I have a scenario for you guys

[Guest guest]

If the patient is in your care, you make the decisions, not the foreman.

(Is the foreman medically trained?)

**************New MapQuest Local shows what's happening at your destination.

Dining, Movies, Events, News & more. Try it out

(http://local.mapquest.com/?ncid=emlcntnew00000002)

[Guest guest]

Respond to a call were someone has been hit in the head by a tire. Will he

is airing it up it explodes. You arrive and find a 20-25 year old male

sitting with blood clotting in nose laceration to bridge of nose and

swelling to the forehead and nose and severe knee pain with laceration.

Patient is sitting in chair as we approach the foreman tells the patient to

put his head back, we stop that action and take manual c-spine the patient

states " what happened to me? " Due to the local hospital being level IV and

the nearest level III is 45 miles away we decide to airlift. The foreman

immediately states no helicopter! We tell him that whatever this young man

has cannot be fixed in our local hospital and that it would be best to have

him at a higher level of care as quickly as possible he again says no

helicopter and that we are wasting time we have the young man c-collared,

spiders, head blocks, backboard moved to unit monitors attached IVs

attempted pt begging to be airlifted and foreman still refusing helicopter

screaming we been on scene 45 minutes (in reality 15 minutes). He even

states that every time you come out here you have to airlift(we have been to

this plant 5 times airlifted one with all ribs separated from sternum due to

crushing injury from forklift).

What would you do?

Would you complain?

And if yes to who?

This is the highest man on the totem pole at this plant so where do you go

from here? Just forget it or is this something that can be taken up with

DSHS?

Debbie

[Guest guest]

Seems to me like you ought to have your EMS director contact the foreman's

boss and explain that the foreman is not in charge of EMS decisions and

needs to stay out of the way during a call.

Joe Percer, LP

> If the patient is in your care, you make the decisions, not the foreman.

> (Is the foreman medically trained?)

> **************New MapQuest Local shows what's happening at your

> destination.

> Dining, Movies, Events, News & more. Try it out

> (http://local.mapquest.com/?ncid=emlcntnew00000002)

>

>

[Guest guest]

I just noticed that you said he's the highest man at the plant... However,

he must have a boss somewhere...

JP

> Seems to me like you ought to have your EMS director contact the foreman's

> boss and explain that the foreman is not in charge of EMS decisions and

> needs to stay out of the way during a call.

>

> Joe Percer, LP

>

>

>

>

>> If the patient is in your care, you make the decisions, not the

>> foreman.

>> (Is the foreman medically trained?)

>> **************New MapQuest Local shows what's happening at your

>> destination.

>> Dining, Movies, Events, News & more. Try it out

>> (http://local.mapquest.com/?ncid=emlcntnew00000002)

>>

>>

[Guest guest]

Call the police, sheriff or whatever local law enforcement agency you have in

your area have him REMOVED from YOUR scene.....

This taken directly from the TEXAS PENAL CODE: read 38.15 (2)

38.15. INTERFERENCE WITH PUBLIC DUTIES. (a) A person

commits an offense if the person with criminal negligence

interrupts, disrupts, impedes, or otherwise interferes with:

(1) a peace officer while the peace officer is

performing a duty or exercising authority imposed or granted by

law;

(2) a person who is employed to provide emergency

medical services including the transportation of ill or injured

persons while the person is performing that duty;

(3) a fire fighter, while the fire fighter is fighting

a fire or investigating the cause of a fire;

(4) an animal under the supervision of a peace

officer, corrections officer, or jailer, if the person knows the

animal is being used for law enforcement, corrections, prison or

jail security, or investigative purposes;

(5) the transmission of a communication over a

citizen's band radio channel, the purpose of which communication is

to inform or inquire about an emergency;

(6) an officer with responsibility for animal control

in a county or municipality, while the officer is performing a duty

or exercising authority imposed or granted under Chapter 821 or

822, Health and Safety Code; or

(7) a person who:

(A) has responsibility for assessing, enacting,

or enforcing public health, environmental, radiation, or safety

measures for the state or a county or municipality;

( is investigating a particular site as part of

the person's responsibilities under Paragraph (A);

© is acting in accordance with policies and

procedures related to the safety and security of the site described

by Paragraph (; and

(D) is performing a duty or exercising authority

imposed or granted under the Agriculture Code, Health and Safety

Code, Occupations Code, or Water Code.

( An offense under this section is a Class B misdemeanor.

© It is a defense to prosecution under Subsection (a)(1)

that the conduct engaged in by the defendant was intended to warn a

person operating a motor vehicle of the presence of a peace officer

who was enforcing Subtitle C, Title 7, Transportation Code.

(d) It is a defense to prosecution under this section that

the interruption, disruption, impediment, or interference alleged

consisted of speech only.

(e) In this section, " emergency " means a condition or

circumstance in which an individual is or is reasonably believed by

the person transmitting the communication to be in imminent danger

of serious bodily injury or in which property is or is reasonably

believed by the person transmitting the communication to be in

imminent danger of damage or destruction.

VanBibber

Communications Supervisor

Hopkins County EMS

115 Airport Rd.

Sulphur Springs, Texas 75482

" It's a funny thing about life; if you refuse to accept anything but the best,

you very often get it. "

-W. Somerset Maugham

From: texasems-l [mailto:texasems-l ] On Behalf

Of Debbie Fishbeck

Sent: Tuesday, October 21, 2008 3:15 PM

To: texasems-l

Subject: I have a scenario for you guys

Respond to a call were someone has been hit in the head by a tire. Will he

is airing it up it explodes. You arrive and find a 20-25 year old male

sitting with blood clotting in nose laceration to bridge of nose and

swelling to the forehead and nose and severe knee pain with laceration.

Patient is sitting in chair as we approach the foreman tells the patient to

put his head back, we stop that action and take manual c-spine the patient

states " what happened to me? " Due to the local hospital being level IV and

the nearest level III is 45 miles away we decide to airlift. The foreman

immediately states no helicopter! We tell him that whatever this young man

has cannot be fixed in our local hospital and that it would be best to have

him at a higher level of care as quickly as possible he again says no

helicopter and that we are wasting time we have the young man c-collared,

spiders, head blocks, backboard moved to unit monitors attached IVs

attempted pt begging to be airlifted and foreman still refusing helicopter

screaming we been on scene 45 minutes (in reality 15 minutes). He even

states that every time you come out here you have to airlift(we have been to

this plant 5 times airlifted one with all ribs separated from sternum due to

crushing injury from forklift).

