# EMT-B responds to 2 GSW Victims



## HardKnocks (Dec 4, 2022)

See page 147 for the EMT's interview with Law Enforcement.
GSW Victims

Seems like the EMT failed to use several immediate treatments for a GSW.

I had a few questions for those of you that are familiar with the Scope of Practice for EMT-Bs in California;

1) Do they currently teach and authorize Hemostatic Agents;
2) Do they teach and authorize the use of Chest Seals for GSW's that violate the Chest Cavity?
3) Do they teach to apply an AED to a Pt just with only an observation that the Pt's color diminished before vital signs are evaluated?

IMHO it sounds like this EMT-B has very little clinical experience, (especially treating Trauma/GSW's.

The EMT knew she had two GSW Victims and only called for two Ground Ambulances?? IMHO Air Medivac for both Pts should have been immediately initiated.

It also appears that a medical operations plan was never put into place prior to starting this work project.


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## DesertMedic66 (Dec 4, 2022)

This didn’t happen in California…


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## Carlos Danger (Dec 4, 2022)

Hindsight is always 20/20, but even so, without knowing what protocols were in place and what supplies were available and not having more details about the care rendered, I'm not sure how one would come to the conclusion that the EMT's actions were substandard.

Probably was a chaotic scene and the medic probably had very limited supplies and wasn't the least bit mentally prepared for an MCI involving penetrating trauma. I think direct pressure, oxygen, and calling for help / transport resources is a pretty reasonable start.


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## DesertMedic66 (Dec 4, 2022)

Additionally, many areas only allow specific responders to request HEMS. A 911 caller or even a “set medic” is usually not one of those who qualify. So your ground units would have to arrive on scene first and then request HEMS.


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## HardKnocks (Dec 4, 2022)

DesertMedic66 said:


> This didn’t happen in California…


From what I can gather, the EMT was first employed as a Set Employee before becoming an EMT-B in California, (then recently licensed in NM).


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## HardKnocks (Dec 4, 2022)

Carlos Danger said:


> Hindsight is always 20/20, but even so, without knowing what protocols were in place and what supplies were available and not having more details about the care rendered, I'm not sure how one would come to the conclusion that the EMT's actions were substandard.
> 
> Probably was a chaotic scene and the medic probably had very limited supplies and wasn't the least bit mentally prepared for an MCI involving penetrating trauma. I think direct pressure, oxygen, and calling for help / transport resources is a pretty reasonable start.


In the last two years Ive assisted in EMT Refresher Courses in AZ and we cover GSW's treatment both in the Classroom and in a practical.  Hemostratic Agents and Chest seals, for Chest incursions were a must.


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## HardKnocks (Dec 4, 2022)

DesertMedic66 said:


> Additionally, many areas only allow specific responders to request HEMS. A 911 caller or even a “set medic” is usually not one of those who qualify. So your ground units would have to arrive on scene first and then request HEMS.


In AZ. any first responder/medical professional, (both on and off-duty) can request HEMS, as its recognized under the ICS protocols he/she is first on scene and is the first on-scene command.

That's why I brought up the Medical Operations Plan.  Usually when I've seen  a Medical Ops Plan executed, (usually for a large multi-person event) A copy is given, as a courtesy, to the local responding agencies to facilitate a timely and appropriate response, (especially when we're usually over an hour from a Level 1).  The MOP doesn't guarantee anything, but gives public safety managers an idea of possible resource allocation, if needed.

The more important and valuable item with a Medical Ops Plan is that EVERYONE participating in the even attends a briefing and has a mental primer of the what, when, how a medical event will be handled, and their expected task. But as you know, even the best laid plans can turn chaotic.

The purpose of my aformention post is not to bash the on-set medic, but to stress the importance of professionalism with the younger inexperiencd EMTs out there.  Taking this job for a paycheck only, and not keeping up on your skill set and knowledge, can have dire consequences for a Pt.  Reoccurring Training and proficiency also need to be taken seriously.


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## DesertMedic66 (Dec 4, 2022)

HardKnocks said:


> From what I can gather, the EMT was first employed as a Set Employee before becoming an EMT-B in California, (then recently licensed in NM).


Sure, chest seals are taught in CA and is an EMT skill. Hemostatic gauze? Some programs teach it and some don’t. Some protocols allow it and other don’t. Some agencies carry it and some don’t. 

In the world of set medics, it’s going to really depend on what their policy/protocols are and what their required equipment list is. 

I wouldn’t base any opinions of treatments on what the police report said as it is very brief with not a lot of information. 


HardKnocks said:


> In AZ. any first responder/medical professional, (both on and off-duty) can request HEMS, as its recognized under the ICS protocols he/she is first on scene and is the first on-scene command.
> 
> That's why I brought up the Medical Operations Plan.  Usually when I've seen  a Medical Ops Plan executed, (usually for a large multi-person event) A copy is given, as a courtesy, to the local responding agencies to facilitate a timely and appropriate response, (especially when we're usually over an hour from a Level 1).  The MOP doesn't guarantee anything, but gives public safety managers an idea of possible resource allocation, if needed.
> 
> ...


So if I am the designated first responder working at a warehouse and someone has chest pain, I can immediately request a HEMS response? If I am an off duty EMR and pass by someone laying on the ground I can immediately request a HEMS response? 

Most HEMS companies will only launch when requested by the local EMS system or hospital.


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## HardKnocks (Dec 4, 2022)

DesertMedic66 said:


> Sure, chest seals are taught in CA and is an EMT skill. Hemostatic gauze? Some programs teach it and some don’t. Some protocols allow it and other don’t. Some agencies carry it and some don’t.
> 
> In the world of set medics, it’s going to really depend on what their policy/protocols are and what their required equipment list is.
> 
> ...


