Is EMS definative care?

[whit72]

The definition of difinitive is serving to provide a final solution or to end a situation. So I would say no. In the case of the diabetic possibly. But most who are trasported need further care and intervention, so it dosent provide a final solution.

[paramedicmike]

In that case what would be? We don't provide a final solution to a patient's problems. I can agree with that. But then what? We take the person to the ER. She winds up getting moved to the ICU. Then she's sent to step down or rehab. Finally she's discharged to home with follow up, in house nursing care.

There's nothing final in each step, yet each step works until it has reached a final point as defined by the location/specialty of the service. Yet each step "above" us is considered definitive care.

If you want to look at the whole broad picture with clear marked end points and solutions then no, EMS is not definitive care. But when considered in the big picture with each step not having anything more than a final endpoint before transferring the patient off to the next step in care then yes I think it could be.

And your posted definition is a bit narrow. There are other definitions and meanings to consider.

-be safe.

[PRPGfirerescuetech]

In that case what would be? We don't provide a final solution to a patient's problems. I can agree with that. But then what? We take the person to the ER. She winds up getting moved to the ICU. Then she's sent to step down or rehab. Finally she's discharged to home with follow up, in house nursing care.

There's nothing final in each step, yet each step works until it has reached a final point as defined by the location/specialty of the service.

If you want to look at the whole broad picture with clear marked end points and solutions then no, EMS is not definitive care. If you want to look at what's immediately available and compare EMS care to the alternatives then it may be.

-be safe.

Aha! Now were thinkin!

Whew, I was hoping someone would go there. Thanks Mike. Hope the new job is working out well...

Now, relating this to scene times. Lets look at the big picture. Lets face it, the overall scope of medicine is the big picture, and EMS seems to narrow in and get a bit o' tunnel vision quite often.

How does a longer or shorter scene time effect a patients care, when relating to the "bigger picture" definative care that EMS is involved in?

PRPG

[paramedicmike]

Yeah, sorry. Been on vacation for a few days. And the new job's going well! Thanks!

I think, though, I was clarifying my points while you were posting. That should explain the discrepancies between what is now visible and what was quoted.

As to time, I've been on some lengthy transports. I wasn't doing anything differently on those transports than what was being done in the hospital. So I'll echo the question, while I wasn't doing anything different from the hospital was my care less than definitive? I'd like to think no. Especially if it's in line with treatment that would be readily available in the ER.

But IMHO I think it goes back to the conception of medicine as a whole or the consideration of each step along the way. Consider it as a whole and there's no such thing as definitive care. Consider each step individually and respectively and I think you'll see that there is definitive care starting with the connection of the 911 call.

-be safe.

[PRPGfirerescuetech]

Definative care, starts at the initiation of 911.

Your right on. As you should be, and I would expect nothing less.

Medicine is a huge picture, with each facet being as important as the last in making the system work. Similar to sprockets on a wheel (or some other silly analogy, you get the idea)...

Now, without any of those points, does the patients care get completed.

EG: Cardiac Arrest

Home

911 (they aint getting EMS without 911)

EMS (ACLS, and transport to the facilty for the next steps)

ER (further ACLS, ABG, scans, initial cardiology consult for nexxt step)

Cath lab (why did it happen? If EMS and ER werent there, morgue would be in this place, dx)

Icu (primary tx of underlying conditions causing arrest)

CCU (2ndary tx)

EMS: (transport to rehab)

Rehab (get better time)

Discharge (with instructions)

Home (to call again at some pointe im sure)

Now, remove any of those sprockets, and the rest of the treatment fails. But, are any of those sprockets the definative, final care of the patient standing alone?

Nope.

Now, relate to scene times. How would extending scene times adjust this system? How would violating everyones apparent 10/20 minute rule?

[Scaramedic]

I would take definitive care even a step further, the patient themselves. A Diabetic can have all the EMS/hospital care in the world, but unless they take care of themselves after they leave the hospital the process breaks down.

As far as scene times, I do not know what to say. I have never worked in a system that sets scene time limits. EMS works around stabilizing/treating the issues the patients have, regardless of scene time. Outside of Level 1 trauma of course.

But I have to agree, quickly packaging the patient for a stupid scene time limit could affect the long term care of the patient. It makes no sense to me, but then again a lot of the stuff I read about other systems makes no sense to me.

:dontknow:

Peace,

Marty

:joker:

[JPINFV]

When talking about EMS, I believe that definitive care is achieved when the optimal level of care can be provided for the acute or emergent disorder. Following that, some things are definitive care for prehospital (nontraumatic arrests, for example. The body doesn't care if the epi is being pushed an EMT-P under standing orders from an MD or being pushed by an RN under direct orders from an MD), some are definitive in the ED, and some are definitive in other hospital departments (cath lab, OR, etc), or other hospitals (trauma center vs. basic ED).

[whit72]

The scene times? Are you reprimanded for being on scene to long?

[Ace844]

The scene times? Are you reprimanded for being on scene to long?

Read the thread on scene times which coincides with this one and you'll find out....

ACE844

[whit72]

another quality post from ACE.