Re: Health briefs: Lights, sirens prople ambulances

[Guest guest]

So Andy, what are you saying?? That it is appropriate to run Code 3 because

it is unpleasant for the medic in the back, not because the patient requires

the rapid transport himself due to condition? If that is true, then I think

you need to step back and re-think your position. Bad move if so. Not only

do you endanger people (yourself, your partner, the patient, and the innocent

public) needlessly, but you are partially responsible for the negative

attitude that people have towards EMS, Police, Fire, etc........for running

with lights and sirens " just to get off on time, get to the donut shop

faster, to get to chow faster (and many other remarks) " that result from

unneccesary emergency traffic. Not to mention, I think there are some legal

ramifications to it as well........hmmm, I could be wrong, but I think I am

right.

My 2 cents

Blum, EMT-P

[Guest guest]

To Steve and Mike,

I have to say, Dave put it more eloquently than I did, but the point Dave was

making is exactly the point I was trying to make.

Blum, EMT-P

[Guest guest]

Did anyone see the original article/ report? I'm curious what the length of

their transports were and what types of roads they were on (city, highway,

multi-lane, 2-lane, divided, etc). I agree that a lot of the time, there

isn't much of a difference in transport times. Yet every second can be

another cardiac or brain cell dying and 2 minutes can be a long time with

some patients. On the other hand, that truck running code could be hauling

a GI bleed and lessening of transport time could be more for the benefit of

the medic than the patient. 8'D

Keep Truckin',

Andy Wheeler, EMT-I

----Original Message Follows----

Reply-To:

To: < >

Subject: Health briefs: Lights, sirens prople ambulances

Date: Mon, 19 Mar 2001 11:27:16 -0600

Star-Telegram.Com

Health briefs: Lights, sirens propel ambulances

Compiled from wire reports

You've seen ambulances racing through traffic, lights

flashing and sirens blaring. Have you ever wondered whether all that light

and noise makes a difference in how fast the ambulance gets to the hospital?

The department of emergency medicine of the State

University of New York at Syracuse did, so researchers timed 64 ambulances

-- 32 with lights and sirens, 32 without.

They also checked the routes to make sure the trips went

through areas where there would be traffic. Otherwise, the lights and sirens

wouldn't mean anything.

As reported in the journal Prehospital Emergency Care,

the ambulances with lights and sirens did get to the hospital faster -- by

an average of 1 minute and 46 seconds.

_________________________________________________________________

Get your FREE download of MSN Explorer at http://explorer.msn.com

[Guest guest]

If the patient has a condition that precludes the medic from being able to

perform his duties, and getting him to the hospital faster will give him the

range of treatments he needs, I don't see a problem with deciding that

running Code 3 is in the best interest of this patient.

If a GI bleed patient smells so bad that the medic can barely keep from

vomiting, much less actively being able to work with the patient, then it

may very well be appropriate that emergency transport be used simply to get

the patient to a place where they can be cleaned, treated and approached by

a team, not a single medic doing well to keep himself conscious and

non-vomitile.

Code 3 decisions are in the patient's best interest, which sometimes means

that you go faster to get the patient to appropriate care, which a medic may

not be able to provide under all circumstances.

Not everyone has SCBA gear on the ambulance or is trained in its use, and

HEPA masks don't filter *all* the smells.

Mike

>From: CBlum26666@...

>Reply-To:

>To:

>Subject: Re: Health briefs: Lights, sirens prople ambulances

>Date: Mon, 19 Mar 2001 14:41:00 EST

>

>So Andy, what are you saying?? That it is appropriate to run Code 3

>because

>it is unpleasant for the medic in the back, not because the patient

>requires

>the rapid transport himself due to condition? If that is true, then I

>think

>you need to step back and re-think your position. Bad move if so. Not

>only

>do you endanger people (yourself, your partner, the patient, and the

>innocent

>public) needlessly, but you are partially responsible for the negative

>attitude that people have towards EMS, Police, Fire, etc........for running

>with lights and sirens " just to get off on time, get to the donut shop

>faster, to get to chow faster (and many other remarks) " that result from

>unneccesary emergency traffic. Not to mention, I think there are some

>legal

>ramifications to it as well........hmmm, I could be wrong, but I think I am

>right.

>

>My 2 cents

>

> Blum, EMT-P

>

>

>

[Guest guest]

,

I think you missed the point of Andy's post. The use of red lights and

siren is done so frequently that it is hard to believe that in every case

the handful of seconds or minutes saved by emergent transport are any real

benefit to the patient. All too often the choice to run emergent is more

related to the medic's own comfort zone that to the actual needs of the

patient.

Ever since they started publishing articles about the use of emergent mode

versus non-emergent and have demonstrated how little time is actually saved,

I have re-evaluated my own criteria for determining emergent versus

non-emergent and in many cases opted for the non-emergent transport mode.

Certainly, there are patients that warrant the higher risk associated with

emergency transport but we as providers can save far more time on scene than

what we can during transport. (According to most studies I have seen,

emergency transport only saves less than 2 minutes (that is on the outside,

actually most have shown savings of less than 1 minute). With that in mind

it is much easier to trim 5 minutes off of the scene time and go

non-emergent and save more time than running emergent.

