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Asysin2leads

Trauma Docs with lights and sirens?? What do you think?

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Okay, I remember hearing about this a long time ago and I can't remember where this was, but here's a subject of debate.

A certain hospital which was designated a trauma center (obviously not a level I) put forward the idea that the on call trauma surgeons be allowed to equip their personal vehicles with warning devices and be allowed to respond, to the hospital only, with the same rules applying as an emergency vehicle, if a critical trauma came in.

The plan was shot down, because they didn't want to give lights and sirens to the trauma surgeons. Given the mentality towards EMS in many places, I can't say this is particularly surprising. My feeling is that if Skippy the vital signs certified first responder is allowed to put some lights on his car, I think we should allow the docs to have some too if they're coming into the hospital to do some surgery. That emergency vascular graft is going to make a heck of a lot of more difference than Skippy and his first aid kit.

Comments? Anyone know where this was? Anybody have similar programs in their area?

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There is a medical director for a local squad who had his POV outfitted with L&S. He has been known to respond to scenes using L&S.

However, I don't agree with L&S on POVs regardless of who you are whether you be Ricky Rescue or a medical director.

Sorry Asys...can't help you with the details for which you're looking. I'm fairly positive this isn't the guy you heard about.

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Thinking from our local perspective...

  • Physicians and Surgeons usually have in their contracts a longer response time when called in for an emergency. No need for them to be there when we were still on scene... and allowed them time to finish up whatever they were doing at home (i.e. supper, night out, etc...)

i.e. we had 5-7 mins to be in the rig and on the road when called in... physicians had 25 mins to get to the hospital (we weren't allowed any Lights/Sirens on our personal vehicles... only Fire Department Volunteers)

[*]We have somewhat eliminated the problem of impaired emergency responders with shiny lights in the outlying communites (we quit calling for their assistance for a couple of years... and made sure if anyone did show up in that form... the PD did something about it)... I'm thinking the Surgeons would not have this attitude of "we're on call 24/7... can't be sober all the time (oh yea... then why were we sober was my question to them ???)".

[*]Most of the accidents that have occured have involved youthfull enthusiasm when just starting in EMS, or an impairment of sorts... (yeppers... 24/7 crew....) maybe this wouldn't be too much of a problem with the age factor... or professional factor?

So.... why not? Would it hurt?

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According to American Academy of Surgeons (ACS) Level I criteria is to have surgeons in house and have the ability to respond in a timely manner. By not having such they could be in violation of the criteria of the Level I rating. With several other criteria, and response of other surgical teams.. i.e anesthesia, scrub teams, lab, & radiology.

Some states do deviate from ACS and have local policies. Most require the surgeon to have a response within 15 minutes of notification. Usually the ER physician or attending is responsible until arrival and the work up is usually began.

The lights and sirens on P.O.V. is never a good idea, especially on private vehicles ( hard to imagine a light bar on a Lexus or Jaguar) I still have a hard time with us even having such sometimes. They already have a "MD Deity" complex, this would encourage this more...

R/R 911

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I believe the main problem is why they would be at home on call in the first place. Its usually because they want to be at home and are required to do oncall shifts. If they need lights to get to the hosp in time then they should stay at the hosp. Whether it means no time for the new sailboat or missing out on a few thousand $$. It all boils down to money.

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Trauma centers get their trauma ratings based on what services are available in-house and what are available within "a reasonable amount of time". For level I centers, the trauma surgeon has to be in-house. Other surgical specialties, such as neurosurg, ENT, orthopedics, and optho are usually not in-house but must be able to be in-house within a given amount of time. As you work down the trauma designations, the trauma surgeons don't need to be in-house, but available in a certain period of time.

The fact is that most hospitals cannot afford to pay for in-house trauma surgeons 24/7, particularly if they don't often see trauma that requires an operation. This is the same reason that the surgical subspecialties are not required to be in-house, as they are urgently required to operate so infrequently that it just isn't cost-effective to pay them to be in-house all the time. Critical trauma patients may find their way to these hospitals because of a variety of reasons.

1) Homeboy ambulance

2) There is no other hospital close enough

3) Airway that cannot be secured

4) Loss of pulse in the field

Some may be too unstable to be transferred, necessitating on-site surgery regardless of the hospital's trauma designation.

Trauma doesn't pay. The patients are less likely to have insurance (in some places, they almost never do), and so the surgeons must either be payed by the hospital for taking care of them OR have it negotiated into their contract to do emergency and trauma cases periodically as pary their hospital privileges. This means that they have to have a full OR and office schedule in addition to covering the trauma call. If you know anything about a surgeon's life, this isn't a small thing.

I think that allowing trauma surgeons to respond with L&S to the hospital for patients meeting certain criteria is appropriate. This isn't some Ricky Rescue who red balls it to every patient who calls 911 for a sniffle. Why do we haul ass with trauma patients to the hospital? Because minutes wasted before surgery for those who need it loses lives. The data that support this are hardly controversial. Something else to consider is that there is a better medical assessment done of the patient before the surgeon puts his/her life at additional risk (and others too), as opposed to most emergency services, who by default respond with L&S to any 911 call unless it meets certain very narrow criteria.

'zilla

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If the ER Doc or services can't stabilize the patient long enough for the surgeon to respond in safe and timely manner, then the patient outcome is probably so low surgical services will not matter. Trauma Alert system (prehospital) will buy enough time to notify a heads up.. There is enough idiots out there, without any more ego's running with lights on their vehicles. Sorry, they already usually have an attitude enough, and have enough special services without additional. I can see the surgeons now responding in their Porsche's ...pegged out.

R/R 911

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I've got to disagree with Doc.

In the grand scheme of things, how much time do the lights and sirens actually save? Truth be told, very little. If the surgeons are forced to take call, then the parties involved should recognize that they will not be in house, and their response will be longer than if they were.

I will agree that less time from the incident to the knife will increase survivability, but there are better ways to achieve this.

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I can see the surgeons now responding in their Porsche's ...pegged out.

R/R 911

Kewl, a Porsche pegged out with flashing lights! It'll be just like the Autobahn! :lol:

I guess we are lucky here in the fact that a Level 1 trauma center is the only game in town. There is always a surgeon here since it is a teaching hospital. Between flights and ground transport, there is unfortunately a steady flow into the ED. :(

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I'm going to have to say this is a major problem waiting to happen. Studies (and I wish I could find the URLs) have shown that in a typical urban area, responding under lights & siren saves an average of 43 seconds. And it increases the risk of a motor vehicle collision by an order of magnitude. If I bend a rig because I didn't do the right thing while responding, well, that's a bad thing. But if a surgeon bends his POV while responding, that's incredibly, hugely bad, because now he not only can't help whoever he was on his way to help, but he can't help anyone in hospital either. And surgeons aren't exactly available for plucking from the nearest tree. (Okay, so neither are EMTs. But there are a lot more EMTs out there than there are surgeons.)

Just my two cents' worth...save up the change for a root beer or something...

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