# Ped major trauma - Houston FD delayed EMS response?



## systemet

http://www.ems1.com/communications-...-family-questions-Houston-ambulance-response/

This sounds bizarre...


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## Handsome Robb

That's terrible.

Remind me never to move to Houston. Talk about a Fire Department trying to justify its existence


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## Tigger

That is not a good system. When someone calls 911 for an ambulance, an *ambulance* needs to be sent. Period. We have ALS FD first response on every call where I live, but an ambulance is sent to every call as well (except lift assists). Fire is useful since there are almost twice as many of them than ambulances, so at least they can settle things down till an ambulance arrives. 

Is there evidence to support ALS first response? Nope. Poor contract wording that allows the bare minimum of AMR trucks to cover the city? Yes. But having fire respond to every medical at least ensures that everyone gets a paramedic in a timely manner, and the care actually provided by the crews is usually quite good. I


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## STXmedic

Personally, I think that this is more a terrible accident with the parents looking for something to pin it on. The general public does not understand how our systems work, and during an emergency minutes seem like an eternity. The news will always do a great job at contorting verbiage to make a good story. 

Houston's dispatch system sounds nearly identical to the one we use (willing to bet it's the same one). It is not "send only fire to every call, then let fire dispatch EMS". Both get dispatched with very few exceptions. In a major city, 8min response times for EMS is not all that long (I regularly have a longer than 4min eta waiting on EMS), and when there are nearly twice as many fire units, of course fire is going to get there first. 

I'm not saying Houston is a great service by any means, but I think that story has a lot of holes left in it and a lot of facts left out.


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## Tigger

I misread that story. The fire official quoted makes note that an ambulance is dispatched automatically for life-threatening emergencies. The only time one is not is for "non-emergent" calls, which is like the system here. I don't understand how this call gets mishandled as non-emergent. I suppose it could happen, but I think Poetic is right and the system probably worked but the child still died. Sometimes it takes longer than we would like to get an ambulance.


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## McGoo

I don't see a major problem with sending FD first. If someone is majorly sick, especially from a trauma, most of the time they dont need advanced doodads and doohickeys, they need airway, breathing, and circulation. Which an EMT-B person should be able to do. On the big calls I go on, it's really the basic stuff that saves lives. 

There are exceptions to this, such as needle decompression for tension pneumothorax, but on the whole sending someone is better than waiting a long time for the advanced someone.


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## Farmer2DO

PoeticInjustice said:


> Personally, I think that this is more a terrible accident with the parents looking for something to pin it on.



Actually, the family is stating exactly the opposite.  They are trying to make sure the system worked well, and at first glance, it appears it did not.  If it didn't work well, they want to make sure that gets fixed.




McGoo said:


> I don't see a major problem with sending FD first. If someone is majorly sick, especially from a trauma, most of the time they dont need advanced doodads and doohickeys, they need airway, breathing, and circulation. Which an EMT-B person should be able to do. On the big calls I go on, it's really the basic stuff that saves lives.



Most of the time, expecially with trauma, we are NOT definitive care.  Definitive care for trauma is bright lights and cold steel, which you can't get without an ambulance.

If they are using EMD protocols, I can't even begin to comprehend how this isn't dispatched as an emergency job, and thus withhold an ambulance.  I can see how withholding an ambulance on an OBVIOUS low priority job during high call volume and low ambulance availability can help, but this doesn't meet that criteria.  In my system, this would be a Delta level job every day.  

Did it make a difference?  Maybe, maybe not.  I do think the program is an epic fail, from what we know so far and how this situation appears to have been handled.  Houston better change the dispatch program, or they better get used to paying out lots of money to angry family members.


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## Handsome Robb

There's not an issue with sending the FD seeing as they will more than likely be on scene first, depending on the time of day and how the EMS system is setup. Here we run System Status, during the day FD usually beats us to priority 1-2 calls. If its in the middle of the night we usually get there first seeing as we are already in the truck whereas they have to get out of bed get dressed then leave the station.

The issue is FD and EMS weren't dispatched simultaneously or back to back. There is no way HFD is going to be able to justify sending an engine to this, ALS or not, then waiting for them to arrive on scene and make an assessment then to decide to dispatch the Ambulance.


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## STXmedic

Farmer2DO said:


> If they are using EMD protocols, I can't even begin to comprehend how this isn't dispatched as an emergency job, and thus withhold an ambulance.  I can see how withholding an ambulance on an OBVIOUS low priority job during high call volume and low ambulance availability can help, but this doesn't meet that criteria.  In my system, this would be a Delta level job every day.
> 
> Did it make a difference?  Maybe, maybe not.  I do think the program is an epic fail, from what we know so far and how this situation appears to have been handled.  Houston better change the dispatch program, or they better get used to paying out lots of money to angry family members.


That's the thing though. We don't know if an ambulance was held or not. The family ASSUMED that one was held because of the response time, but the fire department did not confirm this and I doubt that was the case. EMD would have absolutely dispatched an ambulance with that.


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## JPINFV

PoeticInjustice said:


> Personally, I think that this is more a terrible accident with the parents looking for something to pin it on. The general public does not understand how our systems work, and during an emergency minutes seem like an eternity. The news will always do a great job at contorting verbiage to make a good story.



From the article:


> City Council member Mike Sullivan, whose district includes Kingwood,  said the family was told by the crew of the fire engine that an  ambulance could not be sent until they arrived on the scene to make an  assessment.
> "It's not uncommon for a firetruck to show up on EMS  calls," said Sullivan, who said he talked to HFD personnel at the scene  of the Kingwood accident. "However, they usually show up and an  ambulance is en route at the same time. The new policy is: The firetruck  is dispatched to the scene, makes an assessment, and then requests an  ambulance."



Either the council member is mistaken, or explain to be how "The new policy is: The firetruck  is dispatched to the scene, makes an assessment, and then requests an  ambulance," is anything but fresh horse apples. Explain to me how your system works. I don't understand how YOUR system works if that direct quote is accurate. Would the fire department send a battalion chief to a fire with visible flames to make an "assessment" before dispatching a structure assignment?


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## JPINFV

McGoo said:


> I don't see a major problem with sending FD first. If someone is majorly sick, especially from a trauma, most of the time they dont need advanced doodads and doohickeys, they need airway, breathing, and circulation. Which an EMT-B person should be able to do. On the big calls I go on, it's really the basic stuff that saves lives.



Make sure to tell the trauma surgeon to stick to the basics like A, B, C, and not to use all of those fancy operating doohickeys.


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## STXmedic

JPINFV said:


> From the article:
> 
> 
> Either the council member is mistaken, or explain to be how "The new policy is: The firetruck  is dispatched to the scene, makes an assessment, and then requests an  ambulance," is anything but fresh horse apples. Explain to me how your system works. I don't understand how YOUR system works if that direct quote is accurate. Would the fire department send a battalion chief to a fire with visible flames to make an "assessment" before dispatching a structure assignment?



