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Sat Apr 15 03:12:54 BST 2006

I am EMS.  I am not qualified nor would I recommend chest tubes in the 
field.  We are frankly too close to a compentent hospital to even consider 
such a thing.  We have had many of the "golden hour saves", however.  All we 
do is package them as well as we are trained and pray you experts on the 
other end can do those miracles we know you will.  And usually you do.  I 
hope to GOD that fact never changes.  As long as there are trauma 
organizations and incredible people like all of you out there, I KNOW that 
my patient is going to get the best care humanly possible and they WILL make 
it.  I had an excellent EMS teacher, but I do agree with the one gentleman 
who said he wished he was trained by Dr. Maddox.  I would love to some day 
meet the man!  Great group to sit back and read your views.  I've learned so 
much!  THANK YOU!  Paula Baley, EMT, Maryland
----- Original Message ----- 
From: "Charles Brault" <c_brault at yahoo.com>
To: "Trauma &amp, Critical Care mailing list" <trauma-list at trauma.org>
Sent: Monday, April 10, 2006 2:45 AM
Subject: Re: PHTLS, Ground EMS, Air EMS, Chest Tubes


>
>
> 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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