Why do urban EMS fear on-site treatment?

[CTXMEDIC]

Thanks. I don't know how much of a response I can muster to that...

Wendy

CO EMT-B

hazing within reason. expecting you to lock n pop as a new EMT is lame and creates a hostile working environment. I mean like freezing your pillow type of hazing

[Just Plain Ruff]

You know, I've kept out of this for a while but this mentality that you have to get things done in 5 minutes or you aren't a good medic or you haven't done well for your patient is a load of crap.

I know that it's easy to get an IV on a patient, check a glucose, do a 12 lead, put oxygen on them, give em drugs and a dozen other things but to expect that you get them done in 5 minutes is absurd.

I've always said that if you can do all that in 5 minutes then I'll show you a medic who's making mistakes and sometimes big mistakes.

When you rush, you make mistakes or you miss things.

To stay and play on a patient who needs a load and go situation is just as silly but why not take the time to get your required items done and not rush. Be that in an ambulance or be that in the house, I am always going to err on the side of prudence and patient safety and patient care.

If you rush me thru things, then I'm not going to a happy camper nor am I going to be doing the patient any favors.

Sure if you have like some departments I've worked in that sends a fire truck(als), a supervisor, a bls rig and my ALS ambulance that stuff can be done quickly but the services I've worked at in the majority have been services where I am the only medic, I have an emt partner and maybe a first responder or two. I try to get what i need done in the right amount of time and done the first time.

5 minutes is a very short time.

The better part of valor or patient treatment is knowing when to rush and when to slow down.

If the patient is going to die they are going to die, 5 minutes isn't really gonna make much difference if it's their time to go.

[DwayneEMTP]

I agree with ya dwayne. what i dont agree with is sitting there just to 'do stuff' because it looks good on paper or the hospital (seriously?) expects you to do it. I do whats in my patients best interest. if moving em is going to hurt, we're going to sit there until i get an analgesic on board, if they cant breathe, they will be by the time we leave. Im sure everyone here would do the same thing. doing it just cuz some guy in a suit and a 2 o'clock T-time expects you to is B.S. I think we have some great nurses at our hospitals and i value their opinions. where the line for me is, i dont tell em how to do their jobs and they dont tell us how to do ours. working a patient in a dark house with one other guy is alot different than a fully staffed and equipped ER.

As for somebody hazing Wendy? Thats fine with me, just keep it away from patient care.

Yeah, I hear you. We're definately on the same page here. Thanks for your thoughts.

Dwayne

[spenac]

You know, I've kept out of this for a while but this mentality that you have to get things done in 5 minutes or you aren't a good medic or you haven't done well for your patient is a load of crap.

I know that it's easy to get an IV on a patient, check a glucose, do a 12 lead, put oxygen on them, give em drugs and a dozen other things but to expect that you get them done in 5 minutes is absurd.

I've always said that if you can do all that in 5 minutes then I'll show you a medic who's making mistakes and sometimes big mistakes.

When you rush, you make mistakes or you miss things.

To stay and play on a patient who needs a load and go situation is just as silly but why not take the time to get your required items done and not rush. Be that in an ambulance or be that in the house, I am always going to err on the side of prudence and patient safety and patient care.

If you rush me thru things, then I'm not going to a happy camper nor am I going to be doing the patient any favors.

Sure if you have like some departments I've worked in that sends a fire truck(als), a supervisor, a bls rig and my ALS ambulance that stuff can be done quickly but the services I've worked at in the majority have been services where I am the only medic, I have an emt partner and maybe a first responder or two. I try to get what i need done in the right amount of time and done the first time.

5 minutes is a very short time.

The better part of valor or patient treatment is knowing when to rush and when to slow down.

If the patient is going to die they are going to die, 5 minutes isn't really gonna make much difference if it's their time to go.

Good answer. Do what needs done, correctly. If that means your at the hospital prior to getting all the toys played with tough. Again do not delay patient care just to get patient in the ambulance. Do whats best for the patient.

[stcommodore]

I've found that my partner and I working in an urban SE Pennsylvania city (mentioned before in this thread) do most of our care on scene. The hospital is typically 5-15min away depending on diversion, location, traffic and working on scene gives us the chance to get the most acomplished for the patient. Obviously for the time critical things like STEMI, stroke, and Trauma on scene time is limited but showing up at the hospital empty handed just because its 5min away pretty much defeats the point of being advanced providers, right?

I want to add do that what we do is for the benifit of the patient and not for the hospital as some have seemed to confuse here. While what we do can assist the hospital (bloods, etc) we don't treat based on what they are going to do we treat based on what the patient needs.

[wrmedic82]

In my opinion its about reading the scene and doing whats best for the patient, as well as you and your partner. Lets face it there are tons of people out there that freak out over stubbed toes or other related bs. If you can start a treatment at the patient's side why the hell not? Another option is to start treatment while moving the patient to the ambulance if possible. Whatever it takes to get the patient taken care of safely and efficiently without delay. Remember that EMS is in the transportation business. The hospital can do more good for the patient that any ambulance service. That is one thing alot of people in EMS forget.

[spenac]

In my opinion its about reading the scene and doing whats best for the patient, as well as you and your partner. Lets face it there are tons of people out there that freak out over stubbed toes or other related bs. If you can start a treatment at the patient's side why the hell not? Another option is to start treatment while moving the patient to the ambulance if possible. Whatever it takes to get the patient taken care of safely and efficiently without delay. Remember that EMS is in the transportation business. The hospital can do more good for the patient that any ambulance service. That is one thing alot of people in EMS forget.

