"Allergic reaction? Call an ambulance" says CNN

[WuLabsWuTecH]

Am I spoiled at my agency? As a basic I can administer non-prescribed epi-pens to patients in anaphylaxis, can get a medic while loading the patient in under five minutes if I'm on a BLS or ILS ambulance, only have a 2-15 minutes drive to the hospital depending where we are coming from and how we are getting there, and I don't need to contact online medical direction for over 95% of my treatments.

I think we both are. Only ALS units are left more or less in my county. Average response time of 4 minutes. Average time to hospital is 5 minutes. Average time to one of the trauma centers is 8-10 minutes.

Basics can give Epi (IM or Sub-Q), ASA, charcoal, glucose.

Sounds like NM EMT-Bs... way too much scope for so little training.

You won't like me running 12 leads, CPAPs, and dropping an OTT much then!

Epi-Pens aren't too much for a basic... in PA we have em as primary use onboard the units. Before an EMT can administer, they have to call medical command. Anaphylaxis is a condition where a patient needs epi NOW and not 20 minutes later when ALS arrives. Not all areas are blessed to have Paramedic ambulances.

Some areas still run an out dated two-tier response system.

Agreed, EPI is one of those that minutes makes a difference.

Exactly.


ASA, Epi-pens and oral glucose is the norm around here.

Yep!

 

[Melclin]

It would have been better for family to immediately loaded and transported as they would have reached hospital before the basic crew was even ready to begin transporting and hospital would have hopefully gotten the meds in time for them.

The public needs to be educated that patient care is not equal at all levels. Honestly city's/towns/communities/counties should have to post an ad every day that lists what level of patient care is available.

No, I don't think it's fair. I think it gives them a false sense of security. If they live within 10-15 minutes to the hospital, it may actually be faster for them to just drive themselves to definitive care, however if they think they can get treatment enroute, why would you drive yourself?

I think the public should be educated to what is really available to their areas and what each level does. Not just "This area has basic EMTs." But "This area has basic EMTs, they are not capable of invasive procedures except for a combitube. They cannot control your pain, they can not provide drug interventions for your medical emergency."

Undoubtedly in some circumstances it is better to drive, or be driven, to hospital. Trauma is a good example. Also, we actually have a program here for rural areas in which families of people with asthma have an action plan that gets them to definitive care quicker. If that involves driving themselves to hospital depending on where they are, then so be it. That program involves specific education regarding a specific problem, tailored to the normal severity of that specific individual's condition.

What you're asking is that a complex approach be applied, in some sort of public health message, covering areas with different levels of responses and different traveling times to the pt and to the hospital and perhaps involving different kinds of conditions.

You're asking untrained people, in an emergency to:

-properly identify the condition.
-consider the severity of the condition.
-know and consider the response time.
-know and UNDERSTAND the responders scope of practice, specific to location.
-considerthe distance to the hospital.

Then expecting them to drive safely to hospital.

You can't send the public a message saying:, "If you're in situation X, Y distance away from a hospital and the problem is N level of severity, and you're sure its specifically problem X and not problem Z, and prehospital providers of level 3 not level 2 are available (in some areas level 2 is acceptable, see appendix), and their response time is Q, then call an ambulance/drive to hospital".

CNN can't tell America that; no one will listen and if they did, they sure couldn't make a good decision based on information that complex.

These are clinical decisions that are difficult to make correctly for us (and are still widely debated amongst highly educated professionals), let alone a panicked member of the community. Public health requires a reductionist approach to information and is based on the payoff principle. You simplify everything, even if the ultimate message is wrong sometimes, so that most of the time you bring about a better outcome. Somewhere, someone has weighed the risks of people sitting at home and waiting for an ambulance with the risk of driving frantically to hospital, and decided this was a better message to send.

Compressions only CPR is a good example. People are so likely to bugger up ventilation, take up too much time ventilating, or be too scared to even try CPR because they can't remember it, that it may be better off just teaching people the more simple message of doing compressions only. That doesn't mean that compressions only is always the best thing, and in fact in many situations it is not what you want, but it may provide statistically better outcomes as a public health policy. (I'm not advocating this, it's just an example).

 

[TransportJockey]

You won't like me running 12 leads, CPAPs, and dropping an OTT much then!




Yep!

