Treatment Vs. Transport

TomP

TomP

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I'm the training officer for a rural EMS company and looking to start a discussion on this topic.

Is your companies top priority to transport the pt or to treat the pt?

Thanks for your replies
 
That's an extremely broad question and very situation dependent.

In the most basic sense, we have a primary responsibility to transport our patients while providing stabilizing medical treatment as necessary. In some cases, some of these treatments are best performed on scene prior to any kind of movement, and in others that is detrimental. That sound really vague, but you'll have to be more specific if you want more specific answers.
 
It is vague and that's what I was going for. I want to see what people say.

I don't believe it has to be one or the other and every situation is different, but what made me ask this is I've recently had some Paramedic turnover in my company and I'll be training some new hires soon. I've noticed my older "old school" medics usually have the attitude of "well I got them to the hospital alive" and they do only the basics as far as treatment. Although they do have quick scene times and fast call turn overs. They are the ones who have the attitude of transport being their top priority. On the other hand my new medics have the attitude of every pt needs everything done to them and treatment is their top priority. However this leads to long scene times and their EMT partners complaining to me about them "playing Dr." on scenes.

I think there should be a happy medium and every call is different, but with these new medics about to start and most being fresh out of school I was thinking about how I would answer this question myself and what I should instill on my new employees.

I think a lot of it is that new medics want to use all the skills they've just learned and the seasoned ones have been been there done that and just want to get the call over with.

I'm sure I'm not the only training officer dealing with this so how do others train their employees?
 
Depends:
Sick/Alive - Expedite scene times by limiting interventions to the most critical; the rest done en route with 2 sets of hands working the whole time. (Tx equal to Txp - HIGH)

Sick/Dead - Run the algorithms at-scene to see if we can get them to Sick/Alive status; then see above. (Tx over Txp)

Not Sick - Cover my bases but usually BLS the call to allow receiving hospital to place in waiting room if they like. (Txp over Tx)

Kinda Sick - Try to determine what the receiving hospital will likely do and get a head start for them (IV etc...) to form/maintain positive relationships. (Tx equal to Txp - LOW)

In general, we are moving down the road once the 12-lead is snapped.
 
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You can probably ask this question of 10 providers and get 15 different answers. I think the answer is-it depends on what is appropriate for the call. Sometimes a little extra time on scene to stabilize will be the best way to go and sometimes scoop and run is best. Both treatment and transport are an important part of the job. I think this whole push to reduce scene times (and extending it to my world, length of stays) is ridiculous. Sometimes things are appropriate but take a little longer. As for the EMTs that complain about the medics playing doctor, don't put too much on it unless it seems to be a recurring issue with a specific provider.
 
Is this about the "load and go" vs. "stay and play" decision? I wasn't the lead on the call, but we took a patient from a roomy front room and rapidly whisked them away to a cramped patient compartment in the ambulance holding 4 people plus the patient while fire drove. We might have saved 2 to 3 minutes on the transport to the hospital, but the effectiveness of our skills were severely hampered. I wish we had stayed to do some minimal skills in the room, first.

Allow me to deviate from your question and apply it to patient transfers vs. emergency calls.

I think it's more relevant to keep provider's attention towards patient care and assessment while doing a "routine transport" just the same as a 911 call. Just the other day, one of our routine transports developed RVR en route and needed to be seen in the ER before going to the floor. Too often, providers get complacent with the stability assessments provided by the hospital and take for granted basic assessment and patient monitoring en route. Sometimes providers will just jot down the last vitals from the room instead of taking their own en route. Lazy and dangerous. I've been guilty of the same when I was unwisely mimicking behaviors from others that I probably shouldn't have. No longer.
 
Meh...easy answer. Providers should stay on scene for as long as is necessary to perform the needed examination and treatements, and should do those things in the most appropriate location for the given situation.

Course...knowing what is needed and what is appropriate is the trick...
 
TomP said:
I'm the training officer for a rural EMS company and looking to start a discussion on this topic.

Is your companies top priority to transport the pt or to treat the pt?

Thanks for your replies
Click to expand...
Our priority is to evaluate the patient and then determine what is the most appropriate next step. Not every patient needs to go to the hospital, and making that determination is possibly the most important thing to figure out follow sick or not sick.

We are taxpayer supported (in theory). It is my belief that our residents pay us for prehospital medical care and not just ambulance transport. Many (most?) of our patients have less than excellent access to healthcare and often only call 911 seeking our advice on what to do next, as they have no one else to turn to. I am happy to go out and evaluate/navigate patients to appropriate care. Sometimes that means an expeditious transport via ambulance, other times it means shoveling the driveway so their family member can drive them to the local ED. Perhaps we medicate them before hand too, saving them money and reinforcing our value.

My boss supports and nearly mandates this line of thinking, which is in part why I feel fortunate to work where I do.
 
If it's a medical call and not trauma, you should definitely stay where you found the pt. There are a few time sensitive exemptions such as an MI or CVA but as a whole we tend to be able to do a large majority of the first line treatments the ER can and taking the time to initiate these treatments as soon as possible is usually beneficial for the pt. There's also the issue that standard of care isn't that we're just cot jockeys anymore. In fact, in many cases we have the capability to stabilize if not correct the pt condition now.
As far as EMTs complaining about people "playing doc" on scene, my opinion is that regardless of your cert level, if your partner is signing the report and is legally accountable for care rendered then you have no say as long as they aren't behaving in a negligent manner.
 
Sorry for the typos on my last post. I'm on my phone and sometimes I miss the autocorrect.
 
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