Ped major trauma - Houston FD delayed EMS response?

[systemet]

http://www.ems1.com/communications-...-family-questions-Houston-ambulance-response/

This sounds bizarre...

 

[Handsome Robb]

That's terrible.

Remind me never to move to Houston. Talk about a Fire Department trying to justify its existence

 

[Tigger]

That is not a good system. When someone calls 911 for an ambulance, an ambulance needs to be sent. Period. We have ALS FD first response on every call where I live, but an ambulance is sent to every call as well (except lift assists). Fire is useful since there are almost twice as many of them than ambulances, so at least they can settle things down till an ambulance arrives.

Is there evidence to support ALS first response? Nope. Poor contract wording that allows the bare minimum of AMR trucks to cover the city? Yes. But having fire respond to every medical at least ensures that everyone gets a paramedic in a timely manner, and the care actually provided by the crews is usually quite good. I

 

[STXmedic]

Personally, I think that this is more a terrible accident with the parents looking for something to pin it on. The general public does not understand how our systems work, and during an emergency minutes seem like an eternity. The news will always do a great job at contorting verbiage to make a good story.

Houston's dispatch system sounds nearly identical to the one we use (willing to bet it's the same one). It is not "send only fire to every call, then let fire dispatch EMS". Both get dispatched with very few exceptions. In a major city, 8min response times for EMS is not all that long (I regularly have a longer than 4min eta waiting on EMS), and when there are nearly twice as many fire units, of course fire is going to get there first.

I'm not saying Houston is a great service by any means, but I think that story has a lot of holes left in it and a lot of facts left out.

 

[Tigger]

I misread that story. The fire official quoted makes note that an ambulance is dispatched automatically for life-threatening emergencies. The only time one is not is for "non-emergent" calls, which is like the system here. I don't understand how this call gets mishandled as non-emergent. I suppose it could happen, but I think Poetic is right and the system probably worked but the child still died. Sometimes it takes longer than we would like to get an ambulance.

 

[McGoo]

I don't see a major problem with sending FD first. If someone is majorly sick, especially from a trauma, most of the time they dont need advanced doodads and doohickeys, they need airway, breathing, and circulation. Which an EMT-B person should be able to do. On the big calls I go on, it's really the basic stuff that saves lives.

There are exceptions to this, such as needle decompression for tension pneumothorax, but on the whole sending someone is better than waiting a long time for the advanced someone.

 

[Farmer2DO]

Personally, I think that this is more a terrible accident with the parents looking for something to pin it on.

Actually, the family is stating exactly the opposite. They are trying to make sure the system worked well, and at first glance, it appears it did not. If it didn't work well, they want to make sure that gets fixed.

I don't see a major problem with sending FD first. If someone is majorly sick, especially from a trauma, most of the time they dont need advanced doodads and doohickeys, they need airway, breathing, and circulation. Which an EMT-B person should be able to do. On the big calls I go on, it's really the basic stuff that saves lives.

Most of the time, expecially with trauma, we are NOT definitive care. Definitive care for trauma is bright lights and cold steel, which you can't get without an ambulance.

If they are using EMD protocols, I can't even begin to comprehend how this isn't dispatched as an emergency job, and thus withhold an ambulance. I can see how withholding an ambulance on an OBVIOUS low priority job during high call volume and low ambulance availability can help, but this doesn't meet that criteria. In my system, this would be a Delta level job every day.

Did it make a difference? Maybe, maybe not. I do think the program is an epic fail, from what we know so far and how this situation appears to have been handled. Houston better change the dispatch program, or they better get used to paying out lots of money to angry family members.

 

[Handsome Robb]

There's not an issue with sending the FD seeing as they will more than likely be on scene first, depending on the time of day and how the EMS system is setup. Here we run System Status, during the day FD usually beats us to priority 1-2 calls. If its in the middle of the night we usually get there first seeing as we are already in the truck whereas they have to get out of bed get dressed then leave the station.

The issue is FD and EMS weren't dispatched simultaneously or back to back. There is no way HFD is going to be able to justify sending an engine to this, ALS or not, then waiting for them to arrive on scene and make an assessment then to decide to dispatch the Ambulance.

 

[STXmedic]

If they are using EMD protocols, I can't even begin to comprehend how this isn't dispatched as an emergency job, and thus withhold an ambulance. I can see how withholding an ambulance on an OBVIOUS low priority job during high call volume and low ambulance availability can help, but this doesn't meet that criteria. In my system, this would be a Delta level job every day.

