Trauma protocol question

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soybean55

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Hello everyone, Not sure if im posting this in the right spot but anyways I have a question for a class topic and was just seeing if i could get some insight or maybe personal experiences.

basically if ordered by medical control or a pt is indicated for a level 1 or level 2 trauma center i.e GCS<12 systolic below 90 according to state regs but the patient wants to go to a local hospital that is not a level 1 or level 2 are you allowed to follow med control or do you have to abide by the pt possibly preventing a positive outcome. What would you do and why?

thank you
 
Is a pt with a GCS of 12 able to give informed consent and make informed medical decisions for themselves?
 
cprted said:
Is a pt with a GCS of 12 able to give informed consent and make informed medical decisions for themselves?
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This. Altered = my decision for what hospital they get transported to.
 
very true thanks for the replies...but what about the cases where they are not altered and in my state the protocol states if traumatic injury is present with 90 or less systolic automatic level 1 or level 2 what about the pt that baseline at 90 or relatively close?
 
Inform the patient. Call the hospital and let the Doc know.
 
What are their injuries? Other physical findings? Mechanism? Vitals? Comorbidities?

Is there a difference between a pt with a pressure of 88/56 and HR of 70 and a pt with a pressure of 92/60 with a HR of 132?
 
soybean55 said:
basically if ordered by medical control or a pt is indicated for a level 1 or level 2 trauma center i.e GCS<12 systolic below 90 according to state regs but the patient wants to go to a local hospital that is not a level 1 or level 2 are you allowed to follow med control or do you have to abide by the pt possibly preventing a positive outcome. What would you do and why?
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soybean55 said:
in my state the protocol states if traumatic injury is present with 90 or less systolic automatic level 1 or level 2
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Do you follow protocol?

What you have a stroke patient who doesn't want to go to a stroke receiving center? What about a STEMI pt?
 
cprted said:
Is a pt with a GCS of 12 able to give informed consent and make informed medical decisions for themselves?
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Well, Stephen Hawking would be something like a GCS9.... and that's assuming you want to give him credit for his electronic voice.
 
JPINFV said:
Well, Stephen Hawking would be something like a GCS9.... and that's assuming you want to give him credit for his electronic voice.
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which is why this is important:
cprted said:
What are their injuries? Other physical findings? Mechanism? Vitals? Comorbidities?

Is there a difference between a pt with a pressure of 88/56 and HR of 70 and a pt with a pressure of 92/60 with a HR of 132?
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Someone with a chronic GCS of 9 before the TC is less likely to need the trauma center as the patient who was a GCS 15 before and is now a 9....
 
I think you'll find that anyone who really needs a trauma center or specialty facility generally won't fight you when you tell them where any why they are going. Only ever had one person that we needed to trauma activate who absolutely refused to be transported to the trauma center, saying he wanted to go to his HMO hospital or not go at all, threatening to just get up and go (with a flail chest, mind you). After going around in circles we hit up base and the doc just kind of sighed and said that any hospital was better than no hospital at all so we took him to his HMO.... Who then arranged for a code 3 transfer to the trauma center.
 
soybean55 said:
very true thanks for the replies...but what about the cases where they are not altered and in my state the protocol states if traumatic injury is present with 90 or less systolic automatic level 1 or level 2 what about the pt that baseline at 90 or relatively close?
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I would rather get yelled at for talking a patient to a more appropriate facility vs getting yelled at for bringing a decompensating patient to a place that cannot handle them. Just like in the hospital, If they are going to collapse as they walk out the door its better to hold them against their AMA then to let them walk out.
 
samiam said:
I would rather get yelled at for talking a patient to a more appropriate facility vs getting yelled at for bringing a decompensating patient to a place that cannot handle them. Just like in the hospital, If they are going to collapse as they walk out the door its better to hold them against their AMA then to let them walk out.
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...except it doesn't work that way in the hospital. I've AMAed one patient in a new 3rd degree heart block and I've respected the wishes of another patient who was refusing a blood transfusion despite a hemoglobin in the 4s.
 
samiam said:
I would rather get yelled at for talking a patient to a more appropriate facility vs getting yelled at for bringing a decompensating patient to a place that cannot handle them. Just like in the hospital, If they are going to collapse as they walk out the door its better to hold them against their AMA then to let them walk out.
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Holding patients who are legally and mentally capable of making their own Healthcare decisions is not going to end very well for you even if they are having a STEMI/Stroke/Trauma. I signed out a patient having an inferior STEMI during medic internship. I was on the phone and the patient was also on the phone with the doctor for a decent amount of time.
 
Patients can make poor choices if they have decuaion making capability and are adequately informed of the risks associated with their choices.

I wouldn't want to be the guy who takes a patient of sound mind to a hospital they adamantly refused. I bet we won't be able to bill that, and that's the least of our worries.
 
I was referring to someone who LITERALLY was going to collapse and die in the parking lot before he made it to his car. The legal and political backlash would be much worse then adamantly convincing him he needed to stay and that you would not take no for a answer. There could be a lawsuit either way and I would prefer to have one with an alive patient then with the family of a dead one. If you are gushing blood out of your femoral artery, you are not walking out the door until I can at the very least control the bleeding. If he can make it off the property and maybe even get home then I suppose that is on him. Maybe I was too strong with the word "force" I was intending "pull out every play in the book to convince them otherwise"

As far as the transfusion goes, that is a little bit different as it is on religious grounds.
 
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samiam said:
I was referring to someone who LITERALLY was going to collapse and die in the parking lot before he made it to his car. The legal and political backlash would be much worse then adamantly convincing him he needed to stay and that you would not take no for a answer. There could be a lawsuit either way and I would prefer to have one with an alive patient then with the family of a dead one. If you are gushing blood out of your femoral artery, you are not walking out the door until I can at the very least control the bleeding. If he can make it off the property and maybe even get home then I suppose that is on him. Maybe I was too strong with the word "force" I was intending "pull out every play in the book to convince them otherwise"

As far as the transfusion goes, that is a little bit different as it is on religious grounds.
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So you would willingly hold a patient against their will? Another example, you walk in and find a bleeding patient who is alert and refuses all of your care (assuming it's not an attempted suicide), are you really going to assult the patient because you know they need treatment?
 
DesertEMT66 said:
So you would willingly hold a patient against their will? Another example, you walk in and find a bleeding patient who is alert and refuses all of your care (assuming it's not an attempted suicide), are you really going to assult the patient because you know they need treatment?
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Again what I am getting at is a bit more of a extreme circumstance. I am not going to get 5 guys to tie the patient down but I am going to do everything I can with out directly assaulting the patient. If they are competent and stable to the effect that they can get up on their own and walk out the door and get in their car and drive away then ethically and legally they can go and I wont stop them. If they are hemorrhaging blood and crawling down the hallway leaving a trail of blood behind them then I am going to try to stop them. Could also just wait for them to pass out and there would be implied consent. Again it all comes down to circumstances. The decision would have to be made then and there. Patients have complete autonomy 100% but there can be circumstances where judgment calls need to be made in the best interest of the patient. To play devils advocate, a suicidal person could be completely competent and in their right mind. If we think they are going to hurt themselves we hold them against their will. They dont need to be having a psycotic break. Again I dont want to argue. Just presenting that from a LEGAL standpoint there are circumstances that you might be better off doing one thing over the other. Obviously as healthcare providers ethics has to play a roll as well but there is a balance. Not advising others what to do just presenting things that I have considered.
 
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