I nead your opinions on a MVA call that I went on.Thankx

[chaser]

"I remember many times watching my senior partner doing something I thought was incorrect, yet thinking silently to myself, "Well, he has more experience than me, so he must know something I don't know, so I'll keep my mouth shut." It's damn hard to tell somebody with more experience than yourself that they are doing something wrong when you are fresh out of school. Not only do you run the risk of looking like an idiot when they show you why you're wrong, but in any case, you risk alienating your partner who now thinks you are either an idiot or a smart arse. So yeah, I totally understand the concept of just staying silent and going with the flow in many such cases. But remember, you run almost as much risk by remaining silent, because if the scene goes bad, the powers that be will be looking at BOTH of you wondering why neither one of you knew wtf you were doing. Then your claim that you knew better but didn't want to rock the boat isn't going to save your job.

Good question, but how do you rock the boat?? I have been shut down by some with more field experience yet less medical than me and, like you, thought "Well, he has more experience than me, so he must know something I don't know, so I'll keep my mouth shut (which I recognize in many cases is true)." So hypothetically, what is a good, positive approach that would result in a good learning experience in this kind of situation?

[becksdad]

Hey chaser, I think possibly a key principle here is to focus on what is right instead of what is wrong. What I mean by that is instead of coming off with "you're doing this wrong", which immediately puts someone on the defensive, you approach with the spirit of "let's do this right", which invites someone to join you in doing things the very best you can. The situations where this can apply are so numerous, I think it would take all night to think of them, but I find it works really well.

I know that is kind of non-specific, but the principle can apply to nearly any situation.

[Malignant-Hyperthermia]

Yeah! what Dustdevil said.............. =D> =D> =D> :D/ :D/

[Asysin2leads]

I didn't read all the posts because I didn't feel like it. The only thing I would have done differently was to use a KED because the woman did not meet the rapid extrication criteria. If you can get the KED on safely, the patient on the backboard, and the patient out safely without adding fire engines to the equation, we call that good utilization of resources. A single BLS crew could have handled this call, it sounds like.

[whit72]

I am still wodering how I implied that I wouldnt board this person.

Neropath stated that a judgement call was "famous last words"

I stated 95% of this job is judgement calls or decisions. He disagreed (the words are one in the same) We cry about protocol robots, but yet we state we dont make judgement calls. Which way is it?

I treat pts based on assesment, that is the greatest tool I (We) have. My job is first and foremost recognition. Without that nothing else really matters.

As far as Extrication, please explain to me if a person is immobilized either by ked, short board etc. How one way would be more beneficial then another (Passenger door, drivers door or through the roof)? If your immobilation practices and techniques are thorough. You should be able to pull them through the keyhole, without chance of further injury. (Keyhole is sarcasm)

Anyway

We can either diagree or realize there is more then one correct way to get to the eventual goal.

[Malignant-Hyperthermia]

I stated 95% of this job is judgement calls or decisions. He disagreed (the words are one in the same) We cry about protocol robots, but yet we state we dont make judgement calls. Which way is it?

No...

I argued that Evidence Based Practice is the ENTIRE job, not judgement calls. education, practice, experience, knowledge, exposure, evidence with a sound base of data that is clinically applicable and appraised approprately

"judgement call" does not even begin to scratch the surface of the philosophy that is evidence based medicine. "Judgement Call" does not take into account wholistic approach..a judgement call is what to eat for lunch, the turkey or the ham. Clinical Decision Making is REAL medicine.

As far as Extrication, please explain to me if a person is immobilized either by ked, short board etc. How one way would be more beneficial then another (Passenger door, drivers door or through the roof)? If your immobilation practices and techniques are thorough . You should be able to pull them through the keyhole, without chance of further injury. (Keyhole is sarcasm)

Please.......you cannot see any variables in which way they are taken out of the vehicle despite the use of appropriate immobilisation techniques?

I am still wodering how I implied that I wouldnt board this person.

like this......

