Would you ALS or BLS this patient and why?

[Arizonaffcep]

So, I'm curious. I ran into a situation the other day that, while I have my own oppinions about it, I would like some varried thoughts, from BLS providers to ALS and above. Here's the situation (Admin, if this is in the wrong area, please feel free to do what you need to):

The city FD, who has ALS engines/ladders and dual medic boxes-but they turf the BLS transports to a private company, responded to a stabbing the other night. A 60ish yom was "stabbed" in the back by his wife in the parking lot of the Circle K. The wound; on the laderal edge of the right scapula, around rib 5/6, which was about 1 inch in length. It didn't appear to go very deep. So...here's the question...to BLS or not. As per any level 1 trauma in Southern AZ, for transport to the trauma center (UMC), a "telemetry" must be done (AKA a "patch"). The RN who answered the radio said no for the BLS-ALS was needed. Upon arival at UMC, the medics were relatively indignant, frustrated that they weren't allowed to BLS this call (around 0300 hrs). Don't know HX, meds, alergies of the Pt (not really relevant for this discussion, as there was nothing major HX wise). Vitals, don't remember exactly, however I do remember they were WELL within normal limits. LS were clear = bilat, Pt talking in full sentences without difficulty. Unk how big the weapon was.

So, how do you guys feel about the decision to ALS? Should the FD have even considered BLS as an appropriate measure? They are known for BLSing SICK pts. So, what would you guys/gals have done? What are your thoughts.

Title changed to reflect content..AK

[reaper]

Most states that have trauma criteria, list any penetrating injury to the torso as a major trauma. On that basis alone, it would be an ALS call.

Had one like this that I brought in a few years back. Except the stab wound was right front chest, around 4th intercostal space. Vitals WNL, LS=clear,Pt A&Ox4, no signs of distress.

When we arrived at the ED, the Dr. proceeded to rip into us about this not being a trauma alert. He stated that the wound was superficial and the pt was fine. When we moved pt to ED bed, he crashed. They had to crack his chest in ED and rush him to the OR. Come to find out that the knife had nicked the Aorta and ripped open, when he was moved.

I was just happy that it held till he was at the ED. But, the ED Dr. did come an apologize to us, for jumping down our throats! Never see that happen again! :shock:

[medicwithabullitt]

Due to the fact that this was a penetrating trauma and the area you described, I would say ALS. But then again there really isn't enough information to say. How big was the weapon or knife? Was it serrated? what was the loss of blood? Was he having SOB..? LS? more info about the initial assessment needs to be known before you can make this determination.

I have my own Opinions on "BLSing" Pt's. Esp if there is a ALS truck on scene. In our area this doesn't happen. ALS cannot turn a Pt over to BLS, regardless of Pt status.

[medicwithabullitt]

my appologies, I reread your post and missed the part about the weopon and LS. I still would have gone ALS on this probably. Theres just too many unknowns

[flight-lp]

ALS, no doubt about it. Tell the firemonkeys to do their job and stop b!tching about it................

[Dustdevil]

So, what would you guys/gals have done?

There is nothing you can do. Arizona is just like California and Florida.

The firemonkeys are always right. And if you bitch about it, you get the shaft.

[ERDoc]

Being the one on the other side of the radio who makes these decisions, I would have done the same thing. This guy had a pentrating injury to the chest that left a 1" wide opening. There is great potential for this to have caused some major damage. Just because the pt was stable at the scene does not mean that he was going to be stable five minutes down the road. This is why we reassess our patients. This guy had to potential to crump enroute to the hospital and that would require ALS. Unless these medics are psychic there is no way to predict which way this guy will go. Sounds like pure laziness to me.

[Kiwiology]

I agree with the decision to send ALS. Stabbing is different from being cut by accident with the kitchen knife; the chest contains lots of vital organs (yes ... I think I learnt'd that somewhere); even though you say the wound may not have been very deep you have the potential to do major damage. We don't have portable x ray and CT in the ambulance so there's really no definate way of knowing where that knife has gone or what it's done.

[fiznat]

ALS, no question about it.

[Just Plain Ruff]

sound like the fire guys need to go back to penetrating trauma 101.