Giving the base station a quick “heads up” while en route to calls that have a high potential for serious trauma is an important part of the El Dorado County trauma system. By doing so you accomplish the following: 1) you prepare the ER staff for a possible trauma patient; 2) you get a faster response to the radio by the MICN or base physician; 3) you find out regional trauma center availability; and, 4) you get real-time info on CT scan status and other critical destination information to assist in determining the best possible trauma destination for your patient.
Please remember to re-contact the base as soon as possible to cancel the trauma alert if the trauma system becomes unnecessary (i.e., cancellations, minor injuries, etc.)
Avoid H1N1. Upon initial exam stay at least 6 feet away from patient and ask them if they have a fever (they should be able to tell you). If they say “yes” or if you feel they may have the flu based on their symptoms, don your PPE (fitted N95 mask, gloves, glasses, and gown) and hand the patient a regular surgical mask to wear. After everyone is masked you can continue on with your normal assessment and treatment procedures.
Don't be fooled by normal blood pressures. Unexplained tachycardia, tachypnea, ALOC, or pale cool skin signs may be the result of compensatory shock, even if the patient's blood pressure is within normal limits. Any trauma or medical patient that presents with any of these signs or symptoms should be considered for aggressive IV fluid resuscitation. Remember, the blood pressure is the last vital sign to change in hypovolemic shock.
It is OK to put a traction splint on an open femur fracture. Open fractures receive antibiotics and a surgical washout regardless of level of contamination. Obvious contaminating debris should be removed as much as possible. Contraindications to applying a traction splint for a femur fracture include: Fracture of the knee or close to the knee; Fracture of the pelvis or hip; Partial amputation with bone separation; Obvious fracture or deformity of the leg or ankle.
When you encounter intoxicated patients that are refusing treatment and/or transport, any intoxicated patient that is presenting with an altered mental status must be transported to the most appropriate emergency department, even if they are refusing. When in-doubt, consider law enforcement involvement.
Remember that saline locks must be used for CHF/pulmonary edema patients in place of 1000cc IV bags. Accidental runaway IVs can result in exacerbation of the patient's condition. Saline locks should also be considered for other medical conditions, such as hypertensive crisis and CVA.
Whenever bystanders on scene help the injured and sustain a body fluid exposure, advise them to seek immediate medical attention. Offer transport when appropriate. Time is of the essence.
Treat the Patient Not the Blood Glucose Monitor. When you encounter an alert and oriented patient with an abnormal glucose monitor reading consider the big picture and not just the numbers on the screen. If in doubt about treatment, contact your base physician for advice.
Carbon Monoxide Poisoning. When treating victims of carbon monoxide poisoning, your focus should be on delivering 100% oxygen, ruling out other possible conditions (i.e., hypoglycemia, narcotic use, etc…), and transporting the patient to the closest emergency room. While hyperbaric therapy may be indicated for some rare cases of CO toxicity, its use is controversial and is not considered a first-line therapy. Stabilization at the nearest emergency room with transfer to hyperbaric capable facility, if needed at a later time should dictate your decision on transport destination. As always, if in doubt, contact the base station physician for consultation.
AMA'sDon't make the mistake of documenting an otherwise perfect AMA in a patient you can't convince to consent to ambulance transport to the hospital by telling them after the "you may have a life-threatening illness/injury including death" by then saying "you'll probably be fine". Don't reassure. Your job is public safety and service, not being the patient's friend. And when the patient does go to the hospital, the part they often remember is only, the medic said, "you'll be fine".
I.C.E. for Cell PhonesPatients found with no identification may be carrying their cell phone. It is now being recommended that cell phone owners put an entry in their "contact list" called "ICE" or "In Case of Emergency". This number can be used by rescuers to contact a close friend or relative to obtain emergency information.
A distracting injury in trauma is anything that hurts to the point the patient dwells on it. "My leg really hurts", "My head hurts", etc. These patient's spines should be fully immobilized to prevent motion of a patient that may have a spinal fracture or occult spinal cord injury. Other patients that should be fully immobilized (i.e., hard C-collar, backboard, and straps) include pediatric patients, drunk or impaired patients, head injured with GCS 14 or less, etc. You can just never be too careful.
Two PCR's are required when providing a round-trip transfer for patients receiving treatment at another facility. Insurance companies will only pay for one transfer if the documentation is on a single PCR. Also, be sure the transfer order clearly indicates the patient's diagnosis or chief complaint as the reason for medical necessity. "Heart Cath" or "Radiation Treatment" are not acceptable as justification for medical necessity. Instead, the transfer order should include "Chest Pain", "Cancer", etc. as the reason for medical necessity.
When drawing blood for more than one type of blood tube, hospital labs recommend that tubes be drawn in a certain order to avoid potential cross contamination with Heparin. Marshall Hospital recommends the following order: Gold top, Red top, Blue top, Green top, then Purple top.
Never judge the worthiness of a 911 call at the scene. Do your job professionally and transport the patient. Inform the ER staff if you feel there is suspected elder abuse, neglect, or inability to care for self. You may also notify Adult Protective Services, or ask the ER to do so.
REMINDER!! Nasal intubation is contraindicated in the presence of head or facial trauma due to risk of possible intercranial perforation.
"Vital Health Information Packets" are now being distributed by the Senior Health Education Program in collaboration with the EMS Agency to El Dorado County seniors. These kits contain useful patient information that can be important to field providers and hospitals alike, especially when the patient has an altered level of consciousness. Seniors are instructed to place the completed packet on the outside of their refrigerator door with an attached magnet. When responding to a senior citizen in their residence be sure to look for this health information.
A 60 cc syringe with a catheter tip (not a needle tip) is standard equipment for El Dorado County ALS units and is necessary to check for correct nasogastric tube placement. It is also useful to check endotracheal tube placement and is now recommended by ACLS. Simply insert the catheter tip into the distal end of the ET tube and draw back. If you draw back air with no resistance, you are probably in the trachea. If you meet with resistance when you draw back, you are probably in the esophagus.