You call in for orders and medical control asks “What’s your ETA?”
That’s an interesting question.
There are several answers.
I am fifteen minutes from the hospital grounds.
I am eighteen minutes from my back door opening.
I am twenty minutes from arriving at the triage desk.
I am anywhere from twenty-five to fifty minutes to getting through registration/triage.
I may be as far as an hour from putting my patient on a bed.
My patient may be an hour and a fifteen minutes to an hour and a half away from being assessed by a nurse.
My patient may be two hours away from being seen by the doctor asking for my ETA.
So what’s my ETA?
Every system and every service is different and has its unique challenges. I know some medic services that practice load and go on most patients, rarely treating anything within ten minutes transport unless urgently needed because they have no wait at their EDs and can quickly clear for another, potentially more urgent call. I know other services whose medics will in some cases spend ten minutes or more in their hospital parking lot, providing care and treatment because time to care is not the thirty second distance to the ED door.
Just last week we had a patient with suspected kidney stones and generous orders to give the patient 5 mg of morphine every ten minutes X 3. We had given the morphine X 2 when our wheels came to a stop in the visibly crowded ED parking lot. We talked about our options, and included the patient in our discussion. He was still 9 out of 10 on the pain scale. We can bring you in now, or we can sit here for another five minutes until it is time to give you your last dose. He wanted us to sit. We did. We gave him the last 5 mg of Morphine and then rolled through the ED doors. We were in triage 22 minutes. By the time we had the patient in his room thirty minutes later, his pain was down to a 3.
I had an interesting conversation with a doctor the other day. We were talking about nitro paste, which he said was really a bad drug for us to carry because its absorption rate was so variable. I always defer to doctors on these types of questions that are beyond my education, but I raised the one merit of nitro paste was that it provided the patient nitro continuously while they worked their way through the triage zone — the time between exiting our ambulance door and a doctor’s arrival at the patient’s bedside in the ED.
Our conversation lead to his opinion that it was completely acceptable for us, as long as we had the patient on the monitor and an ability to take their blood pressure, to continue to give the patient sublingual nitro while in the triage line, and if we felt that the patient needed care that urgently, it was our duty to cut the line if necessary to get the patient the care needed.
I have often cut the line, and have often allowed others to cut in front of me, and I have never seen anyone object to this practice which we all agree is in the patient’s best interest. I have, on the other hand, heard of medics being scolded for giving meds in the triage line because we are then on the hospital’s turf and not our own. But I would agree with the doctor, and argue that until the patient is put on a hospital bed and care discussed with a nurse or doctor at the patient’s side, there is nothing wrong with continuing to treat. We don’t take them off oxygen. We don’t turn our drips off. What’s wrong with nitro spray?
I wonder if we had wheeled the kidney stone patient in, and syringe in hand, proceeded to slowly push morphine in through the IV port, while we waited in the line of stretchers, if it would have created a stir?