Scene times....

[Dustdevil]

Trauma=10minutes, Medical= 20 minutes.

But why?

Other than "because that's what my protocols say," of course.

[AZCEP]

It could be the widely held American medical control physician's belief that less time spent on scene and enroute to the hospital will limit the damage done by the un-educated providers. Those with half of a clue can get everything they need to done during transport reasonably effectively.

As I already said, due to my transport times being so blasted long anyway, I shoot for less time on scene for everything.

[Asysin2leads]

If we get the patient stabilized, to the truck, and en route without any adverse effects caused by a delay, then it really doesn't matter how long we are on scene.

This is especially true for the 10 minutes for trauma rule. If the patient is packaged correctly, has a secure airway, has painful injuries immobilize and has bleeding controlled, is it okay if it takes us 12 minutes to do it? I'd say, yep. People need to think in terms of efficiency of medical care, rather than play beat the clock.

[Ace844]

Hello Everyone,

Yes, I agree with you 'ASYS, and Vs, etc..' But, also isn't most time expired in the pre-hospital arena considered 'Zero time'. It's my understanding that the 'patient care clock' doesn't truely start at least as far as most of 'medicine' is at large until the pt 'rolls through the Hospital door.' I think all of this business with scene times came about For a number of reasons.

1.) When modern EMS was young and before ALS was known to be considered definitive

care so thus the goal was in fact to get the pt to the 'Hospital' ASAP.

2.) You need to 'train' EMS people to think on a clock and get used to only having 'so much

time'. Thus you must have uniform standards. Hence, the 10/20 min nearly

universal 'scene time rule we all talk about here.

3.) Since the 'clock' by 'medicine' doesn't start until the patient got to the 'ER', and

the 'Golden Hour' became so important in M&M reduction. Thgis 'system' further provided

a way to 'limit liability' as it became a 'Standard of Care'.

4.) As times have changed and EMS has 'evolved' we have changed, but this principle has

become institutional dogma. I think most of us would agree that at bthe 'Paramedic level'

EMS provides nearly the same care and interventions provided by an ER in the first 30

mins or so of it's care. Yet, as mentioned above, we haven't changed the 'time standard'

or the dogma to reflect this. Thus, potentially putting EMS providers in the 'poor position'

of having to choose between following accepted 'Scene time standards' and or providing

the appropriate 'Standard of Care' to the pt while they are in the ambulance. Thus

putting said clinician in a VERY TENEUOUS LEGAL POSITION with potential for

being 'wrong' from 2 directions. Thus as 'VS & others' have posted there should be no

'short' clock on patient care. Yes, there should be 'guidelines' but that is all, but they

should be flexibile, not used to put ones livelyhodd in danger!!

I have more points to add, but I'll just throw this into the mix for the groups consideration.

Food for thought,

ACE844

[PRPGfirerescuetech]

Ace.

The time standard, in my opinion, applies to nothing but critical trauma, which in large is due to ER's, EMS's and anything less than a surgeon not being able to do anything productive for a patient.

Well put sir.

Now. Heres a thought. Could the dogma of 20/10 minutes for medical/trauma be more from a EMS oversight perspective? Too long in field = less available squads = more covers = less cash?

Not that i believe this, but its a thought.

[Ace844]

Ace.

The time standard, in my opinion, applies to nothing but critical trauma, which in large is due to ER's, EMS's and anything less than a surgeon not being able to do anything productive for a patient.

Well put sir.

Now. Heres a thought. Could the dogma of 20/10 minutes for medical/trauma be more from a EMS oversight perspective? Too long in field = less available squads = more covers = less cash?

Not that i believe this, but its a thought.

"Prpg,"

I think there is a large combination of factors involved and that the one you mention above is certainly one I had overlooked. By 'erradicating' this except in special circumstances I think it would bring to the fore alot of other issues, like the one you mention above. Thus it is in the interest of both our 'profession', the lobby, and 'medicine' at large to keep it in place. I am of the opinion that this should be taught and re-enforced in training, but that any 'EMS clinician' who has an IQ over 50 and an ounce of common sense knows to spend 'alot' of time on a scene with a 'CRITICAL patient,' either medical or trauma is DEADLY!! If one can't recognize this they shouldn't have a ticket in the first place!! JMLO..

Out here,

ACE844

[emt-b_wa]

When we have a really sick pt. and we are trying to get to the hospital in the golden hour we can only spend about 10 minutes on scene. But for the average call it's about 15-20 at least. We have a minimum of a 15 minute transport so most of us like to get things done in route to the hospital/

[Asysin2leads]

Even for a critical trauma, if the guy is conscious and screaming, take a minute or two to secure that fractured radius or humerus or secure him really well to the back board. Scene time, like everything else in medicine, and life in general, is about ranges, not numbers. Be it heart rate, or BP, or respiratory rate, or scene time, its the range you look for and shoot for, not an exact number. So, the range for a critical trauma scene time is AROUND 10 minutes. That doesn't mean you have to shoot for under 10 minutes. In other words, look at it like this:

Scene time, critical trauma without extenuating circumstances, i.e., difficult location, extrication, etc.

UNDER 10 minutes: IF everything is done properly, and you didn't needlessly endanger crew members and bystanders and the patient in doing so, then nice job, here's a cookie.

10 minutes: Yay!

11 minutes: Still yay.

12 minutes: Doing good.

13 minutes: Good

14 minutes: Ok.

15 minutes: Need to pick up the pace.

16 minutes: Need to get going.

17 minutes: Is what is going on critical to the patient's survival? If not, stop doing it, go.

18 minutes: Seriously, lets get going.

19 minutes: Let's go, time is brain tissue, come on people

20 minutes: What are you doing, the f#$ing Sunday Times Crossword for the love of god?

Catch my drift?

[madmedic8522]

where I'm working we fall under that "protocols state 20mins and be moving", of course you always have your special situations, but i like to get moving asap so we can get back to the house and kick back in the old recliner , and take a nap, LOL!!!

[PRPGfirerescuetech]

Even for a critical trauma, if the guy is conscious and screaming, take a minute or two to secure that fractured radius or humerus or secure him really well to the back board. Scene time, like everything else in medicine, and life in general, is about ranges, not numbers. Be it heart rate, or BP, or respiratory rate, or scene time, its the range you look for and shoot for, not an exact number. So, the range for a critical trauma scene time is AROUND 10 minutes. That doesn't mean you have to shoot for under 10 minutes. In other words, look at it like this:

Scene time, critical trauma without extenuating circumstances, i.e., difficult location, extrication, etc.

UNDER 10 minutes: IF everything is done properly, and you didn't needlessly endanger crew members and bystanders and the patient in doing so, then nice job, here's a cookie.

10 minutes: Yay!

11 minutes: Still yay.

12 minutes: Doing good.

13 minutes: Good

14 minutes: Ok.

15 minutes: Need to pick up the pace.

16 minutes: Need to get going.

17 minutes: Is what is going on critical to the patient's survival? If not, stop doing it, go.

18 minutes: Seriously, lets get going.

19 minutes: Let's go, time is brain tissue, come on people

20 minutes: What are you doing, the f#$ing Sunday Times Crossword for the love of god?

Catch my drift?

Time is trauma yes. Nothing incredibly productive we can do for them in reality...