Taxi vs. 911 - page 3

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   Dixielee
    I am here to say a few good words about EMS as well. I did not read every word of the above research, because reading research data makes my eyes glaze over and I go catatonic, but I got the gist of it. I didn't notice that it took extracation time into the mix. I know there are situations when major trauma arrives via POV. We have had GSW victims dropped off at the door or the parking lot, but by and large most people who arrive or witness a trauma scene are going to call EMS. Obviously there is a lag time between EMS arrival and the few minutes it might take to load a victim into the back seat of a car, but I think the wait is definately worth it. I do not see our EMS "wasting" a lot of time on scene. In fact, other than immobilization, most treatment is done en route. I am thankful that EMS has started an IV, usually 1-2 large bore ones, started fluids, O2, intubated, checked blood sugar if indicated, given lasix or morphine to my COPD or MI patients, etc. Being "at the scene" and being in a controlled environment of the hospital are completely different animals. We do need to support our EMS and appreciate what they do for us. I think the research may be skewed by the reports of severity of injury. If the injury is not life threatening, then maybe the arrival via taxi vs EMS is irrelevant, but given a major trauma, give me EMS intervention every time!

    I do see a MAJOR misuse of EMS by people who don't have a ride or just want the drama of an ambulance ride. I can't even begin to list the abuses, such as the 27 year old with a sore throat at 0400, the woman with a UTI who wanted a second opinion because she still had symptoms after 2 doses of Bactrim, the LOL with belly button lint that she thought was cancer, the chronic back pain patients who need drug refills in the middle of the night, the MVC's with NO injuries who come in "just to get checked out". That is the problem I Have with EMS, it is the idiots who abuse it and leave the medics tied up when real emergencies need treatment and transport.
  2. by   susswood
    Believe me, there are plenty of morans in both fields.

    Christine EMT-P, BS-RN[/QUOTE]

    Erin Moran played Joannie in "Happy Days." I do not believe she was in health care. I don't know if any of her family were in health care either.

    Moron is spelled M-O-R-O-N.

    :roll
  3. by   teeituptom
    The trouble you see with EMS

    Is the same trouble you see growing in ER nursing

    That is the Magic Word

    P-R-O-T-O-C-O-L-S

    Protocols are designed to replace judgment, knowledge, and assessment skills.

    Chest pain----Iv,O2,Monitor,EKG,Asa 325, Nitro times 3

    doesnt matter if it is a 16 yo boy whose girlfriend just broke up with him. Its still the chest pain protocol.
  4. by   RNin92
    Quote from teeituptom
    The trouble you see with EMS

    Is the same trouble you see growing in ER nursing

    That is the Magic Word

    P-R-O-T-O-C-O-L-S

    Protocols are designed to replace judgment, knowledge, and assessment skills.

    Chest pain----Iv,O2,Monitor,EKG,Asa 325, Nitro times 3

    doesnt matter if it is a 16 yo boy whose girlfriend just broke up with him. Its still the chest pain protocol.
    You have a valid point Tom.

    But there has to be a certain amount of judgement utilized, even with protocols.
    You can't possibly mean that EVERY patient who presents with CP you follow to the letter of your protocol?
    I look at them as a starting point...I can follow all of them...or some of them...as my nursing judgement allows.
    It just helps protect me from the litigators who want to charge me with "practicing medicine without a license"

    And...
    As I questioned in another thread...
    Not all EMS systems were created equal.

    And this is in no way a slam to any EMS system.
    I would put my life in their capable hands anyday.
  5. by   urbancowgirl
    Protocols are not designed to replace common sense. They are standing orders that normally a doc would have to give directly. They save time by not having to report signs and symptoms and then wait for a docs reply. If nothing else, they encourage autonomy because you must think through the scenerio before treating, you don't have the crutch of a doc on the horn.

    Thank you to all of the EMS supporters, I am just really tired of being screamed at for 'wasting time on scene'. Usually the only time I even use on scene is for a quick primary assesment and to wait for extrication, secondary assessment and treatment occur on the fly (I can't even start an IV on a stationary patient :chuckle ). Except for the cardiac arrest scenerio, our locol protocol states that we must 'stay and play'. We have to go through the entire ACLS protocol before we transport. We know have the ability to either rescusitate the pt or call the code.

