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This has nothing to do with the money. The decision to accept the pt was made by the ERDoc, who gets paid the same either way but the decision was left up to the crew since they were the ones who had eyes on the pt. Sorry about leaving off the units on the glucose. It is in mg/dL so for those not in the US it is a level of 1.28 mmol/L. 12 lead shows a NSR without any concerning findings. Sat was 99% on room air. Lungs are clear bilat.

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OK the doc gets the same $$ for his 24 hr shift , But the pressure from management [ Read bean counters above] is to bring up the revenue stream versus having EMS bypass them for the big city hospital that is a level 1. At least that is what we were seeing for a couple years. It got to the point they stopped having coffee cups in the ER for the EMS crews.

"do you know how much we spend providing you guys with coffee at all hours of the day" ????

Was the response we were given.

We said to the ER manager one day at a meeting when the subject came up, "thats OK we can start taking our patients to the other hospital in town as they appreciate the fact that we bring in the revenue stream for them" ...

The very next days coffee cups were back and so were boxes of pastry and bowls of fresh fruit in the EMS room. $$$$$$$$ won the argument.

back to the original pt : since her BG is only 23 she will be getting a little D-5 once we get a nice solid IV line in and see what happens to her level of conciousness. Since the on-scene crews cant agree on her pupils we are still looking for the reason for her being unconscious. any history of hypoglycemia or other pancreas problems.

still think she wants to go to the level 1 since the local doc has left it up to us to make the decision. This lady could well need a drain to take off the inter-cranial pressure

Hey RUFF :: the site did it again when I typed coffee cups above. it hyperlinks to amaz on

Edited by island emt

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You arrive at the local ER where they repeat the finger stick and get 19 (1.06 mmol/L). They push D50 and with 3 minutes the pt wakes up and asks where she is and what is going on. Her neuro exam fully improves. Head CT shows a small scalp hematoma with no intracranial pathology. She recalls all events from the night before. She is watched in the ER for several hours and is sent home when her sugar and temp stabilize. All other workup is negative.

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OK the doc gets the same $$ for his 24 hr shift , But the pressure from management [ Read bean counters above] is to bring up the revenue stream versus having EMS bypass them for the big city hospital that is a level 1. At least that is what we were seeing for a couple years. It got to the point they stopped having coffee cups in the ER for the EMS crews.

"do you know how much we spend providing you guys with coffee at all hours of the day" ????

Was the response we were given.

We said to the ER manager one day at a meeting when the subject came up, "thats OK we can start taking our patients to the other hospital in town as they appreciate the fact that we bring in the revenue stream for them" ...

The very next days coffee cups were back and so were boxes of pastry and bowls of fresh fruit in the EMS room. $$$$$$$$ won the argument.

back to the original pt : since her BG is only 23 she will be getting a little D-5 once we get a nice solid IV line in and see what happens to her level of conciousness. Since the on-scene crews cant agree on her pupils we are still looking for the reason for her being unconscious. any history of hypoglycemia or other pancreas problems.

still think she wants to go to the level 1 since the local doc has left it up to us to make the decision. This lady could well need a drain to take off the inter-cranial pressure

Hey RUFF :: the site did it again when I typed coffee cups above. it hyperlinks to amaz on

Yeah Island, I was just givin ya a hard time. But this time it linked out to a blankie, so I have a feeling it's not just you.

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You arrive at the local ER where they repeat the finger stick and get 19 (1.06 mmol/L). They push D50 and with 3 minutes the pt wakes up and asks where she is and what is going on. Her neuro exam fully improves. Head CT shows a small scalp hematoma with no intracranial pathology. She recalls all events from the night before. She is watched in the ER for several hours and is sent home when her sugar and temp stabilize. All other workup is negative.

I was expecting something more tricky.

It would be quite embarrassing to come into the ER with the blood glucose still so low. Do we have a reason why she became hypoglycemic? She doesn't have a history of DM, Is this just some physiologic stress coupled with beta-blockade and some low glycogen stores?

Do you know if there's a name for neurological deficit in the setting of hypoglycemia? I've seen this a lot -- usually it's obvious that they're hypoglycemic because you see a lot of sympathetic response (in this situation elderly + beta-blockade this is blunted).

"do you know how much we spend providing you guys with coffee at all hours of the day" ????

Was the response we were given.

We said to the ER manager one day at a meeting when the subject came up, "thats OK we can start taking our patients to the other hospital in town as they appreciate the fact that we bring in the revenue stream for them" ...

The very next days coffee cups were back and so were boxes of pastry and bowls of fresh fruit in the EMS room. $$$$$$$$ won the argument.

While I would kill my own dead grandmother for a free cup of coffee on any given day (actually, I'm pretty sure she'd kick my ass), I'm not sure what's more concerning, the fact that the ER would provide free coffee to incentivise transport to their site, or that EMS providers would bypass an ER just because it didn't have free coffee. Mostly I feel jealousy. My ERs have a free mop bucket, with complimentary scum.

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it wasn't incentives for us bringing pt's to them.

We have two level 3 hospitals with similar ER capabilities and travel time. Some of our pt's went to hosp A & others went to hosp B by their choice. The rest were folks from away who would ask us which one they should go to.

It 's just something they always had available until a bean counter decided they could cut costs in the ER dept by doing away with providing coffee for the EMS crews. they still had it available for the nursing staff & docs , so it was only the cost of a few sleeves of paper cups each week and a few more pounds of coffee

I've been in other hospitals were the triage nurse would hand us a pass for the cafeteria to buy a meal up to $5.00 and others where you could get a drink out of the water fountain.

Once we explained the foolishness to the hospital director who often would roam the ER to meet with the EMS folks he agreed that there were much better areas to cut costs.

Edited by island emt

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Out of curioisty, is there anyone here who would not have treated hypoglycemia in the field? I accidentally forgot to say that she was a known diabetic. She did have a bit of a UTI and doesn't think she ate before bed so that seemed to be the cause of the hypoglycemia.

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it wasn't incentives for us bringing pt's to them.

Sorry, I realised after posting that my comments came across as rude. I'm sure you guys act professionally, and in the best interests of the patient.

But, still jealous.

Out of curioisty, is there anyone here who would not have treated hypoglycemia in the field? I accidentally forgot to say that she was a known diabetic. She did have a bit of a UTI and doesn't think she ate before bed so that seemed to be the cause of the hypoglycemia.

My hope is that one day we might treat the UTI in the field. This is already happening in some of the assisted living / long-term care centers locally.

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No worries mate. I knew where you were coming from.

On our semi rare trips to the big city level 1 trauma center , with cath lab ,which is an hour & 30 min south they have an EMS room where we exchange linens for the stretcher replace schedule drugs and IV supplies etc. They have coffee , tea,hot chocolate machine and soda dispenser machine, plus there are always small snacks for the crews. Thats the hospital where if the triage nurse was in a friendly mood , she would hand out the cafeteria passes.

Maybe they took pity on us rural crews when we had to go to the BIG City and didn't want us to go home on an empty stomach. :whistle:

Doc

As soon as we determined the low BG reading ,I would have double checked results with a sample from other hand , gotten a patent IV and started with D-5 in NS slow push and see how she responded to our treatment.

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