ATGATT: I'm a paramedic student, this is my story.

[Hellgate]

Shook me up a little.

Oh, in his underwear was a pisock containing a whole lot of Ice... I mean ALOT...

Yickes. Hang tough, and take care of yourself. Seeing trauma like that is very hard and sticks with you for a very long time. The weird part is it rears it's head whenever it wants to.

Honestly I don't see how EMT's and Paramedics do it. Hats off to you brother.

 

[FZ09Bandit]

With the amount of facial and jaw trauma, intubation might not have been possible. Situational. Can you guys surgical cric (assuming no trachial damage, either)? You say he had a pulse, but cpr was in progress?

Its awesome if you save em, but the way i think of things if they do end up dying. IF in the slightest chances this fella woulda "lived" what would the quality of life have been considering the head trauma and brain damage incurred?

Yes we can cric. Yes CPR was in progress untill the doc called it.

 

[Bill]

With the amount of facial and jaw trauma, intubation might not have been possible. Situational. Can you guys surgical cric (assuming no trachial damage, either)? You say he had a pulse, but cpr was in progress?

Its awesome if you save em, but the way i think of things if they do end up dying. IF in the slightest chances this fella woulda "lived" what would the quality of life have been considering the head trauma and brain damage incurred?

Medics can do crics. EMT-I's can on medical direction and if certified. Which I am not. Being an OPA was in place intubation could have been possible... also being that close to a hospital and assuming they were able to maintain the air way, just go with the oral.

Don't know about other jurisdictions but Maryland did just go through some protocol changes that allow EMT-B, I, and P's to call a patient on certain criteria. Asystole, levidity, etc. However if a patient has a confirmed "pulse", either by palpation or 12 lead, regardless of trauma we transport. In this case to a level one trauma center.Quality of life isn't for us to consider, thats for the Dr's and the patients family to contemplate.

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[tejkowskit]

Medics can do crics. EMT-I's can on medical direction and if certified. Which I am not. Being an OPA was in place intubation could have been possible... also being that close to a hospital and assuming they were able to maintain the air way, just go with the oral.

Don't know about other jurisdictions but Maryland did just go through some protocol changes that allow EMT-B, I, and P's to call a patient on certain criteria. Asystole, levidity, etc. However if a patient has a confirmed pulse, either by palpation or 12 lead, regardless of trauma we transport. In this case to a level one trauma center.

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Ah didnt see the part about the oral.

This is where my medical orders and procedures differ from yours. Depending on the "region" not all paramedics in IL can do surgical crics. Emt I is almost extinct in IL, and cannot cric. From what I've read about other states EMS, IL is a cluster f*** in regards to how it's run lol. We can call it in the field under the same circumstances of obviously deceased, but the reason I questioned CPR is because the pt had a pulse; Maybe just different sop's, again, but we'd never do compressions if the pt had a pulse unless it was neonatal resusc with a pulse <60? You cant confirm a pulse by ekg, either.

 

[iviyth0s]

Damn...no helmet though. Even most squids where helmets!

 

[Bill]

Ah didnt see the part about the oral.

This is where my medical orders and procedures differ from yours. Depending on the "region" not all paramedics in IL can do surgical crics. Emt I is almost extinct in IL, and cannot cric. From what I've read about other states EMS, IL is a cluster f*** in regards to how it's run lol. We can call it in the field under the same circumstances of obviously deceased, but the reason I questioned CPR is because the pt had a pulse; Maybe just different sop's, again, but we'd never do compressions if the pt had a pulse unless it was neonatal resusc with a pulse <60? You cant confirm a pulse by ekg, either.

Yes! There are some differences. Maryland (Maryland Institute for Emergency Medical Services Systems or MIEMMS) is just as screwed up. When you throw in NR and Federal (DoD which I am) things get real interesting. The medical director I operate under is a DoD physician. Real good guy. He "gets" what our issues are and works with us very well. Heck, most of us are on a first name basis with him so he knows his providers personally. We operate under his direction while on and off base but follow Maryland protocol. Being I've been in for a little while, 10 years, I see Maryland doing the EMT-A (which is basically EMT-I) and doing away with EMT-B all together. Might take a few years but they just rolled out some interesting protocols for the B's that were only for I's and P's in the years past.

This fella that was brought in was it in his and everyone's best interest to run code to the hospital just to have the Dr's pronounce him? Maybe a good medic and medical consult could have called it on the street. I dunno, I wasn't there. Was it necessary to take up a bed for some other patient who might really needed it? The guy wasn't wearing a helmet... The EMT's running code from the scene, was it necessary to endanger their lives for one individual who had little regard for their own life? Again I don't know. These are the tough calls we have to make.

