In the house vs. In the ambulance

[Dustdevil]

So I think the poll question should have a third option: "I assess my scene and patient and then decide where I am going to work."

If neither of the given choices work for you, then you either did not read the original question, or you're reading into the question, which I specifically asked you not to do.

For that matter, I don't think anybody read the original post. Not one person so far has answered the four distinct questions I asked. :?

[Beagle189]

DustDevil,

1) My preferred method is to begin tx at scene, stabilize, then move to ambulance, Why is because I get better results with my tx and it's the way I was taught.

2) My service has a SOP on max. scene times, 10 for Trauma, 20 for Medical, the SOP states we follow on majority of calls or document reasons why it took longer.

3) My Instructor taught us to do as I stated in #1.

4) Not everyone in my service does it the same, but all attempt to follow the 20 min time; Nor does everone in the 3 closest services to me do it the same, it is a controversy that is on-going in my area.

[Dustdevil]

Thanks Beagle!

What area are you in?

[Ace844]

DustDevil,

1) My preferred method is to begin tx at scene, stabilize, then move to ambulance, Why is because I get better results with my tx and it's the way I was taught.

2) My service has a SOP on max. scene times, 10 for Trauma, 20 for Medical, the SOP states we follow on majority of calls or document reasons why it took longer.

3) My Instructor taught us to do as I stated in #1.

4) Not everyone in my service does it the same, but all attempt to follow the 20 min time; Nor does everone in the 3 closest services to me do it the same, it is a controversy that is on-going in my area.

Ditto to the above....

[Beagle189]

I'm in the wonderful area of Northwest Arkansas,Home of the Arkansas Razorbacks! We're rednecks but educated.

[Sassafras]

Doesn't sound like a very progressive medical control. Better medical controls will be more concerned with the patient getting the care they need at the earliest possible time than with how long it takes to get them to the hospital. The point of ALS EMS is to take the hospital to the patient. And if the patient immediately requires something we have within our capability, any overriding concern for scene time is grossly misplaced.

I absolutely agree. The only time our on scene times are scrutinized are when we have a priority 1 (immediately life threatening) trauma. On these calls we are ideallyrequired to be off scene within 10 mins. In these pts. we obtain an airway, place them in FSP, etc. and then load them into the unit. (Most) everything else can be done en route. These are the pts. that will likely require immediate surgery, so there is no need to be dicking around on the scene playing. On most other calls, we begin the appropriate care on scene (asthma, CP, diabetics, etc.). Once we have the pt. in a stable condition then we proceed with transport.

[Rezq304]

It's my opinion that BASIC treatment be initialized on scene and escalated to ADVANCED treatment on the unit en route the hospital.

[Dustdevil]

It's my opinion that BASIC treatment be initialized on scene and escalated to ADVANCED treatment on the unit en route the hospital.

Okay, but why? Why should your patient have to wait five more minutes to receive advanced care? Isn't that what you were sent out to deliver?

And, as asked in the original post, what does your local SOPs say about the matter? What did your paramedic school teach you? And does the controversy exist within your agency, or does everybody do it the same way as you?

[Rezq304]

You can't tell me that you walk in the room, slide someone on the stretcher and take them straight to the unit without even a hint of a basic assessment? When I say basic, I'm talking Focused History, initial vitals, O2 admin if necessary, initial assessment. This is along the lines of our local SOP's. The only time I would rush any of the initial is when I suspect the patient is crappier than they are presenting. You know, that gut feeling that this one is going to be CTD very soon.

[Dustdevil]

I'm afraid you misunderstood me. I wasn't suggesting that you should rush. I was wondering why it is you rush your patient to the ambulance instead of stabilizing their condition in the house? If they truly need an IV, don't they need it now and not five minutes from now? If they need lidocaine, don't then need it now, and not five minutes from now? If they need D50, don't they need it now and not five minutes from now? You gotta figure that it took you upwards of ten minutes or more to reach them after the initial call. And they had already been in trouble well before that or they wouldn't have called 911. So why does anybody insist on making their patient wait even longer for treatment by dragging them to the ambulance for something you could have already done in the house?

I don't quite understand what you are saying about your SOP's. Can you clarify?