In the house vs. In the ambulance

[PRPGfirerescuetech]

My personal preference is the reverse.

O2 / vitals if the scene is stable / extricate to truck / assessment / drive

I also come from systems where true ALS calls are 20 minutes or less from tones to available.

[Ace844]

When I left the field, there was still much debate among medics in the field over whether we should carry all our equipment into scenes and work the patient where we find them, like Johnny and Roy did it, or if everybody should be dragged back to the ambulance before beginning advanced therapy. Interestingly, there was never really any question over the matter in academic circles. They had long ago established the "proper" course of action. Yet, as frequently happens in EMS, a lot of undereducated technicians take it upon themselves to decide that they know better than their instructors and do whatever they want to when they get into the field.

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?

Qualifiers: I don't want to hear a bunch of "what ifs." This is not a trick question. It is a simple, straightforward question that does not require any reading into. Your scenario is a safe, uncomplicated medical (not trauma) scene in a well lit suburban home with the ambulance parked close by and fair weather. You are not being rushed by low staffing levels, danger, or a lack of support. And I am asking specifically about ALS intervention, not ABC's.

Again, you ARE delaying their care if you have the means to provide it, but are not giving it to them in the house?

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?

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

I think there is a deeper question here. Is it not important to distinguish those patients with instabilities that we can correct from those with instabilities we cannot correct? Our ultimate goal is the improvement of the patient's condition and outcome. Sometimes the only way to achieve that is by rapid transportation to surgery or other definitive resources. But many other times, it is achieved by us in the field through medical intervention. I don't care how "unstable" my patient is, if the cause is something I can correct, then the place to do that is here and now, not later.

Our decision to stay or run should be driven by science, not by adrenaline.

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?

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?

Did you know that the great majority of medics killed in the line of duty are killed in their trucks?

Food for thought.

Hello Everyone,

Here's the original post above. It will give you an idea of what you WERE ASKED TO ANSWER!!!Next to the most recent set of respondednts; I would encourage all of you who are just finding this thread and commenting that you read the entire thread FIRST!!! There have been alot of good points from many of the experienced posters here and you all would do well to remember some of them. Although, I must say I'm quite surprised that there are still posters here who are still 'posting'absolutes for their responses....!?!?!?!?

In case you don't know, or are just coming into the field let me clue you in on one fo the few absolute trueisims we have in medicine.....THERE ARE NO ABSOLUTES IN EMS-MEDICINE!!!!!! AGAIN, THERE ARE NO ABSOLUTES IN EMS-MEDICINE!!!!

To say that one must or must not ANY-EVERYTIME do anything in medicine is with a few exceptions generally considered a ludicrous idea. There is nothing etched in stone which forces you to do (work the patient in the house, or in the truck)either one or the other. Fact of the matter is you should be going into every call FULLY EQUIPPED WITH THE APPROPRIATE TOOLS, and after a size up of the scene, situation, other factors and an full assessment make an APPROPRIATE DECISION based on this information.

Are you going to walk into a residence find someone in cardiac arrest and leave them to go get the gear you already shgould have with you???? NO.....(Unless your incompetent, negligent, or stupid) Are you going to delay your treatment until you get to the AMBULANCE..??? NO...(Unless your incompetent, negligent, or stupid) Conversely are you going to stay in an unsafe residence where the scene is unsafe to treat your pt? NO.... .....(Unless your incompetent, negligent, stupid, OR HAVE A DEATH WISH) Are you guys seeing a pattern?!?!?!?!? THINK!!!! USE YOUR HEAD!!! EXPEND SOME ATP!! Not Everything in EMS is cut and dry, it requires you to adapt, improvise, and overcome. It requires you to problem solve actions, interventions, and obstacles in a critical, stressful, unstable environment!! If you can't do this or it is too difficult to understand, go work the local car wash and save us all the trouble of having to overcome the ignorance you bring to our career.... IN CLOSING THINK!!!! USE YOUR HEAD!!! EXPEND SOME ATP!!

