EMS management/crush injury

Mon Jun 11 16:17:32 BST 2007

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-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Bill Grayum
Sent: Monday, June 11, 2007 9:34 AM
To: Trauma &amp; Critical Care mailing list
Subject: RE: EMS management/crush injury

Please remove me from the list......Bill Grayum

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Shelley Sides
Sent: Monday, June 11, 2007 7:28 AM
To: trauma-list at trauma.org
Subject: Re: EMS management/crush injury

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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