As a Basic here in NM, I can do the following with just standing protocols:
MLA, LMA, IM/SQ drug admin for Epi, IM/SQ/IN Narcan, Neb Albuterol, Administer Activated charcoal, ASA, Oral glucose, take CBGs, administer APAP, run 4 leads, setup 12 leads, run CPAP, administer O2, etc etc...

The point is that I believe that most of that is just 'skills' given to the EMT with not adequate education behind pathophys, reasons for doing them, or adverse reactions, among other things.

NM has a total of... 1 trauma center for the entire state, which is one of the thoughts of NM basics having such a broad scope, and one of the reasons NM is not an NREMT state for anything other than Medic.

 

[MrBrown]

Undoubtedly in some circumstances it is better to drive, or be driven, to hospital You can't send the public a message saying:, "If you're in situation X, Y distance away from a hospital and the problem is N level of severity, and you're sure its specifically problem X and not problem Z, and prehospital providers of level 3 not level 2 are available (in some areas level 2 is acceptable, see appendix), and their response time is Q, then call an ambulance/drive to hospital".

That's true mate; I just think the media and maybe EMS itself with all its inconstiency and fragmentation has done a piss poor job of really marketing itself appropriately. Example: This is BLS, this is ALS, not everybody is a "Paramedic" etc etc

As a Basic here in NM, I can do the following with just standing protocols:
MLA, LMA, IM/SQ drug admin for Epi, IM/SQ/IN Narcan, Neb Albuterol, Administer Activated charcoal, ASA, Oral glucose, take CBGs, administer APAP, run 4 leads, setup 12 leads, run CPAP, administer O2, etc etc...

The point is that I believe that most of that is just 'skills' given to the EMT with not adequate education behind pathophys, reasons for doing them, or adverse reactions, among other things.

I am curious; are you taught the pharmacology, anatomy, physiology and pathophysiology of those skills you list?

 

[medic417]

Undoubtedly in some circumstances it is better to drive, or be driven, to hospital. Trauma is a good example. Also, we actually have a program here for rural areas in which families of people with asthma have an action plan that gets them to definitive care quicker. If that involves driving themselves to hospital depending on where they are, then so be it. That program involves specific education regarding a specific problem, tailored to the normal severity of that specific individual's condition.

What you're asking is that a complex approach be applied, in some sort of public health message, covering areas with different levels of responses and different traveling times to the pt and to the hospital and perhaps involving different kinds of conditions.

You're asking untrained people, in an emergency to:

-properly identify the condition.
-consider the severity of the condition.
-know and consider the response time.
-know and UNDERSTAND the responders scope of practice, specific to location.
-considerthe distance to the hospital.

Then expecting them to drive safely to hospital.

You can't send the public a message saying:, "If you're in situation X, Y distance away from a hospital and the problem is N level of severity, and you're sure its specifically problem X and not problem Z, and prehospital providers of level 3 not level 2 are available (in some areas level 2 is acceptable, see appendix), and their response time is Q, then call an ambulance/drive to hospital".

CNN can't tell America that; no one will listen and if they did, they sure couldn't make a good decision based on information that complex.

These are clinical decisions that are difficult to make correctly for us (and are still widely debated amongst highly educated professionals), let alone a panicked member of the community. Public health requires a reductionist approach to information and is based on the payoff principle. You simplify everything, even if the ultimate message is wrong sometimes, so that most of the time you bring about a better outcome. Somewhere, someone has weighed the risks of people sitting at home and waiting for an ambulance with the risk of driving frantically to hospital, and decided this was a better message to send.

Compressions only CPR is a good example. People are so likely to bugger up ventilation, take up too much time ventilating, or be too scared to even try CPR because they can't remember it, that it may be better off just teaching people the more simple message of doing compressions only. That doesn't mean that compressions only is always the best thing, and in fact in many situations it is not what you want, but it may provide statistically better outcomes as a public health policy. (I'm not advocating this, it's just an example).

We did not say tell them to drive themselves. We said the public should be told what level of care to expect. Sadly people think all ambulances are equal. They expect all ambulances to be able to do all advanced procedures. Yet sadly in the USA in order to cut costs many services run basics only ambulances. That just provides a false sense of security.

 

[Melclin]

That's true mate; I just think the media and maybe EMS itself with all its inconstiency and fragmentation has done a piss poor job of really marketing itself appropriately. Example: This is BLS, this is ALS, not everybody is a "Paramedic" etc etc

That problem doesn't exist here . Paramedics as far as the public are concerned are all the same thing. There is no talk of BLS or ALS. Occasionally you have talk in the media of some kind of special "elite" paramedic called MICA, but, if anything, its a case of good and better, not bad or good. While Ambulance Victoria (I can't speak for the other states) has many problems, to their credit, I don't feel PR is one of them.

