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)
h34r: *quietly goes back to lurking the shadows*
