6 ms·

So many good questions/points. Responding to each: 1. This would be an ideal world, but it just isn't the case. Nor do I think its a feasible solution to train

by tpeck 11y ago

So many good questions/points. Responding to each: 1. This would be an ideal world, but it just isn't the case. Nor do I think its a feasible solution to train nursing home nurses to be as knowledgeable about pathophysiology as physicians. Subtleties of acute cardiac syndrome (heart attacks, etc) are difficult to recognize, and it takes a few years of residency after medical school to be able to quickly recognize and act on them. There are many great nurses that can too, but that usually comes with lots of experience in critical situations (especially in the ICU, ER, and PACU). Nursing home nurses just don't have the same exposure to critically ill patients. 2. Which county? Those are great times. A word of caution when interpreting response times - they often start the clock at the time of dispatch, not the time of the patient calling 911. A lot of Call9's value is cutting out the inefficiencies between the 911 call and the dispatch. 3. Administering aspirin (ASA) is very significant. Anti-platelet therapy (e.g. aspirin) has been shown to decrease the mortality of heart attack patients significantly, and the earlier you give the aspirin, the sooner it works. As for nitroglycerin ('nitro'), the medication that dilates the blood vessels on the hearts surface and allows for better oxygen delivery to heart muscle as its dying in a heart attack, it is extremely dangerous to self administer nitro in certain situations that can only be interpreted if you have an EKG - in one of our patients, we in fact identified this issue and purposefully held the nurses giving off this medication which could have killed the patient. As for the nursing home, this situation happened in, the nurses are well trained and I've been happy with their level of care and concern for their patients. 4. I too think a proactive response makes sense. Good point about the utility of these diagnostics - we surely have cases where they are useful in facilitating the care of patient in an emergency. But they are extremely useful in preventing unnecessary hospitalizations - another key value of Call9. In this way, we do practice urgent care too. . Thanks for your comments - seems like you've been in the field and know your stuff.

FireBeyond 11y ago
Thanks for the thoughtful reply! I agree, the ideal world and the real world are two very different things. Though still, given the length of your average RN course (or even LPN, since as we're talking real world, many nursing facilities are supervised by one RN over many LPNs) versus EMT... certainly it "should" be better. You do make a very good point about the nature of chronic versus acute patients. 2. Thurston (http://www.co.thurston.wa.us/medic1/stats.htm http://www.co.thurston.wa.us/medic1/stats.htm) - I'm not entirely sure about the measurement of response time, would have to clarify with a dispatchers. 3. Thank you for calling out this. Agreed, ASA is very significant, and should not be discounted. I meant that emergently it's not going to improve patient condition, but I should have acknowledged that's only one part of the treatment plan. NTG, too, at least here, is typically administered or assisted by BLS with numerous contra-indications (brady/tachycardia, hypotension, etc), but most patients I have seen are instructed by their physician to self-administer with symptoms "similar to previous cardiac event". I'm presuming right ventricular infarction on your example patient? As said elsewhere, I would like to see a service like this succeed, and apologize if I come off 'skeptical' in some of my comments!
- ezzzz 11y ago
  This whole thread looks like tempest in a teapot. They provide emergency physicians on call for nursing homes (and maybe other facilities) that already have nurses and other healthcare providers in them. So any analogy to 911 is beside the point. Their 911 claims (and the people who attack them on HN) - all this could easily be just viral marketing. :)

by tpeck 11y ago

FireBeyond 11y ago

Thanks for the thoughtful reply! I agree, the ideal world and the real world are two very different things. Though still, given the length of your average RN course (or even LPN, since as we're talking real world, many nursing facilities are supervised by one RN over many LPNs) versus EMT... certainly it "should" be better. You do make a very good point about the nature of chronic versus acute patients. 2. Thurston (http://www.co.thurston.wa.us/medic1/stats.htm http://www.co.thurston.wa.us/medic1/stats.htm) - I'm not entirely sure about the measurement of response time, would have to clarify with a dispatchers. 3. Thank you for calling out this. Agreed, ASA is very significant, and should not be discounted. I meant that emergently it's not going to improve patient condition, but I should have acknowledged that's only one part of the treatment plan. NTG, too, at least here, is typically administered or assisted by BLS with numerous contra-indications (brady/tachycardia, hypotension, etc), but most patients I have seen are instructed by their physician to self-administer with symptoms "similar to previous cardiac event". I'm presuming right ventricular infarction on your example patient? As said elsewhere, I would like to see a service like this succeed, and apologize if I come off 'skeptical' in some of my comments!

ezzzz 11y ago
This whole thread looks like tempest in a teapot. They provide emergency physicians on call for nursing homes (and maybe other facilities) that already have nurses and other healthcare providers in them. So any analogy to 911 is beside the point. Their 911 claims (and the people who attack them on HN) - all this could easily be just viral marketing. :)