And I believe everything that comes out of an upset citizen's mouth. Especially when it's something they were told when they were panicking and not thinking straight. When the FD comes out an publicly releases the dispatch records showing that this was indeed the case, then I will side with you 100% that their system is terribly flawed and needs a complete overhaul. Until then, I'm not going to weigh too heavily on the word of a distraught parent.


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## Handsome Robb

JPINFV said:


> Make sure to tell the trauma surgeon to stick to the basics like A, B, C, and not to use all of those fancy operating doohickeys.



I see your point, but your comparing apples to oranges. 

This is a prehospital forum, not a trauma surgeon forum. 

At the ALS level there are few things we can do beyond what a B/I can do for a trauma patient. Needle decompression, fluid replacement, monitor for dysrhythmias, if your real rural maybe pericardiocentesis, intubation/cric and many places I's can drop ETTs.


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## JPINFV

PoeticInjustice said:


> And I believe everything that comes out of an *upset citizen's mouth.*



Do you know how I know that you haven't read the article?




> _*City Council member Mike Sullivan*_, whose district includes Kingwood,  said the family was told by the crew of the fire engine that an  ambulance could not be sent until they arrived on the scene to make an  assessment.
> "It's not uncommon for a firetruck to show up on EMS  calls," _*said Sullivan, who said he talked to HFD personnel at the scene  of the Kingwood accident.*_ "However, they usually show up and an  ambulance is en route at the same time. The new policy is: The firetruck  is dispatched to the scene, makes an assessment, and then requests an  ambulance."






So, let's ignore the upset citizen and listen to the elected representative who was talking to the people who responded. Unless we shouldn't be listening to emergency responders who are trying to cover their own behind.


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## JPINFV

NVRob said:


> At the ALS level there are few things we can do beyond what a B/I can do for a trauma patient. Needle decompression, fluid replacement, monitor for dysrhythmias, if your real rural maybe pericardiocentesis, intubation/cric and many places I's can drop ETTs.



I won't argue otherwise, however a "stick to the basics" line, to me, stinks of "BLS before ALS" which stinks of inadequate training and silly little boxes like "basic" or "advanced." How about instead of "sticking to the basics" we stick to "evidence based medicine"? The really strange thing is that all of those things you mentioned are important interventions used to manage airway, breathing, and circulation issues when used appropriately and prudently.


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## STXmedic

I would like to know how you think I did not read the article. I'm just pulling this other info out of my ***. An educated shot in the dark if you will.


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## JPINFV

I edited my post above, but I'll copy paste it...



PoeticInjustice said:


> I would like to know how you think I did not read the article. I'm just pulling this other info out of my ***. An educated shot in the dark if you will.




You identified the source as an "upset citizen."




> _*City Council member Mike Sullivan*_, whose district  includes Kingwood,  said the family was told by the crew of the fire  engine that an  ambulance could not be sent until they arrived on the  scene to make an  assessment.
> "It's not uncommon for a firetruck to show up on EMS  calls," _*said Sullivan, who said he talked to HFD personnel at the scene  of the Kingwood accident.*_  "However, they usually show up and an  ambulance is en route at the  same time. The new policy is: The firetruck  is dispatched to the scene,  makes an assessment, and then requests an  ambulance."




So, let's ignore the upset citizen and listen to the elected  representative who was talking to the people who responded. Unless we  shouldn't be listening to emergency responders who are trying to cover  their own behind.


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## Handsome Robb

JPINFV said:


> I won't argue otherwise, however a "stick to the basics" line, to me, stinks of "BLS before ALS" which stinks of inadequate training and silly little boxes like "basic" or "advanced." How about instead of "sticking to the basics" we stick to "evidence based medicine"? The really strange thing is that all of those things you mentioned are important interventions used to manage airway, breathing, and circulation issues when used appropriately and prudently.



I never said they weren't important. Although, you can't utilize these interventions "appropriately and prudently" unless you start with your ABC assessment which is a BLS skill.

JP you should know that I am with you on increasing education and changing the way EMS medicine is practiced in a majority of places but it's not really fair to present an argument with trauma surgeons referenced....


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## Farmer2DO

McGoo said:


> I don't see a major problem with sending FD first.



I don't think any of us have a problem sending the fire department at all.  Just don't wait on an ambulance when a mother says "I ran over my child."  




> If someone is majorly sick, especially from a trauma, most of the time they dont need advanced doodads and doohickeys, they need airway, breathing, and circulation.



No, they need a surgeon to fix them, or they will die.  We don't yet do surgery in the field, so it requires getting them somewhere where they can.  Like a hospital.  Which requires an ambulance.




> Which an EMT-B person should be able to do. On the big calls I go on, it's really the basic stuff that saves lives.



Again, no.  What EMS of any level can TRY to do is keep the patient viable until they arrive somewhere where definitive care can be given.  We are rarely definitive care. 



> but on the whole sending someone is better than waiting a long time for the advanced someone.



How about sending someone who can actually get the patient to DEFINITIVE CARE?  A fire truck ain't gonna do jack squat for a trauma patient.  Period.



JPINFV said:


> Make sure to tell the trauma surgeon to stick to the basics like A, B, C, and not to use all of those fancy operating doohickeys.





NVRob said:


> I see your point, but your comparing apples to oranges.



No, he's not.



> This is a prehospital forum, not a trauma surgeon forum.


 
You're absolutely right.  And one of our major jobs is to get the trauma patient to the trauma surgeon.



> At the ALS level there are few things we can do beyond what a B/I can do for a trauma patient. Needle decompression, fluid replacement, monitor for dysrhythmias, if your real rural maybe pericardiocentesis, intubation/cric and many places I's can drop ETTs.



You seem to have a fairly level head, and I believe you're a paramedic student.  One of the things that you will learn is that often what makes a paramedic more valuable in the patient care arena is what's between the ears, not what's in the bag of tricks.  You're right; often trauma doesn't require a lot of stuff to be done.  But the paramedic, by the nature of their training, and especially compared to the EMT-B and EMT-I (I operated at both levels extensively) brings much more to the table, with their education and understanding of anatomy, pathophysiology and treatment, and their clinical experience allowing them to make judgement calls and to recognize when a situation is emergent and when it isn't.  I don't care if all the patient needed was transport; the paramedic is far more equipped to assess, choose the mode of transport, the destination, and pre-notify, all of which can make a huge difference in time to definitive care.  No EMT-B or EMT-I has the didactic education, clinical education, and experience to make those judgement calls.


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## JPINFV

NVRob said:


> JP you should know that I am with you on increasing education and changing the way EMS medicine is practiced in a majority of places but it's not really fair to present an argument with trauma surgeons referenced....




I believe that it's very fair when using it to compare and contrast how fields who aren't contaminated with "BLS/ALS" or "basic/advanced" dichotomy looks at things. I have yet to hear in medical school anything that compares with sticking some interventions into "basic" or "advanced." Some interventions may be used before others, but that doesn't make the first line treatments "basic" or further treatments "advanced."


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## DV_EMT

Do it like LA does it.... send an engine & ALS crew and contract out an ALS ambulance or use their own if its available. Thats how its done.


