude are helpful in anyway to proving your point. Really, you're qualified to tell me that "I don't know how much I don't know" from a few posts of mine with a differing viewpoint on BLS use of glucometers. Seems somewhat hypocritical, even. Thanks for "entertatining my tangent", though.

First off, you are the first one to bring up the possibility of a low BGL being all that is involved, and you are the first one mentioning an EMS diagnosis and refusal. I did not say anything about either in my post, and it is in fact you who is making that assumption. Second, monitor placement is another skill that Basics are not allowed to perform (at least here). I'm not saying it never happens, but it's not in our scope. But let me get this straight, you're suggesting Basics should be forbidden to perform dextrosticks as part of their assessment because it only provides a BGL of which Basics can do little about, but instead we should be placing limb leads as part of an assessment even though we can do nothing with a rhythm strip? As for the point of this thread, the question posed at the end of the OP was "Who can offer reasons for and against this diagnostic tool for BLS providers?" You'll have to excuse me for pointing out how it is useful for me everyday I work.

Scenario: 60yo F complains of bilateral leg weakness. Gradual onset, it's 3AM now, she woke up to go to the bathroom and noticed her legs were very weak. No other complaints. History of IDDM and HTN. Good strong PMS. BGL turned out to be 48 mg/dl. Gave her some orange juice (or oral glucose) and suddenly she feels fine and has no complaints. With a BLS crew that didn't have the option of checking BGL, their options would have been: Transport while twiddling thumbs saying "I don't know what's going on!", or request ALS so that ALS can do the exact same thing BLS would have done on scene if they had a glucometer. Is that really what's best for the patient? It's also important to remember that not all BLS providers are part of BLS-only crews. I work with a paramedic and being able to check someone's glucose is a valuable tool for me as a Basic or Intermediate to have. When we have an unconscious patient, for example, it's nice for my partner to accomplish the "more ALS" aspects like starting a line, hooking up the monitor, etc. while I check the BGL (among other things, of course). It's just one less thing the medic has to worry about and one more thing the basic can accomplish for the good of the patient.

I understood that, my point was that referring to an RN as an LPN is not like referring to a Paramedic as an EMT, because the latter is accurate. EMT is an all-encompassing umbrella for the different certifications, so being a paramedic and being called an EMT should not be considered offensive or inaccurate. Sure, "paramedic" is a more accurate term, just as "RN" is a more accurate term for an RN than "nurse", but that's just the way it goes. Now, if someone referred to you as an EMT-Basic, then you'd have a complaint.

You're comparing apples to oranges. "Nurse" is a general umbrella including LPNs and RNs. "EMT" is a general umbrella including Basics, Intermediates, and Paramedics. Calling an RN a nurse is not an insult, and calling a Paramedic an EMT should not be considered an insult either. You're operating under the assumption that EMT means EMT-Basic (or Intermediate), which simply isn't the case. Look at the site you're on now. EMT City. Who is the "national governing body" of this profession? The national registry of EMTs. I just don't understand why there's stigma attached to the "EMT" title...despite popular belief, "EMT" is not a level of certification. It is many, including paramedic.

That's nothing when it comes to noticing small spelling/grammar/punctuation errors. I even notice that in the page title, "EMTs" is spelled with an unnecessary apostrophe!

I don't rely on machines for anything. I use all of my senses. For example, when checking someone's BGL, I don't use a silly high-tech machine. I taste their capillary blood. Mmm, hyperglycemia.

So if I'm a doctor and believe that I would be harming my patients by giving them blood transfusions (damning them to hell), I should be able to refuse to administer blood products to dying patients because of my own beliefs? Who's to say my beliefs are wrong? That's a huge taboo. You can't question other people's beliefs. Why? Because you can't. People are free to make all the stupid decisions they want about their own life, but when their beliefs start infringing on others' lives by withholding potentially life-saving procedures from someone else (like in the OP's case), that is negligent homicide. And really, I'd even go as far as to say that attempting to teach an impressionable child beliefs that may later cause their death is shameful abuse of power. There would be a lot less problems these days if kids weren't presented beliefs as fact at an early age and brought up to just accept it.

