Trauma Point Of Entry.& Sacred Cows
KMATTOX at aol.com
KMATTOX at aol.com
Sun Apr 27 18:31:49 BST 2008
Unfortunately, (or even maybe fortunately) many different "protocols" exist
in many different communities and around the world. Even in those regions
which are considered to have "mature" EMS & trauma systems in place, today's
("correct") protocols are often very different from those of just 10 or 20
years ago. That is as how it should be. Advance the better, throw out those
things which did not work or which were found to be urban legend. The list
of unacceptable protocols and tactics, be in the field, the EC, the OR, the
ICU, or in the committees of the American College of Surgeons, ACEP, or AMA,
are determined by days, weeks, months, or years of evidence analysis. AND
policy makers who have stuck their necks out and become champions of one
policy, are very slow to accept a new policy that countermands their previous
sacred cow. I could share with the members of this list well over 100 such
items from the past and over 200 policies still under debate.
Such progress and continuing analysis of the old and new is essential as we
make progress together. I am personally closely watching:
STEMI protocols
Infusion of hypothermic solutions in patients with suspected spinal cord
injury
Hypothermia in heart attacks
Hypothermia in head injury
rFVIIa
Topical hemostatic agents
designer fluids
Medication to combat MOF syndromes
Use of Plavix in the ambulance
The new wrap around mechanical CPR devices
and many others.
I really am encouraged to see disagreement and even passion for one's
position stated on this list server. It demonstrates that the list server and its
members are alive and contributing. Thank you for each of your
contributions.
New news I am still trying to get the details about. Apparently two of the
European Trauma organizations have joined ranks together for the betterment
of trauma systems. What were these organizations and can one now JOIN this
new bigger and vibrant new group?
k
In a message dated 4/25/2008 2:11:13 P.M. Central Daylight Time,
bowwow49 at bellsouth.net writes:
Sir every thing is just not that cut and dry, and yes the state protocols do
address it, but lets take a step back for a second, because you might as
well just insult every medic that works their butt off every day to do
everything they can for each and every patient we have , trauma and medical alike !
And for you to say it is a possibly a lack of education on our part, I am
assuming sense you where not clear on if you are pointing that finger at
Paramedics, but at this point I will take it as that, you can quote protocols , state
and local all you want, it comes down to what the boss says ! We have to
follow our local protocols and procedures that keep us from getting fired or sued
for deveating from local protocol, by your attempt at dropping this failure
in the laps of the front line people , the Paramedics and first responders is
typical of someone that is not in educated and aware of what happens in
prehospital care, I don't know your qualifications , you have not stated, but
to blame the bullet for killing some one instead of the person who pulled
the trigger is like blaming a pencil for a misspelled word sir ! It is so easy
for doctors and emergency room staff and the like to stand back and talk
about something they think they understand, yet not being directly involved , and
even the medical directors have no clue cause they are the ones that make
our local protocol yet are never on the trucks, never have to make the choices
we do on scene, all just set back and make uninformed or "perfect world
declarations" and dump the blame where it does not belong ! Now how you think
politics has nothing to do with where a patient goes, you can not possibly be
involved in a EMS in any way, politics are every thing in a county run 911
service that has county commishners that want to get paid, and Insurance
companies demand a patient not be taken past a medical facility or they will not pay
! There is all kind of politics that are involved, we are not talking of
political causes, we are talking about political governing, we can not by
protocol transport a patient out of the county by ground, if the patient can
not go by air we must transport to the closest facility, which is the county ER
! And due to county commission not wanting trucks transporting to Nashville
on every call they will not change this because of our high call volume, we
as medics can request of a supervisor in significant cases if we can transport
to Nashville, but will likely get turned down except in exceptional cases,
which I have had and basicly had to beg for the patients sake to allow
transport and still been turned down! We do not have the luxury of multiple
hospitals and a trauma center in our direct area, we have one public hospital that
has 250 beds, in a pinch we can transport to the military base , but they do
not want trauma brought there, so the medics have no choice but to try and fly
patients , if the aircraft is not available, we have little choice but t
o take to local level 2 ER. Now how that reflects on Paramedics and first
responders is a uneducated statement on your behalf ! We have bosses and that
is the law of the day, what needs to happen is for there to be a means ,
training of medical directors and law makers to make it so the "Pencils" ( the
Paramedics and first Responders) are not blamed when words gets misspelled !
You can stand on a soap box and spew all you want about state protocols, they
mean nothing when countered by the local protocols that where written to
protect the population of our county as a whole for the rest of the calls that are
not trauma ! It does not make it right but you are pointing your finger in
the wrong direction , plain and simple! Insult all you want , you are the
uneducated here, you are the problem cause people like you look at the tree that
fell as the problem, not the weak roots and the high wind that caused the
tree to fall, the people making the rules need the education sir until then
we MUST follow those rules !
LB
-------------- Original message from Anthony Caruso <medic541 at hotmail.com>:
--------------
>
>
>
> LB, I'm not quite sure how it's political. EMT's on scene make the
> determination . If the patient(s) has been traumatized severely enough
then
> they go to the appropriate hospital. State wide protocols dictate that. No
way
> around it. Calling for a chopper is a tool that we have. What may be the
> underlying cause here is the lack of education possibly. More is needed to
be
> able to identify the patients that have been severely traumatized and make
the
> appropriate transport decision. My decision to transport who where and
when has
> never been influenced by any political causes.
>
> Just my 2 cents.
>
> AMC.
> > To: trauma-list at trauma.org> Date: Fri, 25 Apr 2008 16:46:56 +0000>
Subject:
> Re: (no subject)> > Sorry about that, I meant they are usually in the air
once
> we call in 4-8 mins which they can get to a scene anywhere in the county
within
> minutes, depending though on how we receive the call , we sometimes call
while
> responding to let them know what we are going on and put them on standby
which
> shortens there responce because they will go ahead to the aircraft, once
we
> determine need we let them know to launch or not, Air Evac does flying
standbys
> , they will launch and head your direction and we can cancel them
dependant on
> need for airlft or not.> LB> -------------- Original message from "Andrew
J
> Bowman" : -------------- > > > > How can you safely
> get a helicopter to a scene within 4 minutes of calling > > them? > > > >
You
> call, they receive call, re-check weather, quick aircraft check, > >
start-up,
> lift off, fly to scene, land, get out. > > > > Andrew > > > > > > > is
just not
> acceptable! We have one of the four of Vanderbilt's BK's right > > > here
at our
> local hospital, and if they are on the pad we can usually > > > either get
them
> to a scene within 4-8 mins of calling for them, > > > > -- > >
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