Has this ever happened to you?

[Ace844]

"peppermint,"

you should also reference this post here:: http://www.emtcity.com/phpBB2/viewtopic.php?t=5264

[GreenHat]

I was quite distressed upon reading this topic. This patient, in my honest opinion should have been transported to the nearest trauma center... level two as she was A/Ox3 and life flight should not have been activated. What we do here in Oregon is put them on standby until we arrive on scene then activate after we have done an assessment, but conscious patients almost never require life flight... of course, we have two level one trauma centers within 5 miles of each other and a 3 level two's within 10 miles, so we really have plenty of hospitals to take people to. Based on MOI and possible head trauma and the possible ETOH, there is no excuse for allowing this patient to refuse transport, they needed to go to the hospital for assessment and ongoing care just to rule out internal head injury. Also, what is your cert level? We have paramedics on all rigs and both partners are medics in Multnomah County (our highest population county) so these decisions would have been made by a medic. Also, why would you listen to police about whether this person needs to go to the hospital or if they can put them into temporary custody? Remember, you are the medically trained person on scene and as far as patient care goes, the buck stops with you and it is your responsibility to be a patient advocate even if they are unwilling...

[whit72]

Green hat Wrote:

I was quite distressed upon reading this topic. This patient, in my honest opinion should have been transported to the nearest trauma center... level two as she was A/Ox3 and life flight should not have been activated. What we do here in Oregon is put them on standby until we arrive on scene then activate after we have done an assessment, but conscious patients almost never require life flight... of course, we have two level one trauma centers within 5 miles of each other and a 3 level two's within 10 miles

It must be nice to get choose between 2 level ones, and a level two.......LOL.

[paramedicmike]

What we do here in Oregon is put them on standby until we arrive on scene then activate after we have done an assessment, but conscious patients almost never require life flight... of course, we have two level one trauma centers within 5 miles of each other and a 3 level two's within 10 miles, so we really have plenty of hospitals to take people to.

Ummm...so if you have that many trauma centers that close why do you bother putting a helicopter on standby? There's no need for it. Especially if you decide to wait until you've done an assessment before requesting a fly. If you do that now you have to wait for the helicopter to take off, get to you, land, complete their assessment, load, take off and fly to the hospital. Congratulations! You've just wasted an unacceptable amount of time when you could otherwise have already been en route to, and possibly have arrived at one of those trauma centers before the helicopter would have even landed at the scene.

Your situation isn't limited to Oregon. I've seen it other places, too. In Maryland where this call originally took place (and where I used to work). In Pennsylvania where I currently work. In Virginia and West Virginia, too. I'm not quite sure why people wait so long but for some odd reason they do.

The only time this might be acceptable practice in an urban area is during rush hour where traffic is so bad that even a trauma center three miles away would take you an hour to get to. But there are only a handful of places in the country where that might be a consideration.

Otherwise, thanks for raising an important issue with regards to HEMS.

-be safe.

[GreenHat]

That is very true and we normally only use life flight during rush hour in urban areas, but it is important to remember that Clackamas county, our largest county area wise that has EMS service has no level one trauma centers and only 3 Er's (where I would not allow myself to be taken, by the way) to service more land. Much of this area is classified as frontier and our response time is 4 hours or whenever we make it. In these areas, we tend to activate life flight more often, and also to transfer from other states as the next closest trauma center is 5 hours away to the north, 14 hours to the south, not sure on the east, but we do take several flights in from states to the east of us, and nothing on the west side. We have 2 mountain ranges that are more than an hour from any hospital code three after you make it to The freeway, and several other rural areas that have need of our life flight. We only put them on standby until we have assessed the patient (that is EMS or fire as all of our fire crews are paramedic crews) due to the plethora of false calls where life flight went to a scene where the 911 caller was panicked and said the call was much worse than it was in actuality. It is an imperfect system, but it works in our area, especially since flight craft are only ever about 10 minutes away from any of our urban calls. Again, not perfect, but it works... Also, it puts health care decisions in the hands of *gasp* health care professionals, not Joe public.

