Helmets?

[VentMedic]

Back to the topic.

This near tragic event should be used as an opportunity learn from it. I am hoping that a formal report was also made so a paper trail can start to boost your arguments in the future or in the event one of those passengers find they may have more lingering serious injuries than just a little soreness post event.

The call itself should be reviewed to see if anything could have been done differently. Was there something else that could have been done in the stabilization and was the closest facility really the best option? Did the speed of the ambulance also prevent you from providing adequate patient care since it is noted that CPR is almost useless in a speeding vehicle? Did inexperience in the vehicle play a role in the speed and patient care decisions?

The issue with using L/S and speed may also require the supervisors/managers to determine if additional training or retraining might be necessary concerning the operation of an emergency vehicle for all involved.

The company may also have to explore the idea of investing in different patient compartment restraint devices.

Helmets by themselves will not prevent injury as an unrestrained passenger in the back of an ambulance.

Essentially there were many factors involved.

 

[marineman]

I know in the area I work its useless to drive crazy the transport times are 20 min max and you really don't save that much time. It really is not worth the risk.... I think the question here is less about having to wear helmets and more of a question of should we have more involved driver training.... I have had my Class B cdl for 6 years now and drove buses for the first 5 of those years and it really troubles me how they will just let anyone drive emergency vehicles with little to no training. Personally I feel you should be made to go through a class B program or a modified but similar program that will properly train you but thats just my 2 cents!

Drove semi's for 5 years and I couldn't agree more. Too many people get in the ambulance and drive it like a car failing to realize that it weighs roughly 15,000lbs.

For the topic at hand pass on the helmet and get ready for a harness and tether system that should be coming sometime.

I do however agree with the fact that if the patient is in that bad of shape that you can't make it to a trauma center when you had 2 medics on board then it's senseless to drive to the hospital l&s

 

[Pudge40]

I would not advise wearing a helmet while in motion. I know NFPA was either working on or has passed a STANDARD* that all new fire trucks must have compartments to put in the personnel's helmets because in crashes they were detrimental.

*They are not laws and you can not be fined for not following them, however if the case is taken to court your case my be lost if you are not in compliance with them.

 

[WolfmanHarris]

For the topic at hand pass on the helmet and get ready for a harness and tether system that should be coming sometime.

Stop management from wasting money on a harness and tether. I don't have a text source as it was a webinar, but Dr. Nadine Levick has some very interesting things to say on these. She strongly advises against them. If I get the chance later I will look for a linkable source.

 

[SurgeWSE]

I do however agree with the fact that if the patient is in that bad of shape that you can't make it to a trauma center when you had 2 medics on board then it's senseless to drive to the hospital l&s

I don't follow. I would imagine that most EDs that you see will have blood, central lines, RSI, etc. I'm certainly not arguing that we should regularly stop at smaller hospitals with our criticals, but I can easily sit here and brainstorm scenarios where it would be prudent.

As to the original question, no helmet is going to do anything about the massive axial load your spine is gonna take when you go head-first into the cabinets. I certainly understand that the currently prevalent box designs make it nearly impossible to stay restrained 100% of the time. I have to unbuckle to adjust wall mounted O2, cycle NIBP, repeat EKGs, start IVADs in the right extremities, and on and on. As a side effect, I spend way too much time unrestrained.

 

[WuLabsWuTecH]

Ok, in response one by one to what everyone has said as much as possible without quoting each message.

@ JPINFV - He was hemodynamically unstable. Injuries were a punctured carotid and Jugular. He would have fared well at the trauma center, but would have bleed out by then. He got that I'm about to code look on his face twice during the 7 minute transport. We had a long discussion about choice of hospital. In Charge Medic first called for us to go to the Level I trauma center. The other medic said closet hospital, they reevaluated and decided on closest hospital.

