Ped major trauma - Houston FD delayed EMS response?

[DV_EMT]

Do it like LA does it.... send an engine & ALS crew and contract out an ALS ambulance or use their own if its available. Thats how its done.

 

[STXmedic]

I edited my post above, but I'll copy paste it...




You identified the source as an "upset citizen."





So, let's ignore the upset citizen and listen to the elected representative who was talking to the people who responded. Unless we shouldn't be listening to emergency responders who are trying to cover their own behind.

City Council member Mike Sullivan, whose district includes Kingwood, said the family was told by the crew of the fire engine that an ambulance could not be sent until they arrived on the scene to make an assessment.

"It's not uncommon for a firetruck to show up on EMS calls," said Sullivan, who said he talked to HFD personnel at the scene of the Kingwood accident. "However, they usually show up and an ambulance is en route at the same time. The new policy is: The firetruck is dispatched to the scene, makes an assessment, and then requests an ambulance."

Is this the text you are referencing? Because here I see exactly what I mentioned; the family stating they were told by the fire crew. Then, the councilman talks about the new system (that I doubt he has too strong of an understanding of), and says he spoke to the personnel. He does not say that they told him they were dispatched solo and were required to assess the pt before dispatching EMS. If YOU were to read earlier in the text, you would have read that the Fire Chief also made a statement:

Under the new "All Hazards Response Program" launched Aug. 1, there were no changes to the dispatch of ambulances with advanced life support capabilities to respond to calls where there is a life-threatening incident, said Fire Chief Terry Garrison.

I bet you this guy has a slightly better understanding of the dispatch system than some city councilman with second-hand information.

 

[Handsome Robb]

I believe that it's very fair when using it to compare and contrast how fields who aren't contaminated with "BLS/ALS" or "basic/advanced" dichotomy looks at things. I have yet to hear in medical school anything that compares with sticking some interventions into "basic" or "advanced." Some interventions may be used before others, but that doesn't make the first line treatments "basic" or further treatments "advanced."

Yet again your bringing advanced medical education to the table.

You have to look at the simplicity of medical education brought to the table in both, don't shoot me but I'm gonna say it, basic and advanced EMS education.

I don't see how you were comparing and contrasting but then again I'm just a stupid EMT-I/Medic Student

 

[DrParasite]

City Council member Mike Sullivan, whose district includes Kingwood, said the family was told by the crew of the fire engine that an ambulance could not be sent until they arrived on the scene to make an assessment.

"It's not uncommon for a firetruck to show up on EMS calls," said Sullivan, who said he talked to HFD personnel at the scene of the Kingwood accident. "However, they usually show up and an ambulance is en route at the same time. The new policy is: The firetruck is dispatched to the scene, makes an assessment, and then requests an ambulance."

City Council member Mike Sullivan, whose district includes Kingwood, said the family was told by the crew of the fire engine that an ambulance could not be sent until they arrived on the scene to make an assessment.

"It's not uncommon for a firetruck to show up on EMS calls," said Sullivan, who said he talked to HFD personnel at the scene of the Kingwood accident. "However, they usually show up and an ambulance is en route at the same time. The new policy is: The firetruck is dispatched to the scene, makes an assessment, and then requests an ambulance."


So, let's ignore the upset citizen and listen to the elected representative who was talking to the people who responded. Unless we shouldn't be listening to emergency responders who are trying to cover their own behind.

The elected representative is speaking for his district, getting his name in the paper, and making the appearance that he cares. the reality is, he knows nothing, shouldn't be talking, and is doing it to get votes.

He is giving second hand information from the firefighters based on ONE call. you can't run a system based on one call, nor can you make policy based on one call.

The obvious solution to this problem would be to double the EMS fleet to a more manageable number of units to handle the call volume, so you don't need the FD to play first responder and decide if an ambulance is needed. in this case, the FD delayed care; the injured child needed an ambulance to take them to the trauma center and bright lights & cold steel. not a fire truck to say "yes, the kid is sick, put a rush on the ambulance."

Sadly, this happens in urban areas all over the country. the only reason it made the news today was because it involved a young child, and the City Councilman wanted a soundbite. So sad.

 

[Farmer2DO]

"She said a full hour passed before Rebecca arrived at Memorial Hermann Children's Hospital, where she was pronounced dead."

If that's anywhere near true, then this public safety system is failing their community. A trauma patient should not take an hour to reach a trauma center from within the city limits of a city with 2 pediatric level 1 and 2 adult level 1 trauma centers. That's abysmal, and horrendous patient care.

 

[McGoo]

Make sure to tell the trauma surgeon to stick to the basics like A, B, C, and not to use all of those fancy operating doohickeys.

In the first few moments after a major trauma, a person first needs A, B, and C. What are the first things that are checked when you bring in any unstable patient? Airway, breathing, and circulation. Yes, they still need all manner of procedures that are far beyond the pre-hospital scope, but without A, B, and C they are useless.

I don't think any of us have a problem sending the fire department at all. Just don't wait on an ambulance when a mother says "I ran over my child."

