I think it's time to clarify what I meant, again. There have never been protocols written, nor will there ever be protocols written to satisfy me. You can write a trillion pages of protocols, and I guarantee it won't be enough to prepare me for any situation I might encounter. Thus, we have to be willing to think outside our protocols and even deviate from them. If not, there will come a time when an ems provider lets someone die because a nationally recognized, easy treatment--well within their scope--isn't performed simply because it wasn't in their protocols. Earlier in this thread, I outlined a very easy to understand example involving a tk and a 40 min entrapment that highlights this point perfectly. This is basic, basic, stuff guys. The world is not black and white. Protocols at their best, are guidelines. During the Apollo 13 incident, they used protocols to fly the rocket. When an unexpected error occurred, the protocols went right out the window (figure of speech). If they had continued following protocols at that point, those three men would have died. They had to get together and do some critical thinking. They had to find a way to make a CO2 filter out of extra crap they found lying around. On the spot, they had to calculate how to use the lunar module rocket to propel the men around the moon and back to earth (something it wasn't designed to do). They had done very extensive research and had thousands of protocols. But to save the men, they were forced to deviate from those protocols. Basic, basic stuff guys.
Radial Artery Bleed
- Thread starter Shabo
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I think it's time to clarify what I meant, again. There have never been protocols written, nor will there ever be protocols written to satisfy me. You can write a trillion pages of protocols, and I guarantee it won't be enough to prepare me for any situation I might encounter. Thus, we have to be willing to think outside our protocols and even deviate from them. If not, there will come a time when an ems provider lets someone die because a nationally recognized, easy treatment--well within their scope--isn't performed simply because it wasn't in their protocols. Earlier in this thread, I outlined a very easy to understand example involving a tk and a 40 min entrapment that highlights this point perfectly. This is basic, basic, stuff guys. The world is not black and white. Protocols at their best, are guidelines. During the Apollo 13 incident, they used protocols to fly the rocket. When an unexpected error occurred, the protocols went right out the window (figure of speech). If they had continued following protocols at that point, those three men would have died. They had to get together and do some critical thinking. They had to find a way to make a CO2 filter out of extra crap they found lying around. On the spot, they had to calculate how to use the lunar module rocket to propel the men around the moon and back to earth (something it wasn't designed to do). They had done very extensive research and had thousands of protocols. But to save the men, they were forced to deviate from those protocols. Basic, basic stuff guys.
I hope I never become apathetic in my career, and I hope my co-workers are caring individuals that care about the patients. Once I am more experienced, I will be more active in improving protocols and EMS in general.
Back to the thread topic - Was the guy really trying to kill himself? Most people attempting suicide would do it right on the wrist and not in the middle of the forearm. I haven't got to trauma yet in my class, so how should you deal with this situation? Direct pressure? arterial pressure?
Back to the thread topic - Was the guy really trying to kill himself? Most people attempting suicide would do it right on the wrist and not in the middle of the forearm. I haven't got to trauma yet in my class, so how should you deal with this situation? Direct pressure? arterial pressure?
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Direct pressure, elevation, pressure point.
No, He wasn't trying to kill himself. It appears as though he slipped and cut/stabbed himself while making something to eat. He mostly bled out before BLS arrived, but they couldn't stop the bleeding either. I'm guessing that he was probably taking some kind of med that kept his blood from clotting (or he had hemophilia). Either way we were all shocked at how small of a wound killed this guy.
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Ok... Guardian, I see your point, and Rid's too... Protocols can cover a lot... but they CAN'T cover everything... I like Rid's idea that sometimes we have too many protocols... on the same token, we shouldn't always have to call command for "simple" things... like 2mg of MS for Chest Pain...
I think the big thing we are all saying is that there are times we have to say "This protocol dosen't work" and call command... I think that is absolutly correct.
