Ideal ED length of stay?

[Stephen Richey]

>
> I have taken unstable penetrating cases direct to OR, but it's not common
> for us by any means.



I can count on one hand (actually 3 fingers) the times I've done that in
going on 12 years as an EMS provider.  What amazes me is that our primary
receiving hospital had direct to cath lab admissions for field diagnosed MIs
but a penetrating trauma to the chest with deteriorating vitals we were
expected to stop in the ED.  The last time I did it, the ED physician on
duty (our deputy medical director) told me to stop and my response involve a
four letter word starting with 'f' and "you".  It was a hunting accident
with a through and through from one mid axillary line to the other at about
nipple level, and barely obtainable vitals.  I was not stopping for anything
and we had already called the trauma alert, the ED charge nurse had notified
the OR and had let us prior to our arrival know the OR was read.  So we kept
going.....I walked out of the hallway that leads back towards the ORs to
find the ED doc waiting on me.  He ripped into me and my 'defense' was
"Look, you can fire me if you like, but he needed a surgeon.  He made it to
the OR alive.  If that is worth me losing my job or my cert, so be it."
Then I turned around and walked off.

BTW, the patient died on the table.  And no, I didn't get fired.

-- 
Stephen L. Richey, CRT

"It is better to know some of the questions than all of the answers."- James
Thurber