Did this warrant Lights and Sirens?

[Medic29]

Where you take a temp at? Oral or axilary or rectum ???

Temperal thermometer. Right behind the ear.

 

[Aidey]

The list the nursing home gave me I left with the hospital. I don't need to put them in any of my reports so I don't keep them. I only keep for my report purposes are a list of allergies.

...................

For the other people around who do BLS transfers, is this normal?

 

[Medic29]

...................

For the other people around who do BLS transfers, is this normal?

I'm kinda glad we don't. Most of the people we get calls for are nursing home patients with a grocery list of medications that never fit on our paper reports. Our paperwork consists of the information about the transport as well as the patients diagnosis which we do chart on. Meds aren't one of them. It's a :censored::censored::censored::censored:ty company in the way they operate I understand that. If I could change a few things about it, believe me I would.

 

[Akulahawk]

I've been dispatched on chest pain calls when I worked in So. Cal, but my threshold for calling 911 for medics is very low. I agree that it's wrong to dispatch an EMT crew to something like that, but unless the local government regulation agency (be it state or regional) places limitations on what levels can accept what calls, you aren't going to see it go away.

JP, over the years, when I was working as a basic, I have been dispatched to many calls where 911 was refused. A lot of the time it was because they don't want all the commotion that comes along with a 911 call. Some of the nursing homes are very good at playing the "we want BLS" game. So they'd call us with complaints such as "weakness and lethargy" or other similar complaint that supposedly wouldn't make our dispatchers ears perk up... Of course, we all knew and we'd bet each other what the complaint would really be.

I don't have a low threshold for calling for paramedics, I have a low threshold for wanting to get the patient to definitive care as soon as possible in the most appropriate manner. Once I decide that my patient needs to go to the hospital emergently, it becomes all about ETA. Specifically, that means ETA to some kind of advanced level care. Ultimately it boils down to I get the patient to the ED faster than I can get a paramedic to the patient.

 

[TransportJockey]

...................

For the other people around who do BLS transfers, is this normal?

Not at all. Ever. If it's a long list, I either type in the pertinent meds and scan the page and put 'see sheet for rest of medications' or hand write the pertinent meds and make a copy of the sheet and staple it to my PCR. You NEED to have the meds documented, IMHO.

 

[Medic29]

I can start doing it I guess. My company doesn't ever ask for it and I was never trained to do it.

Hopefully they won't complain about all the extra paperwork. Crappy thing about Capital is that everything is paper. They don't do nothing computers and that really blows!!

 

[the_negro_puppy]

After doing a bit of reading:

Wikipedia: Hyperpyrexia is a fever with an extreme elevation of body temperature greater than or equal to 41.5 °C (106.7 °F) The most common cause is an intracranial hemorrhage.

Could this patient be having a stroke/CVA?

 

[FourLoko]

Why wouldn't you check temp before even putting the patient on the gurney? Especially if they actually admitted to a fever.

On Saturday we had the opposite, hypothermia. PT temp was 94.1 and supposedly was 91 earlier that day. We went outside and called the FD.

 

[bstone]

Why wouldn't you check temp before even putting the patient on the gurney? Especially if they actually admitted to a fever.

On Saturday we had the opposite, hypothermia. PT temp was 94.1 and supposedly was 91 earlier that day. We went outside and called the FD.

Our BLS and ALS buses don't carry thermometers, tho I am uncertain why. Why did you call the FD for a hypothermia PT?

 

[JPINFV]

JP, over the years, when I was working as a basic, I have been dispatched to many calls where 911 was refused. A lot of the time it was because they don't want all the commotion that comes along with a 911 call. Some of the nursing homes are very good at playing the "we want BLS" game. So they'd call us with complaints such as "weakness and lethargy" or other similar complaint that supposedly wouldn't make our dispatchers ears perk up... Of course, we all knew and we'd bet each other what the complaint would really be.

The problem is that when a "lethargy and weakness" call is, "Our patient has a pulse of 26 because he's in a 3rd degree heart block," than something needs to happen to keep that from being BLS. That's also why the Riverside County BLS call protocol includes some of the key phrases.

I don't have a low threshold for calling for paramedics, I have a low threshold for wanting to get the patient to definitive care as soon as possible in the most appropriate manner. Once I decide that my patient needs to go to the hospital emergently, it becomes all about ETA. Specifically, that means ETA to some kind of advanced level care. Ultimately it boils down to I get the patient to the ED faster than I can get a paramedic to the patient.

I worded that poorly and your wording is what I was going for. Also, my bar wasn't nothing and I was comfortable with some patients that others weren't. I also had no trouble going toe to toe with ED nurses who weren't happy that I didn't call paramedics ("No, I'm not going to call paramedics for the patient with chest pain at the SNF down the side street from you. There's a stop sign and anyone responding would have to pass the hospital to get there. Here's a copy of the county protocol, enjoy.") I also never, for what it counts, called for paramedics and had them retriage back to BLS.

However we get posters all the time on here who say something like, "Well, I called dispatch and they just told me to take the patient and not call paramedics," but I'm of the opinion that the buck always stops at the crew.

 

[Meursault]

...................

For the other people around who do BLS transfers, is this normal?

I don't keep anything from the sending facility, but I do document meds and history, and when time permits, I'll spend an extra minute or five hunting them down before I leave. Occasionally, I'll get a call that's both very close to the ED and time-sensitive; I'll reconstruct some info from memory and scrawled notes afterward.

Knowing history and medications plays into my delusion of providing medical care and spares me the scorn of ED nurses. It's also required for our documentation.

