ratel Posted September 5, 2007 Share Posted September 5, 2007 This was an actual call I attended. You are dispatched to a MVC between a sedan and a 15 seater mini-bus. On arrival you find that the mini-bus has T-Boned the sedan on the passenger side. Inside the sedan you find a 16 year old female trapped with no pulse or respiration. Lying outside the sedan on the drivers side you find a 40 year old female, GCS 14/15 (pt confused and disorientated) Pulse 140 weak and thready, BP 80 systolic and falling rapidly, respirations 18 clear and equal. No signs of fractures, no bleeding, Abdomen soft, no guarding or tenderness. In side the mini-bus you find 8 people with minor bumps and bruises. There is extensive damage to the passenger side of the sedan and the front passenger door has been pushed in at least one foot. On scene you have 1 ambulance (no EMT-P, 1 EMT-I and 1 EMT-, 1 rescue tender (First responder and 1 EMT-B on board), and 2 police patrol vehicles. Other vehicles enroute ETA 20 minutes. nearest ALS unit 30 minutes away (in the opposite direction of the hospital). Nearest hospital 22 minutes away. Link to comment Share on other sites More sharing options...
AnthonyM83 Posted September 5, 2007 Share Posted September 5, 2007 I'm not sure about any issues with maintaining paramedic level of car for everyone, though this is a triage situation. So, I'd say transport the one who seems to be in shock immediately. I would consider an air ambulance. Link to comment Share on other sites More sharing options...
steph1030 Posted September 5, 2007 Share Posted September 5, 2007 triage skills work best here send trhe worst out via air if need be and then work on the less criticals to keep them stable until further resources come always use your resources ...be it als units ,flight units etc really help when backed into a corner Link to comment Share on other sites More sharing options...
BEorP Posted September 5, 2007 Share Posted September 5, 2007 If I can assume that all of the people on the bus can walk then they would initially be triaged as green under START and dead girl is black/blue. This leaves the 40 year old female who would be be red if she had no radials (as she won't for long if her BP is 80 systolic and dropping). Seeing as you have the "rescue tender" that has some medical personnel on it who can worry about the greens then it would seem to be appropriate to transport immediately. Link to comment Share on other sites More sharing options...
ratel Posted September 5, 2007 Author Share Posted September 5, 2007 If I can assume that all of the people on the bus can walk then they would initially be triaged as green under START and dead girl is black/blue. This leaves the 40 year old female who would be be red if she had no radials (as she won't for long if her BP is 80 systolic and dropping). Seeing as you have the "rescue tender" that has some medical personnel on it who can worry about the greens then it would seem to be appropriate to transport immediately. All the people on the bus were triaged green, and I did triage the dead girl as blue. I started bilateral I.V's on the red patient and even with them running full her BP continued to fall. Air ambulance was not available due to weather so when I heard that the nearest ALS was 30 min. out I decided to scoop and scoot. At hospital we found out that she had a ruptured diaphragm, and was bleeding into both her abdominal cavity and her chest cavity. When I returned to base I found out that the ALS unit had put a complaint in against me for not waiting on scene for them. As far as I'm concerned this patient would have died without immediate hospitalization, and ALS could not have done anything more then what I had already done. Link to comment Share on other sites More sharing options...
Kaisu Posted September 5, 2007 Share Posted September 5, 2007 judgement call.. you did the right thing... the patient survived. What is the ALS team trying to accomplish ? Do you have a history with them ? Link to comment Share on other sites More sharing options...
ratel Posted September 5, 2007 Author Share Posted September 5, 2007 Do you have a history with them ? First and only time I've had contact with that specific crew. Link to comment Share on other sites More sharing options...
BEorP Posted September 5, 2007 Share Posted September 5, 2007 I hope ALS did not actually expect you to wait on scene for 30 minutes for them, that is just crazy. You did the right thing and recognized the importance of time for this patient. Link to comment Share on other sites More sharing options...
Baldrick Posted September 5, 2007 Share Posted September 5, 2007 What were they going to do that you didn't? The treatment for trauma is ultimately a surgon. So go don't hand around at the side of the road with a bag of salty water. Link to comment Share on other sites More sharing options...
whit72 Posted September 5, 2007 Share Posted September 5, 2007 ratel wrote: When I returned to base I found out that the ALS unit had put a complaint in against me for not waiting on scene for them. Waiting, fantastic.......I would have filed a complaint against the medics for being retards, you treat trauma with diesel. Link to comment Share on other sites More sharing options...
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