@ Sasha - Patient was not dead. Still talking to us the whole way there, but was rapidly deteriorating. Alert, but only oriented to person as much as we could tell. Its been a few years since I've spoken spanish but he was having trouble even giving us his name. He was obeying commands but coudn't tell us the date or where he was.

@ clarkkent "I am taking it if he was not at a hospital very quickly, he would be dead. The trauma hospital was an extra 10-15 minutes add on to the call, and that would make him dead." That is precisely what we feared. Blood loss was too great. We estimated 1-1.5 Liters on the pavement of arterial blood (it was a hot day with hot pavement do some of it was already coagulating). Bystanders estimated he staggered into the parking lot and had been down for 10 minutes. Patient estimated an hour which to us indicated confusion.

@ Linus, ClarkKent, Sasha. The difference around here between Level I and Level II trauma centers is just hours of staffing and research. It being a Holiday weekend sunday, it was probably not likely for there to be a trauma surgeon avaliable, but had we gone the extra 20 minutes, chances are the trauma surgeon wouldn't have been able to do a thing b/c the blood loss was so great. Once again, the patient was still alive when we got there--no dead patient. We actually did get lucky and a trauma surgeon happened to be there. They did have to call in the cardio though.

@Sasha and others, yes the driving was too aggressive. But I think going lights was the right choice here. The 7 minutes was considerably shorter since there were probably 15-25 traffic lights between us and the hospital. I think that had we gone lights, but at a slower speed, we would have been just as well off. It was not having to stop and wait 3 minutes at each light that decreased our transport time, not the going fast.

@JPINFV - I also agree, please give constructive criticism, this was a situation that was going to break 6 eggs one way and a half a dozen the other. If you think you had a way that would have only cracked 5 eggs, I'd like to know about it. There was absoluately no way for me to be restrained in this situation or for the Medic starting the IV to have been restrained. The In charge may have been able to strap in and I think she should have.

@VentMedic, Marineman, Surge - Yes I am thinking of filing a formal report. One of the reasons I asked here was to determine whether I should make a reccomendation for helmets. I will make one for better restraints, but short of harnesses, I doubt there is much we can do for that situation. This was just a bad situation. We discussed after the call (not in the presence of the driver) that we thought lights and sirens was the way to go, as was the choice of hospital. Yes, we took a chance, but at least we could get whole blood into him at the hospital. We had a chopper called in and standing by. We lucked out and there was a trauma surgeon there so we cancelled the chopper and the MICU (we also called for a MICU incase the chopper couldn't fly for some reason).

The driver was the ranking paramedic. He does not take criticism kindly which is why we didn't tell him to his face. For the time being I have not signed up for any shifts with him until this can be resolved but didn't tell him this was why I removed myself form some shifts. The official reason I gave was "personal scheduling conflicts." I think he might need retraining on driving the rig and understanding what is acceptable and what is not.

@VentMedic - No CPR was being performed, i'm not sure where you got that from b/c it hasn't been mentioned in this thread. He didn't code on us, but he might have if we went to the level I trauma center. At that point CPR is worthless since he has no blood left to circulate. As stated in the original post 1 Medic Student was starting an IV, I was trying to control the bleeding as best as I could, and the in charge medic was assessing for other injuries. I might PM you when I get back from studying for more info on what to include in the report.

@marineman - we had 2 experienced medics, a medic student, and a basic. Even so, medics are still just that, medics, not doctors. They were both experienced (one with decades of experience and an instructor, the other with just shy of 3 years) but there are some things a medic just cannot do. Of these, the two most important ones were administering whole blood, and repairing the tear, something a doctor can do, but not a medic. Lights and sirens here was prudent. The transport time to the same facility would have been extended by probably about 10 minutes or more. Since he lost about a liter to 2 of blood in the first 10 minutes and we were having trouble controlling the bleeding, another 10 minutes and we might be looking at a different story. The human body only has about 5 liters of blood. The speed was uncalled for, but the Lights and sirens I believe was justified in this case as it was very certainly possible (and I might go out on a limb and say probable) that it did make the difference between life and death.

