Is this Advanced Life Support?

[Genie]

Hello! I want to know if I'm being unfair as to what I should have expected from paramedics who came out to my house. I'm hoping you can help me by replying as to what should have been done, or what you would have done!

I called our city 9-1-1 requesting an ambulance for my 67 year old husband who was experiencing severe abdominal pains throughout the morning. It was 1:30 p.m. when we decided something serious was happening to him. He could no longer get up and when he even tried to turn over, he was breathing very heavily.

When I called 9-1-1 I gave a basic background of my husband's health the last 7 months. First he had undergone a colon resection in December. In February he started chemo and radiation for mediastinal cancer, finishing in the middle of May. He was just starting to eat well and gain weight and strength when in the middle of July, the day I called, he got the lower right-sided abdominal pain.

My reading says our paramedics on average, take 8-1/2 minutes to arrive. The dispatcher said it would be about 20 minutes and it took 25. We are within city limits, within two blocks of two major intersecting highways. That isn't my complaint though.

The paramedics came into my house and while I showed one the medicines my husband was taking, the other took my husband's blood pressure and asked him if he was throwing up, which he wasn't. We were told they wouldn't be able to bring the stretcher into our bedroom (we live in a one-floor ranch-style house). They told him to move to the other side of the bed and they would help him walk out, down the hall, to the livingroom. I ran to hold the door open so the one paramedic could come in with the stretcher, but he told me he couldn't get it past the 90 degree turn in the sidewalk outside our door.

I went outside, wanting to lift the thing up myself, turned around and saw my 120 pound husband, in his underwear, painfully coming down the two steps from the door, unassisted. (He had lost 45 pounds because of his cancer treatments.) He was tall enough to get his butt up to the edge of the stretcher, but because of the pain, couldn't lay back. The paramedic made no offer to help! I finally reached round the paramedic to put a hand on his back as he flopped back.

The neighbors were running outside to ask if we needed help. They did have some consideration, murmuring something about giving my husband some privacy. By the time I got the neighbors away, my husband was in the ambulance and thank goodness, they were giving him oxygen and had an I.V. in. The I.V. is easy part since he already has a Groshong catheter.

I am thankful for him being taken to a good hospital. It didn't take them long to get his pain under control and diagnose a ruptured appendix. It's now six weeks later and he is finally getting back to where he was before this all happened – trying to gain weight and strength before undergoing another round of chemo. It was a fantastic surgeon who succeeded with a laproscopy and was able to clean him out well.

I tell all my relatives, friends and neighbors what to expect when they make that call to 9-1-1. He's only 120 pounds so why couldn't they lift him out? He was in horrible pain so how could them make him walk? All they did in our house was check his blood pressure. I now wish we had just gone in our own car. There is a very good chance, due to his cancers that this sort of thing could happen again and we do intend to take a car –- I'm sure I can do better than the paramedics did getting him out of here!

One more thing. Our billing lists the service in the house and the transport to the hospital as both being Advanced Life Support

[KEVD18]

it was billed as als because an als crew was used and they performed at least one als procedure(iv).

he shouldnt have been made to walk. if they couldnt get the stretcher in, they should have used a stair chair.

this sounds like a fairly normal call. some bad decisions by the patient/family(waiting half a day to call an ambulance) and some bad decisions by the ems crew(walking the pt instead of carrying). should the crew be disciplined, absolutely. but does that mean you should never call an ambulance again? HELL NO!!!

true, their care wasnt textbook perfect. its was seriously deficient. but the next time he needs medical attention, it might be something the medics can treat onscene/enroute and save his life in doing so. you cant provide those treatments and procedures. failing to call the ambulance could very well cost someone their life next time.

if you feel that strongly about it, initiate proceeding to have that crew punished but dont shun the whole ems system on account of one bad crew.

[Genie]

Sorry -- I didn't intend to shun the whole EMS system -- just our city I suppose! I know we would do it over again, but next time I need to know what to expect. I would like to file a complaint with our city and will after I know whether I have any right to complain. I want to complain and try to "fix it" since I have many family and friends that I don't want to experience this!

Please don't blame us for waiting too long. It wasn't a half day, more like 4 hours. I need to explain that this is a man who had already endured lots of abdominal pain from his colon surgery, constipation from CT scans, constipation from morphine (taken with eating because his esophagus had radiation burns), etc. Days before he had to take six bottles of barium for a scan and he figured that's what was causing him trouble.

[KEVD18]

i apoligize. i misread your post. i read 1:30 as 10:30. ive seen that type of thing a thousand times. agian, sorry for my mistake.

yes, you absolutely have the right to complain and you should do so as soon as possible. this isnt the sort of thing you want to let go for a while.

i hate to throw my collegues under the bus, but that just not right.

[traumateam1]

I agree here with KEVD18. I too hate to put my colleagues under the bus, but that behavior was completely un called for. While there isn't a whole lot you can do prehospital setting for stomach pain, they should have never made him walk. Like KEVD18 said, there is something called a stair chair, a chair with wheels and handles that they could have used. Also they could have covered up your husband a little more than they did.
Like KEVD18 said, complain as soon as you can. We are here to help people, not make them walk with severe abdominal pain to a stretcher while in his underwear.

