I have a scenario for you guys

October 22, 2008

Safely and time efficiently - or as Gene stated " balanced " . That term works

well. I see nothing but benefit in teaching these concepts. We can get away from

terms like " golden hour " and " platinum ten minutes " but it's still the same

priorities - safely and time efficiently. Those terms are just semantics anyway.

I have no problems with those terms, or if we replace them with others either,

if they convey the right concepts.

Now I'm beginning to think we're all in a choir here and preaching to each

other.

>>> " vernon.wickliffe " 10/22/2008 1:32 PM >>>

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

> > > >

> > >

October 22, 2008

I don't disagree. When I said " not scientifically proven " I didn't mean

" not intuitively obvious. "

What I'm talking about is the fact that we have adopted a belief system

from the original Golden Hour concept. Cowley mentioned nothing about

the " Platinum Ten Minutes. " That was extrapolated by other people much

later.

My problem is that people seem to hold the ten-minute scene time as some

sort of EMS Holy Grail, even at the cost of shoddy assessment and

packaging. We even apply it to those situations where it obviously has

no bearing at all - like prehospital medical cardiac arrest.

Unless the patient is a critical trauma patient, what is the point of a

10 minute scene time other than rapid unit turnaround? EMS managers have

long used the ten minute scene time as a means of managing system

resources while couching the issue as " patient care. "

Sometimes, an extra few minutes on scene - even with a critical patient

- is time well spent.

vernon.wickliffe wrote:

>

> 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

> > > > >

> > > >

October 22, 2008

Rob I gotta agree with you. I think productive time on scene is much

better than just load and go. It is safer for you as the provider

to stabilise the patient while sitting still rather than trying to

perform interventions while also hanging on for dear life. If you

have the ability under your guidelines to perform an intervention

that benefits your patient, a few more seconds or minutes on scene

will not cause more harm IMHO. If I can do something for my patient

on scene that I can not do bouncing down the road I can justify

spending more time.

Renny

>

> 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

>

October 22, 2008

a few more seconds or minutes on scene

will not cause more harm IMHO. If I can do something for my patient

on scene that I can not do bouncing down the road I can justify

spending more time.

I was thinking of responding on this thread a few times and kept putting it off

until I saw this statement...and although I know what was intended...the way it

was worded stirred some thoughts (or maybe it was the chinese food I had for

lunch???)

1.? Although research is starting to show that length of scene time does not

have any affect on mortality...that doesn't mean the marketing of the last 20 to

30 years we have been doing has not sunk in to our citizens and customers...i.e.

with the exception of the brilliant few who subscribe to this list...not many

other people know it and it will be 6 to 8 years before ITLS and PHTLS

successfully beat the new mantra into our heads...so we have to keep that in

mind.

2.? Research also shows that other than ventilation and stopping

bleeding...NOTHING else we can do in an ambulance will make a difference in

outcomes either....

3.? If you can't do the 2 things in #2 while traveling down a road...we are

going to have trouble getting to the hospital at all

4.? Why are we bouncing down the road?? Leave the scene as soon as

possible...then we keep the sparkly lights and whooping noises shut off which

will allow us to drive a little slower and calmer...keeping us all in our seats,

securely belted in place...making sure that our trauma patient has the best

chance of survival and we have the best chance of survival too.?

Like it was stated earlier...and I can't state it enough...If we are going to

put someone on a helicopter OR if we are going to turn on the lights and sirens

to transport someone to a hospital we have to ask ourselves...is this action we

are about to do worth the responders who will be accomplishing it NOT going home

in the morning to their families.? If that answer is honestly YES...then we can

do it...if it is cavalier or cocky...we need to be slapped down to the ground.?

This is serious stuff...and just because our ambulance or favorite helicopter

hasn't been balled up yet...doesn't mean it won't happen on this call...

Dudley

Re: I have a scenario for you guys