Philly police transport trauma patients.

[paramedicmike]

This was an interesting article in the Philadelphia Inquirer.

Just thought I'd throw it out there as an FYI. If you're interested in commenting you know what to do.

[BillKaneEMT]

Ok. 50 rigs for the whole damn city with fewer at night? That seems low to me. I wonder if that's just PFD rigs or what. I could be off on that but with 50 rigs doing 250000 calls a year.... Hmmm. I guess... That would average out to 14 calls per day if every day was perfectly equal in call volume. Which it isn't. What do you guys think? I'm glad the patient and her baby lived and depending on the ETA I can't say I wouldn't have made the same call if I were that officer. As for the larger ramifications, maybe the city needs to buy some more rigs and hire more medics. My numbers may be wrong but I just think that sounds low.

[paramedicmike]

The city only allows PFD medic units to cover the city. Those numbers you see are pretty accurate. The math you did is pretty accurate. Talking to guys I know who work in the city 14 calls a shift is an easy shift.

They've tried to hire more medics. For a variety of reasons it has never worked out.

[BillKaneEMT]

Yar. It's not that I think 14 calls isn't workable in a shift, it's just that I doubt they're evenly distributed. If I have 7 calls on a slow day I might have 21 tomorrow. They just said a quarter mil a year and while that may be workable most times what happens on the 4th of July? That town goes nuts on Independence day and I can imagine what happens when they get 1500 calls in a shift. 30 calls in a day per rig? I'd be worried if I had to try it. We're never that busy here. I admire the guys that stick it out in a place like that.

Obviously I have no inside info regarding the city budget or anything but it may be a good idea to look into buying some new rigs and adding some medics if they can. I saw that you said they've tried it and if it doesn't work then... I guess the police might have to keep doing gsw transports themselves if it's critical? Without a ground level view of the ems situation there I can't think of a useful solution. I wonder if their police have anything beyond first responder training? We have a number of EMT-B's and a few medics as well on our local and county departments. Maybe the city could offer free classes and an incentive for officers who get certs? Just tossin ideas around, I have no idea how practical that would be.

[paramedicmike]

The cops show up, throw the patient/victim/person into their vehicle and haul arse to the closest trauma center. There is no care provided en route. As such, there really isn't much need for formal EMS training for them.

It's been something they've done for at least 20 years as noted by the article. So it seems that what they've been doing has been working.

I have pretty much nothing good to say about the PFD as it relates to running EMS. There are some good providers working there. But the city, and the system, are beyond broken.

[DwayneEMTP]

I think with significant trauma it's probably not a bad plan. But it should be a stopgap measure instead of a formal plan for EMS support.

And I do think that there is a significant amount of EMS training necessary if this plan is to continue. Who will benefit from being left in place? How do you protect yourself from coughed blood, etc?

I think that there is an almost certainty that they are saving lives, but as well I think that there is a near certainty that they are also killing people that didn't need to die.

I'm not blaming the cops, as that's the rules that they play by there I guess, but I also think that there is a reason that they don't keep track of the numbers, particularly in a violent city like that, if they're transporting 1/3 of trauma patients. If they're not tracking them, then to say that they are ultimately doing more good than harm is premature...

Interesting article. It's not my intention to support or condemn their policy as I just don't know...Just thinking out loud...

[Kiwiology]

Probably the quickest way for the patient to the get to the hospital

Lets face it, not a lot of what the ambos do in major trauma has even been proven to be of help, a focus on quickly throwing them in the car and driving to the hospital while providing some basic first aid is probably better!

Philly is bad man seriously, I've walked the streets of New York at 1am and felt quite safe, I didn't even want to get off SEPTA in Philly and just kept on ridin' ...

[Bernhard]

Kiwi, I don't agree. Securing & maintaining airway, stopping severe bleeding on extremities and pain control are things you need on almost every (trauma) patient. This simply can't be substituted by a random police officer with a car running lights & siren.

Yes, I know the studies about penetrating thoracal injuries and I'm the first to admit, that a lot of providers try to do far too much on (trauma) patients than the above ABCDEs disrespecting transport time to ED/OR, but the solution can't be a non-trained individual transporting someone with a non-medical-equipped car without proper transportation possibility. That's simply fourth world medicine.

Plus: LEOs usually have totally other and important responsibilities on such a call - maybe there are too much of them there, beeing able to get retrained as medics and getting equipped with real ambulances? I don't dare to solve the problems of that big city, but the described situation is neither medically, politically, socially, ehtically and not ecologically correct.

EDIT: typo.

Edited June 4, 2012 by Bernhard

[Bieber]

I'm with Bernhard at on this. We know too little about trauma, and what we do know is inconclusive when it comes to the effect of times and survival, but it tends to lean toward the notion that people who are going to die are going to die regardless and people who are going to live will live regardless; our role should be to focus on that narrow subset of folks for whom airway management and hemorrhage control may make the difference.