Ped major trauma - Houston FD delayed EMS response?

[usalsfyre]

I just spoke to a good friend that now works for HFD. He said the councilman is actually correct concerning dispatch policy. However it has been this way for quite a while. Fire is dispatched behind HPD and a decision for ambulance transport is made upon arrival unless fire is on another call then either a medic unit or ambulance will respond.

That's taking using EMS to prop up run volumes to a new low...

 

[Farmer2DO]

That's taking using EMS to prop up run volumes to a new low...

This ^^^

You said more simply the point that I was trying to get across.

 

[crazycajun]

That's taking using EMS to prop up run volumes to a new low...

Agreed. This is why EMS and Fire need to be separate.

 

[usalsfyre]

I wonder if they're providing the equivalent of an EMTALA screening exam as required by law of EDs...

 

[abckidsmom]

I wonder if they're providing the equivalent of an EMTALA screening exam as required by law of EDs...

I'd like to know what percentage of patients are found to need an ambulance. And how it's more cost effective to have a half million dollar engine with a crew of 4 to go out and screen patients for the ambulance. Sigh.

 

[Handsome Robb]

I will say FD can be very helpful on scene for extra hands. They also are usually on scene prior to our arrival unless it's some ungodly hour of the night like I explained before. I have noticed lately that the use for the extra hands of Fire on scene in my area has diminished due to the fact that nearly every single one of our units has a 3rd onboard between EMT students, Paramedic Interns and EMTs in their FTO period.

There's nothing wrong with fire responding except for the financial side of it, like other people as well as myself have voiced it's playing with fire to only dispatch an engine/truck/squad to a "non life-threatening emergency" then have them request an ambulance. Farmer2DO made the point that many high priority dispatched calls end up as BLS whereas many low priority calls end up as ALS. In my limited experience many of our rippin' STEMIs are dispatched as "Priority 3, sick person" calls andd they are super apologetic about calling. Then they end up being the patient that has a time-sensitive condition.

 

[bigbaldguy]

Speaking from experience I once called FD for a man down unknown cause and a BLS ambulance showed. A few months later I called when I found my neighbor dead. Call went out as full arrest CPR in progress and they sent a fire truck. HFD is not a well run organization.

 

[Sasha]

Speaking from experience I once called FD for a man down unknown cause and a BLS ambulance showed. A few months later I called when I found my neighbor dead. Call went out as full arrest CPR in progress and they sent a fire truck. HFD is not a well run organization.

Still it didn't cause her death...

Trauma codes die. They don't come back. If the ambulance had been there in 8 seconds or 8 minutes she probably would've died.

/end thread.

 

[Farmer2DO]

Still it didn't cause her death...

Trauma codes die. They don't come back. If the ambulance had been there in 8 seconds or 8 minutes she probably would've died.

/end thread.

You've got to be kidding me. By that logic, we shouldn't work ANY trauma codes. "I'm sorry mam, but the liklihood that your daughter is going to live is slim to none, so we're just going to call her dead right here. Oh, and it's your fault."

So much for treating reversible causes.

Oh, and by the way, nowhere in the article did it say she arrested in the field. You have no idea what caused her death; you saying that is pure guessing. She may have arrested just prior to arriving at the hospital, and may have had a chance if she had arrived at the trauma center 15 minutes after the accident rather than 60 minutes after.

 

[exodus]

How you read what?

It sounded like she was saying you shouldn't reproduce. Dead horse now though.

 

[fast65]

It sounded like she was saying you shouldn't reproduce. Dead horse now though.

Oh, gotcha. Yup yup, dead horse.


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[Shishkabob]

You've got to be kidding me. By that logic, we shouldn't work ANY trauma codes. "I'm sorry mam, but the liklihood that your daughter is going to live is slim to none, so we're just going to call her dead right here. Oh, and it's your fault."

We do that for blunt traumas already.


Penetrating trauma codes are a different beast entirely.

 

[JPINFV]

 

[Sasha]

You've got to be kidding me. By that logic, we shouldn't work ANY trauma codes. "I'm sorry mam, but the liklihood that your daughter is going to live is slim to none, so we're just going to call her dead right here. Oh, and it's your fault."

So much for treating reversible causes.

Oh, and by the way, nowhere in the article did it say she arrested in the field. You have no idea what caused her death; you saying that is pure guessing. She may have arrested just prior to arriving at the hospital, and may have had a chance if she had arrived at the trauma center 15 minutes after the accident rather than 60 minutes after.

It said she arrived dead at the hospital.

That tells me she arrested prior to the hospital.

And what exactly is reversible about trauma in the field?

The ambulance arrived 8 minutes and some change after the initial 911 call. I doubt their dispatching caused them to arrive an hour after as oppose to 15.

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[Farmer2DO]

It said she arrived dead at the hospital.

No, it doesn't say that.

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

That tells me she arrested prior to the hospital.

