MVA Scenario

[Melclin]

Two pt's in one unit is a common occurance. Opposite drivers are a common occurance. If it is during a busy time in your system, why tie up another unit.

If both pt's are fairly stable, there is no reason a medic cannot treat both. It is done all the time. You have to think outside the box on this job. Be prepared to do what is needed.

Are there any problems with caring for someone on a bench? I'm not entirely familiar with the layout of those ambulances but things like, "Does the suction reach?", "How many oxygen taps have I got?", "Are there privacy concerns in asking questions of patients?" etc, come to mind.

 

[Shishkabob]

"Does the suction reach?"

In my experience, yes, with a long enough hose.



"How many oxygen taps have I got?"

Most boxes I've seen have 1-2 oxygen taps above the bench seat.




"Are there privacy concerns in asking questions of patients?"

We speaking legally or morally?

 

[mycrofft]

Bench issues part dux

IF the pt is on a litter it shold be either just flat to the ground, or it has to have feet that match the detents on the bench. Need to be able to firmly secure litter or it will fall off. And, once secured on, th bench contents are locked in unless your ambo has a side hatch for the bench as well.

Pt is firmly against the starboard side (passenger side is different for different countries).

If sitting, bench pt's do not have the full restraint the would if on a civilian vehicle or up front (heaven forbid). They also have their feet where you will be working.

Maybe smack em down with fentanyl and strap em into the suction station captaion's chair?

Don't even start about the ceiling hangers!

 

[mycrofft]

Ah, yes there we are...

http://www.emtlife.com/showthread.php?t=8820&highlight=caddy Am I a weird magnet or what?

Those old cadillac were not roomy, but could they ever move.

 

[exodus]

I am curious to know what the difference in prehospital treatment for a major and moderate trauma are and how you could possibly make those triage decisions with the information presented?

Did the driver have an MI and code which preceded the impact? Was he/she looking in the back seat? People generally don't just decide to head on somebody.

There could be all kinds of reasons one patient died and the other didn't. Off center hit,body position, unrestrained, preexisting condtions, extremis of age, medications, and/or struck by an object in the car, to name a few.

Likewise the occupant in the 2nd vehicle could have any number of similar comorbidities.

Just as linus said with limited info in the scenario, as far as Triage, anybody in a vehicle with a death in the same passenger compartment, is considered a major trauma. And the other patient, has a simple eventually stabilized fx, and his vitals are 'stable'. If there was enough energy to kill the driver, there was enough energy to kill the passenger. For all we know, the driver of the other car, was just clipped and happen to have his leg in that one freak position that will break it.

 

[CAOX3]

Just as linus said with limited info in the scenario, as far as Triage, anybody in a vehicle with a death in the same passenger compartment, is considered a major trauma. .

Really?

Interesting, here mechanism of injury is a poor indicator of potential injury.

 

[Shishkabob]

Really?

Interesting, here mechanism of injury is a poor indicator of potential injury.

MOI is a great indicator for potential injury. You are more likely to suffer an injury from a 30 foot fall than a 3 foot fall, correct? Yes, there are freak accidents, but there's also laws of physics, which are definitely alive and well in trauma.

 

[CAOX3]

Here is a good article.

http://www.ems1.com/ems-products/ed...anism-of-Injury-in-Prehospital-Trauma-Triage/

In a 2004 San Francisco study, trauma researchers found MOI a very poor predictor of which patients required trauma team activation. Of the 700 trauma team activations for MOI criteria, only 54 (7.7 percent) patients required ICU or operating room admissions, and none resulted in death in the emergency department. The four least predictive MOI criteria were found to be "motorcycle crash with separation of rider," "pedestrian hit by motor vehicle," "motor vehicle crash with rollover," and "motor vehicle crash with death of occupant."4

While agree with you there are circumstances or exceptions to the rule basing hospital destination on mechanism alone is outdated.

There was also another great article but since Im old now I cant seem to remember where I read it.

 

[Shishkabob]

Oh I wasn't saying a significant MOI should be an instant trauma alert... to the contrary. But the more significant the force put on the body, the potential for injury is greater and more scrutinization of the patient is to be done, even if they have no complaints.

We've all seen someone injured that had no clue they were injured.

 

[thinkABC]

Uhh....

Is this a trick question? I think I'm concerned with the DOA first. (I assume that means dead on arrival?) Unless he's missing a head or something, if this guy has any chance in the world of being revived, I'm loading him up and going. The arm fracture and the confused, possibly-injured-but-no-apparent-life-threats are waiting on the next responder. Right?

