Guest guest Posted June 23, 2003 Report Share Posted June 23, 2003 Per PEMSS protocols a scene time of more than 20 minutes will require an incident report. Times are attempted to be kept at a minimum of 10 minutes. Danny L. Owner/NREMT-P Panhandle Emergency Training Services And Response (PETSAR) Office FAX Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 23, 2003 Report Share Posted June 23, 2003 I've had many good times on scene. GG Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 23, 2003 Report Share Posted June 23, 2003 I realistically shoot for 20 minutes. Statco has a report that I get that allows me to set for various elements ( on scene, call to enroute, enroute to arrival, time at hospital ect....). I don't look at these as often as I should but do call in crews to tell me why we are outside the limits I expect. Henry AAEMC wrote: > We are currently reveiwing our list of performance improvement filters and would like your opinions on scene times. > > Thanks for your assistance. > > Lucille > > Lucille Maes, LP > Chief of Emergency Services > Angleton Area Emergency Medical Corps > P O Box 1420 > Angleton, TX 77516-1420 > > fax > aaemc@... > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 23, 2003 Report Share Posted June 23, 2003 I after many years of observing other ems units in the field suggest a maximum field time of no more than 20 minutes unless there are dangerous considerations, or long extrication times evolved. scene time > We are currently reveiwing our list of performance improvement filters and would like your opinions on scene times. > > Thanks for your assistance. > > Lucille > > Lucille Maes, LP > Chief of Emergency Services > Angleton Area Emergency Medical Corps > P O Box 1420 > Angleton, TX 77516-1420 > > fax > aaemc@... > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 23, 2003 Report Share Posted June 23, 2003 Strict scene time rules is road that you do not want to go down, the exception being trauma. Guidelines are all that is needed, unless you have a group of medics that you do not trust, and want them not to trust you. This is also a function of what your service has in the way of standing orders. If you have to waste time getting orders for something, you might as well have left for the hospital. If the overwhelming thought in your head is " I have to get this guy outta here in another 8 minutes, or I'm gonna be in the office " you are going to miss something eventually, and it will bite.....hard. What can you say at that point? " But, I was trying to stay in the scene time parameters! " You learn " load and go " vs. " Stay and play " thru experience and education, not thru racing the clock on scenes. I have heard 20 minutes bandied about here. Well, I'm pretty good, and I'm going to tell you that I can't get a drowning CHF pt. assessed, medicated, assessed again, RSII performed, packaged and off to the ED in 20 minutes. CVAs? Unless they need RSII, there's squat I can do, so off we go. I can buy some time for an MI with Os, ntg, asa and morphine, and I'm going to spend the time to do it because it will help. You just have to learn what you can affect and what you can't thru experience. What are your hospitals like? On a busy Saturday nite, I know if I have an asthma/COPD pt. I'm gonna be in the hall on the stretcher 45-90 minutes. Guess what? I'm gonna stay an extra 15 minutes on scene to fluid bolus, take a full neb tx. and give some 'roids, otherwise I'm pissing in the wind and the pt. will just get worse sitting on my stretcher in the hall after my outstanding scene time. Throw in there fractious family members, stairs, pt. weight and cooperation level and a myriad of other complications, and you are going to be creating a lot of paperwork for yourself. Trying to enforce some kind of " 20 minute rule " will turn a group of dedicated pre-hospital professionals into a mob of ambulance drivers quicker than you can imagine. My mother begged me to be a lawyer....... > We are currently reveiwing our list of performance improvement filters and would like your opinions on scene times. > > Thanks for your assistance. > > Lucille > > Lucille Maes, LP > Chief of Emergency Services > Angleton Area Emergency Medical Corps > P O Box 1420 > Angleton, TX 77516-1420 > > fax > aaemc@m... > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 23, 2003 Report Share Posted June 23, 2003 20 minute scene times or a letter of inquiry gets sent back to the EMS agency on trauma patients. Obviously if there is a problem with prolonged extrication, weather ,uncooperative patients etc that I can determine from the documentation I don't send a report. We report this to the state with our