Do you preform a trauma assessment on all trauma patients

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Tk11

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I know thats what I was taught to do. I'm in training right now for this company and we had a mvc. I noticed the medic didn't do much. We held C spine, put the collar on, and back boarded. And the areas the patient was complaining about were palpated. That's it. I wasn't going to question anyone but.... ??? Shouldn't more have been done?
 
Qulevrius said:
Like what ?
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I mean I don't know... I was just taught to preform a rapid trauma assessment. The vehicle was hit on multiple sides
 
Reputation breeds familiarity so you learn when to cut away what isn't needed based on pt presentation and C/C and when to go all out. And based on pure speculation from what you've said, that is probably the case.
 
If the pt is A/O a focused assessment based on C/C is all that's warranted.
 
MS Medic said:
Reputation breeds familiarity so you learn when to cut away what isn't needed based on pt presentation and C/C and when to go all out. And based on pure speculation from what you've said, that is probably the case.
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I was just thinking for the narrative, you wouldn't want to document that you checked more than just where they were complaining? When they were involved in something like a mvc
 
There is a difference between what is taught to pass NR skills check and practical application. In some cases like this you can shave a lot off. In others, you need to add more.
 
Qulevrius said:
^ This. You can rule out lots of things based on CC, LOC & MOI.
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Mechanism can tell you where to look, if you know how to read it. What it cannot do is tell you if there is actual injury involved.
 
Now bear in mind that my answers are very generic based on the limited information I'm being given.
 
If the pt is not unconscious a full head-to-toe is usually pretty unnecessary. Just use common sense and don't freak people out by checking everything when they hurt their finger...
 
A lot of things get lumped together.

If someone talking to me ( and actually making sense) I get a pretty good indication of their LOC, as well as I can tell they are breathing. If they are walking with normal gait and deny leg/pelvic pain, it's pretty safe to assume not much is going on with their south side. Etc etc. if they are unconscious, then do a full head to toe, but is they are aox4 it's typically not needed.
 
I had a PT who was in a low speed vehicle crash last week. She wasn't complaining of any specific issues but she was pregnant and wanted to get checked out. She may have been a "trauma" patient based on the mechanism but based on her complaint and the MOI it didn't warrant a full trauma assessment.
 
I've had sleep and more time to think about this. What you're asking about as far as a full trauma assessment on every pt is more a defensive medicine issue than an actual necessity for every pt. Trauma is more likely to occur on younger more healthy pts. In these cases, if the pt is A/O then they will generally be able to tell you where they hurt so are able to localize injuries. Those times, your focused assessment is generally sufficient. There will be the rare odd case where a pt can't feel, or more than likely doesn't tell you about an injury. So a full trauma assessment can be justified by someone in that context.

As far as documentation goes in trauma, a normal body system with no significant findings or pertinent negatives isn't really all that relative.
 
Well, remember that we are not "medicine", we are "the hands of medicine". We work specifically under the protocols of a doctor. There are no absolutes as to whether one type of evaluation is better than another 100% of the time. If the paramedic followed his protocols, the paramedic may be thinking about other things like rapid transport. I'm not going to spend 5 minutes on scene if the hospital is across the street. Just because something "appears" one way to you, may not mean that this is how it went. I would recommend asking the paramedic directly about that circumstance and what you can do in the future to grow in EMS yourself...this might lead to some insight as to what the paramedic was thinking. On the other hand, if your protocol is specific and says one thing, then protocol must be followed, provided it is within your scope.
 
joshrunkle35 said:
Well, remember that we are not "medicine", we are "the hands of medicine". We work specifically under the protocols of a doctor. There are no absolutes as to whether one type of evaluation is better than another 100% of the time.
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On the other hand, if your protocol is specific and says one thing, then protocol must be followed, provided it is within your scope.
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This attitude is so incredibly misguided.
 
joshrunkle35 said:
Well, remember that we are not "medicine", we are "the hands of medicine". We work specifically under the protocols of a doctor. There are no absolutes as to whether one type of evaluation is better than another 100% of the time. If the paramedic followed his protocols, the paramedic may be thinking about other things like rapid transport. I'm not going to spend 5 minutes on scene if the hospital is across the street. Just because something "appears" one way to you, may not mean that this is how it went. I would recommend asking the paramedic directly about that circumstance and what you can do in the future to grow in EMS yourself...this might lead to some insight as to what the paramedic was thinking. On the other hand, if your protocol is specific and says one thing, then protocol must be followed, provided it is within your scope.
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chaz90 said:
This attitude is so incredibly misguided.
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Well, I couldn't agree more, chaz90. While we do function under protocols, we also need to think about the patient and what's going on with them. There are occasions where the patient seems to fit one protocol but needs another... or needs you to become a bit more creative and actually ask for orders (or suggest them) because the patient doesn't fit any protocol you have available to you.

I might just spend 5 minutes on scene, even if the hospital is across the street, so that I can figure out if the hospital across the street is actually the closest, most appropriate facility for this patient. Where I work, we're not a trauma center. We occasionally do get traumas, but quite frankly, when EMS identifies a trauma patient, they usually fly the patient out from the scene OR they'll fly the patient out by meeting the helicopter at our pad. Usually the only times we'd get such a patient is if a helicopter won't be available for a while and we can be of benefit to the patient, such as giving platelets, FFP, or blood before a helicopter can arrive.

Where I live, unless the patient is airway compromised, trauma patients go to the closest trauma center, even if the patient is right across from a hospital. The reason is actually very simple: it takes TIME for a facility to arrange even a STAT transfer to another hospital... and that could very well be a 911 call to do that. So, why take a trauma patient to a non-trauma center where they're going to do their own workup and then call 911 for a stat transfer when EMS can bypass that 30-40 minute workup time and transport directly to a trauma center that's just 10 or 15 minutes away?
 
Tk11 said:
The vehicle was hit on multiple sides
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Due modern crumple zones in cars, mechanism isn't much of an indicator of potential injury. I have a picture posted in the 100% directionless thread of a car with one half of the passenger compartment completely flattened and both occupants self extricated and we're ambulatory. In fact, the only mechanisms considered in our state trauma activation protocols are ejection, occupant death in same car, and car vs pedestrian.

joshrunkle35 said:
Well, remember that we are not "medicine", we are "the hands of medicine". ... I'm not going to spend 5 minutes on scene if the hospital is across the street.
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WOW, I don't about anyone else but I'm expected to assess and provide pt care, not be an ambalance driver. Not only am I expected to think critically and provide appropriate pt care, but failing to provide said care could cost me my job. In my opinion, failing to stabilize and treat a pt because of your proximity to the hospital is unethical and negligent.
 
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