What would you do?

Would you complain?

And if yes to who?

This is the highest man on the totem pole at this plant so where do you go

from here? Just forget it or is this something that can be taken up with

DSHS?

Debbie

________________________________

IMPORTANT NOTICE: This e-mail message is intended to be received only by persons

entitled to receive the confidential information it may contain. E-mail messages

to clients of Hopkins County Memorial Hospital may contain information that is

confidential and legally privileged. Please do not read, copy, forward, or store

this message unless you are an intended recipient of it. If you have received

this message in error, please forward it to the sender and delete it completely

from your computer system.

[Guest guest]

What about scene time 15 minutes with no extraction. Where is the

platinum 10 minutes? Maybe he is right ground transport why wait on

HEMS.

>

> Respond to a call were someone has been hit in the head by a

tire. Will he

> is airing it up it explodes. You arrive and find a 20-25 year old

male

> sitting with blood clotting in nose laceration to bridge of nose

and

> swelling to the forehead and nose and severe knee pain with

laceration.

> Patient is sitting in chair as we approach the foreman tells the

patient to

> put his head back, we stop that action and take manual c-spine the

patient

> states " what happened to me? " Due to the local hospital being

level IV and

> the nearest level III is 45 miles away we decide to airlift. The

foreman

> immediately states no helicopter! We tell him that whatever this

young man

> has cannot be fixed in our local hospital and that it would be

best to have

> him at a higher level of care as quickly as possible he again says

no

> helicopter and that we are wasting time we have the young man c-

collared,

> spiders, head blocks, backboard moved to unit monitors attached IVs

> attempted pt begging to be airlifted and foreman still refusing

helicopter

> screaming we been on scene 45 minutes (in reality 15 minutes). He

even

> states that every time you come out here you have to airlift(we

have been to

> this plant 5 times airlifted one with all ribs separated from

sternum due to

> crushing injury from forklift).

>

> What would you do?

>

> Would you complain?

>

> And if yes to who?

>

> This is the highest man on the totem pole at this plant so where

do you go

> from here? Just forget it or is this something that can be taken

up with

> DSHS?

>

> Debbie

>

[Guest guest]

Easy to solve. Advise the individual that he does not have the right to " refuse "

air transport, regardless of his " ranking " status. Unless you are on a military

installation then no one has the right to tell you no EXCEPT your immediate

supervisor (on scene) or medical director/control. If you are the highest

medical person on scene then you make that call. If he becomes belligerent then

have law enforcement step in and remove him. Sounds simple because it is.

Just curious though, did this patient need to be air lifted due to the injuries

or due to the absence of ALS staff or what? Without additional information it

could be seen as this patient could be transported by ground.

________________________________

To: texasems-l

Sent: Tuesday, October 21, 2008 3:14:45 PM

Subject: I have a scenario for you guys

Respond to a call were someone has been hit in the head by a tire. Will he

is airing it up it explodes. You arrive and find a 20-25 year old male

sitting with blood clotting in nose laceration to bridge of nose and

swelling to the forehead and nose and severe knee pain with laceration.

Patient is sitting in chair as we approach the foreman tells the patient to

put his head back, we stop that action and take manual c-spine the patient

states " what happened to me? " Due to the local hospital being level IV and

the nearest level III is 45 miles away we decide to airlift. The foreman

immediately states no helicopter! We tell him that whatever this young man

has cannot be fixed in our local hospital and that it would be best to have

him at a higher level of care as quickly as possible he again says no

helicopter and that we are wasting time we have the young man c-collared,

spiders, head blocks, backboard moved to unit monitors attached IVs

attempted pt begging to be airlifted and foreman still refusing helicopter

screaming we been on scene 45 minutes (in reality 15 minutes). He even

states that every time you come out here you have to airlift(we have been to

this plant 5 times airlifted one with all ribs separated from sternum due to

crushing injury from forklift).

What would you do?

Would you complain?

And if yes to who?

This is the highest man on the totem pole at this plant so where do you go

from here? Just forget it or is this something that can be taken up with

DSHS?

Debbie

[Guest guest]

When I was in a VFD we had a similar situation when the nursing home

administrator refused to have patients moved from a possible haz-mat

exposure. After multiple attempts to explain that once 9-1-1 comes on

scene that the scene belongs to the emergency service folks until turned

back to the owner/administrator didn't work, we had law enforcement come

on scene to remove her as she was interfering with EMS/fire operations.

That changed her mind and she started cooperating. (It's amazing what

the sight of handcuffs coming out of their holster will do to motivate

people.)

Other than being the person who called, once you are scene the foreman

is just another bystander. What would be the response if the situation

was a fire and he said no water just because you used water the last

five fires and it created mud issues at the plant.

Barry

Barry Sharp, MSHP, CHES

Program Coordinator

Tobacco Prevention & Control

Texas Dept. of State Health Services

Barry.Sharp@...

PLEASE NOTE NEW MAILING ADDRESS:

P.O. Box 149347

Mail Code 2018

Austin, Texas 78714-9347

________________________________

From: texasems-l [mailto:texasems-l ] On

Behalf Of Debbie Fishbeck

Sent: Tuesday, October 21, 2008 3:15 PM

To: texasems-l

Subject: I have a scenario for you guys

Respond to a call were someone has been hit in the head by a tire. Will

he

is airing it up it explodes. You arrive and find a 20-25 year old male

sitting with blood clotting in nose laceration to bridge of nose and

swelling to the forehead and nose and severe knee pain with laceration.

Patient is sitting in chair as we approach the foreman tells the patient

to

put his head back, we stop that action and take manual c-spine the

patient

states " what happened to me? " Due to the local hospital being level IV

and

the nearest level III is 45 miles away we decide to airlift. The foreman

immediately states no helicopter! We tell him that whatever this young

man

has cannot be fixed in our local hospital and that it would be best to

have

him at a higher level of care as quickly as possible he again says no

helicopter and that we are wasting time we have the young man

c-collared,

spiders, head blocks, backboard moved to unit monitors attached IVs

attempted pt begging to be airlifted and foreman still refusing

helicopter

screaming we been on scene 45 minutes (in reality 15 minutes). He even

states that every time you come out here you have to airlift(we have

been to

this plant 5 times airlifted one with all ribs separated from sternum

due to

crushing injury from forklift).