What these studies show us is that we need to be extremely cautious, more

than we already, about the decision to run emergent and make sure the

patient actually justifies that mode of transport.

Steve Dralle, EMT-P EMSC

San , TX

Re: Health briefs: Lights, sirens prople

ambulances

So Andy, what are you saying?? That it is appropriate to run Code 3

because

it is unpleasant for the medic in the back, not because the patient requires

the rapid transport himself due to condition? If that is true, then I think

you need to step back and re-think your position. Bad move if so. Not only

do you endanger people (yourself, your partner, the patient, and the

innocent

public) needlessly, but you are partially responsible for the negative

attitude that people have towards EMS, Police, Fire, etc........for running

with lights and sirens " just to get off on time, get to the donut shop

faster, to get to chow faster (and many other remarks) " that result from

unneccesary emergency traffic. Not to mention, I think there are some legal

ramifications to it as well........hmmm, I could be wrong, but I think I am

right.

My 2 cents

Blum, EMT-P

[Guest guest]

Re: GI Bleeds: I mainly meant that as a joke (hence the 8'D following it)

but you've got to admit sometimes there are patients who stink so bad in the

small confines of your box that it is beyond overwhelming. I purposely try

to stock up on peppermints or altoids to suck on to try to overwhelm my

senses with something else.

Andy Wheeler, EMT-I

_________________________________________________________________

Get your FREE download of MSN Explorer at http://explorer.msn.com

[Guest guest]

Mike:

I have to respectfully disagree with part of what you have said here. While

I agree that Code 3 might be appropriate for a patient whose condition is so

critical and unstable that prehospital treatment can't do much for them, I

absolutely cannot accept the idea of running code because the patient stinks

from his condition. The first situation is a medical decision, in which the

dangers of running Code 3 have to be weighed against the benefit of getting

a deteriorating patient into the doctors' hands a few minutes sooner. Not in

all of those cases, do I see the objective decision swinging in favor of

Code 3. The second situation, no matter how you slice it, is a decision to

put your patient and your crew at higher risk because the patient is

unpleasant to be around. It is a crew-comfort issue. Putting yourself and

your patient at greater risk because the patient's smell makes you want to

ralph is not professional, although, having been there myself, I can

sympathize. With modern, well-trained, educated, well-equipped paramedics,

Code 3 responses back to the hospital, except in trauma/Golden Hour

situations, should be an extremely rare event and should automatically

initiate a quality assurance review when they do happen.

That, at least, is my humble opinion.

Dave

Re: Health briefs: Lights, sirens prople ambulances

> >Date: Mon, 19 Mar 2001 14:41:00 EST

> >

> >So Andy, what are you saying?? That it is appropriate to run Code 3

> >because

> >it is unpleasant for the medic in the back, not because the patient

> >requires

> >the rapid transport himself due to condition? If that is true, then I

> >think

> >you need to step back and re-think your position. Bad move if so. Not

> >only

> >do you endanger people (yourself, your partner, the patient, and the

> >innocent

> >public) needlessly, but you are partially responsible for the negative

> >attitude that people have towards EMS, Police, Fire, etc........for

running

> >with lights and sirens " just to get off on time, get to the donut shop

> >faster, to get to chow faster (and many other remarks) " that result from

> >unneccesary emergency traffic. Not to mention, I think there are some

> >legal

> >ramifications to it as well........hmmm, I could be wrong, but I think I

am

> >right.

> >

> >My 2 cents

> >

> > Blum, EMT-P

> >

> >

> >

[Guest guest]

Dave,

I don't disagree with any of your posting.

However, not all systems in this great state of ours have the ability to

control someone who is vomiting.....vomiting does cause a slight odor, it

also creates airway problems as well. For some systems/medics this might

constitute an emergency and the call might be made to transport code 3. It

may very well constitute a quality assurance review. However, for any medic

to sit back the next day in a clean environment and arm chair quarterback a

call and decision that was made where the medic errored on the patients side

is wrong.

Should this be a common occurrance? ABSOLUTELY NOT....but there are times

it does and may very well be appropriate. We teach students to use all

available tools they have to treat patients. The ability for rapid transport

is a tool that should be use when apropriate.

my 2 cents......

Re: Health briefs: Lights, sirens prople

ambulances

> > >Date: Mon, 19 Mar 2001 14:41:00 EST

> > >

> > >So Andy, what are you saying?? That it is appropriate to run Code 3

> > >because

> > >it is unpleasant for the medic in the back, not because the patient

> > >requires

> > >the rapid transport himself due to condition? If that is true, then I

> > >think

> > >you need to step back and re-think your position. Bad move if so. Not

> > >only

> > >do you endanger people (yourself, your partner, the patient, and the

> > >innocent

> > >public) needlessly, but you are partially responsible for the negative

> > >attitude that people have towards EMS, Police, Fire, etc........for

> running

> > >with lights and sirens " just to get off on time, get to the donut shop

> > >faster, to get to chow faster (and many other remarks) " that result

from

> > >unneccesary emergency traffic. Not to mention, I think there are some

> > >legal

> > >ramifications to it as well........hmmm, I could be wrong, but I think

I

> am

> > >right.

