I think the Pt's are getting it in the...........

[Riblett]

I think it depends on who is making the trauma decisions. If it is an MD who is significantly informed on the patient condition, then okay. In my county most of our medics are highly competent and have excellent assessment skills. We have a Level 1 trauma center (recently upgraded from a Level 2) and have very specific criteria for initiating a trauma one or trauma alert. Unfortunately we have some idiot nurses who will screw with us. They will downgrade our traumas or make patients trauma based on their own opinions and not established criteria.

Two times they have done this to me. Once was a 49 y/o f who fell down a flight of stairs, had blunt trauma to the head in addition to multiple lacerations, had significant LOC, and had a GCS of 12. Because of the AMS post traumatic injury she met criteria for a trauma alert (lesser of the two.) The nurse took our report as usual. We arrive at the hopital and roll our patient into the trauma room, expecting to see the usual gowned cavalry of the trauma team. The room was completely empty. We went back out to the triage area and find this snotty little fresh-out-of-school nurse sitting there by the radio eating a bagel. When we asked her why there was no trauma team she replies that she did not think it met criteria so she downgraded it. My partner rather angrily jerked out his protocol book and shoved the trauma criteria section in her face.

Second time was a low speed roll over MVC. According to witnesses the car just kinda slid off the road slowly and rolled on to its side when it hit the ditch inside the subdivision. Patient was alert and oriented, no LOC, normal lung sounds, and no complaints other than a laceration on the forearm from glass Vitals signs within normal limits %100. We call in report and the nurse tells us room assignment on arrival. We get there and they take us to the trauma room and there is the trauma team. As soon as she heard roll over she upgraded it with no criteria and cost this patient several thousands of dollars before he ever got to the hospital.

[Dustdevil]

The nurse took our report as usual. We arrive at the hopital and roll our patient into the trauma room, expecting to see the usual gowned cavalry of the trauma team. The room was completely empty. We went back out to the triage area and find this snotty little fresh-out-of-school nurse sitting there by the radio eating a bagel. When we asked her why there was no trauma team she replies that she did not think it met criteria so she downgraded it. My partner rather angrily jerked out his protocol book and shoved the trauma criteria section in her face.

I notice you didn't say she turned out to be wrong, and the patient ended up in emergency surgery.

Congratulations to your idiot partner for making you, him, and all of us look like ignorant arseholes operating over their heads. Yeah... whip out your cookbook and recite it to people with four times your education level. That's a great way to prove to the medical community that we have the intellectual foundation to make independent clinical judgements. Not. :roll:

[medic001918]

The other thing I noticed is that in the second case presented, he feels the nurse was wrong for calling a trauma on an occupant of a vehicle that rolled over. While the patient may not have been injured, you can certainly make a case for a hospital calling a trauma alert for any patient involved in a roll over motor vehicle accident. I also wonder what kind of radio report the hosptial got on this patient. Did they accurately describe the roll over as low speed, self extricated (if that was the case), or was it simply a "roll over MVC?" Our wording when we notify a hospital has a great outcome on what will be ready for us when we come walking through the door.

I'm not totally sure that the hospital was at fault for calling a trauma on that one. Quite possibly, the same problem could have contributed to the nurse's decision in the first case as well.

Dust, I have to agree with your points about making us look poor to the hospital. While you may have disagreed with the decision the triage nurse made, there was far better ways to handle it. Why not explain why you think the patient needs a trauma room instead of throwing the protocol book in her face? Protocols are really just guidelines. There's not a single thing absolute in the entire book, and that includes trauma criteria. If you think a patient needs a certain level of care, advocate for it through your educated assessment, not by something that was read out of a book.

Try to work well with those who work in the hospital. You can learn a great deal from them, and their respect can certainly be earned. I've seen it plenty of times in the hospitals we frequent. Certain people get taken seriously, where others are nothing more than a joke to the ED staff. It all has to do with your rapport with them, and past history. Chest thumping and belittling (such as stuffing a book in someone's face) does nothing and gets you nowhere. An educated conversation about your reason's for why the patient requires a certain level of care will go much further towards advocacy for your patient, and respect to you as a provider from the receiving facility.

As far as costing a patient money before they get to the hosptial, guess what? It's not really my concern. That's something he can sort out later in life. I would prefer to see a hospital be more aggressive than needed than not be aggressive enough and miss something. When I'm treating a patient and making decisions, the last thing on my mind is the end cost to the patient. My concern is their care. The hospitals concern is their care. Most facilities don't enjoy misusing resources when they're not needed, but erring on the side of caution is far better than not and having it come back to haunt you (as one of the hosptials in our area learned). Don't fault the hospital for ensuring an adequate assessment and treatment promptly for a questionable trauma. You're not paying the bill in the end anyway.

Shane

NREMT-P