What would you do?

[MMiz]

You ATF 2 patients involved in MVC (MVA), sitting in car. 1 is backboarded and being transported as you arrive, you assist with another, taking 25 minutes.

You know there is another patient in the car, but cant see or hear him. Your supervisor and lead medic states the patient is deceased. The medic then states he called the pt. on scene, and begins transporting the other pt. to the hospital.

You are now the lead EMT on scene, working at a BLS level. PD approaches you and begs you to work the patient, stating they initially got a pulse.

What do you do?

 

[Chimpie]

You and the lead medic approach the vehicle and at the same time discuss what the police officer told you. When you arrive at the vehicle you doing a quick patient assessment (ABC, look over) and determine the status of the person. You notify your lead medic of your observations and let them make the call.

What you have done:
1) You have responded to the request of the police officer by checking the status of the person.
2) You have stayed within your guidelines by discussing the situation with your lead medic since he was the one who already called the patient.
3) You've morally done the right thing by not just walking away.

Chimp

 

[rescuecpt]

I'm not trying to put words or thoughts in anyone's mouths, but as I see it from what you wrote, I would assume that the lead medic was probably working in an MPI (multi patient incident <25pts, MCI > 25pts) frame of mind - when he/she arrived they had limited resources, three potential patients, and prioritized.

In classifying pts into IMMEDIATE, DELAYED, MINOR and DEAD/DYING categories, the criteria are (thanks to http://phoenix.gov/FIRE/triage2.pdf for the definitions):

IMMEDIATE patients are those who “RPM” is altered.

DELAYED patients who are unable to follow instructions to evacuate the scene, but who “RPM” is intact. Also includes patients who have a significant mechanism of injury, but whose “RPM is intact.

MINOR patients are those at large incidents who were able to leave the impact area on the instruction of EMS personnel. They are the “walking wounded” and should be tagged later.

The DEAD/DYING are those who cannot breath after the airway is opened and are mortally wounded. The patients will probably die despite the best resuscitation efforts.

It is often a difficult decision to leave a dying patient, especially if it is a child. But remember resources are often wasted here on unsalvageable victims.

So just by what you told me, it would seem to me as if in his mind the medic tagged the 3rd patient as DEAD/DYING and then the other two patients as IMMEDIATE. Once additional resources arrived (ie, you), the decision to work the DEAD/DYING patient could be changed, but similar to what Chimpie said, let the medic know your intentions. If the medic is leaving the scene with the other two patients, he really should have no objection to you and your crew trying to work the patient, especially if the first two patients are properly cared for and there are adequate resources to work the third.

 

[PArescueEMT]

Originally posted by MMiz@Sep 14 2004, 04:15 AM
You are now the lead EMT on scene, working at a BLS level.

I see you all forget this line.

I would notify the officer that the Pt. has been called by a higher level of care than I am. and they have acces to more equipment to confirm mortality than I have. Therefore, I respect their decision and don't feel it's appropriate to change it.

 

[MMiz]

Let me try to add additional information that I may have missed.

1. There are enough EMS resouces for the call, the patient could be worked as a full cardiac code without placing strain on EMS resources.

2. The patient was placed on a 3 lead prior to being called. I do not know the results of the 3 lead, but I can assume they were not good.

Once again, all patients have been evaluated by 3 lead EKG and by EMT-Paramedics. There would be no strain on EMS to continue to work this patient.

Again, this patient would have been worked BLS until an ALS unit arrived. Note that this patient was already evaluated by ALS and called on scene. ALS is now transporting their patient to the hospital, leaving BLS on scene to pick up odds and ends when the PD officer begins his demands.

Does that change anything?

 

[rescuecpt]

It all comes down to personal judgement. I obviously don't know whether the patient was salvageable or not... if the patient is dead (obvious, prolonged asystole, etc) then I wouldn't want to start anything. If the patient was still hanging on, and there was a chance of saving them now that adequate resources arrived, I would ask the medic if I could start interventions. But if the guy is dead, then there's no point in starting and wasting the time, effort, energy, and supplies involved.

 

[MMiz]

rescuelt,

I think your last post was great, and is how I have come to look at the situation.

One day I'll have an "lt" at end of my forum name. One day.

 

[PArescueEMT]

That is how I was looking at the situation. I basically feel the same as the LT but I will bow to the higher level of care and still explain this to the officer.

 

[rescuecpt]

Originally posted by MMiz@Sep 16 2004, 02:34 AM
rescuelt,

I think your last post was great, and is how I have come to look at the situation.

One day I'll have an "lt" at end of my forum name. One day.

It's Captain now. I got a promotion.

 

[ffemt8978]

Congrats, RescueCapt.

But you'll always be the Ell-Tee to us.

 

[PArescueEMT]

Originally posted by rescuelt@Sep 19 2004, 12:22 AM
It's Captain now. I got a promotion.

Congrat's cap. How long before you get cheif? B)

 

[Chimpie]

Congrats!! Now you need to talk to Matt about changing your name without losing your stats. But then again, if you lose your post count I wouldn't mind. B)

 

[rescuecpt]

Originally posted by Chimpie@Sep 19 2004, 06:43 AM
Congrats!! Now you need to talk to Matt about changing your name without losing your stats. But then again, if you lose your post count I wouldn't mind. B)

Hehehe... thanks guys!

This is at the FD, so I'm not in the "line" to become Chief, but I still run the most used (and what I consider most important) function of my FD. We have 1 working fire every 5 - 10 years or so, but we have ambulance calls much more often than that...