On a more lighter note: It's good to hear that your husband it doing well. :) and the reason you had to wait so long (if that's not normal) is there could of been a higher than average call volume going on. If you do have an emergency call 9-11, don't take a personal vehicle. Remember, you can always call 9-11 back if someone's condition gets worse, or you are worried and they will upgrade your call.
Take care, and again glad to hear he is doing well.

[triemal04]

Was that an ALS call? Yes.
Should you have been billed for it being an ALS call? Yes.

Beyond that...I, and everyone else here was not there. Thus we don't know what actually happened (not saying that you aren't being accurate, but you aren't passing along everything that happened, and what was seen by those who responded may have differed from what you saw for various reasons...as well, you weren't privy to all the care your husband recieved prehospital it seems, and without knowing everything that happened and the system you live in, they may have done everything possible...albiet maybe not in the nicest way).

It's extremely easy to second guess people, but without all the information...not always the best thing to do.

Threads like this should also always pop a warning flag into people's minds.

[KEVD18]

Was that an ALS call? Yes.
Should you have been billed for it being an ALS call? Yes.

Beyond that...I, and everyone else here was not there. Thus we don't know what actually happened (not saying that you aren't being accurate, but you aren't passing along everything that happened, and what was seen by those who responded may have differed from what you saw for various reasons...as well, you weren't privy to all the care your husband received prehospital it seems, and without knowing everything that happened and the system you live in, they may have done everything possible...albeit maybe not in the nicest way).

It's extremely easy to second guess people, but without all the information...not always the best thing to do.

Threads like this should also always pop a warning flag into people's minds.

the only problem with that is that, at least as far as my protocols are concerned, patients are [b]never[/i] allowed to walk under their own power. they, by protocol, may stand and pivot, but are not supposed to be allowed to take even a single step, regardless of chief complaint.

that isnt to say i havent let patient ambulated. thats not the case. but i have never asked or forced a patient to walk. if they are adamant about it and their condition allows it, i will let them walk a reasonable distance. but its their choice and at my discretion. these medics forced a patient to walk an extended distance when the patient was clearly in no condition to do so. i agree that theres is two sides to every story and we cant burn those medics at the stake just on the wife's story. but there is no excuse for that action(actually inaction).

[triemal04]

the only problem with that is that, at least as far as my protocols are concerned, patients are [b]never[/i] allowed to walk under their own power. they, by protocol, may stand and pivot, but are not supposed to be allowed to take even a single step, regardless of chief complaint.

that isnt to say i havent let patient ambulated. thats not the case. but i have never asked or forced a patient to walk. if they are adamant about it and their condition allows it, i will let them walk a reasonable distance. but its their choice and at my discretion. these medics forced a patient to walk an extended distance when the patient was clearly in no condition to do so. i agree that theres is two sides to every story and we cant burn those medics at the stake just on the wife's story. but there is no excuse for that action(actually inaction).
Ah, but you're helping to prove my point.
1) Do you know what system these medic's work in? I don't. If it's like my system and many others, they have every right to tell someone to walk to the gurney. Or ask, as the case may be.
2) Are you sure this patient wasn't in any condition to walk? Again, all there is to go on is what the wife is saying (not saying that's she exagerating, just that we don't have all the facts). He very well may have been...and he very well may not have been.
3) What was the extended distance? If it's your average 1 story ranch house from the bedroom to the front door is probably about than 30 feet. (yes, that definetly can be considered extended in some situations)

I'm not saying it was right or wrong, just that it's hard to accurately judge this sort of thing in this type of setting.

[KEVD18]

I went outside, wanting to lift the thing up myself, turned around and saw my 120 pound husband, in his underwear, painfully coming down the two steps from the door, unassisted. (He had lost 45 pounds because of his cancer treatments.) He was tall enough to get his butt up to the edge of the stretcher, but because of the pain, couldn't lay back.

so i realize that we're still dealing with only one side of the story, but some of the statements made by the op are faily well inarguable.

[triemal04]

so i realize that we're still dealing with only one side of the story, but some of the statements made by the op are faily well inarguable.
Sure. But she also said earlier that he was unable to turn over, which would indicate that he was able to lay flat. And that she wishes she had taken him herself, which again indicates that he was capable of walking.

Again, not sayin right or wrong, just that with only one side in this situation...

[KEVD18]

Sure. But she also said earlier that he was unable to turn over, which would indicate that he was able to lay flat. And that she wishes she had taken him herself, which again indicates that he was capable of walking.

Again, not sayin right or wrong, just that with only one side in this situation...

i disagree. he desire to tranport by pov indicates a desire not to deal with ems and/or the bill, not the patients ability or inability to ambulate.

[daedalus]

Original poster, the crew took 20 minutes to arrive based on the information you gave to the dispatcher. She probably has a protocol to dispatch Code Two (no lights/no sirens) to all abdominal pain calls. The paramedics should have been more helpful assisting your husband to the gurney. I would file a complaint. Unfortunately, they will be able to bill you at the advanced level because the medic placed an IV.

[ffemt8978]

I agree with triemal...none of us were there, so we're only getting one side of the story. We don't know if the patient insisted on walking rather than being carried, we don't know what his vitals were, there's just too much we don't know.

