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Would You Run Emergency To This?

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No I was agreeing with you. I was just saying that just because you go L&S to something doesn't mean it's balls to the wall... I was actually agreeing with you, and just reinforcing the idea that we both share. Did you misread something???

Edited by scubanurse
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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

In our service, the protocol is that if you called out from a 911 dispatch, you run Code Three. I have gone to the nursing home, which is 3/4 mile away from the base, (how convenient?) and faced a patient that was acting totally normal. However, we tend to always to take them to the hospital simply because they called us. The staff obviously had a reason so we do what we get paid for.

And if you are dealing with a PT that is already cognitively impaired, then you really can't know if that PT has an injury without CT or X-rays. On more than one occassion, I have responded to the nursing home and taken a PT that was injured and had been living that way for a few days and the staff couldn't figure out that because they don't look for it. I transported a pt with a tib-fib that the staff didn't know about because they just didn't examine her. Scares the crap outta me!

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No I was agreeing with you. I was just saying that just because you go L&S to something doesn't mean it's balls to the wall... I was actually agreeing with you, and just reinforcing the idea that we both share. Did you misread something???

I probably read something wrong, its been a monday for me =)

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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.

playing devils advocate here:

Are you the 911 contract service for the area ???

Or just contracted ambulance hauler for the nursing home chain?

Personally If they felt the pt needed to be taken emergency to the Emergency room then a call to 911 would be in order.

However if your private service has a discount contract with them then thats why they didn't use 911.

Did the pt need emergent care?? Yes definatly.

running lights & sirens for 21 miles in a large city rush hour is asking for trouble.

WAAY too big a risk of a crash.

You didn't have much choice but to follow the company policy , but the questions your raising here should be discussed with your supervisor or branch manager in a calm manner and ask for the reason behind the corporate policy.

Is it the empire by chance?

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In my area SNF's are staffed by morons. I don't trust what they say so yes I would have ran hot to the call. I once responded priority to a Rehab center for an unconcious only to find the patient had no medical complaints other than vomiting (duh! its withdrawls) but the "nurse" just didn't want to deal with the patient. On the other hand I went routine to a fall only to find the the patient was ALOC, Hypotensive and had positive results when doing postural vitals.

There is a big difference in responding to a scene priority and transporting to a hospital priority. I am sure anyone who has been in EMS can attest to responding to calls which they thought were going to be minor or BS only to arrive on scene and find out the call is nothing like dispatch said. It isn't just SNF's. The general public lies too.

We respond to all calls priority. I rarely transport to the hospital priority. About the only time I go priority to the ER is if it is a suspected CVA or we are suctioning. Anything else should be going ALS if it requires priority transport to ER. Obviously this isn't a set rule, i will always do what is necessary for the patient care.

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How many times has anyone read my "sign-off" at the end of all my postings?

"Balance the need for speed with the ride that's a glide."

Over the years, I have seen numerous non-9-1-1 Inter Facility Transfer (IFT) ambulances running L&S as if they are trying to get out of town before the nuke explodes. If I caught up to them at the ER, I'd ask why they were trying to break the ground vehicle speed record, whatever the current MPH/KPH at the Salt Flats, on the streets of NYC, and too often get as answer, "That's how the bosses want us to respond!"

Check back on my postings over the years, and you'll read of an EMT/MVO (Motor Vehicle Operator) who, while doing such type response in Brooklyn, "T-Boned" a private car, killing 2 pre-teens and severely injuring their mother, the driver. Madam EMT was brought up on double homicide charges, and found by jury trial to be guilty. Never served a day, because the mother asked the court not to send the now former EMT to jail, as she was now going to have a life sentence of knowing what she had done, no matter what punishment the courts might assign. The courts and judge actually went along with the idea!

Going with a theme one EVOC (Emergency Vehicle Operations Course) instructor used in a class I attended, how many ambulances do you take out of service if you crash? There's the one you're in, of course. Another ambulance now has to go for the patient you were running for, and a third one to check out your partner's and your injuries. Add a forth to check out the person driving the other vehicle in the collision. More if there's numerous folks in the other car. No, they just declared an MCI (Multiple Casualty Incident) because you caused a fully loaded 49 passenger intercity bus to overturn when you broadsided it. Now how many ambulances?

Even if there wasn't a bus involved, how are the other crews going to feel, knowing "one of their own" got hurt? I'm not going to mention they might be thinking of your partner instead of you, as partner might be more popular than you (sorry, had a day someone pushed my nasty button).

I also mention New York State Vehicle and Traffic Law 1104, which translates to, no matter if driving as a regular vehicle or emergency vehicle in your ambulance, you MUST drive with due regard for any and all other drivers on the road.

Last comment regarding the driving:

You can't help anyone if you don't get there.

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Our service would code this as a "Green" priority which means anything coded Purple, Red or Orange would get priority over it. Green's have a KPI of ambulance arrival within 2 hours of the call. Maybe as it is the head it might be ProQA'd as a possibly dangerous body area and be an Orange which means it is a non-emergency dispatch but if the crew read the clinical notes from the call they can decide to upgrade to an emergency.

I personally don't think it should be a lights and sirens job.

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In our service, the protocol is that if you called out from a 911 dispatch, you run Code Three. I have gone to the nursing home, which is 3/4 mile away from the base

I got one better than that, I worked at a service where our station was direction across the street (not a busy street mind you) from the hospital. We would run code to that hospital for a patient transfer. The total drive time was about 25 seconds. And guess what, if you didn't run code to the hospital for the transfer you got suspended. What a freaking stupid policy.

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It's been a while since I've dealt with EMS billing issues. However, if memory serves correctly this a billing issue. An emergent response allows for a higher billing amount than a non-emergent response. Or it at least meets a checklist criteria for billing purposes.

More than one place I've worked has had a "mandatory billing statement" that must state something to the effect of "911 dispatched to... ambulance unit number responded emergently..."

ETA: This would explain why there are mandatory response policies in place even for a scene right across the street... or for someone on the other side of town at rush hour.

All of this says nothing to what you'll actually find once you get on scene. There is still the potential, given the scenario in the OP, for a variety of injuries to the patient presented even though on the surface it doesn't look that bad.

Perhaps a bigger issue is why the closest ambulance is 21 miles across a big city at rush hour. Such poor resource management would be a bigger concern for me. But I digress.

Edited by paramedicmike
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