erraticating trauma alerts

[aztraumamedic]

As an EMT/Paramedic, I have worked many years running Emergency calls in the field and for the last several years I have worked in ER. Back in the late 1980's in Southern California, we had many Trauma Centers. However, many hospitals dropped out of the trauma system. The primary reason for this was MONEY! A trauma center must have many different specialists on call 24/7. These doctors get paid when they are on call and more when they are actually called in for a trauma case. I have worked in gang areas and most of the GSW's, stabbings, TC's and other trauma calls are on gang bangers and others who have no medical insurance. This means the hospitals do not get compensated or paid. However, the hospitals must still pay the doctors who are called in to treat the patient and supplies used, etc. Even though hospitals may get some type of reimbursement from the county or state, they still lose money. Every time we as EMT's or Medics call in a trauma from the field, the specialist doctors are called in and must be paid. I do agree that calling a trauma is best left up to us in the field, the "desk jockeys", as you said, only see dollar signs.$$$ I am afraid it is all about money

[Flasurfbum]

In the FDNY EMS, we call in "notes" (notifications) when we feel the patient may benefit by having the ER crews advised prior to our arrival of what is coming their way.

Asysin2leads' statement of "Our notification system is very brief, including usually only patient's age, vitals, mechanism of injury, and care given (Sometimes simply saying ALS established) with an ETA" is accurate, and usually done when going to an area trauma center. Then, again, I have heard over the scanner, that it seems to be mandated that any ambulance in New Jersey heading to an ER sends a "note" prior to the arrival, from the stubbed toe, to the patient pulled from the wrecked car in traumatic arrest from the gun shot wound (I seem to like drama, don't I?).

In many places, that is standard. Example

Holmes ER, Rescue 67, Class 3 Medical. Good afternoon Holmes, Rescue 67, Paramedic Jones, we are currently en route to your facility with a Class 3 45 year old female, chief complaint today is going to be nausea and vomiting x3 days. We have a line started, vitals within normal limits, pt on nasal cannula, resting comfortably on the cot, eta to your facility is 3 min, do you require anything further?

From the stubbed toe to the trauma arrest, we call them all in. Part of it is a courtesy to the ER to let em know we are coming in, part of it is to just perfect the radio report.

[BEorP]

I do agree that calling a trauma is best left up to us in the field, the "desk jockeys", as you said, only see dollar signs.$$$ I am afraid it is all about money

But money is not unlimited. If the hospital spends money on unnecessary trauma alerts and then can't afford enough RNs to staff the ED, how does that help anyone?

[sevenball]

There is alot to answer, sorry if I don't get to all your questions. As for my own level of education, I have been in the field of medicine for 17 years, attended college for an associates in fire investigations and fire science. I have been a Paramedic for 6 years, am currently employed with the largest 911 provider in my state. Have worked on the CAAS accredidation team, I am a field Supervisor. I also worked as adjunct faculty to a large education company teaching paramedic courses and recently became their clinical coordinator.

Big fancy titles which mean very little in the grand scheme of things. My service is strictly ALS on the streets. We do have a BLS division, but it is ift's only.

I'll give you one thing, I don't have any hard evidence that proves that calling a trauma team in from the field does anything to improve mortality, but I have to believe that they wouldn't have created that particular protocol for no reason. Much like the recent changes in calling in a "cath alert" to call in a cath team. As for my own experience, maybe I am an exception to the rule, WHEN I call a trauma team, it's for real. I don't needlessly call. One of my jobs is working in an ER, I know that money motivates. I think that it's sad really. Changes should not come about because money dictates it. Thats just the game though, I get that part.

BEorP- you said that "all too often uneducated field providers disregard what more educated people say because "they don't know what it is like on the road."'

my intentions were to drive the point home that many times (just like you said is often the case) people who make the rules and changes in protocols, do not account for all situations, and often make knee jerk reactions based on some surgeon that feels his time is being wasted. Or worse, makes knee jerk reactions based on some insurance company that is leaning on him to tighten the purse strings.

