is a broken arm an ALS or BLS call?

[Sam Adams]

Without overanalyzing I would have to say that it is a BLS call unless the PT presents with at least one of the following:

1. Pain 7/10 or above.
2. No or weak extremity pulse or sensation.
3. No capillary refill being present or refill being >2-3 sec.
4. Severe bleeding secondary to a complex fracture (or edema if justified).
5. PT is presenting that they are having those rare but sometimes founded cardiac complications due to the fracture, i.e. clotting that is causing some kind of a blockage in which ALS intervention will be critical.
6. I am sure that I can think of others but these are the basics that would justify getting ALS on-scene. Pain alone can be called in to the hospital along with a preliminary report (they can have MS or Dilaudid on standby) if not too debilitating (0-6/10) but severe pain or complications would definitely justify the intercept.

Without over analyzing? You have 6 bullet points!?! :lol:

Very simple question, please do not over think or over analyze:

is a broken radius/ulna, just the arm and nothing else, simple fx, an ALS or BLS call?

ok, follow up: if you are on a A/BLS crew (medic and EMT) would the medic treat, or the EMT (going back to ALS or BLS)?

This is a BLS call.

Unless the pt tripped and fell because he was running away from a swarm of Africanized Killer Bees and is now in anaphylactic shock with subsequent cranial nerve damage and he's very upset due to Pluto no longer being a planet.

 

[EMS/LEO505]

I'd have to say that it's a BLS call unless, certain extreme conditions are present.

 

[jjesusfreak01]

I didn't get pain meds at any point when I broke my arm. If the pain is bad, give the meds, but don't overmedicate just because you can. Usually a BLS call IMHO.

 

[medic417]

It is ALS because it is about patient care. If patient needs pain relief they need it. If you are a basic only ambulance patients suffer. There is no excuse to cause a patient to suffer.

 

[CAOX3]

Mechanical fall with isolated extremity fracture is going to get a BLS response here, upon arrival extenuating circumstances exist an ALS truck can be summoned.

 

[akflightmedic]

I didn't get pain meds at any point when I broke my arm. If the pain is bad, give the meds, but don't overmedicate just because you can. Usually a BLS call IMHO.

Why have any pain at all?

Remember the pain scale? It is 0-10...ZERO as in no pain being the goal.

We are not talking about snowing them into a coma, but if you have the ability, why not take the edge off?

 

[aewin90]

It is ALS because it is about patient care. If patient needs pain relief they need it. If you are a basic only ambulance patients suffer. There is no excuse to cause a patient to suffer.

This is the stupidest thing I've seen on the internet.

Pain control is an extremely important part of EMS. Pain is the 5th vital sign. But when someone stubs their toe and has a 2/10 on the pain scale, you really want an ALS rig to be pulled out of service?

Heck, why not just call a chopper? They can get to that big trauma center faster. We can't let our stubbed-toe patient suffer in a small ER.

 

[medic417]

This is the stupidest thing I've seen on the internet.

Pain control is an extremely important part of EMS. Pain is the 5th vital sign. But when someone stubs their toe and has a 2/10 on the pain scale, you really want an ALS rig to be pulled out of service?

Heck, why not just call a chopper? They can get to that big trauma center faster. We can't let our stubbed-toe patient suffer in a small ER.

What in the heck are you talking about? The case presented is a broken arm. Any broken bone including a toe would justify a Paramedic for pain management.

Now your stubbed toe are you sure that is all? Are you sure they do not have a mental problem? Are you sure its not actually referred pain in a diabetic having a cardiac event. See I can act stupid to. Please refrain from attacking someone until you have enough education to debate with.

 

[46Young]

ALS. Whether or not the pt needs pain management is a decision for the paramedics, resulting from their paramedic level assessment. We all know that a dispatch for an isolated extremity Fx can be much more upon arrival, just like the report of a multi system trauma can be a simple superficial lac and a bruise or two. There's no way of knowing the pt's presentation until we're there. Besides, if it's really a minor injury regarding pain, and blood loss, you can always turf the pt to the BLS for txp.

I'm not a big fan of the EMD system that's used by dispatchers w/o any EMS experience. Too many calls get over triaged. However, in the case of a potential pain management situation, such as a Fx or Hx strongly suggesting the possibility of kidney stones, then it should be an ALS dispatch. Ideally, the call would be BLS with a medic chase car so the pt would have prompt access to pain management and the proper level of asessment that comes with that.

