Taxi vs. 911

Specialties Emergency

Published

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.

Just thought I would share. :coollook:

Specializes in Emergency Nursing Advanced Practice.
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.

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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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Specializes in ER.

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.

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Believe me, there are plenty of morans in both fields.

Christine EMT-P, BS-RN

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

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Specializes in ER, ICU, L&D, OR.

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.

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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.

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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'.

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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"

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.

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Specializes in ER, IICU, PCU, PACU, 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.

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 :)

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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. :p
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! :rolleyes:
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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.

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what are pick ups?

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