> > >

> > >My 2 cents

> > >

> > > Blum, EMT-P

> > >

> > >

> > >

[Guest guest]

It is distressing to see someone equate a review of a call to " arm-chair

quarterbacking " . Every true profession requires some form of peer review,

why should EMS be different.

Steve Dralle

Re: Health briefs: Lights, sirens prople

ambulances

Dave,

I don't disagree with any of your posting.

However, not all systems in this great state of ours have the ability to

control someone who is vomiting.....vomiting does cause a slight odor, it

also creates airway problems as well. For some systems/medics this might

constitute an emergency and the call might be made to transport code 3. It

may very well constitute a quality assurance review. However, for any medic

to sit back the next day in a clean environment and arm chair quarterback a

call and decision that was made where the medic errored on the patients side

is wrong.

Should this be a common occurrance? ABSOLUTELY NOT....but there are times

it does and may very well be appropriate. We teach students to use all

available tools they have to treat patients. The ability for rapid transport

is a tool that should be use when apropriate.

my 2 cents......

Re: Health briefs: Lights, sirens prople

ambulances

> > >Date: Mon, 19 Mar 2001 14:41:00 EST

> > >

> > >So Andy, what are you saying?? That it is appropriate to run Code 3

> > >because

> > >it is unpleasant for the medic in the back, not because the patient

> > >requires

> > >the rapid transport himself due to condition? If that is true, then I

> > >think

> > >you need to step back and re-think your position. Bad move if so. Not

> > >only

> > >do you endanger people (yourself, your partner, the patient, and the

> > >innocent

> > >public) needlessly, but you are partially responsible for the negative

> > >attitude that people have towards EMS, Police, Fire, etc........for

> running

> > >with lights and sirens " just to get off on time, get to the donut shop

> > >faster, to get to chow faster (and many other remarks) " that result

from

> > >unneccesary emergency traffic. Not to mention, I think there are some

> > >legal

> > >ramifications to it as well........hmmm, I could be wrong, but I think

I

> am

> > >right.

> > >

> > >My 2 cents

> > >

> > > Blum, EMT-P

> > >

> > >

> > >

[Guest guest]

An uncontrollable airway sounds like an emergency to me!

" Leadership is action, not position "

Larry RN ...and some other stuff

These are my opinions only, and do not necessarily reflect those of any

employers, organizations, family, or pets

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[Guest guest]

Steve,

I'm not saying it shouldn't happen....call reviews are great, if they serve

the purpose to educate and not to punish. I'm not sure of your systems view,

but mine is to give the employees the tools to make sound medical decisions

for the best care of their patients. We may not all do exactly the same

thing (cook book medicine). But did we practice good medicine for what the

patient presented with.

Re: Health briefs: Lights, sirens prople

> ambulances

> > > >Date: Mon, 19 Mar 2001 14:41:00 EST

> > > >

> > > >So Andy, what are you saying?? That it is appropriate to run Code 3

> > > >because

> > > >it is unpleasant for the medic in the back, not because the patient

> > > >requires

> > > >the rapid transport himself due to condition? If that is true, then

I

> > > >think

> > > >you need to step back and re-think your position. Bad move if so.

Not

> > > >only

> > > >do you endanger people (yourself, your partner, the patient, and the

> > > >innocent

> > > >public) needlessly, but you are partially responsible for the

negative

> > > >attitude that people have towards EMS, Police, Fire, etc........for

> > running

> > > >with lights and sirens " just to get off on time, get to the donut

shop

> > > >faster, to get to chow faster (and many other remarks) " that result

> from

> > > >unneccesary emergency traffic. Not to mention, I think there are

some

> > > >legal

> > > >ramifications to it as well........hmmm, I could be wrong, but I

think

> I

> > am

> > > >right.

> > > >

> > > >My 2 cents

> > > >

> > > > Blum, EMT-P

> > > >

> > > >

> > > >

[Guest guest]

I agree, when a review is conducted it should be based on whether the

treatments were good for the patient, not that they follow item A then item

B etc. When we return cases to the employees, they are almost universally

marked, " Did you consider... " not, " You should have done this... " .

I just get irritated with the " Armchair quarterback " thing as I have had

people accuse me of that despite how I phrase the questions of their care.

Interestingly enough, it is usually from the ones that didn't really do that

good of a job with the patient! : )

Steve

Re: Health briefs: Lights, sirens prople

ambulances

Steve,

I'm not saying it shouldn't happen....call reviews are great, if they serve

the purpose to educate and not to punish. I'm not sure of your systems view,

but mine is to give the employees the tools to make sound medical decisions

for the best care of their patients. We may not all do exactly the same

thing (cook book medicine). But did we practice good medicine for what the

patient presented with.

