Sunday, February 7, 2010

Dealing with Disappointment

Sometimes there is nothing quite so bad as when your peeps let you down. I have alot of peeps...fellow PAs, NPs, Docs, Nurses, Secs and Techs, etc. However, the peeps I generally hold most near and dear to my heart are the EMTs. If you haven't skimmed my profile, I'll just say that my medical career begain as an EMT. That was WAY back in 1980, while I was still in high school and I subsequently started working with local volunteer rescue squad. I got hired by the county EMS agency shortly after my graduation and within a year started training as an EMT-Intermediate and over the subsequent years as an EMT-Advanced Intermediate (essentially a cardiac care technician) and finally a paramedic. I worked mostly prehospital EMS, with several years spent as an EMS aeromedical team and, while in PA school, as a critical care transport Paramedic for the University. I also had the opportunity to serve as the training coordinator for a county EMS system and lead instructor for advanced EMS programs for the local community college. It is safe to say that, with almost half of my medical experiences being as an EMS care provider, I still hold a special fondness for those that still make house calls and do their best to provide life-saving care under conditions that many in the ED cannot begin to fathom.

Recently though, my peeps let me down. I was working in the ED when EMS brought in an elderly couple from a high impact MVC. Trauma is disproportionately devastating to the elderly and the mechanism of the crash was significant, but these factors were apparently lost on EMS and the problems were immediately noticeable. The driver, with noticeable head and upper extremity orthopedic injuries has rolled in the ED in a wheelchair. Later I learned that EMS had even told the nurses that the driver's seatbelt failed during the collision. The passenger was at least lying on a spine board, but not really secured to it. Both patients wore cervical collars...literally wore them. Neither collar was correctly fitted or locked and were therefore ineffective. Despite the mechanism of injury, neither patient had an IV. Fortunately both were talking and had fairly stable vital signs.

Through evaluation, the driver was fortunate to have no potentially life-threatening injuries, but the passenger wasn't quite so lucky. In this patient we found that she had not only suffered a fracture of C1, but also three (3) severe liver lacerations, an unstable pelvic fracture and an associated rupture of the urinary bladder. Though she remained hemodynamically stable in the ED, she has three potentially immediately deadly injuries. I had her choppered out to the closest trauma center, during which she fortunately remained stable.

I was profoundly disappointed in my EMT peeps. For whatever reasons, none good, all of the basics of trauma care that we have tried to teach since the late-1960's...the very impetus for the development of EMS itself, were all but ignored. I am trying to find a way to deal with this issue in a constructive, rather than critical way. My peeps can do better, and I'll do everything I can to help them achieve that.

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