There was no mention of any LOC in the statement. I am guessing no one asked.

There was no mention of any spinal neck/back point tenderness. I am guessing it wasn't assessed

There was no mention of any neuro deficits. I am guessing it wasn't assessed.

No, I feel confident in the fact that if I choose to immobilize someone in a car, I am quite confident, that it wont matter how the pt is extricated.

I am not an extrication specialist, my job is to prepare the person safely and securely for any means of extrication.

I love the fact that people have a problem with the fact that its not of big importance to me how the pt is extricated.

Everyone now quotes nexus, but has no problem that the actual NEXUS assessments were not followed.

That is trying to debunk the patient aplicability to the NEXUS criteria - and as Dust said, incredibly ignorant because it totally negates the information provided

[Dustdevil]

As far as Extrication, please explain to me if a person is immobilized either by ked, short board etc. How one way would be more beneficial then another (Passenger door, drivers door or through the roof)? If your immobilation practices and techniques are thorough. You should be able to pull them through the keyhole, without chance of further injury. (Keyhole is sarcasm)

As Malignant stated, that is almost such a silly question as to not even warrant a response. In fact, it is a good argument for college Physics being a mandatory pre-requisite to EMT school. But if you don't have time for all that book learnin', just try this. Have some of your nimrod partners wrap you up in a KED, stuff you into a car, and then extricate you onto a long board utilising all three of the routes mentioned here. Afterwards, you'll be able to answer your own question. And I guarantee you that you will never want to be lifted out of a peeled back roof again in this lifetime.

And yes, I have done this myself. Back when EMT school was actually a semi-serious programme in the US, an entire weekend was dedicated to extrication training and we got to experience what our patients would be experiencing. I guess these days they have replaced that practical experience with studying all those drugs you have no business giving to anybody.

[AnthonyM83]

So, another day at work...

Usually, we're a roving unit, but lately we've been spending more time in Inglewood, so I'm getting to recognize the firefighters. I think this makes it a bit easier to discuss patient tx decisions with them. I have to say it's definitely intimidating to try to stop tx when it's a team of 6 FF who have no hesitation in what they're doing when you're the EMT crew (who is usually looked down upon).

If you're more heavily in the mix, you can say something like, "So, we're going to do ___ and ____ because ____? Okay, but we're not going to give him oxygen cause _____?" Just stick in a random reason why treatment is different than what you think and they'll correct you, "No, O2 because ____" or "Well, yeah, O2 is good, put him on 15LPM". If you ask as if just confirming why you're doing something for education purposes, it comes off less aggressive and makes the FF/ALS/senior stop to think about their reasons....and you usually learn something without seeming stupid...and shows you're interested in the "why's" of pt care, not just in transporting them.

That was my latest thought on that anyway if there's other noobs reading this.

[zippyRN]

keep them all running , possibly cancel the other BLS vehicle once you have an ETA from the ALS vehicle or keep them running and then stand them down once the ALS vehicle is on scene ... as the other driver warrants at least checking over if not transporting

if the patient is stable the answer with extraction is let the trumpton do their worse with the extrication kit ... however relative entrapment requiring formal extrication is an indication of the damage sustained

[hfdff422]

No, my experience was that there was probably enough extrication training in B class, Dust. Most other things were lacking though!

My take is use the resources you already have coming, three people are not usually enough to extricate a person, and that is leaving another patient without supervision. (My understanding is that there were only the three persons involved in the extrication.) You don't leave patients alone and you don't half-a** immobilizations particularly with such an obvious need per the MOI. Also, the physics of removing a driver seat patient without having access from both sides is either going to hurt you or the patient. The KED is the most underused piece of equipment in our inventory and to all those who don't use it, shame on you (yes, I know rapids need the PHTLS trick or less, but normal process should be to use the KED.)

Your partner is an idiot, get a transfer if you can, or just do it by the book because he is not likely to teach you anything useful.