MVA - BLS or Trauma alert?

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LEB343

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So I had a call yesterday that I thought was BLS (I'm an EMT) but ended up being a trauma alert according to the ER. What do you guys think?

Got called to a MVA right across the street from the ED. Two cars involved, head on collision, moderate front end damage, no airbag deployment (don't know why, should have been), no windshield damage, and no compartment intrusion. There were 7 passengers in a 4 door sedan, all unrestrained. 1 person spoke english, my patient did not. Also, my patient was the only patient "injured".

Pt was a 26 y/o female 8 months pregnant c/o abdominal pain. She was unrestrained in the back seat. No obvious injuries found except a small abrasion on the top of her forehead. Unknown LOC. Non english speaking but in obvious abdominal pain. Vitals stable: BP 120/82, P 90, R 20.

Now let me explain what type of system I work in. My partner is a medic and the fire dept has medical control and they have 1-2 medic on an engine. The pt was handed over to me with no spinal immobilization, no IV, not even a SPO2. So this patient was handed over to me with no interventions and no concern from 2-3 medics. Was this an ALS call?

When I arrived at the ED (in 2 mins) there was a trauma team activated and I almost :censored::censored::censored::censored: in my pants! I was so nervous and I did my hand off speaking a million miles per hour. I felt like an idiot! Do you think my partner is going to get in trouble (I actually hope he does) and maybe the fire dept because they have medical control in the field? Do you think this should have been a trauma alert?

Thanks! I needed to get this call off my chest.
 
8 months pregnant, obvious abdominal pain? I would have been asking a paramedic to come along, calling for an ALS intercept if they refused, and a translator since communication is very important.

Just noticed you said 2 minutes. I guess there wouldn't have been time for an intercept. I'm in a rural area, and used to those time-frames.
 
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Trauma is not an ALS call.

There are actually studies showing improved outcomes when rapidly transported by BLS compared to ALS.

There are many reasons a hospital may call a trauma alert, they get paid extra for them which may play a role in liberal criteria for such.

Additionally, the hospital policy on what constitutes a trauma alert may not in anyway reflect what EMS considers ALS.

Even if this patient was in cardiac arrest from trauma, there is nothing ALS can offer.

Hemorrhage control is a BLS skill.
 
I hope you didn't put this woman on a board.
The first available transport unit should have taken this pt. like vene said Trauma is BLS . Trauma alerts are different from place to place. I have seen trauma alerts for very minor trauma and even no trauma pts. Did you call in an accurate report? Were you panicked and they might not have heard you or gotten the whole story?

So why do you want you partner to get in trouble? Was he driving and you attending?
What would you have done differently?
 
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My "partner" was not my normal partner. He does nothing to help out and I felt like I was on my own with no direction. He's the medic and should have looked at the pt. All he does is sit in the front seat until I'm ready to go. I was so worried I was going to get in trouble after this call. There could have been injuries I over looked.
 
I'd bls it, however, as a devils advocate...
8 months pregnant with abdominal pain?
Unrestrained in a head on MVA?
Unrestrained with even a head abrasion?

All of these are reasonable justifications for a Trauma alert.
 
As long as you documented and performed every thing in your scope of practice as a EMT then your good. If you neglected to do a proper head to toe and failed to get proper V/S then yeah I would be worried. I live in a area where BLS has transported trauma alerts many times and they have all been handed down from a engine. I have taken 2 trauma alerts myself and as long as you document everything your in the clear.

Reason being for a trauma alert is simple she's 8 months pregnant with severe abd pn secondary to a MVA. Theres no telling what is going on inside w/o proper equipment so I can see the ER calling it to be on the safe side. No need to question yourself or others for that matter if you performed 100% at your certified level. Take the call as a lesson learned. What were her v/s btw
 
Veneficus said:
Trauma is not an ALS call.

There are actually studies showing improved outcomes when rapidly transported by BLS compared to ALS.

There are many reasons a hospital may call a trauma alert, they get paid extra for them which may play a role in liberal criteria for such.

Additionally, the hospital policy on what constitutes a trauma alert may not in anyway reflect what EMS considers ALS.

Even if this patient was in cardiac arrest from trauma, there is nothing ALS can offer.

Hemorrhage control is a BLS skill.
Click to expand...
I tell people all the time that Trauma is a BLS Sport. EMTs often deal with trauma faster and have better outcomes than Paramedics do. Why? Paramedics tend to stay and play a little bit before rolling. In other words, Paramedics tend to stay on scene a little bit longer than they should. As a Paramedic, I have taken that "lesson" to heart and whenever I had trauma patients, I did only what was absolutely necessary on scene and did EVERYTHING else while rolling toward the hospital. In other words, I "thought" like an EMT.

As to knowing what constitutes a "trauma alert" for your EMS system, know your protocols for that. What constitutes a trauma alert for each individual hospital depends upon the hospital's own protocols. Given a choice between having an EMT transport immediately or waiting for a Paramedic to arrive when the ED is literally 2 blocks away, I'd choose the EMT transport every time.

Also, at 8 months pregnant, complaining of abdominal pain, that's a high priority/acuity patient because the fetus could be going south right before you and you wouldn't know it. Put that patient on the backboard and you could very well cause some problems for both mother and fetus because you might forget to roll her over to one side.
 
Milla3P said:
I'd bls it, however, as a devils advocate...
8 months pregnant with abdominal pain?
Unrestrained in a head on MVA?
Unrestrained with even a head abrasion?

All of these are reasonable justifications for a Trauma alert.
Click to expand...

Nobody is disputing it is a trauma alert for a hospital, we are saying ALS is not going to make a difference.
 
