Rapid Transport

John buck227@bellsouth.net
Mon, 9 Oct 2000 09:09:44 -0500


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Mike,

The big thing to remember (of course you probably know this) is safety =
en-route to the hospital for your crew. It does the patient no good if =
the unit is involved in an MVA because they were driving recklessly =
fast.

Answers to your other questions,

1) I would base the decision of using lights and siren on whether or not =
the patients complaint and/or symptoms dictate that they need  immediate =
medical care. This is best judged by vital signs. A B/P less than 90 =
diastolic accompanied by diaphoresis and tachycardia is extremely =
urgent. Some people walk around with a pressure of 90, so if they have a =
low blood pressure and no other accompanying symptoms, this is an =
exception to the rule. Also consider oxygen saturations less than 92 % =
while on supplemental oxygen and uncontrollable bleeding. Falls greater =
than 10 feet, MVA victims where there was a fatality on the scene =
require carefull attention. I could go on and on.

2) The decision for ALS  vs BLS would be in my opinion those illnesses =
or injuries which my require immediate treatment with cardiiac drugs and =
or defibrilation. The same for question number 3.

My other question would be, Do you have access to helicopter ambulance =
service in your area. If you do have this service, they should be called =
for all level one type patients to expedite their transport to a higher =
level facility.

It is very important that the EMT or Paramedic pays close attention to =
how the patient looks and not just the numbers on a monitor. This =
requires experience, but if the rescuer has the "feeling" that the =
patient is real sick, he probably is.

I hope this helps. It is hard to set specific guide lines for these =
situations. A continuous assment of the patients status is very =
important in the decision process.

John Meister RN
Level 1 Trauma ICU=20
Former Firefighter/EMT




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<DIV><FONT size=3D2>Mike,</FONT></DIV>
<DIV>&nbsp;</DIV>
<DIV><FONT size=3D2>The big thing to remember (of course you probably =
know this)=20
is safety en-route to the hospital for your crew. It does the patient no =
good if=20
the unit is involved in an MVA because they were driving recklessly=20
fast.</FONT></DIV>
<DIV>&nbsp;</DIV>
<DIV><FONT size=3D2>Answers to your other questions,</FONT></DIV>
<DIV>&nbsp;</DIV>
<DIV><FONT size=3D2>1) I would base the decision of using lights and =
siren on=20
whether or not the patients complaint and/or symptoms dictate that they=20
need&nbsp; immediate medical care. This is best judged by vital signs. A =
B/P=20
less than 90 diastolic accompanied by diaphoresis and tachycardia is =
extremely=20
urgent. Some people walk around with a pressure of 90, so if they have a =
low=20
blood pressure and no other accompanying symptoms, this is an exception =
to the=20
rule. Also consider oxygen saturations less than 92 % while on =
supplemental=20
oxygen and uncontrollable bleeding. Falls greater than 10 feet, MVA =
victims=20
where there was a fatality on the scene require carefull attention. I =
could go=20
on and on.</FONT></DIV>
<DIV>&nbsp;</DIV>
<DIV><FONT size=3D2>2) The decision for ALS&nbsp; vs BLS would be in my =
opinion=20
those illnesses or injuries which my require immediate treatment with =
cardiiac=20
drugs and or defibrilation. The same for question number 3.</FONT></DIV>
<DIV>&nbsp;</DIV>
<DIV><FONT size=3D2>My other question would be, Do you have access to =
helicopter=20
ambulance service in your area. If you do have this service, they should =
be=20
called for all level one type patients to expedite their transport to a =
higher=20
level facility.</FONT></DIV>
<DIV>&nbsp;</DIV>
<DIV><FONT size=3D2>It is very important that the EMT or Paramedic pays =
close=20
attention to how the patient looks and not just the numbers on a =
monitor. This=20
requires experience, but if the rescuer has the "feeling" that the =
patient is=20
real sick, he probably is.</FONT></DIV>
<DIV>&nbsp;</DIV>
<DIV><FONT size=3D2>I hope this helps. It is hard to set specific guide =
lines for=20
these situations. A continuous assment of the patients status is very =
important=20
in the decision process.</FONT></DIV>
<DIV>&nbsp;</DIV>
<DIV><FONT size=3D2>John Meister RN</FONT></DIV>
<DIV><FONT size=3D2>Level 1 Trauma ICU </FONT></DIV>
<DIV><FONT size=3D2>Former Firefighter/EMT</FONT></DIV>
<DIV>&nbsp;</DIV>
<DIV>&nbsp;</DIV>
<DIV>&nbsp;</DIV></BODY></HTML>

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