Was that a critical call?

Got a message from my Paramedic mentor a little while back about the title of this post.  He was asking what makes a call critical?

The definitions include “at or of a point at which a property or phenomenon suffers an abrupt change especially having enough mass to sustain a chain reaction; characterized by careful evaluation and judgment; urgently needed; absolutely necessary; forming or having the nature of a turning point or crisis; being in or verging on a state of crisis or emergency;”

But what does it mean to an EMT or Medic in the street he wonders.

Is it the presentation?

The required interventions?

Is it a feeling we get either before or after?

Well?

What makes a “critical call” in our book?

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30 thoughts on “Was that a critical call?”

  1. As used in my system, a patient who is “critical” displays injries or illnesses that are or could become (in the near future) life threatening. For us, its a combination of standing orders and judgement.

    On the light hearted side; a critical patient is one that allows us to use our lights and siren on the way to the hospital!

  2. As used in my system, a patient who is “critical” displays injries or illnesses that are or could become (in the near future) life threatening. For us, its a combination of standing orders and judgement.

    On the light hearted side; a critical patient is one that allows us to use our lights and siren on the way to the hospital!

  3. I would have to say, a patient that, without intervention, would deteriorate rapidly, would have significant deficits, and possibly not survive – e.g. serious respiratory patients, MIs, many serious traumas, etc.

  4. I would have to say, a patient that, without intervention, would deteriorate rapidly, would have significant deficits, and possibly not survive – e.g. serious respiratory patients, MIs, many serious traumas, etc.

  5. I’m with Ethan. For me, “critical” is any patient who is beyond my ability to stabilize or treat effectively. I take a lot of very sick people – MI patients even – to the hospital without lights and siren, because I don’t believe the time savings is worth the extra stress, rough ride and danger of RLS transport.

    So when I *do* tell my partner to light ‘em up, you can bet that patient is in imminent danger of shuffling off the mortal coil.

    Those are the ones I call critical.

  6. I'm with Ethan. For me, “critical” is any patient who is beyond my ability to stabilize or treat effectively. I take a lot of very sick people – MI patients even – to the hospital without lights and siren, because I don't believe the time savings is worth the extra stress, rough ride and danger of RLS transport.

    So when I *do* tell my partner to light 'em up, you can bet that patient is in imminent danger of shuffling off the mortal coil.

    Those are the ones I call critical.

  7. I’m with AD and Ethan. I seldom use RL&S. My partners know “I’m ready, lets go” and then there is “lets go now” (two or three times in the past few years). If I can’t handle it, “we go now”. With that said, I try not to let my ego overload my a$$, but it has happened once or twice. And AD is right, there is just not enough time savings with RL&S to matter much.

    As to that “warm & fuzzy feeling”? I get that more from the 26A1 sick calls and 17A1 falls than I do a shooting, pin-in, or full arrest.

  8. I'm with AD and Ethan. I seldom use RL&S. My partners know “I'm ready, lets go” and then there is “lets go now” (two or three times in the past few years). If I can't handle it, “we go now”. With that said, I try not to let my ego overload my a$$, but it has happened once or twice. And AD is right, there is just not enough time savings with RL&S to matter much.

    As to that “warm & fuzzy feeling”? I get that more from the 26A1 sick calls and 17A1 falls than I do a shooting, pin-in, or full arrest.

  9. That’s Tom, not Tim! Hi EMT Tim!

    To me, a critical call is any call where the patient is in genuine need of medical attention; simply because these are so often rare.

  10. That's Tom, not Tim! Hi EMT Tim!

    To me, a critical call is any call where the patient is in genuine need of medical attention; simply because these are so often rare.

  11. The definition of critical differs according to the competence level of the most competent person on scene.

    Personally, I would define “Emergent” as “likely to die without my help” and “critical” as “likely to die even with my help”. If there’s someone more qualified on scene, then “likely to die without *their* help” or “likely to die even with *their* help” respectively.

  12. The definition of critical differs according to the competence level of the most competent person on scene.

    Personally, I would define “Emergent” as “likely to die without my help” and “critical” as “likely to die even with my help”. If there's someone more qualified on scene, then “likely to die without *their* help” or “likely to die even with *their* help” respectively.

  13. Critical is . . . any patient that is in danger of dying before or soon after arrival at the receiving facility. Especially evident when none of our interventions are making a difference.

  14. Critical is . . . any patient that is in danger of dying before or soon after arrival at the receiving facility. Especially evident when none of our interventions are making a difference.

  15. This will sound a little trivial compared to some of the other answers, however my own definition of a critical call is any which makes you go “oh sh@t!” to yourself when you walk into the situation. It is a gut feeling that sometimes you cannot fully place into words, but when you ‘move it up a gear’ you know that the patients life is literally in your hands and your actions or inactions can make the entire difference in their outcome.

  16. This will sound a little trivial compared to some of the other answers, however my own definition of a critical call is any which makes you go “oh sh@t!” to yourself when you walk into the situation. It is a gut feeling that sometimes you cannot fully place into words, but when you 'move it up a gear' you know that the patients life is literally in your hands and your actions or inactions can make the entire difference in their outcome.

