EMS management/crush injury

Mon Jun 11 15:28:18 BST 2007

It sounds like one of the major problems here is communication. Medical
Control should be used as a resource for such decisions. The situation
sounds as though very little information was offered initially and then
there was no follow up on patient status before the decision was made. Maybe
a discussion with all of the local EMS crews in regards to role of Med.
Control as well as professional communication would benefit. There are so
many variable in the patient "pot" of potential injuries and the decisions
made for treatment. As some of you have written, EMS may have been following
protocol which is great. However, every call is a learning call. The take
home message may be to communicate better with all of your resources. Once
the call is made to the trauma center then they should in fact be used as a
member of the team and thus be involved in the decision tree that ensues.

-------Original Message-------

From: Jules K. Scadden
Date: 6/10/2007 6:21:13 PM
To: trauma-list at trauma.org
Subject: Re: EMS management/crush injury

  I understand what you are wanting to look at Dr. Caropreso, and applaud
you for following up with this or any case in question. What is in the best
interests of the patient must be re-evaluated often and I am happy to see
this is being done.

Just to clarify a couple points....Mercy Medical Center in Sioux City is our
designed Level II. I believe St. Luke's is a Level III, now, but could be
mistaken.

The closest hospital to me is approx a 65 minute ground transport to any
Level II or III. They do not "often" call trauma alerts at all but when they
need to, they? have a very good policy in place that aids their EMS
providers in making the determination on when that should happen AND it also
supports the OOHTTP as well. I do not know how many trauma alerts you have
in your area and personally feel each area needs to determine their own
policies best suited to their location.

Again, I applaud you for following up. Continued evaluation of ANY program
is important.

Patient outcome will indeed be interesting to hear about.

I guess my question is whether the scene flight is being questioned because
of "unwarranted" need or a feeling of mismanagement of resources?

I was taught, many, many moons ago, if there is a question as to whether to
call for a scene flight, because the patient is unstable, or potentially
unstable, rule on the side of what is in the patient's best interests. That
doesn't mean, in this case, flight was warranted, but one has to wonder if
your EMS people were not taught and thinking along the same lines, based on
what they were seeing and interpretation of the state protocol..

It will, indeed, be interesting for all, including Iowa's Trauma system, to
hear the committee thoughts on this..

Thanks for sharing it.

Jules

-----Original Message-----
From: pjcabdds at mchsi.com
To: Trauma &amp; Critical Care mailing list <trauma-list at trauma.org>
Sent: Sun, 10 Jun 2007 5:00 pm
Subject: Re: EMS management/crush injury

Thanks for the note, Jules. I wish that I could give you more information,
but I
suppose it's the only conclusion that can be made: >20 minutes extrication
and
two long bone fractures, go to the level 1. Now, I don't know where the two
fractures came from. Perhaps, it's an assumption. I hope to get some info
from
UIHC.
If you are calling trauma alerts often and not utilizing them, I hope that
such
events are being analyzed. You can do only so many drills. I do know your
part
of the state, and was involved in the verification of St.Luke's. Iowa is
rural
and similar. But everything may not be the same. Are you 100 miles from your
level 2's? You're right: I would never to past a level 2 to get to a level 3

With the protocols not ignored in the least, the questions remain: what were
the
injuries, what were the indications for
transfer, who has authority for transfer, and what were the benefits and
risks
of the management selected. I hope that I will be able to provide these
answers
when I can get followup.

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

----------------------  Original Message:  ---------------------
From:    "Jules K. Scadden" <jkaymdc at aim.com>
To:      trauma-list at trauma.org
Subject: Re: EMS management/crush injury
Date:    Sun, 10 Jun 2007 21:37:44 +0000

>
>  I am also from Iowa, as well as a rural area similar to Keokuk..I agree
with
> Rob, as I have learned and taught the OOHTTP in Iowa, they did as the
protocol

> directed, and as we would have done on the NW side, with only Level IV and
maybe
> a level III, almost as close as the Level II....
>
> We also call trauma alerts that can and often are not utilized after
further
> scene evaluation that indicates perhaps scene flight. ...
>
>
>
>
>
>
> Jules
>
>
>
>
>
>
> -----Original Message-----
> From: Rob Farnum <latigo at firehousemail.com>
> To: trauma-list at trauma.org
> Sent: Sun, 10 Jun 2007 10:58 am
> Subject: re:EMS management/crush injury
>
>
>
>
>
>
>
>
>
>
> I think in this case, you should look at the Iowa Bureau of EMS Out of
Hospital
> Trauma Triage Protocol.? This is a state protocol, not local, and could
shed
> some light on the decisions made for you.? It would appear this Pt falls
out
in
> 2 categories:? "Suspected 2 or more Long Bone Fx", and "Extrication time >
20
> minutes".? Both of these direct the crew to expedite transfer to a Trauma
Care

> Facility.? It does state in the Protocol that "If time can be saved, or
level
of
> care needs exist, tier with ground or air ALS service." with the suspected
2
or
> more long bone Fx.
> According to the Iowa Department of Public Health, the hospital in Keokuk
is
an
> "Area Trauma Facility" which appears to translate into a Level III
Facility.?
> With some knowledge of your area, knowing how far it is the the University
by
> ground, I would have probably done the same thing.? If you feel there was
> "Over-triage on scene" then you should approach the ambulance director for
the

> service FIRST.? I work in a Level 4 facility in Iowa, and I would without
a
> doubt call for a chopper, and a scene flight is a good option here.? Even
after
> calling a trauma alert.? It isn't unknown for us to call one and then
stand
down
> when we get on scene and perform a scene flight due to extended
extrication.?
If
> you feel the crew doesn't understand the Out of Hospital Trauma Triage
Protocol,
> then by all means offer to give more education on it.? But, from your
> description of events, it sounds to me like they performed correctly.
>
> ?
>
>
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