seizure in L.A. county

[RichEMT]

Today we were called to a psych facility to transfer a recently admitted pt. to the hospital to be evaluated for the cramps he was having that day. we could not get any medical much medical history from the pt. or the facility other than a Hx of alcohol abuse. pt's vitals were WNL except his skins were a little flushed, a little clammy and slightly elevated temp. he said he felt shaky and had severe abdominal cramping. pt. not on any meds, no med Hx, bla bla anyhow loaded and started to transport. about half way through transport patient started siezing i figured it was dt's so we lit it up and continued to hospital. only 5 minutes to hospital. i radioed dispatch to ley them know we upgraded and as i pilled into the hospital i got a cell call from the screaming supervisor saying we cant transport a witnessed siezure. the problem is we were allready en route am i supposed to pull over and call fire when the hospital was less than 5 away. im sure fire would love that what do u think. u guys have experience. everybody said i was in the right but she was mad lol

[medicgoddess]

One question...WHY can't you transport a witnessed seizure?

[RichEMT]

she says it protocol i asked her to show me she couldnt. i tried to find it, i have not seen it she was also throwing out goofy rules. for instance l.a. county says if we can make it to the hospital faster than a medic can get to us we can transport. but she said if we pass a fire station we can get in trouble. well not all stations have medics from what i was told, some are bls. anyhow do i just pull to the curb and call fire while the guy is rockin da bus haha thats freakin lame

[RichEMT]

i can understand calling for als if we were on scene when it happened. its just we were enroute thats what makes the difference here, as it was a short transport

[medicgoddess]

I would think that stopping would have delayed patient care due to the fact that fire would have had to be paged, load up, drive over, transfer care, etc... Kudos to you for thinking of the patient first!

[PSYCtest040]

Here in New York (MLREMS in paticuler)

1. ......if enroute and closer to the hospital than ALS we continue to the Hospital.

2. ......if enroute and more than 10 minutes from a hospital start ALS and continue to the hospital and meet enroute.

3. ......If on scene and ALS is more than 10 min out we load and meet in route.

[strwblue]

Ok.. Here is the thing.. As long as you are a certified Emergency Medical Technician and you are acting within your level of training to the best our your ability, you are doing the right thing.

In the above case you always have the option to call dispatch (no matter were you work) and request ALS back to MEET you some where between your location and the hospital. Any Paramedic worth his or her salt will load up onto your rig and begin treatment as your continue to the nearest appropriate emergency room.

As far as your supervisor is concerned, advise him or her that anyone can have a seizure at anytime for any one of a hundred reasons. Had the call taker done their job you would have had an idea that your patient was in the middle of detox and had get potenial for siezure activity.

If you are an emergency medical technician you are trained to handle siezure patients. (At least I was in my EMT class). Creating a protocol that say you can't transport actively siezing patients is stupid, what if there is no ALS unit avail? Do you just wait and hope the patient stops Siezing? What if the patient turns into a status epilepticus patient, do you wait until the patient is in respiratory arrest or cardiac arrest? I'm sure you supervisor will get the point.

Battle on.

[wvditchdoc]

Here's the thing, some Medics in some stations want to be glory hounds. What you did was correct no matter what state or region or what ever you were in. You continued supportive care and got the patient where they needed to be. I speak from many years in a rural EMS service and worked many days when I was the only medic in the county. The idea that your supervisor called and reamed you out for doing what was right for the patient makes me wonder what her idea of good patient care is. The only thing you may have done is advised your dispatch to go ahead and tone a medic. Once they figured out they were never gonna get there in time to do anything for the patient, they probably would (or at least should) have cancelled. Although I have seen some medics meet up with a BLS crew and have them stop on the access road to the facility to do ALS, which is completely asinine. So next time have dispatch officially tone for an BLS intercept and that way you have done everything in your power to provide "appropriate" care. That way no one will have anything to bitch about. :glasses2:

Keep up the good work and always err on the side of your patient, if you do that, you will never have trouble sleeping at night wondering if you did everything you could for them.

[CornholioMedic]

I'm thinking that, with a great deal of confidence that almost every state has laws regarding the delay of patient care. If you are in transport, why would you pull over because someone is having a seizure? I would have told that boss to blow me and charge him or her with delaying patient care. This is why ALS intercepts or ECHO units do NOT work in an Urban environment.....we tried it once and it sucked royally. The city wasted valuable resources and tax payer money on a program that department doomed from the start. Not to mention it put patients lives in jepordy as well as our personnel.

[RichEMT]

ya everybody says the supervisor was wrong. i was embarrassed when trained by her. crappy patient care/ attitude so i just look at the source. Plus her lack of experience. but thanks guys i just wanted your opinions. there is a ton of experience her i figured u guys would know. thnx

[smiley]

To those whom are not familiar with the EMS system in Los Angeles County this topic may seem a little confusing, even seem a tad obscured, and then ask why can’t this person transport a patient whom is in distress and contemplate calling a ALS responder. ECHO units are non existent in LA. ALS CARE “IS” the Fire Department Engine Company and or a Fire Department Ambulance / Squad. Paramedics for Privates in LA County do IFT work almost 95% of the time.

BLS crews make up almost the entirety of ambulance staff. Two EMT’s on a rig and respond to 911 calls with the fire department. The Ambulance Company is the transport medium for ALS Fire Providers, unless the Fire department has their own ambulances “La City Fire” for example, then a private ambulance would not respond within that jurisdiction to any EMS call unless requested for disaster type assistance. Ambulance companies mainly do IFT work and convalescent home transfers to the ED per doctor requests and dialysis transportation.