If I gave that call in (with all the info available) I would more then likely get into the ER then a Spanish speaking employee would ask some questions about LOC, head, neck, back pain. If she denied all of that then the ER would most likely have us bypass them and head up to L&D/OB.

And per the protocols in my area nothing about this call would make us call for a trauma alert. We would just transport to the closest hospital that has OB or patients choice.
 
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Veneficus said:
Nobody is disputing it is a trauma alert for a hospital, we are saying ALS is not going to make a difference.
Click to expand...

Excluding the part where the OP specifically asks if this should of been a trauma alert?
 
No one is perfect. We all make mistakes

LEB343 said:
My "partner" was not my normal partner. He does nothing to help out and I felt like I was on my own with no direction. He's the medic and should have looked at the pt. All he does is sit in the front seat until I'm ready to go. I was so worried I was going to get in trouble after this call. There could have been injuries I over looked.
Click to expand...


Yes there could have been injuries you looked over. It's quite obvious that your partner wasn't very worried (Should he have been?) Are you a capable BLS crew member? My first piece of advice is not to be to harsh on yourself. We all make mistakes. A 2 min ride to the ED, fantastic. You definately got there within a reasonable time.

I have a few questions for you.... Was the B/P stable? Any obvious life threats? Did you have time to listen for fetal heart tones or feel for movement from the baby? If not, its ok you WERE ONLY 2 minutes away for a hospital with doctors and rn's and a surgical ward.
 
LEB343 said:
So I had a call yesterday that I thought was BLS (I'm an EMT) but ended up being a trauma alert according to the ER. What do you guys think?

Got called to a MVA right across the street from the ED. Two cars involved, head on collision, moderate front end damage, no airbag deployment (don't know why, should have been), no windshield damage, and no compartment intrusion. There were 7 passengers in a 4 door sedan, all unrestrained. 1 person spoke english, my patient did not. Also, my patient was the only patient "injured".

Pt was a 26 y/o female 8 months pregnant c/o abdominal pain. She was unrestrained in the back seat. No obvious injuries found except a small abrasion on the top of her forehead. Unknown LOC. Non english speaking but in obvious abdominal pain. Vitals stable: BP 120/82, P 90, R 20.

Now let me explain what type of system I work in. My partner is a medic and the fire dept has medical control and they have 1-2 medic on an engine. The pt was handed over to me with no spinal immobilization, no IV, not even a SPO2. So this patient was handed over to me with no interventions and no concern from 2-3 medics. Was this an ALS call?

When I arrived at the ED (in 2 mins) there was a trauma team activated and I almost :censored::censored::censored::censored: in my pants! I was so nervous and I did my hand off speaking a million miles per hour. I felt like an idiot! Do you think my partner is going to get in trouble (I actually hope he does) and maybe the fire dept because they have medical control in the field? Do you think this should have been a trauma alert?

Thanks! I needed to get this call off my chest.
Click to expand...

8 months pregnant, unrestrained passenger in an MVC, complaining of abdominal pain?

And only 2 minutes from the hospital?

I think you can make a case that absolutely nothing should have been done - literally - except BLS airway management, slap some pressure on any bleeding you see, and get her to the ED.

I wouldn't even bother with vital signs unless I had time to do them during the two minute ambulance ride.
 
I agree in this instance "load and go" was the best course of action. However, unlike many medics on here, I would not have given this call to my BLS partner. He has been a Basic for several years and is fantastic at his job, but this patient is an ALS patient all the way. Now, with such a short transport time, I wouldn't have done any ALS interventions, still "loading and going", but the distance of transport should not be a deciding factor on "is this ALS or BLS?" If at any time you don't feel comfortable taking a pt, speak up, your partner should step up and take over.
 
emtdansby said:
I agree in this instance "load and go" was the best course of action. However, unlike many medics on here, I would not have given this call to my BLS partner. He has been a Basic for several years and is fantastic at his job, but this patient is an ALS patient all the way. Now, with such a short transport time, I wouldn't have done any ALS interventions, still "loading and going", but the distance of transport should not be a deciding factor on "is this ALS or BLS?" If at any time you don't feel comfortable taking a pt, speak up, your partner should step up and take over.
Click to expand...

If you were not going to do any ALS interventions, why is this an "ALS call"? An EMT can sit and watch somebody during a 120 second ride to the hospital just as well as a paramedic can.
 
In a 120 second transport time. It would tough to argue anything. However I share Dans opinion. For the sake that I am a higher level of care for the patient and should something go wrong, I can correct it immediately without stopping transport. Unfortunately, liability plays a huge role in my decision process only because my place of employment is too small and can't afford a malpractice lawsuit (even with liability insurance). They put such a heavy emphasis on higher levels of care and the less liability the better. Personally, the only calls I should be on are Trouble Breathing, Chest Pain, Syncope, Arrests, Diabetics, Unknowns, and calls concerning advanced airway management.
 
At my company, the mechanism of injury and the high risk OB makes this an ALS patient irregardless of the transport distance. Also, the OP seemed very uncomfortable taking this pt in the first place, that right there make his paramedic partner very irresponsible and a poor excuse for a medic
 
Sure. I see your point, and if I were the medic on scene, I would have transported this patient, but my report would have reflected that it was a BLS call.

If you don't DO any ALS, it's not ALS. It's not JICALS. :)
 
I see your point, at the company I'm at now I would have to document it as ALS per our assessment protocols, but other places it could be documented as BLS
 
As a Paramedic, I would have been the one to be the guy in the back. My verbal report and subsequent documentation would have shown that I assessed at an "ALS" level but did absolutely NOTHING that would have been considered an "ALS" intervention because I didn't have time to do anything during transport. There's no real point in me getting set up to start an IV line or do much of anything else in that 2 minutes. I'm doing the best intervention at that point anyway: transport!
 
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