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## STXmedic

JPINFV said:


> I edited my post above, but I'll copy paste it...
> 
> 
> 
> 
> You identified the source as an "upset citizen."
> 
> 
> 
> 
> 
> So, let's ignore the upset citizen and listen to the elected  representative who was talking to the people who responded. Unless we  shouldn't be listening to emergency responders who are trying to cover  their own behind.





> City Council member Mike Sullivan, whose district includes Kingwood, said the family was told by the crew of the fire engine that an ambulance could not be sent until they arrived on the scene to make an assessment.
> 
> "It's not uncommon for a firetruck to show up on EMS calls," said Sullivan, who said he talked to HFD personnel at the scene of the Kingwood accident. "However, they usually show up and an ambulance is en route at the same time. The new policy is: The firetruck is dispatched to the scene, makes an assessment, and then requests an ambulance."



Is this the text you are referencing? Because here I see exactly what I mentioned; the family stating they were told by the fire crew. Then, the councilman talks about the new system (that I doubt he has too strong of an understanding of), and says he spoke to the personnel. He does not say that they told him they were dispatched solo and were required to assess the pt before dispatching EMS. If YOU were to read earlier in the text, you would have read that the Fire Chief also made a statement:



> Under the new "All Hazards Response Program" launched Aug. 1, there were no changes to the dispatch of ambulances with advanced life support capabilities to respond to calls where there is a life-threatening incident, said Fire Chief Terry Garrison.



I bet you this guy has a slightly better understanding of the dispatch system than some city councilman with second-hand information.


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## Handsome Robb

JPINFV said:


> I believe that it's very fair when using it to compare and contrast how fields who aren't contaminated with "BLS/ALS" or "basic/advanced" dichotomy looks at things. I have yet to hear in *medical school* anything that compares with sticking some interventions into "basic" or "advanced." Some interventions may be used before others, but that doesn't make the first line treatments "basic" or further treatments "advanced."



Yet again your bringing advanced medical education to the table.

You have to look at the simplicity of medical education brought to the table in both, don't shoot me but I'm gonna say it, basic *and* advanced EMS education.

I don't see how you were comparing and contrasting but then again I'm just a stupid EMT-I/Medic Student


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## DrParasite

City Council member Mike Sullivan, whose district includes Kingwood, said the family was told by the crew of the fire engine that an ambulance could not be sent until they arrived on the scene to make an assessment.

"It's not uncommon for a firetruck to show up on EMS calls," said Sullivan, who said he talked to HFD personnel at the scene of the Kingwood accident. "However, they usually show up and an ambulance is en route at the same time. The new policy is: The firetruck is dispatched to the scene, makes an assessment, and then requests an ambulance."


JPINFV said:


> City Council member Mike Sullivan, whose district includes Kingwood, said the family was told by the crew of the fire engine that an ambulance could not be sent until they arrived on the scene to make an assessment.
> 
> "It's not uncommon for a firetruck to show up on EMS calls," said Sullivan, who said he talked to HFD personnel at the scene of the Kingwood accident. "However, they usually show up and an ambulance is en route at the same time. The new policy is: The firetruck is dispatched to the scene, makes an assessment, and then requests an ambulance."
> 
> 
> So, let's ignore the upset citizen and listen to the elected representative who was talking to the people who responded. Unless we shouldn't be listening to emergency responders who are trying to cover their own behind.


The elected representative is speaking for his district, getting his name in the paper, and making the appearance that he cares.  the reality is, he knows nothing, shouldn't be talking, and is doing it to get votes.

He is giving second hand information from the firefighters based on ONE call.  you can't run a system based on one call, nor can you make policy based on one call.  

The obvious solution to this problem would be to double the EMS fleet to a more manageable number of units to handle the call volume, so you don't need the FD to play first responder and decide if an ambulance is needed.  in this case, the FD delayed care; the injured child needed an ambulance to take them to the trauma center and bright lights & cold steel.  not a fire truck to say "yes, the kid is sick, put a rush on the ambulance."

Sadly, this happens in urban areas all over the country.  the only reason it made the news today was because it involved a young child, and the City Councilman wanted a soundbite.  So sad.


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## Farmer2DO

> "She said a full hour passed before Rebecca arrived at Memorial Hermann Children's Hospital, where she was pronounced dead."



If that's anywhere near true, then this public safety system is failing their community.  A trauma patient should not take an hour to reach a trauma center from within the city limits of a city with 2 pediatric level 1 and 2 adult level 1 trauma centers.  That's abysmal, and horrendous patient care.


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## McGoo

JPINFV said:


> Make sure to tell the trauma surgeon to stick to the basics like A, B, C, and not to use all of those fancy operating doohickeys.



In the first few moments after a major trauma, a person _first_ needs A, B, and C. What are the first things that are checked when you bring in any unstable patient? Airway, breathing, and circulation. Yes, they still need all manner of procedures that are far beyond the pre-hospital scope, but without A, B, and C they are useless.



Farmer2DO said:


> I don't think any of us have a problem sending the fire department at all.  Just don't wait on an ambulance when a mother says "I ran over my child."



I was not advocating delaying the ambulance, I was advocating someone with medical skills being sent ASAP.




Farmer2DO said:


> No, they need a surgeon to fix them, or they will die.  We don't yet do surgery in the field, so it requires getting them somewhere where they can.  Like a hospital.  Which requires an ambulance.



Are you saying people _dont_ need A, B, and C? If so, I would advise you to do some revision. Yes, an ambulance will convey them to hospital quickly, and it will get them to definitive care. I wasnt saying that we (Paramedic/EMT/whatever) can provide definitive care, I was saying we can provide them with life saving interventions that give them a chance at making it to definitive care. 




Farmer2DO said:


> Again, no.  What EMS of any level can TRY to do is keep the patient viable until they arrive somewhere where definitive care can be given.  We are rarely definitive care.



See above.




Farmer2DO said:


> How about sending someone who can actually get the patient to DEFINITIVE CARE?  A fire truck ain't gonna do jack squat for a trauma patient.  Period.



Actually, a fire truck will do more than jack squat, if it has a trained medical person on board with appropriate equipment. It may not be able to convey a patient (at least not in the same way or with the same care) an ambulance can, but in those first few minutes treatment can be started-an airway can be obtained (hopefully), ventilations can be given, major bleeding can be stopped or slowed. These are the important things in a major trauma. What is the point of doing a 12 lead or other advanced protocol on someone who has already bled out?



Farmer2DO said:


> No, he's not.



Yes, he is. A trauma surgeon can and will only bother doing a procedure if the basics are taken care of. Unless, of course, the procedure is to correct the basics-Im thinking thoracotomy etc.


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## Martyn

Sorry but this just reinforces my view that fire trucks should stick to fire and ambulances should, well, ambul


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## Farmer2DO

And am I missing somthing?  I used Google Maps to try and figure out where the trauma centers in Houston were in comparison to the incident.  It appears that the only trauma centers in Houston (all 4 are level Is, 2 are peds and 2 are adult), are all in a 2 mile loop, and all almost touching each other.  No place else in Houston or the surrounding suburbs is a level I or II.  So much for your trauma system being geographically accessible.....


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## Farmer2DO

McGoo said:


> I don't see a major problem with sending FD first.




