# Trauma and bls



## Focallength (Apr 2, 2011)

Your a bls unit, you come upon a single vehicle mva on the freeway, driver is out of the vehicle .female 5mo pregenant, abd/chest pain 8/10 knee pain 6/10 + bruising. - deformities. Your told fire is responding, your on scene for 11 minutes. Scene is clear, traffic is flowing chp is leaving, still no fire. Your in the ambulance, with the patient. Do you stay and wait for fire or transport and why. Your a non 911 provider.


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## DesertMedic66 (Apr 2, 2011)

Focallength said:


> Your a bls unit, you come upon a single vehicle mva on the freeway, driver is out of the vehicle .female 5mo pregenant, abd/chest pain 8/10 knee pain 6/10 + bruising. - deformities. Your told fire is responding, your on scene for 11 minutes. Scene is clear, traffic is flowing chp is leaving, still no fire. Your in the ambulance, with the patient. Do you stay and wait for fire or transport and why. Your a non 911 provider.



What do your protocols say? How far away is the hospital? Get an ETA from fire if possible. If fire is 10 mins out and the hospital is 8 mins away why would you wait for fire?


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## abckidsmom (Apr 2, 2011)

To avoid a potentially enormous pain in the butt, in the ridiculous system that is CA, I would wait as long as possible for fire.  I can't imagine working in this system, and I really can't imagine letting PD clear the scene without a "real" ambulance on scene.  I would have had my partner make a huge stink with the cop when we realized they were planning to clear.

I probably wouldn't have stopped in the first place, if I couldn't finish the job.


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## DesertMedic66 (Apr 2, 2011)

abckidsmom said:


> To avoid a potentially enormous pain in the butt, in the ridiculous system that is CA, I would wait as long as possible for fire.  I can't imagine working in this system, and I really can't imagine letting PD clear the scene without a "real" ambulance on scene.  I would have had my partner make a huge stink with the cop when we realized they were planning to clear.
> 
> I probably wouldn't have stopped in the first place, if I couldn't finish the job.



Most companies require you to stop at an accident scene unless you have a patient on board already.


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## abckidsmom (Apr 2, 2011)

firefite said:


> Most companies require you to stop at an accident scene unless you have a patient on board already.



require or allow?  Yet another reason I won't be going to California to do EMS.


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## DesertMedic66 (Apr 2, 2011)

abckidsmom said:


> require or allow?  Yet another reason I won't be going to California to do EMS.



Require. Think about the publics view of "there is an accident and people are probably hurt". And then an inservice ambulance just drives by the scene and waves if that. The company would get alot of complaints and possibly could get written up.


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## JPINFV (Apr 3, 2011)

Focallength said:


> Your a bls unit, you come upon a single vehicle mva on the freeway, driver is out of the vehicle .female 5mo pregenant, abd/chest pain 8/10 knee pain 6/10 + bruising. - deformities. Your told fire is responding, your on scene for 11 minutes. Scene is clear, traffic is flowing chp is leaving, still no fire. Your in the ambulance, with the patient. Do you stay and wait for fire or transport and why. Your a non 911 provider.



ETA for fire? Heck, if I can't see them after waiting that long and lack the ability to contact them directly (where I worked in So. Cal., only the 911 units had access to the radio system that the fire department was on) I'd call 911 directly to get patched through to the fire department dispatcher. The other consideration is what is the ETA to a trauma center. It would be better to wait a few minutes longer in order to get the patient to the proper hospital in this case.


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## Akulahawk (Apr 3, 2011)

firefite said:


> What do your protocols say? How far away is the hospital? Get an ETA from fire if possible. If fire is 10 mins out and the hospital is 8 mins away why would you wait for fire?


Simple. This. IMHO, for a trauma, if you've been on scene for 11 minutes, you've been on scene too long. Probably 3-5 minutes too long. I'm not saying you should simply scoop and run, but it's not like you really need to be sitting on scene. Whether or not you're supposed to put her on a backboard

If your local protocols allow for a non-911 BLS unit to transport such calls, get an ETA from Fire, if their ETA is > than your ETA to the appropriate hospital, generally it's best to transport.

ETA: Some county policies require that an ambulance that doesn't have a patient on board to stop and render aid, some to include transport. Some counties stipulate that a BLS unit may transport if the time from patient contact to arrival at the hospital is less than some specified period of time, regardless of the availability of ALS. If that time is 10 minutes or less... most units won't be speedy enough to assess, load, and transport within that time thus ALS can arrive on scene and "properly" determine patient destination. Incidentally, Santa Clara County's destination policy isn't all that different BLS vs. ALS. The exception to that rule is Code 3 Transports... ALS goes to the most appropriate facility unless it's a no-airway situation and BLS would go to the closest facility regardless for Code 3. Code 2 transport destinations for ALS and BLS units are identical, at least when I last reviewed that policy.