 

[MonkeySquasher]

I feel this scenario has much potential, but very little information. It doesn't mention plenty of key things, such as speed/damage to the vehicle, location/position the occupants were found, extrication required, physical exam or vitals...


But I concur with all the responses though, load both and go. Make passenger nakkie, full ALS workup, while you provide splinting and pain support for the other driver. Fire drives, Medic/EMT ride, slow Hot to a trauma center.




.....OR WE CAN USE THE HELICOPTER!

 

[Stewart1990]

Uhh....

Is this a trick question? I think I'm concerned with the DOA first. (I assume that means dead on arrival?) Unless he's missing a head or something, if this guy has any chance in the world of being revived, I'm loading him up and going. The arm fracture and the confused, possibly-injured-but-no-apparent-life-threats are waiting on the next responder. Right?

If there is one ambulance, 2 EMS personell and 3 patients, this is considered a mass casualty incident. Mass casualty triage dictates that once someones code black, theres no going back. By all means, if you could diferentiate that the injuries of the moderate trauma weren't 'life threatening', you might be able to rationalize working the code. Otherwise, the two living patients are the ONLY patients....Just what I was taught.

 

[Smash]

Uhh....

Is this a trick question? I think I'm concerned with the DOA first. (I assume that means dead on arrival?) Unless he's missing a head or something, if this guy has any chance in the world of being revived, I'm loading him up and going. The arm fracture and the confused, possibly-injured-but-no-apparent-life-threats are waiting on the next responder. Right?

I don't like interfering with corpses. Despite what the plaintiff had to say I... sorry?... oh, my lawyer says I shouldn't talk about that.

Seriously though dead from trauma is dead, they don't come back.

Too little info to do much with this one, I'll just go with 'sick people don't :censored::censored::censored::censored::censored:' and be more concerned about the quiet one. Arm dude can come for a ride too.

Assuming that road transport time is < 5 minutes, we are in an urban area, there is an electrical storm on the go with strong cross winds and we are right next to a large number of high tension power transmission lines, I say call out all the choppers, cos they gave me a mouse mat once.

 

[EMSLaw]

In a 2004 San Francisco study, trauma researchers found MOI a very poor predictor of which patients required trauma team activation. Of the 700 trauma team activations for MOI criteria, only 54 (7.7 percent) patients required ICU or operating room admissions, and none resulted in death in the emergency department. The four least predictive MOI criteria were found to be "motorcycle crash with separation of rider," "pedestrian hit by motor vehicle," "motor vehicle crash with rollover," and "motor vehicle crash with death of occupant."4

The underlined one has always seemed like something of a red herring to me. Honestly, I've lain a bike down, and I came off it. I think that separation of the rider from the bike is the sine qua non of a motorcycle crash.

But then again, it's not a predictive MOI, so my anecdotal experience, for once, matches up with the evidence. Blind squirrel. Nut found.

 

[usafmedic45]

motorcycle crash with separation of rider

In the injury epidemiology literature, usually that is referring to a "Evel Knevel style over the handlebars" separation. The problem is that you can't assume EMS personnel are smart enough to make the distinction since a good number of our colleagues are, in fact, of very questionable intellect. Case in point:

Unless he's missing a head or something, if this guy has any chance in the world of being revived, I'm loading him up and going.

To the person I just made an example out of, as Smash said, he's dead. Please don't flog him because of it. Remember, descration/abuse of a corpse is a crime in most (all?) jurisdictions.

I assume that means dead on arrival?

Nah, in this case it's more like "dead on asphalt".

Meanwhile, at the Legion of Doom...:

the confused, possibly-injured-but-no-apparent-life-threats are waiting on the next responder.

...you just increased the likelihood of that patient having a poor outcome.

.....OR WE CAN USE THE HELICOPTER!

"What we have here is, failure to communicate...." :lol:

MOI is a great indicator for potential injury.

Linuss, I love you man, but seriously, don't intentionally try to confuse the newbies and the folks who simply practice off the "We've always done it this way" principle.

We've all seen someone injured that had no clue they were injured.

The ones that really piss me off are the people who know they are seriously hurt, but aren't.

"Are there privacy concerns in asking questions of patients?" etc, come to mind.

"Bob meet George. George, meet Bob. You'll both be seeing each other naked tonight, but don't worry, if doesn't mean either of you are gay."