Trauma Docs with lights and sirens?? What do you think?

[Ace844]

Since this is the 'latest Lights&Sirens thread' in a long list of them here. This is what the NAESP thinks

[web:80d082e225]http://www.naemsp.org/Position%20Papers/WarnLghtSirn.html[/web:80d082e225]

Hope this helps,

ACE844

[SSG G-man]

That is an interesting read. Where I am we respond to the scene L&S unless otherwise directed. Response to hospital will depend on patient. Priority III- No L&S. Priority II L&S, but not always pushing it. Helps with traffic at intersections. Priority I L&S and time critical.

This past weekend we were dispatched to a vehicle in a ditch. We had passed the vehicle earlier on our way back from the hospital. So we downgraded to priority III and continued in to verify it was the car we had seen earlier.

We never use L&S going from hospital to station.

[JakeEMTP]

We never use L&S going from hospital to station.

That's a good thing SSG G-man. I beleive that would constitute " Wanker of the year". Honours :roll:

[Ace844]

Here's a study related to this topic which specifically covers MD prehospital responses.

(Prehospital Emergency Care

Publisher: Taylor & Francis Health Sciences @ part of the Taylor & Francis Group

Issue: Volume 4, Number 3 / July-September 2000

Pages: 217 - 221

URL: Linking Options

DOI: 10.1080/10903120090941227

PHYSICIAN FIELD RESPONSE: A NATIONAL SURVEY

David C. Cone A1, Gerald C. Wydro A1, Cherie M. Mininger A1

A1 Division of EMS, Department of Emergency Medicine, MCP Hahnemann School of Medicine, Philadelphia, Pennsylvania (DCC, GCW); and Department of Emergency Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania (CMM). Dr. Cone is currently at the Division of EMS, Section of Emergency Medicine, Department of Surgery, Yale School of Medicine, New Haven, Connecticut.)

Abstract:

Objective. To assess the availability, scope of practice, and training of physician field response (PFR) units for emergency medical services (EMS) systems in the United States. Methods. The physician medical directors of EMS systems in the 125 most populous U.S. cities were surveyed by mail, with a second mailing and phone follow-up to nonresponders. In cities that listed multiple services, a survey was sent to each. Results. One hundred sixty-eight surveys were mailed, and 121 responses were received (72%), representing 109 of the 125 cities (87%). Seventy-seven cities (71%) reported having no PFR capability. Of the 32 (29%) with some type of PFR, two reported having a dedicated field response unit, while 30 had an "on-call" system from the hospital or home. Staffing patterns were highly variable, with no dominant pattern. The number of annual PFR responses ranged from 0 to 10,000 (median 15, IQR 3-200). All systems reported that their PFR unit was well accepted by EMS providers. The following scope-of-practice items were reported (n = 30): physician triage, 30 teams (94%); on-scene medical direction, 14 (47%); amputation, six (20%); tube thoracostomy, 12 (40%); and blood administration, 29 (97%). The following training requirements for physician team members were reported (n = 32): incident command system, 15 (47%); emergency vehicle operations, 12 (38%); hazardous materials, 13 (41%); vehicle rescue/extrication, seven (22%); confined space medicine, four (13%); and none 12 (38%). Conclusion. There is a wide variability in the availability, training, and scope of practice of PFR units across the country. No standardization or trends could be detected.

In short, it says...NOTHING...

The next one though makes an interesting point...

(Role of the physician in prehospital management of trauma: European perspective.

Trauma

Current Opinion in Critical Care. 8(6):559-565 @ December 2002.

