Multiple patient, single ambulance transport scenario..

[ambodriver]

I would have transported them both. Horrible spot to be in friend.

[fiznat]

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.

I donno man, its impossible to say without being there. If you thought these patients were altered I can't argue with your decision. Just the way you described them here, in type, it didn't seem like a whole lot was there. It is difficult to communicate these things in this format though.

To sorta answer your question-- if the patients were both alert, reasonably responsive (considering the circumstances), with a normal (complete) neuro exam and stable vitals, yeah I'd wait. I won't take the risks of a two patient transport (HIPPA, unconventional/possibly ineffective restraints, distractions to medical care, etc) unless I think it is a true emergency and there is absolutely no other alternative. If that was your mindset on this call, I don't see how anyone could fault you for what you did.

[DFIB]

Nope. Don't think I would wait.

[Chief1C]

We had to transport 7 ppl from a CO poisoning incident w/ two ambulances, quite a while ago. Hotter than the blazes of hell outside, late at night. Good night to sit outside, power went out. These folks put a generator in the bedroom closet to run an AC unit. Darwin Award. Two unresponsive went in one unit, and five in the unit I was with. Used an MCI Minilator and a second oxygen cylinder that we stuffed under the bench seat, strapped to a short board w/ blankets to keep it from moving. Tried to get more units, but nobody else responded.

[RaceMedic]

Tried to get more units, but nobody else responded.

WHAT !?!?!?!

[ambodriver]

We had to transport 7 ppl from a CO poisoning incident w/ two ambulances, quite a while ago. Hotter than the blazes of hell outside, late at night. Good night to sit outside, power went out. These folks put a generator in the bedroom closet to run an AC unit. Darwin Award. Two unresponsive went in one unit, and five in the unit I was with. Used an MCI Minilator and a second oxygen cylinder that we stuffed under the bench seat, strapped to a short board w/ blankets to keep it from moving. Tried to get more units, but nobody else responded.

I work in a very large city, this is crazy to me. i can't understand---I always have resources.

Sounds like you did the best with what you had. That's all we can ask. Strong work.

[Chief1C]

Shit happens in rural areas, just gotta deal with it as it comes...

[BushyFromOz]

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

LOL

I dunno dwayne, given the restriction of our sprinter vans and the dimensions they are and the size of the kids in question im not sure i can fit 2 kids on it, though i deffinately know i cant restrain them if i could get them on it.

The ethical part of me says i cant actually down triage either of them.

The altruist in me says i have to help both and so one of them is going to get placed in a KED and sat up in a seat, but i cant get 2 treating officers in the back if the kid is in the second chair in the back, and sitting up front next to the driver aint going to work eiher

The resource allocation part of me says i should split my crew, steal a driver and transport one to the chopper and wait on scene with the less critical kid

The MCI part of my brain says i should either create a staging area where we are and wait, or, ferry the patients to the chopper pad in 2 trips and stage there for addition resources.

I dunno man, its not really a problem i'm likely to have. This question actually gets easier if their were 5 or 10 patients, the lines gets a bit blurry with only 2.

so....

At this point in time im going to say i would KED one of them and place it in a jump seat and board the other one on the stretcher and treat with diesel, but until im confronted with the same situation, i wont gurantee i will make the same decision in real life.

<<< EDIT>>>

What sort of time frame are we talking about in regards to reaching an appropriate level of trauma service if we

A ) wait on scene for the second unit

B )send one on the chopper and wait for the second unit

C ) Start to transport both ourselves and meet the second vehicle on the way?

And Bushy, thanks for participating in the spirit intended. Many of these calls look cut and dried until you see them through the eyes of others.

Dwayne

No problems man,

Edited October 20, 2011 by BushyFromOz

[DwayneEMTP]

From a learning perspective, what an excellent post. I love how it walked through the 'What if, but if that changes, what then, but what if I do this instead?" of EMS.

...What sort of time frame are we talking about in regards to reaching an appropriate level of trauma service if we

A ) wait on scene for the second unit

B )send one on the chopper and wait for the second unit

C ) Start to transport both ourselves and meet the second vehicle on the way?

Second unit if it left from quarters is probably an hour twenty out as the weather is making the roads muddier now. But it can't really leave from there or it leaves the town uncovered so there would need to be the back up, back up ambulance called out. So likely an hour 30 or hour 45 for the second ambulance to arrive, and hour 20-30 for it to return to the local hospital, 20-30 mins for transfer on to the FFL helicopter if it goes per usual, and 45 mins to a trauma center.

So, waiting, lets say, 4hrs to difinitive care.

If I take them and run, (Though it worked out differently) say, 2hrs 15-30 mins or so. Unless I run past the hospital/helicopter and take them on my own, though the time would probably be about the same.

And both kids fit on a normal LBB without significant issue. The problem was that I didn't trust anyone else to drive for us on the muddy mountain roads, so was forced (in my opinion) to have my partner drive and provide care for both patients on my own.

Not sure about the boy, though I think that he was in ICU for a while at a childrens hospital, but I believe that the girl died.

Though again, both were hearsay.

I work in a very large city, this is crazy to me. i can't understand---I always have resources.

Sounds like you did the best with what you had. That's all we can ask. Strong work.

Thanks.

And I seem to have been noticing a different tone to your posts lately. Good to have you here man...thanks for playing.

Dwayne

Shit happens in rural areas, just gotta deal with it as it comes...

Always some bullshit words of wisdom as opposed to any type of thought out response...

C'mon man. Sack up and put yourself out there a little bit. You might find that you actually have something to contribute.

Dwayne

[WelshMedic]

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

Dwayne,

You get my vote as that is exactly what I meant by topping and tailing the kids on one cot/backboard. I can't see any other workable option that would benefit both these kids in your scenario.

Uder Dutch law, we are not allowed to convey more than one pt. anyway but I will sometimes make an exception for someone with an extremity injury. That's the joy of the job, adapting to each individual case.

WM