Just for reference, he was in surgery as we left and we have later heard that he is expected to survive this ordeal. But I know that just because he's going to make it, it doesn't mean that we did everything right, although it means we did SOMETHING right! Anyways, I value all of your opinions on this (and we're slightly off topic but it's ok) and appreciate the constructive criticism and opinions!

------- Slightly unrelated below------
@USAFmedic - yes, I got my card exactly 365 days ago as of last shift. I guess when I lost my rookie status, the white cloud left in a hurry. Also ran on a MVC - Van vs. Motorcycle later that day (only two runs, the ambulance was such a mess after this run we're talking about now that we were out of service for nearly 3 hours afterwards cleaning ourselves up and then the ambulance. One of my partners was soaked in blood. I had it all over too, but not as bad. The cot was bright red as was the floor of our truck)

 

[VentMedic]

@VentMedic, Marineman, Surge - Yes I am thinking of filing a formal report.

@VentMedic - No CPR was being performed, i'm not sure where you got that from b/c it hasn't been mentioned in this thread. He didn't code on us, but he might have if we went to the level I trauma center. At that point CPR is worthless since he has no blood left to circulate. As stated in the original post 1 Medic Student was starting an IV, I was trying to control the bleeding as best as I could, and the in charge medic was assessing for other injuries. I might PM you when I get back from studying for more info on what to include in the report.

The report should already have been done. Usually 24 -48 hours is the time frame. The person who flew over you and the one who hit his head on the seat should definitely have already filed a report. It is not counted against them but does provide documentation that something did occur and they had the potential for serious injury that may result in disability later. Unfortunately, many spinal cord and nerve injuries do not show up immediately and quite often those in EMS who start getting aches and pains later can attribute it to some incident months or years past that was not reported or checked.

If you ever get the opportunity to have a thorough spinal exam, including an MRI, you would be surprised as to what a good neurologist can tell you. He/She will read your life story in the films and ask you questions that will bring back memories of every accident and stupid thing you have even done to influence the health of your back, neck and head.

 

[WuLabsWuTecH]

The report should already have been done. Usually 24 -48 hours is the time frame. The person who flew over you and the one who hit his head on the seat should definitely have already filed a report. It is not counted against them but does provide documentation that something did occur and they had the potential for serious injury that may result in disability later. Unfortunately, many spinal cord and nerve injuries do not show up immediately and quite often those in EMS who start getting aches and pains later can attribute it to some incident months or years past that was not reported or checked.

If you ever get the opportunity to have a thorough spinal exam, including an MRI, you would be surprised as to what a good neurologist can tell you. He/She will read your life story in the films and ask you questions that will bring back memories of every accident and stupid thing you have even done to influence the health of your back, neck and head.

Thanks, as of right now we're only 20 hours from the end of shift. I'm still a provisional status with them so I don't have a report per se to fill out but will probably write an email to the captain or personnel LT to let them know about this.

Like I said though, give what we had at the time, I'm not sure there was much more we could have done in the back with what HE was doing up front.

 

[VentMedic]

Like I said though, give what we had at the time, I'm not sure there was much more we could have done in the back with what HE was doing up front.

I forgot to finish my post.

That was the point I was making about CPR. If you are hanging on for your own life, you won't be caring for the patient.

Since he was an experienced Paramedic, he may also have thought that there wasn't too much experience in the back and speed might be the best option. I sorry if that sounds insulting but sometimes if who you have in the back caring for the patient is freaking out, the hospital might seem like a million miles away when you are driving.

This is also why our pilots and drivers for specialty teams know very little to nothing about the condition of the baby or child. We in no way would want it to influence their driving and our safety.

 

[WuLabsWuTecH]

I forgot to finish my post.

That was the point I was making about CPR. If you are hanging on for your own life, you won't be caring for the patient.