Furthermore, that poor marketing that you speak of is exactly what some of the others in this thread are suggesting. Complexity. "If BLS in your area: then got to hospital". "If ALS in your area:, then call 911". How many member of the public really know what all that means? I spend a bit of time on this forum and I still don't know what those yanks are on about, how can we expect Joe Citizen to know. That's what you need to get rid of - the mixed messages, this is what I'm saying

We did not say tell them to drive themselves. We said the public should be told what level of care to expect. Sadly people think all ambulances are equal. They expect all ambulances to be able to do all advanced procedures. Yet sadly in the USA in order to cut costs many services run basics only ambulances. That just provides a false sense of security.

Well the 'driving themselves' component was not that important to most of my original argument. Have someone else drive them- what I said still stands. Besides, how do they know they aren't supposed to drive themselves? That adds a whole other education problem (an no matter how much time & money you spent telling them, some still would - and that factors into the decision of which public education strategy you chose in the end).

It's not a matter of accurate education for the general public (see above response to Mr brown). If the public has a false sense of security...who cares, if the plan that lead to that, over all, lead to less fatalities. Public health messages often employ strategies that could almost be considered lying by well informed medical professionals. It's about sending a simple message that is easily communicated and remembered, but that still leads to the best outcome most of the time. The message that brings about the best outcome most of the time: "Emergency = ambulance". Not: "Emergency = ambulance, except when A, B, C, not D (when D, call and ambulance) and E". If some people get a response that they were not expecting, then tough: on an individual basis it's not a big deal (besides how many people call an ambulance and say, "Well frankly I'm shocked. I called 911 expecting IM adrenaline and you're saying you're medical director doesn't authorise that!? Outrageous"). Overall, if the policy of "tell them to call 911" kills less people than " tell the to call 911 in A, B and C; but go to hospital directly if D, E, F and G", then you pick the first one as a policy maker. Simple as that.

I've done quite a bit of the old book learning on the subject of public health, and I've yet to hear a better summation of it that this (I think it was from HOUSE, MD), "A person is smart, people are dum". While you could site a person down and explain all these things adequately to them in 5 mins, when talking to the general public, you have to allow for all kind of factors that get in the way of the message, and as such, you effectively have to treat them as though they are the stupidest people in existence.

 

[Ridryder911]

Unfortunately, many areas ony provide the very of the basics. Of course they are not going to discuss that there is difference between ALS and BLS because of the possibility of causing change or allowing the public to be informed on what or should I say care NOT available.

Yes, there are some remote areas that have to depend upon BLS care but in comparrision it is far fewer than what is represented. So many areas base the care upon their own needs and agenda and not what is best in the patients behalf. Tradition and self serving ego's supercede common logic.

Yes, a large area of the U.S. is still served with lower care than the infamous t.v. Emergency that started the information about EMS over 35 years ago.

R/r 911

 

[k8ek8e]

I honestly didn't know that there were differences (ALS vs BLS) until I started class. I was as ignorant as the rest. Education is the key to so many things.

Fortunately as an EMT-B I can also do epi-pens for patients in anaphylaxis.

 

[el Murpharino]

Prevention on the patients part could benefit as well - if they have a known allergy and have had any sort of medical care - even at a community/low-income clinic staffed by a N.P. or doctor - they should have an epi-pen prescribed to them. Whether or not they carry it on them is their choice.

 

[emtjack02]

In Illinois there is a section in the EMS act that says every EMT, all levels, will carry and epi pen and be able to use. It obviously is in our local protocols as well. It is true that many people do not know the difference between all the different levels. Hopefully if people call early the EMTB can get there and give the albuterol for minor rxn...or give the epi early on to prevent the airway closure that...they can not handle..at least not here.

 

[ResTech]

There is a large national advocacy group called the Food Allergy & Anaphylaxis network that pushes legislation to have States mandate BLS ambulances carry Epi-Pens.