Re: Health briefs: Lights, sirens prople

> ambulances

> > > >Date: Mon, 19 Mar 2001 14:41:00 EST

> > > >

> > > >So Andy, what are you saying?? That it is appropriate to run Code 3

> > > >because

> > > >it is unpleasant for the medic in the back, not because the patient

> > > >requires

> > > >the rapid transport himself due to condition? If that is true, then

I

> > > >think

> > > >you need to step back and re-think your position. Bad move if so.

Not

> > > >only

> > > >do you endanger people (yourself, your partner, the patient, and the

> > > >innocent

> > > >public) needlessly, but you are partially responsible for the

negative

> > > >attitude that people have towards EMS, Police, Fire, etc........for

> > running

> > > >with lights and sirens " just to get off on time, get to the donut

shop

> > > >faster, to get to chow faster (and many other remarks) " that result

> from

> > > >unneccesary emergency traffic. Not to mention, I think there are

some

> > > >legal

> > > >ramifications to it as well........hmmm, I could be wrong, but I

think

> I

> > am

> > > >right.

> > > >

> > > >My 2 cents

> > > >

> > > > Blum, EMT-P

> > > >

> > > >

> > > >

[Guest guest]

:grin:....I didn't mean to " push " your button......will look for new

analogy....

Re: Health briefs: Lights, sirens prople

> > ambulances

> > > > >Date: Mon, 19 Mar 2001 14:41:00 EST

> > > > >

> > > > >So Andy, what are you saying?? That it is appropriate to run Code

3

> > > > >because

> > > > >it is unpleasant for the medic in the back, not because the patient

> > > > >requires

> > > > >the rapid transport himself due to condition? If that is true,

then

> I

> > > > >think

> > > > >you need to step back and re-think your position. Bad move if so.

> Not

> > > > >only

> > > > >do you endanger people (yourself, your partner, the patient, and

the

> > > > >innocent

> > > > >public) needlessly, but you are partially responsible for the

> negative

> > > > >attitude that people have towards EMS, Police, Fire, etc........for

> > > running

> > > > >with lights and sirens " just to get off on time, get to the donut

> shop

> > > > >faster, to get to chow faster (and many other remarks) " that result

> > from

> > > > >unneccesary emergency traffic. Not to mention, I think there are

> some

> > > > >legal

> > > > >ramifications to it as well........hmmm, I could be wrong, but I

> think

> > I

> > > am

> > > > >right.

> > > > >

> > > > >My 2 cents

> > > > >

> > > > > Blum, EMT-P

> > > > >

> > > > >

> > > > >

[Guest guest]

Steve,

Unfortunately, many EMS field personnel see QI, QCI,

QA whatever you wish to call it as " Arm-Chair

Quarterbacking " . The reason for this is the way the

" company " sells the process to the field personnel. I

have worked for several companies and some of them use

the process as an improvement mechanism, the way it

should be. Some on the other hand, use it to call

someone on the carpet for mistakes they made or

perceived mistakes they made. The companies that do

this typically have non-field personnel supervisor

level people doing their program. This causes the

" big brother " effect. Administrators and supervisor

level people should not be doing quality assurance in

a Medic X you screwed up again type thing and so many

do.

The best program I ever saw was done my field

personnel on each other. The run forms were copied

and distributed randomly to other field personnel for

review. The only stipulation was that you could not

review a higher level than your own and you could not

review your regular partner’s report. The reports

signature was deleted to help reduce the amount of

buddy-buddy type issues that might arise. This system

used a form that was filled out that had an outline to

help the reviewer during the process. Everyone was

very receptive to the process.

E. Tate, LP

--- " Dralle, Steve " wrote:

> It is distressing to see someone equate a review of

> a call to " arm-chair

> quarterbacking " . Every true profession requires

> some form of peer review,

> why should EMS be different.

>

> Steve Dralle

>

> Re: Health briefs: Lights,

> sirens prople

> ambulances

>

>

> Dave,

>

> I don't disagree with any of your posting.

>

> However, not all systems in this great state of ours

> have the ability to

> control someone who is vomiting.....vomiting does

> cause a slight odor, it

> also creates airway problems as well. For some

> systems/medics this might

> constitute an emergency and the call might be made

> to transport code 3. It

> may very well constitute a quality assurance review.

> However, for any medic

> to sit back the next day in a clean environment and

> arm chair quarterback a

> call and decision that was made where the medic

> errored on the patients side

> is wrong.

>

> Should this be a common occurrance? ABSOLUTELY

> NOT....but there are times

> it does and may very well be appropriate. We teach

> students to use all

> available tools they have to treat patients. The

> ability for rapid transport

> is a tool that should be use when apropriate.

>

> my 2 cents......

> Re: Health briefs:

> Lights, sirens prople

> ambulances

> > > >Date: Mon, 19 Mar 2001 14:41:00 EST

> > > >

> > > >So Andy, what are you saying?? That it is

> appropriate to run Code 3

> > > >because

> > > >it is unpleasant for the medic in the back, not

> because the patient

> > > >requires

> > > >the rapid transport himself due to condition?

