Investigated Because They Did Not Start The I.V. Enroute To Hospital

[romneyfor2012]

I would be interested to know if the receiving facility even had a surgeon in the house, it was a non-trauma center in bad weather conditions. If not, 3-5 minutes would not have mattered (it would not have mattered anyway as 99% of trauma arrests die). With that being said, many years ago, our local trauma hosptial who also was the EMS provider for that area did a study and found that patients with penetrating trauma who were transported by car instead of ambulance arrived at the ER much faster (can not remember exact time difference, this was before we adopted "load and go" into our practices) and had better outcomes statistically. Which makes sense in that if everyone does their job perfectly, the car would at least have an 8-10 minute head start on you, and would probably transport at a higher speed than we would.

[Just Plain Ruff]

I would be interested to know if the receiving facility even had a surgeon in the house, it was a non-trauma center in bad weather conditions. If not, 3-5 minutes would not have mattered (it would not have mattered anyway as 99% of trauma arrests die). With that being said, many years ago, our local trauma hosptial who also was the EMS provider for that area did a study and found that patients with penetrating trauma who were transported by car instead of ambulance arrived at the ER much faster (can not remember exact time difference, this was before we adopted "load and go" into our practices) and had better outcomes statistically. Which makes sense in that if everyone does their job perfectly, the car would at least have an 8-10 minute head start on you, and would probably transport at a higher speed than we would.

I think there are a couple of reasons why patients who got loaded in the car had a better out come.

1. They were thrown in the car and driven directly to the hospital thus saving the waiting time for the ambulance to get there, assess, load and go and drive to the hospital. The wait time, the assessment time and the load and go time were cut out.

2. The patient didn't have to rely on the medic to be the one that doesn't dick around on scene.

3. If a crime scene the patient didn't have to wait for Police to clear the scene before letting the medics in. Saving a few minutes.

4. The speed of the car would be much faster than the speed of the ambulance for obvious reasons.

[DwayneEMTP]

Even the term 'load and go' can be an issue when considering whether or not too much time was spent on scene.

When I was new at another service we were dispatched to motorcycle v guard rail, reportedly at high speed. Arrived on scene to find a 50ish y/o male packaged with spider straps, fully clothed, leathers and all, to a long board by fire. multiple breaks to arms and legs, about half of his face left of the pavement, unresponsive.

They'll yelling "Go! Go! Go!" but as they lift the board I can see blood running off of it at a pretty good rate. I asked, "Where is all of that blood coming from??" Fire chief says, "Just fucking drive God damn it!" Classic load and go, right? I grab a radial pulse and get nothing. Carotid is thready and very rapid.

We set the board on the cot and I start ripping off spider straps, my partner pulls out his shears and starts taking off clothes. Fire had done a good job of putting all of his parts back into anatomical alignment before strapping him down, but they didn't asses anything. He has a compound fracture (or whatever it's called now when fractured bones protrude through the skin) of his L tib/fib as well as his L femur, which is just pouring blood. I'm guessing that the femoral artery is involved based on the flow rate of the blood. He had many other injuries, but these were the most critical.

We get him naked on the side of the road in about 30F weather, (heater is blasing lava temp air in the box) I put on a tourniquet above the femur fracture, get him untangled from his clothes, re strap him and load him up and do the rest of treatment enroute.

Get bilat IV with blood tubing hanging, try and pack the femur lac so that I can release the tourniquet but there's no chance that I can pack it well enough in the time that I had to make much of a difference and still do the other things I need to do.

We hand off to the ER, fire is majorly pissed off and complains to anyone that will listen, including my boss, my medical director, the ER doc, and the family of the man being treated, (You would have been very proud of them Flaming!) that if this guy dies it will be because of my paragod attitude.

Anyway, it turns into a major clusterfuck for providing what appears to me to be a logical course of treatment. But my medical director saves me in the end.

Now, there are likely some here that have more experience than I do, that will say, as fire did, that they can cut clothes off of a trauma around the spider straps, and in the ambulance, just as fast as without them, and on the side of the road. I won't call bullshit on that, but will say that I can't...it just takes to friggin' long with the straps on and in the ambulance on a critical patient and I believe that it may have killed this guy if I'd tried to do it. As well in that confined space with the straps on there is just so much more pt manipulation necessary, in my opinion.

Anyway, this is a great conversation. I've never really tried to define load and go in my own mind before as I just don't tend to think that way. It's an interesting exercise trying to do so now...

Dwayne

[Vorenus]

Now, there are likely some here that have more experience than I do, that will say, as fire did, that they can cut clothes off of a trauma around the spider straps, and in the ambulance, just as fast as without them, and on the side of the road. I won't call bullshit on that, but will say that I can't...it just takes to friggin' long with the straps on and in the ambulance on a critical patient and I believe that it may have killed this guy if I'd tried to do it. As well in that confined space with the straps on there is just so much more pt manipulation necessary, in my opinion.

Well, if you won`t - I will. Can`t imagine that to be possible.

There is, without a doubt, a certain group of patients that would/will benefit of a strict Load and go tactic without any treatment - there is however also a large group, that will benefit by initially treating life-saving conditions, on which they may not have survived the travel to the ER, or at least the outcome would have been worse. Problem is, only by a quick initial survey, you can determine which pt. is which.

Edited December 21, 2011 by Vorenus

[Just Plain Ruff]

DWayne, didn't they teach you in EMT School that load and go trumps fixing the life threats any day of the week?

Sounds like had you not have found the art bleed the patient would have been bleeding pink fluid.

I had a similar incident with a motorcyclist who hit a metal sign post at 45 miles per hour direct in the middle of his spine. On fires arrival all I could hear on the radio was "hurry the hell up EMS" The guy was basically bent in the middle of his spine at about a 40 degree angle. Any movement of any sort elicited major pain screams.

On our arrival found that fire was trying to package this guy the normal way by packing under his back enough towels to keep the spine in the allignment in order for me to put him in the ambulance and going. I disagreed with their thought process.

I told them to stop and they got really pissed. We ended up packaging him on his side with lots of padding to support his spine (he severed his spinal cord at t9).

Would their packaging have caused more harm than good, can't tell for sure. But I say mine helped him more because my method decreased his pain while their method of packing him was causing him extreme pain.

[DFIB]

DWayne, didn't they teach you in EMT School that load and go trumps fixing the life threats any day of the week?

Sounds like had you not have found the art bleed the patient would have been bleeding pink fluid.

I had a similar incident with a motorcyclist who hit a metal sign post at 45 miles per hour direct in the middle of his spine. On fires arrival all I could hear on the radio was "hurry the hell up EMS" The guy was basically bent in the middle of his spine at about a 40 degree angle. Any movement of any sort elicited major pain screams.

On our arrival found that fire was trying to package this guy the normal way by packing under his back enough towels to keep the spine in the allignment in order for me to put him in the ambulance and going. I disagreed with their thought process.

I told them to stop and they got really pissed. We ended up packaging him on his side with lots of padding to support his spine (he severed his spinal cord at t9).

Would their packaging have caused more harm than good, can't tell for sure. But I say mine helped him more because my method decreased his pain while their method of packing him was causing him extreme pain.

I bet that guy needed a lot more than a blanket to keep warm!

[Just Plain Ruff]

Actually the call was in mid july. So he didn't need any warming the temp I think was enough to make me sweat through my shirt.

Needless to say, I emptied my narc box out prior to getting him to the helipad

Edited December 22, 2011 by Captain Kickass