Also, Santa Clara County ambulances can all communicate with the County Comm directly via radio. When I used to work in Sacramento County, all units were provided direct telephone numbers for fire dispatch and the Sheriff's Department as well as direct phone numbers to all the ED's in the area.


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## exodus (Apr 3, 2011)

I would just transport? Or call the base hospital and talk to them...


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## usafmedic45 (Apr 3, 2011)

abckidsmom said:


> require or allow?  Yet another reason I won't be going to California to do EMS.



It's been the general rule in the several states I've lived in (Indiana, Illinois, Missouri, Maryland, etc).  I always assumed that it was kind of a standard practice.


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## DesertMedic66 (Apr 3, 2011)

usafmedic45 said:


> It's been the general rule in the several states I've lived in (Indiana, Illinois, Missouri, Maryland, etc).  I always assumed that it was kind of a standard practice.



i assumed it was standard practice also. But i guess its not :wacko:


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## Focallength (Apr 3, 2011)

We transported. Level 1 trauma 5 miles away. Who knows when als will arrive. Trauma doc said we did good, trauma nurse pissed because we didnt wait for als, complained to company, filed charges with state. I have yet to find a protocol we broke. Sac county only mentions max 10 minutes on scene, txp to trauma center. She could have delivered a viable baby, not to mention internal injuries. co. put us on unpaid leave for violating protocol, but the co. has no protocol for this issue.

Agreed we had pt interest in mind, everyone but one nurse says we did the right thing, from nicu nurses,bc's trauma md.

Our protocol is stop and render aid to anyone who may need it.

Hospital was told we were txp code3 bls. Gave no orders. Disp told we were txp code 3 bls gave no orders.


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## DesertMedic66 (Apr 3, 2011)

Focallength said:


> We transported. Level 1 trauma 5 miles away. Who knows when als will arrive. Trauma doc said we did good, trauma nurse pissed because we didnt wait for als, complained to company, filed charges with state. I have yet to find a protocol we broke. Sac county only mentions max 10 minutes on scene, txp to trauma center. She could have delivered a viable baby, not to mention internal injuries. co. put us on unpaid leave for violating protocol, but the co. has no protocol for this issue.
> 
> Agreed we had pt interest in mind, everyone but one nurse says we did the right thing, from nicu nurses,bc's trauma md.
> 
> Our protocol is stop and render aid to anyone who may need it.



if that happened to me i would talking to the company about unpaid leave. if they have no evidence that you violated protocol then they wont have any defense as to why they put you on unpaid leave.


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## Veneficus (Apr 3, 2011)

*and that is why...*

Nursing should have no independant authority.

Their decisions should always go through a doctor.


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## boingo (Apr 3, 2011)

Focallength said:


> Your a bls unit, you come upon a single vehicle mva on the freeway, driver is out of the vehicle .female 5mo pregenant, abd/chest pain 8/10 knee pain 6/10 + bruising. - deformities. Your told fire is responding, your on scene for 11 minutes. Scene is clear, traffic is flowing chp is leaving, still no fire. Your in the ambulance, with the patient. Do you stay and wait for fire or transport and why. Your a non 911 provider.



Unless you suspect she needs an immediate airway or needle in the chest, go to the hospital.  Even if she needs and airway or needle in the chest, unless they are much closer or you can intercept while heading in the direction of the hospital, go to the hospital.


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## Trevor (Apr 3, 2011)

Im confused? Now i dont know your protocols or policies involving this kind of stuff. You working for a private/transport company would probably be an important factor in this... I'm lucky enough to work for a third service and if someone said i "had to wait for the Fire Department to show up" I'd probably laugh hysterically... Then take care of my patient. But i know Fire has their hands in everything in Cali (anything to justify their big budgets right?) But is this an ALS patient where you live? I mean in my system she meets "trauma Transport" criteria (sometimes called Cat 2 other places). So she probably needs to go to the trauma center for eval and 10 minute scene time is a good idea, because she COULD have seriuos injuries, but...

1) Was she ALS?
2) Was she hemodynamically stable?
3) were there other injuries?
4) If the nurse is upset that you didnt wait for an ALS crew, then obviously she thought the patient was sick, then why would they want you to wait for an ALS crew to get there and prolong scene time of a trauma patient even longer?
*******5) Why the F is a nurse "filing charges" against you with the state?


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## Veneficus (Apr 3, 2011)

ALS doesn't matter at all.

This is a trauma patient. 

Surgical or not, what is needed is the expertise and equipment found in the hospital. 

As those resources are not possible to bring to the field, the only solution is to take the patient to the hospital as safely and quickly as possible.

The fact that a nurse decided that ALS was beneficial goes to show how little he/she knows about trauma, and how said nurse should not be making decisions at all where it is concerned.