> If that is true, then I

> > > >think

> > > >you need to step back and re-think your

> position. Bad move if so. Not

> > > >only

> > > >do you endanger people (yourself, your partner,

> the patient, and the

> > > >innocent

> > > >public) needlessly, but you are partially

> responsible for the negative

> > > >attitude that people have towards EMS, Police,

> Fire, etc........for

> > running

> > > >with lights and sirens " just to get off on

> time, get to the donut shop

> > > >faster, to get to chow faster (and many other

> remarks) " that result

> from

> > > >unneccesary emergency traffic. Not to mention,

> I think there are some

> > > >legal

> > > >ramifications to it as well........hmmm, I

> could be wrong, but I think

> I

> > am

> > > >right.

> > > >

> > > >My 2 cents

> > > >

> > > > Blum, EMT-P

> > > >

> > > >

> > > >[Non-text portions of this message have been

> removed]

> > > >

> > >

> > >

>

_________________________________________________________________

> > > Get your FREE download of MSN Explorer at

> http://explorer.msn.com

> > >

> > >

> > >

> > >

> > >

> > >

[Guest guest]

Steve,

Unfortunately, many EMS field personnel see QI, QCI,

QA whatever you wish to call it as " Arm-Chair

Quarterbacking " . The reason for this is the way the

" company " sells the process to the field personnel. I

have worked for several companies and some of them use

the process as an improvement mechanism, the way it

should be. Some on the other hand, use it to call

someone on the carpet for mistakes they made or

perceived mistakes they made. The companies that do

this typically have non-field personnel supervisor

level people doing their program. This causes the

" big brother " effect. Administrators and supervisor

level people should not be doing quality assurance in

a Medic X you screwed up again type thing and so many

do.

The best program I ever saw was done my field

personnel on each other. The run forms were copied

and distributed randomly to other field personnel for

review. The only stipulation was that you could not

review a higher level than your own and you could not

review your regular partner’s report. The reports

signature was deleted to help reduce the amount of

buddy-buddy type issues that might arise. This system

used a form that was filled out that had an outline to

help the reviewer during the process. Everyone was

very receptive to the process.

E. Tate, LP

--- " Dralle, Steve " wrote:

> It is distressing to see someone equate a review of

> a call to " arm-chair

> quarterbacking " . Every true profession requires

> some form of peer review,

> why should EMS be different.

>

> Steve Dralle

>

> Re: Health briefs: Lights,

> sirens prople

> ambulances

>

>

> Dave,

>

> I don't disagree with any of your posting.

>

> However, not all systems in this great state of ours

> have the ability to

> control someone who is vomiting.....vomiting does

> cause a slight odor, it

> also creates airway problems as well. For some

> systems/medics this might

> constitute an emergency and the call might be made

> to transport code 3. It

> may very well constitute a quality assurance review.

> However, for any medic

> to sit back the next day in a clean environment and

> arm chair quarterback a

> call and decision that was made where the medic

> errored on the patients side

> is wrong.

>

> Should this be a common occurrance? ABSOLUTELY

> NOT....but there are times

> it does and may very well be appropriate. We teach

> students to use all

> available tools they have to treat patients. The

> ability for rapid transport

> is a tool that should be use when apropriate.

>

> my 2 cents......

> Re: Health briefs:

> Lights, sirens prople

> ambulances

> > > >Date: Mon, 19 Mar 2001 14:41:00 EST

> > > >

> > > >So Andy, what are you saying?? That it is

> appropriate to run Code 3

> > > >because

> > > >it is unpleasant for the medic in the back, not

> because the patient

> > > >requires

> > > >the rapid transport himself due to condition?

> If that is true, then I

> > > >think

> > > >you need to step back and re-think your

> position. Bad move if so. Not

> > > >only

> > > >do you endanger people (yourself, your partner,

> the patient, and the

> > > >innocent

> > > >public) needlessly, but you are partially

> responsible for the negative

> > > >attitude that people have towards EMS, Police,

> Fire, etc........for

> > running

> > > >with lights and sirens " just to get off on

> time, get to the donut shop

> > > >faster, to get to chow faster (and many other

> remarks) " that result

> from

> > > >unneccesary emergency traffic. Not to mention,

> I think there are some

> > > >legal

> > > >ramifications to it as well........hmmm, I

> could be wrong, but I think

> I

> > am

> > > >right.

> > > >

> > > >My 2 cents

> > > >

> > > > Blum, EMT-P

> > > >

> > > >

> > > >[Non-text portions of this message have been

> removed]

> > > >

> > >

> > >

>

_________________________________________________________________

> > > Get your FREE download of MSN Explorer at

> http://explorer.msn.com

> > >

> > >

> > >

> > >

> > >

> > >

[Guest guest]

Old Spice works better on a mask after you've packed your nostrils with Vics

Vapor Rub. The only problem is you will not be able to stand to wear Old Spice

to impress the ladies, anymore. You'll have to switch to that old stadby - Tia

Winds.

