EMS management/crush injury

[pjcabdds at mchsi.com]

Roy,
Thanks for your response. I appreciate your analysis, and it will help me at our
committee meeting. You have a unique perspective because of your experience
pre-hospital and in the ED. Hope to see you in Kansas City.

--
Kind regards,
Phil
Phil Caropreso, MD, FACS
1813 Grand Avenue
Keokuk, Iowa, USA, 52632
pjcabdds at mchsi.com


----------------------  Original Message:  ---------------------
From:    Roy Danks <roydanks at hotmail.com>
To:      "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
Subject: RE: EMS management/crush injury
Date:    Sun, 10 Jun 2007 02:51:25 +0000

> Phil,
>  
> If I understand your question:  why would EMS go to the length of mobilizing you 
> and your associates, then divert the chopper to them and transport "around" you 
> to the university (I assume, knowing your geography).  I think you have a strong 
> argument to present to your EMS crews/director.  Again, I have the advantage of 
> knowing you and your capabilities...so should they...more so than me.
>  
> For whatever reason, we have allowed EMS to become completely autonomous in 
> certain situations where, clearly, a more experienced person, such as yourself 
> would/could/should be more involved.  I am speaking of your specific situation 
> because I am well aware that there are many EMS providers who get little more 
> than an occasional pat on the back from their FP trained, EMS "Medical 
> Director"...but, I digress.
>  
> First, for all you EMS providers out there, hold back on your strike.  I was a 
> field medic in a busy system for 10 years, I write for your #1 journal (JEMS), 
> have book chapters in your books and I have been medical advisor for a 
> nationally accredited paramedic program for more than 8 years...I speak from 
> experience.
>  
> That said, Phil, your EMS people need to be reigned in.  If they are going to 
> communicate like they did with you at the outset, the lines need to stay open.  
> Not only did you assemble an experienced crew to handle the patient (no matter 
> how sick she was), you also took time away from other duties to do so...this is 
> taxing to any system, especially a smaller one such as yours...not only in the 
> terms of manpower, but fiscally as well.
>  
> We now know a couple of things about air transport:  1) it is very, very 
> expensive 2) they are probably not as safe as ground transport and 3) they may 
> or may not contribute a survival benefit 
> (http://publicsafety.com/article/article.jsp?id=2029&siteSection=1).. I think 
> they do not...personal opinion only.
>  
> So, if EMS crews are going to take the initiative to make the patient a trauma 
> alert in your system, they damn well should take the initiative to call you with 
> VS every 10 min or so, an update on pt condition and mostly, they should ask for 
> YOUR input as to the next step.  
>  
> As an aside, my monthly rant at our local EMS run review is the lack of adequate 
> analgesia/sedation in the field.  2 weeks ago a 34 y.o. woman with bilat 
> displaced radius fx, s/p fall from ladder was transported by a paramedic crew of 
> 2 with a paramedic student...no IV, no pain meds...their excuse: "we couldn't 
> start an IV in her arms because of the fractures".  This is 7 kinds of 
> B.S....she had foot veins the size of the AK pipeline and would've gladly taken 
> a poke there to receive much needed analgesia.
>  
> Anyway...that's the way I see it.
>  
> Hope this finds you well, Phil.
>  
> Roy Danks
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