Monday, February 27, 2012

When will we change?

If we, EMS as a whole, were right less than 15% of the time there would be a outcry among Medical Directors and Managers for remedial training and a plethora of terminations happening.  The study results Rogue Medic has posted are not new.  Looking at the following numbers makes me wonder why are we not changing our ways.  To summarize, the accuracy of the indicators of major trauma are (percentages based on the number of patients entered into the trauma systems in each catagory vs. the confirmed number of major traumas):

Vital Sign changes - 2.8%
Injury only - 4.7%
MOI - 8%
Vitals Sign changes + Injury - 15.4%
Vital Sign changes + MOI - 14.6%
Injury + MOI - 10.6%
Vital Sign changes + Injury + MOI - 50%

There will always be the patients entered into trauma systems based on altered mental status on scene that were over triaged because of a concussion along with the ones that we are given no choice because of abdominal pain or percieved chest trauma. 

I was pleased during my recent PHTLS update to find out they have taken assessment and added it to MOI for the criteria of admission into a trauma system.  I have seen some of the worst trauma that can be experienced while deployed for Operation Iraqi Freedom and seen how much the body can really take.  What we classify as major trauma here was normal, everyday injuries for us there.   It has given me a whole new perspective of "major" trauma.

This does not even begin to address the overuse of HEMS, that is a whole other post...

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