Since he was an experienced Paramedic, he may also have thought that there wasn't too much experience in the back and speed might be the best option. I sorry if that sounds insulting but sometimes if who you have in the back caring for the patient is freaking out, the hospital might seem like a million miles away when you are driving.

This is also why our pilots and drivers for specialty teams know very little to nothing about the condition of the baby or child. We in no way would want it to influence their driving and our safety.

There wasn't much we could do. Aside from starting lines, keeping them wide open and squeezing the bag, and me applying as much pressure as I could, there were no interventions in the field that could help this guy. Had there been, I'm sure the most experienced medic would have asked the other medic to drive and he would have been in the back, but I think he too understood there was nothing to be done but get to the hospital.

That being said, he overreacts and gets jumpy sometimes at scenes and I think something got into him. unfortunately there is no way we can get dedicated drivers that know nothing about the condition of the patient, but I see how in a bird its possible to keep the pilot more in the dark.

And we in the back wern't freaking out, it was surprisingly calm except for the being tossed around everywhere!

 

[marineman]

Maybe your area is different than mine but not all hospitals here stock whole blood products. It's hard not being able to see exactly what's going on and I don't want to armchair this and say an experienced provider that did see the whole story was wrong however the only time I have taken a major trauma patient anywhere other than a trauma center was when we picked up 3 from one incident and I wanted to allow them some time to get the others out before bringing a third in.

Like I said I didn't see what was happening nor do I know your protocols but an uncontrolled bleed is a reason for us to call a trauma alert, not enough to divert.

Back to the topic at hand definitely make sure something is on file that says exactly what happened, Vent as usual was right on the money about the delayed pain response and if it's not on file you're SOL

 

[WuLabsWuTecH]

I have talked to the LT and we will be drawing up a report. Thank for all of your guys' help.

I was wondering if anyone had pictures of other restraint systems (other than seatbelts). I know some have overhead but I hear they are not that great so I was wondering what you guys might suggest.

Thanks!

 

[scottmcleod]

That being said, he overreacts and gets jumpy sometimes at scenes and I think something got into him.

My communications teacher would call that a definite need for CISD. I actually just finished completing that section (5 pages) in my syllabus, and those are a few of the symptoms that a call may have affected him more than he's willing to admit...

Just my $0.02 (Cautiously, as I see VentMedic has entered the thread ^_^ )

h34r: *quietly goes back to lurking the shadows*

 

[usafmedic45]

My communications teacher would call that a definite need for CISD.

Two things.

#1: In what way is your communications teacher qualified to make that judgment?

#2: When was the last time this bastion of knowledge actually looked at the research on this subject? CISD does not work. In fact, it may actually be harmful. Please do not confuse real psychiatric care (you know....medicine?) with its quasi modo illegitimate little brother.

 

[WuLabsWuTecH]

Two things.

#1: In what way is your communications teacher qualified to make that judgment?

#2: When was the last time this bastion of knowledge actually looked at the research on this subject? CISD does not work. In fact, it may actually be harmful. Please do not confuse real psychiatric care (you know....medicine?) with its quasi modo illegitimate little brother.

usaf: Read http://www.ncbi.nlm.nih.gov/pubmed/15131998 .

I will not debate it here b/c 1) we're going off topic, and 2) its entirely not certain still whether CISD helps or hurts or does neither. There are studies that say both, but when you dismiss something so perfucntly.

Also, any restraint systems anyone has seen yet?

 

[VentMedic]

usaf: Read http://www.ncbi.nlm.nih.gov/pubmed/15131998 .

I will not debate it here b/c 1) we're going off topic, and 2) its entirely not certain still whether CISD helps or hurts or does neither. There are studies that say both, but when you dismiss something so perfucntly.

Read the articles to the right of the abstract you linked and then read th e articles linked on each of those pages and you will find more than enough reasons why CISD can be harmful.

There will always be articles pro just like it was mentioned in another thread that advanced skills for an EMT-B are great as concluded by some researcher. Or, that MAST work. As more data is available, which has been for CISD since it has been around for a long time, the participants have been studied carefully in some areas.