It sounds like I'm putting down BLS, but understand that I did 911 BLS for three years. I've worked countless injuries where the pt winced or screamed with each attempt at slinting them and packaging them. Our ALS at the time couldn't use pain management for injuries, only morphine for CX pain and APE, and those weren't even standing orders. Now that I can give pain meds on standing orders, I use them quite frequently, so long as I'm not suspicious of the pt being a drug seeker. I use fentanyl and zofran for their respective symptomatic relief on a regular basis.

 

[Veneficus]

I think this a broken arm is like a mercedes.

You don't need a paramedic, but you want one.

a boy scout with a stick and triangular bandage can stabilize an uncomplicated fx. But, if you hurt, you probably don't want to continue hurting.

 

[46Young]

This is the stupidest thing I've seen on the internet.

Pain control is an extremely important part of EMS. Pain is the 5th vital sign. But when someone stubs their toe and has a 2/10 on the pain scale, you really want an ALS rig to be pulled out of service?

Heck, why not just call a chopper? They can get to that big trauma center faster. We can't let our stubbed-toe patient suffer in a small ER.

See my previous post. What's dispatched and what's found onscene can vary greatly. To use your stubbed toe example, most pain management protocols and guidelines refer to long bone Fx's, not digits. The debate is on long bone Fx's, and the potential insult to bodily systems and appropriate pain management. How does a stubbed toe qualify as a comparable case when compared with a long bone Fx? Also, a stubbed toe wouldn't fit the criteria for a medevac. Flying out the stubbed toe to the big trauma center is an obvious strawman argument.

Let's see how it is when you're the one experiencing the pain or maybe a parent or child of yours.

Stay in your lane and refrain from overtly insulting other member's posts, as in "This is the stupidest thing I've seen on the internet". Telling someone that their post is stupid is not the way to effectively argue your point.

Edit: I could have made mention that you haven't even completed your EMT training yet, and that the extent of your medical education is that of a CNA. Actually, I just did make mention of it. But you get the point.

 

[Dutch-EMT]

Well, I can tell you that the ambulances don't show up for only a broken arm in the Netherlands. (Only when an ambulance is dispatched to an accident on the streets (by emergency call), an broken arm will be seen by the ambulancecrew.)
A broken arm isn't life-threatening and the dispatcher will tell you to bring on a sling and drive with the patiënt to the nearby physician or hospital.

 

[aewin90]

What in the heck are you talking about? The case presented is a broken arm. Any broken bone including a toe would justify a Paramedic for pain management.

You didn't comprehend my post. Let's try this again:

Pain control is an extremely important part of EMS. Pain is the 5th vital sign. But when someone stubs their toe and has a 2/10 on the pain scale, you really want an ALS rig to be pulled out of service?

You've basically reiterated what I said about the importance of pain management, assuming the pain is strong enough to require pain medication. Not every fracture results in a 8/10+ on the pain scale.

Now your stubbed toe are you sure that is all? Are you sure they do not have a mental problem? Are you sure its not actually referred pain in a diabetic having a cardiac event.

Sure, the toe pain can be any number of things, which would necessitate ALS response. But more than likely it is what it is-- toe pain secondary to a stubbed toe. A BLS call if there ever was one. A taxi call, more like it.

If BLS arrives and the toe pain turns out to be something else, that's what ALS intercepts are for.

Please refrain from attacking someone until you have enough education to debate with.

:lol:

 

[46Young]

Well, I can tell you that the ambulances don't show up for only a broken arm in the Netherlands. (Only when an ambulance is dispatched to an accident on the streets (by emergency call), an broken arm will be seen by the ambulancecrew.)
A broken arm isn't life-threatening and the dispatcher will tell you to bring on a sling and drive with the patiënt to the nearby physician or hospital.

How accurate is the dispatcher's information? Here in the U.S. many dispatch centers use the EMD flip chart. These dispatchers typically have no medical experience and can only ask questions, refer to the appropriate page, ask a few more questions, and then arrive at the appropriate call type. Too many calls are given a higher level dispatch classification. Also, the dispatchers here don't have the authority to triage over the phone and deny the caller an assessment by the ambulance crew.

For example, if you trip and fall, and injure your ankle, you may call 911. The dispatcher, in using the EMD manual, must ask a whole array of questions, such as "Do you have difficulty breathing?" and such. The pt, in dealing with the pain, may in fact be breathing heavily. Now it's an ALS call. Same thing for someone with a productive cough that's sore from days of dealing with the cough. Now, instead of a BLS sick call, it's now an ALS chest pain. The pt may be 20 years old with no other inclusion criteria suggesting a cardiac event, just the "chest pain."

