Priority intervention?

VentMonkey

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Bowie knife?
Who has two thumbs and regrets pulling the trigger on his Dundee knife reference in another thread...this guy.

Back on topic (sort of). I would imagine knife wounds to the the chest to be slightly more of the advantage? when it comes to a traumatically assaulted patients torso.
 

DesertMedic66

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With the understanding I have never seen or treated a patient who has been shot, nor would 99.9% of ambulance personnel ever see it in their careers, nor would most hospital personnel (except maybe for somebody who has had a slug pellet accidently fired at them)
Not here in the land of the free and the home of the brave. I'd wager to guess the majority of providers who are in a emergency system for any amount of time. Just in my 2 years on as a medic I have had a handful of patients who have been shot.
 

CWATT

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Not here in the land of the free and the home of the brave. I'd wager to guess the majority of providers who are in a emergency system for any amount of time. Just in my 2 years on as a medic I have had a handful of patients who have been shot.

I've heard of EMS personnalle doing a rotation through high gun violence areas for experience. In all honesty, it's something I'd like to do. I think it's important having someone in the ED who has dealt with such high-velocity/energy penetrating wounds would be a real benefit and I'd argue the same applies for ambulance services.
 

TransportJockey

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I've heard of EMS personnalle doing a rotation through high gun violence areas for experience. In all honesty, it's something I'd like to do. I think it's important having someone in the ED who has dealt with such high-velocity/energy penetrating wounds would be a real benefit and I'd argue the same applies for ambulance services.
I know pj students do that but I've never heard of it for field staff.

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NomadicMedic

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It's a rarity to find someone in my area who hasn't run on at least 3 or 4 GSW calls. We have a TON of gun violence here. Savannah gets a shooting or two almost everyday. Even out in the sticks where I work we get a GSW call every few weeks. (Of course we also get snake bites and gator attacks.)
 

Tigger

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I've run suicides and accidental shootings but nothing related to gun violence in the last four years here. Usually they dead when we get there it seems.
 

StCEMT

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Hell, here in STL we had 7 people shot at once on Saturday. Last I heard, 4 of our crews responded and then how many ever city EMS folks. North STL is a **** hole, gun shots are not at all uncommon here.
 

VentMonkey

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I've heard of EMS personnalle doing a rotation through high gun violence areas for experience. In all honesty, it's something I'd like to do. I think it's important having someone in the ED who has dealt with such high-velocity/energy penetrating wounds would be a real benefit and I'd argue the same applies for ambulance services.
I'm curious to know how this would "benefit" prehospital ambulance personnel?

In all honesty most GSW's in the field are kept to a very basic approach...keep them alive until they arrive at the trauma center so they can go to OR (theatre?) while employing standard trauam care ALS, BLS, or both. These patients really don't even need a paramedic most of the time, but I digress...

Knowing ballistics and trajectories is all fine and dandy, but does nothing to change their outcomes that the often referenced "lights, and cold hard steel" won't. In short, they're usually a bloody mess, keep them as conscious as relatively possible, and get them to definitive care.

"Seeing" it in real-life doesn't change much of your treatment plan out of the hospital than what's probably already been beat to death via curriculum, and PHTLS/ ITLS.

If it's one thing EMS buys into, it's the latest "cutting-edge" trauma care, which in all honesty has hardly changed over decades with the exceptions that again, are often brought up.

Oh, and @kirkyrabbit to answer your (homework) question- ABC's as applicable to how they're found, and yes, they're in-hospital and gasping, so they'll probably get cracked.
 

CALEMT

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I've run suicides and accidental shootings but nothing related to gun violence in the last four years here. Usually they dead when we get there it seems.

It's mostly gang violence and officer involved shootings (every once in a while) out here.
 

StCEMT

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@VentMonkey the main thing that comes to mind is comfort. I don't get serious traumas all that much. I know definitive care is the thing they need, but more experience would be good just so I'd be a bit more comfortable in managing it.
 

VentMonkey

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@VentMonkey the main thing that comes to mind is comfort. I don't get serious traumas all that much. I know definitive care is the thing they need, but more experience would be good just so I'd be a bit more comfortable in managing it.
It's going to be a whole slew of things that dictate comfort-level, mainly experience.

If you're in the farmlands perhaps tractor incidents, by the highways a lot of MVC's, inner-city ghetto urban blight?--->knife and gun clubs.

What do they all share in common? It's all the same standard approach to trauma care- rapid delivery to the trauma center. Aside from a combative TBI, and a few others that are beyond less means, there aren't many traumas I want to RSI right off the bat, so my "care" is similar to what a brand-new paramedic would/ should be. See what I'm sayin'?...
 

NysEms2117

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i agree with mostly everything said above. I've been working in EMS <1 year and i've had about 5 GSW calls. All of them we(my CC-P partner and I) are doing a super rapid trauma assessment, C-spine if needed, Blood sweeps, and we are off scene ASAP. Often times our EMR driver doesn't even get out because he knows how fast we will be off scene and en-route to the hospital. Tbh I as an EMT-B do just about the same things a CC-P would do, aside from potentially giving pain control(which isn't that common here anyway)(also means starting lines obviously).
My favorite EMS quote: "air goes in and out, blood goes round' and round' any deviation is a problem".
 