To the OP: A complaint may or may not be warranted, but I would suggest that you, at a minimum, do the following. Call the ambulance company and ask to speak to the supervisor/manager. Get the name of their medical director, and request that this call be sent in for a QA/QC review by their medical director. Then contact that person, and explain your concerns to them. Request to be kept in the loop on this one.

[bstone]

Echoing the sentiments here that this crew should have absolutely not made the patient walk. Only when a patient *demands* to walk do I even let them take a few steps. Otherwise I try to keep them off their feet and as comfortable as possible. If the historian is correct then this crew was just being lazy. His level of pain and the area of pain makes it clear that walking is and was a bad idea. If I was their medical director (and I will be one day) I would call them into my office and have them read for me the protocols which say no patient shall walk to the ambulance- especially not one in intractable pain.

[Genie]

I wrote, "He could no longer get up and when he even tried to turn over, he was breathing very heavily."

I've tried to be as accurate as possible. No exaggerating has been done because I want good accurate answers. I can get more precise if you like. It's 52 feet from where he got out of bed to the front door. Then he had to step down once unto the front stoop, cross it, go down two steps to the walkway and walked another 15 feet to where they left the stretcher.

I say I should have taken him myself to the hospital – correct! That's because since he had walked that far, he might as well have walked another 15 feet to get into the hatchback of our car!

I know my husband and his pain tolerance. He's amazingly tough. Before I called the ambulance, he rolled out of the bed, crawled into the bathroom, tried to stand so he could use the toilet, and fell into the wall. I helped him back and I was extremely worried about his heavy breathing. Then I had to find a jug and help him urinate into it! Before the paramedics came he asked if I would change his briefs. That was a chore for me since he couldn't raise his butt up! So, I don't know how he got out of the house except because of his determination.

My husband was up and walking within 8 hours of having colon re-sectioning, and his appendectomy. Every week for two months, I was taking him into the hospital to be re-hydrated. His whole system has been "out of whack because of the chemo". Sometimes he could walk in, other times, we put him in a hospital wheelchair. The oncologist would usually tell him he was in serious condition, ask him what his pain level was and he would usually say "3" when I knew it was well over 5! Sorry – I could go on and on. Fact is, he did a feat most healthy people couldn't do and I guess he's really called a survivor.

My neighbors witnessed him coming out of the house on his own.

One more thing – this is Denver, Colorado. I called our 911 for an ambulance. I've been billed by Denver Health & Hospital.

[Genie]

Another thing -- this isn't to get out of paying the bill. I already made my payment on it!

[EMTDON970]

Ive always said "anything can go BLS"

[KEVD18]

Ive always said "anything can go BLS"

spoken with the utmost ignorance possible.

well, let me correct myself. anything can go bls, if you want a large percentage of the patients to die or experience significantly increased after effect or defecits when they could have otherwise been spared.

a cardiac arrest has pretty dismal chances overall, but they are better with the earliest als possible.
for the services that utilize prehospital thrombolytics, they are drastically decreasing lasting effects from strokes.

i could go on all night....

im not one of the people that thinks basics are worthless(and those people do exist, even here). but we have to know our place. we cant handle everything. if we could, there would be no medics. there are als calls and bls calls.

[mycrofft]

Most immediately convert from scope to open procedure (they have both instrument sets on hand just in case) if they find a ruptured anything; can't visualize, clean and close friable tissues via scope like you can manually. In fact, darn near 100% go to "open".

[bstone]

Ive always said "anything can go BLS"

Everything can be ALSed. Not everything should be BLSed.

That's my motto.

[traumateam1]

Based one the original posters second post on the second page, the medics were in the wrong. Why would you allow a patient to walk 52 feet. And I say allow because wouldn't you try to convince the p/t to take a stair chair ride? Or use the medics as crutches? I think they were just being lazy.
Now for the record could Genie answer a question for me?
Did your husband DEMAND to walk to the door on his own in his underwear?

[KEVD18]

Everything can be ALSed. Not everything should be BLSed.

That's my motto.

no, i wouldnt agree with that either.

sure, every call can have an als procedure. but does the call need an als procedure is the question? and if the procedure isnt justified, is it really an als call?

example: suicidal ideations with a plan. pt called 911 for transport to H for voluntary commitment. denies cp, sob, dizziness, nausea, vomiting, pain or discomfort of any kind. denies any substance ingestion. pt is compliant in all regards. pts airway is patent. they are speaking in full sentences. l/s are equal and clear bilaterally. vital signs are stable and within normal limits. no significant findings in any part of the exam.

what als procedures are needed here? they dont need a line. they dont need to be monitored(cardiac) anymore than i do. they dont need to be intubated, vented, paced, medicated, have labs drawn. im literally sitting here racking my brain trying to justify any als procedure here. in fact, this isnt even a bls call. this is a taxi/friends car call, but since health insurance doesnt pay for that, they called the ambulance. but it certainly isnt an als call.

[triemal04]

Kev18- Maybe. The fact still remains, he did walk. Unaided. (again, I'm not saying either way if this was right or wrong). Given what the medics on scene saw and were faced with in regards to his location, this may have been warranted. Or may not have been.

