In the house vs. In the ambulance

[Ace844]

Hi All,

In short every call, and situation is different and dictates different approaches, there is no hard and fast concrete "SOP' or "rule" which can dictate what cations you take on a scene..period..

out here,

Ace844

[temsp40]

1. All things being equal, which is your preferred method of operation on an ALS medical run? Why? I prefer to bring the first in bag, O2 with me and monitor depending on the call, assess the patient, determine if interventions need to happen "right now", initiate immediate interventions, extricate and continue treatment en route to the hospital.

The why answer to this is that this is how I operated as BLS, having been trained with the mindset that I need to figure out what is wrong with the patient and why this may be wrong with the patient, something I have carried with me to the ALS side of this profession.

2. Does your agency have an SOP covering this? If so, what is it? Like many of the other posters here, 10 minutes for trauma and 20 minutes for medical

3. Did your instructor or school ever tell you which way was the "right" way or the way you should do it? Yes and no. I have been trained to assess my patient and decide if I should be initiating treatments where the patient is found, or if things can wait the 2 minutes until we get to the ambulance.

4. Does everybody in your agency operate the same way, or does the controversy still divide the profession? Not everyone works under the same mindset. Some prefer to get the patient the "F" out of the house/apt/vehicle and into the ambulance, others play around on scene too long, without adequate explaination.

Dust, I hope this adequately covers your request for answers!

P40

[Dustdevil]

Thanks, P40! Very helpful, my friend!

[Rezq304]

Yes, I wasn't saying deny needed treatment, I'm just saying that if it's not a major life threatening problem, I'll do it in the truck. If my line is to attempt to up their BP which is only slightly low, then it'll wait for me to be in the truck. Hypoglycemic patients will get their line and D50 where I find them. My SOP's don't go into much detail as to scene vs truck. They unfortunately leave the decision to the ALS provider which some times isn't the best idea.

[Dustdevil]

Yes, I wasn't saying deny needed treatment, I'm just saying that if it's not a major life threatening problem, I'll do it in the truck. If my line is to attempt to up their BP which is only slightly low, then it'll wait for me to be in the truck.

Why? You carried all that crap in. Why not use it?

[Skuter]

My specific questions are:

1. All things being equal, which is your preferred method of operation on an ALS medical run? Why?

In the house but on the stretcher. At least get the basics done, first round of meds or whatever. Being on the bed means no laying in god-knows-what on the floor of the the house and a quick exit if required.

2. Does your agency have an SOP covering this? If so, what is it?

No. We are pretty much left to do what we need/want to do, when and where.

3. Did your instructor or school ever tell you which way was the "right" way or the way you should do it?

NO. All good road guys with lots of experience who knew that there are no "right ways" to do things in this job -- Embrace the grey! :wink:

4. Does everybody in your agency operate the same way, or does the controversy still divide the profession?

NO and NO but we always armchair quarterback every call and discuss how and why things were done the way they were done.

[Guest]

My specific questions are:

1. All things being equal, which is your preferred method of operation on an ALS medical run? Why?

2. Does your agency have an SOP covering this? If so, what is it?

3. Did your instructor or school ever tell you which way was the "right" way or the way you should do it?

4. Does everybody in your agency operate the same way, or does the controversy still divide the profession?

Dustdevil: will try to avoid whatifs, Safe or Secure Environment, no mention of transport times.

1-Bottom line if you don't have your hat in your pack then you cant put it on, old hikers motto but I believe apropos.

Often the dispatch information provides clues as to the severity of the patient condition, in saying so not always correct info, lets not get into why as dispatchers as do the best job they can. Johnny and Ray did not have that luxury..just "MAN DOWN stuff if I recall. If specific to "on truck" scenario and medical, lets say CVA....O2, monitor, IV, rapid evaluation and Transport to ER. MI again (O>M>I>12) evaluate and stabilize, and unless you are carrying thrombolitics time to get the heck out of Dodge... for definitive care. Seizures dependent on history and response to initial treatment. But once in the truck I get the wheels turning....EMT Eds Moving and Transport! Only rare instances dictate a unit sitting on scene, unless invasive care is needed, portable suctions are not perfected quite yet for the peas and carrots the fixed units in the Trucks are superior, most Monitors these days don't need the truck turned off, tongue held sideways, a little praying, to get a clear picture sans artifact, those old cables in Johnny's Day were not even shielded.

2- Nope no SOP, but if your more than 20 minutes there should be a good reason, further if it is NOT lifethreatning then scrambling around can cause more anxiety for the patient.

3- I cant remember, what Johnny and Gage said?

4-Most practitioners I work with are like Kev. they are pros and don't play hero and delay, they take care of business with a smile!

[Ace844]

Why? You carried all that crap in. Why not use it?

To continue your line of thinking "Dust, etal.," There is going to come a time when you don't bring your gear into a call or all of the appropriate gear, and then your gonna hang because you didn't have it....food for thought...Not a Lesson to be Learned firsthand..:blob6::boxing::ky::sign3::blackeye:

out here,

Ace844

[ambulancecat160]

"I assess my scene and patient and then decide where I am going to work."

I would tend to agree here, unless it's a code, then airway, IV, 1st round drugs etc before transfer to truck.

[Ace844]

I would tend to agree here, unless it's a code, then airway, IV, 1st round drugs etc before transfer to truck.

the poster didn't imply they would do anything different...???? :?: