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PHTLS, Ground EMS, Air EMS, Chest Tubes
Charles Brault c_brault at yahoo.comMon Apr 10 07:45:55 BST 2006
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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. Mattox. 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 But 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 ? Cheers Charles
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