Did it make a difference? Maybe, maybe not. I do think the program is an epic fail, from what we know so far and how this situation appears to have been handled. Houston better change the dispatch program, or they better get used to paying out lots of money to angry family members.

That's the thing though. We don't know if an ambulance was held or not. The family ASSUMED that one was held because of the response time, but the fire department did not confirm this and I doubt that was the case. EMD would have absolutely dispatched an ambulance with that.

 

[JPINFV]

Personally, I think that this is more a terrible accident with the parents looking for something to pin it on. The general public does not understand how our systems work, and during an emergency minutes seem like an eternity. The news will always do a great job at contorting verbiage to make a good story.

From the article:

City Council member Mike Sullivan, whose district includes Kingwood, said the family was told by the crew of the fire engine that an ambulance could not be sent until they arrived on the scene to make an assessment.
"It's not uncommon for a firetruck to show up on EMS calls," said Sullivan, who said he talked to HFD personnel at the scene of the Kingwood accident. "However, they usually show up and an ambulance is en route at the same time. The new policy is: The firetruck is dispatched to the scene, makes an assessment, and then requests an ambulance."

Either the council member is mistaken, or explain to be how "The new policy is: The firetruck is dispatched to the scene, makes an assessment, and then requests an ambulance," is anything but fresh horse apples. Explain to me how your system works. I don't understand how YOUR system works if that direct quote is accurate. Would the fire department send a battalion chief to a fire with visible flames to make an "assessment" before dispatching a structure assignment?

 

[JPINFV]

I don't see a major problem with sending FD first. If someone is majorly sick, especially from a trauma, most of the time they dont need advanced doodads and doohickeys, they need airway, breathing, and circulation. Which an EMT-B person should be able to do. On the big calls I go on, it's really the basic stuff that saves lives.

Make sure to tell the trauma surgeon to stick to the basics like A, B, C, and not to use all of those fancy operating doohickeys.

 

[STXmedic]

From the article:


Either the council member is mistaken, or explain to be how "The new policy is: The firetruck is dispatched to the scene, makes an assessment, and then requests an ambulance," is anything but fresh horse apples. Explain to me how your system works. I don't understand how YOUR system works if that direct quote is accurate. Would the fire department send a battalion chief to a fire with visible flames to make an "assessment" before dispatching a structure assignment?

And I believe everything that comes out of an upset citizen's mouth. Especially when it's something they were told when they were panicking and not thinking straight. When the FD comes out an publicly releases the dispatch records showing that this was indeed the case, then I will side with you 100% that their system is terribly flawed and needs a complete overhaul. Until then, I'm not going to weigh too heavily on the word of a distraught parent.

 

[Handsome Robb]

Make sure to tell the trauma surgeon to stick to the basics like A, B, C, and not to use all of those fancy operating doohickeys.

I see your point, but your comparing apples to oranges.

This is a prehospital forum, not a trauma surgeon forum.

At the ALS level there are few things we can do beyond what a B/I can do for a trauma patient. Needle decompression, fluid replacement, monitor for dysrhythmias, if your real rural maybe pericardiocentesis, intubation/cric and many places I's can drop ETTs.

 

[JPINFV]

And I believe everything that comes out of an upset citizen's mouth.

Do you know how I know that you haven't read the article?

City Council member Mike Sullivan, whose district includes Kingwood, said the family was told by the crew of the fire engine that an ambulance could not be sent until they arrived on the scene to make an assessment.
"It's not uncommon for a firetruck to show up on EMS calls," said Sullivan, who said he talked to HFD personnel at the scene of the Kingwood accident. "However, they usually show up and an ambulance is en route at the same time. The new policy is: The firetruck is dispatched to the scene, makes an assessment, and then requests an ambulance."

So, let's ignore the upset citizen and listen to the elected representative who was talking to the people who responded. Unless we shouldn't be listening to emergency responders who are trying to cover their own behind.

 

[JPINFV]

At the ALS level there are few things we can do beyond what a B/I can do for a trauma patient. Needle decompression, fluid replacement, monitor for dysrhythmias, if your real rural maybe pericardiocentesis, intubation/cric and many places I's can drop ETTs.

I won't argue otherwise, however a "stick to the basics" line, to me, stinks of "BLS before ALS" which stinks of inadequate training and silly little boxes like "basic" or "advanced." How about instead of "sticking to the basics" we stick to "evidence based medicine"? The really strange thing is that all of those things you mentioned are important interventions used to manage airway, breathing, and circulation issues when used appropriately and prudently.

