Questions surround paramedics' response to head trauma victim

[VentMedic]

Going along some of the themes lately with the Golden Hour, treat on scene and release or determining which patients need an ambulance, here is another situation that is being reviewed in public. The additional attachments and comments are rather interesting also.

http://www.islandpacket.com/trauma/story/749484.html

Questions surround paramedics' response to head trauma victim

By RENEE DUDLEY

At 9:31 p.m. the night before Halloween, a Beaufort County ambulance rolled up to a house in greater Bluffton. Two paramedics, responding to a 911 call about a severely beaten man with a head injury, got out.

Inside the house on the living room floor lay Brian Lanese, 33, bleeding profusely from the right side of his forehead, speaking incoherently and behaving combatively -- often signs of severe head trauma.

What happened in the next 20 minutes has raised questions -- not only about the two paramedics' actions, but also about how the county's Emergency Medical Services handles trauma cases:

The paramedics brought no medical equipment inside with them -- no stretcher, backboard, cervical collar or oxygen, according to Tracy Lanese and the Hoffmans. The county's "EMS Standing Orders" for trauma patients recommend that "immobilization equipment and any necessary supplies should be taken to the patient on initial approach" so time isn't wasted if they're needed later.

http://www.islandpacket.com/trauma/story/749484.html

 

[karaya]

Yeah, this is a little of bit of a PR firestorm for the EMS provider. The comments are interesting and it would suggest this provider has an ongoing credibility issue in the eyes of the community it serves.

The outcome will certainly be interesting!

 

[emtfarva]

That is just wrong. I would have taken c-spine precautions and I would never had that Pt cuffed. That's just wrong. Why was family carrying the Pt? Why was the cop yelling at him also? no backboard or c-spine. com'on.

 

[Sasha]

What sad excuses for Paramedics.

 

[karaya]

I'm going to suggest some caution here.

Although from the looks of the article it appears the medics have a lot of questions to answer, there may be additional information that may paint a differing version from the article. I have nothing to suggest that such information exists, but we should be cautious that articles may not contain all the facts.

I'll give you a for instance. Last year I did an investigative article about a Florida fire-chief / paramedic who was terminated over taking scene photos of a partially clad patient. The television media and news articles would lead one to believe the chief was some sort of pervert. But I did a three month investigation into the incident and came up with testimony and facts that were never brought to light.

Although my article concluded that mistakes were made, it clearly showed the chief was not what the media was making him out to be. Furthermore, we turned up witnesses and testimony from sources that were never contacted by the media or the city's own investigation.

http://www.jems.com/news_and_articles/articles/Anatomy_of_Florida_Photo_Controversy.html

Just a point to keep our minds open about speculative articles. All the facts have not been presented.

 

[Doug]

I have walked head trauma pt's before. Listen sometimes you have to choose between lesser of 2 evils...do you fight the comabtive pt and force him to the board where he continues to struggle, possibly injuring himself more and/or increaseing ICP? Or do you try and calm him and let him feel as if he's in control and calmly walk him to the truck? It's hardly ever black and white...just make sure you document!!

 

[Sasha]

I have walked head trauma pt's before. Listen sometimes you have to choose between lesser of 2 evils...do you fight the comabtive pt and force him to the board where he continues to struggle, possibly injuring himself more and/or increaseing ICP? Or do you try and calm him and let him feel as if he's in control and calmly walk him to the truck? It's hardly ever black and white...just make sure you document!!

According to the report, while Ray is right and it could be slanted, the family and friends of the patient CARRIED him to the stretcher. You want to forgo the board because of the combativeness? That's all fine and good but there is no excuse for family members carrying the patient to the truck. If he couldn't be boarded or walked, the paramedics should have been the ones to carry him to the truck and put him on the stretcher. Family and bystanders and friends, off duty paramedic or not, shouldn't.

And comments about the patient being drunk or using drugs? Did they miss the whole "AMS" portion of Paramedic class?

 

[JPINFV]

I'm having trouble downloading the statement from Shayna Orsen right now, but it looks like a fuster cluck. I was able to read the statement from Jeff Knieling and his statement only delt with why they didn't call for HEMS. Ok, but he has to know that this incident goes well beyond activating/not activating HEMS. Why did he not respond to why they choose not to transport to the trauma center? Why did it take an order from OLMC after initiating transport? Why did they force the family to carry the patient? What about the difference in GCS and the assessment on the patient's ability to open his eyes? There's too many unanswered and unresponded to questions about this case.

