ATV Accident

[Ace844]

"firefighter523,"

Here's something you should print and post at your station and or give to your boss. It was made by a group of people whose JOB AND ACADEMIC LIFE is spent in this specialty....

Triage decision scheme. BP, blood pressure; GCS, Glasgow Coma Score; PTS, pediatric trauma score; RR, respiratory rate; RTS, revised trauma score. Reproduced with permission from American College of Surgeons Committee on Trauma Resources for Optimal Care of the Injured Patient, 1997. (Resources for optimal care of the injured patient. Chicago: Committee on Trauma, American College of Surgeons; 1993.)

Hope This Helps,

ACE844

[Dustdevil]

I agree with Rid that, although I cannot read the supervisor's mind, I would seriously doubt that this had anything to do with money. And frankly, I'm getting a little tired of the constant Canadian assumption that there is a private profit motive at fault for everything that goes wrong in American EMS. The grim reality is just the opposite. It is the cheap arse government who is responsible for most of those problems. But, I digress.

I would like to hear the supervisor's rationale, and if he is a good supervisor, he gave that rationale, so I am surprised that firefighter 523 didn't share it with us in the original post. Also good to share with us would be whether the EMS is a fire function there, or if he's just a volly fireman working EMS for a living. If it is fire EMS then, again, this talk of private profit motives is way off base.

My guess is that the rationale was simply that it is not usually prudent to take first responders' word for medical assessments when making medical decisions. He's probably been burned a few times -- as most of us have -- by doing that and it turning out that the FR's were idiots. Yes, it is unfortunate that we have to be so sceptical, but it is our licence that is on the line when we make medical decisions based upon third party info, not theirs. I am betting the supervisor is just tired of him, his people, and his organisation looking stupid because of faulty first responder assessments.

[Ridryder 911]

[quote="SSaint

Oh, I'm not saying my municipal service doesnt bill. We bill at just a hair above cost, to pay the professional portion of our staff, and other expenses (insurance, etc)

I've heard of agencies that bill as much as $1,000 if a 'medic even RESPONDS to a call. That's just for showing up. Let's not even get into the expenses behind procedures, and transport mileage.

[whit72]

Firefighter523 wrote:

Fire on location shortly after dispatch, reporting a 27 yom, confused, in and out of conciousness. Longest period of LOC is 20 to 30 seconds witnessed by fire chief.

I don't really see the question here. Head injury with LOC, repetitive questioning, slurred speech and confusion = flying the friendly skies.

That's an easy one.

You are making your decision on the possibility of head injury, if all the pieces of the puzzle lead you to believe this person has a chance of significant brain injury. Why wouldn't you fly him. If all he got was his bell rung, that's fine. They can watch him for 24 hours and send him on his merry way.

You did the right thing.

I wouldn't worry about pissing someone off, I would just get used to it.

Your the pt advocate. You have to do whats in his best interests.

[Dustdevil]

I wouldn't worry about pissing someone off, I would just get used to it.

Obviously you have.

[whit72]

Dust wrote:

Obviously you have.

If it needs to be done. I don't allow political or financial beliefs to determine pt care. If you have worked long enough in this field, you understand people are going to get pissed off, that's out of my control.

I can't believe a person of your obvious attitude would disagree with such a comment. I am sure everyone you (Dust) encounter in a day leaves pissed off at you.

[AZCEP]

Some people will become less than diplomatic with their interactions with us, but often times it is well within each provider's control to alleviate this problem. Some will get out of bed upset about their situation in life, and take it out on everyone they come into contact with. When we walk into a scene, and we recognize this, it makes things much easier for us, if we are able to communicate in a way that these challenges become less of a factor.

[whit72]

AZCEP wrote:

Some people will become less than diplomatic with their interactions with us, but often times it is well within each provider's control to alleviate this problem. Some will get out of bed upset about their situation in life, and take it out on everyone they come into contact with. When we walk into a scene, and we recognize this, it makes things much easier for us, if we are able to communicate in a way that these challenges become less of a factor.

I totally agree.

The positions we find ourselves in day in and day out. Whether it be with Pt's, nurses, or doctors, police and fire. We are in situations where tensions run high, there is bound to be friction.

It comes with the territory. All I was stating was that you have to be able to deal with it and not let it cloud your judgment.

I dont walk around all day trying to piss people off. I also cant do my job effectivley if I am worried about pissing somone off.

[mediccjh]

Do you have this patient's dispo and diagnoses, if any? I'm sure that will help you decide whether or not you made the right decision.

In my neck of the woods, if you can go by ground in 20 minutes or less, you go by ground. I usually stretch it to 25, unless the patient is really FUBAR or I don't have an airway.

[Dustdevil]

I am sure everyone you (Dust) encounter in a day leaves pissed off at you.

Ha! Obviously you've never spent time in the military.

Medical Officers are the one person that everybody is happy to see!

Pissing people off is acceptable when you're right. But when you're talking out your arse, it's just stupid.