# Bleeding



## EchoMikeTango (Jun 22, 2011)

I have a question.  A friend was just ... counseled ( I think that's spelled right ) For violation of state protocol 

23yom Cut forearm w/ Arterial bleeding, which was controlled. PT had pulses. AAOx3. and good pressure. minimal blood loss, ambulated on scene. don't have all of the details, but ALS was not dispatched w/ call. Crew was < 5 minutes from trauma center.  ALS was not requested. Crew transported WOI. 

what do you think?

NJ B-t-dubs..


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## exodus (Jun 22, 2011)

What protocol did you break? Sounds like you did what was right.


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## BandageBrigade (Jun 22, 2011)

Would need to know more info. how was the bleeding controlled specifically?


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## EchoMikeTango (Jun 22, 2011)

It was my partner. Just found it is dispatch protocol to send aly for any art bleed. They didn't request it due to prox. 

Sent from my PC36100 using Tapatalk


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## EchoMikeTango (Jun 22, 2011)

Direct pressure. Pulses present. 

Sent from my PC36100 using Tapatalk


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## TransportJockey (Jun 22, 2011)

ITwoudl take ALS longer to show up than for the truck to get to the hospital. I don't see how they did anything wrong.


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## medicdan (Jun 22, 2011)

TransportJockey said:


> ITwoudl take ALS longer to show up than for the truck to get to the hospital. I don't see how they did anything wrong.



No offense, but NJ EMS is extremely screwed up. The fact that someone read your PCR and is actually providing QA/CQI is a great step-- it also helps that you're a medic student. 

We can't armchair quarterback-- and generally don't dispense medical or legal advice on the forum, and we don't know all the details. 

However, whether you think it will help, or they will arrive in time, it never hurts to DISPATCH ALS, again-- it doesn't matter so much whether/when they arrive-- purely to CYA. What happens, for example, if you are stuck in traffic, or the hospital goes on divert, and you need to go elsewhere. You simply aren't prepared or equipped on a BLS truck to handle hypovolemic decompensation. 

Once you arrived on scene, and recognized it was indeed an arterial bleed, you must have spent 6 or 10 minutes assessing, stabilizing, before transporting, no? Shouldn't that have been plenty of time for ALS to be dispatched, and arrive, assuming they were dispatched when you recognized the emergency? Were EMD protocols not followed in this case?

If you were to be intercepted, a good medic would take one look at the patient (and the vitals), and assuming the bleeding control is adequate, just ride in to the hospital with you (assuming it's <5 min away). 

You did the right thing by moving the patient towards definitive care. 
Just my $.02


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## EchoMikeTango (Jun 22, 2011)

EMD did not send als. error on their part. 

Scene time was literally 2 minutes, according to PCR. . PT walked out to rig. PT stopped bleeding with dish towel. The crew applied Trauma Dressings, Held Pressure. They were giged for not putting the PT on O2, Not calling ALS, Not requesting a supervisor to scene. 

Its just a giant Charlie Foxtrot. 

These people are crazy.


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## johnrsemt (Jun 22, 2011)

So:  dispatch screwed up by not dispatching ALS to begin with.  
BLS crew did correct thing by:  assessing patient finding controlled bleeding, PTA (it sounds like) and transporting patient with no delay; to definitive care.  
BLS gets written up for Dispatch's mistake.

Did dispatch get written up also?


This is the reason that Protocols need to be clarified that they are G U I D E L I N E S.  Not set in stone.

   What if the scenario was teenager cut arm, with arterial bleed 6 hours earlier and stopped it himself.  When mom came home from work, saw blood freaked out, called EMS.  BLS arrives, pt stable, good v/s, (patient was asleep) patient transported BLS  to hospital of family choice, with no ALS request:  no need. 
    My LT wrote me up for that run because I didn't call for ALS, and I didn't transport Emergent. 
    Medical director made him read the protocol book:  (and ours has no orders/protocols about bleeding control except tourniquet use due to BLS stuff is learned in EMT-B school and we shouldn't need to be guidelined of how to do it).


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## Lifeguards For Life (Jun 22, 2011)

can we get one of those :censored:: symbol things to show up when ever someone says the word "protocol"?

Can we sensor that?


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## lightsandsirens5 (Jun 22, 2011)

Lifeguards For Life said:


> can we get one of those :censored:: symbol things to show up when ever someone says the word "protocol"?
> 
> Can we sensor that?



Someday the protocol book will be banished to the tenth circle of hell, where it belongs. h34r:


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## medichopeful (Jun 22, 2011)

EchoMikeTango said:


> They were giged for not putting the PT on O2, Not calling ALS, Not requesting a supervisor to scene.



