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PHTLS, Ground EMS, Air EMS, Chest Tubes

Charles Brault c_brault at yahoo.com
Mon Apr 10 07:45:55 BST 2006

Roy Danks <roydanks at hotmail.com> wrote:  I've followed this thread long enough now to feel as if I can add something.

As a trauma surgeon with extensive EMS experience, I must side with Dr. 

EMT's/Paramedics and Flight RNs have no business putting in chest tubes.

This is the trauma algorithm:

Step 1: Load the patient

Step 2: Transport the patient

Step 3: Maintain the airway, give some oxygen, etc during transport.

Helicopters are fast, flying billboards for hospital systems (by and large). 
At least one study has refuted the "Golden Hour" concept. Many studies 
have shot down the concept that air transport "saves lives by saving time" 
(in trauma).

Don't get me wrong: I love EMS and medics. I think they are doing a 
terrific job under difficult circumstances, but I simply cannot support 
advanced procedures in the field. And, it's not because I don't think 
they're capable. It's unneccessary. EMS was developed for the delivery of 
cardiac care. I am convinced it has a role for this. I'm less convinced of 
it's role in trauma. Spine and fracture immobilization, oxygen, airway 
control, etc: YES. Advanced Procedures: NO.
  Dr Danks I agree with you
  The component of time may come in and alter the tail end of our usual case load
  1 ) EMS does not do chest tube
  2 ) Flight crews are involved in them, mostly in Hosp to Hosp Pts
  Whereby the treating MD put's in the chest tube (Medico-Legal issue)
  Perhaps some medical directors after evaluating time/distances and the quality of care available at his outlying hosp decided that he could get better results by training his Medevac crews. A specific judgement that has as much value as the general judgements that we are all making right now.
  One last question for you
  Needle Chest Decompression in EMS
  YES ?  or  NO ?

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