Medics BLS'ing Traumas

[jordanfstop]

As an EMT-B who rides for a BLS agency with a medic fly car I have a question regarding what are some guidelines as a medic you ride isolated traumas in? For example, the other night I was on when somebody was found on the road in front of a party with a lac with an arterial bleed to somewhere on the forehead. If I remember correctly, you can't bleed out due to a facial/head laceration. PD on scene later reported that it was due to a beer bottle. We located the 1/2" lac right on the hairline in the bus and didn't see anymore blood coming out onto the stretcher; it was controlled with a few 5x9's. There was a bit of blood on scene and he was (+)ETOH on breath and (+)AMS, (assumibly) due to the alcohol, but had to r/o a head injury. Backboard/collar for precaution. The medic just did a NS drip.

I personally would have felt comfortable enough with alone this particular pt, plus I had another EMT (very very competent junior member) with me as well.

Do you think they rode it in due to what happened to the pt or what could possibly happen during txp (say if it was AMS due to a head injury and not the ETOH)?

What guidelines do you have to ride in isolated traumas?

For example, nearly every trauma in FDNY is txp BLS.

BTW, with blinkies and woowoos our max txp time at this time of day (5a) is going to be no more than five minutes. Without blinkies and woowoos it's a fifteen minute txp max.

 

[firecoins]

Its Rockland. If you show up to the ER without a medic, the nurses flip. Think BLS is short for bullsit. The nurses have the wrong attitude. Trauma is BLS. It should be to pick up the patient and run to surgery.

I do my medic class in the city and get pissed off I miss all the traumas on rotations. But that is just me.

 

[uscgk9]

Sounds like the Medic just wanted to go for a ride. From what you described it sounded like a BLS transport. Sometimes I like to ride calls in because I want to and not because I feel the BLS crew can't handle it. Don't get upset.

 

[jordanfstop]

It wasn't an ego thing or anything of that sort, I should've made that clear in my original post. I just don't like tying up the ALS when it's not needed is all. I know it used to be a thing with another agency here to always "cancel the medics asap" because people will think you're cool for "cancelling the medics on hot jobs" (then you later look like an *** for calling them back and subsituting ego for top patient care.) As I'm still fairly new (yet confident) I'm just trying to figure out when I should and shouldn't cancel ALS especially when they're dispatched to another job, and it seems to me that most isolated traumas don't require ALS, although a lot of them here end up riding them in (it could also be that there aren't the most competent EMTs around here, as I imagine it's everywhere.)

 

[Tincanfireman]

(Caution-Monday Morning Quarterbacking to follow) It could be anything from a medic trying to catch an "easy" call to hide for awhile, to maybe listening to his/her gut and erring on the side of caution because something didn't feel right. I worked a very similar call on New Year's Eve and my -P partner was more than happy to let me ride the call to the ED. My pt was just a bit AMS, but he was very +ETOH to the tune of a gallon+ of beer in the 4 hours prior to the event. As long as we're talking less than major blood loss and no other pertinent factors, I think letting a capable -B or -I ride the call is a great way for them (us) to gain good experience in patient management with backup just a short distance away if things go sour. If the ED has issues with a BLS attendant, maybe it's time to have a quiet, casual chat with the charge nurses regarding the capabilities of -B's working for your service and how it's a valuable method to gain experience and confidence. Just my .02, your mileage may vary. BTW, I like the "blinkies and woowoo" part too...

 

[Ridryder911]

or...maybe it is a smart medic realizing that one should not assume LOC is actually caused by the ETOH. As well have seen missed internal head bleeds because anyone that has experience has been burned by them. Meningeal tears are usually silent and can become suddenly acute.. thus, if you flag a patient as a basic call then mid stream the patient goes down the tube, so you will your reputation and possibly career. After all these years, I never assume it is ETOH, even if I see empty gallon whiskey bottle.. high probability yes.. but?...

For as Trauma are basic ... yes and know. Intubating, crich, decompression of pnuemos and detailed assessments are not basic care or taught in basic curriculum. Again, unfortunately we even have the implied need to have "basic" anything on any trauma call. It should be one care and one level all the time....so if the s*it hits the fan, qualified people are already there.


R/r 911

 

[JPINFV]

(very very competent junior member)

Please tell me that by "junior member" you mean "a new basic that we call a "junior member" because we have to have a hierarchy in place to feel good about ourselves" (I'm not a fan of the entire probational period shenanigans that goes on some places) and not someone under the age of 18.

 

[jordanfstop]

Please tell me that by "junior member" you mean "a new basic that we call a "junior member" because we have to have a hierarchy in place to feel good about ourselves" (I'm not a fan of the entire probational period shenanigans that goes on some places) and not someone under the age of 18.

By "Junior Member" I mean (straight from our by-laws) “Any member under the age of eighteen (18) years, shall be considered a Junior Member.” <_<<_<

Some other places call them "youth squad" or something to that extent.

 

[firetender]

"Blinkies and Woo-Woo's!"

LOL but I don't know why.

 

[mdtaylor]

Do you think they rode it in due to what happened to the pt or what could possibly happen during txp (say if it was AMS due to a head injury and not the ETOH)?