To be fair, you really shouldn't have been driving the ambulance on the tracks in the first place.

I've had a few. The one that immediately comes to mind is when we had two shark bites in the same town, about two hours apart. That was an interesting shift

It depends on the dispatcher, really, but it's always qualified with a "possible". "Per the caller, possible open ankle fracture", "per the caller, possible dislocated shoulder", "per the caller, possible MI". I imagine the latter is only transmitted to us if the dispatcher thinks the caller really knows what they're talking about. For example, if they've had previous MIs or if there's a transferring physician.

I don't know about how your dispatch works, but we never get dispatched to a "broken leg" or "heart attack". We may get dispatched to a traumatic injury/leg injury, or chest pain. 90% accuracy seems about right to me with that system in place. Maybe a little high, but not unheard of.

Right, because the fact that someone could improperly use a tool causing a minor inconvenience is a good reason to withhold it. I really can't think of an example of how you could mishear a 911 call causing poor pt care that would be any more likely than mishearing dispatch info. At least if you got to listen to the 911 call you would probably catch your mistake if you do mishear dispatch. But I think that's such an improbability that it doesn't really need to be worried about. We wouldn't be relying on the 911 call 100% either, it is just an extra tool. More info. It would be a good thing. We'd still listen to dispatch. Nothing would change except for a little extra info at our disposal.

I guess I don't really feel like I have a right to complain about not getting every bit of info from dispatch for a few reasons. 1: I don't want to be "telling dispatch how to do their jobs". B: I've been on ride-alongs in neighboring counties, and the only info they get is age, whether the pt is conscious and alert, whether they are breathing "ok", and the address. What we have is far better than that. 3: I'm very new to EMS. I guess we should take away GPSs and radio/stereos too, then. One of the best parts about being able to listen instead of actually being on the line is that you don't have to be paying 100% attention. No one is counting on you to respond to everything they say. It's just another tool. And as I said in my first post in this thread, it could be just the passenger that listens. I'm pretty sure I'm qualified to look to my right at intersections and say "clear" while listening to something else. At least in my area, navigation isn't really an issue.

Oh, dear lord. I don't know how I can say this more clearly. I'm not asking to try to do dispatch's job. I don't want dispatch to tell me every minute detail they get. Hell, one of the benefits to being able to listen to the 911 call on the computer en route would be so you DIDN'T have to tie up radio traffic with every single detail from the call. Apparently your system divulges more info to the crews than ours does, because our dispatchers don't tell us if a patient who is bleeding is on blood thinners. It changes the priority in their dispatch protocols, but we don't get that information. That would be one way listening to the calls can be beneficial. Of course I'm thinking and doing the same things you are on the way to a call. But I don't see how you can argue that listening to the 911 call to the call you are headed to is not helpful in preparing you for the call, just like looking at your protocols is. It would just be an added resource. More information at our disposal. It's not a bad thing, no one is trying to take anyone else's job, it is just potentially useful info. If nothing else, it would allow us the hear how much misinformation dispatch gets told on a day to day basis, right?

Where did I suggest we start telling dispatchers how to do their job? Again, nothing at dispatch would change one bit. We would just have an extra resource at our disposal which may or may not give as a better idea of what we're walking into. Nobody said anything about "needing" to listen to the 911 calls, again, it would just be a nice tool to have at our disposal. I don't know how to make it any clearer.