What would you do?

Would you complain?

And if yes to who?

This is the highest man on the totem pole at this plant so where do you

go

from here? Just forget it or is this something that can be taken up with

DSHS?

Debbie

[Guest guest]

I'd politely suggest to the foreman that the patient, not the foreman, makes the

decisions what happens to the patient.? In this case, the rules of implied

consent may apply as the patient may have an altered mental status.

If the foreman continues to protest, I'd recommend retaining the services of

local law enforcement to

1) Assist the foreman in understanding the gravity of the situation, or

2) Escorting the foreman from the scene and/or to " time-out. "

-Wes Ogilvie, MPA, JD, LP

-Attorney/Licensed Paramedic

-Austin, Texas

**Standard disclaimer applies -- since you're not paying me, what I'm saying

isn't legal advice.**

I have a scenario for you guys

Respond to a call were someone has been hit in the head by a tire. Will he

is airing it up it explodes. You arrive and find a 20-25 year old male

sitting with blood clotting in nose laceration to bridge of nose and

swelling to the forehead and nose and severe knee pain with laceration.

Patient is sitting in chair as we approach the foreman tells the patient to

put his head back, we stop that action and take manual c-spine the patient

states " what happened to me? " Due to the local hospital being level IV and

the nearest level III is 45 miles away we decide to airlift. The foreman

immediately states no helicopter! We tell him that whatever this young man

has cannot be fixed in our local hospital and that it would be best to have

him at a higher level of care as quickly as possible he again says no

helicopter and that we are wasting time we have the young man c-collared,

spiders, head blocks, backboard moved to unit monitors attached IVs

attempted pt begging to be airlifted and foreman still refusing helicopter

screaming we been on scene 45 minutes (in reality 15 minutes). He even

states that every time you come out here you have to airlift(we have been to

this plant 5 times airlifted one with all ribs separated from sternum due to

crushing injury from forklift).

What would you do?

Would you complain?

And if yes to who?

This is the highest man on the totem pole at this plant so where do you go

from here? Just forget it or is this something that can be taken up with

DSHS?

Debbie

[Guest guest]

Joby asks a good question.? Why is there a need for helicopter transport?? What

interventions is a helicopter bringing that a ground unit can't perform?

-Wes Ogilvie

I have a scenario for you guys

Respond to a call were someone has been hit in the head by a tire. Will he

is airing it up it explodes. You arrive and find a 20-25 year old male

sitting with blood clotting in nose laceration to bridge of nose and

swelling to the forehead and nose and severe knee pain with laceration.

Patient is sitting in chair as we approach the foreman tells the patient to

put his head back, we stop that action and take manual c-spine the patient

states " what happened to me? " Due to the local hospital being level IV and

the nearest level III is 45 miles away we decide to airlift. The foreman

immediately states no helicopter! We tell him that whatever this young man

has cannot be fixed in our local hospital and that it would be best to have

him at a higher level of care as quickly as possible he again says no

helicopter and that we are wasting time we have the young man c-collared,

spiders, head blocks, backboard moved to unit monitors attached IVs

attempted pt begging to be airlifted and foreman still refusing helicopter

screaming we been on scene 45 minutes (in reality 15 minutes). He even

states that every time you come out here you have to airlift(we have been to

this plant 5 times airlifted one with all ribs separated from sternum due to

crushing injury from forklift).

What would you do?

Would you complain?

And if yes to who?

This is the highest man on the totem pole at this plant so where do you go

from here? Just forget it or is this something that can be taken up with

DSHS?

Debbie

[Guest guest]

How about packaging the patient, notify air, load patient, head toward

Level II hospital and meet helicopter enroute.

My question is: why airlift a possible head injury patient to a Level

lll hospital?

Eddie , EMT-P

Education Coordinator

National EMS Academy-Texas

Acadian Ambulance Service, Inc.

4100 Ed Bluestein Blvd., Suite 100

Austin, TX 78721

office:

cell:

ewalker@...

" Nullis Ovis "

From: texasems-l [mailto:texasems-l ] On

Behalf Of vernon.wickliffe

Sent: Tuesday, October 21, 2008 3:29 PM

To: texasems-l

Subject: Re: I have a scenario for you guys

What about scene time 15 minutes with no extraction. Where is the

platinum 10 minutes? Maybe he is right ground transport why wait on

HEMS.

>

> Respond to a call were someone has been hit in the head by a

tire. Will he

> is airing it up it explodes. You arrive and find a 20-25 year old

male

> sitting with blood clotting in nose laceration to bridge of nose

and

> swelling to the forehead and nose and severe knee pain with

laceration.

> Patient is sitting in chair as we approach the foreman tells the

patient to

> put his head back, we stop that action and take manual c-spine the

patient

> states " what happened to me? " Due to the local hospital being

level IV and

> the nearest level III is 45 miles away we decide to airlift. The

foreman

> immediately states no helicopter! We tell him that whatever this

young man

> has cannot be fixed in our local hospital and that it would be

best to have

> him at a higher level of care as quickly as possible he again says

no

> helicopter and that we are wasting time we have the young man c-

collared,

> spiders, head blocks, backboard moved to unit monitors attached IVs

> attempted pt begging to be airlifted and foreman still refusing

helicopter

> screaming we been on scene 45 minutes (in reality 15 minutes). He

even

> states that every time you come out here you have to airlift(we

have been to

> this plant 5 times airlifted one with all ribs separated from

sternum due to

> crushing injury from forklift).

>

> What would you do?

>

> Would you complain?

>

> And if yes to who?

>

> This is the highest man on the totem pole at this plant so where

do you go

> from here? Just forget it or is this something that can be taken

up with

> DSHS?

>

> Debbie

>

--------------------------------------------------------------------

The information contained in this communication is confidential and proprietary

information intended only for the individual or entity to whom it is addressed.