{ACE shakes his head, sighs and throws his hands up while walkign away..}

OUT HERE,

ACE844

[PRPGfirerescuetech]

Dear Ace,

Drink more. Go get a massage, take a nap. Get a hooker, take some xanax, and F-in relax fella.

XoXo

PRPG

That being said, there are no absolutes in medicine. This seems to be a thread about preferences.

[Ace844]

:wink: :wink: 8) 8)

Dear Ace,

Drink more. Go get a massage, take a nap. Get a hooker, take some xanax, and F-in relax fella.

XoXo

PRPG

That being said, there are no absolutes in medicine. This seems to be a thread about preferences.

:shock: :shock: "PrPG,"

Check, I've doen all of that. I guess recently it has begun to boggle my mind at soem of the ignorance that has been posted. I mean as a 'whole' group are we really this bad? It's a wonder any patients get 'care'... Yes, there are alot of great, talented individuals out there who do this and post here, that being said, what's up the recent spate of excrement that has begun to permeate our boards??.. Maybe it's just me though and I need to repeat the above x3..?!?!? :shock: 8) 8) :oops: :wink: 8)

ACE844

[PRPGfirerescuetech]

1. your right. But considering the downturn in education, standards, and every other pillar feebly holding up EMS as a whole, its not a supise.

2. Repeat what I said x 3. Its the key to life

[Ace844]

1. your right. But considering the downturn in education, standards, and every other pillar feebly holding up EMS as a whole, its not a supise.

2. Repeat what I said x 3. Its the key to life

{hiccup..} :wink: So now we know how the venerable "PRpG," retains his Koombyuah....Goodness... Don't worry your secret is safe with some of us..{hiccup}... :wink:

Agreed..Thanks,

ACE844

Lou: Next time you try banging the cat? Put little booties over its paws so it can't scratch. That's what I do.

Tommy Gavin: My cousin, the priest, said it's all apart of God's plan, like God's got a plan. You know what, if there is a God, then he's got a shit load of explaining to do.

Father Mickey: Tom, I, uh, I don't know what you want me to say.

Tommy: Mick... I want you to say that it's all... it's bullshit. You know? There is no plan, there is no map. There's no golden ring at the end of the ride. It's just... bullshit. You know? (sighs) I want you to take away the hope, man, that's the thing that's killing me.

"Sometimes it is entirely appropriate to kill a fly with a sledge hammer.It is better to live one day as a lion than a hundred years as a sheep. I love that guy, but moreover...I worship the quicksand he walks in. Some people are alive because it's illegal to kill them! So Don't piss me off today, I'm running out of places to hide bodies!! He is one of those people who would be enormously improved by death."

"It is not the critic who counts, not the man who points out how the strong man stumbled, or where the doer of deeds could have done better. The credit belongs to the man who is actually in the arena; whose face is marred by the dust and sweat and blood; who strives valiantly; who errs and comes short again and again; who knows the great enthusiasms, the great devotions and spends himself in a worthy course; who at the best, knows in the end the triumph of high achievement, and who, at worst, if he fails, at least fails while daring greatly; so that his place shall never be with those cold and timid souls who know neither victory or defeat."

THEODORE ROOSEVELT

(Paris Sorbonne,1910)

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[AZCEP]

The intelligent mind will find all measure of ways to overcome even the most difficult challenges, up to and including winning a war with another human being.

Sun Tzu

I don't know Ace, just thought you could use some perspective. Cheers, pal.

[ffpm41]

Dust, with all due respect, as you know, it's no so black and white.

Depend on the situation. Hope everything is doing good in the sand box.

[almostamedic]

Usually take vs on scene and then get them to the truck thats where I feel comfortable and can get done what needs to be done.

[mediccjh]

No matter what you do, never, never, NEVER! go into the house without your airway bag and oxygen.