trauma response within the hospital

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On Mon, 03 Aug 2009 07:58 -0500, "McSwain, Norman E Jr."
<nmcswai at tulane.edu> wrote:
> We have been doing that for years. Works well
> 
> Ron, Do you train you ED personal to the EMT-B level? If you want them to
> respond to those falls from the building, 'Man Down' etc. You must train
> and equip them to do the fulfill the responsibilities that you have
> assigned to them. Also equipment, Backboards, Small defibrillators, small
> ET and drug kit

Why would this involve much more than requiring an EMT basic card as a
condition of employment?

I worked at a trauma center that had this requirement. Even though I was
a medic in 2 neighboring states, states that were automatically granted
reciprocity for their medics and EMTs, the hospital insisted that I
obtain an EMT basic card in their state. In this case, it was
administrative overkill, but this is one way to obtain people with the
skills to package people for transport within the ED/trauma center
grounds. Adding a requirement for an EMT card would probably not even
require an increase in pay for the position, since EMTs are some of the
lowest paid people in the country.

Why would you want more than a BLS response? 

If you do not have your own backboard and stretcher available for things
that happen inside the hospital, you really need to invest in these
budget busters. A used stretcher might even be donated to the hospital
by an ambulance company. You could require that the techs maintain their
EMT cards the same way ambulance companies do. Just add it to the list
of certifications tracked for expiration. 

The drugs, ET tubes, and defibtrillator are a waste of time. When has
anyone on this list made a good argument for ALS interventions in the
prehospital setting? If they have, would they really suggest that ALS
treatment in the parking lot is at all responsible? The closest ALS is
the hospital, which is right there. That is the point of the thread,
isn't it? Patients within view of, or on the grounds of the hospital.
Immobilization, BLS airway management, BLS bleeding control, and
transport on your used EMS stretcher. The same way EMS would do it. 

Many of the EDs around me keep an old stretcher with a simple trauma bag
by their doors. Many of the EMTs drive around with trauma bags in their
personal vehicles, so they certainly do not cost a lot to put together.
You just need to add a BVM.

I do not see why trauma patient management needs to be more than BLS. As
Dr. Krin noted, you do not send your doctors out to deal with this,
unless it is something that can only be done by the doctor, such as
amputation. And how often is that going to happen?

> You cannot ask a person to do a job for which they are not prepared...not
> fair to the patient either and that is the most important thing
> 

Why would trauma techs not be prepared to do this?

If it is a busy night in the world of trauma, there may be a delay in
EMS response. You may have to wait for the next ambulance to come in
drop off a patient, then head out into the parking lot to pick up the
patient they drove around to get there. As much as the hospital lawyers
make the rules, a plaintiff's attorney can have a field day presenting
something like this to a jury. 

How do you handle trauma in the hospital? There are shootings and
stabbings inside hospitals. Would you claim that the ability to package
and transport the patient from the hallway to the trauma bay is
something that is beyond your hospital's capabilities? If a patient
falls out of bed, do you have to call EMS to put the patient back in
bed? If a patient falls in the hallway, do you have to call EMS to
package the patient and transport to the ED?

Requiring techs to have EMT certification would not cost much, if it is
not already a job requirement. If I remember correctly, packaging is
covered in ATLS. Packaging might also be covered in CEN.

Tim Noonan.


> Norman
>  
> Norman McSwain MD
> Professor, Tulane School of Medicine
> Trauma Director, Charity Hospital Trauma Center
> norman.mcswain at tulane.edu
> 504 988 5111
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Gross, Ronald
> Sent: Monday, August 03, 2009 6:29 AM
> To: 'Trauma-List [TRAUMA.ORG]'
> Subject: RE: trauma response within the hospital
> 
> If in the hospital we dispatch the code team.  IF outside the hospital
> but on grounds, security responds and - get this one - calls 911.  Yup. 
> Calls 911.
> Another heavy sigh.
> 
> Ron
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Gad Shaked
> Sent: Sunday, August 02, 2009 11:51 AM
> To: trauma-list at trauma.org
> Subject: trauma response within the hospital
> 
> Dear friends,
> I would like to know your protocols for trauma response for incidents
> occurring within the hospital,  i.e in the parking lot, suicide attempt
> (like jumping off the roof of the hospital) etc. Not for ER or ward
> patients. Who is responding, from where they get the equipment, do they
> also do the rescue if needed?
> Thanks, 
> Gadi 
> 
> 
> Gadi Shaked, MD
> Department of Surgery
> Trauma Unit
> Soroka University Medical Center
> Beer Sheva
> Israel‎
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