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  • I’ve been reading conflicting procedures in the use of a tourniquet. If a patient has a bleed around the ankle, should the tourniquet be just proximal to the wound or put up on the thigh (single bone)?  Was wondering because of the ischemia it would cause the leg"
    We continue to recommend applying the tourniquet “high and tight” for extremity injuries and at least a “hand palm” width above the injury, never over a joint. It has been found, that even for prolonged applications of the tourniquet, long term CMS injury to the distal extremity is limited. Orthopedic surgeons use the intervention frequently for joint replacement, etc, to limit bleeding, with positive outcomes. In order for a tourniquet to work adequately, it has to be placed over the part of the extremity that has a single bone in order to get adequate compression.
  • Joe Blow down the street is cleaning his garage, someone comes up, robs him and Joe chases him down the street with say a baseball bat, drops down and goes into cardiac arrest. We get paged out and his wife presents us with a DNR letter. I was taught that if a crime was committed than we need to start CPR. This is a far fetched situation, but in todays world we may never know what can happen"
    No matter what the circumstances, one would need to follow the wishes of the patient relative to CPR efforts on their behalf. (That is assuming, however, that proper documentation is in place). The real concern would be that proper documentation has been presented more than anything else in this situation.
  • If you have a patient on a 12-lead, and the patient goes into cardiac arrest, do the 12-lead stickers and wires need to come off of the patient in order to use the defib pads?"
    Only the patches that would interfere with the placement of the defibrillator pads need to be removed. If possible the 12 lead wires should be removed, but the other patches can remain in place.
  • If a patient has a DNR bracelet or tattoo, does that hold the same weight as a paper order?"
    DNR braclets and tattoos are not recognized by the state. Bracelets are far to easy to be placed, so paperwork is needed.
  • If a crewmember is prescribed medical marijuana, is there any restriction from allowing that person to run on the crew or to taking call?  Would the restriction be the same as with any other prescribed medication?"
    As long as the crew member has the appropriate prescription for it, and is taking it as prescribed, there should be no problem.
  • Our service is asked to BLS transfers from the hospital on a regular basis.  If the hospital has a patient hooked up to a 4 lead, and asks that we leave the patient hooked up to our monitor for the transfer, is that allowed?  What about for a 12-lead?"
    The opinion is that a four lead EKG is considered routine monitoring, so BLS should be comfortable with that. IF you are looking to have 12 lead monitoring you are looking for a potential condition (STEMI) that may require interpretation and intervention that BLS cannot perform. If there is concern about ischemia or arrhythmias, is the patient better served by ALS.
  • If a hospital has a transfer patient that is hooked up to an IV pump pushing medications, can a BLS unit take that transfer while the pump is pushing those medications. If they can, what would the crew do if something were to go wrong with the machine, the dose, or anything else?
    The answer to that question is “no”. A BLS crew does not have the skill set to transport a patient in need of this service. That staff would have to be familiar with that pump, and also understand how to troubleshoot it if anything went wrong . This would demand an ALS transfer
  • Can a service that is certified only as an ALS transport take a critical care patient transfer?
    Yes, in fact, serveral of our ALS services do this every day. There is no license designation for “Critical Care” , however there is Specialized Life Support, which is a restricted license (e.g. Childrens ). According to the EMSRB: A specialized life support service provides basic or advanced life support, and is restricted by the EMSRB to: • * Operation less than 24 hours of every day; • * designated segments of the population; • * certain types of medical conditions; or • * air ambulance service (fixed or rotor-wing) A specialized ground life support service providing advanced life support must be staffed by at least one EMT and one EMT-P, registered nurse, or physician assistant.
  • We recently had a trauma call in which we called for a helicopter. We asked that the helicopter land at the helipad at our local hospital. We loaded our patient up, and as we were pulling into the ambulance bay, we could hear the helicopter landing. We elected to wheel the patient directly to the helicopter rather than go into the ED first. Should we have done that, since we were already inside the hospital?
    This can bit nuanced, so let's take a walk thru this. This scenario is really dealing with EMTALA ( Emergency Medical Treatment and Labor Act). EMTALA requires hospitals with emergency departments to provide a medical screening examination to any individual who comes to the emergency department and requests such an examination, and prohibits hospitals with emergency departments from refusing to examine or treat individuals with an emergency medical condition IF their intent was to take the pt to the ER (which backing into the ambulance bay would suggest) this would be construed as “requesting an ED evaluation” (aka medical screening exam) then EMTALA was triggered. The answer may be where they said they were going on the radio. On the other hand IF they were only using the hospital pad as an LZ (e.g. best spot due to proximity to scene) and they had no intention of taking the pt to the ED then EMTALA is not triggered. At the end of the day, the only choices are 1. Take the patient into the emergency department, letting the emergency department know you’re coming to ask for formal evaluation and treatment of the patient...OR 2. To use the hospital as an LZ and transfer point for the helicopter There is no in between. EMS needs to make the decision. As always, we encourage asking more questions if uncertain. This is a tricky subject with significant potential implications.
  • We recently transferred a patient less than 2 years old.  We we arrived at the hospital and asked for a set of vitals, they replied that they don't take blood pressures in patients under 2 years old.  Is that a policy of ours as well?"
    While this may be the hospital policy, our crews should be taking vital signs. The crew should identfiy the age-appropriate viatal signs and use the correct blood pressure cuff. Crews should also use a length based resuscitation tape (such as a Broselow) or pediatric color code system (such as a Handtevy).
  • Do we still need to wear masks on calls even when we aren't dealing with COVID patients?
    As it currently stands, since we are considered part of the the healthcare system, masks would continue to be required just as they are in hospitals. The bottom line, crews should continue to wear masks as they are constantly dealing with unknown quantities and mixing with the general public that is ill.
  • If a crewmember passes away, and they have Cooper Sams credits, can their surviving spouse redeem those credits?"
    Absolutely! Spouses can go to https://mn.gov/emsrb/ambulanceservices/cooper-sams-volunteer-ambulance-award-program.jsp to find instructions on claiming those credits. Simply put, they'll want to create a SWIFT Vendor number and then fill out the Claim form.
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