Golden Eye
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Ventilate with a BVM, treat her for possible shock. Use an air evac because she's in shock and need immediate treatments. I would also suspect and ask if she's diabetic or possible stroke. Ask her my sample /opqrst.
43 female/unconscious
- Thread starter NomadicMedic
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So not to be a prick...or awesome paramedic for that matter...but how do you plan on asking this woman about her SAMPLE history when she is unconscious?
I don't particularly think air is inappropriate for this patient, depending on your location and abilities to control her airway. If she's not protecting her airway, you're not doing well with BLS and don't have an RSI option if be on the radio calling for a flight crew just to RSI her if they're gonna be quicker than code 3 to the hospital.
About the only time I'll transport code 3 now is if there's an airway issue that I can't fix or uncontrollable life threatening hemorrhage.
I don't particularly think air is inappropriate for this patient, depending on your location and abilities to control her airway. If she's not protecting her airway, you're not doing well with BLS and don't have an RSI option if be on the radio calling for a flight crew just to RSI her if they're gonna be quicker than code 3 to the hospital.
About the only time I'll transport code 3 now is if there's an airway issue that I can't fix or uncontrollable life threatening hemorrhage.
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What kind of shock are you treating this patient for? If it's the generic first aid version, I don't think raising her legs in the air and tossing a blanket on is going to change a heck of a lot. Flight wise, remember this patient is 25 minutes by ground from the hospital and the helicopter hasn't even been alerted, let alone launched.
Is this patient critical after she's had her airway controlled? I'd argue that she remains sick of course, but isn't necessarily time critical to the point that I'd fly her even if the aircraft was on the ground in front of me with a ground transport time this short. In fact, I'd transport this patient non emergently unless there was some kind of extreme traffic we were stuck behind. I don't think ~3 minutes of time saved would be worth it otherwise.
In regards to your questioning, remember this patient is unresponsive and not in a position to answer your questions. A SAMPLE history would be great, but it seems like you got as much as you can of that out of the husband. I don't see how the OPQRST mnemonic would be at all beneficial in this scenario. As far as your differentials go, hypoglycemia would be ruled out on scene with a glucometer, and the husband doesn't relate any kind of diabetic history anyway. Stroke is of course a possibility we can't rule out, and a head bleed would be high up on my list of differentials.
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Great minds think alike
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You guys are allowed to use Diprivan in the ED? That isn't right!
Just kidding, of course.....
h34r:Make sense. I haven't worked in the ED in a long time or in the streets for nearly as long, so I *occasionally* commit the sin of briefly forgetting that there are extra considerations that need to be taken into account when you are outside the OR or the endo suite.
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Hopefully that or just a really green guy who doesn't know any better because his EMT instructor unfortunately used to often something along the lines of "But don't worry about that.....in real life, if the patient is really sick just call for ALS or the helo".
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Along with an epic humblebrag intro post.
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I caught one of our PRN instructors telling an AEMT class this. She didn't teach that class again after I straightened out the miscommunication for the class.
abckidsmom
Dances with Patients
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If it's only 30 minutes to the hospital, it's important to have worked out well beforehand what the real-time dispatcher to dispatcher, dispatcher to pilot, pilot to weather check, crew to helo, helo to scene (approx.) time is. Those times can really mean that it's a lot faster for the patient, safer, with less expense to just load up and drive to the hospital. I need to see a clear difference (like airway is unmaintainable for the ride, or >10 minutes difference on time to definitive airway [no RSI here], etc.)
I have a sort of geographical line I like to keep in my head in our service area, and if we're west of that line (toward the hospitals to the west), or east of another line (toward the hospitals to the east), then I really have no intention of calling the helicopter unless I'm up against a transport delay for extrication or something.
VFlutter
Flight Nurse
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I think they taught the same thing to the ER docs in our community hospitals...
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Exactly how I do it as well ma'am
I've got specific geographic locations where I know they have to be co-dispatched to make any difference and locations where I know I can request them from the scene and they're still faster, or if I want to bypass the trauma center and fly them into California for the Burn Center in at UC Davis I can do that too as long as I'm outside a specific road that loops was the original city limits. Our HEMS is dispatched by our communication center so all it is is the dispatcher calling out to the ACS and saying "38 wants Cf on an airborne (standby, or ground standby or go)" and they dispatch the helo. Generally 8 minute request to launch time. Then 5-15 until overhead and 5 to on the ground.
Those Astar B350s are fast like a NASCAR
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You have an unconscious, unresponsive patient. She can't answer your questions. The husband's probably about out of info at the moment, and probably freaked out so he's not going to be of much help at the moment.
The hospital's about 25 minutes away. The helo has to be launched, fly there, find an LZ that you have to set up, land, possibly be transported to the scene, do their own assessment of the patient and begin their own treatment of her, possibly be transported back to the helo, lift and fly 10 minutes to the hospital, where they then have to land, cool down the helo, unload it, and go to the ED. If you transport the patient instead, you'd have been there at the ED for about 20-30 minutes before the helo actually gets the patient to the ED.
A lot of us here have real-world experience with helos vs ground. Unless the helo is already in the air, if the ground transport time is about 40-60 min or more, you would be better served initiating transport instead of waiting for the helo to arrive. Were I to get shot or in a wreck where I'm at, I would hope that the ground EMS crew drives me to the Level 1 Trauma Center instead of waiting for a helo to pick me up. They may alert them and get them flying this way, but if they can initiate transport before the helo is orbiting overhead, ground transport is the fastest way to get me to the ED. Not by much, but it is fastest.
What isn't the case any more is we used to have a helo base about 7 miles from here. From alert to being overhead was about 6-8 minutes. If they were simultaneously dispatched with ground EMS, they'd arrive at about the same time. I've seen that happen a couple of times. That base was moved quite a bit further away about a year ago so we no longer have that fast of a response if we need someone flown out. That happens maybe once a year. Maybe.
abckidsmom
Dances with Patients
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Exactly how I do it as well ma'am
Our HEMS is dispatched by our communication center so all it is is the dispatcher calling out to the ACS and saying "38 wants Cf on an airborne (standby, or ground standby or go)" and they dispatch the helo. Generally 8 minute request to launch time. Then 5-15 until overhead and 5 to on the ground.
Those Astar B350s are fast like a NASCAR
The other thing is that our primary helicopter service is very, very, very conservative for weather. So if it might storm this afternoon, and it's closing in on lunchtime, they're not coming.
Or if there's a cloud in the sky between here and Singapore. Or something.
OP
OP
NomadicMedic
I know a guy who knows a guy.
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That's the joke here. There's a cloud between here and Philly. Trooper 2 is down due to weather.
It's not really that bad... Except when it is.
unleashedfury
Forum Asst. Chief
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I swear the new EMT-Basic curriculum goes as follows
Scene Safe/BSI
Apply High Concentration O2
Call for ALS
A lot of EMT's in my area are not taught how to appropriately manage a critical patient. diesel bolus is often the best treatment in most cases. our primary coverage area is within 10 minutes of the local band aid shop. So when new techs here they have to ride a call BLS they can often get a pucker factor and deer in headlights look YOU CAN'T DO THAT!! When my closest ALS is a hospital by all means I can and will.
The nice thing about here is we have about 3 different programs that are within reasonable time of our coverage area. One having hangars literally right across the runway from each other. Since each hospital network is trying to take over the world. They will fly except when its truly not possible.