Genie- If I've offended you, then I do apologize, that's not my intent at all. But, in this type of situation, with a family member/bystander/whatever who was personally and emotionally involved in the situation and who has no background in mediciene or EMS (I'm guessing here) it's hard to make a full determination of what should or should not have happened based only on that person's statement. My recomendation would be the same as ffemt's; contact Denver Health and file a formal complaint if you feel it was warranted. I will tell you up front that Denver Health is a system with a lot of problems, so you may not get a satisfactory resolution, but if you want, you should definetly try. This next part doesn't apply to you, so you can ignore it.

To EVERYONE- This situation comes up fairly regularly on these type of forums, even though this does not appear to be one of those cases. But it is not uncommon to find someone who is on a fishing expedition for information they can use to sue a particular service because they didn't like the quality of their care, right or wrong. Usually it's fairly obvious from the beginning, other times it takes awhile for things to get clearer. Providing your opinion based on limited information is not the best idea, and can lead to problems for someone else, all due to the fact that YOU did not know what really happened before you spoke up. If you are going to provide an opinion, especially to a layperson who may take what you say as gospel, then you need to be fully informed of really happened, something that is next to impossible on the internet.

[triemal04]

Based one the original posters second post on the second page, the medics were in the wrong. Why would you allow a patient to walk 52 feet. And I say allow because wouldn't you try to convince the p/t to take a stair chair ride? Or use the medics as crutches? I think they were just being lazy.
Now for the record could Genie answer a question for me?
Did your husband DEMAND to walk to the door on his own in his underwear?
A patient? Yep. Done it many times and for more than 52 feet. Ordered them to walk that far too. Why? Because not everyone needs a gurney ride for the whole trip. Are you going to put a broken finger from the second floor (or hell, even the first floor) on the gurney/stairchair instead of having them calmly walk to the ambulance?

[Genie]

Based one the original posters second post on the second page, the medics were in the wrong. Why would you allow a patient to walk 52 feet. And I say allow because wouldn't you try to convince the p/t to take a stair chair ride? Or use the medics as crutches? I think they were just being lazy.
Now for the record could Genie answer a question for me?
Did your husband DEMAND to walk to the door on his own in his underwear?

He absolutely did not!! They flatly stated to my husband, "We can't carry you out of this bedroom. You'll have to walk out." Outside of the house the paramedic rolled the stretcher up until the sidewalk turned a 90 degree angle towards our 2 steps up to the door. He just plain stopped and said, "I can't take it any further." My neighbor was taken by ambulance to the hospital last year, having abdominal pains. He has the same house design we do and he said he was carried out of the master bedroom.

[bstone]

no, i wouldnt agree with that either.

sure, every call can have an als procedure. but does the call need an als procedure is the question? and if the procedure isnt justified, is it really an als call?

example: suicidal ideations with a plan. pt called 911 for transport to H for voluntary commitment. denies cp, sob, dizziness, nausea, vomiting, pain or discomfort of any kind. denies any substance ingestion. pt is compliant in all regards. pts airway is patent. they are speaking in full sentences. l/s are equal and clear bilaterally. vital signs are stable and within normal limits. no significant findings in any part of the exam.

what als procedures are needed here? they dont need a line. they dont need to be monitored(cardiac) anymore than i do. they dont need to be intubated, vented, paced, medicated, have labs drawn. im literally sitting here racking my brain trying to justify any als procedure here. in fact, this isnt even a bls call. this is a taxi/friends car call, but since health insurance doesnt pay for that, they called the ambulance. but it certainly isnt an als call.

You misunderstand. Everything can be ALSed but not everything needs to be. Big difference.

[traumateam1]

A patient? Yep. Done it many times and for more than 52 feet. Ordered them to walk that far too. Why? Because not everyone needs a gurney ride for the whole trip. Are you going to put a broken finger from the second floor (or hell, even the first floor) on the gurney/stairchair instead of having them calmly walk to the ambulance?
Are we talking broken finger here or not?

[traumateam1]

So based on what Genie is saying here.. they straight up told a p/t with moderate to severe abd pain to WALK to the front door, without taking the time and decency to dress him with pants. So tell your unit chief, or supervisor you made a moderate to severe abd p/t walk >50 feet to the stretcher because you were to lazy to get the stair chair. Yeah we'll see how that one goes over.
Genie: Follow ffemt's advice, best thing you can do.

[daedalus]

I agree with triemal...none of us were there, so we're only getting one side of the story. We don't know if the patient insisted on walking rather than being carried, we don't know what his vitals were, there's just too much we don't know.

To the OP: A complaint may or may not be warranted, but I would suggest that you, at a minimum, do the following. Call the ambulance company and ask to speak to the supervisor/manager. Get the name of their medical director, and request that this call be sent in for a QA/QC review by their medical director. Then contact that person, and explain your concerns to them. Request to be kept in the loop on this one.

Actually, this is a great idea. Calling and requesting QA/C and getting the low down from the medical director (a medical doctor) will get you an unbiased and expert opinion, and also get anyone who deserves it in trouble. I echo this idea. Lets not armchair quaterback this crew, guys. Why not let the MD do it so we can keep our hands clean on this one

[KEVD18]

Actually, this is a great idea. Calling and requesting QA/C and getting the low down from the medical director (a medical doctor) will get you an unbiased and expert opinion, and also get anyone who deserves it in trouble. I echo this idea. Lets not armchair quaterback this crew, guys. Why not let the MD do it so we can keep our hands clean on this one

that may not be entirely accurate.

in massachusetts, service medical directors are paid employees on the company. sure, its not their main income. quite the opposite, a small fraction of it. now i haven't met a doc yet that would risk their medical license to side with the service just because they were being paid a pittance to do so. but they are on the payroll and therefore there is the possibility that they are susceptible to being influenced in the wrong direction.