-Mike

" Steve M. Boykin " wrote:

> I'm not going to get into the merits or demerits of using code three for a

> rancid patient. I do have my own opinion, but I feel that most departments

> will have a policy or protocol that guides the medic's judgment as to how

> fast the patient will be transported. I've found that keeping a bottle of

> Skin Bracer cologne on board the rig proves to be very valuable when dealing

> with a patient such as this. Just a little splash on a mask, and you should

> be ready for anything ( and smell good too!:-)

>

> Steve Boykin EMT-I

> Re: Health briefs: Lights, sirens prople ambulances

>

> > Re: GI Bleeds: I mainly meant that as a joke (hence the 8'D following it)

> > but you've got to admit sometimes there are patients who stink so bad in

> the

> > small confines of your box that it is beyond overwhelming. I purposely

> try

> > to stock up on peppermints or altoids to suck on to try to overwhelm my

> > senses with something else.

> >

> > Andy Wheeler, EMT-I

> > _________________________________________________________________

> > Get your FREE download of MSN Explorer at http://explorer.msn.com

> >

> >

> >

> >

> >

> >

[Guest guest]

:

You are absolutely right that a violently vomiting patient may, for some

limited-capability systems, constitute an unstable airway situation. If the

decision to transport Code 3 in those cases is based on that concern above

all others, then it is defendable in my book. If the main consideration is

the smell, the sound, and what it is doing to your own gorge, then I don't

think Code 3 can be justified. ly, if one cannot stand the heat in the

kitchen, one should not become, or remain, a cook.

Dave

Re: Health briefs: Lights, sirens prople

> ambulances

> > > >Date: Mon, 19 Mar 2001 14:41:00 EST

> > > >

> > > >So Andy, what are you saying?? That it is appropriate to run Code 3

> > > >because

> > > >it is unpleasant for the medic in the back, not because the patient

> > > >requires

> > > >the rapid transport himself due to condition? If that is true, then

I

> > > >think

> > > >you need to step back and re-think your position. Bad move if so.

Not

> > > >only

> > > >do you endanger people (yourself, your partner, the patient, and the

> > > >innocent

> > > >public) needlessly, but you are partially responsible for the

negative

> > > >attitude that people have towards EMS, Police, Fire, etc........for

> > running

> > > >with lights and sirens " just to get off on time, get to the donut

shop

> > > >faster, to get to chow faster (and many other remarks) " that result

> from

> > > >unneccesary emergency traffic. Not to mention, I think there are

some

> > > >legal

> > > >ramifications to it as well........hmmm, I could be wrong, but I

think

> I

> > am

> > > >right.

> > > >

> > > >My 2 cents

> > > >

> > > > Blum, EMT-P

> > > >

> > > >

> > > >

[Guest guest]

:

It is not a matter of punishment. There are a lot of things we do in which

there is a fine line between a good decision and a flawed decision.

Automatically reviewing certain kinds of cases should be viewed as a routine

part of the process of making sure we are following the best practices. I

group non-trauma Code 3's back to the hospital in the same category as field

pronouncements, missed intubations, and full codes. They need to be 100%

reviewed to make sure the decision process and the actual procedures were

optimum for the case. If they weren't, then it should be presented to the

participating medics as an opportunity to learn from a mistake unless, of

course, it appears to be part of a continuing pattern of unimproved bad

decisions and flawed judgement. A lot of medics look at QI processes as a

" gotcha " mechanism, probably because some badly-managed EMS services use

them that way but, used properly, these processes are critical to program

development.

Dave

Re: Health briefs: Lights, sirens prople

> > ambulances

> > > > >Date: Mon, 19 Mar 2001 14:41:00 EST

> > > > >

> > > > >So Andy, what are you saying?? That it is appropriate to run Code

3

> > > > >because

> > > > >it is unpleasant for the medic in the back, not because the patient

> > > > >requires

> > > > >the rapid transport himself due to condition? If that is true,

then

> I

> > > > >think

> > > > >you need to step back and re-think your position. Bad move if so.

> Not

> > > > >only

> > > > >do you endanger people (yourself, your partner, the patient, and

the

> > > > >innocent

> > > > >public) needlessly, but you are partially responsible for the

> negative

> > > > >attitude that people have towards EMS, Police, Fire, etc........for

> > > running

> > > > >with lights and sirens " just to get off on time, get to the donut

> shop

> > > > >faster, to get to chow faster (and many other remarks) " that result

> > from

> > > > >unneccesary emergency traffic. Not to mention, I think there are

> some

> > > > >legal

> > > > >ramifications to it as well........hmmm, I could be wrong, but I

> think

> > I

> > > am

> > > > >right.

