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Old 01-13-2011, 11:59 AM   #1
emtvirus
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Maryland Trauma Decision Tree


Anyone work in Maryland that can explain the Trauma Decision Tree and its purpose/implementation to me? I am, hopefully, taking my reciprocity exam next week and am from the midwest where we seem to do things a bit different. Just hoping for a little clarification. Thanks!


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Old 01-13-2011, 02:50 PM   #2
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Straight from the MD protocol

WHILE TIME, DISTANCE, AND PROXIMITY ARE ALL FACTORS TO BE CONSIDERED IN
THE TRIAGE DECISION, THE TRAUMA DECISION TREE SHOULD BE USED TO
DETERMINE WHO SHOULD BE TRANSPORTED TO THE NEAREST APPROPRIATE
TRAUMA CENTER AND WHEN THE TRANSPORT SHOULD OCCUR.

Really, its main focus seems to be the utilization of the helo. For a cat a or b trauma you do not need to consult with the receiving trauma center while a cat c or d trauma requires a consult in order to get the helo on the way.
Maryland really has been trying to stop the over use of helo transports since the trooper 2 crash. I agree with it too. A lot of the transports done around my area can make it to the major trauma centers in less than 30 minutes unless the roads are just jammed to all heck.

http://www.miemss.org/home/EMSProvid...6/Default.aspx

This link has the full protocols in pdf form.
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Old 01-13-2011, 03:12 PM   #3
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Thanks for the reply, that info really cleared that up. I actually have the full copy I'm studying to, hopefully take my test soon.

If you don't mind me asking, what all did the miemss protocol exam cover? I'm trying to figure out what to study but the manual is huge... Just wondering if there is some areas they tend to focus on. Thanks!
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Old 01-13-2011, 03:14 PM   #4
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Here is the chart.
http://www.miemss.org/home/LinkClick...id=106&mid=534

The best thing to remember is "when in doubt take patient to appropriate trauma center"
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Old 01-13-2011, 03:29 PM   #5
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Category A are the life-threatening injuries.

Category B are serious injuries not immediately threatening to life but not likely to be fixed at the local hospital.

Category C are the "mechanisms", when something about the MOI says the patient should go, even if they don't necessarily seem that bad. For example, death in the same passenger compartment, ejection from vehicle, etc.

Category D are the co-morbid factors, such as age <5 or >55, pregnancy, etc.

(Explanation from my instructor.)
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Old 01-13-2011, 05:12 PM   #6
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Really, its main focus seems to be the utilization of the helo.
"It puts the patient in the helicopter or else it gets the hose again."
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Old 01-13-2011, 05:52 PM   #7
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Trauma decision tree stemmed from the over utilization of MSP helicopters for trauma flights and too my knowledge is now a National Model. Just got a trauma tree in this months copy of JEMS which is exactly what the MD tree is.

As far as the protocol test it has been about 8 years for me but I will tell you EVERYTHING in that huge book is fair game. When I took it for EMT-P there were ALOT of legal questions such as: You have a exceptional call how long do you have to notify the state medical examiner.

Also alot of peds dosage questions, and study the CPAP and NTG protocol's. Those have recently changed in the past two years and my guess is with the escalating NTG dosages and Captopril/NTG paste there will be a few questions on that as well.

You can skip the jurisdictional extras, wilderness medicine, tactical medicine, and specialty care protocols. None of that stuff will be on there.

Where are you coming from and where are you looking to get a job. If you need ne help or have questions PM me. I currently work F.T. in a MD 911 system and do Critical Care for a very large local hospital.
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Old 01-13-2011, 06:05 PM   #8
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Thanks that really helps a lot. I was actually only glanced at the high dose NTG stuff. Guess that's one more notecard I'll have to make
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Old 01-13-2011, 07:18 PM   #9
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I took the I protocol test early last year and canman is correct. Everything in the book is fair game including how long you have till the medical director for situations.

I will be taking the p protocol test hopefully next month.
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Old 01-13-2011, 09:05 PM   #10
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I just took my reciprocity paramedic exam last month. There aren't many jobs in PA, so I was hoping I'd have better luck in my home state. So far it's been a bust (I'm not a fire fighter), so it looks like private ambulance might be my future. My exam was heavy on peds, both dosages and electrical therapy. I had two questions on crush syndrome/hyperkalemia and all I can say to that is high-dose albuterol 20 mg for adults, know your ped doses for crush as well. I had questions on the first couple of pages of the book where they go through the "exceptional call, failure to carry out a physician order, protocol variation" stuff.

I actually have such a memory that I could immediately recall nearly 30 questions and answers from the 50 question test I received (oh, yes, I wrote them all down).

I warn you, Maryland has some peculiar protocols and they are a tiny bit behind a lot of other states. What you know to be true through evidenced-based medicine may not be the correct answer on this exam.

Which exam are you sitting for?
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