[Genie]

Broken finger? Re-read my posts and learn. My husband had been through Chemo and Radiation on his middle chest. As a result, the chemo damaged his kidneys and the radiation damaged his esophagus. He is 6 feet tall and down to 120 pounds. He looks like death. He lost all his hair, which was obvious, and we showed paramedics the extension radiation burns and Groshong catheter. His radiation may also have caused heart damage. His kidneys were throwing out all sodium, magnesium and potassium. Just having a low blood pressure, like the paramedics found, does not mean he's all right. We know, from him being re-hydrated frequently, that his blood pressure would be low on laying down and drop lower when being elevated. He was very lucky to never have had a heart attack.

We know from being often in cancer treatment that there are many normal-looking people receiving treatment. Radiation to the mid-chest can cause heart and lung problems 4-6 months, even a year after treatment. It's rare, but it is apparently happening to my husband.

Back to the main issue though. He was having severe right-side obdominal pain and that's what we called the ambulance for. We gave history of my husband to the dispatcher and paramedics but thought the paramedics were the ones to assess him, not us. We shut up, stood back and followed their orders -- walk.

I will follow through with your advice to have this reviewed. I have scared many relatives and friends, telling them what happened. I know they would feel better if there were consequences for the actions of these paramedics and they feel they can trust most paramedics.

[KEVD18]

genie: you're confused. the broken finger thing was a side comment about another type of call we see a lot.

[Bosco578]

Broken finger? Re-read my posts and learn. My husband had been through Chemo and Radiation on his middle chest. As a result, the chemo damaged his kidneys and the radiation damaged his esophagus. He is 6 feet tall and down to 120 pounds. He looks like death. He lost all his hair, which was obvious, and we showed paramedics the extension radiation burns and Groshong catheter. His radiation may also have caused heart damage. His kidneys were throwing out all sodium, magnesium and potassium. Just having a low blood pressure, like the paramedics found, does not mean he's all right. We know, from him being re-hydrated frequently, that his blood pressure would be low on laying down and drop lower when being elevated. He was very lucky to never have had a heart attack.

We know from being often in cancer treatment that there are many normal-looking people receiving treatment. Radiation to the mid-chest can cause heart and lung problems 4-6 months, even a year after treatment. It's rare, but it is apparently happening to my husband.

Back to the main issue though. He was having severe right-side obdominal pain and that's what we called the ambulance for. We gave history of my husband to the dispatcher and paramedics but thought the paramedics were the ones to assess him, not us. We shut up, stood back and followed their orders -- walk.

I will follow through with your advice to have this reviewed. I have scared many relatives and friends, telling them what happened. I know they would feel better if there were consequences for the actions of these paramedics and they feel they can trust most paramedics.

Glad you feel better. Hope you find closure on this issue. Sorry to hear you have "scared many relatives and friends" with your tale of woe. File as many complaints as needed to make you feel better. Best of luck.

[Guardian]

I've had cancer patients with abdominal pain walk to the stretcher. I've taken 20 mins to get on scene. I've started an IV and billed the patient for ALS.

You love your husband and want him to be treated like a king. We don't love your husband and treat him like the other 10 people in similar conditions we saw that night. Thus, nothing we do is ever going to be good enough. Because you love your husband, you most likely overreacted. He most likely did not need to be carried from his bed. The real world dictates we make judgments based on our vast previous experience in dealing with people in you husband's condition. We are usually much more accurate than family members when making those judgments because of our experience and lack of emotional involvement. While you saw an emergency, the paramedics most likely more accurately saw a routine call with relatively minor discomfort.

You mentioned that you and your husband did what you'll were ordered to do (walk). Generally speaking, paramedics can't order anyone to do anything. I would encourage you and your husband to request more assistance next time. Your husband has the real power because only he really understands how bad it hurts and he could have refused to walk or requested something to cover himself up with. Tell your husband to not be afraid to take a little more of the initiative next time. If he refused to walk, they would have carried him out. I hope this helps with any future paramedic contacts.

[triemal04]

So based on what Genie is saying here.. they straight up told a p/t with moderate to severe abd pain to WALK to the front door, without taking the time and decency to dress him with pants. So tell your unit chief, or supervisor you made a moderate to severe abd p/t walk >50 feet to the stretcher because you were to lazy to get the stair chair. Yeah we'll see how that one goes over.
Genie: Follow ffemt's advice, best thing you can do.
Well...yes, yes I have done that. And will do that again. And again. And again. And you know what? Never had any problems come from doing that. Not from my partners, not from anybody that I work with at any level.

Does this mean that each person needed to be carried? That what I did was detrimental? That each really had pain? That some weren't drug seekers? That there weren't other circumstances involved that dictated my course of action? I'm not saying, and you don't know. Why? Because you weren't there.

Is this getting clear yet?

