Should we have done something different for this trauma call?

chickj0434

Forum Lieutenant
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So went to an mva. Pt was in her 40s unresponsive with agonal breathing. When we go on scene she was already pulled out of vehicle on ground. Engine crew was bagging pt when we got there. Transferred her to backboard while maintaining c spine and put her in back of ambulance. Immediately suctioned pts airway and inserted npa as pt still had gag reflex. Continued to bag pt. Pt had decent size laceration on her chin with moderate bleeding. Applied pressure. We did not collar pt due to this injury but tried to hold c spine best we could. Pt had elbow bone protruding through skin. Wrapped and secured that injury. Did full trauma assessment on body. Pupils we're all over the place def had a head injury possibly bleed as well. Als could not meet up with us and our local trauma hospital is 5 min away. Pt had strong radial pulse, with the lac it was hard to get a carotid pulse. Pulse ox read 100 sp02 and hr in the 90s. Partner could not obtain a bp. Mainly we continued to suction and bag pt during transport. Anything we should of done differently? Always overthink after calls thinking I should of done something different. Medflight met at hospital one of the guys thought she may have flatlined after we brought her in about 5 min later. Back at the station one of our guys asked if we applied the aed in case she did. Was that something we should have done? Always hear mixed opinions on aed and trauma pts
 

FiremanMike

Just a dude
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Trauma patients who arrest don’t typically go into a shockable rhythm, so I wouldn’t sweat that. Everything you posted sounds like good decision making
 

DrParasite

The fire extinguisher is not just for show
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AED application? no. it's one more thing to get in the way. wires and such, pads.

Traumatic arrest AED? sure, but keep in mind it's rarely a shockable rhythm.

Did you take them to the trauma center in no worse care than you found then? good job then.

This person needed bright lights and cold steel. manage any life threats (like you did) and take them to the hospital (like you did).
 

E tank

Caution: Paralyzing Agent
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Back at the station one of our guys asked if we applied the aed in case she did. Was that something we should have done? Always hear mixed opinions on aed and trauma pts
they can just get in the way of left sided chest tubes.
 

IsraelEMS

Forum Crew Member
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You did great. I agree with everyone else that the AED would not be helpful. Does your protocol allow for you to give iv's in trauma pts?
 

johnrsemt

Forum Deputy Chief
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Since you are posting on a BLS site I would guess no on the IV, sounds like you did everything right.
 

DrParasite

The fire extinguisher is not just for show
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Why on earth would you not want bls to take blood sugar?!
because of stupid legislation and a belief that while a civilian can be taught how to do it, a trained provider can't, as it is considered invasive in some states.
 

E tank

Caution: Paralyzing Agent
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Why on earth would you not want bls to take blood sugar?!
Creates a duty to act, which introduces risk of malpractice which administrators at various levels are advised by legal counsel to avoid. Tort law is a thing in the United States and is one of the disadvantages of a non-socialized/nationalized system of health care delivery. I'm not advocating for a nationalized delivery system as has been envisioned and proposed so far by those who could authorize it, just answering the question.
 

E tank

Caution: Paralyzing Agent
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Hard to conceptualize for folks that work in national systems about the size of the smallest US states. You can't really judge the US as a whole when, while a single, united entity, it covers one of the largest land masses on the planet. If you must compare, you have to find similar population densities, land mass and geography apples to apples. Those similarities may cross state borders to muddy the waters even more. Easy to be critical of US EMS delivery when looking at it from across the world, but it isn't so clear cut when you take a closer look.
 

IsraelEMS

Forum Crew Member
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I was referring more to dr. Parasites comment. I am well aware of how litigious the US is how lucky I am to be protected from such litigation.

As it happens I agree that our system would not work on the scale of most US states.
 

HardKnocks

Forum Crew Member
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You did great. I agree with everyone else that the AED would not be helpful. Does your protocol allow for you to give iv's in trauma pts?
Arizona has been very proactive in expanding the Scope of Practice for EMT-B (Basic). They have a list of proceedures and medications that require add-on "STR" Training. This is where your Medical Director will provide additional training and authorize additional skill, as its an advanced skill not taught in the EMT-B curriculum and usually reserved for the EMT-P Scope of Practice, (i.e. Paramedic).

There have been several STR Skills added in AZ. in the last 12 months. They have added IV access and basic IV Fluid administration(Unmedicated) to the STR list for EMT-Bs.

Here are the updated STR skills for both basic and Paramedic, (note: EMT-I(99) were previously licensed in AZ. but have been phased out due the expanded scope of practice and the addition of STR Skills for EMT-B).

AZ EMT-B/P Scope of Practice Skills

Updated Medical Director Protocols Aug 2021

I refuse to practice in over-regulated States that keep EMT-Bs restricted in their Scope of Practice.

Some States don't realize that the U.S. Military have Medics out doing the field work at a level far greater than some States EMT-Ps. Arizona is one State that recognizes this and has expanding the advanced training and STR Skills for EMT-Bs.

Maybe one day we'll have a National Standard in the U.S. and eliminate all the Fiefdom Infighting.
 
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