EMS registry data. ) Hollett RN, BSN, MA, MICN, CEN, EMT-P Trauma Coordinator Trauma Service Methodist Dallas Medical Center 1441 N. Beckley Dallas, TX 75265 lisahollett@... fax scene time We are currently reveiwing our list of performance improvement filters and would like your opinions on scene times. Thanks for your assistance. Lucille Lucille Maes, LP Chief of Emergency Services Angleton Area Emergency Medical Corps P O Box 1420 Angleton, TX 77516-1420 fax aaemc@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 23, 2003 Report Share Posted June 23, 2003 You are right Henry, in that there is a legitimate need for QA and oversight in all aspects of medicine, EMS included. What I'm talking about are hard and fast " rules " regarding scene time. Services that have those sorts of restrictions and others that make sense from a statistical POV, but are not based in reality DO have trust issues, running both ways. Scene time enters my thinking, but only as far as the management of my patient is concerned, not due to some arbitrary rule. My patient comes first, my UHU rate comes last. Checks and balances are an integral part of education and improvement, as long as that's the intent. Resistance to QA/QI more often means that the employee views it as punative rather than educational, and while it's difficult to really convince your employees that you aren't hounding them, you are just staying on top of YOUR job, it's imperitive that they are convinced that you have their best interests at heart, and their interest is in doing the right thing for their patients. At some point in your career, you begin to stop worrying so much about what your co-workers and managers think of your performance, and begin to self-evaluate, because it's you that has to face the mirror every day. If a clinical oversight program is a tool for self-improvement, the benefits are many and tangible. Every scene could have gone better, everybody knows that. If it is like so many currently in use, and is used for intimidation and keeping the " reigns " in tight, it's monumentally detrimental. Anyone in an organization that has a problem with legitimate QI has bigger issues. Unfortunately, beneficial clinical improvement programs are tough to maintain, even with the best of intentions. Most medics do not take criticism well to begin with, due to the level of clinical responsibility they have, and any percieved hint of " second guessing " or threat to their jobs eliminates the benefits. Again, it all goes back to trust, and it's a 2-way street. In allied health, we have the most clinical responsibility, and the least ammount of training to go along with the least tolerance for clinical errors. Another thing you are right about Henry is that not all managers are stupid, in fact, I've never had one that was. Stupidity and lack of education are 2 completely different things. A fortunate few are born with an inate sense of how to lead and inspire. The rest of us have to be taught. EMS does not develop leaders like the other public service organizatios do, at least not in any structured way, and it is a detriment to the profession in general. Hey, were we talking about scene time? :-) > > > We are currently reveiwing our list of performance improvement > > filters and would like your opinions on scene times. > > > > > > Thanks for your assistance. > > > > > > Lucille > > > > > > Lucille Maes, LP > > > Chief of Emergency Services > > > Angleton Area Emergency Medical Corps > > > P O Box 1420 > > > Angleton, TX 77516-1420 > > > > > > fax > > > aaemc@m... > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 23, 2003 Report Share Posted June 23, 2003 With respect to the discussion of scene times I will have to disagree with some posting on how long to stay on scene. Ladies and Gentlemen we are Emergency Medical Technicians and as such our office is different from other offices. Physicians work in offices in bldgs. and in Hospitals. Nurses work in offices in Bldgs. and in Hospitals. Emergency Medical Technicians (and I refer to the Basic, Intermediate, and Paramedic) work in the back of ambulances. That is our office, not in some hallway or someone's living room or bedroom. The whole point of being able to transport patients is to get them to the HOSPITAL. Scene times are built around the premise of getting the patient to definitive care. I would interject that If we are having problems working in our office we need to figure out another place to be. We do not make " house calls " they are called " 911 Emergency Calls. " We make these to take the patient to the hospital. I would suggest that some skills practice (or sometimes a discussion with our drivers) take