Comments for Street Watch: Notes of a Paramedic

Comment on 6. Termination of Rescusitation Protocols by Jess

Jess — Sun, 20 May 2012 07:22:09 +0000

We are quite fortunate in the UK to have quite liberal rules on not starting resus. Techs and above can decide not to start in the present of rigor, PM staining or injuries incompatible with life. We can also not start if there has been no CPR in the last 15 minutes and the patient is asystolic (subject to certain exceptions). If we start, we do 20 minutes ALS then stop.

Recently things have been liberalised further, we are now encouraged to look at the bigger picture and if we believe resus to be futile we can decide not to start. We are now dissuaded from conveying unless we get ROSC, and can terminate in PEA (or even VF/VT, though that would be rare). We hardly ever convey cardiac arrests now, conversely we are seeing a lot more ROSC.

Comment on 7. Decreased Use of Lights and Sirens by Derek

Derek — Thu, 10 May 2012 13:53:46 +0000

Love this article. The public perception hasn’t caught on to this, as already mentioned. I’m a big fan of taking the ER to the scene, not rushing to the ER. Panic breeds errors.

We tend to be more effective with our treatment when we work in a comfortable environment. That’s why I transport Code 2 whenever possible.

Comment on 8. Selective Spinal Immobilization Guidelines by mpatk

mpatk — Wed, 09 May 2012 05:12:17 +0000

Spiros,

IIRC, the thought behind immobilizing someone with hemodynamic instability (let’s just call it what it is, hypotensive shock) is that the source is due to disruption of the nerves to the veins and arteries. It’s “spinal shock”, a form of distributive shock, where some or all of the blood vessels below a spinal injury fully dilate and cause hypotension.

It might be better for the protocol to require “UNEXPLAINED hemodynamic instability” to prevent protocol monkeys from immobilizing someone with uncontrolled bleeding by mistake.

Comment on 7. Decreased Use of Lights and Sirens by TrekMedic

TrekMedic — Tue, 08 May 2012 20:48:34 +0000

As a paramedic who started in the days of the horse and buggy and documenting using a slate and chisel, I agree – the days of dying a “heroic” death from an MVA while screaming to that band-aid sized laceration are long gone. My county recently adopted a similar L/S policy, accompanied with much resistance by many squads. I am also not a fan of some priority dispatcing, either. Per our county, BLS calls do not warrant an emergent response; however, when you see in the notes that “sick person” is actually a post-chemo CA patient who passed out, you ramp it up to an emergent response.

Quoting you “When I started, the Golden Hour ruled, but it has been discredited over time. Quality Care and Safe Transportation are the new watchwords. I hope this trend continues.”

Again, the rationale locally has been so much more is done for the patient pre-hospital it is rare they need rapid intervention beyond our scope.

Finally, as a long-time friend of mine in the area pointed out “these people are our customers. Its what they want that matters the most to them.” If that means getting the right care a few minutes slower, so be it.

Comment on 7. Decreased Use of Lights and Sirens by Christopher

Christopher — Tue, 08 May 2012 13:10:33 +0000

Even without an emphasis on lights and sirens, a lot of the public gets antsy when we don’t leave the scene fast enough. Take for instance a young kid with an angulated fracture. The family would like for us to hurry their child off to the hospital…while we would like to start an IV, administer pain meds, then enjoy a nice and slow ride to the ED (pain free).

We could do more to educate the public as to the actual benefit we can provide, unfortunately TV (which is how America educates itself) doesn’t help out…