Ped major trauma - Houston FD delayed EMS response?

[CAOX3]

If I call 911 assume its an emergency and send an ambulance, sorry it isn't my fault your in financial disarray and attempting to save a nickel and dime because you cant balance a budget I pay me taxes.

So send the ambulance or I'll see you in court.

An the F'n outcome is irreverent, if you run over your kid assume that they will need transportation to a hospital I'm not driving a big wheel.

What a bunch of dipsh!ts.

 

[McGoo]

Just in case this thread isnt far enough off topic, I thought I would raise the following:

For all those who are saying more ambulances and more crews, (Im not disagreeing here whatsoever), Im curious as to how these should be paid for? From an outsider's point of view, your economy is not doing the best, cash isnt falling out of trees, etc, yet putting more vehicles on isnt a cheap thing to do. Also, say the city/whoever does put on more trucks-what would you give up to pay for them? Would you raise taxes? Charge more? Pay less somewhere else? If so, where?

Like I said, Im not at all against more ambulances on road (if they are needed), but just curious as to what people would be willing to sacrifice to make it happen.

 

[usalsfyre]

How about we start by reassigning some of the 3000+ firefighters in Houston to ambulances instead of firetrucks...

 

[Handsome Robb]

How about we start by reassigning some of the 3000+ firefighters in Houston to ambulances instead of firetrucks...

Beat me to it.
Ambulance ~$150k Engine ~$500-750k ladder ~$1 million +

 

[Shishkabob]

Just in case this thread isnt far enough off topic, I thought I would raise the following:

For all those who are saying more ambulances and more crews, (Im not disagreeing here whatsoever), Im curious as to how these should be paid for?

Because it makes sense to staff vehicles that are used less often?

 

[McGoo]

I agree that we probably don't know all of the details.

But to argue that it's OK to wait until you get on scene to decide if you need an ambulance, and that it's good patient care to sit there in the meantime and start IVs is just plain wrong. IVs get started while enroute to the hospital. Starting an IV is a low priority unless the patient is peri-arrest. Getting an IV will not save a life, and doing it on scene is delaying care. There is some research out there that is saying that trauma patients that get intubated and/or have fluid challeneges in the field have higher mortality rates.

So much for treating reversible causes.

:huh:

IV's dont save lives, yet you go on to mention reversible causes? From what you wrot, you seem to be saying if you had a BLS crew who could start an IV, but were waiting for an ALS van for transport, you wouldnt want the BLS crew to start an IV. If my summation is correct, I am absolutely stumped as to your reasoning. Hypotension in trauma is a major cause of death, and some fluids can help massively.

As for patients who get treated with ALS skills on scene having a higher mortality, if they are the same ones I have seen those studies didnt have much detail on patient injuries, and likely survivability of injuries sustained. Not a conclusive finding IMHO.

 

[usalsfyre]

Crystaloids DON'T help hypotension in uncontrolled hemorrhage. In fact, large volumes of crystaloids worsen the situation.

An example of a reversible cause would be tension pneumothorax.

 

[JPINFV]

Don't crystaloids help hypotension at the expense of oxygen carrying capacity?

 

[usalsfyre]

Don't crystaloids help hypotension at the expense of oxygen carrying capacity?

Yes...but I didn't feel like writing a book on TappaTalk about washout of hemoglobin and clotting factors, the coagulopathy caused by hypothermia and acidosis, ect.

 

[Farmer2DO]

IV's dont save lives, yet you go on to mention reversible causes?

What I said was that delaying transport, or justifying the delay of an ambulance so that you can do stuff like start an IV and board and collar (which doesn't take me 5 minutes) is bad medicine.

From what you wrot, you seem to be saying if you had a BLS crew who could start an IV,

BLS crews don't start IVs. ALS crews do.

but were waiting for an ALS van for transport,

Is the BLS crew an ambulance or first response? If they are first response, then they are a crappy substitute for an ambulance. If they are an ambulance, then load the patient up and head for the hospital. Meet the ALS enroute.

you wouldnt want the BLS crew to start an IV. If my summation is correct, I am absolutely stumped as to your reasoning. Hypotension in trauma is a major cause of death, and some fluids can help massively.

As usalsfyre said, large volumes of fluid to a bleeding patient will likely make the situation worse. Google "permissive hypotension".

As for patients who get treated with ALS skills on scene having a higher mortality, if they are the same ones I have seen those studies didnt have much detail on patient injuries, and likely survivability of injuries sustained. Not a conclusive finding IMHO.

I didn't say they were conclusive. But we know that turning the patient's blood to kool-aid doesn't help, and we know that delaying the patient's arrival to a surgeon so that we can play and feel important doesn't help. Sure, the studies may have more factors, like maybe these patients were sicker from the start, and thus were destined for a poorer outcome. That still doesn't mean that delaying the arrival of an ambulance for ANY level of a first response to decide if an ambulance is needed is good patient care. It's not. It's horrible, irresponsible, I would say unethical patient care being provided courtesy of the city of Houston, Texas. Maybe the way the call was run from the time 911 was called had a negative impact; maybe it didn't. It certainly didn't help that 4 year old, innocent girl any.

I truly hope the family sues the city, so that someone comes to their senses and realizes this policy will just cause more death, and thus, more money to the city, and changes it to something more reasonable.

 

[rmabrey]

That's the thing though. We don't know if an ambulance was held or not. The family ASSUMED that one was held because of the response time, but the fire department did not confirm this and I doubt that was the case. EMD would have absolutely dispatched an ambulance with that.

I agree, Car vs pedestrian per EMD would be automatic ambulance response. Most systems it may be unheard of, but the system I work in 8 minute response would be believable, given how busy we are, and we are dispatched ~90 seconds after fire