Instead of just pulling the plug on trauma alerts, why wouldn't these rule makers have a sit down chat with those who run the streets to comprise a smarter, more efficient system, instead of just taking their ball and going home? No need to pull the plug so hastily.

[BEorP]

I'll give you one thing, I don't have any hard evidence that proves that calling a trauma team in from the field does anything to improve mortality, but I have to believe that they wouldn't have created that particular protocol for no reason.

I showed you a study that said that it was a waste of resources to call solely based on your gut feeling in a pt who appears stable. Find me a paper that says otherwise to back up your point then.

To me, the best example of our lack of evidence based medicine in EMS that "made sense" is the old defib guidelines. It just makes sense to try to shock someone as soon as you arrive on scene, doesn't it? If they are in a shockable rhythm you want to get them out of it as soon as possible and who knows how long it will last. And if you shock them once they might not come out of the rhythm so you should immediately analyze again and shock again if you can and then do it once more. It made sense. It was wrong. This EMS mentality of "we do it because that's how we've always done it" or "we do it because it makes sense" needs to end if we want the profession to move forward.

[sevenball]

I agree with you. I never said I call because it made sense. I said sometimes i call because I have a gut feeling, and I've never been wrong. I know that not everyone has that ability. Its the same ability most of us have when we walk into the room and can say with certainty that the pt. is "sick" or "not sick".

I told you that I cannot show you numbers. I'm sure that I can research and find it, but off the top of my head, I cannot find a research paper that supports my claims. The only thing that I can offer you is my stance that we as providers should be given the benefit of the doubt that we know what we are doing out there, and if we don't (and there are many of them too) then we as providers should be creating a training environment to bring us up to speed. I think that pulling the plug on the trauma alert system is too punitive and throws us back to the days of calling med control to drop an aspirin.

[BEorP]

I said sometimes i call because I have a gut feeling, and I've never been wrong. I know that not everyone has that ability.

I hope your patients know how lucky they are to have a paramedic who has never been wrong treating them. I don't mean to be disrespectful, but (this is not just directed at you) I always get concerned when I hear any level of provider speaking of themselves as if they do not make mistakes.

[sevenball]

I never said that I don't make mistakes, all I said is that when it comes to my gut, I've never been wrong. Thats not arrogance, it's fact. I've been plenty wrong when treating my pt.'s. I had a 26 year old kid that I put money on the fact (based on clinical findings, not gut) that he had pneumonia. Turns out he was in failure. WHO KNEW? I've been plenty wrong, just not when listening to my gut, we should all listen to our instincts, thats why we have them.

[ERDoc]

http://www.ncbi.nlm.nih.gov/pubmed/1505075...ogdbfrom=pubmed

http://www.ncbi.nlm.nih.gov/pubmed/1698831...ogdbfrom=pubmed

That last one is not limited ti trauma pts so it does not exactly answer the question being asked.

[Just Plain Ruff]

I wish it were just to get the activation criteria to change, and I'm sure that it is just to keep cost down, but there is industry wide speculation (and I stress speculation) that trauma alerts will no longer be used, that the call will be from the accepting physician based on the information provided to him from EMS. That would be fine, but that takes away from the "hunch" aspect, that takes away from the simple fact that the physician cannot see the pt. and will only go by mechanism of injury, and if the pt. is hemodynamically stable, which can provide false readings if the pt. is compensating.

where are you getting this industry wide speculation that trauma alerts are going away or will go away? That's a pretty broad claim.

I have worked over the past 5 years in nearly 15 different cities ER's (computerizing them) and not once have I heard that trauma alerts are going away or there is talk about them going away.

At the client I'm at right now, 110K patient visits per year they rely on the trauma alerts to get their teams ready to go. There is no way in hades that they are going to stop receiving trauma alerts. This is in Springfield Massachussetts, the trauma center there.

So where are you getting your claims of Industrywide speculation? Or are you just saying your Area wide speculation focusing on your specific area?