Any unauthorized use, distribution, copying, or disclosure of this communication

is strictly prohibited. If you have received this communication in error,

please contact the sender immediately. If you believe this communication is

inappropriate or offensive, please contact the Acadian Ambulance Information

Systems Department at .

[Guest guest]

A really big fan and a great deal of wind and noise....

Dudley

I have a scenario for you guys

Respond to a call were someone has been hit in the head by a tire. Will he

is airing it up it explodes. You arrive and find a 20-25 year old male

sitting with blood clotting in nose laceration to bridge of nose and

swelling to the forehead and nose and severe knee pain with laceration.

Patient is sitting in chair as we approach the foreman tells the patient to

put his head back, we stop that action and take manual c-spine the patient

states " what happened to me? " Due to the local hospital being level IV and

the nearest level III is 45 miles away we decide to airlift. The foreman

immediately states no helicopter! We tell him that whatever this young man

has cannot be fixed in our local hospital and that it would be best to have

him at a higher level of care as quickly as possible he again says no

helicopter and that we are wasting time we have the young man c-collared,

spiders, head blocks, backboard moved to unit monitors attached IVs

attempted pt begging to be airlifted and foreman still refusing helicopter

screaming we been on scene 45 minutes (in reality 15 minutes). He even

states that every time you come out here you have to airlift(we have been to

this plant 5 times airlifted one with all ribs separated from sternum due to

crushing injury from forklift).

What would you do?

Would you complain?

And if yes to who?

This is the highest man on the totem pole at this plant so where do you go

from here? Just forget it or is this something that can be taken up with

DSHS?

Debbie

[Guest guest]

Having worked at Houston Raceway Park during the NHRA Spring Nationals in 2007 I

can attest that Lifeflight was very effective. They helped dry the track not

once but twice and we actually got see a few runs toward the end of the day.

To: texasems-l@...: THEDUDMAN@...: Tue, 21 Oct 2008

23:57:32 -0400Subject: Re: I have a scenario for you guys

A really big fan and a great deal of wind and noise....Dudley-----Original

Message-----From: ExLngHrn@...: texasems-l@...: Tue, 21

Oct 2008 3:36 pmSubject: Re: I have a scenario for you guysJoby

asks a good question.? Why is there a need for helicopter transport?? What

interventions is a helicopter bringing that a ground unit can't perform?-Wes

Ogilvie I have a scenario for you guysRespond

to a call were someone has been hit in the head by a tire. Will heis airing it

up it explodes. You arrive and find a 20-25 year old malesitting with blood

clotting in nose laceration to bridge of nose andswelling to the forehead and

nose and severe knee pain with laceration.Patient is sitting in chair as we

approach the foreman tells the patient toput his head back, we stop that action

and take manual c-spine the patientstates " what happened to me? " Due to the

local hospital being level IV andthe nearest level III is 45 miles away we

decide to airlift. The foremanimmediately states no helicopter! We tell him that

whatever this young manhas cannot be fixed in our local hospital and that it

would be best to havehim at a higher level of care as quickly as possible he

again says nohelicopter and that we are wasting time we have the young man

c-collared,spiders, head blocks, backboard moved to unit monitors attached

IVsattempted pt begging to be airlifted and foreman still refusing

helicopterscreaming we been on scene 45 minutes (in reality 15 minutes). He

evenstates that every time you come out here you have to airlift(we have been

tothis plant 5 times airlifted one with all ribs separated from sternum due

tocrushing injury from forklift).What would you do?Would you complain?And if yes

to who?This is the highest man on the totem pole at this plant so where do you

gofrom here? Just forget it or is this something that can be taken up

withDSHS?Debbie

[Guest guest]

Vernon: Recent reports have come to light that the " golden hour " and the

" platinum ten minutes " theories may be flawed. I have read that they may

be complicated, and widely adopted marketing strategies to support

trauma systems. I believe it was the Baltimore land Shock Trauma

system that promoted this theory first. I'm sure the good Dr. Bledsoe

would have some literature on its use. If I find a link I will send it.

Lt. Steve Lemming, A.A.S., L.P.

C-Shift

EMS Administration Officer

Azle, Texas Fire Department

This e-mail is confidential and intended solely for the use of the

individual (s) to whom it is addressed. Any views or opinions presented

are solely those of the author and do not necessarily represent those of

The City of Azle or its policies. If you have received this e-mail

message in error, please phone Steve Lemming (817)444-7108. Please also

destroy and delete the message from your computer.

For more information on The City of Azle, visit our web site at:

http://www.cityofazle.org <http://www.cityofazle.org>

From: texasems-l [mailto:texasems-l ] On

Behalf Of vernon.wickliffe

Sent: Tuesday, October 21, 2008 3:29 PM

To: texasems-l

Subject: Re: I have a scenario for you guys

What about scene time 15 minutes with no extraction. Where is the

platinum 10 minutes? Maybe he is right ground transport why wait on

HEMS.

>

> Respond to a call were someone has been hit in the head by a

tire. Will he

> is airing it up it explodes. You arrive and find a 20-25 year old

male

> sitting with blood clotting in nose laceration to bridge of nose

and

> swelling to the forehead and nose and severe knee pain with

laceration.

> Patient is sitting in chair as we approach the foreman tells the

patient to

> put his head back, we stop that action and take manual c-spine the

patient

> states " what happened to me? " Due to the local hospital being

level IV and

> the nearest level III is 45 miles away we decide to airlift. The

foreman

> immediately states no helicopter! We tell him that whatever this

young man

> has cannot be fixed in our local hospital and that it would be

best to have

> him at a higher level of care as quickly as possible he again says

no

> helicopter and that we are wasting time we have the young man c-

collared,

> spiders, head blocks, backboard moved to unit monitors attached IVs

> attempted pt begging to be airlifted and foreman still refusing

helicopter

> screaming we been on scene 45 minutes (in reality 15 minutes). He

even

> states that every time you come out here you have to airlift(we

have been to

> this plant 5 times airlifted one with all ribs separated from

sternum due to

> crushing injury from forklift).

>

> What would you do?

>

> Would you complain?

>

> And if yes to who?

>

> This is the highest man on the totem pole at this plant so where

do you go

> from here? Just forget it or is this something that can be taken

up with

> DSHS?

