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Penetrating Chest Trauma

Bjorn, Pret trauma-list@trauma.org
Tue, 29 Apr 2003 08:02:57 -0400


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Not that outcome was at stake, but there's a lesson here: you and your
patient are both better off obeying EMS rules than the emotional demands of
next of kin--especially next of kin encountered at the scene of an apparent
attempted homicide.
 
All the more reason to assure these medics and their peers that the EMS
system is watching, every bit as carefully as the civil litigation system.
Message being, the prehospital provider's legal responsibilities start and
stop at the level of local protocols.
 
My initial recommendations stand.  And my sympathy for these medics is
tempered by the fact that they chose to ignore a simple and crucial mandate
in the misguided notion that it would cover their asses.
 
Pret
 
 
 -----Original Message-----
From: Andrew J Bowman [mailto:sumieb@compuserve.com]
Sent: Monday, April 28, 2003 10:53 AM
To: trauma-list@trauma.org
Subject: Re: Penetrating Chest Trauma



Pret,
 
Protocol states "threat to life or limb goes to closest facility".
 
Later found out that wife of patient threatened to sue if medics took to the
closest facility because she works at the more distant one.
 
What a fun time for the medics. Feel sorry for them in this situation.
 
But protocol is protocol.
 
Andrew

----- Original Message ----- 
From: Bjorn, Pret <mailto:pbjorn@emh.org>  
To: 'trauma-list@trauma.org' <mailto:'trauma-list@trauma.org'>  
Sent: Monday, April 28, 2003 8:51 AM
Subject: RE: Penetrating Chest Trauma

Jeff,
 
Beg to differ.  It's Monday, and I'm intolerant.
 
Destination decisions must be driven by adherence to protocol, not by any
given medic's education, experience or perceived situational awareness.  The
capability and capacity of any given trauma system hospital cannot be left
for each prehospital provider to reckon.  This is not a time to reflect what
one thinks is best; it's a time to look at the protocol and do what it says.
Assuming, of course, that Lafayette's protocol coincides with Andrew's
opinion...
 
Someone in authority must determine whether this was a misunderstanding or a
violation.  If a Bowmanesque protocol is in the books, then the medics broke
it, and their actions should be recorded, with a plan to remediate and
monitor them.  That's where the positive, constructive, self-affirming
phototropism comes into play.  
 
But unless he works from the framework of local rules, then Andrew's advice
will merely be digested along with all the other opinions and folklore in
the community, and the system will decay from lack of attention.
 
Pret
 
 
----Original Message-----
From: Jeff Brosius [  <mailto:medic245@mindspring.com>
mailto:medic245@mindspring.com]
Sent: Monday, April 28, 2003 8:05 AM
To: trauma-list@trauma.org
Subject: Re: Penetrating Chest Trauma

...Find out WHY the medics think that bypass will be needed for thoracic
trauma patients... teach them the truth, in a constructive, positive manner,
and offer to help them see the light.  Then request to be part of a review
committee, such as Pret suggested.

Also, this situation tells me they have some SERIOUS problems in the CQI
department.  That will be much harder to fix, I think... and I'm not sure
where you'd begin.

Not much help, I'm afraid.  To me, it sounds like an educational issue.


Best,

Jeff Brosius
Paramedic, etc.
Atlanta, GA
brosius@prehospitalperspective.com
 <http://www.prehospitalperspective.com>
http://www.prehospitalperspective.com
"...deliver them that are drawn unto death."
Proverbs 24:11 (NIV)



