HERBIE1

What type of call volume do you see?

State exams are based on a NATIONAL curriculum and standards. Thus, everyone is tested to the same level when gaining their licenses. No, not every EMT or paramedic program is created equal- nor is every medical school, dental school, university, or vocational training program. As with any educational experience, you also get what you put into it. If someone wants to take the NREMT, hooray for them. They should be applauded and encouraged, but it does NOT automatically translate into making someone a better provider. On the other hand, if someone chooses NOT to pursue a national accreditation, it does not diminish their education or ability to do their job. As we all know, book knowledge or test taking ability is not always an accurate indication of someone's ability to do their job. There are so many intangibles and experience related skills that are crucial to being an effective provider that simply using a score on the NREMT may not mean a thing. I've met some people who were walking encyclopedias of EMS. They can cite ACLS, PHTLS, PALS, and their protocols chapter and verse, backwards and forwards. They are walking PDR's-they can give every medication's doses, side effects, generic and brand name, but I wouldn't let them touch my dog. Best case scenario- be proficient in didactic AND skills- regardless of that NREMT patch.

This was my point, and doc seemed to concur. Interfacility transfers can take forever and even in a best case scenario, it would still probably be a couple hours before he hit the doors of the trauma center. Yes, this person may very well would have died no matter what- we simply don't know what his injuries were, or whether or not they were even operable. Appropriate care- that's why the trauma system was established.

I agree with the doc that the end result here might have been the same regardless of where he was taken. Point is, I STILL would have taken the patient to the trauma center. As long as you paint a complete and accurate picture of the scene- the condition of the car, the distance he was ejected, the condition of the patient and other victims- let medical control decide. If the patient deteriorates, then it wasn't meant to be, but the Trauma center is his best shot. As for playing Monday morning QB, isn't that part of what this forum is about??

Agreed about the local ER- to a point. Unclear what the actual injury was, but a simple CT would have probably showed that they were not able to handle this guy's treatment. 2 hours before they could transfer? It may seem excessive, but... Even under ideal conditions, a transfer isn't going to happen in 5 minutes. The doc here can attest to that- you need to contact the appropriate receiving hospital, sort out insurance info, notify family if needed, get a physician to accept the patient, give the reports, copy any records and Xrays, call for a transport- this all takes time. I still think that based on the MOI, if the crew make the choice to head to a Level One, everything could have been in place when the patient hit the door and a neurosurgeon could have been working on this patient long before he was transferred there. Maybe the outcome would have been the same, but at least he would have received definitive care LONG before he did.

I worked in a Level 1 Trauma center for 15 years. When I first started, "cracking chests" upon arrival was the thing to do. The trauma center heyday was in full swing, and hospitals were just starting to realize how much money trauma centers cost to operate- staff, equipment, salaries, ancillary staff- not to mention the fact that most of these patients were indigent or underinsured. In the countless cases I saw, I can count on one hand how many were successful, and those were because the person crashed as they hit the ER doors. Because of the poor outcomes, in most cases, the policy has since gone by the wayside. There has to be a darn good reason to do a crash thoracotomy- as in an arrest witnessed by the surgeon. Massive, multiorgan trauma that results in an arrest is essentially a death sentence- there is a reason why most places do NOT work these patients. In these cases- as opposed to a medical arrest, the dead stay dead. Resources and money need to be saved for someone that has a real chance of survival.

Exactly.

No, MOI is not always indicative of the severity of an injury and no, we do not treat mechanism of injury, but you damn well had better at least suspect a serious injury. Intuitively, there should be a high index of suspicion with something like this. The victim was ejected 30 feet from the vehicle- that's more than enough force to cause a multitude of problems- up to and including the apparent bleed that killed him. According to the article, the patient had a significant scalp lac, thus he experienced more than enough force to cause his injury. I've seen people ejected from vehicles who didn't have a scratch on them and still died. I've also seen people who were ejected, were transported and were discharged from the ER with no injuries. Point is, in situation like this, it's up to the hospital to rule out any internal or unlikely injuries, not us. This is an example of why most policies state this MOI- ejection from a vehicle- is a reason to transport to a trauma center. Again, I'd be curious to see any other info not provided in the article that could explain why the crew made the decisions they did, but I do hope they documented their arses off. Clearly, transport times are important, but if this guy's vitals are stable and he has a patent airway, I see no reason why he couldn't make that trip.

Just because you CAN do something, it doesn't mean that you should. Clearly, where you work- meaning call volume-has alot to do with how long you should stay in the business. After 25-30 years or more in this business, I think someone's experience should be utilized- teaching, training, management- whatever they can be qualified for. Aches, pains, poor eating habits, lack of sleep, chronic injuries, endless cycles of adrenaline surges and dumps, mental wear and tear, relationship strains, emotional issues- it's a tough business. Yes, there are exceptions to every rule, but I've worked with some old timers(I'm getting too close to that description myself these days) who were around from the onset of EMS- and to a (wo)man, they are pretty beat up. It reminds me of the old school firefighters who started with no SCBA's and after they retired were barely able to collect a pension check or 2 before they died. I swore to myself I would never work that long in the field- which is why I went back to school and got my Masters as a back up.