 

[Doug]

Sasha, I apoligize. I commented before I was able to read the full article. My browser had difficulty with it, I was going only on the quotes pulled from the article in the first post.

 

[JPINFV]

Ok, so I was finally able to open the statement by Shayna Orsen and it just opens up more questions? The reconized the need for immediate transport, but still spent 20 minutes on scene? By her own admission, the first set of V/S was taken just before transport. While yes, vital signs aren't necessarilly the first thing done on scene, I don't think it's too much to ask for a set after standing on scene for 20 minutes. The reason that they were originally going to transport to the smaller hospital was because he "may need stabilization." If you aren't sure if you should divert or not, why not ask OLMC prior to starting transport?

 

[emtfarva]

Boarding a combative Pt can be hard but I have done it. I just had a sz Pt last week that fell and ended up with a head injury. We boarded her it wasn't easy. Did I mention she was combative. She kept trying rip off the C-collar and NRB. But we got it done. It helped that we had nursing home staff and another crew from another service to help us. we did restrain her though. But in this case the Pt should have been boarded and he should have not been carried by his family.

 

[BossyCow]

We had one similar to this and fuster cluck is an understatement. It was an assault, and the pt had fxs to his skull, occipital bone, and most of the bones in his hands.

We were called by law enforcement and had to stage while they subdued the guy who did the damage. Both men were severely intoxicated.

The pt was the most combative pt I've ever seen. He was restrained by the cops with handcuffs to the gurney and was so violent he almost knocked the gurney over several times. We spent a lot of time on scene just waiting for the thrashing to stop long enough to get a restraint on one of his extremeties. He had multiple sheriffs 'assisting' him and would calm down for a minute or two only to amp it back up.

He was bleeding copiously and was flinging his bleeding head around spraying a large amount of blood from his hair. I ended up duct taping a towel around his head turban style in order to keep that semi under control.

This patient could not be safely placed in our rig until he was fully restrained. He ended up restrained to our gurney in the ER for hours, while the staff tried to give him enough halodol to allow him to be safely moved from my gurney to the ER bed.

This may have been the medics bad.. but I'm not going to pass judgement.

 

[Sasha]

We had one similar to this and fuster cluck is an understatement. It was an assault, and the pt had fxs to his skull, occipital bone, and most of the bones in his hands.

We were called by law enforcement and had to stage while they subdued the guy who did the damage. Both men were severely intoxicated.

The pt was the most combative pt I've ever seen. He was restrained by the cops with handcuffs to the gurney and was so violent he almost knocked the gurney over several times. We spent a lot of time on scene just waiting for the thrashing to stop long enough to get a restraint on one of his extremeties. He had multiple sheriffs 'assisting' him and would calm down for a minute or two only to amp it back up.

He was bleeding copiously and was flinging his bleeding head around spraying a large amount of blood from his hair. I ended up duct taping a towel around his head turban style in order to keep that semi under control.

This patient could not be safely placed in our rig until he was fully restrained. He ended up restrained to our gurney in the ER for hours, while the staff tried to give him enough halodol to allow him to be safely moved from my gurney to the ER bed.

This may have been the medics bad.. but I'm not going to pass judgement.

You were unable to get him to the stretcher. A family member and bystander didn't come by, pick him up, and carry him to your stretcher. There in lies the difference. If the paramedics COULDN'T do it, with the cop's assistance, that's different. However if his wife and his friend could pick him up and get him in the truck, why could the paramedics not do it?

 

[ffemt8978]

You're assuming the patient would have allowed the medics to do so...we've all had cases where the patient was more comfortable with family members than EMS, and we've all had cases where the patient didn't want anything to do with family.

We simply don't have enough information to pass judgment...all we can do is ask questions.

 

[Ridryder911]

That is just wrong. I would have taken c-spine precautions and I would never had that Pt cuffed. That's just wrong. Why was family carrying the Pt? Why was the cop yelling at him also? no backboard or c-spine. com'on.

What sad excuses for Paramedics.

Spoken as inexperienced providers would say.

