Trauma Arrest Do you or Dont You

[BURNSEMS]

Hello All, I am Looking for info on differant aspects of working a Trauma Code, mainly critera for Decision makeing,, beyond the obviouse that we all Learned Day one,, I personaly have a problem NOT working a Arrest just because its Trauma Induced and Stats say Less than 1% will survive,,I had rather give the benifit of the doubt to the Patient rather than go home wondering what if I had only??????? Ok lets hear Good and Bad

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Here today for a Safer Tomorrow

[This message has been edited by BURNSEMS (edited February 01, 2000).]

[skymedic]

I did my training in Johannesburg, South Africa, where we worked on the road with both Private Sector and local Authority (state) services. State sector tended to be more enthusiastic about initiating a resus on a code, be it medical or trauma, and use it as a training (academic) resus for the students on the vehicle for the day. Private sector tended to be more cautious, only initiating a resus if a near probable cause of death could be established or guessed.(eg witnessed arrest or chest trauma with a tension pneumo).

It's been three years since I qualified, and while I initially would resus almost any code I got to, I am now much more critical when making a decision: resus - yea or nay.

Keeping to trauma codes, as per your original message, I believe that analysing the mechanism of injury and aquiring an accurate case history must be paramount in making the decision. For example, a patient ejected from a vehicle at high speed in an mva, with multiple major fractures in cardiac arrest, has for all intents and purposes, no chance of survival. Rapid acceleration or deceleration induced injuries usually include transection of major blood vessels or organ rupture, not to mention the high incidence of high spinal injuries. Often it's easy to decide, based on the extent of external visible trauma, Yet I've seen a case of a female pedestrian, struck by the side of a passing car. She was spun our of her shoes, fracturing her pelvis and c-spine, and was dead on scene within minutes, yet externally she showed little signs of injury.

If the condition which caused the arrest can be corrected, eg hypovolemia, tension pneumothorax, then a resus should be initiated, with priority on correcting the cause of arrest (fluid replacement, thorocentesis/chest drain etc). I have had one successful case where this train of thought was followed.

The other consideration which must be borne be the paramedic concerned, is the quality of life available to the victim if the resus is successful, as well as the financial imlications on his/her family. I realise that in the US there are malpractice lawyers around every corner, but here in Africa, we have a bit more leeway when deciding whether to initiate a resus or not. It's unfortunately very difficult when someone else becomes intent on placing a price on a victims life at your expense, when (assuming he would have been a successful resus) the medical expenses involved in keeping a cabbage head alive as well as the psychiatric trauma involved would have ammounted to much more than lawyer's fees!

This said, a good decision must be based on experiece. A newly qualified paramedic should in all cases, where a shadow of a doubt exists, initiate a resus. It's a lot easier to get permission to terminate from your SMO than to explain to the family why no effort was made to intervene.

"It's better to be on the ground wishing you were flying, than to be in the air, wishing you were on the ground!" (:>

Michael Dollenberg
N.Dip AET, ACLS, PALS

[This message has been edited by skymedic (edited February 02, 2000).]

[Trauma_Dog]

Hey Burns, I look at the overall multi-systems trauma picture first, naturally if there injuries are not compatable with life eg...massive head trauma ect. I will not.

However with our broad range of protocols such as chest decompresstion and pericardiocentesiss (my spelling sucks) and traumatic arrest termination makes an argument that says, hey if my med director gives me these tools maybe he wants me to use them. One of our medics was able to get a pulse return after a centesiss. I guess that falls into the catagory of, you will never know until you try, after all isn't what we are here for? At least I am. Not faulting other for not working them I just do. Thanks, The Dog

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Kent Simon
Paramedic Incharge
MCHD EMS,
Montgomery Co.,TX

[Romania]

We work every trauma code that isn't obviously dead unless we can use our resources better to help a greater number of people. We get onscene so quickly in the urban enviroment that we see few true trauma codes, and we have so many trauma center so close we can get them in fast, so it is worth working em for us.

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Alan Romania, CEP
romania@uswest.net
IAFF Local 3449

My Opinions do not reflect the opnions of the IAFF or Local 3449.

[Wabash Express]

Hey Burns,

Here in Durham, North Carolina at Durham EMS, we resuscitate penetrating trauma cardiac arrests only. We do not resuscitate blunt trauma cardiac arrest patients. The statistics that we have seen show there to be less than a 0.1% chance of resuscitation. As busy as our metro system is, we can utilize the resources elsewhere, instead of tying them up working someone who is for all intents and purposes dead. The only exception to this rule is children, and that is not because the probability of resuscitation increases, but because of human nature.

Mike Clumpner
Paramedic
Durham EMS