Did this warrant Lights and Sirens?

[Medic29]

I work for a BLS transport company only. We got an emergency call to go to a nursing home. If you're familiar with the Denver area it's in the area of Federal and Arkansas. C/C was fever. In my rig I get a set of vitals.

BP 150/60
Resp 28
Pulse 144
BGL 448
Temp 107.6 (That's right 107.6)

I double check, then check again, and then again and each time I got 107.x. Ok so my thermometer is F*cked cause the NH reported a temp of 102. We start going normal. I check my temp it's 97.6. I check his again 107.4.

I tell my driver to go faster. We're going to St. Anthony's Medical Center off of Alameda and 2nd. We're driving on Alameda about 1730. It's rush hour still in Denver.

Besides the BP, everything is wrong for this patient (I'm used to working in nursing homes and I see patients with this BP everyday with hypertension).

I had my driver go lights and sirens because even if the resp were normal and the pulse was lower, the temp alone is enough to fry the brain. Some people have told me I did good, others said lights and sirens were not appropriate just drive fast.

Interventions: Undress and turn on air. I'm from SD so I don't yet have my IV cert to cool with fluids and being I'm still new, I forgot to use the ice packs I have available (something I'll be sure to do different next time).

What do you think?

 

[bigbaldguy]

I would have run it with lights. Was the patient conscious? At 107 he/she should have been at the very least unconscious if not dead. Did you double check the thermometer? I would have taken my own temp just to make sure it wasn't reading wacky. Ice packs would have been a good idea. You would want to treat this as hyperthermia.

Diabetic hyperglycemic hyperosmolar syndrome?

 

[Medic29]

Pt AAOx2 baseline 2. Was like that the whole trip. Understood what I was doing and where he was going.

In the hospital he was still at x2.
Pt is diabetic. Nurse reports no insulin given at time of pickup.



I did check my own temp. It was 97.6 (normal for me).

*Edit* After getting his temp down to 104 upon arrival the hospital, ED reported a temp of 105.

 

[Aidey]

Who exactly triaged this as BLS?

 

[bstone]

Yes to L/S.

 

[Medic29]

Who exactly triaged this as BLS?

We are BLS transport company only. We run only minor emergencies. No 911 calls at all. We do not operate under 911 dispatch centers. I don't know exactly how the dispatch system works. All I know is the nursing homes call the ambulance who provides the transportation services and then our boss calls us to go get them.

 

[TransportJockey]

I know exactly which snf you're talking about... and yea that's a code three transport. I'd've possibly considered als too

 

[Medic29]

I know exactly which snf you're talking about... and yea that's a code three transport. I'd've possibly considered als too

It's not the first time I've taken a possible sepsis patient from this home. Not even a week ago I had another one from there go to St. Anthony's at 3am with a fever of 102.

 

[Anonymous]

I would have... and/or called 911 depending on how far out you were.

 

[TransportJockey]

It's not the first time I've taken a possible sepsis patient from this home. Not even a week ago I had another one from there go to St. Anthony's at 3am with a fever of 102.

That's why some services up there (including the one I worked for at that time, ACA,) carried serum lactate meters... I don't know if they still do though

 

[Aidey]

We are BLS transport company only. We run only minor emergencies. No 911 calls at all. We do not operate under 911 dispatch centers. I don't know exactly how the dispatch system works. All I know is the nursing homes call the ambulance who provides the transportation services and then our boss calls us to go get them.

That is my point. This patient should have never been triaged as appropriate for a BLS transfer car.

 

[Medic29]

That is my point. This patient should have never been triaged as appropriate for a BLS transfer car.

That should come from the nursing home then. They're the ones who called my boss. The conditions for them to call us wasn't just with the temp (they tried to get one when we were there and it wasn't reading right) it was with the 77% O2 stats, the shaking, and the BGL. Why they didn't give the insulin I don't know.

 

[JPINFV]

That is my point. This patient should have never been triaged as appropriate for a BLS transfer car.

I think the anger is misplaced. I get a dispatch on pager, I go run a call. If I think I need medics, I call medics (you won't ever catch me calling dispatch to ask about medics, I need medics, I pick up the phone and call 911). I need lights and sirens, I use lights and sirens. It's not the crew's fault that they got paged to a call they had no business being dispatched too. The only thing that's important from the crew's standpoint is if they handled it appropriately.

 

[JPINFV]

Why they didn't give the insulin I don't know.

Type 1 DM or type 2?

 

[TransportJockey]

I think the anger is misplaced. I get a dispatch on pager, I go run a call. If I think I need medics, I call medics (you won't ever catch me calling dispatch to ask about medics, I need medics, I pick up the phone and call 911). I need lights and sirens, I use lights and sirens. It's not the crew's fault that they got paged to a call they had no business being dispatched too. The only thing that's important from the crew's standpoint is if they handled it appropriately.

This. This nursing home also has a poor reputation.

 

[Medic29]

Type 1 DM or type 2?

DM with neurological manifestations, Type II

 

[Handsome Robb]

In traffic like it is at 1730 in Denver a code 3 transport of this patient is absolutely necessary. I'd personally lean towards it anyways, the guy is frying his brain. I'm surprised they maintained their mentation.

I do have a question and will play the devil's advocate though, did your partner have the IV cert? I'm guessing no but if they did I think they probably should have taken the call because this guy needs fluids along with a host of other things but that's just me.

This guy needs active cooling fast but don't stress yourself about missing the cold packs, you still got his temp down 2.x degrees. I'd say you did a good job with what you had to work with. Bet you'll never forget cold packs again though

 

[Aidey]

That should come from the nursing home then. They're the ones who called my boss. The conditions for them to call us wasn't just with the temp (they tried to get one when we were there and it wasn't reading right) it was with the 77% O2 stats, the shaking, and the BGL. Why they didn't give the insulin I don't know.

I really would hope that your service has criteria that cause them to transfer the run to an ALS agency. What happens if a nursing home calls and says they have a patient with crushing chest pain and a BP Of 70/p?

I think the anger is misplaced. I get a dispatch on pager, I go run a call. If I think I need medics, I call medics (you won't ever catch me calling dispatch to ask about medics, I need medics, I pick up the phone and call 911). I need lights and sirens, I use lights and sirens. It's not the crew's fault that they got paged to a call they had no business being dispatched too. The only thing that's important from the crew's standpoint is if they handled it appropriately.

I don't blame the crew one bit, I blame whoever screwed it up before they ever got on scene. This is analogous to calling for a BLS transfer for an active MI patient.

 

[Medic29]

In traffic like it is at 1730 in Denver a code 3 transport of this patient is absolutely necessary. I'd personally lean towards it anyways, the guy is frying his brain. I'm surprised they maintained their mentation.

I do have a question and will play the devil's advocate though, did your partner have the IV cert? I'm guessing no but if they did I think they probably should have taken the call because this guy needs fluids along with a host of other things but that's just me.

This guy needs active cooling fast but don't stress yourself about missing the cold packs, you still got his temp down 2.x degrees. I'd say you did a good job with what you had to work with. Bet you'll never forget cold packs again though

With my company (and soon as I type what I'm about to people in this area will know the company) we don't always run EMT/EMT. In my situation today, I was with a driver only. He's not an EMT so I was the only one there.

 

[Medic29]

I really would hope that your service has criteria that cause them to transfer the run to an ALS agency. What happens if a nursing home calls and says they have a patient with crushing chest pain and a BP Of 70/p?

Under the Denver/Metro EMS protocols, we're not equipped for a call like that. If they called us (which they better not if they're worthy of being a nurse), our boss would still send us and on scene, I'd have to call for an ALS unit.