Life and death

[abckidsmom]

I have really lost track of where the line is between sick people who need the ICU and those who don't in recent years. Acute care has progressed significantly in what it can handle.

 

[VFlutter]

I have really lost track of where the line is between sick people who need the ICU and those who don't in recent years. Acute care has progressed significantly in what it can handle.

Very true and also dependent on the hospitals in your area. A lot of the patients who are transfers from outside hospitals' ICUs are just routine patients for us. Basically the only guaranteed ICU beds are intubated patients and a handful of drips (certain pressors, insulin, tpa).

 

[abckidsmom]

My dad had an insulin drip on the floor of the hospital he was at a week ago. I was surprised. His nurse had 4 patients.

 

[VFlutter]

My dad had an insulin drip on the floor of the hospital he was at a week ago. I was surprised. His nurse had 4 patients.

That is surprising. I personally would not take an insulin drip with 3 other patients but that is just me.

 

[abckidsmom]

I know. I was glad I was there with him.

 

[CritterNurse]

Rural volunteer rescue and between the two departments I'm on, there are probably between 500 and 600 calls a year. I can count on one hand how many runs I've been on where the person was admitted directly into surgery or ICU in the 3 and a half years I've been involved with rescue.

 

[jMed]

I work in a rural area and although there are handfuls of calls a month that transporting emergent is crucial to their well being (Which is different on rural roads than say, intercity gridlock traffic) but when we drop a patient off that goes directly to surgery, where literally every second counted. I would say it happens about 3 to 4 times a year. And usually they take a helicopter ride right afterwards to a more appropriate hospital. (However it, of course, varies)

 

[abckidsmom]

I was on my phone earlier and couldn't see the poll. All patients brought in by 911 ambulance in my area go to the ER first, where they are managed and then transferred to the ICU. In my experience, I've only seen ICU to ICU transfers where ambulance crews drop off in ICUs.

I've taken strokes right to the CT scanner, and STEMIs right to the cath lab, but have never taken a trauma right to the OR. I have seen OR level stuff in the ER, cracked chests, clamped blood vessels, and once a dehiscence that was explored just a bit.

The definition I was going on was a patient requiring critical care- airway/breathing support, pressors or other drips, or altered mental status with metabolic issues, etc.

2 weeks ago, I had a guy who had been actively GI bleeding for 5 days, but thought it was just a "stomach virus." His hemoglobin was 2.7, with SBP in the 50s, syncopal any time he wasn't laying flat, but vomiting. 34 years old. He spent some time in the ER, but he was very sick for me. That's what I'm talking about. Now that I think about it harder, I may get more than 2/month, but that's a good starting place.

 

[Trashtruck]

Definitely more than one per week. I can't say it's one per shift, as some shifts consist of absolute nonsense where I question and laugh that I'm getting paid, but there are days when there are more than one per shift.

Municipal, urban, 911-only system.

 

[Emtbob]

I'm in a suburban volunteer department, been riding ~36 hours a week recently.

In the past 3 months I've run:
2 "stable" vtac that did not perform well after conversion (although I'm on record for converting one of those with a gear change while driving)
1 who was in severe shock despite his newly inserted pacemaker keeping his pulse at 60
1 STEMI that went into cardiac arrest as soon as contrast dye was introduced into his heart (complete occlusion of the LAD, guy walked out of the hospital a couple days later and wrote a very nice letter to us)
1 aspiration pneumonia that was bad enough when I came back an hour later the family was gathered around waiting for her to die (I don't think this counts)
2 Prescription medication OD and 1 recreational OD that were RSI'd before I left the patient's room (all of these were intentional)

I think I'm using a looser definition of patients that required a physician level intervention immediately, as there is no RSI in the field here. The local ED is very happy to hold on to ICU patients for several hours if they aren't overwhelmed.

 

[Veneficus]

I was on my phone earlier and couldn't see the poll. All patients brought in by 911 ambulance in my area go to the ER first, where they are managed and then transferred to the ICU. In my experience, I've only seen ICU to ICU transfers where ambulance crews drop off in ICUs.

I've taken strokes right to the CT scanner, and STEMIs right to the cath lab, but have never taken a trauma right to the OR. I have seen OR level stuff in the ER, cracked chests, clamped blood vessels, and once a dehiscence that was explored just a bit.

The definition I was going on was a patient requiring critical care- airway/breathing support, pressors or other drips, or altered mental status with metabolic issues, etc.

2 weeks ago, I had a guy who had been actively GI bleeding for 5 days, but thought it was just a "stomach virus." His hemoglobin was 2.7, with SBP in the 50s, syncopal any time he wasn't laying flat, but vomiting. 34 years old. He spent some time in the ER, but he was very sick for me. That's what I'm talking about. Now that I think about it harder, I may get more than 2/month, but that's a good starting place.

I would think this guy was probably admitted to the ICU or Surg.

I wouldn't count only taken directly to the OR or ICU from EMS, but admitted there for intervention within a few hours (not more than 24) as being critical.

 

[Hunter]

This varies greatly for me, I would say over a year i average one per week.
I work for a private non 911 IFT company with CCT units, when i work on those units i can average 0-5 patients usually all the patients are critical but can't be transported by HEMS for whatever reason. Either need transport to a higher level trauma Center, Cardiac Cath, or a comprehensive Stroke Center. When i work our BLS trucks I'll get one per month, and our ALS trucks I'll average 2-3 a month, usually all within one shift.

However when I did my ride along with one of the local fire departments for my Medics I say we averaged about one a month, everything else was usually BS non emergency but was still transported priority.