I do.  Send the FD if you want to, but send the ambulance at the same time.  In this article, people are clearly saying there was a delay in starting a transport ambulance.  Make all the arguments you want, but delaying an ambulance is just delaying getting the patient to the care they need.  Again, I have no problem delaying ambulance responses to low priority jobs.  This was not even close to that.  That idiot city councilman was trying to justify why they didn't send an ambulance while that woman's four year old daughter was lying in the driveway, dying.


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## McGoo

Farmer2DO said:


> I do.  Send the FD if you want to, but send the ambulance at the same time.  In this article, people are clearly saying there was a delay in starting a transport ambulance.  Make all the arguments you want, but delaying an ambulance is just delaying getting the patient to the care they need.  Again, I have no problem delaying ambulance responses to low priority jobs.  This was not even close to that.  That idiot city councilman was trying to justify why they didn't send an ambulance while that woman's four year old daughter was lying in the driveway, dying.



Ok, maybe I need to clarify my statement. I have no problem with the FD _arriving_ first. In a major emergency, yes, absoloutely send an ambulance at the same time. But to not send FD at all, when they may be closer, would be a mistake. Without knowing the details of the case in question, we cant say if the ambulance was withheld or not, I dont think it should have been. But it is entirely possible that the FD was half the distance from the job that the ambulance was. Also, sending FD to non-urgent calls is good to alleviate the load on an ambulance crew, but if they are not emergency calls, (Im thinking gout, cellulitis, decreased mobility, etc), then the ambulance is the only crew who can do anything, and that is take them to hospital. (Unless, of course, you are lucky to have a paramedic practitioner handy.) In this instance, sending the FD looks great on a response time list, but does nothing for patient care.


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## tssemt2010

let me start by saying i have quite a few friends that work for HFD, HFD runs both BLS and ALS ambulances, if its an ALS call chances are a BLS ambulance and a squad with 2 paramedics on it will get sent if a medic unit is not available, the reason for BLS ambulances in houston is because there is a large amount of BS calls in houston, hence the reason they typically send an engine or ladder before calling for an ambulance BUT this does not mean its right, if its a BS call you can always obtain a refusal if they dont want to go and go back in service somewhat quickly, instances like this there shouldve been a medic and engine or an engine, ambulance and a squad dispatched


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## fast65

NVRob said:


> Yet again your bringing advanced medical education to the table.
> 
> You have to look at the simplicity of medical education brought to the table in both, don't shoot me but I'm gonna say it, basic *and* advanced EMS education.
> 
> I don't see how you were comparing and contrasting but then again I'm just a stupid EMT-I/Medic Student



In this case I think he's just trying to say that in EMS we shouldn't be classifying our jobs as "basic" and "advanced". We tend to define ourselves in EMS based on what we can do, not on what we know. We shouldn't be placing our interventions in "basic" or "advanced" categories, we should be focusing on when they should and shouldn't be used, and when to use which one first.

Let me use airway management as an example. I see so many paramedics that intubate a patient that would could have been managed with a BVM and use the excuse "I'm a paramedic, it's what I do". That's not the way we should be looking at things, we need to know when and more importantly when NOT to use an intervention. I don't know if I really illustrated what I wanted to say, but I'm digressing from the OP anyways. 

As for the original topic, it's a terrible tragedy that may or may not have been avoided by getting the child to the hospital first. I don't see a problem with a system where FD gets dispatched first to "non-emergent" calls and then requests an ambulance after doing their assessment. However, I think the problem lies in how dispatch is classifying "emergent" and "non-emergent" calls. In this case, I think bad parenting is to blame, I don't care if I'm sounding like a jackass, but I would imagine that a responsible parent would know where her child was before backing out of the driveway. But I'm not a parent, so what do I know...


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## STXmedic

tssemt2010 said:


> if its a BS call you can always obtain a refusal if they dont want to go and go back in service somewhat quickly



LOL!! No. Not at all the case. Without the BLS units in Houston, they'd even more regularly run out of ALS units. I also have several friends at HFD, and even with the BLS, the ALS is regularly ran into the ground. Do not count on a refusal for at least 75% of BS runs. (no, I have no statistics, just pulled that number out of my a$$). 

In regards to the dispatching of BLS units, the dispatchers DO have the ability to override the computer, but I can just about guarantee that even the computer would have sent an ALS unit (which even the story didn't say anything about it being a BLS unit that responded).


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## NomadicMedic

With any kind of PMD system, I simply can't believe that this is the case. Are we getting all of the facts? Was there a paramedic unit even available? Was there a BLS ambulance available? Where there paramedics on that firetruck? Was the call triaged correctly at dispatch? Did the dispatcher ask all the correct PMD questions? Did the caller articulate the urgency enough?

There are too many questions, and not enough information to make a judgment about this before we hear 911 tapes and hear from all the parties involved. And the debate over whether to send a firetruck or an ambulance is irrelevant at this point. The key is a paramedic and the transport unit. It doesn't matter if the paramedic arrives on a firetruck, helicopter or horse and carriage, he needs to get there and then the patient needs to be transported to a trauma center. 

Apparently this system fell apart somewhere, and my guess will be a deficiency in the PMD.


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## Farmer2DO

fast65 said:


> In this case, I think bad parenting is to blame, I don't care if I'm sounding like a jackass, but I would imagine that a responsible parent would know where her child was before backing out of the driveway. But I'm not a parent, so what do I know...



You're right.  What DO you know about parenting?  Precious little, apparently.  I'm curious where you get off saying that bad parenting is to blame.  

Kids are unpredictable, and sometimes, despite the most vigilant parents, kids get somewhere they're not supposed to be.  I would imagine this mother is just completely torn up, and second guessing herself as it is.  You coming in here and throwing your opinion around that this is the parent's fault is ignorant and insulting.  As a parent I do everything in my power to keep my children safe, and there have been several near misses, and there was nothing I was doing wrong.  By the grace of God, they haven't been seriously hurt.

Do us a favor and keep your self righteous, obnoxious opinions to yourself.


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## fast65

Umm, it was my opinion, and I am in no way expecting you too agree with it. In my opinion she Should have been keeping a better eye on her child, if you think she was doing a good enough job of that, then that's your opinion. I would appreciate it if you would hold off on judging my opinion as "self-righteous and obnoxious" when it wasn't presented in such a manner; doing so makes you the ignorant one. I have every right to present my opinion and I won't do you "all" a favor by keeping it to myself, because believe it or not, there are people who agree with me.


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## Farmer2DO

Fine.  You have your opinion, I have mine.  I'm still offended as a parent.

Go have a handful of kids and raise them without any of them ever getting hurt, then we'll talk.


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## fast65

Farmer2DO said:


> Fine.  You have your opinion, I have mine.  I'm still offended as a parent.
> 
> Go have a handful of kids and raise them without any of them ever getting hurt, then we'll talk.



As a non-parent, I expected as much. 

Nope, I'll pass on having a handful of kids, but I can guarantee that if I did, I could make it through their lives without killing any of them.


