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In the house vs. In the ambulance


Dustdevil

Do you work medical patients where they lie when possible, or do you prefer to take them to the ambulance for all treatment as a rule?  

86 members have voted

  1. 1.

    • Work them where I find them.
      53
    • Take them to the ambulance before treatment.
      33


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i generally work my pt in the ambulance , but i do bring everything in just in case i need it. i like to do this way because in the ambulance were in our domain and if i need anything else i know were it is.

So are you saying you don't have (at least some of) everything you might need in your first in bag? Or are you saying that you don't know where things are in your first in bag?

I'm not being flippant or in your face about this. This is a serious question. I used to work with a woman who *NEVER* used the bag. Doesn't matter what the call was, she would put the patient on the stretcher, go to the truck and do everything there. Even codes. She had no idea what was even in the bag.

I really didn't like working with her.

-be safe.

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Its impossible to say weather i'm going to provide patient care in the truck or in the house. I definatly bring all my bags in with me in case I need them. Just as every patient is a unique individual each scene and each presenting medical condition is unique. If the patients condition requires rapid transport than I will pack them up and treat en-route if their condition dictates TX on scene than i will treat on scene and if it requires a middle ground than I will find a middle ground unique to the call.

The answer to this question from everyone should be "whatever patient care requires".

I know some people would prefer to treat in the house and others would prefer to treat en-route and I have my preferences also however when on a call the patient and their condition are in fact "the boss" and I do whatever patient care requires.

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The answer to this question from everyone should be "whatever patient care requires".

Not the question that was asked at the beginning of this topic. It very specifically said there were no circumstances which required rapid transport or departure from the house. That is why I worded it this way, so I wouldn't hear a bunch of "what ifs" and "whatever the patient requires" equivocation.

Again, the question is -- very specifically -- all things being equal, and you have no need to immediately depart the scene, do you work your medical ALS patient where they lie, or do you routinely drag every carcass back to your "domain" out of pointless habit?

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If you load the patient, and then begin your interventions, not only does the patient gain the positive benefits of correct treatment, but also the peace of mind that their access to a more definitive source of care has not been delayed..

Just because you load a pt in your ambulance...this doesn't qualify as "transporting" just because they are in your "vehicle"...nor that you are less likely "to delay their access toi definative care" which BTW, you as an EMS provider are....food for thought,

Ace844

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  • 7 months later...

It depends on the call. I prefer to spend some time on scene and initiate treatment /get an initial round of ACLS, etc....then get'em to the rig and continue care.

My service (s)

Flight Program: load and go for scene calls patient is usually worked in the helicopter

County: we play on scene but not very long. most of our treatment is initiated on scene and then we get'em to the rig.

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Depending on the medical condition the pt is I generll perfer to work in the ambulance, because I can control how many people crowd around me.

We don't have a SOP for this type of run, but they like for us to put the diabetic pt in the ambulance before we treat, because alot of times diabetics wake up with the sugar and then don't eat anything, so this is their way of solving a problem.

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we don't really have a protocol about this, other than be off the scene in 20 mins or less. our airway bag has all the basics including first round drug and IV set up, so that and LP12 go in. depending what we have from there dictates what we are going to do, but i like to get off the scene as fast as i can due to our ETA to the hospital.

it's more call by call for me and my partner.

madmedic

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Just to kind of move another direction with this. In Nova Scotia we too have the same constraints with on scene time. !5 minutes for chest pain, SOB, major trauma, stroke, etc. and 20 minutes for all others. Obviously treating cardiac arrest and hypoglycemics and the like will take longer.

Often we end up transporting within the required time only to arrive quickly at the hospital and end up treating the patient in the hallway for a long time due to ER overcrowding. The record for me so far was 5 hours. So I guess the question is, why rush at the house when the patient will end up waiting at the hospital anyways. Obviously if the patient is CTAS 1 or 2, they should get in the ER right away. But patients with CTAS 3, 4, and 5 tend to sit on our stretcher for a very long time.

Just wondering if other medics experience the same problem with rapid transport only to have to wait a long time at the ER.

p3sibley

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Load and Go with ALL pt.s, period! All this crap about onscene tx. other than O2 is a boondoggle. All we do is feed the governments corporate belly for less funding driven by frivolus costs. It's about our pt.s people. No more corporate cheese.

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Our rule over here is not "what can we do" at the house, its "what should we do". Though we're technicians we still have judgment, and we have to make the call where to treat - by patient severity (usually our first impression), environmental situation etc.

If you're equipped properly it really shouldn’t make any difference.

Personally I like doing as much as possible at the scenario and as little as possible in the truck, the conditions in the truck may be of a more controlled environment, yet it’s a suboptimal situation (bumpy driving, noise from the siren, we can only approach the patient from his left side, safety issues seatbelt wise, etc.)

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