Calling a trauma arrest???

[celestialdaisy]

What are the procedures for calling a trauma arrest in your area's??? We had one the other day, well, thought we had one. The medics called him when they got on scene, then found other info out from a bystander and started working him. Got activity on the moniter as he was being loaded, but that's about as far as it got. I was just wondering how it is in other areas.

[WELLAGEDEMT]

In the words of IAmedic, Don't quit on the patient until they have assumed room temperature or if it is obvious. Right Brad???

[celestialdaisy]

I guess I should also add that the medics first on scene were IRP's arriving in our fire company's squad. That means they didn't have a moniter until the ambulance showed up.

[Nate]

1. When did the trauma happen.

2. Is there any injuries that would make life impossible or pretty close to it. Such as no head at all, a steering wheel in the chest, or they have been floating for 20 minutes upside down in water.

3. Mointor Rhythm

4. Common Sense

5. It never hurts to try to get them back.

[iamwba]

Our protocols mandate that we make resuscitative efforts unless the patient:

is decapitated
has midsection transection of the torso
has rigor mortis
has decomposition of the body
has dependent lividity

We may also withhold resuscitation in blunt traumatic arrest if the patient is pulseless, apneic, and without organized EKG activity OR if the medic believes the injuries are obviously incompatible with life.
This of course does not apply to hypothermic patients, who must be pronounced by a doc.
We have to see either the DNR order or in the case of an ECF patient, it must be documented in their chart that it exists. We can terminate efforts after starting only on order of the EDP or on order of the coroner on scene, provided that said coroner is an MD or DO.

Hope this is helpful!

Bill

[IAMedic]

Working Trauma Arrests can be very tricky. As we all know, the majority of Trauma Arrests come from Aortic Dissections. However, there are other main causes of trauma arrests including internal damage to other vital organs. I have seen people work on Trauma Arrests when there are other viable patients. Our protocols say that if there are obvious signs of trauma that do not necessitate compatibility with life, do not code them. Save your resources for the other viable patients. There was research done that shows that .01% of trauma arrests are viable patients. If that is your only patient, then by all means do what you need to do. However, according to our MCI protocols (we use the S.T.A.R.T. triage protocols) that say "If the patient is not breathing, open the airway. If this does not get the patient breathing on their own, move on to the next patient and label them black" of course, I am paraphrasing here.

So, my opinion is that if you do not have enough resources, the dead is dead and work on the others. But, it is the call of the provider. No one will criticize you for trying, unless you jeopardize the care of more viable patients on the scene.

Good subject that needs to be brought up again. Thanks, celestialdaisy!!

[WELLAGEDEMT]

IAMedic, I didn't realize this was a triage situation. In that case I'll still follow what you taught me, If you find a pulse, treat, If not, tag.

[IAMedic]

It's okay Ray...I forgive ya.... :bang: :hehe:

How are things going over there?? You been riding much??

[WELLAGEDEMT]

I haven't been in the rig for about 3 1/2 weeks, I can run whenever I feel up to it, Just on the day shift. I was taken off the nite shift for a month. I am beginning to wonder about our new director, some things just don't add up!!!!:confused:

[smurfe]

Our protocols mandate that we make resuscitative efforts unless the patient:

is decapitated
has midsection transection of the torso
has rigor mortis
has decomposition of the body
has dependent lividity

We may also withhold resuscitation in blunt traumatic arrest if the patient is pulseless, apneic, and without organized EKG activity OR if the medic believes the injuries are obviously incompatible with life.
This of course does not apply to hypothermic patients, who must be pronounced by a doc.
We have to see either the DNR order or in the case of an ECF patient, it must be documented in their chart that it exists. We can terminate efforts after starting only on order of the EDP or on order of the coroner on scene, provided that said coroner is an MD or DO.

Hope this is helpful!

Bill

What Bill wrote is pretty well the same for me. I can add penetrating trauma to the head plus pulseless/apnic and asystole in 2 or more leads.

Smurfe :beer:

[RyanEMVFD]

Ours are pretty much the sameas the others for any arrest. On trauma it's also included any patient that does not have a pulse when we get there can be DNR'ed. But that's trauma only. If it's in debate, work it and let someone else call it.

[DaSharkie]

Our do not work protocols are what have been mentioned.

If we initiate our cardiac arrest protocol - for medical or trauma codes, we work them on scene for 20 minutes. If we get nothing, we call it with confirmation of the doctor. Logic being that there is nothing that the hospital is going to do to get them back that I am not going to do in the field.

[medic_zeb]

We pretty much have the same across the board here in Indiana. One more addition is that the trauma surgeons here in Indy want us to work every patient providing that they're not cut in half, etc.

Especially if the pt. is asystole on scene. It's best to give them a fluid bolus of at least 1000cc or so to see if we get some sort of rhythm. I've heard there's case studies supporting this but haven't got a hard copy.

Hope this helps.

[mediccjh]

Don't even bother with blunt chest trauma. Survival is 0%.

[Garyb3985]

Pretty much the same as most listed above.One that I don't think I saw menioned (or maybe it was, was multi system trama.

In my opinion age of the Pt. has everything to do with"calling it" or not is age.I am more likley to work a 16 y/o in tramatic arrest than a 50 y/o.And depending on how long they have been down you ain't doin them any favors if you happen to get them back


Just my$.02

[medic_zeb]

Yeah try telling that to the trauma surgeons. Unless it's an MCI or just have multiple pt.