>

> Debbie

>

[Guest guest]

Steve, I understand that the " golden hour " his serious flaws. It was

Dr. Cowley of shock trauma that supported this magical hour. But I

was talking scene time the " platinum ten minute " I believe even the

good Dr. Bledsoe would agree. Getting a patient off the scene in

less then ten minute is support by both BTLS and PHTLS.

> >

> > Respond to a call were someone has been hit in the head by a

> tire. Will he

> > is airing it up it explodes. You arrive and find a 20-25 year

old

> male

> > sitting with blood clotting in nose laceration to bridge of nose

> and

> > swelling to the forehead and nose and severe knee pain with

> laceration.

> > Patient is sitting in chair as we approach the foreman tells the

> patient to

> > put his head back, we stop that action and take manual c-spine

the

> patient

> > states " what happened to me? " Due to the local hospital being

> level IV and

> > the nearest level III is 45 miles away we decide to airlift. The

> foreman

> > immediately states no helicopter! We tell him that whatever this

> young man

> > has cannot be fixed in our local hospital and that it would be

> best to have

> > him at a higher level of care as quickly as possible he again

says

> no

> > helicopter and that we are wasting time we have the young man c-

> collared,

> > spiders, head blocks, backboard moved to unit monitors attached

IVs

> > attempted pt begging to be airlifted and foreman still refusing

> helicopter

> > screaming we been on scene 45 minutes (in reality 15 minutes).

He

> even

> > states that every time you come out here you have to airlift(we

> have been to

> > this plant 5 times airlifted one with all ribs separated from

> sternum due to

> > crushing injury from forklift).

> >

> > What would you do?

> >

> > Would you complain?

> >

> > And if yes to who?

> >

> > This is the highest man on the totem pole at this plant so where

> do you go

> > from here? Just forget it or is this something that can be taken

> up with

> > DSHS?

> >

> > Debbie

> >

>

>

>

>

>

>

[Guest guest]

It might be supported by ITLS and PHTLS, but the evolving literature is

showing that out of hospital time is not a predictor of mortality.

BEB

From: texasems-l [mailto:texasems-l ] On

Behalf Of vernon.wickliffe

Sent: Wednesday, October 22, 2008 11:11 AM

To: texasems-l

Subject: Re: I have a scenario for you guys

Steve, I understand that the " golden hour " his serious flaws. It was

Dr. Cowley of shock trauma that supported this magical hour. But I

was talking scene time the " platinum ten minute " I believe even the

good Dr. Bledsoe would agree. Getting a patient off the scene in

less then ten minute is support by both BTLS and PHTLS.

> >

> > Respond to a call were someone has been hit in the head by a

> tire. Will he

> > is airing it up it explodes. You arrive and find a 20-25 year

old

> male

> > sitting with blood clotting in nose laceration to bridge of nose

> and

> > swelling to the forehead and nose and severe knee pain with

> laceration.

> > Patient is sitting in chair as we approach the foreman tells the

> patient to

> > put his head back, we stop that action and take manual c-spine

the

> patient

> > states " what happened to me? " Due to the local hospital being

> level IV and

> > the nearest level III is 45 miles away we decide to airlift. The

> foreman

> > immediately states no helicopter! We tell him that whatever this

> young man

> > has cannot be fixed in our local hospital and that it would be

> best to have

> > him at a higher level of care as quickly as possible he again

says

> no

> > helicopter and that we are wasting time we have the young man c-

> collared,

> > spiders, head blocks, backboard moved to unit monitors attached

IVs

> > attempted pt begging to be airlifted and foreman still refusing

> helicopter

> > screaming we been on scene 45 minutes (in reality 15 minutes).

He

> even

> > states that every time you come out here you have to airlift(we

> have been to

> > this plant 5 times airlifted one with all ribs separated from

> sternum due to

> > crushing injury from forklift).

> >

> > What would you do?

> >

> > Would you complain?

> >

> > And if yes to who?

> >

> > This is the highest man on the totem pole at this plant so where

> do you go

> > from here? Just forget it or is this something that can be taken

> up with

> > DSHS?

> >

> > Debbie

> >

>

>

>

>

>

>

[Guest guest]

You are a 911 provider. You call the shots. Tell the foreman not to

interfere, if continues have PD remove him from the scene or place him

under arrest. This pt. needs to be evaluated by a Nuerosurgeon. Also,

what is the time frame for air support? Can you rendevousz at the level

IV facility without going inside? Control your scene, do not get locked

into " only air ambulances " can give good care.

NHTSA AND NTIA UNVEIL GRANT PROGRAM TO HELP STATES UPGRADE 9-1-1

SERVICES

The U.S. Department of Transportation's National Highway Traffic Safety

Administration (NHTSA) and the U.S. Department of Commerce's National

Telecommunications and Information Administration (NTIA) recently

announced a proposal to make available more than $40 million in grants

to help states and territories improve their 9-1-1 call centers. The

grants were authorized by the ENHANCE 911 Act. All states, the District

of Columbia, Puerto Rico and U.S. territories are eligible for the

grants. Among other things, the funds will be used to implement

technologies to deliver wireless 9-1-1 calls with automatic location

information. The joint proposal, published in the Federal Register,

spells out details of the proposed grant program, including the

application and administrative requirements of the proposed rule. The

funds will be awarded in fiscal year 2009. Interested parties will have

60 days to comment on the proposal. Please see the following weblink

for more information:

http://federalregister.gov/OFRUpload/OFRData/2008-23266_PI.pdf

Captain Wayne Rutherford

EMS Administration

Re: I have a scenario for you guys

Steve, I understand that the " golden hour " his serious flaws. It was

Dr. Cowley of shock trauma that supported this magical hour. But I

was talking scene time the " platinum ten minute " I believe even the

good Dr. Bledsoe would agree. Getting a patient off the scene in

less then ten minute is support by both BTLS and PHTLS.

> >

> > Respond to a call were someone has been hit in the head by a

> tire. Will he

> > is airing it up it explodes. You arrive and find a 20-25 year

old

> male

> > sitting with blood clotting in nose laceration to bridge of nose

> and

> > swelling to the forehead and nose and severe knee pain with

> laceration.

