Would you ALS or BLS this patient and why?

[ERDoc]

Negative on the probing, but if it did enter the pleural space, wouldn't we expect to see some signs of a sucking chest wound, or a potential pneumo forming?

I don't have alot of experience with penetrating chest wounds, I'll admit, but to me from the OPs original post, it sounds like a laceration more than a penetrating wound.

I'll give you that it sounds pretty superficial, but life threatening injuries can take time to form. You could have a pneumo that is slowly building. You don't have to have a sucking wound and not all sucking wounds are serious. I would always err on the side of caution with penetrating trauma. Does this guy need a helicopter? No, not at all but I think ALS observation would be a good idea.

[Doczilla]

I'd say do whatever gets the patient to the hospital faster. If they have to wait for ALS, just go. If ALS is on scene, ALS it.

I agree that you can't tell how deep the wound is. Calling to ask for orders to BLS it is wasting time. Getting all pissy about it in front of the ER staff as the crew did will only make them look worse.

'zilla

[ERDoc]

I'd say do whatever gets the patient to the hospital faster. If they have to wait for ALS, just go. If ALS is on scene, ALS it.

I agree that you can't tell how deep the wound is. Calling to ask for orders to BLS it is wasting time. Getting all pissy about it in front of the ER staff as the crew did will only make them look worse.

'zilla

Good points. I was assuming that we had both ALS and BLS on scene.

[MedicTroll]

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

[/font:512477a182] More Like the fire guys need to tell the union stop making us do things we don't want to do, just to save jobs. The fire guys should just stick to what they were hired for and fight fires, let the EMS guys do the EMS work. This is a problem all over, the union wants to save firemen jobs so they took over EMS and play Medic. But 80% or better of the guys on the street don't want to be woken up at 2am for what they see as BS, so they make stupid calls like BLSing jobs that clearly should be ALS. But you notice nothing ever happens, now if this was an Ambulance service the state would be all over then and pulling certs.

[Arizonaffcep]

As it played out, the ALS ambulance was on scene first...once they do the assessment, then they call for a BLS transport. The only reason for the patch in the first place (instead of just BLSing him) was it fell under level 1 criteria, which everyone is required to patch on. As it turns out...it was just the first few layers of skin without penetration to the pleural cavity. He was released in a couple of hours of obs, just to make sure he was ok.

As an interesting addendum, they had a medic student with them...I pulled him aside and explained that we as prehospital providers don't have the training to be able to probe this type of wound, and must assume (for the Pt's sake) that it does penetrate into the chest cavity. I then told him this is why something like this is NEVER ok to BLS. What I didn't know was the medic captain was right behind me and heard me say this...boy did I get a glare! Not that I care...they are known for their mad "Pt. don't care" skills vs. "Pt. care" skills. Besides, I know their medical director and his co-director. I work with them and am friends with them...so I know they'd agree with me.

[Dustdevil]

Good points. I was assuming that we had both ALS and BLS on scene.

This covers the thoughts I had on the matter. It was my [correct] understanding that ALS was asking permission to call BLS to the scene to transport the patient, a la the King County nonsense. Completely inappropriate to even consider it, much less waste time and resources calling for it.

But the question now becomes, is calling BLS inappropriate because of the time wasted doing so, or is it because the patient needs or may need ALS?

[sirduke]

Knowing that what ever I say will be wrong, I'll give my two cents.

I would due to the nature of the injury, call this ALS, as several people have pointed out, it has the potential to turn into a life threatening injury quickly. Could be developing a hemo.

At any rate, if ALS is there, take the patient to the damn hospital rather than making him wait for a BLS truck to arrive. Where is the sense in waiting? Are they worried about call volume, or are they worried about getting back to bed or the card game?

How many times have you responded to a "BLS" sounding call, only to arrive to something serious requiring ALS intervention? Or had a patient who had no specific complaint turn out to be in crisis?

As my old drill sergeant often said, " when in doubt, whip it out."

Just one man's humble opinion

[ERDoc]

This covers the thoughts I had on the matter. It was my [correct] understanding that ALS was asking permission to call BLS to the scene to transport the patient, a la the King County nonsense. Completely inappropriate to even consider it, much less waste time and resources calling for it.

But the question now becomes, is calling BLS inappropriate because of the time wasted doing so, or is it because the patient needs or may need ALS?

I would say both. Even if the pt doesn't need ALS (which you obviously cannot predict ahead of time) why sit on a scene waiting for BLS? Just go to the hospital.

[Just Plain Ruff]

here is a prime example of a patient who had a superficial wound but it turned into a trauma code.

32 year old hooker, about 100 pounds, pissed her pimp off and he stabbed her in the thigh.

She thought it was no big deal so she walked over to the local watering hole and sat down on the bar stool. The bartender called EMS because she was bleeding on his floor.

WE get there, the woman is refusing to go to the ER.

I decided to do orthostats and within 15 seconds she slumped to the ground. Her thigh was huge. We thought that was surprising.

She was unresponsive and rapidly coded.

2 large bore IV's and cpr to the hospital (10 minutes away). She died.

On autopsy, the knife had cut the femoral artey completely in two. She bled 3 units out into her thigh.

The pimp couldn't believe he killed her but the knife he did use was a 1/4 inch stilleto style knife about 10 inches in length.

her cut was about 1/4 inch in width.

Kind of a holy crap batman moment.

As for the criteria of the Fire guys on the original posters scenario, she'd have gone BLS.

[emt322632]

Where I run, (the frozen tundra that is Northern NY), we don't have the type of response the OP was mentioning, where an ALS ambulance would call a BLS ambulance to transport a patient. I've never heard of such a thing and it souds kind of ridiculous.

I would have transported the patient without ALS interventions in place, I would not have handed him over to a lower level of care for transport, just because the chance DID exist for him to develop a pneumo.

Just a misunderstanding I guess.