Load and go? Or not so much?

[paramedicmike]

Researchers in Philadelphia are trying to find out. Although, if I remember correctly, I thought they already determined that police transport worked out just as well for the patient.

[island emt]

I remember when the previous study results came out and rocked the EMS world.

WHAT do you mean doing all our tricks and interventions is leading to a lower survival rate????

It makes perfect sense in that specific population with penetrating trauma that NEEDS an immediate trip to the Surgical suite.

[mikeymedic1984]

There have been many studies that show throwing trauma patients in whatever vehicle immediately and transporting, improves outcomes of trauma patients. The sooner they get to the OR, the better, regardless of how they get there --- and there are some studies that show we actually do more harm than good ---- google "hypothermic trauma patients". We cut all their clothes off, throw them on a cold back board, and then dump 65 degree NACL into their body.

[Just Plain Ruff]

You mean with all our bells and whistles and the paragod attitudes that many in EMS have, I scoff at those results, SCOFF dammit I say.

[ambodriver]

So we take a set of patients involved in some major trauma and study their outcomes. Someone has determined we are doing more harm than good? Does anyone else think that people with serious trauma have poor outcomes due to their injuries and not neccesarily because of EMS? These people are ALREADY sick/seriously injured their likelyhood of poor outcome is most likely due to their traumatic injuries. There seems to be too many factors to be able to make a reliable study. Every injury is not the same and neither are the patients reaction to those injuries. Do people stay and play with trauma patients? I load them up and do everything en route.....

Edited February 14, 2015 by ambodriver

[island emt]

The initial Phiily study showed that from EMS time of arrival at the penetrating trauma pt to delivery in to the ER often exceeded 18 minutes whereas the pt who was tossed into a car and hauled by his homies arrived at the ER in less than 7 minutes. Make a big difference getting them into definitive treatment and the OR when time from scene to ER is less than half.

EMS has time to dispatch , time to drive to scene, arrive and assess the pt. do initial TX before packaging and then time to load & transport. Add in 2 large bore IV's to thin down the remaining blood in the system and you have a recipe for lower survival rates as we were not fixing the issues of massive internal damage & bleeding.

Yes it is hard to quantify how many of these severly injured pt's were going to die no matter what , but the study did a pretty fair representation of the pros & cons of rapid delivery to the ER versus Paramedic level intervention in a large urban environment.

[ERDoc]

So we take a set of patients involved in some major trauma and study their outcomes. Someone has determined we are doing more harm than good? Does anyone else think that people with serious trauma have poor outcomes due to their injuries and not neccesarily because of EMS? These people are ALREADY sick/seriously injured their likelyhood of poor outcome is most likely due to their traumatic injuries. There seems to be too many factors to be able to make a reliable study. Every injury is not the same and neither are the patients reaction to those injuries. Do people stay and play with trauma patients? I load them up and do everything en route.....

So we shouldn't bother trying to improve care? It's too hard, let's not try. Trauma registries are full of hundreds of thousands patients. It's not too difficult to control for variables and compare outcomes when you have such huge populations to pull from. No, it's not the randomized, double-blinded, placebo controlled utopia we all hope for but it is good enough to make changes.

[ambodriver]

I'm not sure where you deduced that from my comment. I still think the variables involved in traumatic injuries is too complex. A GSW to the chest could have many different outcomes based on what exactly the bullet hit.

I'm not sure how other people manage their trauma scenes but here for the most part its throw them on the stretcher and go. Get what you can en route but don't sweat it if you don't have enough time, we know they need surgery.

"home boy" ambulances might be fast, but at what cost? Causing anoiher accident? Hitting grandma crossing the street?

[ERDoc]

You do understand why they are comparing EMS to homeboy ambulance, right?

[ambodriver]

First, the term homeboy ambulance is awesome. Often used in these parts and hilarious each time I hear it!

I think I understand your question, but not sure.

Homeboy ambulances are faster, they are already on the scene. They don't waste time trying to do anything, just get them to the trauma center (sometimes, a lot of times they go to regular ERs).

Apparently some people in EMS are fiddle fucking around on scene when they should be driving the patient. Hence why I do all my work en route in a trauma run.

Right?