Is EMS definative care?

[PRPGfirerescuetech]

another quality post from ACE.

???

Hes right. Read this post as well as the scene times, and you'll get the idea.

Til then, shush

[RaceMedic]

ok PRP, Ace, and Paramedicmike you all have a good and valid stand on the EMS as definitive care or the fact that definitive care is a figment of every ones imagination. I like that idea and it makes much more sense than saying that the docs in the ER are going to do more than we are during a non traumatic arrest.

Here is where i have to chime in about scene times. They have given people the " golden Hour" this thought process is outdated as well as most cardiac Pt's and the like are going to more " less invasive " surgeries and interventions by the specialists.

Secondly, we will not ever do away with the 10/20 scene time unwritten rule. Fact is we, in EMS, deal in volume. We are already understaffed over worked in some cases and way underpaid in many cases to allow medics to be tied up for up to possibly 2 hrs working till an arrest is "stable " post resuscitation for transport or risk recurrent arrest from movement. There are other calls to take and Pt's to be transported. Sure not all pay but some do and those are what we are after. the little old retiree's that need a ride to be dis-impacted or cath'ed or what ever. Granted medicare only pays so much but it is better than what the unemployed crack head next door is going to pay when he OD's and you save his wasted ass.

To have your trucks tied up for unlimited amounts of time means that in times of high volume and demand on resources you will have to call in more medics and EMT's meaning you will have to pay more in wages and when budgets come under review you have to justify the spending and increase your transport charges which translates in to medicare paying even less but still more than the unemployed crack head next door when he OD's again and stiffs you for the bill, AGAIN!!!

This also goes for the argument people have about transporting a working code(cpr in progress) to the ED. the docs say .. why do you transport dead people???

and i say to that, Wh y do you initiate CPR on a dead person in the ER? Cause that's what i am paid to do. the "M" in MICU means Mobile and i know i can work in the back as well as i can on the bathroom floor and in the back of my truck i don't have to worry about the wife or husband getting in the way cause they just cant get back and let me work.

I know i rambled on and probably made no sense at all. but hey i voiced my opinion. In the end if you tie up trucks and medics on calls and have to call more in to cover calls that they could be making that's makes little sense.

Now before you all get your panties in a bind .... i am speaking from what i think is an Administrators point of view.

As a medic, yea i would like a little less friction when i decide to stay and play... but i also see the flip side as well.

Be Safe

Race

[Beagle189]

PRPG - what I meant by "no" is the same reasons you and others have listed. One portion of the cog is not the only definite, all must come together for a "Definitive". Maybe just semantics. Maybe just my opinion.

[PRPGfirerescuetech]

PRPG - what I meant by "no" is the same reasons you and others have listed. One portion of the cog is not the only definite, all must come together for a "Definitive". Maybe just semantics. Maybe just my opinion.

Ah, I see now. Very good.

[streetsmart]

If we use the six points of the Star of Life and their meaning - definitive care is obtained when we transfer our patients to the ED.

http://www.streetsmartems.com/staroflife.htm

Each of the six "points" of the star represents an aspect of the EMS System.

They are:

Detection

Reporting

Response

On Scene Care

Care In Transit

Transfer to Definitive Care

Author: From Rescue-EMS Magazine, July-August 1992

[Ace844]

Hello Everyone,

Lots of you have been referring to 'The golden Hour' in your posts. Well here's one of the abstarcts which deals with this:::

(Injury. 1994 May;25(4):251-4. Related Articles @ Links

Comment in:

· Injury. 1995 Apr;26(3):215.

· Injury. 1995 Apr;26(3):215-6.

The golden hour and prehospital trauma care.

McNicholl BP.

Accident & Emergency Department, Royal Victoria Hospital, Belfast, UK.)