> > Patient is sitting in chair as we approach the foreman tells the

> patient to

> > put his head back, we stop that action and take manual c-spine

the

> patient

> > states " what happened to me? " Due to the local hospital being

> level IV and

> > the nearest level III is 45 miles away we decide to airlift. The

> foreman

> > immediately states no helicopter! We tell him that whatever this

> young man

> > has cannot be fixed in our local hospital and that it would be

> best to have

> > him at a higher level of care as quickly as possible he again

says

> no

> > helicopter and that we are wasting time we have the young man c-

> collared,

> > spiders, head blocks, backboard moved to unit monitors attached

IVs

> > attempted pt begging to be airlifted and foreman still refusing

> helicopter

> > screaming we been on scene 45 minutes (in reality 15 minutes).

He

> even

> > states that every time you come out here you have to airlift(we

> have been to

> > this plant 5 times airlifted one with all ribs separated from

> sternum due to

> > crushing injury from forklift).

> >

> > What would you do?

> >

> > Would you complain?

> >

> > And if yes to who?

> >

> > This is the highest man on the totem pole at this plant so where

> do you go

> > from here? Just forget it or is this something that can be taken

> up with

> > DSHS?

> >

> > Debbie

> >

>

>

>

>

>

>

[Guest guest]

It is supported by PHTLS and ITLS...but we in EMS have evolved an entire

belief system out of what was a brilliant marketing ploy by R.A. Cowley.

Doesn't necessarily make it scientifically proven.

Bledsoe wrote:

>

> It might be supported by ITLS and PHTLS, but the evolving literature is

> showing that out of hospital time is not a predictor of mortality.

>

> BEB

>

> From: texasems-l <mailto:texasems-l%40yahoogroups.com>

> [mailto:texasems-l

> <mailto:texasems-l%40yahoogroups.com>] On

> Behalf Of vernon.wickliffe

> Sent: Wednesday, October 22, 2008 11:11 AM

> To: texasems-l <mailto:texasems-l%40yahoogroups.com>

> Subject: Re: I have a scenario for you guys

>

> Steve, I understand that the " golden hour " his serious flaws. It was

> Dr. Cowley of shock trauma that supported this magical hour. But I

> was talking scene time the " platinum ten minute " I believe even the

> good Dr. Bledsoe would agree. Getting a patient off the scene in

> less then ten minute is support by both BTLS and PHTLS.

>

>

> > >

> > > Respond to a call were someone has been hit in the head by a

> > tire. Will he

> > > is airing it up it explodes. You arrive and find a 20-25 year

> old

> > male

> > > sitting with blood clotting in nose laceration to bridge of nose

> > and

> > > swelling to the forehead and nose and severe knee pain with

> > laceration.

> > > Patient is sitting in chair as we approach the foreman tells the

> > patient to

> > > put his head back, we stop that action and take manual c-spine

> the

> > patient

> > > states " what happened to me? " Due to the local hospital being

> > level IV and

> > > the nearest level III is 45 miles away we decide to airlift. The

> > foreman

> > > immediately states no helicopter! We tell him that whatever this

> > young man

> > > has cannot be fixed in our local hospital and that it would be

> > best to have

> > > him at a higher level of care as quickly as possible he again

> says

> > no

> > > helicopter and that we are wasting time we have the young man c-

> > collared,

> > > spiders, head blocks, backboard moved to unit monitors attached

> IVs

> > > attempted pt begging to be airlifted and foreman still refusing

> > helicopter

> > > screaming we been on scene 45 minutes (in reality 15 minutes).

> He

> > even

> > > states that every time you come out here you have to airlift(we

> > have been to

> > > this plant 5 times airlifted one with all ribs separated from

> > sternum due to

> > > crushing injury from forklift).

> > >

> > > What would you do?

> > >

> > > Would you complain?

> > >

> > > And if yes to who?

> > >

> > > This is the highest man on the totem pole at this plant so where

> > do you go

> > > from here? Just forget it or is this something that can be taken

> > up with

> > > DSHS?

> > >

> > > Debbie

> > >

> >

> >

> >

> >

> >

> >

[Guest guest]

Understood Dr.Bledsoe, But from an educational side do we want scene

time greater than ten minute? I would prefer my crew to take care of

the priority then start moving. Same thing you thought us in

Waxahachie many years ago.

> > >

> > > Respond to a call were someone has been hit in the head by a

> > tire. Will he

> > > is airing it up it explodes. You arrive and find a 20-25 year

> old

> > male

> > > sitting with blood clotting in nose laceration to bridge of

nose

> > and

> > > swelling to the forehead and nose and severe knee pain with

> > laceration.

> > > Patient is sitting in chair as we approach the foreman tells

the

> > patient to

> > > put his head back, we stop that action and take manual c-spine

> the

> > patient

> > > states " what happened to me? " Due to the local hospital being

> > level IV and

> > > the nearest level III is 45 miles away we decide to airlift.

The

> > foreman

> > > immediately states no helicopter! We tell him that whatever

this

> > young man

> > > has cannot be fixed in our local hospital and that it would be

> > best to have

> > > him at a higher level of care as quickly as possible he again

> says

> > no

> > > helicopter and that we are wasting time we have the young man

c-

> > collared,

> > > spiders, head blocks, backboard moved to unit monitors

attached

> IVs

> > > attempted pt begging to be airlifted and foreman still

refusing

> > helicopter

> > > screaming we been on scene 45 minutes (in reality 15 minutes).

> He

> > even

> > > states that every time you come out here you have to airlift

(we

> > have been to

> > > this plant 5 times airlifted one with all ribs separated from

> > sternum due to

> > > crushing injury from forklift).

> > >

> > > What would you do?

> > >

> > > Would you complain?

> > >

> > > And if yes to who?

> > >

> > > This is the highest man on the totem pole at this plant so

where

> > do you go

> > > from here? Just forget it or is this something that can be

taken

> > up with

> > > DSHS?

> > >

> > > Debbie

> > >

> >

> >

> >

> >

> >

> >

[Guest guest]

Waxahachie was 10 years ago..but I would agree that out of-hospital time

should be minimized if it can be done safely (avoid lights and sirens,

helicopters) unless the patient is clearly in extremis-not MOI and similar

BS.

