Taxi vs. 911 - page 2

Tonight, in our ER, a man came in with a gunshot wound to the arm via taxi and a three year old came in via ambulance (his parents called 911) because he put a dime in his nose. Silly, I know. ... Read More

  1. by   ERNurse752
    Quote from RNCENCCRNNREMTP
    There was a study not too long ago (Journal of Trauma I think) that compared mortality in major trauma victims who arrived to the ED/Trauma Center via EMS vs Taxi. Those who arrived via EMS fared worse than those who arrived by Taxi. Seems the biggest contributor to mortality was time wasted on scene which EMS did a lot and Taxi drivers did very little. yes, injury severity was comparable in both groups.
    I heard about that study at a trauma conference I went to recently. Pretty neat, eh?
  2. by   BabyRN2Be
    I work in L&D at a local hospital, and one of my pet peeves is when pts use EMSA as a taxi service. Usually they've only had one contraction or two, water is intact, they insist that they didn't have anyone to drive them to the hospital but then 5 minutes later a car full of relatives pulls out and they exit like a carful of clowns!

    What was really sad a few months ago is when I was at the delivery of someone like this. She arrived with a +UDS for marijuana and cocaine. She didn't seem to know (or care) that she was having a baby, and insisted on IV drugs over the epidural. That baby was so tiny due to drug use - she was a few days past due and she had a 4lb. 15oz baby. But I digress...
  3. by   kc ccurn
    Quote from BabyRN2Be
    What was really sad a few months ago is when I was at the delivery of someone like this. She arrived with a +UDS for marijuana and cocaine. She didn't seem to know (or care) that she was having a baby, and insisted on IV drugs over the epidural. That baby was so tiny due to drug use - she was a few days past due and she had a 4lb. 15oz baby. But I digress...


    Poor kid, what kind of a life is he going to have? :angryfire
  4. by   nurse_lilyjaderose
    Quote from LarryG
    Last month we had a teenager with cockroach in his ear. Said it crawled in while he was sleeping.

    Tried irrigating / suctioning it out but we weren't successful.
    so what happened to it?? you just left it there?:uhoh21:
  5. by   nurse_lilyjaderose
    Quote from eak16
    a few weeks ago I saw a woman come in by taxi who had fallen on broken glass and ripped most of the flesh off her forearm . Poor thing was new to the area and didn't know that medic one is free.
    Its so annoying though to see hear the whines of the frequent flyer who called 911 for a hangnail and is promptly triaged and sent out to the waiting room. "But I was brought in by an ambulance, and it has been hurting for a month now and the ambulance driver brought me in!!!"
    an ambulance ride is free? we've always had to pay when we rode in one. like that $600-something ride my mama took when she had to be driven an hour from the nearest hospital (which is 20 minutes away) cuz my little brother decided to be born 3 months early. then all those times i've had to ride no more than 45 minutes... grandma too. i'm in a rural area. perhaps there is looting afoot.... or, we need to stay out of the ER.
  6. by   wellington
    Here in broward florida, I sometimes think better of calling 911 and going in ambulance my wife once had a bad pregnancy bleeding a lot and after 6 hours was allow inside the hospital. While in the ER wanted to go to the restroom the nurse said okay go. A little while later she fainted. Is good she told me to remain with her....Not to good experience..
  7. by   caroladybelle
    Quote from RNCENCCRNNREMTP
    There was a study not too long ago (Journal of Trauma I think) that compared mortality in major trauma victims who arrived to the ED/Trauma Center via EMS vs Taxi. Those who arrived via EMS fared worse than those who arrived by Taxi. Seems the biggest contributor to mortality was time wasted on scene which EMS did a lot and Taxi drivers did very little. yes, injury severity was comparable in both groups.
    As a Southern living in Manhattan, I have yet to have had a taxi ride that didn't break a number of traffic laws, as well as a few laws of Physics and the speed of light.

    So the speed factor probably helps in this case but do they have any records for the cases of shock/terror induced by the taxi ride or injuries from the ride itself?
  8. by   teeituptom
    Cant even remember the last time I was in a taxi. Probably in Chicago, but that was 3 and 1/2 decades ago
  9. by   Spidey's mom
    Last taxi ride for me was 4 years ago in SF. Met an old friend from high school who hailed the taxi, we got in and I saw the "Put On Your Seatbelt" sign, which I promptly did. My friend looked at me like I was crazy. I guess it is, I dunno . . not cool to wear seatbelts in the big city. I took it off. Peer pressure from high school maybe? :chuckle

    We don't have taxi service up here in the mountains. I do know I wouldn't call 911 . . dispatch is 70 miles away and they need street addresses and all that stuff. "Across from the feed store" doesn't cut it. I've taught my family to use the ambulance number . . . goes right into the ER. Everyone on the ambulance DOES NOT need a street address.