As for apathetic basics... I think Guardian and Recylced Words both make good points. I, for example, tried and failed to complete medic school... I'm not a medic... but I can be an asset on a scene... and often end up letting some eager new EMT do compressions on a code, while I stand back and help the single-provider medic (spiking bags, prepping meds, etc) I have one medic I occasionally work events with at the part-time job... we did the Auto Show this year... at one point... I was working up a weakness patient... and came to the conclusion that it was an ALS call... I looked at him, I said it's ALS... he looks at me "you know how to hook up the monitor"... he was catching up on other paperwork when the Pt. walked in to our office... I did most of the workup... he just listened and got handed the strips by me...
I strive to be a caring, compassionate provider (I sometimes fail - espicially with system abusers) but I do my best to make sure every pt. gets the care they expect when they call 911...
I think the big thing we are all saying is that there are times we have to say "This protocol dosen't work" and call command... I think that is absolutly correct.
As for apathetic basics... I think Guardian and Recylced Words both make good points. I, for example, tried and failed to complete medic school... I'm not a medic... but I can be an asset on a scene... and often end up letting some eager new EMT do compressions on a code, while I stand back and help the single-provider medic (spiking bags, prepping meds, etc) I have one medic I occasionally work events with at the part-time job... we did the Auto Show this year... at one point... I was working up a weakness patient... and came to the conclusion that it was an ALS call... I looked at him, I said it's ALS... he looks at me "you know how to hook up the monitor"... he was catching up on other paperwork when the Pt. walked in to our office... I did most of the workup... he just listened and got handed the strips by me...
I strive to be a caring, compassionate provider (I sometimes fail - espicially with system abusers) but I do my best to make sure every pt. gets the care they expect when they call 911...
BossyCow
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The bloodsucking lawyers wouldn't have a chance if the insurance companies who collect money from both sides of every conflict didn't pay off those large settlements. Think about it.... the hospital has liability insurance to cover their liability for when a patient sues them. The patient carries health insurance to cover the rising cost of healthcare that results from the increased cost the hospital has paying its liability insurance. The materials providers and pharmaceutical companies all have huge liability policies to cover their butts in case of suit. Now.. my insurance company insists that if you are hurt on a location, not your home, they want the name of the insurance company of the location where you were injured so they can recover some of their 'losses'. The local hospital is now collecting that information routinely on all accident cases. And who is it who pays off all those settlements that make the legal profession so interested in filing suit? The insurance companies do. So, they make a few huge settlements a year showing all the other suckers the importance of having insurance in case they get sued! Don't talk to me about lawyers..... kill the insurance companies!
Medic's Wife
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Here's what struck me as I was reading that:
Where is the contingency plan? That whole 5 minutes from a hospital plan only holds true if all the "normal" conditions are in place. I would think that in NYC of all places (after the first WTC bombings, and the 9/11 attacks) there would be a strong understanding of the fact that $hit happens. If there ever was a situation that was of a grand enough scale that would get in the way of a 5 minute transfer, lives could possibly be lost because they are turning out a whole generation of EMS personnel that would be ill equipped to deal with that scenario. I personally would feel much more comfortable with a medic taking care of me that could keep me for several hours, if need be, not just 5 minutes!
*ducking for cover now*
Medic's Wife
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And I'm sure you and other experienced folks could do just fine, but what about the brand new guys that never learned the protocals that they're doing away with?
I was trained with the knowledge that even though tourniquets are not part of NYC protocol, that we need to know how to properly use them either way.
I don't understand the difference between my scenario and hers. Both are dealing with saving life/lives. Why the different answer?
She was talking about an unexpected occurrence that could result in human loss if protocols were followed. I was talking about the exact same thing. A mva with the only injury being an uncontrollable arterial bleed and 40 min entrapment in not run of the mill.
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no, it just bothers me that you change you answer in the exact same type of situation like you just did here.
wendyloo
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Hi Shabo,
it took a 33 year old man, 15 to 30 minutes to bleed out, the patient was conscious when found, but died shortly after, despite CPR. He was in a psychiatric hospital and had been checked on half an hour before. the incident.
COmedic17
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This thread is 9 years old.
Gurby
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This thread is such a trip. It was against protocol to use a tourniquet in NYC in 2007? Are you ****ing kidding me?
akflightmedic
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Holy toledo! I think this is the greatest save to date!!! Has anyone beat 9 years yet? We had a few close ones but I think this is the one!!