BEB

From: texasems-l [mailto:texasems-l ] On

Behalf Of vernon.wickliffe

Sent: Wednesday, October 22, 2008 12:17 PM

To: texasems-l

Subject: Re: I have a scenario for you guys

Understood Dr.Bledsoe, But from an educational side do we want scene

time greater than ten minute? I would prefer my crew to take care of

the priority then start moving. Same thing you thought us in

Waxahachie many years ago.

> > >

> > > Respond to a call were someone has been hit in the head by a

> > tire. Will he

> > > is airing it up it explodes. You arrive and find a 20-25 year

> old

> > male

> > > sitting with blood clotting in nose laceration to bridge of

nose

> > and

> > > swelling to the forehead and nose and severe knee pain with

> > laceration.

> > > Patient is sitting in chair as we approach the foreman tells

the

> > patient to

> > > put his head back, we stop that action and take manual c-spine

> the

> > patient

> > > states " what happened to me? " Due to the local hospital being

> > level IV and

> > > the nearest level III is 45 miles away we decide to airlift.

The

> > foreman

> > > immediately states no helicopter! We tell him that whatever

this

> > young man

> > > has cannot be fixed in our local hospital and that it would be

> > best to have

> > > him at a higher level of care as quickly as possible he again

> says

> > no

> > > helicopter and that we are wasting time we have the young man

c-

> > collared,

> > > spiders, head blocks, backboard moved to unit monitors

attached

> IVs

> > > attempted pt begging to be airlifted and foreman still

refusing

> > helicopter

> > > screaming we been on scene 45 minutes (in reality 15 minutes).

> He

> > even

> > > states that every time you come out here you have to airlift

(we

> > have been to

> > > this plant 5 times airlifted one with all ribs separated from

> > sternum due to

> > > crushing injury from forklift).

> > >

> > > What would you do?

> > >

> > > Would you complain?

> > >

> > > And if yes to who?

> > >

> > > This is the highest man on the totem pole at this plant so

where

> > do you go

> > > from here? Just forget it or is this something that can be

taken

> > up with

> > > DSHS?

> > >

> > > Debbie

> > >

> >

> >

> >

> >

> >

> >

[Guest guest]

Then we are on the same page. Saftey and Patient care.

> > > >

> > > > Respond to a call were someone has been hit in the head by a

> > > tire. Will he

> > > > is airing it up it explodes. You arrive and find a 20-25

year

> > old

> > > male

> > > > sitting with blood clotting in nose laceration to bridge of

> nose

> > > and

> > > > swelling to the forehead and nose and severe knee pain with

> > > laceration.

> > > > Patient is sitting in chair as we approach the foreman tells

> the

> > > patient to

> > > > put his head back, we stop that action and take manual c-

spine

> > the

> > > patient

> > > > states " what happened to me? " Due to the local hospital

being

> > > level IV and

> > > > the nearest level III is 45 miles away we decide to airlift.

> The

> > > foreman

> > > > immediately states no helicopter! We tell him that whatever

> this

> > > young man

> > > > has cannot be fixed in our local hospital and that it would

be

> > > best to have

> > > > him at a higher level of care as quickly as possible he

again

> > says

> > > no

> > > > helicopter and that we are wasting time we have the young

man

> c-

> > > collared,

> > > > spiders, head blocks, backboard moved to unit monitors

> attached

> > IVs

> > > > attempted pt begging to be airlifted and foreman still

> refusing

> > > helicopter

> > > > screaming we been on scene 45 minutes (in reality 15

minutes).

> > He

> > > even

> > > > states that every time you come out here you have to airlift

> (we

> > > have been to

> > > > this plant 5 times airlifted one with all ribs separated

from

> > > sternum due to

> > > > crushing injury from forklift).

> > > >

> > > > What would you do?

> > > >

> > > > Would you complain?

> > > >

> > > > And if yes to who?

> > > >

> > > > This is the highest man on the totem pole at this plant so

> where

> > > do you go

> > > > from here? Just forget it or is this something that can be

> taken

> > > up with

> > > > DSHS?

> > > >

> > > > Debbie

> > > >

> > >

> > >

> > >

> > >

> > >

> > >

[Guest guest]

If badly injured - I still like my odds of getting to a trauma center sooner

than later. Nor do I think I'm going out on a limb to say that the idea of

" loading and going " should not be changed no matter who wants to discuss or

debate it. To heck with " scientifically proven " - get me there soon. I'll take

the odds with that approach.

If air transport is the right choice - I'll take that too.

Don

>>> " Grayson " 10/22/2008 12:03 PM >>>

It is supported by PHTLS and ITLS...but we in EMS have evolved an entire

belief system out of what was a brilliant marketing ploy by R.A. Cowley.

Doesn't necessarily make it scientifically proven.

Bledsoe wrote:

>

> It might be supported by ITLS and PHTLS, but the evolving literature is

> showing that out of hospital time is not a predictor of mortality.

>

> BEB

>

> From: texasems-l <mailto:texasems-l%40yahoogroups.com>

> [mailto:texasems-l

> <mailto:texasems-l%40yahoogroups.com>] On

> Behalf Of vernon.wickliffe

> Sent: Wednesday, October 22, 2008 11:11 AM

> To: texasems-l <mailto:texasems-l%40yahoogroups.com>

> Subject: Re: I have a scenario for you guys

>

> Steve, I understand that the " golden hour " his serious flaws. It was

> Dr. Cowley of shock trauma that supported this magical hour. But I

> was talking scene time the " platinum ten minute " I believe even the

> good Dr. Bledsoe would agree. Getting a patient off the scene in

> less then ten minute is support by both BTLS and PHTLS.

>

>

> > >

> > > Respond to a call were someone has been hit in the head by a

> > tire. Will he

> > > is airing it up it explodes. You arrive and find a 20-25 year

> old

> > male

> > > sitting with blood clotting in nose laceration to bridge of nose

> > and

> > > swelling to the forehead and nose and severe knee pain with

> > laceration.

