MVA, occupants deny injury. How do you document this?

[usafmedic45]

Wells and her passenger, Younger, suffered serious injuries.

During the course of the investigation it came out that both patients were walking around and talking on their cell phones after the crash. Neither of them was seriously injured and Wells' attorney has publicly stated that all of the life-threatening and crippling injuries see suffered were as a result of the helicopter crash. Of course, MSP said it was "serious injuries" because according to state protocol at the time (and more or less, today) they did meet the criteria for that based on antiquated and misguided supposition about the predictive nature of damage to vehicles. They were flown because of bad protocols and the lack of a desire of the ground EMS providers to be inconvenienced by driving to a hospital.

 

[usafmedic45]

Have you met usaf?

You haven't so let me Google that for you

 

[dixie_flatline]

You haven't so let me Google that for you

I'm confused. I didn't mean "meet" as in face to face. I just meant that I thought it wasn't a big secret that you don't hold much sacred/nor care when other people are shocked, offended, or otherwise bewildered by your position on a given issue.

 

[JPINFV]

I'm confused. I didn't mean "meet" as in face to face. I just meant that I thought it wasn't a big secret that you don't hold much sacred/nor care when other people are shocked, offended, or otherwise bewildered by your position on a given issue.

Life is more fun that way, or else I'd feel really bad about laughing at the Downfall parodies.

 

[usafmedic45]

I'm confused. I didn't mean "meet" as in face to face. I just meant that I thought it wasn't a big secret that you don't hold much sacred/nor care when other people are shocked, offended, or otherwise bewildered by your position on a given issue.

Oh, OK....I thought you were trying to be snide. My apologies. It's been a rough couple of days.

 

[dixie_flatline]

JJ:

Ashley Younger called her mother just before 11 p.m. and calmly explained that she and Wells had just been in an accident. Her mother rushed to the scene with her best friend and Younger's grandmother. Ashley seemed fine, her mother recalled: no bleeding, no broken bones, just some chest pain.

Bill Rudolph, another medical technician, began helping the two girls. Ashley Younger complained that her head and chest hurt but Jordan Wells, who was also in pain, seemed more worried about the damage to her father's car.

MOI ShmemOI. Yes, the girls could have been in shock, but by all accounts they did not need to be flown. They could have gone to Ft Washington, which is less than 15 miles away. The only thing that said they needed to go to the Level 1 trauma center at PG was the MOI script. The bit about "authorities" saying that both of them suffered serious injuries is suspect at best.

 

[JJR512]

If that's the case then perhaps they didn't need to be flown.

Nevertheless, as a provider functioning in Maryland, I detest and reject the notion that we're all a bunch of mindless idiots who automatically call for a helicopter on every MVC.

Stereotyping is stupid and ignorant.

 

[dixie_flatline]

Stereotyping is stupid and ignorant.

Although they're working to change it (slowly), one could argue that Maryland's formula for establishing trauma priorities and codes is stereotyping, when it should at best be a loose guideline for the provider to build his own conclusions from.

 

[usafmedic45]

Nevertheless, as a provider functioning in Maryland, I detest and reject the notion that we're all a bunch of mindless idiots who automatically call for a helicopter on every MVC.

Stereotyping is stupid and ignorant.

The only people stereotyping Maryland EMS providers and harming the patients as a result are the MSP and MIEMSS by assuming that ground providers are unable to provide quality care. The people I am stereotyping as incompetent tools are the leadership of MSP Aviation and the leadership at MIEMSS. Bass can suck my left nut and I have told him such to his face.

Remember, I used to live in Maryland and one of the major reasons I left was because of the lack of respect the leadership has for rank and file providers. I am too smart and too driven to function in a system that is predicated around keeping the status quo at the time of the death of R. Adams Cowley (circa 1991) around for as long as freakishly possible.

Although they're working to change it (slowly),

It's not changing anymore than your average addict does. They scaled back the flights immediately after Trooper 2 to get the press and everyone off their asses and made some grand proclamations about how people would be endangered by not flying them (thank you Tom Scalea for not being concerned about being burdened by trivial matters such as, you know, evidence) and went right on with the same ol' "It puts the patient on the MSP helicopter or else it gets the hose again" approach they have had since the powers that be at MSP realized they could bump up their budgets and otherwise overcompensate by having the most overworked HEMS operation in the nation.