    What is amazing to me is that when I am running with my jolly Voly squad, I am usually treated differently in the ER's went the nurses find out that I am also 'one of theirs'.
  6. by   urbancowgirl
    I absolutely agree that there are plenty of people in EMS who are in it for nothing else than the glory, however the majority that I have worked with have had the patients best interest as primary goal. Splint a digit at the scene of a bad trauma? You have actually seen this done??!!.. MAST pants are no longer in any protocol - they are outdated and research shows they do more damage than good.

    And the six week medic class part.... SARCASM
    as Steve Berry puts it - "I am not an ambulance driver"

    Quote from RNCENCCRNNREMTP
    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.
  7. by   Medic2RN
    Is the same trouble you see growing in ER nursing
    That is the Magic Word
    P-R-O-T-O-C-O-L-S
    Protocols are designed to replace judgment, knowledge, and assessment skills.
    Chest pain----Iv,O2,Monitor,EKG,Asa 325, Nitro times 3
    doesnt matter if it is a 16 yo boy whose girlfriend just broke up with him. Its still the chest pain protocol.



    I guess I work where the protocols are considerably more flexible than a "cookbook" for patient care. They contain the word *consider*. It enables a paramedic to use judgment, knowledge, and assessment skills. Even without that word, I would think that the paramedic would document why they did not treat one pt. with chest pain resulting from torn intercostal muscles the same as a pt. with chest pain from a global MI. Same chief complaint, but different etiologies. Protocols don't have to be so mechanical and literal. If I gave the aforementioned 16 y/o boy the treatment described above, my paramedic license would probably be suspended. Above all else: do no harm!!!
    Just my buck fifty....have a great day
  8. by   Stewie
    Quote from nurse_lilyjaderose
    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.
    Depending on where you live as to whether you have to pay or not. I live in a rural area that does not charge, but if I moved 5 miles up the road I would have to pay for an ambulance ride. They have a set fee for ALS and BLS transport and then add mileage on top of that. In the closest city to where I live you could be a half a block from the hospital, but it's still going to be a base rate of at least $500! And can you believe with all of that there are still abusers of the system?! Job security I guess!
  9. by   Stewie
    Quote from 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..
    Maybe I don't understand. What does having to wait 6 hours at the ER have to do with calling 911 and getting an ambulance? Sounds like more of a complaint against the hospital.
  10. by   darius000
    what are pick ups?
  11. by   JBudd
    A pickup is an open bed truck, non commercial size, used on farms & ranches, we call them pick up trucks because you can "pick up" just about anything and haul it. Shortened to "pickup".
  12. by   TraumaInTheSlot
    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!!...
    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
    EMS wasted too much time at scene, collaring and boarding anyone who burps the wrong way, and assessing the patient, when that patient truely needs to GET TO THE HOSPITAL. of course, the cardiac arrest is fine to stay, on scene, unless the chest needs to be cracked in cases of trauma.

    I was a paramedic and am now an ER RN. i was a medic first, and when i took the classes, they tought you to think you were gods gift to medicine. they made you think you were a MINI DOCTOR. going to nursing school and working the past 4 years in ER's has made me realize that I had no clue what i was doing when i was an EMT/MEDIC.

    get the patient, stabilize them, and GET THEM TO THE HOSPITAL. They need a doctor to assess them, not a person who took a 6 week course.

    with that, let me state that medics/emts are very essential and helpful to the patients, and by what i said above, dont let what i said above seem like they arent essential, because they absolutely are. god bless you all, esp those who do it for free by volunteering.

    How many times has an EMT brought themselves or a family member to your ER and told you what to do, and argued with you about treatment? Most in this area are out of line. Maybe its just a New York thing..lol
  13. by   TraumaInTheSlot
    Quote from teeituptom
    The trouble you see with EMS

    Is the same trouble you see growing in ER nursing

    That is the Magic Word

    P-R-O-T-O-C-O-L-S

    Protocols are designed to replace judgment, knowledge, and assessment skills.

    Chest pain----Iv,O2,Monitor,EKG,Asa 325, Nitro times 3

    doesnt matter if it is a 16 yo boy whose girlfriend just broke up with him. Its still the chest pain protocol.
    you couldnt be more correct.

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