> > > Patient is sitting in chair as we approach the foreman tells the

> > patient to

> > > put his head back, we stop that action and take manual c-spine

> the

> > patient

> > > states " what happened to me? " Due to the local hospital being

> > level IV and

> > > the nearest level III is 45 miles away we decide to airlift. The

> > foreman

> > > immediately states no helicopter! We tell him that whatever this

> > young man

> > > has cannot be fixed in our local hospital and that it would be

> > best to have

> > > him at a higher level of care as quickly as possible he again

> says

> > no

> > > helicopter and that we are wasting time we have the young man c-

> > collared,

> > > spiders, head blocks, backboard moved to unit monitors attached

> IVs

> > > attempted pt begging to be airlifted and foreman still refusing

> > helicopter

> > > screaming we been on scene 45 minutes (in reality 15 minutes).

> He

> > even

> > > states that every time you come out here you have to airlift(we

> > have been to

> > > this plant 5 times airlifted one with all ribs separated from

> > sternum due to

> > > crushing injury from forklift).

> > >

> > > What would you do?

> > >

> > > Would you complain?

> > >

> > > And if yes to who?

> > >

> > > This is the highest man on the totem pole at this plant so where

> > do you go

> > > from here? Just forget it or is this something that can be taken

> > up with

> > > DSHS?

> > >

> > > Debbie

> > >

> >

> >

> >

> >

> >

> >

[Guest guest]

Gotta agree with Don. Even though evolving literature may not validate the

traditional methods I don't see how we could justify delaying transport as soon

as possible.

Sent from my Verizon Wireless BlackBerry

Re: I have a scenario for you guys

>

> Steve, I understand that the " golden hour " his serious flaws. It was

> Dr. Cowley of shock trauma that supported this magical hour. But I

> was talking scene time the " platinum ten minute " I believe even the

> good Dr. Bledsoe would agree. Getting a patient off the scene in

> less then ten minute is support by both BTLS and PHTLS.

>

>

> > >

> > > Respond to a call were someone has been hit in the head by a

> > tire. Will he

> > > is airing it up it explodes. You arrive and find a 20-25 year

> old

> > male

> > > sitting with blood clotting in nose laceration to bridge of nose

> > and

> > > swelling to the forehead and nose and severe knee pain with

> > laceration.

> > > Patient is sitting in chair as we approach the foreman tells the

> > patient to

> > > put his head back, we stop that action and take manual c-spine

> the

> > patient

> > > states " what happened to me? " Due to the local hospital being

> > level IV and

> > > the nearest level III is 45 miles away we decide to airlift. The

> > foreman

> > > immediately states no helicopter! We tell him that whatever this

> > young man

> > > has cannot be fixed in our local hospital and that it would be

> > best to have

> > > him at a higher level of care as quickly as possible he again

> says

> > no

> > > helicopter and that we are wasting time we have the young man c-

> > collared,

> > > spiders, head blocks, backboard moved to unit monitors attached

> IVs

> > > attempted pt begging to be airlifted and foreman still refusing

> > helicopter

> > > screaming we been on scene 45 minutes (in reality 15 minutes).

> He

> > even

> > > states that every time you come out here you have to airlift(we

> > have been to

> > > this plant 5 times airlifted one with all ribs separated from

> > sternum due to

> > > crushing injury from forklift).

> > >

> > > What would you do?

> > >

> > > Would you complain?

> > >

> > > And if yes to who?

> > >

> > > This is the highest man on the totem pole at this plant so where

> > do you go

> > > from here? Just forget it or is this something that can be taken

> > up with

> > > DSHS?

> > >

> > > Debbie

> > >

> >

> >

> >

> >

> >

> >

[Guest guest]

I agree Don. Get me where I need to be. (But safely) once again that

decision is made by the crews on scene in the badly injury patient.

And educating the crews on (Assessment, Scene times, Mode of

Transportation) and not MOI or the Golden hour is the only way of

giving them the tools of knowledge to make that decision.

> > > >

> > > > Respond to a call were someone has been hit in the head by a

> > > tire. Will he

> > > > is airing it up it explodes. You arrive and find a 20-25 year

> > old

> > > male

> > > > sitting with blood clotting in nose laceration to bridge of

nose

> > > and

> > > > swelling to the forehead and nose and severe knee pain with

> > > laceration.

> > > > Patient is sitting in chair as we approach the foreman tells

the

> > > patient to

> > > > put his head back, we stop that action and take manual c-

spine

> > the

> > > patient

> > > > states " what happened to me? " Due to the local hospital being

> > > level IV and

> > > > the nearest level III is 45 miles away we decide to airlift.

The

> > > foreman

> > > > immediately states no helicopter! We tell him that whatever

this

> > > young man

> > > > has cannot be fixed in our local hospital and that it would

be

> > > best to have

> > > > him at a higher level of care as quickly as possible he again

> > says

> > > no

> > > > helicopter and that we are wasting time we have the young

man c-

> > > collared,

> > > > spiders, head blocks, backboard moved to unit monitors

attached

> > IVs

> > > > attempted pt begging to be airlifted and foreman still

refusing

> > > helicopter

> > > > screaming we been on scene 45 minutes (in reality 15

minutes).

> > He

> > > even

> > > > states that every time you come out here you have to airlift

(we

> > > have been to

> > > > this plant 5 times airlifted one with all ribs separated from

> > > sternum due to

> > > > crushing injury from forklift).

> > > >

> > > > What would you do?

> > > >

> > > > Would you complain?

> > > >

> > > > And if yes to who?

> > > >

> > > > This is the highest man on the totem pole at this plant so

where

> > > do you go

> > > > from here? Just forget it or is this something that can be

taken

> > > up with

> > > > DSHS?

> > > >

> > > > Debbie

> > > >

> > >

> > >

> > >

> > >

> > >

> > >

[Guest guest]

On Wednesday, October 22, 2008 12:57, etxems@... said:

> Gotta agree with Don. Even though evolving literature may not validate the

> traditional methods I don't see how we could justify delaying transport as

soon as

> possible.

The flip side of that argument is that way too many providers have been using

the " Golden Hour " and " Platinum Ten " for way too many years to justify not

providing the care the patient needs that is within their capabilities, like

proper spinal immobilisation. It's as if some schools are teaching that anyone

with a laceration gets " rapid extrication " these days. So yes, I think we can

justify delaying transport for a great many of our patients in order to render

proper care.

Rob