PLSI?

[akflightmedic]

I have been googling and cannot find this acronym. Anyone know what this references?

 

[mgr22]

I think PLSI refers to a Priority 1, 2, or 3 Life-Saving Intervention, where Priority 1 is immediate, 2 is urgent, and 3 is delayed. I don't know if it's valid to combine all three under a generic PLSI abbreviation.

 

[PotatoMedic]

Potentially Life Saving Intervention

 

[akflightmedic]

So it is kind of ill defined because they say potentially, and they say soon after arrival. So it seems like a sending facility could play with the potential part and then also how quick is quick?

 

[E tank]

Yeah, its meaningless. The statement on the slide makes sense, but it's in the category of 'all kids should have shoes without holes to wear to school'. There is pad to OR intervention and then there is fluoro guided pleural catheter type intervention. It's all relative and at the end of the day it so often comes down to the convenience of the sending and receiving physicians and their schedules that night or the next day.

 

[NomadicMedic]

I think the bigger issue here is emergency departments transferring patients from smaller community hospitals to larger receiving facilities in the middle of the night without understanding the risks associated with a middle of the night transport.

A local hospital will often send stable patients to a larger facility, specifying an ALS crew for cardiac monitoring, even though the patient is not currently on a cardiac monitor, and has no indication of decompensation while en route. This places undo strain on the system, removing a paramedic from emergency service and taking him out of the game for several hours to babysit a stable patient that has no real ALS indicators other than the fact that somebody wrote “needs cardiac monitoring“ on the PNMC.

I’ve been working with physicians and administrators to line out some better criteria for determining the need for emergent middle of the night transports. I will always take a patient who needs a PLSI in the middle of the night, but the stable patient being moved in the middle of the night for convenience sake makes zero sense to me.

 

[CCCSD]

I think the bigger issue here is emergency departments transferring patients from smaller community hospitals to larger receiving facilities in the middle of the night without understanding the risks associated with a middle of the night transport.

A local hospital will often send stable patients to a larger facility, specifying an ALS crew for cardiac monitoring, even though the patient is not currently on a cardiac monitor, and has no indication of decompensation while en route. This place is undo strain on the system, removing a paramedic from emergency service and taking him out of the game for several hours to babysit a stable patient that has no real ALS indicators other than the fact that somebody wrote “needs, cardiac monitoring“ on PNMC.

I’ve been working with physicians and administrators to line out some better criteria for determining the need for emergent middle of the night transports. I will always take a patient who needs a PLSI in the middle of the night, but the stable patient being moved in the middle of the night for convenience sake makes zero sense to me.

Nailed it.
A Taxi Cab with an AED on the backseat would suffice in a few cases.

 

[Akulahawk]

I think the bigger issue here is emergency departments transferring patients from smaller community hospitals to larger receiving facilities in the middle of the night without understanding the risks associated with a middle of the night transport.

A local hospital will often send stable patients to a larger facility, specifying an ALS crew for cardiac monitoring, even though the patient is not currently on a cardiac monitor, and has no indication of decompensation while en route. This places undo strain on the system, removing a paramedic from emergency service and taking him out of the game for several hours to babysit a stable patient that has no real ALS indicators other than the fact that somebody wrote “needs cardiac monitoring“ on the PNMC.

I’ve been working with physicians and administrators to line out some better criteria for determining the need for emergent middle of the night transports. I will always take a patient who needs a PLSI in the middle of the night, but the stable patient being moved in the middle of the night for convenience sake makes zero sense to me.

Transporting a patient requiring a legitimate "PLSI" to a facility that actually has that ability should be a no-brainer. HOW that gets accomplished is the question and you've pretty much nailed it. We shouldn't care all that much about transporting stable patient somewhere in the middle of the night... If they're from the ED and they need to go somewhere else, they need to be at that other place.

IMHO, if a patient is going to a Tele floor, then EKG monitoring en-route is appropriate. If the sending / receiving facility is OK with downgrading off tele for transport, then the patient likely doesn't need Tele anyway. If the patient is going to a Med/Surg (no tele) floor, then BLS is likely appropriate. A 911 crew should never be taken out of the system to transport stable patient. If the patient is unstable, sure. Time is your enemy in that instance and it can take hours to arrange transport. If you have an IFT Paramedic resource, that should be used for most of the actual "needs a monitor" stuff. I'm a transport nurse. I transport some very stable and some (sometimes) very unstable patients. Why do I get those very stable patients? It's because around here, Paramedics aren't allowed to monitor patients on a vent, they're not allowed to transport with meds in the IV with a very few exceptions. Nationally speaking, most of that isn't a problem for Paramedics. If my local medics were allowed to do what medics do elsewhere in the US, I'd have a much less busy job in terms of numbers of transports, but the acuity would be much higher than what I usually see.

Please keep pushing for making those changes! It will be of benefit... especially if it spreads beyond your area.

 

[akflightmedic]

A lot of the current discussion from my involvement is related to flight. You gave a great response regarding ground ambulances. But the inherent risk of flight is where this topic is more relevant.

So does a crew need to get in the air to transport that tele patient at 0200 or should it wait? Does that ER patient who is on a dopamine drip and nothing more really need to be flown at 0300?

Yes I know…does he need to be flown at all…and the answer is yes in many areas where I am currently as there are NO ambulances who can transport the patient.

So these questions/scenarios as directed towards flight is my concern.

Another real example….0130…this patient needs to go now. He has occluded arteries and the cardiologist wants the patient there. He is going to get a cath. Transport the patient and get to the receiving facility and then place him in a room. He gets cath the following day.

Stuff like this happens ALL the time.

 

[E tank]

Not to sound defeatist, but it's the nature of the interventional infrastructure. Whether the cath lab or the OR or the IR suite, these are high profile, big earners for hospital systems and the operators are given great deference in the latitude they're given in how they schedule cases. The hospital would rather let the doc park a patient over night and have them tee'd up and ready to dove tail into the next day schedule seamlessly than have a transfer in the morning or later and disrupt the flow of things. Plus, there's always the odds that another hospital will accept the patient and revenue will be lost. Surgeons do that to us all the time and in the end, we're just a means to an end. Welcome to the team....

 

[akflightmedic]

This probe of mine is not a single effort. The organization is driving this, and ramping up to do "education" for the many facilities it serves in these rural areas. I think part of the drive is the recent crash in Oklahoma.

Maybe the cath patient was a bad example. There are a lot of non-interventional flights taking place "after hours", again the big risk, little gain.

 

[Tigger]

I think there is still plenty of risk at night when going by ground. Even if a rural service has a dedicated night shift (rare), it still does not make sense to transfer someone at 0300 just so they can be babysat until they see the specialist after the sun comes up. The only winner is the sending ED.

 

[akflightmedic]

I think there is still plenty of risk at night when going by ground. Even if a rural service has a dedicated night shift (rare), it still does not make sense to transfer someone at 0300 just so they can be babysat until they see the specialist after the sun comes up. The only winner is the sending ED.

I agree, however I am only focusing on medevacs with this inquiry/effort.

 

[Tigger]

I agree, however I am only focusing on medevacs with this inquiry/effort.

Sure sure. I imagine you face many of the same challenges. Stopped counting how many times the local CAH called for flight when we turned down a non emergent ALS transfer for fatigue or low units.