 

[medic417]

You've basically reiterated what I said about the importance of pain management, assuming the pain is strong enough to require pain medication. Not every fracture results in a 8/10+ on the pain scale.

If BLS arrives and the toe pain turns out to be something else, that's what ALS intercepts are for.

Never wait for 8/10 pain. If they hit 3/10 sometimes less based on presentation they get pain meds. It is easier and safer to low dose pain meds early rather than trying to catch up later. And the pain may not be there at the start of transport so BLS crew cancels ALS then driver hits bump and wow pain is extreme now but basic can do nothing. That is why it should have ALS.

ALS intercepts are a bad idea. I do not want you splinting my broken bones until I get pain meds on board. And if a BLS ambulance shows up then I have to lay there screaming in pain while you request ALS and wait for them to get there.

 

[aewin90]

What's dispatched and what's found onscene can vary greatly.

And thus, the fly car was born.

To use your stubbed toe example, most pain management protocols and guidelines refer to long bone Fx's, not digits.

Well, I see you've taken everything I said seriously. I'm not the only one who "needs more education" evidently, but I suppose I can humor you.

The debate is on long bone Fx's, and the potential insult to bodily systems and appropriate pain management. How does a stubbed toe qualify as a comparable case when compared with a long bone Fx? Also, a stubbed toe wouldn't fit the criteria for a medevac. Flying out the stubbed toe to the big trauma center is an obvious strawman argument.

I... um... yeah, you took everything I said seriously. Let's keep it simple then:

-The opening post of this thread states this is a simple fracture, no serious complications.

-Therefore, unless the pt is in pain to the point where pain management is necessary, this is a strictly BLS call.

Let's see how it is when you're the one experiencing the pain or maybe a parent or child of yours.

Well let's see here. There was that laceration I had when I was younger, an easy 8/10 on the pain scale, no pain meds. My wife in intense back labor, 10+/10, no pain management because the nurses couldn't start an IV. My mother's occasional migraines that were so painful she was unable to walk, no pain meds, just lay down in a dark room... I could actually go on for a while with this.

Stay in your lane and refrain from overtly insulting other member's posts, as in "This is the stupidest thing I've seen on the internet". Telling someone that their post is stupid is not the way to effectively argue your point.

It was incredibly stupid, and frankly I see no need to argue "my point". Anyone who has read a protocol book know that this is a BLS call.

Edit: I could have made mention that you haven't even completed your EMT training yet, and that the extent of your medical education is that of a CNA. Actually, I just did make mention of it. But you get the point.

Sorry buddy, my CNA certification is the result of 240 hours of combined classroom and clinical experience in a variety of clinical environments. You can push the education point all you want, but I have twice as much education as most EMT-B's.

 

[aewin90]

Never wait for 8/10 pain. If they hit 3/10 sometimes less based on presentation they get pain meds.

I never would wait for 8/10 pain. I would ask the patient to rate their pain on the scale and ask if they would like some pain relief, even if it's as low as 2 or 3. It's the patient's emergency and the patient's body.

So let's leave it at this: if this is a fracture with no additional complications, it is a BLS call unless the patient requests pain relief.

 

[medic417]

ISo let's leave it at this: if this is a fracture with no additional complications, it is a BLS call unless the patient requests pain relief.

Let's not. Pain levels can change. It's ALS as potential for pain management is there.

 

[46Young]

ALS intercepts are a bad idea. I do not want you splinting my broken bones until I get pain meds on board. And if a BLS ambulance shows up then I have to lay there screaming in pain while you request ALS and wait for them to get there.

On several occasions I've had to medicate a pt before moving them. It could be the knee or long bone injury from a football play, it could be the elderly female that just popped out her recently done hip replacement, to name a couple of examples.

Actually, the football injury is a good example. It came over as a 12 y/o that twisted their ankle on a play. When we got there, his ankle was fine, and we strongly suspected a distal femur fx. We needed to give 0.5mcg/kg of fentanyl just to move him. Besides his screaming on our initial attempts to place an air splint, the parents were asking us to make him comfortable. The fent decreased the pain from a 10 to a 2. We were expecting to do a quick pillow splint job, ice and txp. Instead, he "stubbed his toes" on the turf, so to speak, lodged his foot there, and ended up fracturing his distal femur. This was confirmed by the attending at the ED later on.

 

[aewin90]

Let's not. Pain levels can change. It's ALS as potential for pain management is there.

Nevermind then. Hopefully there's another ALS unit around who will take care of the heart attack across the street.