 

[VentMedic]

http://www.foodallergy.org/advocacy/ems.html

 

[VentMedic]

http://www.foodallergy.org/advocacy/advocacy-schools.html

Below are the states that now have laws or regulations allowing students to carry, and potentially self-administer, their prescribed epinephrine at school (with year of enactment in parentheses):
Alaska (2005)Louisiana (2009) Oklahoma (2008) Arizona (2005) Maine (2004) Rhode Island (1998) Arkansas (2005) Maryland (2005) South Carolina (2005)California (2004) Massachusetts (1993)Tennessee (2005) Colorado (2005) Michigan (2004) Texas (2006) Connecticut (2009) Minnesota (2004) Utah (2008) Delaware (2003) Missouri (2006) Vermont (2008) District of Columbia (2007) Montana (2005) Virginia (2005) Florida (2005) Nebraska (2006) Washington (2005)Georgia (2009) Nevada (2005) West Virginia (2004) Hawaii (2004) New Hampshire (2003) Wyoming (2007) Idaho (2008) New Jersey (2001) Illinois (2006) New Mexico (2005) Indiana (2001) North Carolina (2005) Iowa (2004) North Dakota (2005) Kansas (2005) Ohio (2006) Kentucky (2004) Oregon (2007)

 

[Sasha]

http://www.foodallergy.org/advocacy/ems.html

Why is Florida listed as good coverage? EMTs alone are not allowed to carry epi pens. Although I guess it's irrelevant when your trucks are all ALS...

 

[VentMedic]

Why is Florida listed as good coverage? EMTs alone are not allowed to carry epi pens. Although I guess it's irrelevant when your trucks are all ALS...

We have all ALS response for 911 throughout the entire state. It is rare to see an EMT do 911 even with a Paramedic in some parts of the state.

 

[Sasha]

We have all ALS response for 911 throughout the entire state. It is rare to see an EMT do 911 even with a Paramedic in some parts of the state.

For some reason I thought the picture was just referring to basics, but reading the webpage cleared it up. Perhaps I should read before I reply.

 

[EMTelite]

I really have no clue why this thread is still going...

Honestly, this all comes down to patient advocacy if you think that patients have a better course of action then to call 911 then I am sorry but that is completley false we can still provide ventilatory support as well as comfort and a quicker ride and admittance to the ER, I am not sure how you guys in other states are running it but even our BLS rigs in southern california who respond to 911 are all fire back-ups who have a medic on board who can administer the drug on scene and en route with you, and fire would have no way to get there if one was not to call 911. How would you feel if your throat was closing and you had no clue of the capabilities of the EMS system, would you rather take a chance racing yourself to the hospital or woulid you rather put some trust in the people you know are trained to care of these situations?

 

[VentMedic]

Honestly, this all comes down to patient advocacy if you think that patients have a better course of action then to call 911 then I am sorry but that is completley false we can still provide ventilatory support as well as comfort and a quicker ride and admittance to the ER, I am not sure how you guys in other states are running it but even our BLS rigs in southern california who respond to 911 are all fire back-ups who have a medic on board who can administer the drug on scene and en route with you, and fire would have no way to get there if one was not to call 911. How would you feel if your throat was closing and you had no clue of the capabilities of the EMS system, would you rather take a chance racing yourself to the hospital or woulid you rather put some trust in the people you know are trained to care of these situations?

If you have even dealt with a closed airway due to anaphylaxsis, you would know "BLS" airway may be useless. Even in the hospital with all the meds and techology we have, it usually takes a tube done under a fiberoptic scope and heliox to acheive any ventilation.

For someone who can not breathe, no amount of "good intention" comfort will settle them.

The earlier the treatment the better.

Also, one should be an advocate for their school systems and health clinics to be easily accessible. This is a serious matter and not the time for a peeing match.

 

[EMTelite]

This is not some peeing match but would you rather leave the life of someone in the hands of noone or maybe in the hands of someone who is trained to deal with atleast the reality of serious situations because honestly these people who are suffering from this are going to be panicing and honestly if the family is not used to it they are going to panicing as well where as EMS professionals wether it be BLS or ALS are trained to atleast handle the pshycological aspect of the emergency and provide support OF ANY KIND, this whole situation comes down to wether patients should call 911 for anaphylaxis or not and the answer in my head is of course they should because as I said... even if the car that comes out is a BLS car there will be fire medics on scene that can administer epi etc... plus as a mode of transportation an ambulance WILL get you to the hospital quicker and safer because as I said EMS professionals are trained to handle stressful situations... I have more faith in an ambulance getting to the hospital safer than a mother rushing her kid in the back of her car being distressed and not paying attention to the road.