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What would your treatment be.
This incident actually happened and it involved my daughter. The incident is as follows while me and my family was on vacation just a few days ago.
The incident was for a 6 y/o female with stomach pain, headache, sore throat, pain in the chest, and severe difficulty breathing with accessary muscle use. I took initial vitals before EMS arrived onscene. The initial vitals were pulse of 130 and resp rate of 22. The next set of vitals were a pulse of 110 and resp rate of 20. My daughter was like I said having difficulty breathing. The EMS showed up with a EMT basic crew with a chase truck with a medic 3 mins later. I saw the vitals that the EMS crew took and they had a pulse of 115, b/p of 110/80, resp of 18, and an O2 sat of 91%. The second set of vitals were pulse of 124, b/p of 105/65, resp of 18, and an O2 sat of 92%. The EMS crew was onscene for a total of 30 mins with no O2 given and they concluded it was just a basic call so the medic never treated the patient and left the scene. The transport time was another 30 mins to the hospital. The vitals enroute to the hospital were a b/p of 116/48, pulse of 124, resp of 18, O2 sat of 95%. The last set of vitals enroute were b/p 102/53, pulse of 123, resp of 20, and O2 sat of 95%. The EMS crews only treatment was having my daughter breath into a paper bag cause they assumed it was a case of hyperventilation. My daughter ended up having a bad case of the flue with a temp of 103.5 oh and the EMS crew never took a temp either. I know what I have been taught as an EMT basic is to treat the symptoms and the vitals, which in this case the child needed to be placed on a NRB on high flow O2 instead of breathing into a paper bag and that the onscene time should not have been 30mins with a 6 y/o with severe difficulty breathing. I would like to hear some feedback on this on what your course of treatment would be for this patient.
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Comment by Michael McCarthy on January 13, 2012 at 4:47pm
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Vitals bp and pulse are ok---but the o2 sat being that low??...Why would you take away the oxygen from a patient whose o2 sat is already low?? Unless she already has some underlying previous medical history the patient goes on a pediatric NRB --- period. If the child wont tolerate the mask they have Mom or Dad hold it near their face. Having her breathe into a bag--- thats rediculous !! Just based on her O2 sat and their treatment they should be addressed by someone of authority. Did they ask for a previous history ? How long has the child been like that...hour??...2 hours??...Day ??...2 Days??... Any fever?? Vomitting?? With medical calls you need to be a little bit of a detective and find out why is the patient sick??
Hope the little one is feeling better
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Comment by Rodney(LFD-IAFF L 334) on January 11, 2012 at 10:24am
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Oldman
Her condition was a sudden onset of stomach pain, headache, soar throat, warm to touch, chest pain, and difficulty breathing with accessary muscle use. Initial treatment by me was assess the pt and took pulse and felt for temp since I had no other equipment on hand. He initial pulse was thready and elevated but regular. When ems showed up I identified myself as an EMT and gave initial assessment and vitals. The ems crew ignored me and my assessment of the PTs condition. I still believe that pedi NRB by blow by is a standard treatment for children with low o2 sats and difficulty breathing
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Comment by Oldman on January 10, 2012 at 11:17pm
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Well, I presume your daughter has recovered, and is bouncing around like my children did after recovering from the flu.
Just based on your description, the "paper bag thing" is inappropriate, and the on-scene time is excessive. However, I don't necessarily consider this to be an ALS call either. When one takes a pulse, it is fairly easy to feel an elevated temp. This would explain the tachycardia. I don't consider a respiratory rate of 18 to be "difficulty breathing." I am not now, nor have I ever been a proponent of high flow O2, and while her sat's were a little low, a cannula would probably have sufficed.
One thing missing from your description, were the questions asked by the crew, and your responses. Questions such as onset of symptoms and any treatment given prior to EMS arrival are pertinent in deciding treatment and transport matrix.
You are well within your prerogative to file a complaint, but should you decide to, it needs to be in writing, and more detailed than what space permits here.
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Comment by Aric Stewart on January 10, 2012 at 10:31pm
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i think calling the state would be the best solution in this case too many holes in treatment
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No NRB no Canula at all as a basic EMT I know what the treatment would be this crew had no clue. I have been trying to get a hold of the chief of that department but no luck and now I'm thinking of call the state ems board to lodge a complaint.
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ok first of all i would have not turned the medics away by all means if all they do is put the pt. on o2, they can also start an IV and just not hook up fluids. next why didn't the EMT's put her on O2 i was always taught in a healthy person never hurts to put O2 on. Second why was the pt breathing so fast was it due to she couldn't catch a breath or was it because she was in pain and that was her coping mechanism. Next i would have not dicked around for 30mins to find out i would have scooped and ran. Children are notorious for compensating then all of the sudden just going south fast. so i don't understand their thinking process.
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