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## abckidsmom

fast65 said:


> As a non-parent, I expected as much.
> 
> Nope, I'll pass on having a handful of kids, but I can guarantee that if I did, I could make it through their lives without killing any of them.



Please make sure you use birth control.  This year alone, I can think of three episodes where my kids did not die through the grace of God alone.  Going through life being able to control it is exhausting, and impossible.

Could you stop your kid from getting kicked in the chest by a horse?  Choking on a hot dog?  Falling out of a tree?  

Life is really dangerous.  100% fatal, in the end.


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## fast65

abckidsmom said:


> Please make sure you use birth control.  This year alone, I can think of three episodes where my kids did not die through the grace of God alone.  Going through life being able to control it is exhausting, and impossible.
> 
> Could you stop your kid from getting kicked in the chest by a horse?  Choking on a hot dog?  Falling out of a tree?
> 
> Life is really dangerous.  100% fatal, in the end.



Ok, I apologize, I'll rephrase that as saying that I could get through without killing one of them MYSELF.

While I don't expect you to agree with my opinion, I would at least hope you would not insult me by asking me to use birth control, implying that I'm not responsible enough to raise children. If that's not what you're implying, then feel free to disregard. Thanks.


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## Sasha

Farmer2DO said:


> You're right.  What DO you know about parenting?  Precious little, apparently.  I'm curious where you get off saying that bad parenting is to blame.
> 
> Kids are unpredictable, and sometimes, despite the most vigilant parents, kids get somewhere they're not supposed to be.  I would imagine this mother is just completely torn up, and second guessing herself as it is.  You coming in here and throwing your opinion around that this is the parent's fault is ignorant and insulting.  As a parent I do everything in my power to keep my children safe, and there have been several near misses, and there was nothing I was doing wrong.  By the grace of God, they haven't been seriously hurt.
> 
> Do us a favor and keep your self righteous, obnoxious opinions to yourself.



Maybe the fact she ran over her kid. Good parents don't run them over.

If the kid was outside she should have been with someone to keep her out of the drive. She's 4 years old for god sakes. Whenever ANYONE is coming in or out of the driveway and my nephew is outside we have him by the hand so he doesn't dart in the way and get hit.

It's called common sense.

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## Sasha

abckidsmom said:


> Please make sure you use birth control.  This year alone, I can think of three episodes where my kids did not die through the grace of God alone.  Going through life being able to control it is exhausting, and impossible.
> 
> Could you stop your kid from getting kicked in the chest by a horse?  Choking on a hot dog?  Falling out of a tree?
> 
> Life is really dangerous.  100% fatal, in the end.



Wow Dana I'm shocked at you.

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## Sasha

My take on this, I have no problem with a fire truck being dispatched first to assess if an ambulance is needed. Let's stop pretending that every patient needs an ambulance. How would the mother feel if the ambulance took 15 minutes because they were tied up with a sprained ankle or someone with a sore throat?

I think its great they are trying to keep ambulances free by first sending someone to assess if its needed.

Sent from LuLu using Tapatalk


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## usalsfyre

Two thoughts...

1)Anyone who insist on the "BLS before ALS" mantra has never played with a knackered airway, treated a desating, tired asthma patient or seen a closed tension pneumothorax.

2)Parenting, especially multiple kids, changes one's perspective. Previously, I would have been right there with the "bad parent" crowd. Now? "Holy crap I see how that could happen". Babysitting may give some insight, but not a comprehensive view. At some point, your guard will slip, no matter how good of a parent you are simply from the 24/7 nature of the job. Like Dana, I can recall times God had to have been looking after my kids. It happens. Unfortunately it had a horrible outcome in this case.


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## Farmer2DO

Let's also stop pretending that this is because they are trying to manage their resources.  This is because there aren't enough ambulances on the streets to handle the call volume.  You can't expect to get it right all the time when you're only using telephone triage.  Many of my Delta and Charlie jobs get transported BLS, and many of my Alpha and Bravo jobs get transported ALS.  Stop cutting corners and put the ambulances on the street.  People need to realize that if they want the ambulance there when they call 911, it's going to cost someone money.  The answer is to make people financially accountable, not limit the availability of ambulances.

I don't have a problem with the firetruck response; I DO have a problem with waiting to get a firetruck on scene before deciding if they need an ambulance.  People are going to have bad outcomes with this policy.  This is a band aid for an issue that amounts to a limb amputation.  Put the trucks on the road needed to cover the calls.  Whoever approved this policy should be considered to be part of this child's death.

As for Abckidsmom, I agree with her comments.  It's OK for Fast65 to unilaterally declare that it's the parents fault, but he gets offended when she speaks her mind.  Cuts both ways.


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## Sasha

To say that he should use birth control because he believes the parent is at fault for the death is ridiculous.

Let's face it, the death was preventable. It is not the same as a child choking or gettin kicked by a horse. 

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## abckidsmom

Sasha said:


> Maybe the fact she ran over her kid. Good parents don't run them over.
> 
> If the kid was outside she should have been with someone to keep her out of the drive. She's 4 years old for god sakes. Whenever ANYONE is coming in or out of the driveway and my nephew is outside we have him by the hand so he doesn't dart in the way and get hit.
> 
> It's called common sense.
> 
> Sent from LuLu using Tapatalk





Sasha said:


> Wow Dana I'm shocked at you.
> 
> Sent from LuLu using Tapatalk



I guess I wasn't communicating exactly well.  I just have had several friends who lost children through freak accidents and of course, retrospectively they were always preventable.

And childless people who make sweeping statements about bad parenting really push my buttons.

In this case, the girl could have slipped out of the house without her knowing, the girl could have been hiding behind the car without the mom knowing she was outside, and so on.   Constant vigilance wears out, it really does, even for good parents.  When you know a kid, and you think you know what they're thinking, it gets a little too easy sometimes to think they are going to do what you tell them to do, or to think they are going to keep doing whatever predictable thing they are currently doing. 

Things happen.  Sadly, I've never heard of a neglectful parent runnign over a kid with the car, only loving ones who made a tragic mistake.


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## abckidsmom

Sasha said:


> To say that he should use birth control because he believes the parent is at fault for the death is ridiculous.
> 
> Let's face it, the death was preventable. It is not the same as a child choking or gettin kicked by a horse.
> 
> Sent from LuLu using Tapatalk



I said that in a moment of agitated snarkiness because people who believe they have the world under control are gonna have the rug jerked out from under them the minute they hear that baby cry for the first time and realize that they are really at the mercy of any random thing that comes next.  Control is a big fat illusion, and parents who believe they can protect their kids from every danger are often stressed out beyond words.


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## exodus

I don't understand what the issue is here. It will take about 5 minutes to get the patient packaged on a backboard, and possibly get an IV or two started. Plenty of time for the firefighters to do that by the time thats done, the ambulance is pulling up get a turnover from the FF and is on their way within 2 or 3 minutes.

The issue seems to be about what took so long to get to the trauma center. It took "8 minutes, 30 seconds " for the unit to arrive, which means it took about 51 minutes and 30 seconds to get on their way and to a trauma center. Something more is up with this story, it's not unit allocation. Especially if it's an ALS engine.


