The Role of the Paramedic

[Guest guest]

So you've brought up trauma...which is indeed something that generally

shouldn't be messed about with on scene. Let's try some different things...

You said " Trauma: Tib-Fib fx...otherwise hemodynamically stable, what do you do

on

scene, and what do you do enroute to the hospital? "

On scene splint the extremity - pain comes with movement. Load Do IV/Pain

management during transport.

You said " Pulmonary Edema: Well? What's done on scene and what's en route? "

Access ABC's.. Any emergent needs done right there on scene. Load DO everything

else en route to the Hospital.

You Said " Hypoglycemia: ??? "

Known diabetic? Have I been here before? Is this the guy you show up, wake up

with sugar, get a ama and go on your way?

New onset? Assess your ABC's Any emergent needs done right there. Load Do

everything else en route to the hospital.

You Said " Narcotic OD (not breathing): "

Begin using your BVM. Pulse? Yes No ? Intervene if necessary. Load Start IV

in the truck, Give Narcan etc. what ever your treatment is en route to the

hospital.

Many paramedics I have worked with in the past would spend lots and lots of time

on scene. I even had EMT's ask me how come my scene time was so short. Because

when a patient calls, they want to be taken to the hospital. My primary

function is transport. The side of my ambulance says MICU. That is a " MOBILE

Intensive Care Unit. " So tell me why I can't do everything but the most

emergent of care in the back of my unit? Why must I start an IV on a patient on

the street, when I can put them in a well lighted environmentally controlled

ambulance, with everything I need with in arms reach? Why must I do it sitting

still? The whole idea of a paramedic is to do what we do while trucking down

the road. If you can't do it trucking down the road, then you need to be a

nurse.

Tom LeNeveu

Paramedic

Fort Worth Texas

[Guest guest]

Tom,

I don't yet have all of the experience you do, but I do beg to differ with at

least part of your treatment plan.

I think that, if it was me with the stable fx, I'd sure want you to load me with

pain medicine before you're manipulating my leg to splint it.

Everyone has their differences in call management. To me, there are three

methods, each of which has its place in EMS.

1) Stay and play (Patients who need immediate interventions or patients whose

status won't change with time. You've got the luxury to do what needs to be done

and to make your patient comfortable before moving them.)

2) Play and go (Patients who would benefit from immediate interventions, but

transport can't be delayed. Think STEMI, for example.)

3) Load and go (Critical trauma or inability to establish an airway. EMS doesn't

save critical trauma patients - surgeons do.)

-Wes Ogilvie

The Role of the Paramedic

So you've brought up trauma...which is indeed something that generally

shouldn't be messed about with on scene. Let's try some different things...

You said " Trauma: Tib-Fib fx...otherwise hemodynamically stable, what do you do

on

scene, and what do you do enroute to the hospital? "

On scene splint the extremity - pain comes with movement. Load Do IV/Pain

management during transport.

You said " Pulmonary Edema: Well? What's done on scene and what's en route? "

Access ABC's.. Any emergent needs done right there on scene. Load DO everything

else en route to the Hospital.

You Said " Hypoglycemia: ??? "

Known diabetic? Have I been here before? Is this the guy you show up, wake up

with sugar, get a ama and go on your way?

New onset? Assess your ABC's Any emergent needs done right there. Load Do

everything else en route to the hospital.

You Said " Narcotic OD (not breathing): "

Begin using your BVM. Pulse? Yes No ? Intervene if necessary. Load Start IV in

the truck, Give Narcan etc. what ever your treatment is en route to the

hospital.

Many paramedics I have worked with in the past would spend lots and lots of time

on scene. I even had EMT's ask me how come my scene time was so short. Because

when a patient calls, they want to be taken to the hospital. My primary function

is transport. The side of my ambulance says MICU. That is a " MOBILE Intensive

Care Unit. " So tell me why I can't do everything but the most emergent of care

in the back of my unit? Why must I start an IV on a patient on the street, when

I can put them in a well lighted environmentally controlled ambulance, with

everything I need with in arms reach? Why must I do it sitting still? The whole

idea of a paramedic is to do what we do while trucking down the road. If you

can't do it trucking down the road, then you need to be a nurse.

Tom LeNeveu

Paramedic

Fort Worth Texas

[Guest guest]

Tom replied to Bob:

>>You said " Trauma: Tib-Fib fx...otherwise hemodynamically stable, what do you

do on

scene, and what do you do enroute to the hospital? "

On scene splint the extremity - pain comes with movement. Load Do IV/Pain

management during transport.<<

All other things being equal, and the ONLY thing I note is the tib/fib fracture?

They get the IV first and a healthy dose of analgesics. THEN they'd get

splinted, packaged and transported.

An alternate method - intranasal Fentanyl on scene, splinting and packaging,

transport and get an IV en route in case more analgesics or other care is

needed.

--

Grayson, CCEMT-P, etc.

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