jjd

So the general consensus at the moment is that the SW be transported first based on.... raised JVD, pneumo and the possibility of a tamponade based on the wounds location? Firemedic made a good point that the wound is directly in the same location that a needle decompressionn would be done at. What alternatives do we have to relieve the tension? Would an occlusive dressing make the slightest difference to someone who is already presenting with raised JVD, which as we know present in the late stages of a tension pnuemo. Sorry if this is a mundane scenario, i'm relatively new to ems and believe participating in a few scenarios would benefit me. The reason i posted this particular scenario is that i have a friend who is a new intern at a provincial hospital. She had a similiar situation although the decision she had to make was more along the lines of who would be admitted to surgery first (only one functioning operating room). In the end she decided to go with the GSW. Her decision was based solely on the fact that it was a gunshot vs stabbing and a GSW is generally considered higher priority then a stabbing. (she is not entirely sure her decision was the correct one) I understand her line of thinking but i can't help but think that a penetrating chest wound may pose more of a risk then a low calibre bullet into the abdo. Yes there is the possibility of substantial blood loss and the fact that there is no exit wound makes me wonder what the bullet ricochet off and what else may potentially be damaged.

Hi all, I have a scenario i would like to run past you. You arrive on scene to find 2 patients. 1 x GSW abdo, no exit wound. Patient is approx 35 years old, weighs roughly 79KG's (sorry not sure how many pounds that is) BP 126/75, RR 25, GCS 12, HGT 4.2 (glucose) , Pulse 78. Slightly diaphoretic. 1 x Penetrating chest wound, stabbed with a 5 inch serrated blade at the second IC space, Mid clavicular line on the left side of his chest. Patient approx 35 years old, weight 79kg's, BP 115/72, RR 32, GCS 12, HGT 4.2, Pulse 89, you notice slight diaphoresis and what could possibly be jugular venous distension. Air entry seems = on both sides as does chest expansion. Edit: Your ECG and pulse ox are not operational. Your in an ALS response car and are met at the scene by 2 x BLS in an ambulance. You can only take one patient. Which one would get higher priority and get attention first and what would your treatment be? Your in South Africa where you are registered and considered an indepedant practitioner (in other words there is no such thing as calling medical control and it's your decision in the end)

Hi everyone, This post is directed to those of you that are in South Africa. At present i am BAC/BAA reservist for Ekhurleni EMS based at the Edenvale or Bedfordview fire station depending on where i'm needed. 25 years old. Initially i was under the impression that working on a provincial ambulance would provide me with enough experience to grow, learn and progress up to the AEA level. Over the last 5 months i have accumulated roughly 600 hours (1000 hrs is required to advance). My problem being is that call frequency at these stations is extremely limited and it's not uncommon for me to go an entire shift without receiving a single call. ER24 and Netcare are not interested in volunteers, unfortunately. I would like to spend a few shifts on an ALS response car or on an ILS ambulance that has a slightly higher call volume. I am currently full time employed as a systems architect but devote a substantial amount of my free time to EMS. I am aware that the HPCSA is in the process of stopping the AEA course and my intention is to complete this prior to that. If you have any suggestions as to how i can gain more actual road experience (instead of just sitting around) please feel free to respond. (Translation for non South Africans: BAC/BAA = EMT-B, AEA = EMT-I, HPCSA = Health Care Providers Counsil of SA) Joshua

I forgot to mention, our ALS response cars have a single Paramedic on board (no BLS/ILS unit accompanies them). More often than not the response car will arrive first at a scene, making a single individual paramedic responsible for handling the entire situation regardless of the amount of casualties. I believe in our scenario this is extremely unsafe as ALS units are often sent into unsafe areas with no partner and no additional backup most of the time.

Hi all, (This is my personal opinion based on my experience and should be taken with a pinch of salt *and a shot of tequila if you feel like it *. Below is just what i have heard through various documentaries and are not based on an actual study) I am aware that this thread is quite old, but i thought i would give my 2 cents anyway. The "fly cars" that have been mentioned are standard operating practise for ALS medics in SA (South Africa). Primary reason for this being the lack of ALS units available. Standard level of training at the moment is Basic with very few Intermediate or Advanced practioners. I work in Johannesburg, Gauteng... one of the largest cities in Africa with an estimated population of 7.5 million (2007 census). The area i work in (Ekhurleni) has an estimated population of 2.5 million, with on average 3 - 4 ALS medics practising at any given time. The 3 - 4 ALS medics i mentioned are entirely provincial/government based and the majority of calls for higher LSM's are handled by private ambulance services which have their own ALS units. Provincial ambulance services cater for the majority of the population while the private ambulance services cater for the more afluent individuals that can afford medical aid. I recently watched a well known and reliable TV show that had a documentary on EMS in SA. It is estimated that at present there are only +-330 ALS medics currently practising pre-hospital emergency care (the rest working for private companies or have left to pursue greener grass in another country). 330 ALS medics in SA with a population of over 47 million. On a typical call a BLS or Intermediate will be dispatched to the scene (obviously depending on the severity), once an initial assessment has been done an ALS unit may be requested but not guaranteed due to the dwindling number of ALS medics. Generally what happens is that a particular fire station (housing both EMS, Fire, Hazmat, Rescue) would operate over a small designated area. ALS units would operate over many areas at any given time and are asked to drive long distances to respond to calls. So essentially what is happening is that non ALS units who respond to calls primarly in their designated area get very few calls and spend majority of their time bored and watching TV. ALS response units who span multiple areas and are few and far between are constantly being overloaded with calls and driving huge distances. I can't comment on how the private EMS services operate but within provincial/government our ALS response cars are constantly being pushed to their limits and are extremely over worked. What i have found in the past is that many of the calls that should be regarded as BLS/ILS are being handled by ALS, which given the limited amount of ALS in this country doesn't seem like a good idea.