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Why do urban EMS fear on-site treatment?


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I bring my monitor/defib, O2 kit and trauma/drug bag on every single call without exception. If it is a residence, we will often not bring any transportation equipment in until we have assessed the situation and determined the best equipment to use since it's literally 20 seconds away. But the bags and monitor go in without exception.

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For sick medical/cardiac patients, such as bad CHF'ers who can literally die in front of you, the more you do prehospital, the better chance they have. I have ALWAYS been aggressive with these patients- this is what we are trained for, but you also need to weigh the possibilities. ETA to hospital, how busy the ER may be(how quickly they can mobilize and give the care needed, etc. I've had ER docs tell me that for bad cardiacs, our initial treatment is essentially the same as theirs and can mean all the difference in the world, so stay and play is totally appropriate in most situations. (Yes, sitting in the ER driveway would be an exception to that rule)

Point being, we should all know our limitations, but someone said it above: Unless we use the skills we learned, we are simply ambulance drivers.

Nice quote from Herbie in another thread. Hard to do that when you don't have the right tools with you, isn't it? I can only guess how it feels to find yourself on the 15th floor of a walk-up highrise with no O2, no CPAP, no monitor, no lasix, and no nitro for the "general weakness" patient that ended up being a severe CHF'er. But I bet you can tell me how that feels. :D

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drag 40 lbs. of equipment down to the lowest level of Grand Central Station ….

Btw for your edification Herbie, Grand Central Station has 10 flights of down…

-w

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Nice quote from Herbie in another thread. Hard to do that when you don't have the right tools with you, isn't it? I can only guess how it feels to find yourself on the 15th floor of a walk-up highrise with no O2, no CPAP, no monitor, no lasix, and no nitro for the "general weakness" patient that ended up being a severe CHF'er. But I bet you can tell me how that feels. :D

Interesting….. Any REAL medic who has taken ACLS, would know what we do and give in the field for acute cardiac events, is the SAME as an ER doc would do and give (save for thrombolytics)….

Anyone have a spare BS detector lying around?

I think we could use it here.

-w

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First off, we all know who the real Herbie on the site is (me, and I was here first).

I think we've beaten this in other forums before.

When I am at my full-time place of employment (which is the busiest per capita in the nation, 130.000 jobs w/ 13 ambulances so I WIN!), we tend to treat in the ambulance, unless it is a life threat. Does that mean we just leave? NO. We tend to go in, get the patient, treat any immediate life threats, extricate, and lock everyone else out of the truck until we're ready to go to the hospital. I still stabilize on scene before I go to the hospital; I don't run to the hospital unless it's something I can't handle.

When I work in suburbia, it's different. It's all about situational awareness.

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When I work in suburbia, it's different. It's all about situational awareness.

This is very true, and an understated point. There are certain neighbourhoods -- or even entire cities -- where the time you spend on the scene is inversely correlated to your chances of still having an ambulance when you come out.

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Just another of many problems with the current system of education. Yes, I did go there. :lol:

Due to the variety of situations we find ourselves in, we can't tell people how to manage each and every one of them. Between situational awareness, and critical thinking we've just added another year of clinical rotations before we turn people loose on the public.

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There are always exceptions to the rules; I mostly treat on scene (when treatment is needed).

HOWEVER, I work in area where literally THOUSANDS of people can come out in a few minutes (a partner said it was like turning on a light in a dirty abandoned room, but in reverse), say a fight with minor injuries, or a ped struck that is NBD, then we mostly load and go down the block, or out of view of the scene and work the patient up there, safely away from the accumulating crowd.

I’ve see a riot take place after an ordinary car stop and the perp tried to run, the officer tackled the kid, and suddenly was surrounded by an angry Mob of 3 or 4 HUNDRED, this happened in less than a minute (no kidding) within five minutes the police were calling a 13 and had to block off 8 city blocks, and were retreating, air mail was being posted so heavily it looked like snow. Talk about pucker factor.

Situational awareness and good judgment can be key in our safety and keeping small things small.

It’s like trying to work an arrest with 15 family members in a 1 room apartment; ya have to think of what is best for you and after that the patient.

-w

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This is very true, and an understated point. There are certain neighbourhoods -- or even entire cities -- where the time you spend on the scene is inversely correlated to your chances of still having an ambulance when you come out.

And my city is one of them. Granted, it's not as bad as it was back in the day (hearing the stories from the veterans is unbelievable); however, I've gone outside to find skells trying to break into my truck and I've chased them away with my RSI stick.

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I think this thread goes back to my "what do you bring into a call" thread. I did my paramedic field time in the area that the orignal poster is working in. They had an "A Box" and a "B Box" and for the clearly BS calls you would carry in your oxygen and the small box but for everything ALS you would bring the larger. Then for long and deep runs you take everything, the same applies for medics that ride calls in on BLS units.

I don't run 20 calls a day, heck I'd love to run half that so I can't put myself in that place. But regardless of the system I hope we do the right thing for the patient.

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