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<DIV><FONT color=#800000 face=Arial size=2><SPAN class=070580515-28042003>Not 
that outcome was at stake, but there's a lesson here:&nbsp;you and your patient 
are both better off obeying EMS rules than the emotional demands of next of 
kin--especially next of kin encountered at the scene of an apparent attempted 
homicide.</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=070580515-28042003></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN class=070580515-28042003>All 
the more reason to assure these medics and their peers that the EMS system is 
watching, every bit as carefully as the civil litigation system.&nbsp; Message 
being, the prehospital provider's legal responsibilities start and stop at the 
level of local protocols.</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=070580515-28042003></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN class=070580515-28042003>My 
initial recommendations stand.&nbsp; And my sympathy for these medics is 
tempered by the fact that they chose to ignore a simple and crucial mandate in 
the misguided notion that it would cover their asses.</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=070580515-28042003></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=070580515-28042003>Pret</SPAN></FONT></DIV>
<DIV><SPAN class=070580515-28042003></SPAN><FONT face=Tahoma><FONT size=2><SPAN 
class=070580515-28042003><FONT color=#800000 
face=Arial>&nbsp;</FONT></SPAN></FONT></FONT></DIV>
<DIV><FONT face=Tahoma><FONT size=2><SPAN 
class=070580515-28042003></SPAN></FONT></FONT>&nbsp;</DIV>
<DIV><FONT face=Tahoma><FONT size=2><SPAN 
class=070580515-28042003>&nbsp;</SPAN>-----Original Message-----<BR><B>From:</B> 
Andrew J Bowman [mailto:sumieb@compuserve.com]<BR><B>Sent:</B> Monday, April 28, 
2003 10:53 AM<BR><B>To:</B> trauma-list@trauma.org<BR><B>Subject:</B> Re: 
Penetrating Chest Trauma<BR><BR></DIV></FONT>
<BLOCKQUOTE dir=ltr style="MARGIN-RIGHT: 0px"></FONT>
  <DIV><STRONG><FONT face=Tahoma size=2>Pret,</FONT></STRONG></DIV>
  <DIV><STRONG><FONT face=Tahoma size=2></FONT></STRONG>&nbsp;</DIV>
  <DIV><STRONG><FONT face=Tahoma size=2>Protocol states "threat to life or limb 
  goes to closest facility".</FONT></STRONG></DIV>
  <DIV><STRONG><FONT face=Tahoma size=2></FONT></STRONG>&nbsp;</DIV>
  <DIV><STRONG><FONT face=Tahoma size=2>Later found out that wife of patient 
  threatened to sue if medics took to the closest facility because she works at 
  the more distant one.</FONT></STRONG></DIV>
  <DIV><STRONG><FONT face=Tahoma size=2></FONT></STRONG>&nbsp;</DIV>
  <DIV><STRONG><FONT face=Tahoma size=2>What a fun time for the medics. Feel 
  sorry for them in this situation.</FONT></STRONG></DIV>
  <DIV><STRONG><FONT face=Tahoma size=2></FONT></STRONG>&nbsp;</DIV>
  <DIV><STRONG><FONT face=Tahoma size=2>But protocol is 
  protocol.</FONT></STRONG></DIV>
  <DIV><STRONG><FONT face=Tahoma size=2></FONT></STRONG>&nbsp;</DIV>
  <DIV><STRONG><FONT face=Tahoma size=2>Andrew</FONT></STRONG></DIV>
  <BLOCKQUOTE dir=ltr 
  style="BORDER-LEFT: #000000 2px solid; MARGIN-LEFT: 5px; MARGIN-RIGHT: 0px; PADDING-LEFT: 5px; PADDING-RIGHT: 0px">
    <DIV style="FONT: 10pt arial">----- Original Message ----- </DIV>
    <DIV 
    style="BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: black"><B>From:</B> 
    <A href="mailto:pbjorn@emh.org" title=pbjorn@emh.org>Bjorn, Pret</A> </DIV>
    <DIV style="FONT: 10pt arial"><B>To:</B> <A 
    href="mailto:'trauma-list@trauma.org'" 
    title=trauma-list@trauma.org>'trauma-list@trauma.org'</A> </DIV>
    <DIV style="FONT: 10pt arial"><B>Sent:</B> Monday, April 28, 2003 8:51 
    AM</DIV>
    <DIV style="FONT: 10pt arial"><B>Subject:</B> RE: Penetrating Chest 
    Trauma</DIV>
    <DIV><BR></DIV>