Nope, it doesn't say that either. It says that's where she was pronounced dead. We have no idea when she arrested and how long they resuscitated her.

And what exactly is reversible about trauma in the field?

How about tension pneumothorax and pericardial tamponade?

The ambulance arrived 8 minutes and some change after the initial 911 call.

We don't know that.

But it was not clear how much time passed between when the 911 call was received and the decision was made to send the units.

The ambulance arrived 9 minutes and 19 seconds after the call was dispatched, not after the 911 call was made. (I'm not sure who did the math in the article. 4 minutes 47 seconds + 4 minutes 32 seconds = 9 minutes 19 seconds, not 8 and a half.)

I doubt their dispatching caused them to arrive an hour after as oppose to 15.

Again, we can't know how the time frame may have improved if an ambulance had been sent at the time of the 911 call.

until an ambulance finally arrived and called for an emergency medical helicopter.

But according to the article, the helicopter didn't get called until after the ambulance arrived. So much for first responders recognizing the acuity of the situation.

Precious time was wasted here, and the child died. Until a medical examiner (a physician) determines the cause of death (more specifically than just being run over) saying that she would have died anyway is very premature.

 

[fast65]

So much for first responders recognizing the acuity of the situation.

I certainly hope you're not surprised by that, I had a FF/EMT tell me that I should have let him know how critical the patient was...the patient had snoring respirations and decerebrate posturing. I don't count on any of our first responders to be able to determine the seriousness of a call.



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[Shishkabob]

Or the time I had a volly-FF come out to my truck on arrival of a cardiac arrest saying "He's cold, no point in going in", but I go in and take a feel for myself, and although the hands were cool, the neck, chest, head... pretty much everything but the hands, were still quite warm (like.. living warm)...

And he was shocked when I said we were working it.

 

[Farmer2DO]

I certainly hope you're not surprised by that

Surprised? Maybe not. But I do have a problem advocating for this position, like the next comment does.

My take on this, I have no problem with a fire truck being dispatched first to assess if an ambulance is needed. Let's stop pretending that every patient needs an ambulance.

As I stated, I have a huge problem with it, because in cases like this, it's wildly inappropriate.

I think its great they are trying to keep ambulances free by first sending someone to assess if its needed.

I think it stinks. They're using this instead of putting the number of ambulances on the road that are needed to handle the call volume. Yes, we have major problems with the system, and abusers, and people using us inappropriately. This is not the answer.

I don't count on any of our first responders to be able to determine the seriousness of a call.

I guess I'm lucky. The BLS FR agency I work with on a daily basis is pretty damn good, for the most part. If I need help during transport, I can count on someone being able to do good BLS to go with me. And they almost always flag the patients (if they get there first) that need my attention quickly.

 

[systemet]

Wow. I'm amazed at how this thread has veered all over the place since I posted the link. A couple of things:

* I can't believe this is the actual dispatch policy. Send an (ALS?) engine, then decide if transport is required. This can't be optimal for time-dependent conditions, unless the city has (i) a huge excess of BLS transport ambulances, and can afford to lose the engine medic to transport, (ii) a huge excess of ALS transport ambulances. In either case, it seems like sending a transport capable ambulance with the initial dispatch might be a better idea.

* Agree completely that first response is valuable, in a small minority of cases, if there's no nearby ambulance. I don't think it replaces dedicated EMS resources in an effective manner.

* AMPDS is terrible. Despite it's ability to over-triage homeless people sleeping in bus shelters into cardiac arrests, it misses the sick old people that probably make up the bulk of time-sensitive medical patients.

* Becoming a parent has changed my perspective on what good parenting is. In any accident it's important to judge the information available to the person and their thought process before making judgment about the outcome of the event.

* Not sure I understand the logic that delaying transport is ok, because the ALS engine can provide BLS, when they can't provide the cornerstone of BLS - patient transport.

Has anyone found more information about the event?

 

[Sasha]

No, it doesn't say that.





Nope, it doesn't say that either. It says that's where she was pronounced dead. We have no idea when she arrested and how long they resuscitated her.



How about tension pneumothorax and pericardial tamponade?



We don't know that.



The ambulance arrived 9 minutes and 19 seconds after the call was dispatched, not after the 911 call was made. (I'm not sure who did the math in the article. 4 minutes 47 seconds + 4 minutes 32 seconds = 9 minutes 19 seconds, not 8 and a half.)



Again, we can't know how the time frame may have improved if an ambulance had been sent at the time of the 911 call.



But according to the article, the helicopter didn't get called until after the ambulance arrived. So much for first responders recognizing the acuity of the situation.

Precious time was wasted here, and the child died. Until a medical examiner (a physician) determines the cause of death (more specifically than just being run over) saying that she would have died anyway is very premature.

I'm using this article. http://www.ems1.com/communications-...-family-questions-Houston-ambulance-response/

It says 8 minutes and some change after the call was dispatched, 4 minutes and some change after the ambulance was called for. Doesn't seem like the response was delayed all that much.

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