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Trauma EMS Reports...

Doc Holiday drydok at hotmail.com
Fri Dec 25 11:20:21 GMT 2009

From: LTorrey at maine.rr.com
> I think we'll have to disagree on this point.


--> We don't even have to disagree! I really should not have used that word - it's just another place in Medicine where there's more than one way, I guess. I'll try to look at why...


> The physician in charge of the team certainly needs to have a report.


--> On this we agree.

I know not how it is in the USA, but here in the UK, there is, at the initial phase, ONE physician who is over-all LEGALLY RESPONDIBLE for the patient - the EM consultant. If (as usual) there is a "team", then it functions under this consultant, even though it may include more experienced surgeons within it (which is not the norm - EM is often the only consultant-level doc in the team INITIALLY).


For us it's not because of the risk of being sued and the need to have a "target" for that. It's how it is. And it is at least logical to have this single focal point for care early on.


So we have Rule Number One, your words: "physician in charge of the team certainly needs to have a report"


> along with that, everyone in the room who is a licensed professional has an obligation to the patient


--> Agreed again! Must be Xmas!


We have Rule Number Two.


And paramount herein for us here is the obligation NOT to disrupt Rule One, above, which is the problem people on this thread were discussing - distraction of the paramedic by "others" from complying with Rule One...


It would be lovely if BOTH rules happened, but if I can only guarantee one, I'd guarantee the first.


> needs that fundamental baseline information.


--> Again, I have ZERO objection to the rest of the team hearing the information. I would not contradict you on this either. It's simply not the first priority - that's the team leader getting it. The way WE try to prevent the "distraction" situation is to make this obvious to all.


It would be of great interest to me if anyone has other methods to make sure the team leader hears it, without the potential distractions others have described. But this is what we do.


> The basics of why the patient is here and what happened prior to arrival is essential for every doctor, nurse, and anyone else in the room with a medico-legal responsibility to the injured


--> I guess here is where things would differ for us. This is probably because you work with professionals at a different level from mine. Many nurses and doctors on our teams are NOT as capable of making use of all the information, as you suggest yours are. Some are also inexperienced enough that they don't realise this and they sometimes are at risk of analysing things for themselves and then doing stuff which goes against what the team leader wants or even knows about!


Certainly, we USED TO have the problem of some info never getting to the team leader.


And, in certain situations, as I mentioned earlier in the thread, we have patients arriving so quickly into the ED that they are still in the process of acutely decompensating as they arrive in terms of Airway and potential Catastrophic haemorrhage (as well as the need to "Expose" or remove bits of clothing/equipment which are still potentially harmful to them and us). We need some team members to be tasked with dealing with those INSTEAD of hearing the initial hand-over.


Viva le different stuff, I guess ;-)


> ...by EMS once, loudly...


--> Lovely.


> ...to all in the room


--> Already discussed above.


> After that private conversations may take place per discretion


--> If I am team leader, I expect to be IN every conversation, unless I delegate it to someone and tell them I don't want to be in it. Otherwise, someone might say something important to someone who is not me! I don't mind "private" so long as it's MINE.


So, yes, if the ortho surgeon wants to debate with the general surgeon which priority they will focus on first in the theatre, they've got to debate this with me involved. I might not even understand all they say, but here it is ME who has the legal obligation and I'd rather have no secrets among others.


It's just how we do things


> An acceptable compromise would be to give the report solely to the physician team leader...but only if s/he is standing on the farthest side of the trauma room. <g>

--> This is not inherently a bad idea, actually. But, as things go where I do trauma, it works out better for the paramedic to stand next to the team leader (and the scribe), where the report can still be loud enough for everyone, but aimed at the leader.


Then the leader can ask for clarification... And the scribe, and others, but the leader needs to hear all this to be sure that he knows what they know and what needs to be known (Rule One). Then the paramedic may not leave until the leader sends him. And he'll send him to the scribe, tohave a go at getting details repeated as required in order to record them. THEN he may leave.


This is very interesting to me. Thanks for this response of yours. I look forward to more and others'...
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