Some of the nursing homes are very good at playing the "we want BLS" game. So they'd call us with complaints such as "weakness and lethargy" or other similar complaint that supposedly wouldn't make our dispatchers ears perk up... Of course, we all knew and we'd bet each other what the complaint would really be.

We have exactly the same problem. I don't know whether the primary cause is incompetent call triage, 911-averse SNF staff, or management prioritizing facility relations over patient care. My best guess is all three to varying degrees.

 

[Akulahawk]

The problem is that when a "lethargy and weakness" call is, "Our patient has a pulse of 26 because he's in a 3rd degree heart block," than something needs to happen to keep that from being BLS. That's also why the Riverside County BLS call protocol includes some of the key phrases.

No kidding. Unfortunately, the various facilities were pretty darned sneaky about that stuff. We got pretty darned good at quickly determining whether or not our patient had to go right NOW, and we got even better when the County changed the utilization for BLS to 10 minutes at scene to ED times if your patient needed to be transported code 3. It also meant that the facilities had no control over those 911 calls from BLS units, so they learned to call 911 because it was going to happen anyway - it was just who was going to call, not "if" anymore. After that, BLS transfers to the ED became far more "routine" and less emergent. The facilities hated it though because they had to log more 911 calls... but they could at least "blame" it on local protocol change.

I worded that poorly and your wording is what I was going for. Also, my bar wasn't nothing and I was comfortable with some patients that others weren't. I also had no trouble going toe to toe with ED nurses who weren't happy that I didn't call paramedics ("No, I'm not going to call paramedics for the patient with chest pain at the SNF down the side street from you. There's a stop sign and anyone responding would have to pass the hospital to get there. Here's a copy of the county protocol, enjoy.") I also never, for what it counts, called for paramedics and had them retriage back to BLS.

However we get posters all the time on here who say something like, "Well, I called dispatch and they just told me to take the patient and not call paramedics," but I'm of the opinion that the buck always stops at the crew.

When it's my patient, the buck stops with me. I won't do anything that jeopardizes my cert/license. If I was told to take the patient by dispatch (or management), I'd have simply packaged, placed the patient in my ambulance and turned the patient over to ALS. Fortunately, I worked for a guy that understood that it was far better to do the turnover to ALS outside the facility than to get into a peeing match with the facility staff. It's just as fast and gets the patient where they need to go.

 

[Bullets]

I wouldnt have called for ALS, but in my town my transport time is 10 minutes or less. If they werent dispatched originally then im going to beat them to the hospital.

Welcome to NJ, were BLS goes to every call, and ALS is by request only

 

[johnrsemt]

From the OP I don't see much that makes this patient ALS.
High Temperature, BLS: strip/AC--he did that, Ice packs--he didn't do that.
High HR (144), BLS: due to the elevated temperature.
High BGL: (448): ALS is going to do much in less than 2-3 hours with IV's; doubt that Denver ALS carries insulin.
B/P: (150/90) BLS.
Run fast (lights/sirens) to the hospital: BLS.

 

[usalsfyre]

From the OP I don't see much that makes this patient ALS.
High Temperature, BLS: strip/AC--he did that, Ice packs--he didn't do that.
High HR (144), BLS: due to the elevated temperature.
High BGL: (448): ALS is going to do much in less than 2-3 hours with IV's; doubt that Denver ALS carries insulin.
B/P: (150/90) BLS.
Run fast (lights/sirens) to the hospital: BLS.

The patient was septic, they needed fluid resus and from what it sounds like an airway. I have no idea how a medic could get BLS from this.

 

[Veneficus]

I am of the mind that because of the risks involved and the very few times it makes a difference, no call is worthy of lights and sirens.

The only reason it still exists is public expectation and tradition.

 

[systemet]

The patient was septic, they needed fluid resus and from what it sounds like an airway. I have no idea how a medic could get BLS from this.

Agree 100%.

 

[Medic29]

I just got my patient follow up from St. Anthony's.

My pt is septic from a UTI. Not enough to warrant ICU. They have him on Med/Surge pushing fluids and antibotics. Seems he is doing ok.

 

[Handsome Robb]

The patient was septic, they needed fluid resus and from what it sounds like an airway. I have no idea how a medic could get BLS from this.

Agree 100%.

I'll third that.

 

[NYMedic828]

From the OP I don't see much that makes this patient ALS.
High Temperature, BLS: strip/AC--he did that, Ice packs--he didn't do that.
High HR (144), BLS: due to the elevated temperature.
High BGL: (448): ALS is going to do much in less than 2-3 hours with IV's; doubt that Denver ALS carries insulin.
B/P: (150/90) BLS.
Run fast (lights/sirens) to the hospital: BLS.

Granted we now know the cause was sepsis 2nd to a UTI, fluid resuscitation is fluid resuscitation.

Yes the ER is better suited and educated to do it properly than we are, but we can absolutely start the process a decent period ahead of time if the situation warrants it. Septic patients can require a massive amount of fluids if vasodilatory/distributive shock sets in. Why would you want to delay that process? If by some miracle you managed to establish two 14g IVs, you could potentially give this patient 600ccs of fluid per minute. (My numbers may be off, I forget)

I'm not sure what your insulin comment is about. Insulin resistance 2nd to sepsis is a result of MOD as far as I know. I can't imagine the first thing a doctor is going to do for this patient is hit them with an insulin drip. Treat the underlying cause that is inevitably going to kill them and quite rapidly at that. They will die to other complications before hyperglycemia takes them down.