 

[STXmedic]

I would like to know how you think I did not read the article. I'm just pulling this other info out of my ***. An educated shot in the dark if you will.

 

[JPINFV]

I edited my post above, but I'll copy paste it...

I would like to know how you think I did not read the article. I'm just pulling this other info out of my ***. An educated shot in the dark if you will.

You identified the source as an "upset citizen."

City Council member Mike Sullivan, whose district includes Kingwood, said the family was told by the crew of the fire engine that an ambulance could not be sent until they arrived on the scene to make an assessment.
"It's not uncommon for a firetruck to show up on EMS calls," said Sullivan, who said he talked to HFD personnel at the scene of the Kingwood accident. "However, they usually show up and an ambulance is en route at the same time. The new policy is: The firetruck is dispatched to the scene, makes an assessment, and then requests an ambulance."

So, let's ignore the upset citizen and listen to the elected representative who was talking to the people who responded. Unless we shouldn't be listening to emergency responders who are trying to cover their own behind.

 

[Handsome Robb]

I won't argue otherwise, however a "stick to the basics" line, to me, stinks of "BLS before ALS" which stinks of inadequate training and silly little boxes like "basic" or "advanced." How about instead of "sticking to the basics" we stick to "evidence based medicine"? The really strange thing is that all of those things you mentioned are important interventions used to manage airway, breathing, and circulation issues when used appropriately and prudently.

I never said they weren't important. Although, you can't utilize these interventions "appropriately and prudently" unless you start with your ABC assessment which is a BLS skill.

JP you should know that I am with you on increasing education and changing the way EMS medicine is practiced in a majority of places but it's not really fair to present an argument with trauma surgeons referenced....

 

[Farmer2DO]

I don't see a major problem with sending FD first.

I don't think any of us have a problem sending the fire department at all. Just don't wait on an ambulance when a mother says "I ran over my child."

If someone is majorly sick, especially from a trauma, most of the time they dont need advanced doodads and doohickeys, they need airway, breathing, and circulation.

No, they need a surgeon to fix them, or they will die. We don't yet do surgery in the field, so it requires getting them somewhere where they can. Like a hospital. Which requires an ambulance.

Which an EMT-B person should be able to do. On the big calls I go on, it's really the basic stuff that saves lives.

Again, no. What EMS of any level can TRY to do is keep the patient viable until they arrive somewhere where definitive care can be given. We are rarely definitive care.

but on the whole sending someone is better than waiting a long time for the advanced someone.

How about sending someone who can actually get the patient to DEFINITIVE CARE? A fire truck ain't gonna do jack squat for a trauma patient. Period.

Make sure to tell the trauma surgeon to stick to the basics like A, B, C, and not to use all of those fancy operating doohickeys.

I see your point, but your comparing apples to oranges.

No, he's not.

This is a prehospital forum, not a trauma surgeon forum.

You're absolutely right. And one of our major jobs is to get the trauma patient to the trauma surgeon.

At the ALS level there are few things we can do beyond what a B/I can do for a trauma patient. Needle decompression, fluid replacement, monitor for dysrhythmias, if your real rural maybe pericardiocentesis, intubation/cric and many places I's can drop ETTs.

You seem to have a fairly level head, and I believe you're a paramedic student. One of the things that you will learn is that often what makes a paramedic more valuable in the patient care arena is what's between the ears, not what's in the bag of tricks. You're right; often trauma doesn't require a lot of stuff to be done. But the paramedic, by the nature of their training, and especially compared to the EMT-B and EMT-I (I operated at both levels extensively) brings much more to the table, with their education and understanding of anatomy, pathophysiology and treatment, and their clinical experience allowing them to make judgement calls and to recognize when a situation is emergent and when it isn't. I don't care if all the patient needed was transport; the paramedic is far more equipped to assess, choose the mode of transport, the destination, and pre-notify, all of which can make a huge difference in time to definitive care. No EMT-B or EMT-I has the didactic education, clinical education, and experience to make those judgement calls.

 

[JPINFV]

JP you should know that I am with you on increasing education and changing the way EMS medicine is practiced in a majority of places but it's not really fair to present an argument with trauma surgeons referenced....

I believe that it's very fair when using it to compare and contrast how fields who aren't contaminated with "BLS/ALS" or "basic/advanced" dichotomy looks at things. I have yet to hear in medical school anything that compares with sticking some interventions into "basic" or "advanced." Some interventions may be used before others, but that doesn't make the first line treatments "basic" or further treatments "advanced."