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Caring for patient's kids while treating/transporting


Bernhard

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Scenario, you run in (I just did last night...): 31 y/o male wanted to lift his 2 y/o son and hurt his own back. Half sitting/half lying on the couch. Apparently orientated, but speaks only a foreign language noone of the team is able to understand much, so verbal assessment is a bit tricky. We narrowed it down to: severe back pain, probable herniated vertebral disk, unable to move due to pain, dumb feeling in the legs.

Problem: he's the only adult, father of a 5 month old son and his 2 y/o, caring for them when the mother works night shift in a factory. Mother was reached by phone and could quit work, but needs at least one hour to come home with public transport. The family recently arrived here, speaking only very broken german, knows noone in the neighbourhood, no relatives available. Noone to care for the kids until mummy is home!

Treatment of the patient was straight forward: monitoring (SpO2, ECG), i.v., analgesic drugs (Ketamine/Midazolam), O2, transport on vacuum matress to hospital with neurological/chirurgical capabilities (20 minutes away).

But what to do with the kids? How would you have handled this call? Do you have a plan for this? Just curious... ;)

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In my area care of the children would fall to the police until such time as a parent, guardian, or official from the ministry of children and families was able to take over care. Depending on location, in some instances the police might also pick up the care giver (mother in this case) to reduce the time to care.

Outside of everything else, why the sedation for a non traumatic pain complaint? Most North American services would have done morphine for pain management and that's about it. Maybe tossed in the ketamine and or midazolam if the pain was refractory to morphine.

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Edited by rock_shoes
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Pain treatment is done quick here. Especially in the given case the patient would have really suffered when lifting on the stretcher and would have a rough time to hospital without pain relief. We choosed Ketamine/Midazolam to not repress respiration. Morphine and Fentanly would have been available as well, but affects respiration. Blood pressure was not the problem. BTW the small and slim 60kg patient took 50mg of Ketamine to remain more or less pain free (analgesic effect) and still was not sedated very much!

For the kids we considered police as well, but, knowing they have only one or two cars available at this night, we took another option.

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I have run into this scenario multiple times. As the last option we would load the kids up i the ambulance if we had car seats to secure them. Yes, its less than ideal but if it is the only way to get the patient treated then it has to be done.

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Depending on how critical - law enforcement gets involved at the house...or we load up the kids (or dogs if we are on the road) and everyone goes to the hospital where law enforcement will still get involved.

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I agree with either cops take/watch the kiddos/(or dogs!) or we load everybody up and off we go! What language were they speaking, just out of curiosity? (Wondering about linguistic differences)

It all depends on your situation. If you're in the middle of nowhere? Kids come with the guardian unless the cops are right there to help. If the cops can be right there, and dad won't freak out about leaving kids with someone they don't know? Wait for the cops...

Wendy

CO EMT-B

RN-ADN Student

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The language was italian. Permanently interrupted by "ouch", "ahhh", "noooo".

Our solution: we (mis-)used our local volunteer crisis intervention team for this. They're EMTs/medics with additional training, primary taking care of relatives in case of frustrane resuscitations/death messages until family or normal social contacts can be activated (normally not more than a hour). So this was a more happy variety in their work. I first made phone contact and asked if the colleague would take this type of call and he agreed (experienced father and career medic). Within 10 minutes, he took over baby sitting until mommy came home (mother and father & kids agreed as well). :)

Usual alternative would be police.

Then we have 24/7 access to a supervisor. This night the chief of EMS operations himself had supervisor duty - he surely would have had "fun" to be confronted with the task! :D

Taking two young kids to hospital we would have needed child seats. Those people have no car, so no child seats (our ambulances have child restraint systems, but only for the stretcher which already was ocupied by the father). That would have been on our option list, too, but then we would have needed some organization (and a lot of time)...

On the other hand, we're the Red Cross EMS here, so we have the possibility to activate a lot of Red Cross volunteers out of the local and surrounding branches. This would have taken some telephone work (by the supervisor), but I'm sure, a willing babysitter could have been found.

At least five alternatives to choose from. You just have to know those... Took one - problem solved. :thumbsup:

Edited by Bernhard
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