[daedalus]

I admit, I have asked plenty of patients to walk to the gurney. If my back goes out at my age, I will never be able to continue my career in paramedicine, which means I will no longer be able to be of service to people the way I want to be. If I ever suspected that walking may be detrimental to the patient's condition, I would have assisted or carried them to the gurney. However, I do teach new EMTs that you cannot risk your back just because an obese patient does not want to walk because they are "lazy" or something to that extent.

I doubt that this is the situation here, your husband being so thin due to the treatment for his cancer. Again, I encourage you to ask the ambulance service to review the call with their QC team. My comments above are meant for the professional debate over assisting patients to gurneys.

[Bosco578]

I've had cancer patients with abdominal pain walk to the stretcher. I've taken 20 mins to get on scene. I've started an IV and billed the patient for ALS.

You love your husband and want him to be treated like a king. We don't love your husband and treat him like the other 10 people in similar conditions we saw that night. Thus, nothing we do is ever going to be good enough. Because you love your husband, you most likely overreacted. He most likely did not need to be carried from his bed. The real world dictates we make judgments based on our vast previous experience in dealing with people in you husband's condition. We are usually much more accurate than family members when making those judgments because of our experience and lack of emotional involvement. While you saw an emergency, the paramedics most likely more accurately saw a routine call with relatively minor discomfort.

You mentioned that you and your husband did what you'll were ordered to do (walk). Generally speaking, paramedics can't order anyone to do anything. I would encourage you and your husband to request more assistance next time. Your husband has the real power because only he really understands how bad it hurts and he could have refused to walk or requested something to cover himself up with. Tell your husband to not be afraid to take a little more of the initiative next time. If he refused to walk, they would have carried him out. I hope this helps with any future paramedic contacts.

This hits the nail. Well said.

[yowzer]

he shouldnt have been made to walk. if they couldnt get the stretcher in, they should have used a stair chair.


It's possible they didn't have a stair chair.... When I worked on an ambulance, we didn't have any such beast, just these horrid canvas bucket things with handholds -- assuming it hadn't been lost somewhere. Or we'd use a scoop or backboard, but those tight 90 degree turns into narrow hallways are only slightly less awkward with those than a cot. A couple of times we sat someone down in a sturdy kitchen chair and carried that.

In general, though, if it's a case of walk or carry and the patient is physically able to walk, they're footing it. I'm sure we all know people out on disability with back injuries. Do you want to be another?

Sounds like this guy should have had someone at his side to lean on/assist, though. There are ways and then there are ways of walking someone to the cot.

[Flight-LP]

I really cannot believe some of the responses I am reading. If you use proper lifting mechanics, you will not injure your back. C'mon, we are talking about a 120ish pound man. Every one of us should be able to carry him unassisted, much less with 2 people. Many State's, Texas for instance, requires an ability to lift a particular weight. Can't do it? Then you are not fit to perform your job description. Simple as that. An excuse is all it is. All of this "you are just like the other 10 people we have seen" and the "if they can, they will walk" is B.S.

STOP BEING LAZY AND DO YOUR JOB!

Put a little thought and care into your patients, it won't kill you, you will still get a paycheck, and I don't know, maybe it will make you feel good about doing the right thing instead of being self-centered. If its a problem, then maybe you need a vacation...............

It is so easy to say that he should have refused to walk. The general impression that most get is that EMS will do the right thing for their patient. The pt. and / or family called for assistance, nothing more should be required. the rest is in YOUR hands.

Genie, I agree with the aforementioned opinions that you should contact the agency's QA department and follow up. I am sorry for your experience, I wish you and your husband well..............

[firecoins]

deleted my comment by posting a non sensical comment.

[traumateam1]

I really cannot believe some of the responses I am reading. If you use proper lifting mechanics, you will not injure your back. C'mon, we are talking about a 120ish pound man. Every one of us should be able to carry him unassisted, much less with 2 people. Many State's, Texas for instance, requires an ability to lift a particular weight. Can't do it? Then you are not fit to perform your job description. Simple as that. An excuse is all it is. All of this "you are just like the other 10 people we have seen" and the "if they can, they will walk" is B.S.

STOP BEING LAZY AND DO YOUR JOB!

Put a little thought and care into your patients, it won't kill you, you will still get a paycheck, and I don't know, maybe it will make you feel good about doing the right thing instead of being self-centered. If its a problem, then maybe you need a vacation...............

It is so easy to say that he should have refused to walk. The general impression that most get is that EMS will do the right thing for their patient. The pt. and / or family called for assistance, nothing more should be required. the rest is in YOUR hands.
Thank yooouuu! It's very clear and simple here people. The medics were being lazy and not doing their job. Regardless of "the last 10 people" who cares. It is your job to treat every patient like it's your first of the day. Give them the care they need, not to force them to walk when it's not necessary. If you are making your p.t with a C/C of abd pain walk, when its severe enough to help them (if you don't have a stair chair, and can't fit the stretcher in) than you need a little vacation.

[BossyCow]

He absolutely did not!! They flatly stated to my husband, "We can't carry you out of this bedroom. You'll have to walk out." Outside of the house the paramedic rolled the stretcher up until the sidewalk turned a 90 degree angle towards our 2 steps up to the door. He just plain stopped and said, "I can't take it any further." My neighbor was taken by ambulance to the hospital last year, having abdominal pains. He has the same house design we do and he said he was carried out of the master bedroom.