Are you serious?  What evidence does the company have that O2 was even necessary? h34r:


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## MrBrown (Jun 22, 2011)

Brown thinks Brown knows an appropriate solution .... 

Looks clear down Oz, power lines two o'clock low becoming three o'clock, fire truck also four o'clock low, clear to ground, rotors well clear, Brown thinks we should shut down ....

*Brown grabs the Thomas Pack 

Yes, hello Dr Brown here, helicopter emergency medical service, now, what seems to the problem? 

/serious piss take


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## CAOX3 (Jun 22, 2011)

EchoMikeTango said:


> I have a question.  A friend was just ... counseled ( I think that's spelled right ) For violation of state protocol
> 
> 23yom Cut forearm w/ Arterial bleeding, which was controlled. PT had pulses. AAOx3. and good pressure. minimal blood loss, ambulated on scene. don't have all of the details, but ALS was not dispatched w/ call. Crew was < 5 minutes from trauma center.  ALS was not requested. Crew transported WOI.
> 
> ...



How would a dispatcher know it was an arterial bleed?

Why is this an ALS complaint?


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## CAOX3 (Jun 22, 2011)

EchoMikeTango said:


> EMD did not send als. error on their part.
> 
> Scene time was literally 2 minutes, according to PCR. . PT walked out to rig. PT stopped bleeding with dish towel. The crew applied Trauma Dressings, Held Pressure. They were giged for not putting the PT on O2, Not calling ALS, Not requesting a supervisor to scene.
> 
> ...



He doesnt need oxygen, ALS or a supervisor.

Run from this system, fast.


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## MrBrown (Jun 22, 2011)

MPDS strikes again?


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## medicdan (Jun 22, 2011)

CAOX3 said:


> How would a dispatcher know it was an arterial bleed?
> 
> Why is this an ALS complaint?



I'm not disagreeing this was a BLS call, but a big piece of Emergency Medical Dispatch is call triage based on a set of standard questions asked by the calltaker, one of the first of which is "are they heavily bleeding". It doesn't matter whether it's venous or arterial, heavy bleeding --> Blood loss --> hypovolemia --> hypotention. Somewhere along this becomes an ALS call, or at least an ALS dispatch until cancelled by BLS.


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## CAOX3 (Jun 22, 2011)

emt.dan said:


> I'm not disagreeing this was a BLS call, but a big piece of Emergency Medical Dispatch is call triage based on a set of standard questions asked by the calltaker, one of the first of which is "are they heavily bleeding"..



The original poster stated bleeding was controlled.



emt.dan said:


> It doesn't matter whether it's venous or arterial, heavy bleeding --> Blood loss --> hypovolemia --> hypotention..



Bleeding was controlled with minimal blood loss and a good pressure.



emt.dan said:


> Somewhere along this becomes an ALS call, or at least an ALS dispatch until cancelled by BLS.



Maybe an ALS dispatch but not an ALS transport, this is a non emergent BLS transport in my opinion.


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## mycrofft (Jun 23, 2011)

*Five is four*

If the protocols call for donning party hats and you didn't do it, then protocols were broken. Cut and dried.

Was it right? Since it worked this time, then we ask that question. If there had been a traffic snarl, or there was a misdiagnosis, or some other unforseen (the key word) factor played in (say, external bleeding was stopped but instead it was compartmentalizing internally), then we would not be asking about the protocol, but about the technician.

Wasn't a bonehead move, but it didn't meet protocol. Next case, walk it off and live to swing another day.


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## DrParasite (Jun 23, 2011)

EchoMikeTango said:


> I have a question.  A friend was just ... counseled ( I think that's spelled right ) For violation of state protocol


well, at least it wasn't a formal write up.





EchoMikeTango said:


> 23yom Cut forearm w/ Arterial bleeding, which was controlled. PT had pulses. AAOx3. and good pressure. minimal blood loss, ambulated on scene. don't have all of the details, but ALS was not dispatched w/ call. Crew was < 5 minutes from trauma center.  ALS was not requested. Crew transported WOI.
> 
> what do you think?
> 
> NJ B-t-dubs..


if anything, it should be a counseling notice for the dispatcher.  

Ask any EMD instructor, the reason you send ALS on any arterial bleeding is because uncontrolled arterial bleeding is a life threatening injury.  once the bleeding is controlled, it is no longer an ALS call (because if they are hemodynamicly stable, what is ALS going to do ?).

BTW, the way NJ EMDs determine if its arterial or not is based on if the blood is spurting out, and the location of the hemorage (at least based on the horrible NJ EMD protocols http://www.state.nj.us/911/home/highlights/2009EMDGuidecards.pdf)


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