Why do you ask a question to which you know the answer?  Do they not teach triage in California?

In the original scenario, two GSW's more than 1 hour away from a Level 1, necessitated an Air Medivac.  The medic also dis not specify ALS, only two Ambo's.

Btw, Don't you Guys in California do "hot washes" after a significant event?


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## DesertMedic66 (Dec 4, 2022)

HardKnocks said:


> Why do you ask a question to which you know the answer?  Do they not teach triage in California?
> 
> In the original scenario, two GSW's more than 1 hour away from a Level 1, necessitated an Air Medivac.  The medic also dis not specify ALS, only two Ambo's.
> 
> Btw, Don't you Guys in California do "hot washes" after a significant event?


What question did I ask to which I know the answer for? If you are referring to the hemostatic gauze question, I answered that one already. If you are referring to my other hypothetical questions then I don’t know the answer as in every area I have ever worked or have knowledge of does not allow bystanders or off duty personnel to request HEMS. 

The set medic was not the one who called 911 per the report. They had another member of staff call for them and request 2 ambulances. 

The 911 system will determine what resources to send based on their established policies. At many of these movie sets even if there is a set medic on site all responses are treated as if there are no medically trained personnel on scene. So a set medic saying they need X resources will be treated as a normal bystander saying the need X resources which really means “we are gonna wait for the first actual responder from our system to get there and tell us what is needed”. 

I have not heard the term “hot wash” before but if you are referring to an After Action Review then possibly. Some agencies do them more often than not. A 2 patient GSW is generally not considered a “significant event”. 

Look at it from the EMS side of the response: they got a call for a 2 patient GSW. They responded. They found the patients. They treated the patients and determined what hospital they needed to go to and also the best way of getting them there. That’s a pretty standard call.


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## E tank (Dec 4, 2022)

Hard to have a meaningful conversation on care given based on an SO death investigation report...


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## CCCSD (Dec 4, 2022)

MMQ is strong…


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## BobBarker (Dec 5, 2022)

A 2 person GSW happens like everyday in our system in LA, it's routine. Definitley not de-breifing that. And unless your the 911 provider assigned to the call, calling for a helicopter off duty is not going to get you a helicopter.


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## johnrsemt (Dec 5, 2022)

Yea calling for a helicopter when we are off duty is a tough one.

I have done it a couple of times on my way home or to my PT job (120 miles from home):  I tell dispatch what I have and where it is and who I am; and request a helicopter.  But the dispatchers know me, so that is different.
I have done it away from home and been told know a couple of times.  One of them was a 90 minute wait for EMS to arrive.  So that was fun.  1 was dead already, 1 died (but would have died before the helicopters got there so didn't matter much.

I have dealt with Set EMS at my part time job, and all they are allowed to do is call 911.  Never saw such a happy person when we arrived.   We called for a helicopter from dispatch info (what they got from the set EMS, "Barely Breathing, major asthma attack".) Driver and medic up front called the bird:  and then I cancelled it within 5 minutes of arriving at the set.
The crew up front didn't think to cancel it until we were done with the run.
 Per the Set medic he was out of medic school for 3 months.  Nothing to Medic type school, and it was his 1st critical patient:  patient had used his Albuterol Inhaler 4 times and wasn't wheezing any more;  and was shocked that he was the one we were there for. 
The set medic was closer to needing us than his patient


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## HardKnocks (Dec 7, 2022)

Hot Wash = After Action Report

Any incident where a low time-in-grade employee's performance is subpar during an incident we're going to de-brief it.

Any incident with major media attention will definitely get QC'd, (as you can expect subsequent lawsuits).

Do you guys realize that the incident took place in a rural setting, where the NM. EMS response is probably greater than 30 minutes to the scene? The set location pushes ETA to a Level 1 to over 90 minutes at the minimum, (via ground transportation), thus fits the criterial for an Air Medivac.


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## HardKnocks (Dec 7, 2022)

BobBarker said:


> calling for a helicopter off duty is not going to get you a helicopter.


It will in most Rural areas that I work in.


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## ffemt8978 (Dec 7, 2022)

HardKnocks said:


> It will in most Rural areas that I work in.


And in most rural areas I was in, an off duty requesting a helicopter would only result in it being placed on standby until an on duty responder arrived on scene and requested a flight.  

The point being that just because it is that way in your area does not mean it is the same every where.


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## DesertMedic66 (Dec 7, 2022)

HardKnocks said:


> Hot Wash = After Action Report
> 
> Any incident where a low time-in-grade employee's performance is subpar during an incident we're going to de-brief it.
> 
> ...


As stated before it is going to vary greatly by system. Some systems allow HEMS to be activated upon initiation of a 911 call. Some systems require a designated person to be on scene before HEMS is requested. 

I think we are all aware that this took place in a rural setting. That doesn’t change anything about my earlier comment.


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## CCCSD (Dec 7, 2022)

HardKnocks said:


> Hot Wash = After Action Report
> 
> Any incident where a low time-in-grade employee's performance is subpar during an incident we're going to de-brief it.
> 
> ...


Actually…a Hot Wash is a quick review immediately AFTER an incident or training, while everyone is still there and fresh.
An After Action Report, or Review, is a written document prepared days to weeks AFTER the incident or training and is used to base changes upon.

And to be done CORRECTLY, the review encompasses EVERYONE, not just “low time in grade”.

I think you and your agency need some AAR done on your AAR process and training program.


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