 

[JJR512]

The only people stereotyping Maryland EMS providers and harming the patients as a result are the MSP and MIEMSS by assuming that ground providers are unable to provide quality care. The people I am stereotyping as incompetent tools are the leadership of MSP Aviation and the leadership at MIEMSS.

You say you're not stereotyping anyone, that it's MSP and MIEMSS.

In Maryland, it would be documented as "Called for Trooper 2 due to mechanism of injury/damage to vehicle".

For MSP (and MIEMSS) to stereotype me as a provider unable to provide quality care, they first have to get on scene. And they don't get on scene unless I, or some other provider on the ground, call for them. So you are perpetrating a stereotype here. You're indicating that the ground providers, which includes me, are going to automatically call MSP on every trauma call regardless of if there's an actual need.

 

[Akulahawk]

During the course of the investigation it came out that both patients were walking around and talking on their cell phones after the crash. Neither of them was seriously injured and Wells' attorney has publicly stated that all of the life-threatening and crippling injuries see suffered were as a result of the helicopter crash. Of course, MSP said it was "serious injuries" because according to state protocol at the time (and more or less, today) they did meet the criteria for that based on antiquated and misguided supposition about the predictive nature of damage to vehicles. They were flown because of bad protocols and the lack of a desire of the ground EMS providers to be inconvenienced by driving to a hospital.

JJ:




MOI ShmemOI. Yes, the girls could have been in shock, but by all accounts they did not need to be flown. They could have gone to Ft Washington, which is less than 15 miles away. The only thing that said they needed to go to the Level 1 trauma center at PG was the MOI script. The bit about "authorities" saying that both of them suffered serious injuries is suspect at best.

The thing people need to remember about MOI is while it is predictive of injury, it's not predictive in the way people think that it is. MOI can not predict actual injury, however, if you know the MOI, you can determine where an injury is likely to be. In other words, if I set about busting your arm up with a baseball bat, chances are pretty darned good that you didn't get a head, neck, or back injury from me whaling away on your arm with said bat. Now if you have a particularly tough arm or I have a particularly weak swing, you might not actually have a busted-up arm... it might not even show a bruise, let alone actually have damage.

So, MOI can tell you where to look, but it won't tell you if actual injury occurred. No mechanism, no injury because no injury happens without a mechanism, but the reverse is clearly not the case.

 

[usafmedic45]

You say you're not stereotyping anyone, that it's MSP and MIEMSS.



For MSP (and MIEMSS) to stereotype me as a provider unable to provide quality care, they first have to get on scene. And they don't get on scene unless I, or some other provider on the ground, call for them. So you are perpetrating a stereotype here. You're indicating that the ground providers, which includes me, are going to automatically call MSP on every trauma call regardless of if there's an actual need.

Suffice to say that I'm not maligning the rank and file providers- regardless of what you want to believe- but rather the archaic and harmful system they are forced to work in. If they were the pinnacle of EMS, like MIEMSS so often likes to claim, then they would have standards at least approaching the progressive services in the nation and not have some of the most restrictive protocols around. They don't have to be on scene to render you hobbled because all they have to do is put it on paper out of fear, distrust, disrespect, sincere ignorance and conscientious stupidity.

If I get a full ride to Johns Hopkins or even a faculty appointment there, I will live in Pennsylvania and commute in every day to avoid funding the system that endangers its patients and the very personnel it relies upon. Maryland's EMS programs are broken beyond repair and must be scrapped and all those responsible for the current circle jerk sacked.

 

[epipusher]

 

[JJR512]

Suffice to say that I'm not maligning the rank and file providers- regardless of what you want to believe- but rather the archaic and harmful system they are forced to work in. If they were the pinnacle of EMS, like MIEMSS so often likes to claim, then they would have standards at least approaching the progressive services in the nation and not have some of the most restrictive protocols around. They don't have to be on scene to render you hobbled because all they have to do is put it on paper out of fear, distrust, disrespect, sincere ignorance and conscientious stupidity.

You can keep saying you're not, that it's just what I want to believe...I tend to believe what I see. Earlier you said this MVC, the one described at the opening of this thread, would be documented as a medevac call. Why would it be documented as a medevac call? For it to be a medevac call, the ground provider has to make it one. They don't come because they feel like it, they don't listen to the dispatches and say, "Hey, that sounds good, let's go land at that call!"