Genie:
Let me say first, I'm very happy that your husband is doing well. Please understand that the discussion here is only opinions, based on the information we get from your perception of events. I understand that you are trying to be factual and unemotional on the events but the point being made is that without having seen everything, we cannot understand what was factoring into the medics decision to do what they did.

Was one of the medics recently sanctioned for hurting himself while lifting a pt that could have walked? Is the stretcher on the rig they were assigned that day unable to make a tight corner while the one on your neighbor's call was able to make tighter turns? Was your husband's ability to endure the chronic and severe pain of his recent health history causing the medics to underestimate how much pain he was really in?

There are a lot of factors at work and to leap to the conclusion that the medics should have performed differently is one I'm not willing to make. Your husband arrived at the hospital, was stable and able to enter surgery to correct his problem. That is the goal of EMS. He recovered and is doing fine. In our industry, this counts as a win.

As far as the response time, there is no way of knowing if the agency you called was returning from another call or you were attended to by a second out unit because the first unit was out on another call. It is definitely worth calling the agency and discussing it with the management there. At the very least, you may get some information that will help you understand why things went the way they did.

[Jon]

Genie,

We all make mistakes... and in our line of work, mistakes can kill people. The stakes can be high. We all make mistakes occasionally... that is why we PRACTICE medicine.

On the same token... I think this call does probably deserve review from the service, and I echo the call of others here for you to contact the service and ask for them to review the call and determine that the care that was provided was adequate and in line with their standards of care.

Good luck, and keep us posted.

[EMTDON970]

spoken with the utmost ignorance possible.

well, let me correct myself. anything can go bls, if you want a large percentage of the patients to die or experience significantly increased after effect or defecits when they could have otherwise been spared.

a cardiac arrest has pretty dismal chances overall, but they are better with the earliest als possible.
for the services that utilize prehospital thrombolytics, they are drastically decreasing lasting effects from strokes.

i could go on all night....

im not one of the people that thinks basics are worthless(and those people do exist, even here). but we have to know our place. we cant handle everything. if we could, there would be no medics. there are als calls and bls calls.


Where I work at I have a hospital within 7 minutes away, why wait 10 to 15 minutes for a medic when I can be at the hospital quicker.

I know some worthless EMT's my company employs them :wacko: but I still believe any call can go BLS, whether it should or not is a different story.

[reaper]

In a city the size of Pittsburgh I would expect every truck to be ALS. You should not have to wait 10-15 minutes for ALS, They should be first on scene. If you service is sending BLS trucks to emergencies, then they need to rethink being involved in EMS!

[Genie]

Thanks for all the replies! Some of them I didn't appreciate at first. Then, I did realize what I might encounter when I call our paramedic division for a review of what happened. I'll be ready because of what I've learned from you.

I could go back over all your comments and come up with more explanations of our situation here, but I don't believe it's necessary. I realize that you all must find it very unbelievable and are trying to come up with good reasons for the paramedics to make my husband walk. I found it unbelievable myself and am kicking myself for allowing it to happen as it did. Instead I feel like a "softy" and feel sorry for those two young men if they are disciplined -- stupid, right?

I keep trying to recall everything I said to the dispatcher that made them determine it would be 20 minutes before an ambulance got to the house. I know I said he was a cancer patient suffering affects of chemo and radiation and I took him in frequently for re-hydration and potassium. Then I said he now had a different pain, a severe pain in his lower right abdomin and was in excrutiating pain just trying to move/roll over in bed. The only question I remember the dispatcher asking was, "How is he breathing?" and I said, "he's breathing very heavy, like it's hard to breath." Then I was told they would be out in 20 minutes, open the front door and remove all pets.

Denver is supposed to have a 6-8 minute response time, so I was surprised at that. They came up without lights or sirens as far as I know. I'll have to ask my neighbors! Anyhow, I wasn't as concerned about that as much as their not carrying him out of the house. Our front walk, hallways, etc. are very accessible – you wouldn't believe all the huge items that have come through here the last 35 years!

Oh well – I'm doing what I said I wouldn't do in my first paragraph – coming up with more explanations – sorry! I guess my next communication is with the paramedic director.

[Genie]

One more thing. I called at 1:30 p.m., which is probably an "off" time in Denver. I know that pretty well since I've lived here for 40 years.

[ffemt8978]

Genie, please keep us informed of what comes out of this, as it is something that we can all learn from.

[MMiz]

First, welcome to EMTLife!

You aren't the typical user we get, so please be understanding if the responses you receive aren't as you expected. It's kind of like having a complaint against a police officer and going to a police officer community, we tend to stick up for our own.

It's almost impossible for us to sit here and give you the response you're looking for. There could be a million and a half reasons why your husband received the treatment he did. If I were you I'd submit an inquiry or complaint in writing, and at the very least ask for a review of the call.

As for the long response time, you really need to speak with the EMS provider to see what that was the case. A typical emergency response time in most systems is 8-9 minutes, while a typical non-emergency response is 15-20 minutes. Please understand that your definition of an emergency differs from our version. It's up to the dispatcher to determine the dispatch priority of a call. We've arrived on normal (non lights/sirens) calls to find a patient in cardiac arrest. Clearly there was a breakdown in communication. I've arrived on calls for a gunshot wound victim that were really a jammed finger. It's really the dispatcher's responsibility to take the information and dispatch the unit.

