Stroke call

[EmergencyMedicalTigger]

This call happened a couple weeks ago. I decided to post here for your comments, b/c the disagreements and discussion at work hasn't faded. Our protocols state you are not allowed to fly critical medical, only trauma. However, our MD has stated that you can fly the pt if you’re not w/in 15 mins of an “appropriate facility.” So here goes:

We were dispatched to possible stroke w/PD and FD on scene. Go into this house and are directed up two sets of stairs w/a 90 degree turn and impossibly small landing (I'm starting to figure out the pt is always on the second floor, especially if they weigh over 125 kgs). The bedroom is a mess, clothes and stuff covering the entire wooden floor, and no, there's no "path" like you see in some messy houses. Pt is 49 y.o./f sitting slumped on the bed w/her 17 y.o. son trying to hold her up. The family just got home from son's bday dinner when pt began c/o of really bad headache. She has no pertinent PMH. Pt's got left sided weakness and aphasia. I get her on O2 and start getting her vitals. My paramedic partner asks her to squeeze her hands and blink for yes/no. Pt starts having trouble blinking and begins repeatedly squeezing my partner’s one hand repeatedly as hard as she can. I’m looking at my partner like “this isn’t good.” We can’t use the stair chair b/c of several factors. We’re 20 mins from a Level 2 stroke facility by ground or 10 mins from one of the top Level 1 stroke facilities in the nation by air. My partner calls for air medical and by this time our Lt. is on scene.

We have a 20 min scene time b/c of the extrication from the house. Pt starts decorticate posturing and vomiting coming out of the house. Pt’s mental status is decreasing rapidly. I’m assisting ventilations w/an NPA and suctioning, while my Lt. and partner are trying to get a line on her en route to the LZ. My partner finally gets a line as the flight crew arrives. The flight medic RSI’s her, I intubate, and she’s off for air transport.

Even though our Lt. agreed w/my partner’s decision on this call, she’s catching a lot of disapproving criticism from others, including officers. We caught up w/the flight crew later that night and found out pt was prepping for OR 75 mins from onset. The head nurse of the stroke team said pt had a “massive bleed.” The next day a doc from the stroke team calls and compliments the decision to fly the pt saying that she would have died if she went to any ER. Last we heard she was in ICU.

I understand why management would discourage flying some medical b/c then medics might abuse it. However, I think it was warranted in this instance.

[Dustdevil]

I understand why management would discourage flying some medical b/c then medics might abuse it. However, I think it was warranted in this instance.

I agree. I find no fault with your decision. Sounds like you work with many idiot protocol monkeys who lack the ability to think independently and outside of the box to intelligently evaluate each individual patient and come up with an appropriate plan of action. Clearly, you and your partner possess this ability, and it simply pisses off the competition. They're jealous that you got to call a helicopter and they didn't. They're jealous that you thought of something that they were incapable of thinking of. They're jealous that you got a pat on the back and they didn't.

I have encountered this sort of thing many, many times in my career. It's typical, petty ignorant EMS crap. Although there are many factors which contribute to this nonsense, probably the greatest contributing factor is the prevalence of stupid, uneducated people in EMS with immature and unstable personalities.

Screw them.

Not literally, of course.

But yeah, it is because of the above noted people that administration must indeed openly discourage flying (among many things). Luckily, in your case, they are astute enough to recognise those who are capable of intelligent decision making and sort them from those who are not.

[akroeze]

100% agreed with you

[Cookie]

Well said Dust.

[Shelbmedic]

Great Job Guys I would have called for life flight also. Lucky for you life flight was given the go ahead for you unlike what happend to me a few years back.

[1EMT-P]

I totally agree with your decision to fly this patient...

[chaser]

Our protocols state you are not allowed to fly critical medical, only trauma. However, our MD has stated that you can fly the pt if you’re not w/in 15 mins of an “appropriate facility....

We have a 20 min scene time b/c of the extrication from the house. Pt starts decorticate posturing and vomiting coming out of the house. Pt’s mental status is decreasing rapidly....

I understand why management would discourage flying some medical b/c then medics might abuse it. However, I think it was warranted in this instance.

Hey ETrig-

I completely agree you were warranted in your actions (and sounds like you guys did great!). I can understand concerns re: overuse of med flights, but fail to understand the differentiation of critical medical vs. critical trauma. Critical is critical. Am I missing something?? Correct me if I am wrong and I am sure I will be... but

I agree with the others that protocols need to be reconsidered, and you shouldn't have to be tolerating the disapproving criticism.

[paramedicmike]

Absolutely agree that this was a very appropriate flight. Agree 100% with you and your partner. Agree completely with Dust's assessment of the greater situation.

Maybe you should direct some of that criticism towards this thread and have them read what we're saying. Of course, they may be pissed at the whole idea that they're incompetent. But sometimes the truth hurts.

Nice job on this.

-be safe.

[EmergencyMedicalTigger]

Thanks to everyone for the responses. The only time people get away w/flying medical is if the call is way out in boonies or if you can somehow incorporate trauma into it. Alot of medics who have serious medical pts have slapped c-collars on the pts who may have fallen to the ground so they get away w/flying the pt. I think it is ridiculous they would have to go to such lengths just to not get reprimanded.

As far as the "critical medical" thing, our Deputy Chief states that only 5% of our transports should be code 3 traffic to the hospital and the remaining code 1 (non emergency) according to some national studies. So, basically we're supposed to ground transport every medical call and just drive code 3 to the hospital if necessary.

It made me feel good about the decision seeing people on emtcity support it. I'm fairly new to EMS (about 1 year), so it gets discouraging to have your supervisors tell you a choice wasn't correct. I really feel we went by our gut and chose the best form of care for this pt.

[Dustdevil]

I'm fairly new to EMS (about 1 year), so it gets discouraging to have your supervisors tell you a choice wasn't correct. I really feel we went by our gut and chose the best form of care for this pt.

I feel your pain. I once ran on an MVA where some broad drove her car off the side of the road and over the edge of a 25 foot sheer drop off. The vehicle landed upside down on the train tracks, with her pinned inside. She wasn't "critical" per se, but she had multiple trauma, including a head injury. I called a helicopter, even though we were only a few miles from a trauma centre. The supervisor had a fit and drove to the scene, lights and siren, to ream me out for calling a helicopter for an in-town incident. After the patient was loaded and flying out, the supervisor proceeded to raise hell about my calling the helicopter in the first place, since we were so close to the hospital. After he was through, I calmly asked him how he would have gotten her out of there. Finally he turns and looks around himself and realises that we are in a 25 foot deep hole with absolutely no access by ground, except for trains. Then he stammers and mumbles for a bit about how he has write this up to be sure that people are not using helicopters inappropriately.

Some people are just idiots. And no, it didn't get written up.