Many upon many of times have I scooped up a ALS patient when I was a BLS provider from SNF’s or other tertiary care centers then transported Code 3 to the MAR (La County Term for most accessible receiving). You did the right thing by transporting a patient whom would have waited for the Fire Department to get there to transport the patient and or ride in with you. Unless you bypassed any ED’s on the way to his original destination.

Everyone remember Johnny and Roy, the La County paramedics on the “squad”. Los Angeles County Fire Department provides ALS responders on their squads, (two paramedics) and responds a BLS ambulance under sub-contract with the county. AMR, WESTMED, Mc CORMICK, COLE/SCHAFER. There are many different companies’s whom are contract “Transport Mediums” for LA County Fire.

When FIRE is on scene they use a criteria for ALS vs. BLS care. If the patient does not fall within certain criteria for ALS Follow-up to the ED then the patient is turned over to the Dual BLS crew for transport. Policy 808.

http://ladhs.org/ems/Manuals/policies/ref800/808-1.pdf

This is done to Free Up ALS providers as they are outnumbered 10/1 on ALS to BLS calls. The system actually works quite well and having experienced it from both sides I see its benefits. We all know the BLS to ALS ratio anyways.

What this boils down Mr. RichEMT…….. IS MONEY……. You transported this patient probably to the closest ED, The sending physician probably does not have privileges at that facility and is now mad at your ambulance company for him losing money. Second your supervisor may have got some heat from the city you responded through code 3. Many cities only allow their FD and PD unless ambulance is under sub contract they are not allowed to go code 3 through them, example Redondo, Manhattan, Culver ………

Third, ED’s in LA County CLOSE to ambulance traffic. La uses a system called the Ready-Net and shows open and closed and diverted hospitals. If you transported to a ED that was jam packed and “Closed” to traffic the nurses would be hella pissed off, especially if its like “SURPRISE, We have a Seizure Patient”. No call in to the hospital and now angry nurses with a pissed off city council and a SNF threatening to change their transportation arrangements because a doctor lost a few bucks……;.

ITS ALL ABOUT MONEY,,,,,,,,,, The BLS system is a racket in LA county… BIG MONEY. You have probably 5 or 10 “Marketing” people in you division alone.

They go to these facilities, SNF’s and ED’s drumming up business for that company.

Be confident in you decisions, as long as you did the best thing for that patient you cant be in the wrong.

SMILEY

[CornholioMedic]

Damn you...you beat me to the "Roy and Johnny" bit lol!

[RichEMT]

hahaha marketing we have two they send the actual units out to market. retarded. we typically call dispatch and they let us know if the er is at full sat because they give them a "courtesy call" they are not allowed to turn away Bls units however they can make u wait for hours lol. we didnt have to divert and they were expecting us. so all went well.

[traumajunkyems/fire]

Here in New York (MLREMS in paticuler)

1. ......if enroute and closer to the hospital than ALS we continue to the Hospital.

2. ......if enroute and more than 10 minutes from a hospital start ALS and continue to the hospital and meet enroute.

3. ......If on scene and ALS is more than 10 min out we load and meet in route.

Send Mercy Flight if the ride is more than 20 minutes.

[strwblue]

I say the whole country should go back to one Paramedic and one Emergency Medical Technician per vehicle..

And before all the paramedic jump all over me that would mean that their EMT partners would need to make the effort to be the best EMT they could be. Work hard to understand what their Medic Partner needs without having to ask.

With that kind of combination all ambulances can take any type of patient. We can still have the Fire Departments with Medics for additional back up in a fly car. This would be just a little more cost effective than sending a pumper to someone house with 4 or 5 firefighters.

Just a thought

[fdnyemt5330]

Here the formula is quite simple. If you are already enroutr and the patient deteriorates, go L&S and call ahead to the ER . If ALS ETA is longer than ETA to ER, transport. You did the right thing. No matter what, the patient comes first.

[Dorkfish]

As an EMT Basic that just started Medic school , the first class they tought was the legal requirements of the EMT . A lot of review b/c it was also part of the Basic class . It starts by stating that the first priority of the EMT is to be a advocate for your patient . Doing what is in the patient's best interest , as long as you stay in your scope of practice . Sounds to me you did the right thing . We have billing people trying to tell us what we need to do to make the company money . I know that the money pays my salery , and provides the equipment for us to work , but patient care has to come first .

[medic pathetic]

This is so interesting to hear about others policies on this. We don't have BLS units here, but when it comes to transporting L&S or not, it's our discretion. There are no nity or county ordinances that can tell me when to, or not to run hot and to where. Hospitals will "close"... no, hospitals will put themselves on divert or driveby. but if its a BLS call, even if it's a non emergent ALS call, and the pt wants to whatever hospital, we have to take them. We'll get yelled at if we don't! Sure the nurses want to piss and moan about it, but all i say is that the pt requested to come to this specific hospital, and they are aware of the wait. The two acceptions to the rules are a) if the system level is low on available trucks, we will take you where we want to-the closest open hospital- if it's not an emergent or special case (ie. cancer pt, serious trauma which requires a trauma center downtown, or bad pedis.) and b) the hospital you want to go to isn't properly equiped to handle their particular emergency. But i'm not going to pretend like i havent' convinced someone to go to the closest hospital instead of pass 3 perfectly suitable hospitals to take them to the one they want at 4am.

[fdnyemt5330]

Hospitals here do go on divert, but if the patient wants to go there anyhow, we have them sign a spot on our paperwork. It says that they have been made aware that xyz hospital is on diversion and have chosen to go there anyhow.

[PSYCtest040]

Send Mercy Flight if the ride is more than 20 minutes.

In Monroe County you can't swing a dead cat with out hitting a hospital in less than 10 min.

[traumajunkyems/fire]

In Monroe County you can't swing a dead cat with out hitting a hospital in less than 10 min.

think the county you live in...