Quick trauma assessment question

[DesertEMT]

I have a real quick question about the trauma assessment portion of the licensing test. Would I be faulted for requesting ALS support if it turns out I don't need it? Like say, I prioritize a patient as a high priority but during my rapid trauma assessment I'm able to within my scope fix any life-threats?

[CPhT]

I have a real quick question about the trauma assessment portion of the licensing test. Would I be faulted for requesting ALS support if it turns out I don't need it? Like say, I prioritize a patient as a high priority but during my rapid trauma assessment I'm able to within my scope fix any life-threats?

I'm not that high of a level, and not sure how that portion of your testing works, so this is pure opinion here. If you were on a scene on the job and felt the need to request ALS support, would you do so? Then, upon further assessment/ treatment, found that you were able to handle the situation, what would you do?

If I were responding to a scene where my scene size-up and rapid assessment led me to believe that ALS would be more beneficial, I would call for ALS backup or an intercept. However, if they had a long ETA and I was ready to head for the hospital, I would cancel the ALS unit and just go.

Again, that's just what I would do. That may or may not help you on your exam.

[adp87]

I am testing on saturday, and as far as I know, it wouldn't hurt you. According to your book, requesting additonal help comes before your primary assessment. As an EMT you are BLS, it never hurts to call for ALS backup should a problem arise. It would only hurt you if you decided not to call and later found a life threatening issue and it was too late.

[systemet]

I am testing on saturday, and as far as I know, it wouldn't hurt you. According to your book, requesting additonal help comes before your primary assessment. As an EMT you are BLS, it never hurts to call for ALS backup should a problem arise. It would only hurt you if you decided not to call and later found a life threatening issue and it was too late.

I realise this is a question about testing, but for what it's worth, in a real life situation, I'd far rather a BLS crew call me for an assist and end up doing nothing, than have them not call me and have the patient injured by something I could have prevented / treated / mitigated. I admit that some paramedics feel differently.

[Richard B the EMT]

Due to availability of ALS where I am at, here in NYC, the FDNY EMS policy is, in my words, "When in doubt, give a shout". Call for ALS, and if they have not arrived by the time you're loading, the department's policy is to decide which is the shorter time, the ETA of ALS to the call location, ETA to an intercept point, or your ETA to the ER with no ALS.

I had a run where my ETA was 90 seconds from scene to ER, and the ALS was a minute behind me. They turned in on one end of the block, and saw my lights leaving the other end of the block. They were upset that I didn't wait for them, but my Lieutenant and Captain supported my partner and me in the decision.

[Just Plain Ruff]

Due to availability of ALS where I am at, here in NYC, the FDNY EMS policy is, in my words, "When in doubt, give a shout". Call for ALS, and if they have not arrived by the time you're loading, the department's policy is to decide which is the shorter time, the ETA of ALS to the call location, ETA to an intercept point, or your ETA to the ER with no ALS.

I had a run where my ETA was 90 seconds from scene to ER, and the ALS was a minute behind me. They turned in on one end of the block, and saw my lights leaving the other end of the block. They were upset that I didn't wait for them, but my Lieutenant and Captain supported my partner and me in the decision.

So the patient would have been delayed by a medic getting all his stuff out rather than the ER having all their stuff along with higher trained people than medics already there. and your medics were pissed. you did the right thing Richard. Piss on those medics.

So why were the medics pissed? I"ll bet it was one of those awesome once in a lifetime calls that many medics never get to see wasn't it.

[Chris Taylor]

In my classes so far, We've had "Call for ALS back-up, if you end up not needing them, great, you can always cancel." We've also been taught that you can always meet up with ALS somewhere if you feel that you can't do what your patient needs.

[Richard B the EMT]

Capn C, the call was a Cardiac Arrest from a nursing home rumored to hold off CPR until the ambulance crew arrives on the floor. How else could we be sweating up a storm after 30 seconds, when they supposedly have been doing CPR for the 4 minutes we were in response mode, but are appearing clean and non-disheveled?

[P_Instructor]

I have a real quick question about the trauma assessment portion of the licensing test. Would I be faulted for requesting ALS support if it turns out I don't need it? Like say, I prioritize a patient as a high priority but during my rapid trauma assessment I'm able to within my scope fix any life-threats?

Part of the exam is the realization that 'other' services may be needed. For the EMT crew, it is always better to call and cancel if needed. The cognitive part of the testing is that you are prioritizing and thinking (as well as stating) that ALS services may be needed, or at least 'additional help' dependant on the scenario.

When taking the psychomotor exam, perform AND verbalize everything. It's like documentation, if you didn't write it down, it wasn't done.......if you didn't verbize it, and the examiner didn't see it, it wasn't done. A good examiner should be able to follow, write down, and observe all at once, but this usually never happens.

Best action is to not leave any doubt. again say and do together.

[Kiwiology]

1. Only call for back up if the patient requires or is very likely to require an intervention you cannot provide

Calling for back up because the patient looks "unwell" or "they have tachycardia" is probably a waste of time. What does your patient need that you cannot provide? If your patient is "unwell" is it because they have a cold for which your back up has nothing or is it because they have decompensated septic shock and need fluid, inotrope and antibiotics? If your patient has "tachycardia" is it because they're a bit upset for which your back up has nothing or is it because they have monomorphic ventricular tachycardia for which they require cardioversion?

2. Meet back up en route unless the patient is unmovable or moving toward hospital will move you away from back up

Begin moving the patient toward hospital rather than staying at the scene. Only wait at the scene if you cannot extricate and transport the patient (for example pain, trapped, cardiac arrest) or your backup is coming from the opposite direction to hospital

3. Call for back up only if they can locate faster than you can deliver the patient to an appropriate hospital

If it is going to be significantly faster to deliver the patient to an appropriate hospital vs waiting for backup then transport the patient unless you can't begin to transport your patient because e.g. they are trapped, in cardiac arrest or require pain relief

4. Helicopters take time, call a helicopter only if one hour or more from hospital by road and patient is time-critical

Helicopters are over-rated and over-used. There is little evidence that helicopters make a difference in determining positive outcome on morbidity and mortality. Helicopters also take time and in many cases transporting by road is faster. You need to be more than sixty minutes from a hospital before helicopter transport will significantly reduce the total time it takes to transport the patient to hospital, unless a helicopter has already been dispatched or extrication is going to be very prolonged.

Edited March 7, 2012 by kiwimedic