Study: M.D./Helicotpor vs. BLS/Ambulance Trauma Survival

[ERDoc]

I still wouldn't take this study as justification for working a blunt traumatic arrest, no matter who's onscene.

But it doesn't surprise me at all that doctors think they can save these people (no offense ERDoc). In that vein, it may be worthy of note that the only MD-level HEMS service in my area uses ER residents- who I would guess are more likely than anyone to try and play God (thereby getting skills that can be checked off).

I would have to disagree. Most MDs, at least ER docs and surgeons, recognize the futility of resuscitation in these cases. Residents are not likely to try new procedures without oversite of an attending. They may be gungho in the ER, but put them by theirself and they are not as quick to jump for the scalpel due to their inexperience with the procedures. Whatever they can put off to the ER they probably will.

There was an article in Annal of EM in 2006 that showed we may be missing some people who will survive a traumatic arrest.

http://www.ncbi.nlm.nih.gov/sites/entrez?D...Pubmed_RVDocSum

[katbemeEMT-B]

I think another thing to look at is that these patients were either flown or taken by ground. I would assume that if they were flown, they reached definitive care much quicker than by ground. Would that not be a major factor.

I think if they really wanted to prove their study they could have compared ALS ground to BLS ground or ALS ground to ALS Air Care. Comparing BLS ground with limited scope to ALS Air Care isn't even logical to me. So I guess I would say this study was probably done to promote air care but with a very skewed view. They also fail to mention that some one had to have been caring for that patient prior to air care arriving on scene. What did they do?

Just my opinion and not always the right one.

[whit72]

Doc, I guess it all depends on what you consider quality. I am mandated by the state to work all fatal accidents we encounter unless obvious signs in compatible with life are present.

I guess we have no idea what said pt would consider quality of life. I agree, I have no right to make that decision for them or their family. I do, and will continue to my job unconditionally, without regard for my personal beliefs, whether futile or not. It is hard at times though. Hey if its a one percent chance at survival, who am I to not give them every opportunity to be that one-percent.

A side note, in my EMS career I dont believe I have seen a traumatic arrest pt. live. Where we arrived and the pt. was pulseless. I have seen them arrest in the back of the truck and be resucitated, maybe once or twice. However I have idea what their final outcome was.

[spenac]

Just my opinion and not always the right one.

Your not always right? :shock:

[katbemeEMT-B]

I think I have been wrong twice in my life.

The first is when I got married. Took me seven years to figure out I was wrong when I said I do.

The other was when.......hey maybe that was only time I was wrong. LOL

[AnthonyM83]

I've been wrong once. Once when doing some homework, I thought I made a mistake, and went back to check. I realized I was, of course, right after all. That was my one. I'm only human, I suppose.

8)

[JPINFV]

I've never had a mistake, just wrong questions.

[ERDoc]

Doc, I guess it all depends on what you consider quality. I am mandated by the state to work all fatal accidents we encounter unless obvious signs in compatible with life are present.

I guess we have no idea what said pt would consider quality of life. I agree, I have no right to make that decision for them or their family. I do, and will continue to my job unconditionally, without regard for my personal beliefs, whether futile or not. It is hard at times though. Hey if its a one percent chance at survival, who am I to not give them every opportunity to be that one-percent.

A side note, in my EMS career I dont believe I have seen a traumatic arrest pt. live. Where we arrived and the pt. was pulseless. I have seen them arrest in the back of the truck and be resucitated, maybe once or twice. However I have idea what their final outcome was.

I have to agree with you Whit. I have never seen a traumatic arrest survive. My guy on the motorcycle never actually arrested. I think what the studies are showing is that maybe we need to rethink what our definition of "obvious signs incompatable with life," is. Sure decapitation is dead. Decomposition is dead. If you have someone crushed in a car without a pulse and it is going to take 15 minutes to cut the car away, they're dead.

I'm curious how many traumatic arrests are actually medical arrests that just get into an accident. Maybe cross clamping someone's aorta in the field will improve outcomes for traumatic arrests? Who are we going to trust to do this? Just a few random thoughts I've had since reading these articles.

[katbemeEMT-B]

Hey Doc, we actually had one of those a few months ago. The call came in as a single MVC. Arrived on scene and the very large man had blown through a stop sign on a very busy highway and hit the ditch on the other side of the road. The damage to the car was slightly above minimal with most damage to the front where it had drove itself into the ground. Both driver and passenger air bags had deployed. Upon assessment, he wasn't breathing and had no pulse. CPR was started by passer-byers and continued en-route. Five minutes in the ED and the doc called it. We later found out he had suffered from a massive MI and that was the cause of the accident. We basically were trying to revive a guy that had been dead for six minutes before we got there. It was a great review case at our monthly meeting though. The ED doc even attended.

Thankfully he didn't take out anyone else.