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## fast65

Sasha said:


> To say that he should use birth control because he believes the parent is at fault for the death is ridiculous.
> 
> Let's face it, the death was preventable. It is not the same as a child choking or gettin kicked by a horse.
> 
> Sent from LuLu using Tapatalk



Exactly, I was NOT offended because she voiced her opinion, I WAS offended that her opinion implied I wasn't responsible enough to procreate. Again, if that's not what you're implying, I apologize. 

I realize that accidents happen, and kids are unpredictable, but TO ME, this is a preventable death.


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## usalsfyre

And getting rear-ended in the ambulance is preventable per CEVO. Hindsight is 20/20. 

I hate to say this...but until you've been in those shoes, it's darn hard to Monday morning QB.


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## fast65

abckidsmom said:


> I said that in a moment of agitated snarkiness because people who believe they have the world under control are gonna have the rug jerked out from under them the minute they hear that baby cry for the first time and realize that they are really at the mercy of any random thing that comes next.  Control is a big fat illusion, and parents who believe they can protect their kids from every danger are often stressed out beyond words.



With that explanation I can see where you're coming from, and that does give me some insight into how difficult parenting can be. I don't want to give the impression that I believe children can be prevented from being injured, I know that's not the case and I know that I don't have the world under control. However, I do think that certain things are preventable, and this was one of those things in my opinion.

It seems to me that we're all just gonna have to agree to disagree on this topic.


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## abckidsmom

fast65 said:


> With that explanation I can see where you're coming from, and that does give me some insight into how difficult parenting can be. I don't want to give the impression that I believe children can be prevented from being injured, I know that's not the case and I know that I don't have the world under control. However, I do think that certain things are preventable, and this was one of those things in my opinion.
> 
> It seems to me that we're all just gonna have to agree to disagree on this topic.



Sure thing.  I can agree to disagree.


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## fast65

abckidsmom said:


> Sure thing.  I can agree to disagree.



Alrighty.


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## Farmer2DO

exodus said:


> I don't understand what the issue is here. It will take about 5 minutes to get the patient packaged on a backboard, and possibly get an IV or two started. Plenty of time for the firefighters to do that by the time thats done, the ambulance is pulling up get a turnover from the FF and is on their way within 2 or 3 minutes.
> 
> The issue seems to be about what took so long to get to the trauma center. It took "8 minutes, 30 seconds " for the unit to arrive, which means it took about 51 minutes and 30 seconds to get on their way and to a trauma center. Something more is up with this story, it's not unit allocation. Especially if it's an ALS engine.



I agree that we probably don't know all of the details.

But to argue that it's OK to wait until you get on scene to decide if you need an ambulance, and that it's good patient care to sit there in the meantime and start IVs is just plain wrong.  IVs get started while enroute to the hospital.  Starting an IV is a low priority unless the patient is peri-arrest.  Getting an IV will not save a life, and doing it on scene is delaying care.  There is some research out there that is saying that trauma patients that get intubated and/or have fluid challeneges in the field have higher mortality rates.

Bottom line, trauma patients need to get in the ambulance and go to the hospital, preferrable a trauma center, if possible.  Anything else is just increasing the body count.


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## exodus

fast65 said:


> Exactly, I was NOT offended because she voiced her opinion, I WAS offended that her opinion implied I wasn't responsible enough to procreate. Again, if that's not what you're implying, I apologize.
> 
> I realize that accidents happen, and kids are unpredictable, but TO ME, this is a preventable death.



That's how I read it as well.h34r:


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## exodus

Farmer2DO said:


> I agree that we probably don't know all of the details.
> 
> But to argue that it's OK to wait until you get on scene to decide if you need an ambulance, and that it's good patient care to sit there in the meantime and start IVs is just plain wrong.  IVs get started while enroute to the hospital.  Starting an IV is a low priority unless the patient is peri-arrest.  Getting an IV will not save a life, and doing it on scene is delaying care.  There is some research out there that is saying that trauma patients that get intubated and/or have fluid challeneges in the field have higher mortality rates.
> 
> Bottom line, trauma patients need to get in the ambulance and go to the hospital, preferrable a trauma center, if possible.  Anything else is just increasing the body count.



You forgot the other treatment I mentioned. The one that will actually take about 4-5 minutes to complete from start to finish. The IV only takes 30 seconds.


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## Farmer2DO

An IV may only take 30 seconds in an experienced, proficient provider with someone helping him by setting up the equipment.  Again, research is showing that many paramedic FFs lost their edge and are not as sharp as the medics who are transporting every day.  So I would say that estimate is VERY optimistic.

The fact remains:  we don't delay transport for IVs.


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## crazycajun

I just spoke to a good friend that now works for HFD. He said the councilman is actually correct concerning dispatch policy. However it has been this way for quite a while. Fire is dispatched behind HPD and a decision for ambulance transport is made upon arrival unless fire is on another call then either a medic unit or ambulance will respond.


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## fast65

exodus said:


> That's how I read it as well.h34r:




How you read what?


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## usalsfyre

crazycajun said:


> I just spoke to a good friend that now works for HFD. He said the councilman is actually correct concerning dispatch policy. However it has been this way for quite a while. Fire is dispatched behind HPD and a decision for ambulance transport is made upon arrival unless fire is on another call then either a medic unit or ambulance will respond.


That's taking using EMS to prop up run volumes to a new low...


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## Farmer2DO

usalsfyre said:


> That's taking using EMS to prop up run volumes to a new low...




This ^^^

You said more simply the point that I was trying to get across.


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## crazycajun

usalsfyre said:


> That's taking using EMS to prop up run volumes to a new low...



Agreed. This is why EMS and Fire need to be separate.


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## usalsfyre

I wonder if they're providing the equivalent of an EMTALA screening exam as required by law of EDs...


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## abckidsmom

usalsfyre said:


> I wonder if they're providing the equivalent of an EMTALA screening exam as required by law of EDs...



I'd like to know what percentage of patients are found to need an ambulance.  And how it's more cost effective to have a half million dollar engine with a crew of 4 to go out and screen patients for the ambulance.  Sigh.


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## Handsome Robb

I will say FD can be very helpful on scene for extra hands. They also are usually on scene prior to our arrival unless it's some ungodly hour of the night like I explained before. I have noticed lately that the use for the extra hands of Fire on scene in my area has diminished due to the fact that nearly every single one of our units has a 3rd onboard between EMT students, Paramedic Interns and EMTs in their FTO period.

There's nothing wrong with fire responding except for the financial side of it, like other people as well as myself have voiced it's playing with fire to only dispatch an engine/truck/squad to a "non life-threatening emergency" then have them request an ambulance. Farmer2DO made the point that many high priority dispatched calls end up as BLS whereas many low priority calls end up as ALS. In my limited experience many of our rippin' STEMIs are dispatched as "Priority 3, sick person" calls andd they are super apologetic about calling. Then they end up being the patient that has a time-sensitive condition.


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## bigbaldguy

Speaking from experience I once called FD for a man down unknown cause and a BLS ambulance showed. A few months later I called when I found my neighbor dead. Call went out as full arrest CPR in progress and they sent a fire truck. HFD is not a well run organization.


