Emergencies or Transport

[FuManChu]

I just started with a BLS company. Majority of our IFT's are from SNF's to Dialysis facilities. On occasion we get called to take 5150's to a psych facility, and the occasional code 2 emergency at a nursing home, but other than that its all dialysis runs.

I haven't run a 5150 or a code 2 call yet, but from routine transports to dialysis facilities, or transports to a SNF I haven't learned all that much. What I have learned is how to communicate with patients better, gained experience in doing head to toe exams on patients, and practice in filling out documentation/PCR's.
All which is valuable knowledge and experience, however skills wise, theres not much I'll get to do in BLS IFT other than hooking them up to O2. So hopefully I will get with the CCT company, and can work my way up to a CCT rig.

 

[Clipper1]

but from routine transports to dialysis facilities, or transports to a SNF I haven't learned all that much.

Let me see if I can may SNF and dialysis patients more interesting for you just in case you do CCT and/or become a Paramedic.

Why are the patients on dialysis? What was the cause of the renal failure? Do they still urinate? Are they on fluid restrictions? What type of vascular access do they have? If you were a Paramedic or RN, where would you obtain an IV in an emergency? What are their medications? Do you know at least "ballpark" what they are for and how they relate to the patient's diseases? Do they have a tracheotomy scar? Can you feel good radial pulses? What do you notice about the breath sounds? Is the dialysis permanent or temporary? If this patient coded what would be a likely cause? Does the patient have any renal stints?

Why is the patient in a SNF and not a nursing home? What type of skilled care do they still need? Do they have vascular access?

If you were a Paramedic or an RN in charge of a CCT transport, there are many, many things to note which will affect how you treat a patient during transport. You will have several "knowns" given to you and your treatment will be expected to be based off the known as well as the unknown in an emergency. In a 911 emergency you may not have that luxury and generic protocols might be utilized which often do not produce the same results of the situations where you use the known information to form a treatment plan of action. Often the "routine" and CCT transports carry more responsibility because there is an increased expectation you know how to utilize the history and current values given to you rather than relying on a generic protocol. CCT personnel have broader scope of practice for a reason. But, the main thing to remember is in the routine assessment you should be thinking about the unexpected. These routine transports are the ones which end up embarrassing health care providers of all levels the most and come back to bite them in the arse at some time.

 

[FuManChu]

Thank you for pointing me in the right direction. I've been looking at it from one point of view this whole time. I did my ridealongs in emt school with a 911 agency, so all of my exposure to ems prior to this job was from a 911 point of view. I didn't have transport exposure till now. So when in transporting a patient I feel like my duty is too just load the patient, get vitals, monitor in transport, etc. I haven't thought about going deeper and trying to understand why exactly they need transport, why they are at a SNF, why some have good strong radial pulses, why some dont, etc. I guess it's my lack of experience.

There are a few patients that I am able to talk to and learn a lot from, however there are also a lot who are usually A&O X2 who I can't communicate with and learn more about.

We get a full face sheet on runs which list out meds, Hx, allergies etc. From that alone I learn a lot about the pt I am transporting, however I see your point in the many other things I may learn about.

 

[Clipper1]

I think you might find that some of those SNF and dialysis patients might have been a "save" by someone in EMS. Not all "saves" are able to walk out of the hospital and give an EMT or Paramedic a pat on the back. Also, sometimes the life saving measures we do take a huge toll on the kidneys. You may not see them but there are very young people on dialysis who had been a trauma. They are also in the sub-acutes and SNFs. You might not see them because a CCT is required to transport them. Modern medicine has done a lot of great things to save people but then not all have their life with quality back.