A 1-year prospective study of 12 hospitals, and approximately 1 million people, was carried out to predict the effectiveness of prehospital advanced life support (ALS) for major trauma in Northern Ireland. Inclusion criteria were an Injury Severity Score (ISS) > 15 and reaching hospital alive. Two hundred and thirty-nine patients had mean prehospital times of 24 and 35 min for urban and rural hospitals, respectively. Most patients (75 per cent, N = 179) were within 10 minutes of a hospital. Of the other patients (25 per cent, N = 60), only 1/2 would have benefitted from prehospital ALS. Fifteen patients aspirated (for a mean time of 7 minutes) before ambulance arrival and eventually died. Seventy per cent of patients who died and who either aspirated or were apnoeic had severe primary brain injuries; the other 30 per cent were considered unsalvageable by both TRISS and peer review. ALS for major trauma will be appropriate for less than 50 patients with ISS > 15 per annum in Northern Ireland. Skill maintenance will be difficult for paramedics.

Hope this helps,

ACE844

[pyroknight]

Like nearly ANY statement, there are exceptions. In the case of "EMS is not definitive care" the exceptions are few and far between (and have been listed previously). Transfer to definitive care is not transfer to the ER, but transfer to the hospital facility which includes the ER, the OR, the ICU, and all the other acronyms. EMS at its best rapidly stabilizes patients and safely delivers them to an APPROPRIATE facility. If you take a severe trauma patient to a psych hospital or tiny community hospital, you have failed in your EMS responsibilities. If you take a cardiac patient to a facility that does not have a cath lab when there is a cath lab equipped facility in town, you have failed in your EMS responsibilities (unless, of course, they've already coded - before you go there).

If you are worth your salt, you should be able to do nearly anything en-route that you can do on scene. As has been previously mentioned, EMS units are more limited than ER beds in many areas, why tie one up if you do not have to? If what you are doing on scene will improve the patient's condition, take the time. If not, pack your mess up and get on the road. If you want to have more authority over patient care, go to med school. Too many wanna-be-docs who get in a huff when you call them "wanna-be-docs" set up their little ALS camps on a scene and FAIL to do what EMS is supposed to do - stabilize the patient and quickly and safely transport the patient to definitive care (which, if you haven't been paying attention, AIN'T US).

Just my 0.02.

[whit72]

pyro night wrote:

If you want to have more authority over patient care, go to med school. Too many wanna-be-docs who get in a huff when you call them "wanna-be-docs" set up their little ALS camps on a scene and FAIL to do what EMS is supposed to do - stabilize the patient and quickly and safely transport the patient to definitive care (which, if you haven't been paying attention, AIN'T US).

Get your hard hats out again boys its gonna get messy in here.

For the most part I agree with what your stating. I dont believe sitting on scene does anyone any good ALS/BLS. Thats why they put wheels on those bad boys.

[pyroknight]

Don't get me wrong, I'm all for more education. I went on to get my RN after my paramedic and I have a masters in another field. I have no desire to rack up the debt required to go to med school and EMS people are WAY more fun to hang out with than a bunch of physicians! (If they weren't, why would we have a couple of ED docs hanging out in here instead of in some stuffy MD forum? HMMMMMM?) My medical career has reached its apex, I shall go no further. I accept this fact, follow my protocols, and provide rapid transport with competent care. If a PHYSICIAN were in an ambulance it STILL wouldn't be definitive care. Leave your tent at home - triage, treat, and transport.

[Ace844]

Don't get me wrong, I'm all for more education. I went on to get my RN after my paramedic and I have a masters in another field. I have no desire to rack up the debt required to go to med school and EMS people are WAY more fun to hang out with than a bunch of physicians! (If they weren't, why would we have a couple of ED docs hanging out in here instead of in some stuffy MD forum? HMMMMMM?) My medical career has reached its apex, I shall go no further. I accept this fact, follow my protocols, and provide rapid transport with competent care. If a PHYSICIAN were in an ambulance it STILL wouldn't be definitive care. Leave your tent at home - triage, treat, and transport.

Well...Well....Well... Look Who's back..... We haven't seen or heard from "Pyro," since this thread:: http://www.emtcity.com/phpBB2/viewtopic.php?t=2947

Welcome back.....

Out Here,

ACE844