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## Trevor (Apr 3, 2011)

Veneficus said:


> ALS doesn't matter at all.
> 
> This is a trauma patient.
> 
> ...




Exactly the point i was trying to make...


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## abckidsmom (Apr 3, 2011)

usafmedic45 said:


> It's been the general rule in the several states I've lived in (Indiana, Illinois, Missouri, Maryland, etc).  I always assumed that it was kind of a standard practice.



When I worked at privates, the general practice was for us to stop and act in an assisting role only.  We waited for the dispatched units to arrive, and then cleared pretty quick.

Some municipalities around here have legislation that states that only the designated provider can tranport patients from emergency scenes within the jurisdiction.  Then again, those jurisdictions get people on scene before it's been so long.


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## ZombieEMT (Apr 4, 2011)

I agree with the idea that you have to follow protocol, regardless of how you feel about it. If you are not really sure of it, hell shoot for patient care. If you are a BLS unit, 911 or not, I would assume you have a state licensed ambulance that has the potential to handle the call, and hopefully people trained to treat the problem. Why wait for fire? If you can transport, transport. Fire can or an additional ambulance can always intercept.


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## Akulahawk (Apr 4, 2011)

Focallength said:


> We transported. Level 1 trauma 5 miles away. Who knows when als will arrive. Trauma doc said we did good, trauma nurse pissed because we didnt wait for als, complained to company, filed charges with state. I have yet to find a protocol we broke. Sac county only mentions max 10 minutes on scene, txp to trauma center. She could have delivered a viable baby, not to mention internal injuries. co. put us on unpaid leave for violating protocol, but the co. has no protocol for this issue.
> 
> Agreed we had pt interest in mind, everyone but one nurse says we did the right thing, from nicu nurses,bc's trauma md.
> 
> ...


Possible violation of Policy 2055.07 Section IV B: 





> If no EMS responders are on scene and  the on-viewing unit is not enroute to
> another emergency, or not transporting a patient, the crew of that unit must stop
> and render aid including transport, if  appropriate, *or wait until other EMS
> resources arrive.*


There is no provision for BLS to accept orders from any Base Hospital except perhaps for destination decision when in Round Robin. IMHO, the right thing was done... another issue is that ED RNs aren't used to BLS crews transporting to an ED. By and large, all they see is Paramedics doing all the transporting. If the SRFECC wasn't contacted by YOUR UNIT at the outset of the incident... you might have a problem. In the end, you'll most likely be OK with the County, considering the circumstances. Your company will most likely let you go or try to just to keep the nurses happy so they'll use your company's services... Chances are they won't back you at all.


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## CAOX3 (Apr 4, 2011)

Yeah take her to the hospital.  8/10 abdominal pain s/p traumatic injury in the second trimester. Is she bleeding, contractions?

 I'm no OBGYN but uterine rupture, placenta abrupto, pre-term labor, maternal hemorrhage just a few reasons I'm not sitting around.  Do they expect you too hang around until you have limb presentation and a imminent pre-term delivery?  Maybe it's an extreme example but I'm not screwing around to find out.

I would have politely asked the trauma nurse what exactly an IV is going to do to rectify any of the above conditions.

Take her to the hospital and deal with the political, turf war BS later.


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## Monkey (Apr 4, 2011)

As was said, weigh transport decision vs ALS ETA.

If you REALLY want to make it easy on yourself and take much of the burden off you and your partner, i'd have make base hospital contact as soon as I assessed Pt with C/C

Tell them who you are, what you have and ask them if they'd like you to transport or wait on scene for ALS.  Once THEY make the call, it's on them what happens from there.

Whenever there are questions on scene, and it's one of these kind of situations, I tell crews to contact base hospital, and since they are the ultimate say in SoCals "mother may I" system, let them decide.


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## Lady_EMT (Apr 4, 2011)

Am I missing something here?

Why would you wait for fire, if you have the pt all packaged and loaded into the ambulance?


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## Bullets (Apr 5, 2011)

Lady_EMT said:


> Am I missing something here?
> 
> Why would you wait for fire, if you have the pt all packaged and loaded into the ambulance?



same, usually we run away from the BRTs

And if i cant see Medics, or hear them, im leaving, high flow diesel fuel to a Trauma unit


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## exodus (Apr 5, 2011)

Go to your county office and contact the medical director of your county and your company, as well as a lawyer. Also, do not speak on this matter any more as this is an almost guaranteed to turn into a legal case.


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## Medic2409 (Apr 5, 2011)

Dude, I feel for ya.

As has been said, a max diesel bolus was what this pt. needed.

You've run into the same thing I've run into...trying to do the right thing for the patient gets you in trouble.

If nothing else, you can look yourself in the mirror and know that you did the right thing, and the best that you could do, for the patient.

No matter what anyone else says, as long as you did the best you could, that can't be taken away from you.


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