I think you answered your own question with the above... Alcohol, head injury, reduced LOC followed by a question mark. The suspicion is there but do we have everything we need in a pre-hospital setting to make a definitive diagnosis? Err on the side of patient care.

 

[EMT007]

Around here (Southern CA), head injury with an altered mental status (plenty of alcohol or not) is trauma center criteria. Neither we nor the medics really get to make the determination that "its just the EtOH", so its c-spine, O2, and a quick trip to the RS.

 

[JPINFV]

Southern California is a poor example for anything EMS related. That area isn't anywhere near "progressive" in terms of education, protocols, or scope of practice.

At least, from the looks of it, Orange County will be reintroducing asprin sometime this year.

 

[MasterIntubator]

To the original poster, never under-estimate a 'simple' bleed from the head. There have been documented cases of folks bleeding out from simple lacs, and nosebleeds as well. Not common.... but could happen.

I think the medic was playing it safe, Many times I will do the same thing. Many times recently it has bailed me out. Similar case, except this 20 year old rode his bicycle into a street sign. A little altered, a lot ETOH. He remembered what happened, but now wanted to walk home. Some sutureable lacs to his head, so we transported fully packaged, with an IV KVO.

3 hours later he went into a coma from a closed head injury that was being masked by his self induced etomidate like state ( medic humor ) :wub:.

We have been getting a rush of ETOH folks that end up having worse off things found after we left the ED, and thank heavens we followed our training.

Be safe

 

[CAMedicJohn]

To the original poster, never under-estimate a 'simple' bleed from the head. There have been documented cases of folks bleeding out from simple lacs, and nosebleeds as well. Not common.... but could happen.

I think the medic was playing it safe, Many times I will do the same thing. Many times recently it has bailed me out. Similar case, except this 20 year old rode his bicycle into a street sign. A little altered, a lot ETOH. He remembered what happened, but now wanted to walk home. Some sutureable lacs to his head, so we transported fully packaged, with an IV KVO.

You nailed it.. Same thing.. ETOH, AMS, Head injury-- get you a niffty collar, stiff board, and sharp pointy thing enroute to the CT scanner... LOL...
:wacko::wacko::wacko:

 

[MSDeltaFlt]

You nailed it.. Same thing.. ETOH, AMS, Head injury-- get you a niffty collar, stiff board, and sharp pointy thing enroute to the CT scanner... LOL...
:wacko::wacko::wacko:

Amen. Never, ever treat ETOH. Always treat the TBI until proven otherwise by scan. Nothing against basics. On the contrary, there are some basics I trust over a lot of medics. But an ALOC call is a medic call. Period.

 

[MedicPrincess]

This is reflected in a previous post of mine...when I mention "OLD MEDICS" who say things like..."ETOH is ALS??? Not on my truck!"

The pt had a head lac for UNKOWN reasons (you only later found out it was a beer bottle.) You can't be certain the pt didn't fall, pushed, was hit by a car, etc....The pt had an AMS. He JUST SO HAPPENED to be ETOH.

He s/be ALS. Albeit, most probably an easy ALS call...but ALS none the less.

On the flipside...its a judgement call. I hold the judgment of other Paramedics in fairly high regard....especially those "OLD MEDICS" (right..R/R )

 

[Rangat]

The paramedic rode along on a TBI, but then put up a NS (I'm assuming small bore catheter)???

Sounds like lack of diagnostic confidence?

If you deem ALS Rx necessary, you do it properly. Go big or go home.

Either you put up a 14G with HTS/RL, notify the neurologist, get your ETT and Pipe Spanner ready, or you leave the patient with the EMT-B/EMT-I crew and go do other calls.

Here I'm pretty sure the ALS would not have accompanied, especially with the short Tx times...

 

[So. IL Medic]

In that scenario, possible head injury equals ALS. Period.

Anything less means a trip to the EMS coordinator to find out how long your suspension is.

 

[Guardian]

As well have seen missed internal head bleeds because anyone that has experience has been burned by them.

This thread didn't do much for me, but this sentence is a hidden diamond. To all newer ems people out there (als or bls), go back and review s/s as well as common scenarios for misdiagnosed head injuries. Then let it sink deep into your long term memory. I take this very seriously and know all too well the indicators of head injuries. Despite this, I have still managed to completely miss two cases. It is not fun to watch a seemingly healthy person crash in a matter of minutes and have no idea why. To the educators out there, you really need to start hammering this into your student's minds. Ok, back to your regularly scheduled program.

 

[Ridryder911]

Good points! Like to empathize that head injuries in children are even more sneaky. Children cannot always communicate the exact symptoms as well as ability to find out alertness, behavior and specific changes. In discussing with other health professionals it appears that children will "turn bad" suddenly and crash on you without any precursors or warnings..

On children that I expect real trauma on, I monitor very closely and have things somewhat prepared in case they do crash. For those advanced, this means an IV line. I have seen many times, medics prefer not to start an IV line because it is a child, only to get burned, when the poop hits the fan...

R/r 911