Them old medical director blues…

[NomadicMedic]

Last night I had a pretty significant trauma call. In short, a guy argued with the cops, they got into a tussle and he was tased and then shot by the officer several times. When I got there, he was handcuffed but still extremely combative and not really easy to manage. I have protocols for chemical sedation with midaz and/or Haldol. However, because he was a trauma patient I wanted to talk to the doc to make sure he was okay with me dropping a little versed on this guy to make him easier to manage and examine. My request for midaz orders was denied and I was told to give him some Fent to manage his pain.

Eh. Okay. Now, you should know that I don't sedate patients unless they need it. Either for their safety or my safety. Apparently I didn't make my point clear on the radio. That's okay. I get it, I practice under his license and if he says jump, I say how high.

However, after things calmed down in the trauma room and he went back to his desk, I approached him and said, "hey Doc do you have a minute?" He just said, "no I don't." Walked away, sat back down at his desk and proceeded to pointedly ignore me. He talked to the cops, the nurses, the other doc… But not me

If you don't like the orders I request, that's okay. You're the boss. I get that… But ignoring me and refusing to have a conversation with me is just ridiculous. I simply wanted to explain why I requested what I did and apologize for not making my position clearer on the radio. But apparently, that's not going to happen. I expect a QI review very soon. :/

Just needed to vent. I'll be over it soon … But right now, I'm a little POed.

 

[Wes]

Been there done that. OLMC just isn't always helpful. My best experiences were with services who wanted you to call their specific medical direction rather than a random doc at the receiving facility.

 

[NomadicMedic]

The whole thing was just a Charlie Foxtrot of poor communication. In addition, we've had a bit of an issue with HEMS showing up on scene and wanting to fly a very short distance to the local trauma center. (Although, our trauma protocol very specifically states if the ambulance ride is anticipated to take longer than 10 minutes, use the helicopter) I said to the doc on the radio, "the helicopter is grounded due to weather and we're coming by ground, to you." And he said in reply, on the radio, "why would you put him in a helicopter anyway, he's been shot in the abdomen…"

SMH. Right. I was saying that the helicopter is not a factor here. This is going to be a ground transport. All he heard was helicopter and abdominal gunshot wound and my sedation request and apparently he lost his mind.

 

[Carlos Danger]

Wow. Sounds like a CF of the highest order.

• First the cops are unable to subdue a guy with a tazer, then decide the situation warrants deadly force but after shooting him a couple times, decide that it no longer warrants deadly force. At which point he becomes your problem.
  
  
• Then it sounds like the doc-in-a-box got a little confused when you requested orders, partially by the existence of some ridiculous protocol that says that even if you are only a 15 minute drive from the hospital, you have to delay transport by waiting on scene for a helicopter. As well as some apparent thought that a patient with a GSW to the abdomen shouldn't be flown?
  
  
• Lastly, when you tried to talk to the doc about it, he avoided you because he knew he screwed up and didn't want to hear it from you, even though he'd make you hear it from him, if you were the one who screwed up.

Sounds like a fun time. We've all had days like that, though.

Was this guy one of your medical directors, or just some doc at the receiving hospital?

Does HEMS self-dispatch and just show up on their own, or only when you request them? Having to use a helo when you are only ten minutes away sounds like about the most ridiculous utilization criteria I've ever heard. HEMS utilization should be based on how much time flying will save, taking into account the response time of the HEMS crew, how long they will spend on the ground, how long it will take them to transport, etc., and should be guided by physiologic criteria, rather than MOI, as well as whether the flight crew can do important interventions that ground can't. But I'm sure I'm preaching to the choir.

However, because he was a trauma patient I wanted to talk to the doc to make sure he was okay with me dropping a little versed on this guy to make him easier to manage and examine. My request for midaz orders was denied and I was told to give him some Fent to manage his pain.

Well I guess you learned your lesson about "making sure the docs is OK" with things, huh?

 

[NomadicMedic]

Indeed, I did learn that lesson. I guess it really is better to beg forgiveness than ask permission. And some clarification, he is "the" County medical director, and has my certification in his hand. So I do have to play nice.

Currently, we try to only fly isolated head injuries to a level one trauma center where there is neuro 24/7. However, there has been discussion of flying patients to the local level III for stabilization and then flying them onward to the level one. That's not my decision, that's above my pay grade. And a discussion for another time.

Our helicopter does not self dispatch, but they are added to calls per the PMD. For example, a motor vehicle accident with reported ejection. That gets a helicopter automatically. The ground medic usually makes the decision on whether or not the helicopter will be utilized. And nine out of 10 times the helicopter is a state police Bell 407 with no more advanced skills that I have. In fact, it's more difficult to do anything as flying in that helo is like trying to treat a patient in the back of a Volkswagen bug. Legroom? We don't need no stinking legroom. "Just hold the monitor on your lap"

At any rate, It's over, so… Learning experience, I guess