To Carry, or Not to Carry, that is the question???

[Dustdevil]

Why would you carry a 35 y/o M patient that accidentally cut his hand with a knife while slicing a bagel and you are taking him to the ED for stitches ????????????

Why are we even taking him to the ED at all?

[dahlio]

Why kill your back when it's not necessary. When I get called to the General Illness (Generally Bull@*#!), and they don't feel light headed or another c/c that would prevent them from walking, guess what, they're walking. Then again, where I live, we tend to have people who think EMS is the doctor on wheels.

[Scaramedic]

Patients with real medical issues get the stretcher. Anybody else (notice I didn't use the word patient) gets walked and benched. Walked in to the ER, and 99.9 of the time they will have us take them to triage.

[FireGuard69]

Unless you are having C/P, SOB, dizzyness, lightheadedness, or broken leg, your arse is walking to my bus. Then, you are walking into the hospital.

At my one private job, they tried to tell me that I was load EVERY pt on the cot, and take them in on the cot.

I said, OK, sure, whatever.

Walked every pt I could into the ED.

MY back comes first.

Not some whiner who says mommy hurt his feelings, and he feels depressed, and called 911, and wants to go to the ER. I ain't carryin him.

[AnthonyM83]

It's up to the medics on-scenes. Some use common sense about it, but some want to us carry almost all to the gurney....it's easy to make that decision when it's just the two ambulance privates doing the carrying, unless it's a whale of a patient.

[Doug]

ok, how's this for a nightmare....a crew i worked with was called for a diff breather. Went and picked up the pt. and transported her and her elderly husband to the hospital. The husband wa sin the front seat of the truck and was chatting away while his wife was getting an updraft in back.

During the ride the husband goes into suddon cardiac arrest. Crew is some distance still from hospital out of their normal "primary" coverage are. The call for help. An EMT from local volenteer service arrives no other help forthcoming. The EMT drives as the 2 crew members work a code with the wife right there. They actually get the save. Gentleman makes a full recovery and is discharged 3 days later.

Now get this....Medicare REFUSES to pay bill because the medic who wrote the PCR up started off with the statement "..pt. walked to ambulance to accompany wife to hospital, enroute went into cardiac arrest.." Medicare's reason...PT WAS WALKED TO TRUCK and there fore it was not a medical nessesity to be transported by ambulance!! Claim was resubmitted with an explaination. Medicare finally agreed to pay...BUT ONLY FOR THE TREATMENT AND ASSESMENT portion of the bill...they refused to pay for the milage for the husband...and then they reconsidered the wifes bill and demanded half the milage payment for her back because it was a "shared ride."

So lesson learned? If you want to get paid do what i do "just say pt. to truck/cot" don't say how.

[FormerEMSLT297]

Why are we even taking him to the ED at all?

Because he is unemployed, and has no health benefits, and no primary care physician, and you can not refuse transport, at least not in NYC on a patient with an confirmed injury.

Now, I know Dust, in a perfect world, the person would go to his primary care physician, but like i said, eutopia is a far far away place.

[strippel]

Patients with real medical issues get the stretcher. Anybody else (notice I didn't use the word patient) gets walked and benched. Walked in to the ER, and 99.9 of the time they will have us take them to triage.

Pretty much how we do it.

If we pull up, and the patient is walking (no matter what the complaint), they keep on walking to the ambulance. Especially the ones that run to open the door for you, let you in, and then run upstairs to get some stupid thing, like matching socks. When the return, they walk to the ambulance, and try to get on the litter. Ain't happening.

If someone is sick, and the litter will roll to where they are, they can ride on the litter. If they are upstairs, and are sick, I will use the (new) stair chair to carry them down to where the litter is on level ground (where the litter can roll fine).

There is no reason why someone who is not sick, cannot walk down the steps. The idea of carrying people just because is dumb. I also can't understand crews who carry patients down steps on hydraulic litters, or any litter for that matter.

[captainstandup]

Unless "Bagel boy" has signs of significant blood loss, continued bleeding, nerve or function impairment, or some rare psychosomatic response to the sight of blood or finally is under age, he doesn't need an ambulance. Bandage and have friends or family ir even a taxi transport him to ER triage or even an urgent care clinic for sutures.

Critically ill or injured patients are frequently tied up with bullshit routine nursing home transfers for foley replacement, or transporting meth head loosers for the 15th time this year.

We had a woman in a low rent housing complex that called for an ambulance 231 time in three and 1/2 years. She was nasty, vulgar, abusive as crazy as hell and may have actually needed an ambulance on three occasions. It took me three and 1/2 years to get her committed but finally with the assistance of DSS and adult protective services and through my filing charges against her for misuse of 911, the court put her in a facility. People with valid conditions suffered because of this woman misusing 911 and we had two medics hurt their back while carrying her to the truck. We never carried her again after the last one was injured.

An earlier post implied I would be negligent in walking someone with ACS to the truck, or at least out of a difficult position within a residence. Consider the harm caused by the three pack a day smokers that treat bacon as an individual food group. We routinely see patients in excess of 450 lbs and the heaviest in our community was 923 but fortunately natural selection took care of him.

It is not the fault of society that patients become 200, 300, 400 lbs overweight. Society is forced to suffer the cost of taking care of them in many ways. Injured EMS employees cost taxpayers millions annually and often result in disability or early retirement / career change for medics and remove skilled practicioners from an already tight employee market.

We carry people because we are "trained" to react rather than think based on education. Most providers are driven by the fear instilled by employment practices and lawyers that blindly blame everyone for the patients condition rather than holding them accountable and responsible. This isn't to imply we are to be punitive or abusive but by the same token we have the ultimate responsibility to ourselves and our safety.

It is unacceptale to take unnecessary risk to move someone out of your safe range of ability regardless of the severity of their condition. Always wait on assistance, always. You may be forced to wait for a long time. First responders have virtually stopped answering call in our county, other EMS units are frequently tied up and most law enforcement wouldn't dare. So here we are, faced with remaining on scene with sometimes critical patients or choosing to attempt to move them or finally act in the manner we have been taught for years. Ensure scene safety!

[Mateo_1387]

This discussion brings up an interesting issue. I also think it leads to another issue which is why should we transport people who can walk to our ambulance. Although walking to the ambulance should not always equal no transport, it should make us think about whom we do transport. When a patient can walk to an ambulance what always goes through my mind is "why did they call in the first place" why not get in the car and drive themselves. Too often we have this view that "you call we haul." Just like we decide to give treatment to a patient because of their clinical presentation we should also be able to decide to deny transport based on clinical presentation.