    <DIV><FONT color=#800000 face=Arial size=2>Jeff,</FONT></DIV>
    <DIV><FONT color=#800000 face=Arial size=2></FONT>&nbsp;</DIV>
    <DIV><FONT color=#800000 face=Arial size=2>Beg to differ.&nbsp; It's Monday, 
    and I'm intolerant.</FONT></DIV>
    <DIV><FONT color=#800000 face=Arial size=2></FONT>&nbsp;</DIV>
    <DIV><FONT color=#800000 face=Arial size=2>Destination decisions must be 
    driven by adherence to protocol, not by any given medic's education, 
    experience or perceived situational awareness.&nbsp; The capability and 
    capacity of any given trauma system hospital cannot be left for each 
    prehospital provider to reckon.&nbsp; This is not a time to reflect what one 
    thinks is best; it's a time to look at the protocol and do what it 
    says.&nbsp; </FONT><FONT color=#800000 face=Arial size=2>Assuming, of 
    course, that Lafayette's protocol coincides with Andrew's 
    opinion...</FONT></DIV>
    <DIV>&nbsp;</DIV>
    <DIV><FONT color=#800000 face=Arial size=2>Someone in authority must 
    determine whether this was a misunderstanding or a violation.&nbsp; If a 
    Bowmanesque protocol is in the books, then the medics broke it, 
    and&nbsp;their actions should be recor</FONT><FONT color=#800000 face=Arial 
    size=2>ded, with a plan to remediate and monitor them.&nbsp; That's where 
    the positive, constructive, self-affirming phototropism comes into 
    play.&nbsp; </FONT></DIV>
    <DIV><FONT color=#800000 face=Arial size=2></FONT>&nbsp;</DIV>
    <DIV><FONT color=#800000 face=Arial size=2>But unless he works from the 
    framework of local rules, then Andrew's advice will merely be digested along 
    with all the other opinions and folklore in the community, and the system 
    will decay from lack of attention.</FONT></DIV>
    <DIV>&nbsp;</DIV>
    <DIV><FONT color=#800000 face=Arial size=2>Pret</FONT></DIV>
    <DIV>&nbsp;</DIV>
    <DIV>&nbsp;</DIV>
    <DIV><FONT color=#800000 face=Arial size=2><FONT color=#000000>----Original 
    Message-----<BR>From: Jeff Brosius [</FONT></FONT><A 
    href="mailto:medic245@mindspring.com"><FONT color=#000000 face=Arial 
    size=2>mailto:medic245@mindspring.com</FONT></A><FONT face=Arial 
    size=2>]<BR>Sent: Monday, April 28, 2003 8:05 AM<BR>To: 
    trauma-list@trauma.org<BR>Subject: Re: Penetrating Chest 
    Trauma<BR><BR>...Find out WHY the medics think that bypass will be needed 
    for thoracic trauma patients... teach them the truth, in a constructive, 
    positive manner, and offer to help them see the light.&nbsp; Then request to 
    be part of a review committee, such as Pret suggested.<BR><BR>Also, this 
    situation tells me they have some SERIOUS problems in the CQI 
    department.&nbsp; That will be much harder to fix, I think... and I'm not 
    sure where you'd begin.<BR><BR>Not much help, I'm afraid.&nbsp; To me, it 
    sounds like an educational issue.<BR><BR><BR>Best,<BR><BR>Jeff 
    Brosius<BR>Paramedic, etc.<BR>Atlanta, 
    GA<BR>brosius@prehospitalperspective.com<BR></FONT><A 
    href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2003-April/"http://www.prehospitalperspective.com" target=_blank><FONT 
    color=#000000 face=Arial 
    size=2>http://www.prehospitalperspective.com</FONT></A><BR><FONT face=Arial 
    size=2>"...deliver them that are drawn unto death."<BR>Proverbs 24:11 
    (NIV)<BR><BR><BR><BR>--<BR>trauma-list : TRAUMA.ORG<BR>To change your 
    settings or unsubscribe visit:<BR></FONT><A 
    href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2003-April/"http://www.trauma.org/traumalist.html" target=_blank><FONT 
    color=#000000 face=Arial 
    size=2>http://www.trauma.org/traumalist.html</FONT></A><BR></DIV></BLOCKQUOTE></BLOCKQUOTE></BODY></HTML>

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