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Would You Run Emergency To This?


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I'd like to hear other people's opinions on this. I ran this call about 7 hours ago at the private service I work for...

A call comes in from a nursing home that we have a contract with. A 70ish male has fallen face first out of his wheelchair. He's got a good sized hematoma on his forehead, front and center. Staff reports that the patient is awake and alert to his normal status, is not actively bleeding, and is not mentally altered beyond his regular dementia. The patient is now sitting in his wheelchair again and the hematoma is bandaged. We are dispatched emergency to this call. The kicker is that the nursing home is 21 miles away. It's rush hour in a big city. Dispatch says our protocol is to run hot to this call. So, the question is do you or don't you?

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I work for the same service as cprted and yes we would go to this call L&S but it seems that maybe some things have been overlooked, Fell face first out of his wheel chair = rule in/out C-spin

"Do you?" and "Should you have to?" are two distinct questions in this. If your service's policy is that you do, then it probably would be wise to follow that (while also trying to prompt change).

Your patient is already in a state of altered mental status, might not be able to voice concerns or location of other pains. Me? due to that uncertainty, I'd do my best running L&S to the scene, a

"Do you?" and "Should you have to?" are two distinct questions in this.

If your service's policy is that you do, then it probably would be wise to follow that (while also trying to prompt change).

In terms of whether this should be the policy, I think it is clear that driving lights and sirens is something that adds significant risk (often with little benefit) and should not be taken lightly. It seems unlikely this patient would benefit from the time saved.

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This is probably something that falls into the "We've always run hot to these types of calls so why change now" type of mentality at these types of services.

This also probably goes back to the old management style of thinking that if the public sees you running hot to almost every call then they have to think they are getting their money's worth.

If I was dispatched to the scene running hot then I probably would have but this is a prime example of a call that should have had more information obtained. The dispatcher should have asked more questions in my opinion (sorry Brent and other dispatchers) But seriously, dispatchers are not given enough credit or TIME to get a good enough information from the caller in order to dispatch appropriately.

I love where I used to work. the 911 call taker got the information, dispatched us and then we had the luxury of getting a call back number and were able to call the caller back and get more information. From that call we could either downgrade our response or upgrade and add resources.

For non-breathers, we didn't usually call back but for other calls (many) we did and it worked out well.

I for one would not have responded emergency to this one but unfortunately, you really didn't know what you had until you got there, right?

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Do you have the ability to proceed at your own discretion, and/or confirm that your dispatch is correct about your protocols? If that's the case the case then confirm that they are (or aren't) right, and then proceed as you see fit.

If you can't do that and are required to do what they tell you...how much trouble will you get it if you blatantly ignore them, and how much is your job worth to you? If ignoring them and driving normally is something that will get you in trouble...then absolutely, turn on your lights and sirens and go...but just because your lights are on doesn't mean that you need to be speeding and driving like a nut. If people decide to pull over for you...great. Drive on by...at the speed limit. If you only need to pause at intersections instead of coming to a full stop...great. Go on through...at a safe speed.

You can be told to do almost anything by your dispatch and supervisors...but short of them riding with you, you have a huge amount of discretion in how strictly you do what you are told, versus meeting the letter of the law, so to speak. It's a two-edged sword, but in this situation it's beneficial.

From the managements side, it's worth remembering that a lot of private companies are contracted to have a certain responce time and anything over that will lead to fines, and potentially them losing their contract with that particular location. It's very unfortunate, but this does play a part in how some companies determine the responce mode.

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In my service we would run L&S to that call because the MPDS system would spit it out as a 17D1, "Fall with Injury to Dangerous Body Area." Can't tell you how many 17D1s I've been on where the only injury is a 1/2" lac above their eye that has stopped bleeding by the time I get there ... but to the computer, its a head injury ...

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Your patient is already in a state of altered mental status, might not be able to voice concerns or location of other pains. Me? due to that uncertainty, I'd do my best running L&S to the scene, and decide if the trip to the hospital is also going to be L&S, dependant on V/S and S&S observed when with the patient.

Remember, all bleeding stops...eventually.

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I work for the same service as cprted and yes we would go to this call L&S but it seems that maybe some things have been overlooked,

Fell face first out of his wheel chair = rule in/out C-spine. His age alone could rule this in. (Did have a call where a pt fell from standing face first and was unable to get her hands out in time to break the fall, she was dead on arrival)

Good size hematoma = Possible brain injury (just had a call 28 female fell from standing, got up and said she was fine. Next day being medevac for a possible subdural hematoma)

It always amazes me that when people run L&S they think it means they have drive faster to get to the hospital, when in fact it is designed to make other drivers pull over so you can proceed. Here we are allowed to go 25 km over the posted speed limit while running L&S but that is only if it is safe to do so.

It is always better to be safe than sorry, and I think in this particular case you should have gone L&S because of all the factors that this particular pt could deteriorate quickly.

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I work for the same service as cprted and yes we would go to this call L&S but it seems that maybe some things have been overlooked,

Fell face first out of his wheel chair = rule in/out C-spine. His age alone could rule this in. (Did have a call where a pt fell from standing face first and was unable to get her hands out in time to break the fall, she was dead on arrival)

Good size hematoma = Possible brain injury (just had a call 28 female fell from standing, got up and said she was fine. Next day being medevac for a possible subdural hematoma)

It always amazes me that when people run L&S they think it means they have drive faster to get to the hospital, when in fact it is designed to make other drivers pull over so you can proceed. Here we are allowed to go 25 km over the posted speed limit while running L&S but that is only if it is safe to do so.

It is always better to be safe than sorry, and I think in this particular case you should have gone L&S because of all the factors that this particular pt could deteriorate quickly.

This, and unknown med history makes getting there to assess a priority. That doesn't mean balls to the wall flooring it, but have some urgency. If this patient was on blood thinners, very likely in that setting, had facial fractures that could compromise airway, and several other possible circumstances, why wouldn't you have some sense of urgency?

L&S doesn't mean flooring it and swerving in and out of traffic. Especially at rush hour, it just helps you not waste time sitting in traffic.

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I've also got no issues running 'hot' to this call.

It's an elderly, (meds and other age related frailties), fall, (why did he fall? How did he fall? When did he fall?), with altered mentation, (exhibiting normal mentation? Is his normal mentation un/slightly responsive only? If so, then what does this mean? How does it help?), It's a long way there in city traffic, as well, the odds that he's been examined and/or cared for by anyone that did more than what was necessary to cover their ass is small...

Sorry boys and girl, but my expectation based on experience is that I'll get on scene and find a bandage with dried blood, applied many hours before on a semi comatos patient that needed significant help several hours ago and despite the great report from dispatch, there will be no one on duty but the day nurse that 'just got there.'

Nothing makes me happier, nor seems more appropriate to me, if we're going to accept the risks of emergent response, than to do so for the elderly that have built this country and yet are so often abused...Much more so than the observed fender bender or bar fight.

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This, and unknown med history makes getting there to assess a priority. That doesn't mean balls to the wall flooring it, but have some urgency. If this patient was on blood thinners, very likely in that setting, had facial fractures that could compromise airway, and several other possible circumstances, why wouldn't you have some sense of urgency?

L&S doesn't mean flooring it and swerving in and out of traffic. Especially at rush hour, it just helps you not waste time sitting in traffic.

Okay Scuba what did I say in post that gave you the impression I would drive balls to the wall, I simply stated I would go L&S did you miss read something ?

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