Need to vent and process this

I wonder what the issue is with some of the EMT people - if I was an EMT I personally thought that transport wasn't needed I would just do my job and transport the patient and be glad it was an easy, no stress day.

You did the right thing! Sometimes the paramedics are idiots! It happened to me earlier this year. A kid fell and hit the back of his head, he had a HUGE gash and it wouldn't stop bleeding. Called the parents, they came, and I called 911 because I knew he needed he stitches and I also knew the parents are very poor, have no car and no way to get to ER. Well the EMTs say he doesn't need to go, they wont take him, just put pressure on it. I was LIVID to say the least, they then talk the parents in to just taking him home to rest. Well, guess what, they end up calling 911 AGAIN from home later on because it wouldn't stop bleeding and he needed 10 staples to shut it. I was livid when I found out the next day and I made a report against EMTs.

You did the right thing! Sometimes the paramedics are idiots! It happened to me earlier this year. A kid fell and hit the back of his head, he had a HUGE gash and it wouldn't stop bleeding. Called the parents, they came, and I called 911 because I knew he needed he stitches and I also knew the parents are very poor, have no car and no way to get to ER. Well the EMTs say he doesn't need to go, they wont take him, just put pressure on it. I was LIVID to say the least, they then talk the parents in to just taking him home to rest. Well, guess what, they end up calling 911 AGAIN from home later on because it wouldn't stop bleeding and he needed 10 staples to shut it. I was livid when I found out the next day and I made a report against EMTs.

Holy bad judgement, Batman! What is wrong with those EMTs? Are they getting bonuses to NOT transport?!

I've not had to call, yet. But EMS were the same way when I worked LTC.

I would say all who questioned, need a lesson on biphasic reactions.

I wonder what the issue is with some of the EMT people - if I was an EMT I personally thought that transport wasn't needed I would just do my job and transport the patient and be glad it was an easy, no stress day.

When I'm feeling charitable I wonder if it's like when I see a frequent flier? No, you don't need ice for that. No, you're not sick enough to go home.

And then I remember that I fully assess errything just in case I'm wrong. Because I sometimes am.

You did the right thing! Sometimes the paramedics are idiots! It happened to me earlier this year. A kid fell and hit the back of his head, he had a HUGE gash and it wouldn't stop bleeding. Called the parents, they came, and I called 911 because I knew he needed he stitches and I also knew the parents are very poor, have no car and no way to get to ER. Well the EMTs say he doesn't need to go, they wont take him, just put pressure on it. I was LIVID to say the least, they then talk the parents in to just taking him home to rest. Well, guess what, they end up calling 911 AGAIN from home later on because it wouldn't stop bleeding and he needed 10 staples to shut it. I was livid when I found out the next day and I made a report against EMTs.

JUST WOW!!!!!! It was my understanding that only the patient (or parent/guardian) could refuse. That seems like a huge liability to me. I have gotten questioned by EMT's why i did not give albuterol to an asthma kid. Well, because I do not have any for this kid - that's why. They really have no clue how limited we are in the school setting. WE ARE A SCHOOL NOT A HOSPITAL!!

Thank you everyone for your support :)

I would say all who questioned, need a lesson on biphasic reactions.

Thank you, you beat me to it! It's all well and good when the patient appears okay (the Epi is working, transport-avoidant EMS personnel) but it can wear off in 15-20 minutes...

Those EMTs were jerks. And so unprofessional!

Allergic reactions can take a turn in seconds. Epi and transport was the right call!

Coming from the ER to school nursing, I can assure you they treat them much differently than the school nurse. They do not ask me for report and pretty much disregard anything I report as if it were false. I called 911 for a teacher with a HR of 170 earlier this year. When medics arrived, it was "only 140" at rest, laying on their stretcher. Yeah... I lied. I lied about his HR of all things, and the fact that he has chest pain, dyspnea, and is diaphoretic. *eyeroll*

OMG I couldn't deal. No way...

First, as a paramedic myself, I apologize on behalf of the *ahem* jerk of a paramedic you dealt with. It's so frustrating that there are still quarrels between RNs and paramedics (speaking on the paramedic's unprofessional behavior towards you).

My background is EMS and ED nursing, and I have done many lectures on the proper use of epinephrine. One of the things I really harp on is giving epi early. I use the explanation that epi is for anaphylaxis and I try to explain that anaphylaxis and anaphylactic shock are two different things. You want to give epi at the anaphylaxis point so it doesn't BECOME anaphylactic shock. I have witnessed a paramedic coworker of mine opt not to give epi to my sister, who was experiencing anaphylaxis albeit not shock. In my area, we have been focused for the past few years on really trying to lower the threshold for giving epi.

With that, I'd like to say, when in doubt, give epinephrine. And it sounds like you did just that. However, for educational purposes, it sounds like your patient did not necessarily meet the criteria for requiring epi. I do think it is important to understand when to give and when not to give epinephrine (again, I still stand by when in doubt, give it... and that paramedic should feel the same and not be rude to you about that), but the definition of anaphylaxis is when one or more of the following is met:

1. Acute onset of an illness (minutes to several hours), with involvement of the skin, mucosal tissue, or both (eg, generalized urticaria, itching or flushing, swollen lips/tongue/uvula), and at least 1 of the following: (1) respiratory compromise (eg, dyspnea, wheeze/bronchospasm, stridor, hypoxemia) or (2) reduced blood pressure or associated symptoms of end-organ dysfunction (eg, hypotonia [collapse], syncope, incontinence); OR

2. Two or more of the following that occur suddenly after exposure to a likely allergen for that patient (minutes to several hours): (1) involvement of the skin/mucosal tissue (eg, generalized urticaria, itch/flush, swollen lips/tongue/uvula), (2) respiratory compromise (eg, dyspnea, wheeze/bronchospasm, stridor, hypoxemia), (3) reduced blood pressure or associated symptoms (eg, hypotonia [collapse], syncope, incontinence), or (4) persistent gastrointestinal symptoms (eg, crampy abdominal pain, vomiting); OR

3. Reduced blood pressure after exposure to a known allergen for that patient (minutes to several hours): (1) for infants and children, low systolic blood pressure (age-specific) or greater than 30% decrease in systolic blood pressure, and (2) for teenagers and adults, systolic blood pressure of less than 90 mm Hg or greater than 30% decrease from that person's baseline.

Source

Remember, there are many reasons someone may develop hives that are not going to lead to anaphylaxis. If there are no other systems involved (e.g. hives with respiratory, cardiac, GI, etc. involvement), it may not be anaphylaxis. I'm a big proponent of self-reflection after situations like this, and it gives an opportunity to improve our practice. It helps to boost our confidence the next time we are faced with something similar. Take some time to research epinephrine administration and anaphylaxis/allergic reactions. And again, I apologize for the lack of professional courtesy from EMS.