Multiple patient, single ambulance transport scenario..

[akflightmedic]

No, this was the days before we abused HEMS...we drove a LOT of patients back and forth, many very critical (burns, trauma, medical, you name it). So your "stable" guess is wrong....know much about nipride drips?

Just trying to generate some discussion on the "impossible" or "not allowed ever" thinking which is prevalent in a lot of our new or inexperienced providers.

[RaceMedic]

No, this was the days before we abused HEMS...we drove a LOT of patients back and forth, many very critical (burns, trauma, medical, you name it). So your "stable" guess is wrong....know much about nipride drips?

Just trying to generate some discussion on the "impossible" or "not allowed ever" thinking which is prevalent in a lot of our new or inexperienced providers.

I admit my inexperience with Nipride, I am familiar just none of the services i have worked for used it that or i did not have the opportunity to use it.

I was not referring to HEMS. Personally, I feel that HEMS has very little value in IFT where i am. we have one rotor in my area now that the company operating it has to create situations for it to be used. but to give you an idea, in my area we have 5 fixed wing and 1 rotor (soon to be two, unfortunately) in a 75 mile radius. Ground is the norm here for IFT unless they are extremely critical then they fly fixed wing. Rotors do not do scene flights here. they are to slow compared to ground and have nothing else to offer treatment wise over our ground protocols for emergent response.

Just for a little background, My area is 4 - 5 hrs by ground or 1- 1 1/2 hr by air to the nearest level 1 trauma or full service cardiac care center with 24hr cath lab and/or cardio-thorasic surgeon. I know it is not the farthest from care or the most remote by comparison but i very seldom will refer to HEMS. It has its place just not where i am . ohh and i keep forgetting to add there are no level 2 or 3 trauma centers between the level one's and my area.

in the spirit of your post (that had to point out to me, ) i will gracefully sit back on the sideline.

Race

Edited October 23, 2011 by RaceMedic

[chbare]

A cardiac patient on multiple infusions is not stable. This is a critical patient that requires all of my attention. I'd call the crash in and continue with the transport. I'm sure I'll get flamed a bit, but I'm not a miracle worker and I'm already busy with a critical patient. Life can suck like that sometimes and we have to make hard calls. That is my call for better or worse.

Edit: Call it as soon as I had radio contact.

Edited October 23, 2011 by chbare

[RaceMedic]

. I'm sure I'll get flamed a bit, but I'm not a miracle worker and I'm already busy with a critical patient. Life can suck like that sometimes and we have to make hard calls. That is my call for better or worse.

Edit: Call it as soon as I had radio contact.

Im not gonna flame ya, You called it when you said "That is my call for better or worse" I know many others would do the same thing and there is nothing wrong with your decision.

Race

*edit*

The difference is you have the cojonies to stand up and say it in an open forum when the consensus has been to lean the other way thus far.

Edited October 23, 2011 by RaceMedic

[zippyRN]

very very few vehicles couldn't take second patient ( the exception is extrication ambulances based on medium to large SUVs where there simply is not room by any measure unless they are well enough to sit in the front passenger seat ), the issues arise from securing that second patient in the vehicle especially in vehicles without a bench or a lie-flat option on the side seats ...

while it's very rare in the UK to have to wait prolonged periods for additional resources and the RN and RAF SAR helicopters ( plus other military helicopter resources) are happy to respond to inland incidents etc - so if HEMS (single pilot + air observer trained medics VFR apart from Helimed 27 (London) who fly twin pilot) can't make it due to weather there's a chance that the military will with IFR and Night vision and their 2 pilot 4 person ( 2 WSOp / loadies )crew

[Chief1C]

A bag of large carabiners, a roll of 1" webbing, backboards, reeves, folding stretchers (the orange, maroon, green, black things w/ or w/o wheels and posts)...and a fricken school bus. Instant ambulance.

[DwayneEMTP]

So you slow to look at the scene, whether you (general) choose to stop or not remains to be see, but at least looking in so that you have some half way decent information to radio in seems prudent...

What do you see when you stop/slow down ak? It might help to add some perspective.

Dwayne

[akflightmedic]

You see an upside down vehicle with a person still inside vehicle, very minimal movement.

[Just Plain Ruff]

I agree and so many people are just never exposed to the other side of the coin. This thread has caused me to reflect over the many things I have done in years past which were "out of the box" or completely "unfathomable" to most urbanites. I have had the benefit of working so many systems: city, rural, austere/remote, flight, 3rd service EMS, Fire Rescue....it has all been a huge eye opener and was only made possible by my desire to never become stagnant.

I wanted to share a call from an IFT job many moons ago. I was transporting a cardiac patient from a small hospital to the big city hospital which had the services this patient required. He was on multiple drips, pain free and being monitored. I was with an EMT partner who was driving. In the middle of this transport out in "the sticks" on a not so well traveled 2 lane highway, we came upon an overturned vehicle.

I have a cardiac patient on board and we see a single vehicle roll over. This area is about 35-40 minutes from the closest unit provided it is not already on a call. I do not see another vehicle in sight and radio comms are NOT working. This was also when cell phones were relatively new and too expensive for me to own one. (Probably would not have been good coverage anyways--hard for some of the younger providers to remember/imagine these days)

What would you do?

Have the partner stop the ambulance. Have him get out, walk to the vehicle and look.

IF you see a patient then the partner gets to go to work.

If he can get him out, then he can do something to help him. If he's trapped then he's gonna be in the car for a while.

Depending on severity of the patient depends on what happens to that patient.

Can't put the emt in back to watch the als patient can ya?

So your partners on his own at least till a car drives up. Then put the driver of the car (if possible) to work with the partner.

Sometimes you just cannot help everyone, no matter the fact that you want to, there's just times when you have to help the one who stands a better chance of being helped and for me that's the cardiac patient I'm transporting.

Edited October 24, 2011 by Ruffems

[chbare]

Partner is a basic I believe? They cannot watch the patient. I'd keep going, but understand that will not sit well with others.