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paramedicmike

Load and go? Or not so much?

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They are basically comparing the two thoughts of trauma care by EMS. Which improves outcomes, stay and play or load and go? We can all make guesses about which is better and why but there is a lack of evidence to support either side, although this is starting to change. The best we have for comparison right now is to compare conventional EMS interventions (treating at the scene) to no intervention and rapid transport. The only way we have to evaluate the latter is to use data from homeboy ambulance since there is no significant data from EMS for this arm. I think OPALS came closest to making some recommendations, but I haven't kept up on it recently.

As for fiddle fucking at the scene, yes that is done since that is what protocols say. Try delivering a trauma pt to a trauma center with an unsecured airway and no IV. Best practices will require changing the thought process of both prehospital and hospital providers.

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First, the term homeboy ambulance is awesome. Often used in these parts and hilarious each time I hear it! :mobile:

I think I understand your question, but not sure.

Homeboy ambulances are faster, they are already on the scene. They don't waste time trying to do anything, just get them to the trauma center (sometimes, a lot of times they go to regular ERs).

Apparently some people in EMS are fiddle fucking around on scene when they should be driving the patient. Hence why I do all my work en route in a trauma run.

Right?

in many urban areas you have a short drive time to the nearest ER or trauma center even if it is a level II . Hence we tend to stay on scene longer to try and complete the checklist of stop gross bleeding , secure airway and get at least one IV running.

Homie ambulance doesn't waste any time trying to do any of the above.

They toss the injured party in the car and drive to an ER. Not going to a trauma center is still better than waiting for the EMS system to respond and treat, then transport to an appropriate level trauma center.

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HMMMMM , if I had a dollar for everytime I had to remind a flightmedic that he/she was spending too much time trying to RSI/Intubate a patient, I would be retired now.

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They are basically comparing the two thoughts of trauma care by EMS. Which improves outcomes, stay and play or load and go? We can all make guesses about which is better and why but there is a lack of evidence to support either side, although this is starting to change. The best we have for comparison right now is to compare conventional EMS interventions (treating at the scene) to no intervention and rapid transport. The only way we have to evaluate the latter is to use data from homeboy ambulance since there is no significant data from EMS for this arm. I think OPALS came closest to making some recommendations, but I haven't kept up on it recently.

As for fiddle fucking at the scene, yes that is done since that is what protocols say. Try delivering a trauma pt to a trauma center with an unsecured airway and no IV. Best practices will require changing the thought process of both prehospital and hospital providers.

To be honest, it is extremely rare I deliver a major trauma patient without a secured airway and vascular access though it certainly isn't for lack of trying. It's tourniquet if necessary, load, and transport with everything else done on route. Our local trauma centres have been excellent about accepting that we may not have time to intubate etc. prior to arrival.

I find it comes down to the most basic of assessments. Does the patient require or potentially require hospital based interventions on a time sensitive basis? If so move your ass and do what you can with the wheels turning. I find this is something we frequently over complicate.

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I'm with you Rock. I have no problems with crews bringing in a pt with nothing done as long as it makes sense. I know I am the exception rather than the rule but actually working in the field gives you a different perspective. I hate it when EMS brings in a tubed pt, because then I don't get to do it. :whistle:

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To be honest, it is extremely rare I deliver a major trauma patient without a secured airway and vascular access though it certainly isn't for lack of trying. It's tourniquet if necessary, load, and transport with everything else done on route. Our local trauma centres have been excellent about accepting that we may not have time to intubate etc. prior to arrival.

I find it comes down to the most basic of assessments. Does the patient require or potentially require hospital based interventions on a time sensitive basis? If so move your ass and do what you can with the wheels turning. I find this is something we frequently over complicate.

Exactly my approach to this. I am shocked to learn people *ARE* fiddle fucking on scene when it is not warranted

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I think this depends a bit on what sort of facility you're transporting to. If I'm 10 minutes from a trauma center, they'll only get intubated if they have no gag or I can't keep their sats > 90%, and they'll end up with an IV or IO. If I'm 10 minutes from a rural ER without EM coverage, I'm probably just going to stop and RSI them now, and either bypass to a bigger ER, or call for a helicopter.

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I think this depends a bit on what sort of facility you're transporting to. If I'm 10 minutes from a trauma center, they'll only get intubated if they have no gag or I can't keep their sats > 90%, and they'll end up with an IV or IO. If I'm 10 minutes from a rural ER without EM coverage, I'm probably just going to stop and RSI them now, and either bypass to a bigger ER, or call for a helicopter.

Fair point. Currently I work close enough to trauma centres I no longer have to transport these patients to small local hospitals. That said, even when I did have to transport to smaller facilities I typically had time to either call in a medevac or do everything on route with the wheels turning.

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If I got shot Id rather a buddy (if available) dump me in front of the trauma hospital* key word trauma hospital. The problem is if a cop or friend took you to the wrong hospital. Care will be very delayed (no surgery) and you'll be left wishing you called 911.

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