A "What would you do" situation

[bmennig]

First let me give you some backround on what I'm talking about...

Where our dept lies is right on the county line. We are dispatched from the county that most of our station sits on basically. We frequently get requests to assist our neighboring Ambulance in the other county. Our county has many ALS trucks whereas the other county has 1 truck with anywhere from 1 medic to 3 (we don't know how many there are at any given time).

For this particular call, the single medic truck from the other county was already on a call. Typically dispatch will pull an ALS truck from our county when this occurs.

The dispatch was was for a 26 YOF, diabetic emergency, patient conscious and alert at this time with the location being in the other county. That dispatch to me warrants the medics to respond, even though a conscious and alert diabetic emergency is quite manageable at a BLS level. Keep in mind that the other county's medic is already out on a call so they aren't coming. We are right at the station and respond in emergent mode. We arrive within 5 mins or so to find the pt fully conscious, alert, oriented, just complaining of an upset stomach, which is why she hadn't eaten anything that day (we were dispatched around 1400 hrs) hence the decline in her BGL. Pt does want to go to the hospital to get checked and it's approx 10 mins away, emergent. We put the pt on the stair-chair for ease of extrication from residence. We get the patient in the truck and start heading for the hospital the patient wants to go to. At this time, we are going in emergent due to no medic being available by the sounds of it. We were never notified that an ALS truck was dispatched to assist us. We're going and then all of the sudden a medic truck that was at least an additional 20 mins away from the scene, let alone our current location (about 5 mins from the hospital) calls us and asks for our location. I tell them were about 5 mins out from the ER and we're just going to continue in BLS, thanks anyway. I call the report to the hospital and they absolutely FLIP because there isn't a medic with this pt. I explained my actions and that didn't seem to cut it with the RN. Anyway, she takes my report and we arrived in 3 mins or so. Patient during all this time is fine, she's taking some oral glucose a little bit at a time and is felling a little better. All vitals are stable. We arrive and take the pt in, the RN still seems PO'd over not having a medic, but she eventually calms down.

My question is... Was our decision to continue in a correct one? I feel it was, due to the circumstances. Is it really worth waiting at least 20 mins for an ALS truck and the possibility of the pt going down the toilet? I don't think so in my opinion. The big difference is in the other county, they wait ALL THE TIME for ALS. We don't, hardly ever, we usually meet them enroute to the hospital. After all, the patient doesn't get better sitting at their house and waiting for the medic.

 

[CAOX3]

Conscious and alert diabetic, how do they think the medic would have treated it?

 

[boingo]

We are designed to take our carbs orally, so I tend to do that with patients that are capable, certainly a BLS skill.

 

[wyoskibum]

You didn't mention if the patient was insulin dependant and what the BGL actually was.

If it truly was a BLS call (seems like it was), then why run emergent? I can understand why the RN freaked out, you are patching in to the ER and she hears sirens in the background, it must be serious and there is no Medic.

IMO, I think you are putting patients and yourself at risk running emergent just because there isn't a medic on board. Either the patient is critical or they aren't.

 

[rescue99]

I'm not sure where you work and what the "protocols" are for this but, you acted within your scope of practice. AOX3 patient with a belly ache 10 minutes from an ER? It was hardly even a BLS call. Nurses aren't Med Control so if she's peeved, that's her problem. Med Control has the last word on this.....did the doc have a fit or just some nurse?

 

[Sasha]

Vitals? Any other complaints? Hx? How was she? Calm? Anxious? Keep ib mind womeb can present with atypical mi symptoms, stomach discomfort is one of then.

 

[rescue99]

Oh yeah, good point Wyosk..they were running a stable BLS hot! Ummm...okay, running hot is not protocol on stable patients so the nurse kinda does have a reason to be a wee annoyed.

 

[Sasha]

Sorry missed the age. On a blackberry. Disregard.

 

[JB42]

If this call is exactly as you described then you did the right thing. The hospital was closer than ALS. Transfer to difinitive care is part of our job as is not delaying that care.