I'd hate to say it, but some of my partners in EMS like to see the patients walk whenever possible. It's an absolutely pain trying to maneuver the 100 lb bulky cot through doorways and up and down porches. The truth is, that's it's our job to transport the patient in the safest, healthiest manner possible, which may not have been a stretcher in your case. If I'm unable to put the patient on the stretcher I then use our stair chair or we carry the patient out to the cot with our arms.

It's important that you advocate for your husband's health and well being, which I think can best be served by contacting the service and asking for a review of the call. I've typed out multiple paragraphs where I analyze why your response took so long, and all of them are valid reasons, but I'm really not in a position to rationalize or justify another persons actions. That's what a Quality Improvement committee is for.

I sincerely with you the best of luck, and wish your husband all the best.

[KEVD18]

Where I work at I have a hospital within 7 minutes away, why wait 10 to 15 minutes for a medic when I can be at the hospital quicker.

I know some worthless EMT's my company employs them :wacko: but I still believe any call can go BLS, whether it should or not is a different story.

by that logic sir, any call can go by yellow cab.

as far as time, yes you have to weigh the time to the H against the time it would take the medics to arrive and decide whther its better to wtay and play or load and go an intercept enroute. this is NOT the same as "every call can go bls". this is "in this situation, waiting for als would harm more than help".

its not worth arguing over. i dont agree with you in any way, but i'll agree to disagree

[KEVD18]

In a city the size of Pittsburgh I would expect every truck to be ALS. You should not have to wait 10-15 minutes for ALS, They should be first on scene. If you service is sending BLS trucks to emergencies, then they need to rethink being involved in EMS!

be careful here. thats a really broad statement.

putting R/r's "every 911 call deserves an als assesment" aside from the moment, there are bls emergencies. in some places, they far out number the true als emergencies. true here meaning the call actually required and als procedure, not a call where als interventions were done "because we can".

in the city of boston, there are only 6 medic trucks on during normal days. during special events(4-JUL etc) they might put up an additional -p truck, but normally just the 6. they are complemented by 16 bls trucks that run the majority of the calls. they have a tiered system where a bls truck will be dispatched to teh minor emergencies. if it is classafied as requiring als, they two truck the call. major traumas etc get als, bls and a div chief. fire respond to maybe 30% of the calls.

while i dont really like the system, it works. they answer over 100k calls a year, with upwards of 70k transports. it may not be pretty(you can easily expect to hit 10 calls in 8 hours on a slow day.

you cant paint every city with the same brush.

[reaper]

Sorry, But any major city should have an all ALS service. This means at least one medic on every truck. They are doing the pt no could to have to wait for an ALS intercept. In the Rural areas and smaller towns, they may not have a choice due to funding. Any city the size of Pittsburgh and Boston should not allow an EMS service that is jeopardizing the citizens that pay all those huge tax bills.

You don't see the FD sending out explorers to fires, telling them to call for the FF's if it's needed. Why should the Pt's have to wait on care in a big modern city?

I understand that not all calls are ALS. But, do you want your family to be that call that did need need it and they send a BLS truck out? We are in the game of "What if's". You must be prepared for the worst and hope for the best!

[KEVD18]

Sorry, But any major city should have an all ALS service. This means at least one medic on every truck. They are doing the pt no could to have to wait for an ALS intercept. In the Rural areas and smaller towns, they may not have a choice due to funding. Any city the size of Pittsburgh and Boston should not allow an EMS service that is jeopardizing the citizens that pay all those huge tax bills.

You don't see the FD sending out explorers to fires, telling them to call for the FF's if it's needed. Why should the Pt's have to wait on care in a big modern city?

I understand that not all calls are ALS. But, do you want your family to be that call that did need need it and they send a BLS truck out? We are in the game of "What if's". You must be prepared for the worst and hope for the best!


yep. sending basics to the sub acute left toe pain x 3 weeks is significantly jeopardizing the patient safety. btw, thats an actual call that i personally worked in boston. person called 911 because they had stubbed their toe three weeks prior and it hadnt stopped hurting yet.

tell me, what would you have done at the als level for that call? are you really advocating line, labs, XII lead, and pain management for a toe stubbed three weeks.

the plain facts of the matter are there are als calls and bls calls. quite frankly, it is true that most "bls emergency" calls are more suited for a taxi. but id much rather have a bls crew tied up on that call than an als unit in your all als service.

have you ever been bringing out the dead? its a fdny paramedic movie from the early 90's. theres one seen where the get sent to such and such a location for the neighborhood famous drunk home less guy. john goodman is complaining that "one of these days, we're going to get a cardiac and the only medics are going to be taking care of mr. rowe".

in your all als system, the truck that should be handling that code will be coming from the next district because the primary for that area is hauling drunks to detox(a call i have done hundred of in boston). tell me sir, do we have that extra 3 minutes in the case of say a foreign body airway obstruction? NO!

there is a place in even the busiest urban 911 setting for bls trucks.

[mycrofft]

..............

[ffemt8978]

Since the OP has gotten the information she was looking for, let's not let this turn into another BLS vs ALS debate.

http://www.chimpie.com/smilies/adminsn1.gif