[celestialdaisy]

OK, he's the story...It was fire call, so...Anyways, medics arrive on scene in squad, (read as - no moniter or meds untill the rig gets there) There's a mid 60's male in arrest who just plowed his truck into his daughters front porch (solid cement). From the position found, you would assume that there was at least blunt force to the chest, if not multi systems. The daughter then comes down with the info that she watched him go down before he hit the porch. He was worked for a good 20 minutes on scene, the moniter showed some activity, no resp, so he was loaded for transport. I found out the next day from a guy a work with that he didn't make it, but I wasn't asking any details because it was his friend.

[EMSsquirrel]

OK, he's the story...It was fire call, so...Anyways, medics arrive on scene in squad, (read as - no moniter or meds untill the rig gets there) There's a mid 60's male in arrest who just plowed his truck into his daughters front porch (solid cement). From the position found, you would assume that there was at least blunt force to the chest, if not multi systems. The daughter then comes down with the info that she watched him go down before he hit the porch. He was worked for a good 20 minutes on scene, the moniter showed some activity, no resp, so he was loaded for transport. I found out the next day from a guy a work with that he didn't make it, but I wasn't asking any details because it was his friend.

From that scenario, we probably would have treated it as a medical arrest and not a trauma arrest. Not that it makes a whole lot of difference in whether we call him or not. If he's not super-dead (decapitation, rigor, decomposition, etc.), then our odds of getting physician-directed termination of field resuscitation efforts are bordering on a snowball's chance in heck. But at least we'd be justified in shocking and drugging.

- Greg

[smurfe]

OK, he's the story...It was fire call, so...Anyways, medics arrive on scene in squad, (read as - no moniter or meds untill the rig gets there) There's a mid 60's male in arrest who just plowed his truck into his daughters front porch (solid cement). From the position found, you would assume that there was at least blunt force to the chest, if not multi systems. The daughter then comes down with the info that she watched him go down before he hit the porch. He was worked for a good 20 minutes on scene, the moniter showed some activity, no resp, so he was loaded for transport. I found out the next day from a guy a work with that he didn't make it, but I wasn't asking any details because it was his friend.

You mention "some type of activity" on the cardiac monitor. This being, you are pretty well obligated to work this patient. Most anywhere will require Asystole in 2 or more leads to justify field termination or even starting to work the call. While most of us know when dead is dead, there are the times we have no choice but to work it.

Smurfe :beer:

[celestialdaisy]

Let me rephrase that. He was called as a blunt force trauma arrest, then the daughter gave her info. The medics started working him at that point. When the moniter arrived he was in asystole. They kept working him, and after shocking him a few times there was some activity.

[Tacmedic]

Did anyone read about the guy that was hit by a car and lived but was pronounced DOA? I can't remeber what state it was, but basically a gentleman was hit by a vehicle, due to the high impact and amount of trauma the patient was pronounced dead by an off duty paramedic that was passing by. When the ambulance rolled up the off duty medic told his on duty friends that the Pt was DOA. Knowing the off duty medic as the did they took his word for it. Now the medical examiner showed up and agreed with the medics, after a couple of days (I believe it was 2) this guy was found to be alive in the cooler :o . Needless to say there are some medics that are being evaluated. actually I think they have already been let go and this thing has gone to court.

So inconclusion 1st- IaMedic is correct about S.T.A.R.T triage if multiple patients, this way we NEVER jeprodize the what can be saved for the what is gone. 2nd if it's a single patient and your not sure put the old monitor on and see what you get, it wont kill them, but it can save you!

[celestialdaisy]

It would really have sucked to be that guy. Thanks for the input everyone. I was just curious as to how everyone else handles situations like these after that call.

[swanny]

Circumstances dictate the response in my system. In Alaska a paramedic may pronounce if a physician can not be contacted, which is more commonly the case than not.

If I have more than 1 patient, the pulseless & apneic patient is dead. The corpse gets black-tagged, and I move right along.

If it's the only patient one the scene then I'll have to consider some more factors:

- How fresh is he? If I had to drive for an hour and 1/2 just to get to the scene I'm not likely to work the corpse unless bystanders can provide a much more recent time of arrest. This is associated with......

- How quickly can I get him to definitive care? In my setting that depends a lot upon the availability of either a helicopter, or more often availability of a fixed-wing aircraft and location of nearest landing strip and travel time to some facility more sophisticated than a rural or bush village clinic. In much of Alaska we don't think so much of the "Golden Hour" as we do the "Golden Day".

- How dead is he? If I see his brains spattered all over the pavement, &c, then I'm not likely to bother. On the other hand, if the corpse was an organ donor I may well elect to attempt to resucitate in order to extend the harvest window of time.

- How badly do I want the practice? If it's a reasonably fresh corpse, transport can be reasonably arranged I might decide to work the trauma code just to get in a little a practice. It may sound rude and crude, but I don't get all that many opportunities to practice my hard-earned skills up here so I very well may elect a patient I'm pretty sure is DAGSTW (dead and gonna stay that way) just to pass a tube, get some lines, and give me and my assistants a bit of real-life practice.

There may be other considerations, but these are the ones that come most rapidly to my mind.

Swanny

[EMSsquirrel]

There may be other considerations, but these are the ones that come most rapidly to my mind.

Has anyone mentioned the most common consideration: time until shift change? We're going home in 15 minutes. Quick, pronounce him dead! :confused:

- Greg

[Garyb3985]

Has anyone mentioned the most common consideration: time until shift change? We're going home in 15 minutes. Quick, pronounce him dead! :confused:

- Greg




:D :hehe: :D :hehe:

[M&M]

We're pretty much the same as all the rest. We don't start if they're decapitated, rigor, or basically obvious damage that will not sustain life. Otherwise, once we start we can't stop until online m.d. or the coroner calls it. Like our doc says "They're not dead until they're warm and dead."