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Health- I am surprised that you are not familiar with the Hatzalah model. The EMTs usually show up with their personal vehicles with complete BLS equipment. The ambulance is dispatched from a central location, it is likely that the first responders and realized that this patient will benefit from more advanced care so they requested that ALS get dispatched.
The Hatzalah paramedics also respond with their private vehicles with complete ALS gear, this enables them to arrive and initiate care before the ambulance arrives. Is that hard to grasp?
“This is very questionable! If you’re not a Hatzolah guy, then you’re a Hatzolah wannabe trying to score some points with them!”
Or I’m someone who worked in ems to get a headstart before moving on to a higher level of medical schooling. But what you said is always an option too.“Btw, I don’t believe a word you wrote.”
But everyone should believe you?“On the internet, everyone can be what they choose to be. It is amazing that so many people choose to be stupid”
One can really see people’s middos in this thread.
Gamanit – What are the statistics that you are referring to? It would be nice if I can take a look at those numbers. To say that it is close to nill is very inaccurate, There are algorithms in place for this and these types of emergencies do occur. Not sure from where you take it that there need to be or these patients usually present with a prior indication. While some patients are at higher risk for abruptios and previas one does not need to have any prior indications to have an abruptio or significant post partum hemorrhage. In fact, every woman in the third trimester presenting with abdominal pain is considered to have an abruptio until proven otherwise.
I will ignore the personal attacks, It is irrelevant if I claim to even have any prehospital certification or not. Treating shock is beyond the EMT’s scope of practice. True, the EMTs can place the patient in shock position which might preserve the patients vital organs and even keep the patient warm, yet they cannot offer fluid replacement which is the first step in treating any hemorrhage or even transport to definitive care without an ambulance. Is that not so?
From what I’ve read the risk of hemorrhage post delivery goes up to aproximately 1.5% at about 20 weeks gestation. While you always have to take precautions (if a person complains of chest pains you assume heart attack even though it’s more likely heartburn) the actual risk is fairly low. This 1.5% is risk altogether- if you’ve read enough you know how the typical progression goes. There is pretty much always several hours of worrying symptoms before it becomes actually dangerous. In rare cases it gets serious after only about a half hour or so.
Note – the main reason we are so concerned about abdominal pain in third trimester is because if there is partial placental abruption an emergency c-section can save the baby’s life. I have an online friend who actually had no abdominal pain but called EMS after slipping on the ice and they got her to the hospital on time to do a c-section with no lasting damage. In this case it seems the woman already knew her pregnancy was non-viable. There was no baby to save.
As I’ve said previously- people don’t call third trimester losses a miscarriage. Even laypeople. It sounds like the person who was writing this story was referring to first trimester. While EN doesn’t have their own ambulances, they do transport with other ambulances. They wouldn’t have placed her in shock position and walked off. Typical transport time (even with FDNY these days) would still get her to the hospital with plenty of time to spare.
2scents – I already told you why I spelled that way because I using his terminology:
“I was quoting bk 613:
” I would imagine it would be a violation of HIPPA/ patient’s right to privacy””2scents -” The ambulance is dispatched from a central location, it is likely that the first responders and realized that this patient will benefit from more advanced care so they requested that ALS get dispatched.
The Hatzalah paramedics also respond with their private vehicles with complete ALS gear, this enables them to arrive and initiate care before the ambulance arrives. Is that hard to grasp?”Unfortunately your manipulation never ends! I’m very aware how it works. It’s quite possible in this case that’s what happened – that’s why I asked for all the times to be posted here.
I also know that’s it’s not set in stone!
YWN a few months ago, posted an article about an incident about a guy collapsed on the street in BP.
And guess what they showed in the picture? The first responder wasn’t a guy in a car, but the bus!
Why don’t you tell us the times of the bus in relationship to the medics response, in the OP’s case?
Are you hiding something?!?Gamanit – 1.5% is not second to nill, its a risk that is there and happens to some people, besides this is just postpartum hemorrhage there are a few other conditions that can cause life threatening hemorrhaging such as abruptios which can be life threatening.
There are a few grades of abruption with some being true life threatening emergencies, I am aware of several cases in which the patients life was saved with not much time to spare, these patients needed aggressive volume resuscitation and blood transfusions and of course life saving surgical intervention. I admit that this is not the every day occurrence but its there. Sometimes these can be treated without surgical intervention such as with medication like Pitocin which is even given prophylactically.
I am not familiar with the details of this case other than what was posted here and hearing of it this case at the time.
Health – I never claimed to have this information. But the normal standard for Hatzalah is to have EMTs and Paramedics before the ambulance arrives to the scene.
Of course if it happens that the ambulance is nearby for whatever reason, I am sure that the ambulance would head over to the scene and might even be there before the other first responders, but that is not how they normally operate.
I have no idea if the members were there before the ambulance or not, but there is nothing that would indicate that the ambulance that normally responds from a central location was on the scene before the EMTs and Paramedics that would give your claim any substance.
I will ignore your personal attack as it does not add anything of substance to your argument.
Gamanit – 1.5% is not second to nill, its a risk that is there and happens to some people, besides this is just postpartum hemorrhage there are a few other conditions that can cause life threatening hemorrhaging such as abruptios which can be life threatening.