Originally Posted by WuLabsWuTecH
That being said, he overreacts and gets jumpy sometimes at scenes and I think something got into him.

CISD is not going to change someone's personality or something that has been embedded into their emotional makeup. There may also be many other issues happening with this person that they would prefer not to discuss in a room of their peers in fear of looking stupid or weak. There have been issues with CISD since the beginning and I have watched as many good people leave the job or some have ended their own life because they relied on the "buddy debriefing" provided by their peers instead of seeking true professional help. A few hours of "training" does not make one a Mental Health Professional.

 

[scottmcleod]

Two things.

#1: In what way is your communications teacher qualified to make that judgment?

#2: When was the last time this bastion of knowledge actually looked at the research on this subject? CISD does not work. In fact, it may actually be harmful. Please do not confuse real psychiatric care (you know....medicine?) with its quasi modo illegitimate little brother.

My comm teacher also teaches psych, but I'm not going to get into that, because arguing on the internet is like... (you can finish that sentence yourself).

I never said I was an expert on the subject, and you're right, there are situations where it can make it worse... but;

Is it acceptable for that medic to be acting the way he is? Y/N?

If N, does something need to be addressed? Why is he acting out of character lately?

That being said, I'm stepping away from this conversation before it gets out of hand, and further off topic.

... that, and VentMedic's shown up ;-)

h34r:

*poof*

 

[VentMedic]

My comm teacher also teaches psych,
... that, and VentMedic's shown up ;-)

h34r:

*poof*

I show up because some make comments without posting anything to back it up.

What type of psych does your teacher teach? Is this at a votech or university? Is your teacher a mental health professional? Psych, like many areas in medicine, has many specialites. Not all "psych" instructors are qualified to practice patient care when it comes to mental illness nor are they experts in all areas.

If N, does something need to be addressed? Why is he acting out of character lately?

Yes it is something that may need to be addressed by a qualified professional.

Does he have marital or financial problems? Is he impotent? Is his wife leaving him? Does he have an alcohol and/or drug problem? That is a serious issue when in some CISD sessions others are talking/joking about just having a few beers to cope while someone is struggling to control their addiction and yet want to be "one of the guys". Does he have a true mental disorder that is now just presenting itself? Depression? None of these issues should be handled by someone with just a few hours of training. How willing are some to be truthful to themselves or others that they have other serious problems and this one trauma is just a catalyst for other emotions to arise? How many are willing to openly discuss with their peers that they are having alchohol, sex and money problems that are compounding their ability to deal with the stressors of the job?

It is usually those with the deep seated problems that don't outwardly display serious "psych" issues to the untrained and uneducated eye. Ever wonder why some are so shocked when a co-worker, adult or child they know commits suicide? Most don't know what to look for and a person with serious problems may not be that obvious. We have lost too many in this profession relying on "we take care of our own" and lead them to believe a good "b***S### session with the guys lead by someone who has attended a few hours of training is sufficient. That doesn't just apply to suicide but also to addiction to alcohol and drugs as well as burn out.

 

[mycrofft]

Helmets versus vehicle design.

Nice big boxy units allow more acceleration space when things start to fly and slide. Vehicles nearly always decelerate back-to-front (stern to bow, posterior-anterior) much more strongly than any other direction. As in the driver compartment of cars, padding, avoidance of ninety-degree angle angles of attack form decelerating objects, etc., will help cut down on the impact damage helmets protect from. I'd be comfortable working in a helmet, but a helmet is only part of the issue.

Provider cervical spine damage, shoulder injuries, etc. are harder to prevent because to immobilize them renders you ineffective. Try top find ways to be up against something betwen you and the front so when deceleration happens, you have less acceleration space.

By the way, Wu, very gentlemanly of you to let the lady by...

 

[VentMedic]

The device should prevent collision with other people in the patient compartment as well as the interior.