 

[Epi-do]

Transporting vs. waiting for ALS - you made a good call. There is no reason to sit on scene when you could have driven to the ER twice before ALS got to the patient.

Transporting pt. emergent/lights & siren - not a good call in my area. There was no reason to transport via this method. Your pt was A&Ox3. She was taking the oral glucose. (Are basics able to check BGS in your area? If not, how did you know she was "low"? Keep in mind, even if you can't check a blood sugar, if the patient is able & willing to do so, you can always ask them to do it on their own for you. You can even document it in your PCR if you witnessed the pt doing it, just state that the patient did the check using their home glucometer.) This patient is not unstable at this point, and most likely would have been fine for the few extra minutes it would have taken to get her to the ER without all the flashy things and woo-woos.

 

[Shishkabob]

If you can get to an ER before an ALS unit can arrive, then that is ALWAYS the correct call, no matter what the RN thinks.

 

[EMTinNEPA]

Loading and going because the ER is closer than ALS? Good call.

Running hot to the ER? BAD call. If the patient is stable, there's no point in running hot because there's no medic... especially if running hot gets you exactly halfway to the hospital really really fast.

 

[JonTullos]

As others have already said: Running hot was not needed in this case. She was stable, airway intact, alert and all that... why the disco show?

And yes a call like this would be BLS in my opinion.

 

[bmennig]

In response to your questions, the patient was fine in all aspects aside from the belly ache. She was tolerating the oral glucose as best as she could. The patient didn't have a HX of diabetes however she said she was a borderline diabetic (I apologize for not mentioning that the first time). Pt didn't have a BGL monitor so I have no idea what it was and it's above our practice to do so. My reasoning for going hot was that the pt could potentially go down the crapper quickly and the belly ache may be something I can't see just from a BLS assessment. I do understand it may not have be the greatest idea to go hot, but that's my justification for it. Thanks for the input though, I appreciate it.

 

[rescue99]

Belly ache could be about anything, including hyperglycemia. If you learned something that day, it was still a good day!

 

[WuLabsWuTecH]

Yes I think it was a BLS call. What was the time difference in going hot and not?

We will transport routine, emergent, and expedite with expedite the only one running hot all the way. With an emergent, we'll turn on the light show if there is going to be a long delay (traffic backed up on the highway, we encounter a train so turning on the lights lets us get to the front of the line) but in your case, unless the transport had a LOT of tarfic lights between you and the hospital and getting to the hospital would have taken 30+ minutes otherwise, I probably wouldn't have gone with lights. Even if it did take that long I probably wouldn't have gone with lights.

The nurse has no right to be pissed at you. She isn't the one out in the field waiting for 20 minutes for ALS. Medical control can request that you wait for ALS, but if ALS in unavaliable and you're within 10 minutes they're not going to have you wait.

Going sirens in my area isn't necessarily a cue for our nurses to get hyped up. Yes, usually they are on a critical patient, but sometimes you just get stuck on the highway during rush hour and you have to turn them on to get to the hospital within the next hour.

Finally, squads are technically not allowed to be dispatched in our area anymore, all ambulances must be Medics and must have 2 medics on board, but a couple of the suburban departments get around it. If they are the only one responding, chest pains, abdominal pains, and a few others will get transported code since they have no way of knowing what's going on. They are getting around that now by setting up transmission equipment so Basics (who are allowed to take EKGs here) can transmit the info to the hospital.

 

[wyoskibum]

My reasoning for going hot was that the pt could potentially go down the crapper quickly and the belly ache may be something I can't see just from a BLS assessment.

That could be true with any patient. I typically do not run CODE unless they are going down the crapper. It is much easier to start normal travel and then STEP up to emergent if the patient starts to deteriorate. Just my $.02.

I do understand it may not have be the greatest idea to go hot, but that's my justification for it.

You were there and made the decision to do what you thought was best for the patient. Everyone has their own criteria and protocols to follow. We can Monday morning quarterback this til the cows come home.

Bottom line is that the patient was delivered to definative care in a timely manner and in good condition.