place so that we are able to work competently and effectively " IN OUR OFFICE. " There is no need to " stay on scene " when medicines and procedures are to be done " enroute " to the " HOSPITAL. " Danny L. Owner/NREMT-P Panhandle Emergency Training Services And Response (PETSAR) Office FAX Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 24, 2003 Report Share Posted June 24, 2003 I use scene times as one of my audit filters on trauma patients, just so you know. That info is also reported to TDH. Thanks, Alyce scene time We are currently reveiwing our list of performance improvement filters and would like your opinions on scene times. Thanks for your assistance. Lucille Lucille Maes, LP Chief of Emergency Services Angleton Area Emergency Medical Corps P O Box 1420 Angleton, TX 77516-1420 fax aaemc@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 24, 2003 Report Share Posted June 24, 2003 I once placed a " patient " of this sort in the front seat of the ambulance and drove her 3 blocks to a relative's home. She admitted she did not want to go to the hospital and had no real medical problem, but she did not want to be alone. We drove her because it was after midnight and cold outside. BTW, after this, she only called 911 when she was having a medical problem. Jo Bell EMT/P At 05:19 PM 6/24/2003, you wrote: >Please remember that we respond to things that we feel are not emergencies >but are emergencies to the patients. At that moment, the patient felt it was >something that required your attention. And yes it may be a toothache or a >stubbed toe, but the patient felt that a ambulance was required. Does this >tax the system? Yes, but it is still our job to take care of patients. >Without them, we have no system. In this situation, all that was needed was >some information to fix the problem. They probably knew that the child >needed to go to the dentist but they just wanted to here that from you. Do >we transport all the time? No because sometimes that is not what is needed. >I once had an elderly woman that lived by herself and would call and say she >had trouble breathing. She didn't really, she was just lonely and wanted a >friendly face to talk to. The first couple times, we would end up >transporting her because we didn't realize the real problem. After a while, >we started sitting down and talking to her and she would relax and feel >okay. We didn't talk her out of going. We just talked. When she really did >have problems, she let us know. Did this tax the system when we would just >go talk? Yes, but she felt better and we gained the respect and friendship >of a wonderful person. Many of us on this list, have been in EMS since the >Dark Ages. But we still need to remember, we are here for the patients. > > Ruhnke, NR/CCEMT-P Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 25, 2003 Report Share Posted June 25, 2003 Lucille, we have a 10 minute requirement of all trauma calls and 20 minute on all medical calls. This is part of our contract and they used the guidelines that were set up by the state requirements. Any scene times over the limit require an exception report and has to be given to the hospital for their reporting requirements. scene time > We are currently reveiwing our list of performance improvement filters and would like your opinions on scene times. > > Thanks for your assistance. > > Lucille > > Lucille Maes, LP > Chief of Emergency Services > Angleton Area Emergency Medical Corps > P O Box 1420 > Angleton, TX 77516-1420 > > fax > aaemc@... > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 9, 2003 Report Share Posted July 9, 2003 You are probably thinking of the SB102 grant money. That one, you participate in the RAC, have a protocol statement that says your protocols conform basically to the RAC protocols, you submit to trauma registry in one form or another, etc. The LPG is where you apply to TDH for funding for equipment, training, etc. You can find links to these on the TDH page under the " funding " link, I believe. Steve Re: scene time I after many years of observing other ems units in the field suggest a maximum field time of no more than 20 minutes unless there are dangerous considerations, or long extrication times evolved. scene time > We are currently reveiwing our list of performance improvement filters and would like your opinions on scene times. > > Thanks for your assistance. > > Lucille > > Lucille Maes, LP > Chief of Emergency Services > Angleton Area Emergency Medical Corps > P O Box 1420 > Angleton, TX 77516-1420 > > fax > aaemc@... > > > Quote Link to comment Share on other sites More sharing options...
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