Is trauma easier than medical?

[Chris07]

I had the opportunity to take a PHTLS course recently and found it to be very enlightening...and fun! Since I work mostly BLS IFTs, major trauma situations were not really a strong suit for me and I found the course more challenging than initially expected. Several seasoned medics said they found the course a little more challenging than they expected!
During the course introduction, the principal instructor asked the class which was harder, trauma or medical? There seemed to be an almost immediate consensus among the class that medical was much harder most of the time. Then the instructor said something interesting: "Although trauma calls are thought to be easier, EMS sucks at trauma."

I can defend that medicals are more taxing in that they require more detective work. Even experienced EM Physicians dread acute abdominal pain cases due to their difficulty in diagnosing. At the same time, I can say that trauma is much more difficult. Trauma typically involves less detective work and more mechanical work, but does that make it easier? Is full blown chest pain harder than extracting a 240lb male with a broken hip from his '86 Yugo?

What are your thought? In general, is trauma easier than medical? If it is, then why is EMS (as a whole) not good at it?

 

[firecoins]

It would be hard work for an 86 Yugo to be moving a 250lb male.

Trauma is easier. Yes, there is more mechanical work but you know what to do quickly.

 

[EFDUnit823]

Trauma is pretty straight to the point, thus in my opinion easier.

 

[downunderwunda]

Trauma is in your face in most cases. For example you know where to look for deceleration internal injuries & I'm many cases predict injuries. Mechanism of injuries gives you those predictors.

In the same way we can predict a medical call in some cases, loin pain & renal colic for example but the majority requires a good grasp of a&p as well as being able to get a good history.

 

[mycrofft]

How much "medical" does a basic EMT do?

My experience was that our knowledge beyond Basic EMT-ery was good to keep us from inadvertently doing something wrong, and gathering info beyond name-address-insurance number that could help in later diagnosis.

Also, ask any dedicated MD or super-Medic, everything becomes medical, given time.

Maybe the instructor meant American (and other) EMS is poor at trauma, not that it is more difficult than non-traumatic cases. What were his arguments in favor of that throwaway statement?

 

[Veneficus]

Trauma easier?

Anyone who thinks trauma is easy doesn't know the first thing about it.

But since EMS plays such a small role in trauma, I can see where they think it may be easy or easier.

It is just a question of not knowing what you (collective) do not know.

 

[Remeber343]

How much "medical" does a basic EMT do?

An emt can actually do quite a bit "medical" wise.

 

[firecoins]

Anyone who thinks trauma is easy doesn't know the first thing about it.

But since EMS plays such a small role in trauma, I can see where they think it may be easy or easier.

It is just a question of not knowing what you (collective) do not know.

we don't do trauma surgery in the ambulance, so yes, for EMS, it's easy. If I was a trauma surgeon, I might have the responsibility of actually treating it. Than what would I be doing in an ambulance.

 

[Veneficus]

we don't do trauma surgery in the ambulance, so yes, for EMS, it's easy. If I was a trauma surgeon, I might have the responsibility of actually treating it. Than what would I be doing in an ambulance.

it is not about surgery, it is really the medical part of it that is complex

 

[firecoins]

it is not about surgery, it is really the medical part of it that is complex

Most of that again comes after we have handled the patient, at the trauma center. Of course not every hospital can handle trauma patients which bolster your point that trauma is complicated but also bolster my point that EMS does not handle the complicated aspects of trauma.

For EMS its pretty straight foward. Medically speaking, your right, its complicated.

 

[Veneficus]

Most of that again comes after we have handled at the trauma center. Of course not every hospital can handle trauma patients which bolster your point that trauma is complicated but also bolster my point that EMS does not handle the complicated aspects of trauma.

that was my point

 

[abckidsmom]

Most of that again comes after we have handled at the trauma center. Of course not every hospital can handle trauma patients which bolster your point that trauma is complicated but also bolster my point that EMS does not handle the complicated aspects of trauma.

I agree. For EMS, trauma is supportive care and packaging for delivery. The most complex issues we fight that we can do something about are tension pneumo and cold stress.

 

[mycrofft]

Did the instructor in question limit his definition of EMS to prehospital care (PEMS) or include ED and etc? I'm curous about this persons's take on stuff.

And as to how much medicine (versus "trauma") a basic EMT does, most interventions are not far beyond first aid other than oxygen, maybe Actidose (charcoal), oral sugar, maybe ASA for chest pain with supporting vitals and history of cardiac, and the pusilanimous (on the part of the authorites) "helping" people self-administer nitro, epinephrine, glucagon, etc. All potentially very important, but not in the league with using/choosing from dozens of oral or parenteral meds, IV volume supplementation, etc.

Oh, yeah. CHILDBIRTH! Almost forgot.

 

[Handsome Robb]

Like someone said, from an EMS standpoint trauma is relatively simple. We fix immediate life threats, package and deliver. It's a linear process, you take note of things and fix them as you find them through a systematic approach to your assessment.

Even at the ED level they receive the patient into a trauma room where the patient stays for a short period of time and then is whisked off to CT and surgery then to the ICU, assuming it is a serious multi-system trauma that requires surgical intervention.

I'd be willing to say that definitive care for serious traumas is just as difficult if not more difficult than medical cases.

Oh, yeah. CHILDBIRTH! Almost forgot.

Meh honestly, after my OB rotations I'm not nearly as intimidated by childbirth as I was. With that said I've been fortunate enough to never had to deal with a breach delivery, complications or a serious OB problem.

Neonatal resuscitation is a totally different story. I know what needs to happen but I can only imagine how stressful that situation actually is.

 

[MSDeltaFlt]

Since we are not allowed to treat (read: fix) trauma, our protocols are pretty straightforward thus interpreted as easy. However trauma is not all that easy. It's even more complicated when you add any medical component to it because it also increases their mortality and morbidity.

 

[Veneficus]

Oh, yeah. CHILDBIRTH! Almost forgot.

pssst.

Childbirth is surgical not medical

 

[mycrofft]

(I interpreted the instructor's "medical" to mean anything not involving blunt, sharp or tortuous force. At least none of those occurring less than nine months in the past).

 

[Veneficus]

I'd be willing to say that definitive care for serious traumas is just as difficult if not more difficult than medical cases.

The real kicker to it is that interventions performed or not performed by EMS providers make treatment rendered in the hospital more difficult or even futile.

Neonatal resuscitation is a totally different story. I know what needs to happen but I can only imagine how stressful that situation actually is.

It's like anything else, if you do it regularly, it is just a part of your day.

 

[rescue1]

The real kicker to it is that interventions performed or not performed by EMS providers make treatment rendered in the hospital more difficult or even futile.

Just out of curiosity, what interventions did you specifically have in mind, and what might the effect be in the ER/OR?

 

[Veneficus]

Just out of curiosity, what interventions did you specifically have in mind, and what might the effect be in the ER/OR?

to name a couple off hand,
spinal immobilization, fluid over-resuscitation, and intubation can all have effects that cause long term complications. Some as early as the ER some in the ICU.

I also suspect that with the pathophysiology of hyperoxygenation that there may be harmful implications that have not been properly explored mostly due to lack of interest.