[paramedicmike]

That is very true and we normally only use life flight during rush hour in urban areas, but it is important to remember that Clackamas county, our largest county area wise that has EMS service has no level one trauma centers and only 3 Er's (where I would not allow myself to be taken, by the way) to service more land. Much of this area is classified as frontier and our response time is 4 hours or whenever we make it. In these areas, we tend to activate life flight more often, and also to transfer from other states as the next closest trauma center is 5 hours away to the north, 14 hours to the south, not sure on the east, but we do take several flights in from states to the east of us, and nothing on the west side. We have 2 mountain ranges that are more than an hour from any hospital code three after you make it to The freeway, and several other rural areas that have need of our life flight. We only put them on standby until we have assessed the patient (that is EMS or fire as all of our fire crews are paramedic crews) due to the plethora of false calls where life flight went to a scene where the 911 caller was panicked and said the call was much worse than it was in actuality. It is an imperfect system, but it works in our area, especially since flight craft are only ever about 10 minutes away from any of our urban calls. Again, not perfect, but it works... Also, it puts health care decisions in the hands of *gasp* health care professionals, not Joe public.

But wait a minute...didn't you say this earlier?

of course, we have two level one trauma centers within 5 miles of each other and a 3 level two's within 10 miles, so we really have plenty of hospitals to take people to

So, which is it there, sparky? Do you have all these trauma centers close by or are you out in the boonies? You've just contradicted yourself.

-be safe.

[Ace844]

I think this is the part where either some serious back pedaling happens or better yet, perhaps we should ask this question. How much backpeddaling could a back pedaler do if a backpeddlar were facing backwards on his uni-cycle!?!?!? 8) :shock:

[Ace844]

"Peppermintpatty,"

Here's a decent decision tree which should help you in your practice in the future. This is something you should print and keep for future reference. It was made by a group of people whose JOB AND ACADEMIC LIFE is spent in this specialty....

Triage decision scheme. BP, blood pressure; GCS, Glasgow Coma Score; PTS, pediatric trauma score; RR, respiratory rate; RTS, revised trauma score. Reproduced with permission from American College of Surgeons Committee on Trauma Resources for Optimal Care of the Injured Patient, 1997. (Resources for optimal care of the injured patient. Chicago: Committee on Trauma, American College of Surgeons; 1993.)

Hope This Helps,

ACE844

[GreenHat]

we do Have several trauma centers within a close area in Portland, but there are virtually no hospitals for hundreds of miles around so life flight tends to be activated when we are in the boondocks. I am stationed in clackamas county which is half city and half frontier, so it's basically both here... big city with more than enough hospitals and in places you are hundreds of miles away... there are 8 hospitals in the greater metropolitan area and only one further out, it is a level 2 trauma center, but it has to service quite a large area. any appearance at backpedaling there was just my attempt to better explain our situation, in some areas, you have your choice of several hospitals and in others you have only one choice.

[Ace844]

we do Have several trauma centers within a close area in Portland, but there are virtually no hospitals for hundreds of miles around so life flight tends to be activated when we are in the boondocks. I am stationed in clackamas county which is half city and half frontier, so it's basically both here... big city with more than enough hospitals and in places you are hundreds of miles away... there are 8 hospitals in the greater metropolitan area and only one further out, it is a level 2 trauma center, but it has to service quite a large area. any appearance at backpedaling there was just my attempt to better explain our situation, in some areas, you have your choice of several hospitals and in others you have only one choice.

Just FYI, If you ever tried to use your signature line with ANY of the OB's I've worked with or know they would promptly use their speculum with 'wide spread' action on your anus...Most of them have forgotten more in their undergrad years about emergency patient management than you may ever know. Furthermore if you had chosen a non-intensive critical thinking specialty like say..DERM.. I may not say this, But OB?!?!?! WTF? Food for thought before you go saying that to anyone!!

OUT HERE,

ACE