We are not in the transportation business we are in the Medical Profession. We are Pre-Hospital Medical Professionals and we need to start practicing medicine rather than our taxi driving skills. Transportation is just a part of our job not the job. If that is what you think our job is might be time for a job change.

[wrmedic82]

We are not in the transportation business we are in the Medical Profession. We are Pre-Hospital Medical Professionals and we need to start practicing medicine rather than our taxi driving skills. Transportation is just a part of our job not the job. If that is what you think our job is might be time for a job change.

We can practice medicine, but screwing around on scene delaying definitive care isnt doing the patient much good. We provide transport to the hospital as well as pre-hospital care while enroute. We can give breathing treatments all day long, as well a some steroids, but ultimately a physician has to evaluate and treat the patient according to findings we may not be able to determine in the field. Im all about practicing medicine, however sitting on scene so I can play with all my toys seems crazy. Everything can be done enroute to the hospital..Lets face it, hospitals have more resources to treat things better than we can in the field. We use medicine to attempt to get the ball rolling so definitive care than take over, and determine what further interventions may be needed. Last but not least lets be mature.

[Dragoon]

This was sent to me so I don't have the link.

Scene Time May Not Affect Mortality in Trauma Patients

Vicki Gerson

Medscape Medical News 2008. © 2008 Medscape

October 29, 2008 (Chicago, Illinois) — Time on the scene of an accident or assault does not predict mortality in trauma patients taken to a level 1 trauma center, according to a retrospective observational cohort study. However, the results need to be validated, the researchers say.

The study was presented here at the American College of Emergency Physicians (ACEP) 2008 Scientific Assembly.

Emergency medicine physicians have always believed that the "golden hour" of care was the most important factor for trauma-patient outcomes. "However, there are no real data to support this theory," lead author Michael T. Cudnik, MD, associate professor in the Department of Emergency Medicine, Ohio State University Medical Center, in Columbus, told Medscape Emergency Medicine. "The data for this study was collected from the institution's trauma registry."

Dr. Cudnik and colleagues wanted to determine whether scene time had an effect on mortality in injured patients who were transported directly from the accident scene by ground or by air to a level 1 trauma center. This study took place between January 2001 and December 2006 in a large metropolitan area and included all patients aged 15 years or older who were admitted for at least 2 days or who died before 2 days. A total of 4461 patients were included in the analysis.

These patients had injuries from auto accidents, penetrating injuries, falls, or assaults. They were injured in their homes or in public places. Dr. Cudnik noted that the location of the injury was not accounted for in the analysis. Furthermore, although some of these patients might have had a myocardial infarction, such information was not obtained nor included in the analysis. The researchers did not include transferred trauma patients or patients arriving by private transportation.

A multivariate logistic regression analysis was developed for scene time and mortality to see if there was any association, and it adjusted for factors such as age, mode of transportation, and severity of injury. Injury severity score (ISS) and revised trauma score were obtained. Of the total patient group, 59% were transported by air. According to the study abstract, "the median ISS was 10, and overall mortality was 5.2%. Mean scene time did not differ between survivors (14.4 minutes) and nonsurvivors (15.3 minutes)."

In the final analysis, scene time was the only factor that had no association with mortality (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.96 - 1.01; P = .17). This lack of association remained when patients were stratified by those who had been intubated before arriving at the hospital (OR, 0.98; 95% CI, 0.94 - 1.02) and those who had not (OR, 0.99; 95% CI, 0.95 - 1.02).

Even for patients with a scene time longer than the mean, there was no "observable" increase in mortality (OR, 0.79; 95% CI, 0.51 - 1.22; P = .25). In addition, no increase in mortality was seen when patients were stratified by ground transport vs air transport, blunt vs penetrating trauma, Glasgow Coma Scale score less than 9 vs 9 or higher, and by those with an out-of-hospital systolic blood pressure of less than 90 mm Hg vs 90 mm Hg or more.

The researchers also looked to see whether scene time interval (in 10-minute increments) was found to be associated with an increase in mortality; it was not. The area under the receiver operating characteristic curve was 89.4.

"We can't take the study on its face value [to determine whether] scene time is a predictor or not a predictor of mortality," Brian O'Neil, MD, course director of the Research Forum at the meeting and associate chair of the Department of Emergency Medicine at Wayne State University School of Medicine in Detroit, Michigan, told Medscape Emergency Medicine.

"There are many factors that go into scene time that the study did not look at," Dr. O'Neil pointed out. "Was the scene secure? Did the patient have to be extracted from the car? When it is possible to 'scoop and run' with patients, they do a little bit better."

Nolan McMullin, MD, FACEP, a staff emergency physician at the Cleveland Clinic, in Ohio, who heard the presentation, said, "I find it a little surprising that scene time was not associated with a higher mortality. Throughout emergency medicine, we are taught how important it is to reach the medical center quickly."

Dr. Cudnik did say that he would like to see future studies validate his findings. "It is important to identify which patients need to be transported quicker than others in order to save more lives."

The study did not receive commercial support. Dr. Cudnik has disclosed no relevant financial relationships.

American College of Emergency Physicians (ACEP) 2008 Scientific Assembly: Abstract 171. Presented October 27, 2008.

[spenac]

This was sent to me so I don't have the link.

Here you go.

http://www.medscape.com/viewarticle/582754