erraticating trauma alerts

[sevenball]

My apologies ruffems,

In my little peabrain, the world does not exist beyond the confines of my own bandage shears. When I said industry wide, I meant my own state. Clearly, destroying trauma notifications for the entire country would have devastating effects on our pt.'s

I agree that there are certain hospitals and certain client bases that rely heavily on early trauma notification to allow their teams to get ready. I also agree with some of the early posts that there are some services, and more narrow, some providers, that have no business calling trauma alerts. I am simply stating that it's an overreaction of some beaurocrats to pull the ability to call trauma alerts, and I for one was offended that my call was discounted and judgment piled up with all those who have poor judgment.

[VentMedic]

My apologies ruffems,

In my little peabrain, the world does not exist beyond the confines of my own bandage shears. When I said industry wide, I meant my own state. Clearly, destroying trauma notifications for the entire country would have devastating effects on our pt.'s

I agree that there are certain hospitals and certain client bases that rely heavily on early trauma notification to allow their teams to get ready. I also agree with some of the early posts that there are some services, and more narrow, some providers, that have no business calling trauma alerts. I am simply stating that it's an overreaction of some beaurocrats to pull the ability to call trauma alerts, and I for one was offended that my call was discounted and judgment piled up with all those who have poor judgment.

It seems from your first post, the hospital is not pulling the "trauma alert" but rather just changing who calls the trauma alerts.

By having a physican calling the trauma alert instead of the "emts" in the field should not jeopardize your patients. You should be able to communicate effectively the need for a trauma alert to a physician by following the trauma criteria or effectively describing mechanism of injury. Most trauma alert criteria is so specific, they leave little to be disputed and that is for the protection of all including patient and provider. Since I do not know what state you are in, I do not what protocols have been established by your state wide trauma system.

Florida has a very detailed system, as do most states, to outline the specific trauma alert criteria. It may even vary in a couple of systems as to whether a Paramedic, an onscene Trauma Officer or a physician calls the trauma alert. The trauma system is there for the patient, and providers regardless of title abide by it to activate a trauma alert appropriately.

http://www.doh.state.fl.us/demo/trauma/index.html

http://www.doh.state.fl.us/demo/Trauma/protocols.htm

It sounds like you are taking this very personally without any hard data or would like everyone to agree that you and not a trauma physician is more qualified to make the call for a Trauma Alert. There may have been several incidents to back up their decision if it is more than a rumor or just speculation.

[Just Plain Ruff]

My apologies ruffems,

In my little peabrain, the world does not exist beyond the confines of my own bandage shears. When I said industry wide, I meant my own state. Clearly, destroying trauma notifications for the entire country would have devastating effects on our pt.'s

I agree that there are certain hospitals and certain client bases that rely heavily on early trauma notification to allow their teams to get ready. I also agree with some of the early posts that there are some services, and more narrow, some providers, that have no business calling trauma alerts. I am simply stating that it's an overreaction of some beaurocrats to pull the ability to call trauma alerts, and I for one was offended that my call was discounted and judgment piled up with all those who have poor judgment.

No apologies needed my friend. I was just trying to get a handle on the industrywide speculation comment, was it your area or nationwide which you answered very succinctly.

It appears that having a physician call them is not a bad idea especially if there were lots of trauma alerts that were called which never never should have been called. All you can do is recommend a trauma alert or give the doc what you have and let him make the call.

If he doesn't call the alert and things go sour for the patient then who's butt is on the line, not yours unless you didn't give him all the info.

[Dustdevil]

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.

ROFL!!!

You've been in EMS for seventeen years and still believe that anything that is protocol must be the gospel? :shock:

Have your protocols not changed in seventeen years? Are you still using MAST trousers and bretylium? Two amps of bicarb and calcium? Of course protocols change. Even the venerable "Golden Hour" theory has been found to be baseless. Things change because it is found that they weren't correct to begin with. That is progress. It is nothing to be feared. So why is this particular situation any different? Why would you emotionally cling to something that you have no scientific evidence to validate? Gut feeling? I honestly hope that is not the attitude that you pass on to your students, or you're teaching them to be part of the problem instead of part of the solution.

[Asysin2leads]

Does anyone know the criteria for a Level I trauma center? I don't, and its a rhetorical question, but it includes things like having whole plasma on stand by and in-house neurosurgeons. They are very picky about this stuff. If someone like JCAHO was to ask "Exactly why did the trauma patient succumb?" The answer really should not be "Well, EMS didn't call in a notification."

[Just Plain Ruff]

the criteria for level I's in missouri are the same as level II's but they have less time to get in.

I believe that they have to have in house surgeons 24 hours a day.

But I totally agree that a patient dying because of no ems notification would not fly in any type of court case.

[BEorP]

Clearly, destroying trauma notifications for the entire country would have devastating effects on our pt.'s

Well no, not so clearly... that is why you have been shown studies that back up my point but have said nothing except that you are a superior provider so your judgement is best. That doesn't fly.

[jsadin]

http://www.amtrauma.org/news/news_detail_597.html

A level I facility is a regional academic trauma center and must meet much stricter criteria than a level II center. These requirements include a general surgery residency program, research in trauma, a cardiac surgery program and microvascular and replantation surgery. For 24 hours a day, the center must have a dedicated operating room, surgical personnel and a surgical intensive care unit (ICU) physician. The designation also requires a surgically directed and staffed ICU service, in-house computed tomography scan technician, magnetic resonance imaging, acute hemodialysis, a minimum annual volume of patients and extramural trauma educational activities.

[VentMedic]

The answer really should not be "Well, EMS didn't call in a notification."

But I totally agree that a patient dying because of no ems notification would not fly in any type of court case.

Now that would be a problem for EMS not to notify the hospital they were bringing in a trauma, a cardiac or any seriously ill patient.

If EMS notifies the hospital and a good report is given with the trauma criteria stressed, the physician then activates the internal trauma alert. Likewise it should be the physician's choice to ask the Paramedic who might be calling a Trauma Alert what they are basing it on. Hopefullly, the Paramedics will keep their emotions in check and offer a professional relay of information without attitude.

Having a trauma physician calling the alert does not mean the patient is getting any less care. It just means there may be a better use of the hospital resources and personnel. Not everyone if anyone is in a sleep room just waiting for that "Trauma Alert" from the paramedics.

A trauma center will have most of the essential personnel inhouse to get the party started. By the time the necessary tests are done, all players should be in place if needed. On a busy shift in a trauma center, resources can be stretched thin by unfounded "Trauma Alerts". Think of it as all those ambulance calls that you don't believe warrant an ALS Rescue but you must respond because someone called 911. Not every call requires a trauma surgeon and 6 other team members immediately at bedside. Many of these team members are leaving the bedsides of other critically ill patients only to find the "Trauma Alert" patient has no immediate distress and will probably be triaged to the general ED for the rest of their workup.

[Chief1C]

Protocols were made to be tweaked.