Trauma Training

[gan1hck]

Nope never. Their Medical Director just enjoys the needless mutilation of human flesh.

Yes they have had success. No I do not have the stats. They are a very large, progressive and very well respected provider.

This is EMS. Things are always changing/improving. Keep an open mind.

My mind is only open to data published in peer reviewed journals.

Without that....this is just a story on the internet posted by anonymous posters.

[gan1hck]

Here is a tiny bit of data...

http://regionstraumapro.com/post/4415764711



Seriously....we have too many people who are gung ho about doing stuff that is just not necessary....and which amounts to rearranging deck chairs on the titantic.

If you feel that you must stick needles into dead patients...then feel free to feel good about it....

but I'm just stating the facts...and asking for data to prove me otherwise.

[Hmac]

Thanks everyone for the replies. Just can't seem to ignore the lack if a skill set. Need to have a plan. Sued or not, I refuse to let someone die if I can help, or could have.

How about if you ended up making them worse, or killing them, because you tried to apply an imperfectly understood set of perishable skills based on an imperfectly understood or remembered set of diagnostic criteria.

Non-medical people obsessing over chest cavity decompression in the field. Sheesh. 30 years as a trauma surgeon covering the ERs at two hospitals one-in-three and I can think of ONE instance where a patient MIGHT have needed a needle thoracostomy outside the ER. I can count the number of tension pneumothoraces I've seen in my life on the fingers of one hand.

I agree with the above posters...focus on CPR and the use of automated defibrillators that are springing up like mushrooms in public venues. Don't forget that you need to do that every couple of years or you WILL forget that stuff.

[gan1hck]

How about if you ended up making them worse, or killing them, because you tried to apply an imperfectly understood set of perishable skills based on an imperfectly understood or remembered set of diagnostic criteria.

Non-medical people obsessing over chest cavity decompression in the field. Sheesh. 30 years as a trauma surgeon covering the ERs at two hospitals one-in-three and I can think of ONE instance where a patient MIGHT have needed a needle thoracostomy outside the ER. I can count the number of tension pneumothoraces I've seen in my life on the fingers of one hand.

I agree with the above posters...focus on CPR and the use of automated defibrillators that are springing up like mushrooms in public venues. Don't forget that you need to do that every couple of years or you WILL forget that stuff.

Not a surgeon ....just a gas passer with fellowship training in critical care medicine...with time in the gulf....and 15 years of practice...

My experience mirrors yours.

[Hizzie]

Here is a tiny bit of data...

http://regionstraumapro.com/post/4415764711

...and asking for data to prove me otherwise.

Thanks for the link. To be clear you haven't actually asked for anything. You have just been condescending.

[gan1hck]

Thanks for the link. To be clear you haven't actually asked for anything. You have just been condescending.

sorry if you think I'm "condescending"....I'm just stating what I know to be true based on training, experience, and data.

If you feel or (better) know otherwise, please let the rest of us (who don't know any better) know.

[FL2011]

Thanks for the link. To be clear you haven't actually asked for anything. You have just been condescending.

I wouldn't call that condescending. There have been several physicians here, myself included, attempting to get the same point across.

[Hizzie]

TCCC is excellent. Still strongly suggest getting your EMT-B. Rapidly identifying a Heart Attack or Stroke in someone you love is prolly more likely a scenario.

Just to add some flavor to the soup I'll throw this in.

There is a local 911 Service out here (Texas) that uses bilateral Needle Thorocostomy + Pericardiocentesis on trauma arrests in the field AKA "The 3 Hole Punch". I recently attended an EMS Advanced Skills Verification Lab put on by them in conjuction with a hospital system. There I learned that they are looking to transition to bilateral finger thorocostomy over the needle version.

I still stand by my earlier suggestion of obtaining EMT-B Cert.

The above are my 2 posts. At no point do I recommend any advanced proceedures to the OP or anyone. I suggest EMT-B Certification, twice. My second post was not to suggest a better way of doing anything. Merely pointing out that someone was doing something a little different. I don't have stats simply because I don't work for them. If you were really interested in the stats related to the mentioned proceedure you could of simply asked for the name of the service and gone and done the leg work yourself. Instead you dismiss it as a just a "story on the internet posted by anonymous posters." Respectfully, you would qualify as one of those "anonymous posters" yourself.

[Robert M Miller]

Guys,

Not trying to be a argue with anyone but here is the most relevant data I found on Managing casualties in a tactical environment. The first is a link to the most updated TCCC guidelines. I realize that standards of care and peoples options vary by training, position and support. This was just to get some folks thinking in a tactical environment. I believe this was probably my mistake. All the best- Rob Miller

http://www.naemt.org/Libraries/PHTLS...%20120917.sflb

1. Holcomb JB, et al. Causes of death in U.S. Special Operations Forces in the global war on terrorism: 2001Y2004. Ann Surg. 2007;245:986Y991.

2. Eastridge BJ, et al. We don’t know what we don’t know: prehospital data in combat casualty care. US Army Med Dep J. 2011:11Y14.