Ummenhofer, Wolfgang MD; Scheidegger, Daniel MD)

Abstract:

Advanced prehospital trauma life support is challenged as a whole. Formerly well-accepted basic principles for stabilizing vital functions of the severely injured patient like volume resuscitation, airway protection, and immobilization have been questioned. In prehospital management of trauma, the role of not only the physician but also the paramedic must be redefined. In the absence of evidence about the effectiveness of advanced trauma life support training for paramedic crews, the needs of trauma victims and capacities of emergency medical systems must be re-evaluated. Assessment of patients' conditions, including mechanism of trauma (blunt vs penetrating), source of hypovolemic shock (controlled vs ongoing hemorrhage), concomitant disease (as in elderly patients), and identification of therapeutic goals (such as for cerebral perfusion pressure or secondary brain damage caused by hypoxia in severe head injury), is a subject of increasing importance. Invasive airway management techniques require skills, expertise, and daily routines available only to experienced in-hospital personnel. The controversial issue of paramedic vs physician-based systems should be abandoned. It is the skill, the technique, the awareness of pitfalls, and the capability to handle complications that makes the difference, not the person in possession of the skill.

Hope this helps,

ACE844

[angelbaby1414]

[/font:42217cd01f] I think the EMS Doc you read about was from Morristown Memorial Hospital, in NJ. The Doc got a grant to start the EMS Physician program (Morristown is a Level II Trauma Center). The Doc was a great advocate of EMS and I think it might have been asuccessful program, but something went down with management (imagine that??? hospital management that treats EMS like persona non grata!) and I believe the Doc pulled the grant and took it to Robert Wood Johnson hospital. I wish him success there and if I hear any particulars, I will pass them along.

[Ace844]

[/font:ac2dbe7536] I think the EMS Doc you read about was from Morristown Memorial Hospital, in NJ. The Doc got a grant to start the EMS Physician program (Morristown is a Level II Trauma Center). The Doc was a great advocate of EMS and I think it might have been asuccessful program, but something went down with management (imagine that??? hospital management that treats EMS like persona non grata!) and I believe the Doc pulled the grant and took it to Robert Wood Johnson hospital. I wish him success there and if I hear any particulars, I will pass them along.

"Angel,"

Interesting, thanks for the update, keep us posted. Welcome to EMTCITY!!

ACE

[Ace844]

(On-scene time in advanced trauma life support by anaesthesiologists.

ORIGINAL ARTICLES

European Journal of Emergency Medicine. 13(3):156-159 @ June 2006.

Hoyer, C. Christian S. a; Christensen, Erika F. a; Andersen, Niels T.

Abstract:

Objectives: Severe injury is the leading cause of death among the young. Trauma systems have improved management of the severely injured and increased survival rates, but there is no level-1 evidence of advanced prehospital trauma care. Advanced prehospital trauma care prolongs on-scene time, which may imply a risk of significant delay in definitive trauma care. The aim of this study was to evaluate on-scene time and influence of (1) the presence of an anaesthesiologist on-scene, (2) prehospital intubation, (3) entrapment, and (4) injury severity.

Methods: A cohort of registry-based patients brought to Aarhus Trauma Centre. Data were consecutively reported. On-scene time was defined as the time from vehicle arrival to departure. Severe injury is defined by an injury severity score >15. The study was conducted over the period 1998-2000; only patients brought primarily to the trauma centre were included. Statistical tests used include [chi]2, Kruskal-Wallis, Wilcoxon's rank sum and Spearman's [rho].

Results: Seven hundred and forty-one patients triaged to Aarhus Trauma Centre from which we obtained all information in 596 cases constituted the study group. In 472 cases, an anaesthesiologist was present. On-scene times, median and 95% confidence interval, were as follows: entire study group (n=596) 15.5 min (15-17); ambulance only: 14.0 min (12-15); anaesthesiologist present, no intubation, no entrapment: 15.0 min (14-16); intubation, no entrapment: 21.5 min (16-27); entrapment, no intubation: 21.5 min (17-25); both intubation and entrapment: 22.0 min (16-36).

Conclusion The: presence of an anaesthesiologist prolonged the median on-scene time by 1 min and in cases of prehospital intubation by 7.5 min. This result was no different from the prolongation caused by entrapment.