I do NOT take any equipment in with me except my jump kit/bag. Very apperantly you have never walked into a domestic, stabbing, assault with all that crap to delay you from exiting the area. Over view your scene to determine what is needed and what is not. If possible have a First Responder (FF) obtain for you. As well, no sense dragging all the equipment with you to only find out you do not need it. LSB, C-collars do NOT save lives, you have time to obtain them.

Wow! A whole whopping additional five minutes... that is not really bad considering. If an additional five minutes would matter, there is no hope for them anyway.

As it reads.. patient was reported to be "combatitive" and even some of the bystanders described possible intoxication.

Again .. propaganda from a disgruntled patient. Must have recieved their bill.

R/r 911

 

[medic417]

You're assuming the patient would have allowed the medics to do so...we've all had cases where the patient was more comfortable with family members than EMS, and we've all had cases where the patient didn't want anything to do with family.

We simply don't have enough information to pass judgment...all we can do is ask questions.

Thank you. Finally a voice of reason.

 

[medic417]

Spoken as inexperienced providers would say.

I do NOT take any equipment in with me except my jump kit/bag. Very apperantly you have never walked into a domestic, stabbing, assault with all that crap to delay you from exiting the area. Over view your scene to determine what is needed and what is not. If possible have a First Responder (FF) obtain for you. As well, no sense dragging all the equipment with you to only find out you do not need it. LSB, C-collars do NOT save lives, you have time to obtain them.

Wow! A whole whopping additional five minutes... that is not really bad considering. If an additional five minutes would matter, there is no hope for them anyway.

As it reads.. patient was reported to be "combatitive" and even some of the bystanders described possible intoxication.

Again .. propaganda from a disgruntled patient. Must have recieved their bill.

R/r 911

I agree. With experience comes common sense, what do I need to take care of ABC. I can send my partner back for anything else I need. Based on the dispatch no way of knowing if you will need something so either carry the ABC equipment, in other words jump bag, and see what you got then decide what equipment is needed, otherwise every call would require you carry everything in the ambulance as it could be needed. That would be just stupid.

 

[Airwaygoddess]

True, we can ask questions, even if they are answered we can still wonder why.

 

[emtfarva]

Spoken as inexperienced providers would say.

I do NOT take any equipment in with me except my jump kit/bag. Very apperantly you have never walked into a domestic, stabbing, assault with all that crap to delay you from exiting the area. Over view your scene to determine what is needed and what is not. If possible have a First Responder (FF) obtain for you. As well, no sense dragging all the equipment with you to only find out you do not need it. LSB, C-collars do NOT save lives, you have time to obtain them.

Wow! A whole whopping additional five minutes... that is not really bad considering. If an additional five minutes would matter, there is no hope for them anyway.

As it reads.. patient was reported to be "combatitive" and even some of the bystanders described possible intoxication.

Again .. propaganda from a disgruntled patient. Must have recieved their bill.

R/r 911

I didn't say I would take the c-spine stuff with me, I said I would have taken the precautions. I tend to bring in only a jump kit. depending on the call. I like to do every thing on the truck. exculding c-spine if indicated

 

[Sasha]

Spoken as inexperienced providers would say.

I do NOT take any equipment in with me except my jump kit/bag. Very apperantly you have never walked into a domestic, stabbing, assault with all that crap to delay you from exiting the area. Over view your scene to determine what is needed and what is not. If possible have a First Responder (FF) obtain for you. As well, no sense dragging all the equipment with you to only find out you do not need it. LSB, C-collars do NOT save lives, you have time to obtain them.

Wow! A whole whopping additional five minutes... that is not really bad considering. If an additional five minutes would matter, there is no hope for them anyway.

As it reads.. patient was reported to be "combatitive" and even some of the bystanders described possible intoxication.

Again .. propaganda from a disgruntled patient. Must have recieved their bill.

R/r 911

My issue with the article was not about the lack of equipment or extra five minutes on scene. It was the described lack of action of the paramedics. Fifteen minutes on scene, fine. But fifteen minutes on scene with no vitals? Have family carry him to the truck?

And as one medic was being described as saying "It's not that serious" and calling him drunk when family is telling them there are no drugs or alcohol. When in your right mind do you ever tell the family that? When did YOU go to Medical school where you can determine the definite severity of a person's head injury? Did they have a lab to do a BAL in their truck? Even basics are taught that head injuries and hypoglycemia often mimics being drunk and to never make a butt of yourself and put you in the position to be sued by calling a patient intoxicated.