3. Holcomb JB, et al. Understanding combat casualty care statistics.
J Trauma. 2006;60:397Y401.

4. Butler FK. Tactical combat casualty care: update 2009. J Trauma. 2010;69(Suppl 1):S10YS13.

5. Carey ME. Learning from traditional combat mortality and morbidity
data used in the evaluation of combat medical care. Mil Med. 1987;152:6Y13.

6. Bellamy RF, Maningas PA, Vayer JS. Epidemiology of trauma: military
experience. Ann Emerg Med. 1986;15:1384Y1388.

7. Bellamy RF. The causes of death in conventional land warfare: implications for combat casualty care research. Mil Med. 1984;149:55Y62.

8. Champion HR, et al. Improved characterization of combat injury.
J Trauma. 2010;68:1139Y1150.

9. Mabry RL, et al. United States Army Rangers in Somalia: an analysis of combat casualties on an urban battlefield. J Trauma 2000;49:515Y528;discussion 528Y529.

10. Esposito TJ, et al. Analysis of preventable trauma deaths and inappropriate trauma care in a rural state. J Trauma. 1995;39:955Y962.

11. Kelly J.F, et al. Injury severity and causes of death from Operation Iraqi Freedom and Operation Enduring Freedom: 2003Y2004 versus 2006. J Trauma. 2008;64(suppl 2):S21YS26; discussion S26YS27.

12. Medicine IO. Reducing the Burden of Injury: Advancing Prevention andTreatment. Washington, DC: National Academy Press; 2003.

13. Champion HR, et al. A profile of combat injury. J Trauma. 2003;
54(suppl 5):S13YS19.

14. Hardaway RM 3rd. Viet Nam wound analysis. J Trauma. 1978;18:
635Y643.

15. Hardaway RM 3rd. Care of the wounded of the United States Army from1775 to 1991. Surg Gynecol Obstet. 1992;175:74Y88.

16. Champion HR, Holcomb JB, Young LA. Injuries from explosions:
physics, biophysics, pathology, and required research focus. J Trauma.
2009;66:1468Y1477; discussion 1477.

17. Dismounted Complex Battle Injury, Report of the Army Dismounted Complex Blast Injury Task Force for the Surgeon General. Fort Sam Houston, Texas, June 18, 2011. Available at: http://www.armymedicine.army.mil/reports/
DCBI%20Task%20Force%20Report%20(Redacted%20Final).pdf. Accessed July 2, 2012.

18. Savage E, et al. Tactical combat casualty care in the Canadian
Forces: lessons learned from the Afghan war. Can J Surg. 2011;54:
S118YS123.

19. Eastridge BJ, et al. Died of wounds on the battlefield: causation and
implications for improving combat casualty care. J Trauma. 2011;
71(Suppl 1):S4YS8.

20. Bellamy RF. The medical effects of conventional weapons. World J
Surg. 1992;16:888Y992.

21. Blackbourne LH, et al. Decreasing killed in action and died of wounds rates in combat wounded. J Trauma. 2010;69(Suppl 1):S1YS4.

22. Kotwal RS, et al. Eliminating preventable death on the battlefield. ArchSurg. 2011;146:1350Y1358.

23. Maughon JS. An inquiry into the nature of wounds resulting in killed
in action in Vietnam. Mil Med. 1970;135:8Y13.

24. Alam HB, Koustova E, Rhee P. Combat casualty care research: from
bench to the battlefield. World J Surg. 2005;29(Suppl 1):S7YS11.

25. Morrison JJ, et al. Military Application of Tranexamic Acid in Trauma
Emergency Resuscitation (MATTERs) Study. Arch Surg. 2012;147:
113Y119.

26. Roberts I, et al. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet. 2011;377:1096Y1101, 1101.e1Y1101.e2.

27. Mabry RL, et al. Fatal airway injuries during Operation Enduring Freedom and Operation Iraqi Freedom. Prehosp Emerg Care. 2010;14:272Y277.

28. Kragh JF Jr, et al. Practical use of emergency tourniquets to stop bleeding in major limb trauma. J Trauma. 2008;64(suppl 2):S38YS49; discussion S49YS50.

29. Kragh JF Jr, et al. Battle casualty survival with emergency tourniquet useto stop limb bleeding. J Emerg Med. 2011;41:590Y597.

30. Kragh JF Jr, et al. Survival with emergency tourniquet use to stop
bleeding in major limb trauma. Ann Surg. 2009;249:1Y7.

31. Butler FK Jr, et al. Tactical combat casualty care 2007: evolving concepts and battlefield experience. Mil Med. 2007;172(Suppl 11):1Y19.

Good luck to all

[Robert M Miller]

Just some food for thought. I seen a post that discussed working a traumatic arrest. One should ask how did this happen? why no pulse or respirations? if penetrating trauma was involved you should ask yourself how did he get this way. Likely from hypovolemia. Do you really think CPR or AED is the solution here?

Thank you for the spirited discussions

V/R

Rob