MVA - BLS or Trauma alert?

[emtdansby]

Wow, this really has become a great debate. Glad I finally have some back up on my end. Hal, you are certainly entitled to your opinion and how you treat patients is your way, but I can easily say I wouldn't want you treating my pregnant wife. The statement I have the biggest issue with is "The OP didn't say she was bleeding." just because there isn't any external signs of bleeding, doesn't mean she isn't bleeding internally. Her ABD pain along with her risk factors (8 months pregnant and unrestrained MVA) raise a considerable amount of suspicion towards internal hemorrhage. Also, the OP does mention that there was a fire medic and his partner( also a medic) on scene. So there would have been no delay waiting for ALS. His partner should've treated the patient, even with a short transport.

 

[Clare]

ACH would not active a trauma call for this patient and I would not ask for one (not that I am likely to get it if I did!) and I would classify her as stable with unlikely threat to life (status three).

She was in a low speed road crash, has no significantly abnormal physiology, is alert and orientated, and has no life threatening problems.

I absolutely agree that her being pregnant is a cause for concern and that she should be immediately referred to a hospital emergency department but her problem is not one that is time critical.

Although it is quite difficult for many people to accept (myself included) we must think of a patient's status as being defined by how time critical their problem is, regardless of the history of mechanism. For example, a patient who has been in a road crash but has no significantly abnormal physiology and no time critical problems is not time critical just because they were in a road crash, somebody who is in decompensated septic shock but got bitten by a mosquito 3 days ago (as their avenue of infection) is time critical despite the fact that the road crash has significantly more potential to create a time critical problem than being bitten by a mosquito.

In the past mechanism of injury was quite an objective factor in determining how a patient was classified (particularly, but not exclusively, road crash) and this must stop because regardless of the mechanism it is the state of the patient that determines how time critical they are.

 

[LEB343]

This has turned into a great debate! I guess this call could have been BLS or ALS. Just wanted to clear up a few things.

There was a language barrier with pt. Her orientation was unknown along with unknown LOC. Also, in our protocols, we as ems cannot call a trauma alert. There are no criteria to call an alert.

The most frustrating thing about this call is how it got passed onto the ambulance crew (my partner and I). I've been told by ED physicians that when we bring in a pt and give a hand off, they pick up were we left off and go from there (obviously). We as EMS set the tone. The fire engine that arrived on scene first set the tone. There were about 6-7 people involved in the accident and we were told right away that there were no patients. We stood around for 5-10 mins before we were handed our patient. The fire medic did not seem concerned and therefore my medic partner did not seem concerned. I was then not concerned and figured this was a basic call until I got to the ED.

I guess the lesson to learn was don't be lazy! lol Whether you are a EMT or paramedic, do a full assessment of the pt even if you were handed a pt from another medic.

 

[Akulahawk]

This has turned into a great debate! I guess this call could have been BLS or ALS. Just wanted to clear up a few things.

There was a language barrier with pt. Her orientation was unknown along with unknown LOC. Also, in our protocols, we as ems cannot call a trauma alert. There are no criteria to call an alert.

The most frustrating thing about this call is how it got passed onto the ambulance crew (my partner and I). I've been told by ED physicians that when we bring in a pt and give a hand off, they pick up were we left off and go from there (obviously). We as EMS set the tone. The fire engine that arrived on scene first set the tone. There were about 6-7 people involved in the accident and we were told right away that there were no patients. We stood around for 5-10 mins before we were handed our patient. The fire medic did not seem concerned and therefore my medic partner did not seem concerned. I was then not concerned and figured this was a basic call until I got to the ED.

I guess the lesson to learn was don't be lazy! lol Whether you are a EMT or paramedic, do a full assessment of the pt even if you were handed a pt from another medic.

That's a HUGE lesson right there. Always do your own assessment of the patient, even if you got the patient from a provider with higher medical authority than you. You could end up finding something that makes the patient require care that is outside/above your scope of practice. I can't count the number of times I was "given" a patient that had something that I wasn't authorized to monitor... and some of my former colleagues would have taken the patient on faith that the other provider said it was OK and/or deemed it to be appropriate for them to transport.

Remember, if you feel (and can especially verbalize) that a patient requires care above what you can provide when taking over care from another provider, you (usually) have the right to refuse to take the patient and punt back to the other provider... if that provider is a higher level than you.

 

[Handsome Robb]

ACH would not active a trauma call for this patient and I would not ask for one (not that I am likely to get it if I did!) and I would classify her as stable with unlikely threat to life (status three).

I respectfully disagree.

I'll agree with the no abnormal, obvious, physiological changes, with that said she needs an abdominal assessment from a physician, like I stated before in my replies.

Not sure if I posted it in my earlier replies but per our Trauma Center's trauma criteria this patient would be the lowest level trauma activation, a "Trauma Green". Significant mechanism of injury with gestation >20 weeks and an abdominal complaint is a trauma here.