    We had a family bring their grandma to the ER in a pickup . . she had been knocked over by a lamb. Had hip pain . . . . very caring family. About 20 members showed up to see her from toddlers to grownups.

    steph
  10. by   urbancowgirl
    EMS does not waste time at the scene!!!! It is called 'treatment and protocol' Oh I forget, they don't teach pt care in our 6 week medic class!!!! By the way, Paramedic school was 10 times harder that nursing school!!...
    Did the article happen to mention that the guy who would have been properly packaged in our 'waste of time' on scene is now a paraplegic because someone threw him in the back of a taxi without proper c-spine protection. Or the fact that most Joe-public drivers instantly forget how to drive when they hear sirens and see lights! Or maybe the fact that our protocols are written by ED doctors!!(Our local protocols call for not-transport if we cannot have trauma patients to trauma centers within 10 or 15 minutes if they arrest).
    There are many more things going on then the survival rates! If medics don't make a difference, why not just turn the whole thing back over to the funeral home directors who would 'scoop and run' with patients in the back of the hearses, it would be much cheaper for all involved!

    Why can't nurses and medics just love each other for the unique role that each plays in the EMS system. I hear more bickering between these to groups of professions than I care to report, I have been on both sides of the coin. Believe me, there are plenty of morans in both fields.

    Christine EMT-P, BS-RN
    Quote from RNCENCCRNNREMTP
    There was a study not too long ago (Journal of Trauma I think) that compared mortality in major trauma victims who arrived to the ED/Trauma Center via EMS vs Taxi. Those who arrived via EMS fared worse than those who arrived by Taxi. Seems the biggest contributor to mortality was time wasted on scene which EMS did a lot and Taxi drivers did very little. yes, injury severity was comparable in both groups.
    Last edit by urbancowgirl on Jul 31, '04
  11. by   Katnip
    It didn't sound to me like anyone was saying EMS is a bad thing. They were discussing studies that had been done. There is no doubt EMS provides a very valuable service to the community. Nobody disputes that.

    There is a debate going on nationally whether scoop and scoot or stay and play is a better option. There are times when it's best to just grab and go than to stay and treat. Problem is in deciding when.

    We just had a roundtable discussion with ED nurses, docs, and paramedics about protocols. Everyone agrees that it is a shame the paramedics don't have say in it. Even the docs agreed that some of the protocols were bad. The medics SHOULD have input, after all, they're the ones at the scene, not us. Hopefully, for our hospitals, at least this will change soon.
  12. by   RNCENCCRNNREMTP
    Quote from urbancowgirl
    EMS does not waste time at the scene!!!! It is called 'treatment and protocol' Oh I forget, they don't teach pt care in our 6 week medic class!!!! By the way, Paramedic school was 10 times harder that nursing school!!...

    Why can't nurses and medics just love each other for the unique role that each plays in the EMS system. I hear more bickering between these to groups of professions than I care to report, I have been on both sides of the coin. Believe me, there are plenty of morans in both fields.

    Christine EMT-P, BS-RN
    EMS does make a difference, BUT, if the EMS is stopping to start IV's on the scene of a bad trauma, that is wasted time. If EMS is stopping to splint distal fractures on a bad trauma, that is wasted time. If EMS is stopping to put on MAST, that is wated time. If EMS is sticking needles into chests because they "think" there is a tension pneumo, that is wasted time AND bad practice. If EMS is doing much more on unentrapped bad trauma than securing an airway, collaring, boarding and transporting, that is wasted time.

    Bad trauma requires rapid transport to definitive surgical care and the only thing EMS should be doing is providing an airway (even if it is just a jaw thrust with bag and mask ventilation, not everybody can or should be intubated in the field, especially kids).

    I agree that the public goes stupid when lights and sirens are on. I agree that trauma arrest almost always equals death, especially if some distance from a trauma center.

    But it sounds like you and I both know that there are some medics who will stay and play or will do a procedure because "they can" not because they should. I know several medics who have done procedures (including crics) because they failed to fall back on their BLS skills and provided BLS care with rapid/safe transport to a trauma center.

    EMS and Nursing need to me more complimentary and complementary.

    Your medic class was 6 weeks???? Sounds awfully short. Mine was over a year and that was 20+ years ago.
  13. by   RNin92
    Quote from cyberkat
    It didn't sound to me like anyone was saying EMS is a bad thing. They were discussing studies that had been done. There is no doubt EMS provides a very valuable service to the community. Nobody disputes that.

    There is a debate going on nationally whether scoop and scoot or stay and play is a better option. There are times when it's best to just grab and go than to stay and treat. Problem is in deciding when.

    We just had a roundtable discussion with ED nurses, docs, and paramedics about protocols. Everyone agrees that it is a shame the paramedics don't have say in it. Even the docs agreed that some of the protocols were bad. The medics SHOULD have input, after all, they're the ones at the scene, not us. Hopefully, for our hospitals, at least this will change soon.

    I agree that the EMS system is INVALUABLE.
    but just like every other aspect of healthcare...there is a time and place for everything...and rule number one...life over limb...period.
    So I am sure that these studies will eventually point out what we already know...
    BAD trauma...scoop and run. AIRWAY is the only delayer at the scene.
    sad as it may be...you can live as a quad...but not without an airway.

    I am NOT advocating for every trauma throw the c-spine to the wind and go.
    I am saying we all need to re-evaluate and revise how we treat patients.
    And I think the poster who addressed transport times is right on the money there, too. Those of us fortunate enough to be in areas that are overflowing wiht hospitals and trauma centers are in a very different circumstance than those who are 45-60 minutes (or more) from difinitive care.

    I think your ED is on the right track involving the ED docs, nurses AND EMS in developing new protocols.
    Think I will bring it up at ours.

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