Ok, this is going to seem kind of silly, maybe, but an incident kind of inspired it....an incident I'm still kicking myself over, but anyways...
In my area, most Firefighters are also EMT-Bs or higher, but are non-transporting. I work for a private EMS service that does transport. In the more rural areas, Fire can often get on scene faster than us and they usually have an assessment of some kind already in progress by the time we get there.
In this incident, Fire said they had controlled a bleed prior to c-spining someone. I took it at face value since 4 of them were involved in the whole process. By the time we got on scene, they already had the PT rolled onto the board. We loaded and went. Did a rapid assessment en route, found nothing new of note. Turns out by the time we got to the hospital, after moving the PT off the stretcher still on the board, there was blood on the PT's posterior side, which dripped through parts of the board unseen by me (as they were covered by the PT). I can only think of two possibilities...either an undiscovered lac, or the bleeding *wasn't* controlled afterall (the head blocks on the board covered the gauze from the bleed), basically meaning I'd have had to compromise c-spine to have re-assessed it.
In any case- this bleed went undiscovered til arrival at the hospital, which made me look like a total idiot talking to the RN, because I had a legitimate "Where the heck did that come from?" look on my face. Luckily, the PT was stable the entire time, and that never changed.
Now, here's where my mental dilemma resides. I blame myself 110% for this. If I was more vigilant, I should have caught this bleed somehow. Perhaps I should have done a glove sweep anyways once I assumed PT care (I didn't think about it since I assumed the only bleed was controlled and wanted to catch whatever else might have been missed). Perhaps I should have risked the c-spine compromise to make sure the bleed really was controlled. In either case, I blame my failings on one key thing. I accepted the assessment of another at face value.
How do you go about telling another provider, or multiple providers (in this case, the 4 on scene prior to me), that you want to check the PT out yourself AFTER they've already told you "what's going on"? In this case, the majority of the work was already done by the time I even arrived. Should I have told them to take the PT off the board and let me start from scratch? Was this just one of those ugly situations where I couldn't really do much because of the position I was in?
I'm obviously still new at the EMS thing, but scenarios like this bother me because I feel as though I would have caught this problem where it was missed by the others.
This is kind of a long ramble. I apologize. I feel like I learned a valuable lesson, which compromised PT care, but did not know how to handle the situation any other way without blatently insulting a colleague's skills. Obviously, I documented the hell out of what happened in my run report. Longest narrative I think I ever wrote...
Anyways, opinions, if any of this makes sense?
In my area, most Firefighters are also EMT-Bs or higher, but are non-transporting. I work for a private EMS service that does transport. In the more rural areas, Fire can often get on scene faster than us and they usually have an assessment of some kind already in progress by the time we get there.
In this incident, Fire said they had controlled a bleed prior to c-spining someone. I took it at face value since 4 of them were involved in the whole process. By the time we got on scene, they already had the PT rolled onto the board. We loaded and went. Did a rapid assessment en route, found nothing new of note. Turns out by the time we got to the hospital, after moving the PT off the stretcher still on the board, there was blood on the PT's posterior side, which dripped through parts of the board unseen by me (as they were covered by the PT). I can only think of two possibilities...either an undiscovered lac, or the bleeding *wasn't* controlled afterall (the head blocks on the board covered the gauze from the bleed), basically meaning I'd have had to compromise c-spine to have re-assessed it.
In any case- this bleed went undiscovered til arrival at the hospital, which made me look like a total idiot talking to the RN, because I had a legitimate "Where the heck did that come from?" look on my face. Luckily, the PT was stable the entire time, and that never changed.
Now, here's where my mental dilemma resides. I blame myself 110% for this. If I was more vigilant, I should have caught this bleed somehow. Perhaps I should have done a glove sweep anyways once I assumed PT care (I didn't think about it since I assumed the only bleed was controlled and wanted to catch whatever else might have been missed). Perhaps I should have risked the c-spine compromise to make sure the bleed really was controlled. In either case, I blame my failings on one key thing. I accepted the assessment of another at face value.
How do you go about telling another provider, or multiple providers (in this case, the 4 on scene prior to me), that you want to check the PT out yourself AFTER they've already told you "what's going on"? In this case, the majority of the work was already done by the time I even arrived. Should I have told them to take the PT off the board and let me start from scratch? Was this just one of those ugly situations where I couldn't really do much because of the position I was in?
I'm obviously still new at the EMS thing, but scenarios like this bother me because I feel as though I would have caught this problem where it was missed by the others.
This is kind of a long ramble. I apologize. I feel like I learned a valuable lesson, which compromised PT care, but did not know how to handle the situation any other way without blatently insulting a colleague's skills. Obviously, I documented the hell out of what happened in my run report. Longest narrative I think I ever wrote...
Anyways, opinions, if any of this makes sense?
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