Multiple patient, single ambulance transport scenario..

[fiznat]

The easy solution here seems to be to simply talk to the parents of both children and get consent to transport together. (Assuming you are capable of transporting them both safely, and doing so will not cause danger to yourself or either patient.)

That said, am I missing something? Unless you purposely left out relevant positives in your assessment, these kids don't seem that sick. If parents couldn't be contacted, what was the clinical reason these kids couldn't wait for more resources to arrive? I understand its a chaotic scene at all, but medicine should also be a part of the decision here. What specifically do we think is wrong with these kids?

Edited October 19, 2011 by fiznat

[Happiness]

Right now if I had to

Most critical on the stretcher

Next on a #9 on the bench strapped in with bench seatbelts

If needed I can put a very stable pt in the captians seat and one up front with the driver.

Before we got the big box we had the van style (i sure miss it) and I did have a call that was 1 adult with 5 children, flip and land in a water filled ditch. Only service was us and one 1 hr away. the adult and two children went with me as follows due to injury severity

Adult on the stretcher full spinal internal injuries

One child on #9 on bench Full spinal internal injuries

One child on #9 chained to the roof (when you could do that stuff) this pt was the noisest and the least injured out of the 3. Still was a spinal and the reason he went with me (as 2 were pretty close in severity) is he has already developed seat belt bruising over sternum area, the other child had moved the shoulder strap so it wasnt over him. They all had great vitals through out the 1 hr transport and all turned out okay. The other 2 children stayed and waited for the other ambulance and they made it just as we were leaving.

All I can say about transporting pts is that we need to have the ability to work outside of the box and sometime the unconventional is the only option.

[fiznat]

One child on #9 chained to the roof

Haha wow.

[akflightmedic]

The first box units I worked out of were 3 stretcher patient capable....one on the cot, one on the bench and above the bench seat there were 2 or 3 hooks which folded down and would accommodate a 3rd patient on a backboard.

[ORmedic65]

In this situation I would have taken the most critical on the stretcher, and the other would be on a backboard, strapped down to the bench. I've taken two patients in one ambulance multiple times during my short time in EMS so far, it's not all that uncommon around these parts. We actually had a car wreck last week with 6 patients, only one critical, where our backup unit was able to take 2 patients, we took the most critical, and fire transported the rest in their rigs.

[RaceMedic]

All of the 911 units i currently work for are equipped like that AK. We do not have a rotor in my area right now but will be getting one soon, but thats a different story.

In the description you gave Dwayne, I would have no choice but to transport both. One on the cot and one on the bench. However in that instance either an LEO or Fireman would be pressed in to service driving as myself and my partner would be in the box caring for the PT's.

Race

[DFIB]

_{I would take them both. The boy on the stretcher and the girl in the carseat unless she is already strapped to a backbord.}

_{I once had a MVC With a DOA in the back seat. One crushed thorax and two that were deambulating freely. one had a bump on his head and the other had a broken radius. The guy with the broke arm rode in the capitans chair. One on the stretcher and another on the bench. All were belted in. Closest hospital was 30 min away. The only people with chopers here are politicians, military and police so lifeflight is a no go.}

_{MCI Emergencies demand prioritation of risk benefit.}

[DwayneEMTP]

I have taken 4 patients in one ambulance...have also taken 3 on several occasions. Taking 2 was quite common and routine where I worked. As ERDoc said, most have no concept of the necessity of those situations until they live/work in an area where it demands such. It is never black/white.

...In Dwayne's case, it is clearly an MCI. Where I'm from it is just another call.

...well mate, my decision is made for me bcause my vehicle only has one stretcher and no bench seat...

Man...see, this is what I love about you guys. While you state that many have no concept of ever needing to transport two patients in one ambulance, I truly had no idea that there were places where that wasn't a common reality...having never worked big cities...Pretty cool...

Welsh and Bushy, what about two patients, one cot? (No, that's not a gross out video.)

And, of course, I did take them both. But I did choose to take them both on one cot only because I really had no idea what was truly going on with either so was afraid to let either one be out of my view for long. So I put the boy, who was strapped to the L/B on the cot, the sister who was secured in a KED with their legs next to each other, strapped the hell out of them and away we went.

As it turned out we got a hole in the weather, Flight for life notified us that they believed that they could get much closer if we wanted them to. I really wanted them to. They landed about 15 minutes away, took the kids in my original configuration and away they went.

Of course, different decisions may have been made had my crystal ball been functioning properly, but I doubt it. But I'll never forget FFL choosing to stay on top of the call and notify me when they felt that they could punch through a hole in the weather instead of just sitting at the warm hospital drinking coffee. It would have all paid the same for them...

I love remote medicine for the challenges of being 'stuck' with really sick and/or injured people, but long transport multisystem/head injury trauma can kind of freak me out. Not literally, but enough that it takes the fun out of it. There is just so much going on, much of it you have to be theoretically aware of all the time if you're going to catch the physiological markers quickly...I'm not so good at that often. In this case, I just wanted smarter people to take these kids off of my hands...

But one thing was for sure, neither of them was staying home, and neither of them was going to sit still waiting for add'l help...

Thanks all.

Dwayne

[RaceMedic]

Flight for life is a great service !

[DwayneEMTP]

The easy solution here seems to be to simply talk to the parents of both children and get consent to transport together. (Assuming you are capable of transporting them both safely, and doing so will not cause danger to yourself or either patient.)

That said, am I missing something? Unless you purposely left out relevant positives in your assessment, these kids don't seem that sick. If parents couldn't be contacted, what was the clinical reason these kids couldn't wait for more resources to arrive? I understand its a chaotic scene at all, but medicine should also be a part of the decision here. What specifically do we think is wrong with these kids?

Yeah, that's why I mentioned that I was going to relay it in gross terms only. I was assuming some type of cerebral damage in both. I wasn't sure, but that was my working assumption. The girl from blunt trauma. Her unfocused crying and what appeared to me to be a retarded response to my touching her eyelid led me to worry about that. (again, speaking in gross terms)

The boy, with the injuries described, should have been much more animated in my opinion. I actually wondered if being squeegeed between the bike and the frame of the trailer could have cause a temporary, severe cerebral hypertension doing some type of damage. And his baseline resp rate was retarded..that result had to be produced somewhere.

But if we remove the possibility of cerebral trauma, the MOA combined with the noted injuries cause me significant concern that though I had no immediate, objective, indication, that the index of suspicion was very high for an acute abd. Plus, an add'l two hours min from definitive care secondary to nothing more than the injuries to his hands and knees seemed irresponsible.

But I am curious...given only the information provided here, given the best case scenario to be extrapolated from the s/s presented, you would have waited on scene for over an hour for a second unit? A question, not a challenge.

Dwayne