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## Sasha

bigbaldguy said:


> Speaking from experience I once called FD for a man down unknown cause and a BLS ambulance showed. A few months later I called when I found my neighbor dead. Call went out as full arrest CPR in progress and they sent a fire truck. HFD is not a well run organization.



Still it didn't cause her death...

Trauma codes die. They don't come back. If the ambulance had been there in 8 seconds or 8 minutes she probably would've died.

/end thread.


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## Farmer2DO

Sasha said:


> Still it didn't cause her death...
> 
> Trauma codes die. They don't come back. If the ambulance had been there in 8 seconds or 8 minutes she probably would've died.
> 
> /end thread.




You've got to be kidding me.  By that logic, we shouldn't work ANY trauma codes.  "I'm sorry mam, but the liklihood that your daughter is going to live is slim to none, so we're just going to call her dead right here.  Oh, and it's your fault."

So much for treating reversible causes.

Oh, and by the way, nowhere in the article did it say she arrested in the field.  You have no idea what caused her death; you saying that is pure guessing.  She may have arrested just prior to arriving at the hospital, and may have had a chance if she had arrived at the trauma center 15 minutes after the accident rather than 60 minutes after.


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## exodus

fast65 said:


> How you read what?



It sounded like she was saying you shouldn't reproduce. Dead horse now though.


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## fast65

exodus said:


> It sounded like she was saying you shouldn't reproduce. Dead horse now though.



Oh, gotcha. Yup yup, dead horse.


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## Shishkabob

Farmer2DO said:


> You've got to be kidding me.  By that logic, we shouldn't work ANY trauma codes.  "I'm sorry mam, but the liklihood that your daughter is going to live is slim to none, so we're just going to call her dead right here.  Oh, and it's your fault."



We do that for blunt traumas already. 


Penetrating trauma codes are a different beast entirely.


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## JPINFV




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## Sasha

Farmer2DO said:


> You've got to be kidding me.  By that logic, we shouldn't work ANY trauma codes.  "I'm sorry mam, but the liklihood that your daughter is going to live is slim to none, so we're just going to call her dead right here.  Oh, and it's your fault."
> 
> So much for treating reversible causes.
> 
> Oh, and by the way, nowhere in the article did it say she arrested in the field.  You have no idea what caused her death; you saying that is pure guessing.  She may have arrested just prior to arriving at the hospital, and may have had a chance if she had arrived at the trauma center 15 minutes after the accident rather than 60 minutes after.



It said she arrived dead at the hospital. 

That tells me she arrested prior to the hospital.

And what exactly is reversible about trauma in the field?

The ambulance arrived 8 minutes and some change after the initial 911 call. I doubt their dispatching caused them to arrive an hour after as oppose to 15.

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## Farmer2DO

Sasha said:


> It said she arrived dead at the hospital.



No, it doesn't say that.



> She said a full hour passed before Rebecca arrived at Memorial Hermann Children's Hospital, where she was pronounced dead.





> That tells me she arrested prior to the hospital.



Nope, it doesn't say that either.  It says that's where she was pronounced dead.  We have no idea when she arrested and how long they resuscitated her.  



> And what exactly is reversible about trauma in the field?



How about tension pneumothorax and pericardial tamponade?



> The ambulance arrived 8 minutes and some change after the initial 911 call.



We don't know that. 



> But it was not clear how much time passed between when the 911 call was received and the decision was made to send the units.



The ambulance arrived 9 minutes and 19 seconds after the call was dispatched, not after the 911 call was made.  (I'm not sure who did the math in the article.  4 minutes 47 seconds + 4 minutes 32 seconds = 9 minutes 19 seconds, not 8 and a half.)



> I doubt their dispatching caused them to arrive an hour after as oppose to 15.



Again, we can't know how the time frame may have improved if an ambulance had been sent at the time of the 911 call.



> until an ambulance finally arrived and called for an emergency medical helicopter.



But according to the article, the helicopter didn't get called until _after_ the ambulance arrived.  So much for first responders recognizing the acuity of the situation.  

Precious time was wasted here, and the child died.  Until a medical examiner (a physician) determines the cause of death (more specifically than just being run over) saying that she would have died anyway is very premature.


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## fast65

Farmer2DO said:


> So much for first responders recognizing the acuity of the situation.


I certainly hope you're not surprised by that, I had a FF/EMT tell me that I should have let him know how critical the patient was...the patient had snoring respirations and decerebrate posturing. I don't count on any of our first responders to be able to determine the seriousness of a call.



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## Shishkabob

Or the time I had a volly-FF come out to my truck on arrival of a cardiac arrest saying "He's cold, no point in going in", but I go in and take a feel for myself, and although the hands were cool, the neck, chest, head... pretty much everything but the hands, were still quite warm (like.. living warm)...

And he was shocked when I said we were working it.


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## Farmer2DO

fast65 said:


> I certainly hope you're not surprised by that



Surprised?  Maybe not.  But I do have a problem advocating for this position, like the next comment does.



Sasha said:


> My take on this, I have no problem with a fire truck being dispatched first to assess if an ambulance is needed. Let's stop pretending that every patient needs an ambulance.



As I stated, I have a huge problem with it, because in cases like this, it's wildly inappropriate.



> I think its great they are trying to keep ambulances free by first sending someone to assess if its needed.



I think it stinks.  They're using this instead of putting the number of ambulances on the road that are needed to handle the call volume.  Yes, we have major problems with the system, and abusers, and people using us inappropriately.  This is not the answer.



> I don't count on any of our first responders to be able to determine the seriousness of a call.



I guess I'm lucky.  The BLS FR agency I work with on a daily basis is pretty damn good, for the most part.  If I need help during transport, I can count on someone being able to do good BLS to go with me.  And they almost always flag the patients (if they get there first) that need my attention quickly.


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## systemet

Wow.  I'm amazed at how this thread has veered all over the place since I posted the link.  A couple of things:

* I can't believe this is the actual dispatch policy.  Send an (ALS?) engine, then decide if transport is required.  This can't be optimal for time-dependent conditions, unless the city has (i) a huge excess of BLS transport ambulances, and can afford to lose the engine medic to transport, (ii) a huge excess of ALS transport ambulances.  In either case, it seems like sending a transport capable ambulance with the initial dispatch might be a better idea.

* Agree completely that first response is valuable, in a small minority of cases, if there's no nearby ambulance.  I don't think it replaces dedicated EMS resources in an effective manner.

* AMPDS is terrible.  Despite it's ability to over-triage homeless people sleeping in bus shelters into cardiac arrests, it misses the sick old people that probably make up the bulk of time-sensitive medical patients. 

* Becoming a parent has changed my perspective on what good parenting is.  In any accident it's important to judge the information available to the person and their thought process before making judgment about the outcome of the event.

* Not sure I understand the logic that delaying transport is ok, because the ALS engine can provide BLS, when they can't provide the cornerstone of BLS - patient transport. 

Has anyone found more information about the event?


