MVA scenario

[jrm818]

So you have an ambulance that transports one patient. If the MVA has 2 known occupants, information that would be gathered almost immediately on the part of the 911 dispatcher, then why wasn't the second ambulance dispatched from the initial call? Leaving a patient on the scene is abandonment, period. Leaving that pt. in the hands of a first responder is still abandonment as you are turning over care to a lower level. It is not delegation as you cannot delegate anything if you are not there. You say that the pt. has minor injuries. Are you sure? Can you effectively make that factual statement with your limited assessment ability and lack of diagnostic resources? Remaining on the scene may not be the optimal idea, but it the ethical one and the one that will cause you the least amount of legal headaches. Both pts. require your care. Unfortunately, a small amount of Darwinism will have to apply. Living in a rural environment places you at a higher risk of death secondary to illness or injury due to a lack of effective resources.

Placing a pt. in only a KED and not competely immobilizing them is maleficent and completely half arsed. It leaves you wide open for litigaiton.

Leaving a patient behind with Bubba Joe first responder is abandonment. Again, leaves you open to litigation.

Wait on scene with your patients, then litigation is possible, but it will have to be against the agency, county, or the State. Its hard to name you individually if you are treating both patients.

Yeah life sucks all around when it comes to these conundrums, but you just do what you can...................

He said the other ambulance was 20 minutes out. Guess this is rural territory.

Regardless there are almost defiantly other resources available - the green pt. can be left with a FR, EMT on scene not with the ambulance, etc. In this scenario you didn't really specify the exact status of the "green" pt., but assuming they were properly trialed as green but needed to be c-spined, put them on a board, leave them in the care of a FR/FF or FR/PD or whatever is there.

This is an MCI (2 pts, one ambulance = pt. outnumber resources = MCI) and triage rules apply. Red -->yellow--> green--> black. Get the critical patient out of there, there's no problem with turning over care to a lesser trained individual in an MCI/ triage situation.

I would hope fear of litigation wouldn't override good clinical judgment in this case. The golden hour may be a myth, but that doesn't make it irrelivent how long you take to get to the hospital. Major trauma = rapid transport is required. Load and go.

I agree with not transporting in a KED. I did that once due to special circumstances (pt. unable to lie down, best methods of spinal precautions tolerable), but in general, if they need a spinal precautions, they get full spinal precautions. Just find somebody to watch them.

short answer is yes, the PA exemption does apply in this case.

 

[Flight-LP]

What about air resources, where they considered? that would have eliminated the problem right there....................

I'm sorry, but there are two trained medical professionals on an ambulance (I'll use the term professional loosely). 2 EMT's + 2 patients fails to equal an MCI. This wasn't a lack of medical resources, it was an inappropriate utilization of available resources. If this call was back in the sticks and it is known that one unit can only transport one patient, then a second unit should have been dispatched from the word go. Or, as previously stated, alternate forms of transport (i.e. air medical) arranged.

I find it hipocritical that people come on her arguing a BLS unit is capable of running primary 911 and then calling a simple 2 patient MVA an MCI. Maybe its the different geographic locations, but I would never call an MCI for only 2 people. Besides, if you are going to truly play the MCI card, then just put the green tag in the front seat or even another vehicle for that matter as they are now "walking wounded". I still don't see this scenerio constituting an MCI.....................

 

[BEorP]

"Golden Hour" is the concept that you have one hour to get the pt into the OR after which imporvement is much less likely, and survival less certain. If I'm right, this was based on empirical observation dating from the Korean and Vietnam conflicts and brought to the then-newly blossoming emergency "room " scene.

Did you read my post?

 

[jrm818]

I'll agree that this scenario is a bit contrived...unrealistic limitations.

That said, what if air resources are unavailable (eg its a blizzard, which caused the accident). Even if the 2nd ambulance were dispatched from go, depending on the location, it may be 20 minutes out upon arrival of the first.

The number of EMT's may = the number of patients, but in this hypothetical scenario only one can go in the ambulance with spinal precautions. Mechanism alone is almost certainly going to require spinal precautions on the 2nd patient, even if they are completely stable. Thus only one patient can be transported at this time. May be a small number of pt's for an MCI, but the decision is not based on raw number, but number compared to resources.

There's no question in my mind that sitting on scene with a trauma patient for 20 minutes is not an acceptable decision. If there isn't a way to adequately provide care for every patient with the resources you have, you are dealing with an MCI, regardless of actual patient number.

Leave one EMT behind with the stable backboarded patient (yellow by our triage rules, but I suppose he could be "green" by some...i guess), have a FF drive the ambulance, and get going (the obvious solution now that I think about it more).


EDIT:

I forgot about the BLS/ALS cheap shot. This scenario has the same outcome if its an ALS rig that can only transport one patient: MCI. BLS/ALS has absolutely nothing to do with it. Only possible difference is if medics can give whole blood where you are, might make sitting on scene a few minutes more acceptable. That's not the case in most places, and even if it is, I'd still call that decision poor.

 

[YouthCorps1]

ok i want body substance isolation and scene safety...have a lower-trained partner attend to patient 1...if patient 2 is in shock...i want to do a rapid extrication...spinal injy is not my concern...i will have PD grab neck collars, a backboard, and a stretcher along with o2 and a trauma bag. i also need towels to do a rare extrication technique. first i will throw on the collar, and then wrap a thick towel once around the patients front neck, then overlap them in the back...then go under the arms. now you have complete control and can move them with preventing spinal movement. put the patient on the backboard. throw him into the truck. depending on where he is bleeding from, grab some 4x4's, 5x9's and dress all injs...splint all fractures..take a set of vitals...have some fluids going through this guy,,,start him on oxygen depending on how well or how bad his breathing is at...preferably an NRFM (non-rebreather face mask) . is possible get your suction ready...also if possible...get ready to transport patient in trendelenburg pos...while attending to patient 2, get the partner to go get personal info, check for blood, hair, or anything in that catagory near the winsheild, dash, or airbag deployment...get damage to car sample...and have PD wait with patient 1 and treat him for minor injs with supplies their SUPPOSED to have in their car...rapid transport

 

[JPINFV]

i also need towels to do a rare extrication technique. first i will throw on the collar, and then wrap a thick towel once around the patients front neck, then overlap them in the back...then go under the arms. now you have complete control and can move them with preventing spinal movement. put the patient on the backboard.

 

[EMTinNEPA]

I lol'd for a minute and a half straight, and hard enough that my face actually hurts :lol: x 9999999999999999