I was not advocating delaying the ambulance, I was advocating someone with medical skills being sent ASAP.

No, they need a surgeon to fix them, or they will die. We don't yet do surgery in the field, so it requires getting them somewhere where they can. Like a hospital. Which requires an ambulance.

Are you saying people dont need A, B, and C? If so, I would advise you to do some revision. Yes, an ambulance will convey them to hospital quickly, and it will get them to definitive care. I wasnt saying that we (Paramedic/EMT/whatever) can provide definitive care, I was saying we can provide them with life saving interventions that give them a chance at making it to definitive care.

Again, no. What EMS of any level can TRY to do is keep the patient viable until they arrive somewhere where definitive care can be given. We are rarely definitive care.

See above.

How about sending someone who can actually get the patient to DEFINITIVE CARE? A fire truck ain't gonna do jack squat for a trauma patient. Period.

Actually, a fire truck will do more than jack squat, if it has a trained medical person on board with appropriate equipment. It may not be able to convey a patient (at least not in the same way or with the same care) an ambulance can, but in those first few minutes treatment can be started-an airway can be obtained (hopefully), ventilations can be given, major bleeding can be stopped or slowed. These are the important things in a major trauma. What is the point of doing a 12 lead or other advanced protocol on someone who has already bled out?

No, he's not.

Yes, he is. A trauma surgeon can and will only bother doing a procedure if the basics are taken care of. Unless, of course, the procedure is to correct the basics-Im thinking thoracotomy etc.

 

[Martyn]

Sorry but this just reinforces my view that fire trucks should stick to fire and ambulances should, well, ambul

 

[Farmer2DO]

And am I missing somthing? I used Google Maps to try and figure out where the trauma centers in Houston were in comparison to the incident. It appears that the only trauma centers in Houston (all 4 are level Is, 2 are peds and 2 are adult), are all in a 2 mile loop, and all almost touching each other. No place else in Houston or the surrounding suburbs is a level I or II. So much for your trauma system being geographically accessible.....

 

[Farmer2DO]

I don't see a major problem with sending FD first.

I do. Send the FD if you want to, but send the ambulance at the same time. In this article, people are clearly saying there was a delay in starting a transport ambulance. Make all the arguments you want, but delaying an ambulance is just delaying getting the patient to the care they need. Again, I have no problem delaying ambulance responses to low priority jobs. This was not even close to that. That idiot city councilman was trying to justify why they didn't send an ambulance while that woman's four year old daughter was lying in the driveway, dying.

 

[McGoo]

I do. Send the FD if you want to, but send the ambulance at the same time. In this article, people are clearly saying there was a delay in starting a transport ambulance. Make all the arguments you want, but delaying an ambulance is just delaying getting the patient to the care they need. Again, I have no problem delaying ambulance responses to low priority jobs. This was not even close to that. That idiot city councilman was trying to justify why they didn't send an ambulance while that woman's four year old daughter was lying in the driveway, dying.

Ok, maybe I need to clarify my statement. I have no problem with the FD arriving first. In a major emergency, yes, absoloutely send an ambulance at the same time. But to not send FD at all, when they may be closer, would be a mistake. Without knowing the details of the case in question, we cant say if the ambulance was withheld or not, I dont think it should have been. But it is entirely possible that the FD was half the distance from the job that the ambulance was. Also, sending FD to non-urgent calls is good to alleviate the load on an ambulance crew, but if they are not emergency calls, (Im thinking gout, cellulitis, decreased mobility, etc), then the ambulance is the only crew who can do anything, and that is take them to hospital. (Unless, of course, you are lucky to have a paramedic practitioner handy.) In this instance, sending the FD looks great on a response time list, but does nothing for patient care.

 

[tssemt2010]

let me start by saying i have quite a few friends that work for HFD, HFD runs both BLS and ALS ambulances, if its an ALS call chances are a BLS ambulance and a squad with 2 paramedics on it will get sent if a medic unit is not available, the reason for BLS ambulances in houston is because there is a large amount of BS calls in houston, hence the reason they typically send an engine or ladder before calling for an ambulance BUT this does not mean its right, if its a BS call you can always obtain a refusal if they dont want to go and go back in service somewhat quickly, instances like this there shouldve been a medic and engine or an engine, ambulance and a squad dispatched

 

[fast65]

Yet again your bringing advanced medical education to the table.

You have to look at the simplicity of medical education brought to the table in both, don't shoot me but I'm gonna say it, basic and advanced EMS education.

I don't see how you were comparing and contrasting but then again I'm just a stupid EMT-I/Medic Student

In this case I think he's just trying to say that in EMS we shouldn't be classifying our jobs as "basic" and "advanced". We tend to define ourselves in EMS based on what we can do, not on what we know. We shouldn't be placing our interventions in "basic" or "advanced" categories, we should be focusing on when they should and shouldn't be used, and when to use which one first.

Let me use airway management as an example. I see so many paramedics that intubate a patient that would could have been managed with a BVM and use the excuse "I'm a paramedic, it's what I do". That's not the way we should be looking at things, we need to know when and more importantly when NOT to use an intervention. I don't know if I really illustrated what I wanted to say, but I'm digressing from the OP anyways.