  17. When a 30-year fellow ALS provider arrives onscene to assist me, takes one look at the patient, and gets on the radio to request more help.

    At first I was tempted to define it as anyone who goes to a Critical Care room at our ER, but then I remembered that quite a few people go there due to hospital protocol and not necessarily actual acuity.

  18. When a 30-year fellow ALS provider arrives onscene to assist me, takes one look at the patient, and gets on the radio to request more help.

    At first I was tempted to define it as anyone who goes to a Critical Care room at our ER, but then I remembered that quite a few people go there due to hospital protocol and not necessarily actual acuity.

  19. A critical call for me, lately, is wondering **WHY** the f… heck similarly trained responders can’t:

    A) Recognize that the obstructed airway is the problem…or

    B) hearing that sound I hear entering the house, or apartment, like a law sprinkler, is the blood pressure cuff being blown up OVER AND OVER AND OVER trying to ‘get a Bee Pee’; to which I gently suggest that we WILL NOT get a Bee Pee, cause the pt has somehow lost a large part of their blood supply and are IN SHOCK!!! Holey Moley…or

    C) A mouthful of chewed-up Fentanyl patches is the reason for the pt’s AMS, and that judicious use of Narcan, either IV, IM, nasal sprayed or just SAID LOUDLY [the verbal route] will improve the situation just like that [not italicised]. Then all you have is a lying dumb-shit lying to me and all that goes with denialitis…

    Well…

    The 15 y.o. young man who ‘fainted’ [uh huh] this morning, who was in V-Tach, [WHAT?!?!?] is the call you’re maybe looking for, Happy, but a critical call for me is the WTF factor my co-workers give me just about daily. That’s my kind of critical.

  20. A critical call for me, lately, is wondering **WHY** the f… heck similarly trained responders can't:

    A) Recognize that the obstructed airway is the problem…or

    B) hearing that sound I hear entering the house, or apartment, like a law sprinkler, is the blood pressure cuff being blown up OVER AND OVER AND OVER trying to 'get a Bee Pee'; to which I gently suggest that we WILL NOT get a Bee Pee, cause the pt has somehow lost a large part of their blood supply and are IN SHOCK!!! Holey Moley…or

    C) A mouthful of chewed-up Fentanyl patches is the reason for the pt's AMS, and that judicious use of Narcan, either IV, IM, nasal sprayed or just SAID LOUDLY [the verbal route] will improve the situation just like that [not italicised]. Then all you have is a lying dumb-shit lying to me and all that goes with denialitis…

    Well…

    The 15 y.o. young man who 'fainted' [uh huh] this morning, who was in V-Tach, [WHAT?!?!?] is the call you're maybe looking for, Happy, but a critical call for me is the WTF factor my co-workers give me just about daily. That's my kind of critical.

  21. I should add mine as well I guess.
    My definition of a critical call is when my standard interventions do not have the effect I hoped and I am forced to think outside my training for a solution.
    When my tools and knowledge can't help or aren't working, then the situation is critical.
    Like AD says, RLS has nothing to do with it.
    Although I got a 6 motor escort to the hospital not long ago, that was a perfect 35 mph without braking all the way.

  22. I should add mine as well I guess.
    My definition of a critical call is when my standard interventions do not have the effect I hoped and I am forced to think outside my training for a solution.
    When my tools and knowledge can’t help or aren’t working, then the situation is critical.
    Like AD says, RLS has nothing to do with it.
    Although I got a 6 motor escort to the hospital not long ago, that was a perfect 35 mph without braking all the way.

  23. I should add mine as well I guess.
    My definition of a critical call is when my standard interventions do not have the effect I hoped and I am forced to think outside my training for a solution.
    When my tools and knowledge can't help or aren't working, then the situation is critical.
    Like AD says, RLS has nothing to do with it.
    Although I got a 6 motor escort to the hospital not long ago, that was a perfect 35 mph without braking all the way.

  24. A patient who tells me I need to lose weight.

    I find that the more I learn, the fewer critical patients I encounter.

    The lights are to provide a smooth ride to the hospital with minimal delay. The siren is only to get the attention of those who do not pay attention to the lights.

  25. A patient who tells me I need to lose weight.

    I find that the more I learn, the fewer critical patients I encounter.

    The lights are to provide a smooth ride to the hospital with minimal delay. The siren is only to get the attention of those who do not pay attention to the lights.

  26. A patient who tells me I need to lose weight.

    I find that the more I learn, the fewer critical patients I encounter.

    The lights are to provide a smooth ride to the hospital with minimal delay. The siren is only to get the attention of those who do not pay attention to the lights.

  27. A patient who tells me I need to lose weight.

    I find that the more I learn, the fewer critical patients I encounter.

    The lights are to provide a smooth ride to the hospital with minimal delay. The siren is only to get the attention of those who do not pay attention to the lights.

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