VentMonkey

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i agree with mostly everything said above. I've been working in EMS <1 year and i've had about 5 GSW calls. All of them we(my CC-P partner and I) are doing a super rapid trauma assessment, C-spine if needed, Blood sweeps, and we are off scene ASAP. Often times our EMR driver doesn't even get out because he knows how fast we will be off scene and en-route to the hospital. Tbh I as an EMT-B do just about the same things a CC-P would do, aside from potentially giving pain control(which isn't that common here anyway)(also means starting lines obviously).
My favorite EMS quote: "air goes in and out, blood goes round' and round' any deviation is a problem".
Right, and where would your priorities lie of you dealt with mainly off-road trauma?

I get the comfort-level issue, but if there was ever a rapid learning curve with what we do, trauma care would by far top that list.

Would you--generally speaking--feel the need to do rideouts with your local service in hopes of seeing more ATV accidents?
 

StCEMT

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See what I'm sayin'?...

I know exactly what you mean. It isn't a matter of not knowing what to expect or what needs to be done as much as it is ironing out the kinks with the first few that are bound to occur when something new is presented. That mix of being able to filter out unnecessary details, but also having learned little things to pick up on when running through your assessment.
 

VentMonkey

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I know exactly what you mean. It isn't a matter of not knowing what to expect or what needs to be done as much as it is ironing out the kinks with the first few that are bound to occur when something new is presented. That mix of being able to filter out unnecessary details, but also having learned little things to pick up on when running through your assessment.
I understand exactly where you're coming from as well. I can tell you first hand though that all you can do is prep. For me this includes reviewing current literature, checking all of my gear every day so that when it happens, it's all as fluid as one can possibly hope.

A lot of times we'll get there, and the call these folks will most likely share with their peers, are A) nothing like they've told, and B) most likely not all that exciting.

I'm in no way lecturing you, or insinuating you aren't aware of any of this yourself. The biggest thing I can tell you about making sure to "cross your T's, and dot your I's" is literally just preparing; you'll see (if you haven't already) the all-too-common provider that doesn't. That person: don't do that.

I haven't RSI-d in who knows how long, but I still like to have all of my stuff laid out where I want it so we're not fumbling through stuff. This includes poking around at the vent in case my partner hasn't in a while.

Everyone gets rattled from time to time regardless of the call. It's healthy, it's normal, without it--as you said--you won't know what not to do next go round unless, again, you're that arrogant prick who "never makes mistakes".
I haven't seen much serious traumas ...yet
Also, this. There's no tricks to training. Complacency kills any good provider, but again, you know that. Don't mind me..."Vent's just being Vent".
 

Jim37F

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Not here in the land of the free and the home of the brave. I'd wager to guess the majority of providers who are in a emergency system for any amount of time. Just in my 2 years on as a medic I have had a handful of patients who have been shot.
Depends on where you're working. I've been an EMT little over 4 years, last 3 in 911 systems, yet my first 2 years I never saw a single GSW (Torrance and Glendale). Cut to this last year or so working Compton/Compton-adjacent area and I've personally been on at least 3 or 4.

Hell, here in STL we had 7 people shot at once on Saturday. Last I heard, 4 of our crews responded and then how many ever city EMS folks. North STL is a **** hole, gun shots are not at all uncommon here.
Last night we had 4 in our area more or less all right around the same time, including 2 who were walk ins at the local community hospital
 

NysEms2117

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Right, and where would your priorities lie of you dealt with mainly off-road trauma?

I get the comfort-level issue, but if there was ever a rapid learning curve with what we do, trauma care would by far top that list.

Would you--generally speaking--feel the need to do rideouts with your local service in hopes of seeing more ATV accidents?

I feel what your aiming at, my only counter would be, ATV/offroading accidents are generally further from a hospital no? Meaning in most cases more care would be provided due to longer tx time? Again I could be completely wrong, I know NYS EMS more importantly REMO EMS. I know where i work GSW's are much closer then knox tractor accidents. Granted I work for a county service so it's a bit larger coverage area. I hope to see nobody get hurt/sick/wounded/breakdown personally, call it lazy or optimistic idc :D.
 

DesertMedic66

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I feel what your aiming at, my only counter would be, ATV/offroading accidents are generally further from a hospital no? Meaning in most cases more care would be provided due to longer tx time? Again I could be completely wrong, I know NYS EMS more importantly REMO EMS. I know where i work GSW's are much closer then knox tractor accidents. Granted I work for a county service so it's a bit larger coverage area. I hope to see nobody get hurt/sick/wounded/breakdown personally, call it lazy or optimistic idc :D.
The issue with trauma is for the majority of EMS our initial treatments are going to be no different than a long transport. Trauma for EMS = Get a patent airway, control/monitor breathing, keep blood going around in circles.

We treat a Fx leg that is 10 minutes away from the ED the same way we treat a Fx leg that is 3 hours from the ED (just maybe more pain medications).
 

EpiEMS

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On the point of what is state of the art penetrating trauma care, I would say that the plurality of the studies I've seen (OPALS, the philly PD scoop and run, etc.) provide ample indication that a BLS unit is more than sufficient (and a police car plus hemorrhage control may be better)!


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VFlutter

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Hell, here in STL we had 7 people shot at once on Saturday. Last I heard, 4 of our crews responded and then how many ever city EMS folks. North STL is a **** hole, gun shots are not at all uncommon here.

Barnes was on Divert for a little bit because of it. Ended up flying a few patients to the county.
 
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