There are a few grades of abruption with some being true life threatening emergencies, I am aware of several cases in which the patients life was saved with not much time to spare, these patients needed aggressive volume resuscitation and blood transfusions and of course life saving surgical intervention. I admit that this is not the every day occurrence but its there. Sometimes these can be treated without surgical intervention such as with medication like Pitocin which is even given prophylactically.
I am not familiar with the details of this case other than what was posted here and hearing of it this case at the time.
2scents- of this 1.5%, 99% is already in the hospital. 1% of 1.5% is pretty close to nothing. As a first responder you still have to take every precaution that this isn’t the case with your current patient even though it’s unlikely. Yes, abruption can be life threatening. I’m not disputing that. I still think that the story as it was told here isn’t very plausible. Do you remember how it was discussed at the time when it occurred? Sometimes a story has a kernel of truth in it to make it sound more believable even though as a whole it’s false.
Gamanit – I will not make believe that I did get the details, I did not, nor was I interested at the time. I do know first hand that emergencies like these do happen, especially in the more chassidishe communities as more childbirths means more OB emergencies. Being that I cannot prove that to you I will leave it at that.
Furthermore, most OB related emergencies occur in the hospital, the ones that do not are usually the very serious ones that require the staff to be fully prepared and rapid transport with early intervention makes a difference in patient outcome.
2scents -“I have no idea if the members were there before the ambulance or not, but there is nothing that would indicate that the ambulance that normally responds from a central location was on the scene before the EMTs and Paramedics that would give your claim any substance”
I have a question for you – if the first responder saw a critical pt. with other responders there (EN), why call for medics, pick up the pt. and transport?!?
And unless you know about the call, obesity isn’t usually an issue!Health, I have mentioned this several times, the first responders usually are on scene with the patient before the ambulance arrives to assess and treat. To where should they take the patient, to the street?
In a typical scenario, the first responders arrive on scene and if not already dispatched would request ALS. The ALS would usually be on scene pretty quickly and initiate treatment. All of this prior to the ambulance arriving on scene. If it happens so that the ambulance is on scene before The ALS providers, the EMts would initiate transport and meet up with the ALS in route.
Besides, not sure why there would be an issue of requesting ALS as this is a unstable patient. Requesting ALS does not waste time and can make a difference in patient outcome.
2scents -“Health, I have mentioned this several times, the first responders usually are on scene with the patient before the ambulance arrives to assess and treat. To where should they take the patient, to the street?”
You obviously didn’t understand my question!
When the first responder found a critical pt., along with the bystanders like EN, all he should have done was pick the pt. up and put her in his personal vehicle and then transported her to the hospital.
I’m actually questioning this in all cases where the treatment is in the hospital. Moreover, the way the OP presented the case, she needed blood or blood products, not only saline or Ringer’s lactate.
So any pre -hospital care is putting her life in danger!Health – What you are suggesting is not only not practical and dangerous but also not legal, an ambulance is required for patient transport. Not even sure why we are even having this nonsensical discussion.
True, blood is required for and NS or LR is not sufficient, but even blood is not definitive treatment and the patient might require first line drugs to control the hemorrhage or even surgical intervention.
That said, fluids is first step in the treatment.
2scents -“What you are suggesting is not only not practical and dangerous but also not legal, an ambulance is required for patient transport. Not even sure why we are even having this nonsensical discussion.”
The fact is you don’t specifiy what’s illegal about it? Is it just a tort? I think your expression of illegal is just another way that you manipulate everyone!
And btw, cops do it all the time. Are you suggesting that they constantly break the law?!?“True, blood is required for and NS or LR is not sufficient, but even blood is not definitive treatment and the patient might require first line drugs to control the hemorrhage or even surgical intervention.”
So what? Did I mention all the hospital treatment?
“That said, fluids is first step in the treatment”
Another manipulation! Are you representing Hatzolah with your posts?
I’ll repeat – the care of this patient that the OP presented, – is rapid transport with IV’s started enroute!
Your explanation doesn’t hold water!
All your posts explaining why they did what they did on scene care are just excuses!
The possibility that they did adequate care is very remote!!!
In hospital, they can start IV’s and order blood or blood products at the same time. There is no excuse, in almost all cases, to delay transport!Health,
You can’t start an IV en route, while the ambulance is moving. Maybe at a red light.
PBA -“Health,
You can’t start an IV en route, while the ambulance is moving. Maybe at a red light.”Didn’t you say your on Hatzolah or your brothers are on Hatzolah?!?
Anyways, you’re very wrong!
From Science direct:
“Success rates for initiation of intravenous therapy en route by prehospital care providers
Corey M. Slovis. Author, 1990
Department of Medicine, Emory University School of Medicine, Atlanta,
Emergency Medicine Residency, Emory University School of Medicine, Atlanta
Abstract
The optimal extent of prehospital care, including intravenous (IV) therapy for critically III patients, remains unclear. The authors evaluated the success rate for IV cannulation in a moving ambulance by trained emergency medical technicians and paramedics in 64 – 1 adult medical- and trauma-related cases. At least one IV line was started in 80% of medical patients and 92% of trauma patients, regardiess of blood pressure. In hypotensive patients, the success rates for at least one IV in medical and trauma patients were 80% and 95%, respectively. These data suggest that IV lines can be secured with a high degree of success en route to the hospital by trained personnel, and that prompt transport of unstable patients should not be delayed solely to obtain IV access.”
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