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## Sasha

Farmer2DO said:


> No, it doesn't say that.
> 
> 
> 
> 
> 
> Nope, it doesn't say that either.  It says that's where she was pronounced dead.  We have no idea when she arrested and how long they resuscitated her.
> 
> 
> 
> How about tension pneumothorax and pericardial tamponade?
> 
> 
> 
> We don't know that.
> 
> 
> 
> The ambulance arrived 9 minutes and 19 seconds after the call was dispatched, not after the 911 call was made.  (I'm not sure who did the math in the article.  4 minutes 47 seconds + 4 minutes 32 seconds = 9 minutes 19 seconds, not 8 and a half.)
> 
> 
> 
> Again, we can't know how the time frame may have improved if an ambulance had been sent at the time of the 911 call.
> 
> 
> 
> But according to the article, the helicopter didn't get called until _after_ the ambulance arrived.  So much for first responders recognizing the acuity of the situation.
> 
> Precious time was wasted here, and the child died.  Until a medical examiner (a physician) determines the cause of death (more specifically than just being run over) saying that she would have died anyway is very premature.



I'm using this article. http://www.ems1.com/communications-...-family-questions-Houston-ambulance-response/

It says 8 minutes and some change after the call was dispatched, 4 minutes and some change after the ambulance was called for. Doesn't seem like the response was delayed all that much. 

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## CAOX3

If I call 911 assume its an emergency and send an ambulance, sorry it isn't my fault your in financial disarray and attempting to save a nickel and dime because you cant balance a budget I pay me taxes. 

So send the ambulance or I'll see you in court.

An the F'n outcome is irreverent, if you run over your kid assume that they will need transportation to a hospital I'm not driving a big wheel.

What a bunch of dipsh!ts.


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## McGoo

Just in case this thread isnt far enough off topic, I thought I would raise the following:

For all those who are saying more ambulances and more crews, (Im not disagreeing here whatsoever), Im curious as to how these should be paid for? From an outsider's point of view, your economy is not doing the best, cash isnt falling out of trees, etc, yet putting more vehicles on isnt a cheap thing to do. Also, say the city/whoever does put on more trucks-what would you give up to pay for them? Would you raise taxes? Charge more? Pay less somewhere else? If so, where?

Like I said, Im not at all against more ambulances on road (if they are needed), but just curious as to what people would be willing to sacrifice to make it happen.


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## usalsfyre

How about we start by reassigning some of the 3000+ firefighters in Houston to ambulances instead of firetrucks...


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## Handsome Robb

usalsfyre said:


> How about we start by reassigning some of the 3000+ firefighters in Houston to ambulances instead of firetrucks...



Beat me to it. 
Ambulance ~$150k Engine ~$500-750k ladder ~$1 million +


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## Shishkabob

McGoo said:


> Just in case this thread isnt far enough off topic, I thought I would raise the following:
> 
> For all those who are saying more ambulances and more crews, (Im not disagreeing here whatsoever), Im curious as to how these should be paid for?



Because it makes sense to staff vehicles that are used less often?


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## McGoo

Farmer2DO said:


> I agree that we probably don't know all of the details.
> 
> But to argue that it's OK to wait until you get on scene to decide if you need an ambulance, and that it's good patient care to sit there in the meantime and start IVs is just plain wrong.  IVs get started while enroute to the hospital.  Starting an IV is a low priority unless the patient is peri-arrest.  Getting an IV will not save a life, and doing it on scene is delaying care.  There is some research out there that is saying that trauma patients that get intubated and/or have fluid challeneges in the field have higher mortality rates.





Farmer2DO said:


> So much for treating reversible causes.



:huh:

IV's dont save lives, yet you go on to mention reversible causes? From what you wrot, you seem to be saying if you had a BLS crew who could start an IV, but were waiting for an ALS van for transport, you wouldnt want the BLS crew to start an IV. If my summation is correct, I am absolutely stumped as to your reasoning. Hypotension in trauma is a major cause of death, and some fluids can help massively.

As for patients who get treated with ALS skills on scene having a higher mortality, if they are the same ones I have seen those studies didnt have much detail on patient injuries, and likely survivability of injuries sustained. Not a conclusive finding IMHO.


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## usalsfyre

Crystaloids DON'T help hypotension in uncontrolled hemorrhage. In fact, large volumes of crystaloids worsen the situation. 

An example of a reversible cause would be tension pneumothorax.


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## JPINFV

Don't crystaloids help hypotension at the expense of oxygen carrying capacity?


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## usalsfyre

JPINFV said:


> Don't crystaloids help hypotension at the expense of oxygen carrying capacity?



Yes...but I didn't feel like writing a book on TappaTalk about washout of hemoglobin and clotting factors, the coagulopathy caused by hypothermia and acidosis, ect.


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## Farmer2DO

McGoo said:


> IV's dont save lives, yet you go on to mention reversible causes?



What I said was that delaying transport, or justifying the delay of an ambulance so that you can do stuff like start an IV and board and collar (which doesn't take me 5 minutes) is bad medicine.



> From what you wrot, you seem to be saying if you had a BLS crew who could start an IV,



BLS crews don't start IVs.  ALS crews do.



> but were waiting for an ALS van for transport,



Is the BLS crew an ambulance or first response?  If they are first response, then they are a crappy substitute for an ambulance.  If they are an ambulance, then load the patient up and head for the hospital.  Meet the ALS enroute.



> you wouldnt want the BLS crew to start an IV. If my summation is correct, I am absolutely stumped as to your reasoning. Hypotension in trauma is a major cause of death, and some fluids can help massively.



As usalsfyre said, large volumes of fluid to a bleeding patient will likely make the situation worse.  Google "permissive hypotension".



> As for patients who get treated with ALS skills on scene having a higher mortality, if they are the same ones I have seen those studies didnt have much detail on patient injuries, and likely survivability of injuries sustained. Not a conclusive finding IMHO.



I didn't say they were conclusive.  But we know that turning the patient's blood to kool-aid doesn't help, and we know that delaying the patient's arrival to a surgeon so that we can play and feel important doesn't help.  Sure, the studies may have more factors, like maybe these patients were sicker from the start, and thus were destined for a poorer outcome.  That still doesn't mean that delaying the arrival of an ambulance for ANY level of a first response to decide if an ambulance is needed is good patient care.  It's not.  It's horrible, irresponsible, I would say unethical patient care being provided courtesy of the city of Houston, Texas.  Maybe the way the call was run from the time 911 was called had a negative impact; maybe it didn't.  It certainly didn't help that 4 year old, innocent girl any.

I truly hope the family sues the city, so that someone comes to their senses and realizes this policy will just cause more death, and thus, more money to the city, and changes it to something more reasonable.


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## rmabrey

PoeticInjustice said:


> That's the thing though. We don't know if an ambulance was held or not. The family ASSUMED that one was held because of the response time, but the fire department did not confirm this and I doubt that was the case. EMD would have absolutely dispatched an ambulance with that.



I agree, Car vs pedestrian per EMD would be automatic ambulance response. Most systems it may be unheard of, but the system I work in 8 minute response would be believable, given how busy we are, and we are dispatched ~90 seconds after fire


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