 

[FZ09Bandit]

Paramedic states he had a pulse, our trucks have 3 leads. It quit as soon as they got there.

Considering **** is a level three trauma center. They have a room specifically for this, even have a fancy computer to talk to specialists on stroke patients.

There is a emt advanced here. Intubations and IVs I think.

But like I said, the docs called it fairly quickly.

The only real good thing about Arkansas, is we have a children's.

 

[FZ09Bandit]

About the guys cruiser, it laid on the highway in flames.

A truck was in the turning lane about to make a left into fastfood. And pulled out infront of the biker.

A full size pickup. A vtx 1300

 

[Tailgate]

Try posting on a Harley forum? You'd probably get laughed at. I say that because many HD riders wear helmets that don't look like they provide much protection.

 

[FZ09Bandit]

May have held the dura matter in a bowl instead of all over the street :S

 

[tejkowskit]

May have held the dura matter in a bowl instead of all over the street :S

Lol so true. Those non DOT novelty helmets are pointless.

Yes! There are some differences. Maryland (Maryland Institute for Emergency Medical Services Systems or MIEMMS) is just as screwed up. When you throw in NR and Federal (DoD which I am) things get real interesting. The medical director I operate under is a DoD physician. Real good guy. He "gets" what our issues are and works with us very well. Heck, most of us are on a first name basis with him so he knows his providers personally. We operate under his direction while on and off base but follow Maryland protocol. Being I've been in for a little while, 10 years, I see Maryland doing the EMT-A (which is basically EMT-I) and doing away with EMT-B all together. Might take a few years but they just rolled out some interesting protocols for the B's that were only for I's and P's in the years past.

This fella that was brought in was it in his and everyone's best interest to run code to the hospital just to have the Dr's pronounce him? Maybe a good medic and medical consult could have called it on the street. I dunno, I wasn't there. Was it necessary to take up a bed for some other patient who might really needed it? The guy wasn't wearing a helmet... The EMT's running code from the scene, was it necessary to endanger their lives for one individual who had little regard for their own life? Again I don't know. These are the tough calls we have to make.

Must be nice havin a medical director who knows his medics! Lol. The MD for the system I started in was involved, but the one I am under the direction of now I have never met! I cant blame him though, as Chicago has too many people in its system to get personal with even a small percent.

Ive heard rumors about our basics being able to do more, but again, IL is so behind already and it takes forever to get things moving.

You bring up some good controversial points about calling it and if it was worth it. Thats what is great about this job. There is never the same call based on the situation. Its always different and you actually need to think! Lol

Paramedic states he had a pulse, our trucks have 3 leads. It quit as soon as they got there.

Thanks, thats what I was looking for.:thumbup:

 

[kenh]

May have held the dura matter in a bowl instead of all over the street :S

Not being in the medical field I have found the postings in this thread to be very informative. Thank you for the jobs that you do. It is reassuring for the rest of us to know that you are out there. My helmet is off to you guys and girls - except when I am riding of course. :thumbup:

 

[Nelly]

Medics can do crics. EMT-I's can on medical direction and if certified. Which I am not. Being an OPA was in place intubation could have been possible... also being that close to a hospital and assuming they were able to maintain the air way, just go with the oral.

Don't know about other jurisdictions but Maryland did just go through some protocol changes that allow EMT-B, I, and P's to call a patient on certain criteria. Asystole, levidity, etc. However if a patient has a confirmed "pulse", either by palpation or 12 lead, regardless of trauma we transport. In this case to a level one trauma center.Quality of life isn't for us to consider, thats for the Dr's and the patients family to contemplate.

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12 lead isn't an indication of a pulse, patient could be in PEA. To clarify if your transfers have a pulse or signs of electrical activity ( signs of something reversible) you continue the resus?

Nelly

 

[tejkowskit]

12 lead isn't an indication of a pulse, patient could be in PEA. To clarify if your transfers have a pulse or signs of electrical activity ( signs of somrthing reversible) you continue the resus?

Nelly

Correctomundo, No EKG is an indication of a pulse; rather just a reading of electrical conduction. You can have electrical activity and no mechanical capture, therefore no pulse. Pulses must be palpated.