Need more info, but unrestrained and ejection 30 feet from a vehicle- that buys someone a trip to a Trauma center in any system I know of. Like was noted, he had a stable airway if he was awake and talking. Yes, nobody likes a Monday AM QB, but this one seems pretty obvious. I would simply like to know WHY they did not take the guy to an appropriate facility- that's what they are for.

Time frames are irrelevant. According to whom has the person been down for 1, 5, 10 or 15 minutes? You need to use your own judgment and follow protocols.

Depends on how much you see as an EMT-B. Call volume, types of calls, amount of interaction with patients, family members, and hospital staff. Lousy answer, I know, but too many variables.

We have a hazardous profession, filled with potential health risks as well as opportunities for injury. I agree that suing for injuries sustained in the line of duty is wrong, but I'll play devils advocate here. What if the injury was sustained due to negligence and the injured party has no other recourse? What if that provider's benefits aren't so great, if they were living paycheck to paycheck and became mired in debt as a result of the time off work? Workers comp only covers so much. As distasteful as it may be, the person may have no other recourse but to sue. Your first priority is to your family and if that's what you need to do for them, then you do it.

Welcome. Apparently you guys start training pretty young. (Your age says 10)

With that rationale, and the same reasons you cited, then why resuscitate anyone over the age of, say 75? After all, they probably only have a couple more good years left anyway.

I agree, but it might not be an option in his company.

Now we see a perfect example of why these arbitrary- and completely inaccurate- labels should be banned. Do you think people from Egypt, or those from a North African country, or even South Africa- call themselves African Americans? Of all people, they SHOULD have that title, if we are determined to use it. Once again, be careful what questions you ask- you might not like the answers. Just like the Miss USA pageant- the poor woman was asked a question, she answered it, and was vilified for it.

SOme of those companies also hire for special functions, which would be part time- working at a horse race track, manning a first aid station in a big venue. There is also a company that soley staffs specials events- concert venues, privately run festivals first aid stations at museums, (some museums also hire directly) Good luck.

We cannot refuse to transport anyone who requests service. Obviously, if they endanger the crew, the police become involved but we cannot unilaterally decide we won't take them. Just an FYI- EMTALA does involve prehospital in some ways. If a crew does not properly hand off a patient to an ER- IE properly or inadequately notify a triage nurse, we can be held liable and that is an EMTALA issue.

SafetyPAD. Whatever you use, make sure the field providers(users) have significant input in the process. Much of our software was designed by an MD who was familiar with the system, but not the day to day operations. It is NOT what I call user friendly. The program is only as good as the people who provide the data to the software people.

In my system- he would be worked- no question. The injuries listed were a deep skull lac, and he obviously had a bleed with the deviated gaze. That is NOT massive trauma. PEA is certainly dead, but depending on your system protocols and transport time, he should be worked. Would he stay dead- undoubtedly, but a closed head injury is not what I would consider enough trauma to justify withholding efforts. Since bystanders said he had a pulse,(allegedly), go through the motions. Just because CPR was started however, does NOT mean it cannot be stopped- call medical control and explain the situation. I've seen CPR being performed on people with rigor so severe they rocked with each compression. I've also seen CPR performed on someone who was already beginning to decompose. Does that mean you cannot stop CPR under those circumstances? Again, depending on local protocols, I know some systems do NOT work a traumatic arrest who is asystolic(considering the futility of these situations, it makes sense to me)- regardless of the severity of their injuries. With a PEA, I would say that goes into a grey area and again- I'd work 'em unless told otherwise.

Never saw one personally- I'm a city boy, but I still can see the potential for bad things happening. I would imagine the voltage would need to be pretty high in order to "dissuade" a large animal like a cow or horse from challenging it, so why would someone mess with it?

It actually demonstrated the properties of electricity, but how stupid are these people for participating in this "experiment"? Braniacs, indeed. LMAO

The point about not knowing what you don't know is HUGE. At any age, many times when we are starting out in this business, we do not know if we are being led down the wrong path by a preceptor or a mentor. The younger you are, the more difficult it is to tell the difference between proper instruction and a bum steer- you simply have no point of reference yet. I am hopeful you get proper instruction and guidance- both on and off the job. The problem is, we get absorbed in this business and due to it;s nature, much of our social lives revolve around people who do what we do. At 17, you need a broader perspective on life than that.

\ Good point about the organization. Navigating the politics of an organization, understanding how things work, how to get things done, how to be a good coworker, and your place in that organization. All as important as providing health care instruction.