As for the original topic, it's a terrible tragedy that may or may not have been avoided by getting the child to the hospital first. I don't see a problem with a system where FD gets dispatched first to "non-emergent" calls and then requests an ambulance after doing their assessment. However, I think the problem lies in how dispatch is classifying "emergent" and "non-emergent" calls. In this case, I think bad parenting is to blame, I don't care if I'm sounding like a jackass, but I would imagine that a responsible parent would know where her child was before backing out of the driveway. But I'm not a parent, so what do I know...

 

[STXmedic]

if its a BS call you can always obtain a refusal if they dont want to go and go back in service somewhat quickly

LOL!! No. Not at all the case. Without the BLS units in Houston, they'd even more regularly run out of ALS units. I also have several friends at HFD, and even with the BLS, the ALS is regularly ran into the ground. Do not count on a refusal for at least 75% of BS runs. (no, I have no statistics, just pulled that number out of my a$$).

In regards to the dispatching of BLS units, the dispatchers DO have the ability to override the computer, but I can just about guarantee that even the computer would have sent an ALS unit (which even the story didn't say anything about it being a BLS unit that responded).

 

[NomadicMedic]

With any kind of PMD system, I simply can't believe that this is the case. Are we getting all of the facts? Was there a paramedic unit even available? Was there a BLS ambulance available? Where there paramedics on that firetruck? Was the call triaged correctly at dispatch? Did the dispatcher ask all the correct PMD questions? Did the caller articulate the urgency enough?

There are too many questions, and not enough information to make a judgment about this before we hear 911 tapes and hear from all the parties involved. And the debate over whether to send a firetruck or an ambulance is irrelevant at this point. The key is a paramedic and the transport unit. It doesn't matter if the paramedic arrives on a firetruck, helicopter or horse and carriage, he needs to get there and then the patient needs to be transported to a trauma center.

Apparently this system fell apart somewhere, and my guess will be a deficiency in the PMD.

 

[Farmer2DO]

In this case, I think bad parenting is to blame, I don't care if I'm sounding like a jackass, but I would imagine that a responsible parent would know where her child was before backing out of the driveway. But I'm not a parent, so what do I know...

You're right. What DO you know about parenting? Precious little, apparently. I'm curious where you get off saying that bad parenting is to blame.

Kids are unpredictable, and sometimes, despite the most vigilant parents, kids get somewhere they're not supposed to be. I would imagine this mother is just completely torn up, and second guessing herself as it is. You coming in here and throwing your opinion around that this is the parent's fault is ignorant and insulting. As a parent I do everything in my power to keep my children safe, and there have been several near misses, and there was nothing I was doing wrong. By the grace of God, they haven't been seriously hurt.

Do us a favor and keep your self righteous, obnoxious opinions to yourself.

 

[fast65]

Umm, it was my opinion, and I am in no way expecting you too agree with it. In my opinion she Should have been keeping a better eye on her child, if you think she was doing a good enough job of that, then that's your opinion. I would appreciate it if you would hold off on judging my opinion as "self-righteous and obnoxious" when it wasn't presented in such a manner; doing so makes you the ignorant one. I have every right to present my opinion and I won't do you "all" a favor by keeping it to myself, because believe it or not, there are people who agree with me.


Sent from my iPhone using Tapatalk

 

[Farmer2DO]

Fine. You have your opinion, I have mine. I'm still offended as a parent.

Go have a handful of kids and raise them without any of them ever getting hurt, then we'll talk.

 

[fast65]

Fine. You have your opinion, I have mine. I'm still offended as a parent.

Go have a handful of kids and raise them without any of them ever getting hurt, then we'll talk.

As a non-parent, I expected as much.

Nope, I'll pass on having a handful of kids, but I can guarantee that if I did, I could make it through their lives without killing any of them.

 

[abckidsmom]

As a non-parent, I expected as much.

Nope, I'll pass on having a handful of kids, but I can guarantee that if I did, I could make it through their lives without killing any of them.

Please make sure you use birth control. This year alone, I can think of three episodes where my kids did not die through the grace of God alone. Going through life being able to control it is exhausting, and impossible.

Could you stop your kid from getting kicked in the chest by a horse? Choking on a hot dog? Falling out of a tree?

Life is really dangerous. 100% fatal, in the end.

 

[fast65]

Please make sure you use birth control. This year alone, I can think of three episodes where my kids did not die through the grace of God alone. Going through life being able to control it is exhausting, and impossible.

Could you stop your kid from getting kicked in the chest by a horse? Choking on a hot dog? Falling out of a tree?

Life is really dangerous. 100% fatal, in the end.

Ok, I apologize, I'll rephrase that as saying that I could get through without killing one of them MYSELF.

While I don't expect you to agree with my opinion, I would at least hope you would not insult me by asking me to use birth control, implying that I'm not responsible enough to raise children. If that's not what you're implying, then feel free to disregard. Thanks.