Treat on scene or transport?

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Lil Medic

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Hey, I am an EMT basic and haven't started working anywhere yet. I was just thinking about scenarios after watching an episode of Monk and realized that I am having a little trouble identifying when it is appropriate to treat a patient on scene or to transport and treat en route. What situations would you out in each category?
 
Depends on where you are, how you're staffed, and what the injury/illness is. In other words, it requires a provider to use their judgement.
Do you have any specific scenarios in mind?
 
Lil Medic said:
Hey, I am an EMT basic and haven't started working anywhere yet. I was just thinking about scenarios after watching an episode of Monk and realized that I am having a little trouble identifying when it is appropriate to treat a patient on scene or to transport and treat en route. What situations would you out in each category?
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If they have an immediate life threat you can treat - Stay and play for a few minutes.

If they have an immediate life threat you CAN NOT TREAT - Get to a hospital.


That's as basic as it gets, and should help you a bit.
 
Too many variables. Get some time working and you'll be able to differentiate between the two. Eventually, you'll walk in to a room, see the patient, and say "We need to go...NOW"
 
I'll also add that for EMTs, by and large "load and go"/immediately request paramedics is going to be the better option than treating on scene simply due to the lack of treatment options. The one huge exception is cardiac arrest due to the poor quality chest compressions associated with a moving ambulance.
 
JPINFV said:
I'll also add that for EMTs, by and large "load and go"/immediately request paramedics is going to be the better option than treating on scene simply due to the lack of treatment options. The one huge exception is cardiac arrest due to the poor quality chest compressions associated with a moving ambulance.
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This. As a Basic you can't really do much on scene anyways. You need to take into account what the patient needs right now, what the definitive care they need is and transport time. Sometimes its better to stay a bit longer- for example doing a 12 lead ECG on scene as opposed to enroute to the nearest hospital- if it shows a STEMI pattern you may have to change where youa re taking the patinet.

At a medic level its a little different. You don't always have to rush to hospital. Sometimes its better to stay a little longer, do full assessment on scene for more minor stuff and if the patient is ok, not transporting them if appropriate.

I.E called to a 28 y.o pre-syncopal episode. Symptoms resolved on arrival feels 100% fine. Nil meds or relevant medical hx. You check BP/Temp/HR/Sp02/ECG/BSL with some orthostatics. Nothing of concern shows up. You end up leaving pt at home in car of her partner and instruct to visit GP etc. This outcome is probably better than just loading and doing everything on the way.
 
Linuss said:
Too many variables. Get some time working and you'll be able to differentiate between the two. Eventually, you'll walk in to a room, see the patient, and say "We need to go...NOW"
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Pretty much this and what JP said.
 
Lil Medic said:
Hey, I am an EMT basic and haven't started working anywhere yet. I was just thinking about scenarios after watching an episode of Monk and realized that I am having a little trouble identifying when it is appropriate to treat a patient on scene or to transport and treat en route. What situations would you out in each category?
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Every service is different. Every county is different. H#ll, even the individual states can't seem to get on the same page. Once you get a position, go through their orientation process, learn their protocols, get so.e experience. You'll learn what to do. It'll come. Its called "common sense". It's also called "experience". And you can't teach experience.
 
As a basic trauma is generally stay and play because you typically need to package them to some degree. Just about everything else is load and go with various degrees of urgency.

One you get out there you will also find the 3rd option: Sit and chat. Most of these PTs are 70+ and live alone with multiple cats. They all have COPD but no specific complaint as to why they called 911.

Finally, don't base your opinion on EMS around sit coms. There is a reality show that follows an urban ER on discovery health or one of those channels. It's the COPS of emergency medicine. That's not a bad one to watch.
 
At the basic level it's all load and go. Your primarily transportation, that's just the facts of life. At the medic level if it doesn't require urgent surgical intervention you usually have a bit of time to sort things.
 
the_negro_puppy said:
This. As a Basic you can't really do much on scene anyways. You need to take into account what the patient needs right now, what the definitive care they need is and transport time. Sometimes its better to stay a bit longer- for example doing a 12 lead ECG on scene as opposed to enroute to the nearest hospital- if it shows a STEMI pattern you may have to change where youa re taking the patinet.

At a medic level its a little different. [...cut...]
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Do some services allow basics to get a 12 lead? I read that all in the context of a basic but I don't think that is what you meant. Especially since you implied interpretation.
 
usalsfyre said:
At the basic level it's all load and go. Your primarily transportation, that's just the facts of life. At the medic level if it doesn't require urgent surgical intervention you usually have a bit of time to sort things.
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I agree, if I have a sick patient I'm out of here. But I'm also not one to just throw em on the stretcher either, I'd rather get a set of vitals and some sort of H&P depending on the complaint. This is especially true with a short transport time (less than 5), I need a second to get what the ED wants.I can't stand working with people whose first thought through the door is "how do we get them to the ambulance?" 9/10 the excess urgency "displayed on scene is just not needed.
 
Simusid said:
Do some services allow basics to get a 12 lead? I read that all in the context of a basic but I don't think that is what you meant. Especially since you implied interpretation.
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It's an ALS assist skill in NY. Can't interpret them though.
 
so, do you guys just "Load and go" regardless of the need for analgesia?
 
OzAmbo said:
so, do you guys just "Load and go" regardless of the need for analgesia?
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Again, depends on the situation.


If granny fell and broke a hip, I'll contemplate popping some Fentanyl (for her, not me) before moving her.
 
"contemplate"?

Seriously?

I hope im reading too much into that:huh:
 
A good number of your calls are going to be bull:censored::censored::censored::censored:. Stay and play with a full assessment and your bls. If you're not overly comfortable with the call radio for Als and load your pt. never wait unnecessarily for a medic. If your ready to go and he's still a few out... GO!
 
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