I understand this, and I am not trying to knock dispatchers. I have spent more than a few hours in dispatch listening to calls and watching how they work. To be honest, dispatch intrigues me. When I finish school I would not be opposed to going to train and work as a dispatcher part time. Again, I understand dispatchers do the best they do with what they are given. I have no problem with dispatchers except for the few times that they withhold pertinent information that they DO have (and I have seen the call log/notes to know that). Yes, I realize this is a dispatch issue but "they are doing their best" and it is rare, anyway. I'm going to have to assume that this was not in response to my post, unless you didn't read my post at all. I don't see how you could have read my posts and still come to the conclusion that I advocate being able to talk to the patients, I just said it would be helpful to hear the 911 calls. The dispatcher's job would not change one bit. Ok, now I'm really confused. I'll start from the top of your post. Yes, the supervisors are aware. I think the gist of it is we are told that we should be grateful for whatever info we do get, we should be prepared for anything regardless, and the dispatchers are doing their best. No, I don't have as much experience listening to 911 calls as a dispatcher does, but two sets of ears are better than one. Can you please explain to me a disadvantage of being able to listen to the 911 call that you're about to go on? I'd love to hear how having more info is a bad thing. 911 hangups are usually a police matter, however apparently that one was an exception. I guess she requested EMS, got transferred to our dispatchers, explained that she ran out of her meds and then hung up. There could be more to it, I don't know. I didn't hear the 911 call. In response to your last paragraph, that's what really confused me. No, I don't know the questions to ask or "protcols" to follow, that's why I'm not advocating being on the line with the caller. Yes, I fully understand that often times callers are on the line with dispatch until we get there. Sure, a 911 call could be 5 or 10+ minutes, but at least with EMD the majority of the useful information is in the first minute or so. Again, I've sat in dispatch on multiple occasions and listened. I understand how it works. In those cases, the rest of the call is usually emotional support and/or CPR instructions, bleeding control, having the caller re-assess, etc. Again, the bottom line is I don't see how having access to LISTENING to the 911 calls while en route could be a bad thing. Feel free to enlighten me. Let me just say one more time since there seems to be some confusion: I am NOT for being on the line with the patient or 911 caller. That's dispatch's job and I am not qualified to do that. I am NOT for changing dispatch's job at all. They would do everything they're doing now. I was just suggesting that it would be helpful to be able to listen to the 911 calls before we arrive on scene. It's just more information that could be available to us.

Huh? How was I giving dispatchers a hard time? :? It would be helpful because dispatchers can't tell us everything. They can't convey to us the tone of the call, if we're stepping into a full arrest situation with five family members all screaming at each other during the call. Sure, we need to be prepared regardless, but we need to be prepared for most things regardless. It's still nice to get a head's up. At least in my area, we use the EMD system. Our dispatchers often times tell us the age and gender of the patient, the response code and the chief complaint. Sometimes they'll even forget to tell us the age and gender. Sometimes I'll go back and look up a call only to see helpful location info in the call notes that was never relayed to us. It would be nice to know if the chest pain call we're going on is a "delta response" because the first party caller says he's not breathing normally or because it's a third party caller who says that the pt is altered. With EMD, they're apparently not supposed to downgrade response levels. The other day a call came out as a delta response for chest pain and then in the middle of the call they figure out that it's an 8yo A&O with abd pain x 2 hours ago. We never got that info, and they sent fire because it came out as chest pain. Yesterday, I went to another delta response for chest pain which turned out to be chronic tingling in the extremities. I went to a shark bite call once involving an 8yo, we were never told it was a ped. That would have been nice to know. Same thing the other day with a seizure. Second floor of an apartment building. Would have been nice to know so we could bring the broselow. Two shifts ago, we were sent to a pregnancy that turned out to be a domestic. I talked to the calltaker afterwards and she thought the caller started acting kind of odd in the middle of the call, but otherwise didn't think anything of it. Maybe if we heard the call, we could have picked up on it as well and requested PD while we were still en route. A few shifts ago, we got a 911 hangup. Only info we got was that some lady called, said she ran out of her meds, and hung up. Dispatch acted surprised when I asked if police were en route and if we needed to stage. I don't know if this is a psych patient and neither did dispatch apparently, but maybe if I heard what little they heard I could understand why they didn't think police were necessary. These are just a few examples I can think of off the top of my head. I realize dispatch can only work with what info they get, which may or may not be accurate. But you're really challenging the idea that being able to listen to these calls might just be helpful every now and then? Of course it would be nice to hear the information first hand instead of just getting a little bit of second-hand info.