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Sun Apr 27 18:31:49 BST 2008

Unfortunately, (or even maybe fortunately) many different "protocols" exist  
in many different communities and around the world.   Even in those  regions 
which are considered to have "mature" EMS & trauma systems in place,  today's 
("correct") protocols are often very different from those of just 10 or  20 
years ago.   That is as how it should be.    Advance  the better, throw out those 
things which did not work or which were found to be  urban legend.   The list 
of unacceptable protocols and tactics, be in  the field, the EC, the OR, the 
ICU, or in the committees of the American College  of Surgeons, ACEP, or AMA, 
are determined by days, weeks, months, or years of  evidence analysis.    AND 
policy makers who have stuck their  necks out and become champions of one 
policy, are very slow to accept a new  policy that countermands their previous 
sacred cow.  I could share with the  members of this list well over 100 such 
items from the past and over 200  policies still under debate.   

Such progress and continuing analysis of the old and new is essential as we  
make progress together.   I am personally closely watching:

STEMI protocols 
Infusion of hypothermic solutions in patients with suspected spinal cord  
injury
Hypothermia in heart attacks
Hypothermia in head injury
rFVIIa
Topical hemostatic agents
designer fluids
Medication to combat MOF syndromes
Use of Plavix in the ambulance
The new wrap around mechanical CPR devices

and many others.     

I really am encouraged to see disagreement and even passion for one's  
position stated on this list server.   It demonstrates that the list  server and its 
members are alive and contributing.   Thank you for  each of your 
contributions.      

New news I am still trying to get the details about.   Apparently  two of the 
European Trauma organizations have joined ranks together for the  betterment 
of trauma systems.   What were these organizations and can  one now JOIN this 
new bigger and vibrant new group?

k

In a message dated 4/25/2008 2:11:13 P.M. Central Daylight Time,  
bowwow49 at bellsouth.net writes:

Sir  every thing is just not that cut and dry, and yes the state protocols do 
 address it, but lets take a step back for a second, because you might as 
well  just insult every medic that works their butt off every day to do 
everything  they can for each and every patient we have , trauma and medical alike ! 
And  for you to say it is a possibly a lack of education on our part, I am 
assuming  sense you where not clear on if you are pointing that finger at 
Paramedics,  but at this point I will take it as that, you can quote protocols , state 
and  local all you want, it comes down to what the boss says ! We have to 
follow  our local protocols and procedures that keep us from getting fired or sued 
for  deveating from local protocol, by your attempt at dropping this failure 
in the  laps of the front line people , the Paramedics and first responders is 
typical  of someone that is not in educated and aware of what happens in 
prehospital  care, I don't know your qualifications , you have not stated, but
to blame  the bullet for killing some one instead of the person who pulled 
the trigger  is like blaming a pencil for a misspelled word sir ! It is so easy 
for doctors  and emergency room staff and the like to stand back and talk 
about something  they think they understand, yet not being directly involved , and 
even the  medical directors have no clue  cause they are the ones that make 
our  local protocol yet are never on the trucks, never have to make the choices 
we  do on scene, all just set back and make uninformed or "perfect world  
declarations" and dump the blame where it does not belong ! Now how you think  
politics has nothing to do with where a patient goes, you can not possibly be  
involved in a EMS in any way, politics are every thing in a county run 911  
service that has county commishners that want to get paid, and Insurance  
companies demand a patient not be taken past a medical facility or they will  not pay 
! There is all kind of politics that are involved, we are not talking  of
political causes, we are talking about political governing, we can not  by 
protocol transport a patient out of the county by ground, if the patient  can 
not go by air we must transport to the closest facility, which is the  county ER 
! And due to county commission not wanting trucks transporting to  Nashville 
on every call they will not change this because of our high call  volume, we 
as medics can request of a supervisor in significant cases if we  can transport 
to Nashville, but will likely get turned down except in  exceptional cases, 
which I have had and basicly had to beg for the patients  sake to allow 
transport and still been turned down! We do not have the luxury  of multiple 
hospitals and a trauma center in our direct area, we have one  public hospital that 
has 250 beds, in a pinch we can transport to the military  base , but they do 
not want trauma brought there, so the medics have no choice  but to try and fly 
patients , if the aircraft is not available, we have little  choice but t
o take to local level 2 ER. Now how that reflects on  Paramedics and first 
responders is a uneducated statement on your behalf ! We  have bosses and that 
is the law of the day, what needs to happen is for there  to be a means , 
training of medical directors and law makers to make it so the  "Pencils" ( the 
Paramedics and first Responders) are not blamed when   words gets misspelled ! 
You can stand on a soap box and spew all you want  about state protocols, they 
mean nothing when countered by the local protocols  that where written to 
protect the population of our county as a whole for the  rest of the calls that are 
not trauma ! It does not make it right but you are  pointing your finger in 
the wrong direction , plain and simple! Insult all you  want , you are the 
uneducated here, you are the problem cause people like you  look at the tree that 
fell as the problem, not the weak roots and the high  wind that caused the 
tree to fall, the people making the rules need the  education sir until then 
we MUST follow those rules  !
LB
-------------- Original message from Anthony Caruso  <medic541 at hotmail.com>: 
-------------- 

> 
>  
> 
> LB, I'm not quite sure how it's political. EMT's on scene  make the 
> determination . If the patient(s) has been traumatized  severely enough 
then 
> they go to the appropriate hospital. State wide  protocols dictate that. No 
way 
> around it. Calling for a chopper is a  tool that we have. What may be the 
> underlying cause here is the lack  of education possibly. More is needed to 
be 
> able to identify the  patients that have been severely traumatized and make 
the 
> appropriate  transport decision. My decision to transport who where and 
when has 
>  never been influenced by any political causes. 
> 
> Just my 2  cents. 
> 
> AMC. 
> > To: trauma-list at trauma.org>  Date: Fri, 25 Apr 2008 16:46:56 +0000> 
Subject: 
> Re: (no  subject)> > Sorry about that, I meant they are usually in the air 
once  
> we call in 4-8 mins which they can get to a scene anywhere in the  county 
within 
> minutes, depending though on how we receive the call ,  we sometimes call 
while 
> responding to let them know what we are going  on and put them on standby 
which 
> shortens there responce because they  will go ahead to the aircraft, once 
we 
> determine need we let them  know to launch or not, Air Evac does flying 
standbys 
> , they will  launch and head your direction and we can cancel them 
dependant on 
>  need for airlft or not.> LB> -------------- Original message from  "Andrew 
J 
> Bowman" : -------------- > > > > How can you  safely 
> get a helicopter to a scene within 4 minutes of calling >  > them? > > > > 
You 
> call, they receive call, re-check  weather, quick aircraft check, > > 
start-up, 
> lift off, fly to  scene, land, get out. > > > > Andrew > > > > > >  > is 
just not 
> acceptable! We have one of the four of Vanderbilt's  BK's right > > > here 
at our 
> local hospital, and if they are  on the pad we can usually > > > either get 
them 
> to a scene  within 4-8 mins of calling for them, > > > > -- > >  
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