You can say it's MIEMSS hobbling the ground provider, you can say this happens because of what MIEMSS puts it down on paper, but that's just not true. Nowhere in the Maryland Medical Protocols does it say, to my knowledge, that the ground provider must call for a medevac. On our trauma decision tree, in the two worst cases, it says, "Consider helicopter transport if quicker and of clinical benefit." There's other language in there as well but none of it says a helicopter must be called.

So when you say that Maryland likes to fly all traumas regardless of the benefit, you're not attacking MSP or MIEMSS. They don't automatically send the helicopter nor do they require us to call. You're attacking the ground providers, implying they lack judgement and just always call for a helicopter.

 

[dixie_flatline]

You can keep saying you're not, that it's just what I want to believe...I tend to believe what I see. Earlier you said this MVC, the one described at the opening of this thread, would be documented as a medevac call. Why would it be documented as a medevac call? For it to be a medevac call, the ground provider has to make it one. They don't come because they feel like it, they don't listen to the dispatches and say, "Hey, that sounds good, let's go land at that call!"

You can say it's MIEMSS hobbling the ground provider, you can say this happens because of what MIEMSS puts it down on paper, but that's just not true. Nowhere in the Maryland Medical Protocols does it say, to my knowledge, that the ground provider must call for a medevac. On our trauma decision tree, in the two worst cases, it says, "Consider helicopter transport if quicker and of clinical benefit." There's other language in there as well but none of it says a helicopter must be called.

So when you say that Maryland likes to fly all traumas regardless of the benefit, you're not attacking MSP or MIEMSS. They don't automatically send the helicopter nor do they require us to call. You're attacking the ground providers, implying they lack judgement and just always call for a helicopter.

JJ - you are also in Howard County, which has the luxury of not needing the helo's all that much. State-wide, things are different. Other counties rely on the choppers extensively. Dispatch has been known to pre-alert the helo as well - I have been on a number of calls (in Howard County) where the chopper was already in the air en route before I had done a full assessment and called them off.

Considering the only time I am more than 30 minutes from a Trauma Center (be it Shock Trauma, Hopkins, or Sinai) is during a football game or a blizzard, I have never had a patient that required flight. Between ETA, packaging, and flight into Baltimore, it rarely makes sense to use HEMS in Howard County outside of extenuating circumstances (it took me 15 minutes to drive Priority 1 from the Mall to the Hospital on July 4th - total trip 1.8 miles)

 

[Epi-do]

From the choices you listed, I would select "no EMS needed." We would actually hit dispatch on the radio and advise it is a "property damage only" incident, mark back in service, and complete a unit report in the station log. No need to do a PCR.

 

[abckidsmom]

From the choices you listed, I would select "no EMS needed." We would actually hit dispatch on the radio and advise it is a "property damage only" incident, mark back in service, and complete a unit report in the station log. No need to do a PCR.

Virginia requires a PCR on incident where the ambulance marks on scene.

 

[dixie_flatline]

Virginia requires a PCR on incident where the ambulance marks on scene.

That sounds like a ridiculous requirement.

 

[abckidsmom]

That sounds like a ridiculous requirement.

Not really. It's a short little times, brief narrative and incident number if there's no patient, and more indepth if there is a patient.

They are collecting data, so they can actually see how many times their EMS system is used, whether there is patient contact or not. Thus, all of those choices for incident disposition that refer to incidents that had no patient contact.

 

[dixie_flatline]

Not really. It's a short little times, brief narrative and incident number if there's no patient, and more indepth if there is a patient.

They are collecting data, so they can actually see how many times their EMS system is used, whether there is patient contact or not. Thus, all of those choices for incident disposition that refer to incidents that had no patient contact.

Don't you guys fill out RMS-type reports? (Rescue Management Software from Zoll is what we use). That is what the county uses to track types of calls, units that respond, etc. Every call that is dispatched requires an RMS report to be filed, whether it's a Fire, Water Rescue, MVC, Refusal, or cancellation en route.

We only fill out an MIR/ePCR if there is a patient refusal (or transport obviously). We don't fill out a PCR for an assist (lifting grandma into her chair) or if we roll up and don't have a patient - whether that means there is no patient to be found, or any possible patient found on-scene is agreed to not need medical services. If they don't want medical services and we agree there is no need, a refusal isn't usually obtained.