Posted by: medicblog999 | October 17, 2009

TRAUMA

IMGP0301compressedTrauma is one of those things that don’t really come about as often as lay people think, and by trauma, I mean ‘proper’ trauma. Not just the trip over the kerb or the dizzy faint (which can still cause significant injury but usually don’t), but real, bloody, bad traumatic injuries.

Most of us like these jobs, after all, its what we have been trained to do isn’t it? Never mind that it only accounts for a fraction of our workload, it’s surely the most important part of our job, isn’t it???

Obviously not. It is however, seen to be the most ‘glamorous’ thing that we do.

Out in the middle of a motorway, working alongside the police and fire service, cutting people out of cars, straightening mangled limbs and performing all of those invasive interventions that we have to infrequently and rarely pull out of the skills cupboard every now and then.

But,trauma management is a skill in itself, and not an easy one for every ambulance person to automatically ‘get’.

Which brings me to the point of this post.

What makes a Paramedic/EMT good at Trauma care? What is it that gives one member of staff that extra bit of something that seems to make working a trauma with them almost a pleasure rather than a stressful chore?

  • Initial assessment.

By the time you leave your vehicle, you should already have a plan of action and be calling for the required backup that you are ‘likely’ to need. You don’t need to have to even physically be with your patient before thinking “This is a big impact, he/she is going to need…….” This is especially true for when you are working alone on a rapid response vehicle. A job I had the other week was for a motorcyclist who had come off his bike on a country road.

As I pulled alongside the group of people gathered around him, I quickly glanced down the road, noticed how far his bike had travelled before coming to rest, and the damage done to the bike, then glanced over to where the patient was, and saw him lying next to a tree with one of his legs at a very un-natural angle. As I was getting my bags out of the car, I was already on the radio requesting a ‘Cat A’ backup.

It’s all about the ‘Mechanism of Injury’. This was one of the most interesting parts of my paramedic training, and the knowledge I gained then and more importantly, the knowledge I have learnt since then, has assisted my clinical decision making many, many times and I believe, has served me well.

Once you know and appreciate the forces involved in an impact trauma, both within the body and from outside of the body, then the ‘index of suspicion’ should be turned up along with your ‘spidey sense’ and put the patient into the ‘Lets get a move on Category’

  • Controlling the scene.

On a busy scene of an RTC, the paramedic needs to be vocal. That doesn’t mean shouting loudly and letting your mouth go, but instead, it means talking to the patient, liaising with all of the other services on scene, keeping control up to date and organising what is happening with the patient and when. This needs to be done in a calm and most importantly confident manner. Once the Fire Brigade have told you that the incident area is safe, then it’s down to the Paramedic to work with the Fire Brigade to ensure the casualty is extricated in an appropriate way for his/her injuries.

This isn’t a battle of wills, which can sometimes be happen between the Ambulance and Fire Service. This is a joint effort, which needs to be undertaken with equal respect on both sides. Things happen so much more efficiently when the team actually works together for the common goal of saving a life or preventing further deterioration.

Controlling the scene also means, taking advice from others. If you are in with the patient, then you cannot see what is going on outside and around you. There are better people placed to do that if you are stuck in place with your patient. Take advice and suggestions, you may not use them, but you would be stupid to disregard them.

  • Let’s get a move on!

Now for me, this is the most important skill for a paramedic. That of knowing when to stop ‘fannying about’ (UK, highly technical and medical term) and get a move on. We all know of ‘the golden hour’ (although the importance on patient outcome of that first hour  is in dispute at the moment), but the paramedic I want to be looking after me in that situation is one who does what needs to be done and gets on with it in a calm, efficient manner and with as little fuss as possible. If I have broken legs and a head injury, I want you to get me on a full body vac mattress and immobilise my whole body, in one go, quickly. Please don’t be planning on individually vac splinting my legs, as my body, the spinal board and the Vac Mattress will do that job fine and much quicker.

I sometimes feel myself getting frustrated on scene when I think things are taking too long. Sometimes it has to be that way. If it is a difficult complex extrication, then you can’t rush it, but if it’s a fairly simple ‘roof off and out the back’, then lets just do it and go. The rule is do what is needed and go, if you have time for the other stuff en route then fine, if not then they just don’t get done.

There are many other things that I could rant on about, but these are the main ones that I like to concentrate on.

As much as we would like to think so, not all Paramedics are fantastic at trauma care. All have the basic fundamental understanding, knowledge and skills to do the job, but not all have that ‘extra special something’ that makes them into exceptional ‘trauma care’ paramedics. I know a couple of such paramedics and I have learned a great deal from them over the years which I believe has helped me to become  a confident paramedic on scene at a big RTC.

It’s a long way from the first time I had to work with the Fire Service:

Fire Officer In Charge (FOIC) : “Right son, what do you want us to do?, we can take the roof off, door off, whole side of the car off, you just tell us and we will do it!”

Trainee Medic999: “Errrrr, Ummmm……My partner, who is a paramedic, will be back in a second…..he’s just over there…..can you ask him?”

FOIC: ” Come on Lad, you need to make a decision!!”

Trainee Medic999: “Ummmm,  Errrrr,  Okay, just take the roof off then”

FOIC: “RIGHT LADS!, ROOF OFF!!…..LETS GO!”

Looking back, that man really didn’t need his new BMW`s roof taken off! Sorry!

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