> > > > >

> > > > >My 2 cents

> > > > >

> > > > > Blum, EMT-P

> > > > >

> > > > >

> > > > >

[Guest guest]

Andy:

Sorry if I took a tongue-in-cheek response as totally serious. Myself, I can

recall a patient we picked up at Northside Coliseum in Ft. Worth complaining

of nausea. About five minutes into the transport she began hurling gallons

of bile-colored barf that smelled just like Malathion or inon. That kind

of stuff has been like kryptonite to my olfactory sense since I was a

toddler, so I was in agony. The patient wasn't in particular distress, as

she went right on discussing the merits of Fritz von h between heaves. I

went to open the sliding side window so I could breathe, only to find it had

been glued shut. Had to sit tailor fashion on the squad bench because the

whole floor was awash in whatever she had been eating and drinking for about

the last two weeks. Somehow, I survived without adding to the volume on the

floor, but it was about the closest I've ever come. During that run, I think

I discovered a hitherto unrecognized reflex mechanism, similar to the diving

reflex, which allows a paramedic's respiratory rate to drop to around 2 per

minute for brief periods of time. As I said in one of my posts about this, I

sympathize with people trapped in the back with a living haz-mat case, but

our first responsibility is to that patient, not our own comfort.

Dave

Re: Health briefs: Lights, sirens prople ambulances

> Re: GI Bleeds: I mainly meant that as a joke (hence the 8'D following it)

> but you've got to admit sometimes there are patients who stink so bad in

the

> small confines of your box that it is beyond overwhelming. I purposely

try

> to stock up on peppermints or altoids to suck on to try to overwhelm my

> senses with something else.

>

> Andy Wheeler, EMT-I

> _________________________________________________________________

> Get your FREE download of MSN Explorer at http://explorer.msn.com

>

>

>

>

>

>

[Guest guest]

I always favored a dab of Metholatum smeared on my upper lip, although that

stopped working once I added the caterpillar to my face.

Dave

Re: Health briefs: Lights, sirens prople

ambulances

> >

> > > Re: GI Bleeds: I mainly meant that as a joke (hence the 8'D following

it)

> > > but you've got to admit sometimes there are patients who stink so bad

in

> > the

> > > small confines of your box that it is beyond overwhelming. I

purposely

> > try

> > > to stock up on peppermints or altoids to suck on to try to overwhelm

my

> > > senses with something else.

> > >

> > > Andy Wheeler, EMT-I

> > > _________________________________________________________________

> > > Get your FREE download of MSN Explorer at http://explorer.msn.com

> > >

> > >

> > >

> > >

> > >

> > >

[Guest guest]

One could always light a big ol fat cigar.

Mike

>

>Reply-To:

>To: < >

>Subject: Re: Health briefs: Lights, sirens prople ambulances

>Date: Tue, 20 Mar 2001 09:48:00 -0600

>

>I always favored a dab of Metholatum smeared on my upper lip, although that

>stopped working once I added the caterpillar to my face.

>

>Dave

> Re: Health briefs: Lights, sirens prople

>ambulances

> > >

> > > > Re: GI Bleeds: I mainly meant that as a joke (hence the 8'D

>following

>it)

> > > > but you've got to admit sometimes there are patients who stink so

>bad

>in

> > > the

> > > > small confines of your box that it is beyond overwhelming. I

>purposely

> > > try

> > > > to stock up on peppermints or altoids to suck on to try to overwhelm

>my

> > > > senses with something else.

> > > >

> > > > Andy Wheeler, EMT-I

> > > > _________________________________________________________________

> > > > Get your FREE download of MSN Explorer at http://explorer.msn.com

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

[Guest guest]

Dave -

You and I don't disagree that Code 3 transports should be a rare thing. I

think where we differ, though, is in the actual purpose of Code 3 transports

in cases where patient presentation causes a medic to be completely

ineffective. Allow me to present two cases, and offer up alternatives after

each:

1) 35 year old male, presents with severely swollen scrotum, obviously

" filled " with clear fluid, about the size of a large cantaloupe. Palpable

mass in lower abdomen, non-pulsatile. Patient literally vomiting fecal

material at a profuse rate, followed by dry heaves from the fecal smell and

taste left from the vomitus (everything upstream from the lower GI blockage,

which caused a lymphatic response that filled the scrotum with fluid,

additionally causing vomiting-inducing pain). Here, the actual capabilities

of the system come into review. Obviously, something like Phenergan isn't

going to be effective, and is most likely contraindicated (of course, your

protocols take precedence). If the patient is conscious, sedation and

intubation may not be a bad idea (fecal material in the lungs is probably

not a good thing). But, how do you transport? I can handle a *lot* of

smells, and a *lot* of ghastly-looking things. But a patient covered in

fecal material vomitus isn't something I'm going to be able to handle in an

enclosed space. Obviously, taking control of the situation on scene and at

least cutting off clothes and flushing the patient is a good choice, but if

you can't, what do you do about the now-vomiting, completely-ineffective

medic?

2) 75 year old female, wheelchair bound. Obvious rotting flesh in her legs

where she has been in her own urine and feces, unmoved, for at least months

(fed in her wheelchair and left upstairs). On moving to stretcher (by crews

wearing SCBA), roaches exit *from her flesh* and scurry off. Same situation

as above.

In both scenarios, I could find at least one reason to deem this patient as

neding urgent ED/OR care. But, the *primary* reason in reality for running

Code 3 would be that I, in the back of the ambulance, would not be able to

do anything for the patient, as I'd be too involved in not aspirating my

*own* vomit.