And yes, if the patient has any pulse or electrical activity we treat (unless a DNR order is in place) and transport. Treatment can also be performed with no pulse or electrical activity (known as asystole or flatline to the lay persons) unless signs of irreversible death are present (lividity, rigor mortis, decapitation, decomposition, etc..).

 

[Bill]

12 lead isn't an indication of a pulse, patient could be in PEA. To clarify if your transfers have a pulse or signs of electrical activity ( signs of somrthing reversible) you continue the resus?

Nelly

Correct. :thumbup: If its a witnessed arrest.

Un-witnessed, no. Trauma arrest no. Three rounds of drugs... epi. etc, and as Maryland puts it "high quality CPR" for 15 minutes.

A 12 lead is a confirmation of Asystole. AND Asystole is?

 

[Yasko]

Just another lovely day pulling double 14 hour shifts getting my clincal time in. You know pretty easy day...

I was thinking about getting my paperwork signed and ducking out early, I hear a signal comes over the radio "code blue" "open cranial head injury" so we prep the trauma room, get ready and wheel him in.

Blood everywhere, pulling CPR as soon as they get him out of he truck, we get him on the bed and start to ventilate, we do this for 5 minutes untill the doctor calls it.

Now imagine this scene, a face you couldn't recognize, broken teeth coming up through the nose, the jaw had been pushed back so far there was a gap I could stick my fingers behind it. Eyes, swollen shut. The cranium, you could fell the separation of the bones, it felt like jelly, along with dura matter (brain) exposed and laying in random places.

What does this have to do with ATGATT? Motorcycle VRS truck. The man was wearing no gear, no helmet.

Is this real for you yet? Because it sure as hell is for me.

Would he have lived if he had a helmet? My guess would be yes! He had a laceration on his shoulder and his femur was broke. Take the head out of the equation and the other stuff is manageable.

Thank you for listening, sorry but this is how i "diffuse" to maybe spread some education to those who may not think gear is worth it.

How do you keep ridding after seeing this time, after time?

 

[Bill]

How do you keep ridding after seeing this time, after time?

Look at it this way. Your hungry, you eat. Just don't binge every time you eat. You enjoy sex? But you could get AIDS or another STD. Do you stop? Heck no! You use protection. Riding a bike is the same thing. If I'm gonna die, I'd rather be on my bike now doing what I love then in some retirement home poopin' my pants when I'm 90 years old.

 

[FZ09Bandit]

How do you keep ridding after seeing this time, after time?

Well this is really the first time I have seen a major trauma.

I was an active duty combat medic in the military, so I have the knowledge base and skills, just not experience (i was never deployed, I wasn't given a choice)

This stuff effects even the most hardened veteran. The paramedic after everything was done just kept saying "doc it's the only thing we could have done" I could hear it in his voice that it bothered him and he ain't no spring chicken.

I have been taught battlemind, some of y'all should look into it. But it's not a sign weakness to ask for help either.

The only thing that will really bother me is pediatrics. Being a father myself, I try to study hard to because I acknowledge it's not if, it's when I have to work a serious code on someone's child, and I want it to be the same as if I was working on my own daughter.

 

[Nelly]

The guys (EMT’s) on the ground have to make rapid decisions and still work within their scope of practice. Sadly cardiac arrest secondary to Trauma has a very low survival to discharge outcome. As already mentioned and in my honest opinion, the quality of life for this patient should they have survived would be very poor and not a life I would wish to live.

Quality of life issues throw up huge ethical debates as do when to cease ALS (Advanced life support) fortunately and to reassure you all. We don't just stop ALS once it has started. It's only when all possible reversible causes have been identified and treated, that the decision is made and agreed in the context of a team that ALS will be stopped.

The best we can do as riders is gear up to try and reduce some of those risks. For people who are still in doubt of the benefits of ATGATT just look at this forum. Two recent stories of survival FZ6Joker and Wavex spring straight to mind.

Nelly:thumbup:

 

[Yasko]

Well this is really the first time I have seen a major trauma.

I was an active duty combat medic in the military, so I have the knowledge base and skills, just not experience (i was never deployed, I wasn't given a choice)

This stuff effects even the most hardened veteran. The paramedic after everything was done just kept saying "doc it's the only thing we could have done" I could hear it in his voice that it bothered him and he ain't no spring chicken.

I have been taught battlemind, some of y'all should look into it. But it's not a sign weakness to ask for help either.

The only thing that will really bother me is pediatrics. Being a father myself, I try to study hard to because I acknowledge it's not if, it's when I have to work a serious code on someone's child, and I want it to be the same as if I was working on my own daughter.

God bless you.