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07-06-2016, 15:04 #1
Protocol vs. What you think is best for patient
Happened to me last weekend. Curious as to what everyone thinks.
Call came in for motor vehicle accident involving a motorcycle, possible loss of consciousness reported. Upon arrival found motorcyclist alert, oriented on side of road, C-collar and manual head stabilization in place by first responders. Biker states he was coming back up to speed after stopping for traffic and at 40-50 mph his Goldwing went out from under him and he laid the bike down hitting the pavement on his left side. He complained of L shoulder pain, and had obvious road rash. He denied loss of consciousness, and witness said "I thought he did for maybe a second or two". All other phys find. unremark. After splinting his shoulder, patient stood up and walked to stretcher against advice. At this point I cancelled ALS, medevac, and transp. patient to local hosp. 5 min vs. 35min+ to trauma center. Haven't been able to find out his ultimate discharge condition from hospital. I suspect broken clavicle.
Here is the rub. This call hasn't been QA/QI yet and I doubt it will be. But most of the 1st responders were very unhappy with my decision. Yes, by NYS trauma protocol this guy met the criteria for a medevac but in no way did I find it necessary or appropriate. So I made a judgment call like we all do. But whaddyathink? CYA and go with protocol or treat the patient in front of you, not the book?
Sorry for the long post. Thanks for your insight.
PS: For those interested, lets keep the FD/EMS board alive. After all, we are 911 too"There is no second place winner"-- Bill Jordan
07-29-2016, 14:17 #2Sergeant
- Join Date
- Jul 2000
- Western Hemisphere
Good call, brother. Here's the deal. Why do we study so hard to learn what (incident to and combined with the mechanism of injury) indicates compensated versus decompensated shock; what pupillary reaction indicates; what LOC is apparent? Then the state gives us a license. Then the state says, "Oh- but remember to pull your hair out and bash your skull on your computer regarding the constant continuing education applicable to medical and trauma care for the sick and injured..." Which, I might add, is WAY more con-ed & ceu's than are required for a nurse or physician. I was en-route my field office Wednesday morning about to get onto I-75 when my dispatch gave out a single vehicle MVC/overturned/rollover x 2 w/ multiple passengers entrapped on I-75. Our dispatch automatically launches a helo to such MVCs as we have 8 medevac helicopters available across middle Georgia. I rolled directly to it arriving within one minute; observing a Ford Explorer demolished which landed upright w/ roof caved in and no entrapment. I called dispatch on arrival as I observed the walking wounded: A 10 month old (carried wounded); a 12y/o & two 25y/o parents. I performed rapid trauma assessments on the 4 patients and there were no remarkable injuries nor was there any altered mental status. I cancelled the helo and began focused assessments on each patient w/ assistance from an off-duty police officer. All four were transported by two ambulances for "complaints only." God bless those parents for properly restraining their children and themselves. We DO NOT see such a good outcome very often. I've street medic'd in NJ and what everybody needs to understand is BLS can cancel ALS in the tri-state area per protocol. Here in GA we cannot; although we're ALL advanced life support anyway; with nothing less than an intermediate (now Advanced EMT - but I'm old/reciprocal) on the bus. There is an exception to allow EMT-Bs within a certain very close distance to a level-1 trauma center, however. Bottom line is this, Jim- you incorporated every bit of your decades of gray matter and experience to make a decision; as did I. You cancelled the helo, I cancelled the helo. If every single motorcycle crash and vehicle rollover (without patient assessment) dictated arrival of a helo and ALS in the tri-state area, y'all would run out of paramedics and helicopters in one hour on any given Saturday night. EMS protocols, in my opinion, are designed for the licensed/certified provider to maximize the care or response to the patient IF NECESSARY. Just like LE protocol- if I confront a person with a baseball bat whom I can articulate may be offering me deadly force, I can shoot him. However, if he drops the bat on command, I can put my gun away because I don't need to respond w/ deadly force. Same thing w/ the helicopter/ALS. I guarantee those who are running their pie holes in a negative way about your decision are young, not-so-experienced folks.Stay safe!