Note: Both of these are real calls, but not calls that I've been on

personally. Both of them have been relayed by the actual crews, so they're

not third party or urban legend (to me, anyway, they're third party to the

rest of you now).

I agree 100% that this sort of thing should be a once in a career event, and

that QA/QI should aggresively review these calls for future planning and

education.

Mike

>

>Reply-To:

>To: < >

>Subject: Re: Health briefs: Lights, sirens prople ambulances

>Date: Mon, 19 Mar 2001 16:14:27 -0600

>

>Mike:

>

>I have to respectfully disagree with part of what you have said here. While

>I agree that Code 3 might be appropriate for a patient whose condition is

>so

>critical and unstable that prehospital treatment can't do much for them, I

>absolutely cannot accept the idea of running code because the patient

>stinks

>from his condition. The first situation is a medical decision, in which the

>dangers of running Code 3 have to be weighed against the benefit of getting

>a deteriorating patient into the doctors' hands a few minutes sooner. Not

>in

>all of those cases, do I see the objective decision swinging in favor of

>Code 3. The second situation, no matter how you slice it, is a decision to

>put your patient and your crew at higher risk because the patient is

>unpleasant to be around. It is a crew-comfort issue. Putting yourself and

>your patient at greater risk because the patient's smell makes you want to

>ralph is not professional, although, having been there myself, I can

>sympathize. With modern, well-trained, educated, well-equipped paramedics,

>Code 3 responses back to the hospital, except in trauma/Golden Hour

>situations, should be an extremely rare event and should automatically

>initiate a quality assurance review when they do happen.

>

>That, at least, is my humble opinion.

>

>Dave

> Re: Health briefs: Lights, sirens prople

>ambulances

> > >Date: Mon, 19 Mar 2001 14:41:00 EST

> > >

> > >So Andy, what are you saying?? That it is appropriate to run Code 3

> > >because

> > >it is unpleasant for the medic in the back, not because the patient

> > >requires

> > >the rapid transport himself due to condition? If that is true, then I

> > >think

> > >you need to step back and re-think your position. Bad move if so. Not

> > >only

> > >do you endanger people (yourself, your partner, the patient, and the

> > >innocent

> > >public) needlessly, but you are partially responsible for the negative

> > >attitude that people have towards EMS, Police, Fire, etc........for

>running

> > >with lights and sirens " just to get off on time, get to the donut shop

> > >faster, to get to chow faster (and many other remarks) " that result

>from

> > >unneccesary emergency traffic. Not to mention, I think there are some

> > >legal

> > >ramifications to it as well........hmmm, I could be wrong, but I think

>I

>am

> > >right.

> > >

> > >My 2 cents

> > >

> > > Blum, EMT-P

> > >

> > >

> > >

[Guest guest]

Ahhhh! The ol' outstink-'em-with-a-Stogey maneuver, ehh?

Dave

Re: Health briefs: Lights, sirens prople

> >ambulances

> > > >

> > > > > Re: GI Bleeds: I mainly meant that as a joke (hence the 8'D

> >following

> >it)

> > > > > but you've got to admit sometimes there are patients who stink so

> >bad

> >in

> > > > the

> > > > > small confines of your box that it is beyond overwhelming. I

> >purposely

> > > > try

> > > > > to stock up on peppermints or altoids to suck on to try to

overwhelm

> >my

> > > > > senses with something else.

> > > > >

> > > > > Andy Wheeler, EMT-I

> > > > > _________________________________________________________________

> > > > > Get your FREE download of MSN Explorer at http://explorer.msn.com

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

[Guest guest]

And preach to them about the dangers of smoking at the same time.

Mike

>

>Reply-To:

>To: < >

>Subject: Re: Health briefs: Lights, sirens prople ambulances

>Date: Tue, 20 Mar 2001 11:27:44 -0600

>

>Ahhhh! The ol' outstink-'em-with-a-Stogey maneuver, ehh?

>

>Dave

> Re: Health briefs: Lights, sirens prople

> > >ambulances

> > > > >

> > > > > > Re: GI Bleeds: I mainly meant that as a joke (hence the 8'D

> > >following

> > >it)

> > > > > > but you've got to admit sometimes there are patients who stink

>so

> > >bad

> > >in

> > > > > the

> > > > > > small confines of your box that it is beyond overwhelming. I

> > >purposely

> > > > > try

> > > > > > to stock up on peppermints or altoids to suck on to try to

>overwhelm

> > >my

> > > > > > senses with something else.

> > > > > >

> > > > > > Andy Wheeler, EMT-I

> > > > > >

>_________________________________________________________________

> > > > > > Get your FREE download of MSN Explorer at

>http://explorer.msn.com

> > > > > >

> > > > > >

> > > > > >

> > > > > >

> > > > > >

> > > > > >

[Guest guest]

Right boss, but actually, about ten years further back!

Re: Health briefs: Lights, sirens prople ambulances

>

>

> > Ahhhh! The ol' outstink-'em-with-a-Stogey maneuver, ehh?

> >