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Thread: Homicide Rates vs Trauma Care

  1. #21
    THE THIRST MUTILATOR Nephrology's Avatar
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    Quote Originally Posted by Sensei View Post
    Most of us have moved away from crystalloid fluids for trauma resuscitation, but you may see hypertonic saline used to control ICP in head injury.
    Last I saw it was pretty common out here to hang 2L reflexively during trauma resuscitations alongside blood products, but I haven't been to our ED in a year or two at least.

  2. #22
    Quote Originally Posted by DanM View Post
    Thanks. I guess I thought thereíd be more. I assumed the text linked in the OP was an abstract summarizing the article. I didnít realize it was the entirety of it.
    Can't vouch for the site, but it looks like you can get at the full text of the 2002 article being gisted in that piece here:

    https://www.researchgate.net/publica...ault_1960-1999

  3. #23
    Site Supporter Sensei's Avatar
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    Quote Originally Posted by Nephrology View Post
    Last I saw it was pretty common out here to hang 2L reflexively during trauma resuscitations alongside blood products, but I haven't been to our ED in a year or two at least.
    2L is a remnant of prior ATLS editions. The 10th edition recommends starting blood after the first 500ml-1L of crystalloid, and capping crystalloid volume at no more than 1L. Most of our patients will hit those volumes in their pre-hospital resuscitation. There is also good data for a plasma-based resuscitation strategy in pre-hospital patients when available: https://www.nejm.org/doi/full/10.1056/NEJMoa1802345

    Notice the patients in that NEJM study randomized to plasma got a mean crystalloid volume of only 500cc vs. 900 in usual care.

    After the SALT Trial and its sister study out of Vandy, the only people getting normal saline should only be head injuries and those with a hypochloremic alkalosis; all others should get a balanced solution (LR or plasmalyte for the rich).
    I like my rifles like my women - short, light, fast, brown, and suppressed.

  4. #24
    Quote Originally Posted by Gater View Post
    Can't vouch for the site, but it looks like you can get at the full text of the 2002 article being gisted in that piece here:

    https://www.researchgate.net/publica...ault_1960-1999
    Thanks! Iíll give it a read
    My posts only represent my personal opinion and do not necessarily reflect the opinions or official policies of any employer, past or present. Obvious spelling errors are likely the result of an iPhone keyboard.

  5. #25
    Quote Originally Posted by Nephrology View Post
    and rapid expansion of professional paramedic services who can provide airway support/transfusion in the field
    I started hanging out with a bunch of professional EMTs. The amount of stuff that can be performed in the field is absolutely astonishing. Ditto for emergency medical air transport--yeah, it's a $20k-$50k helicopter ride, but the capabilities it delivers to the field make a big difference. It definitely led me to realize that I should up my medical training game--professional CPR instruction (recognizing agonal breathing, *effective* CPR application), tourniquet application, etc.

    One thing I would suggest is that the non-glamour training is frankly what's most likely to pay off. Yeah, cool, tourniquets save lives. Really good CPR training--protip: gasping for air is not breathing--is useful in much more common situations, and potentially saves the patient all sorts of permanent or long-term damage. And providing good, effective CPR is not fucking easy. For instance, it's not uncommon for people with non-working hearts to flail a little as they're, you know, dying. They're not conscious, they're not breathing, but they'll whack you. Even trained people will sometimes stop performing chest compressions when that happens. Not to mention that compressing a human torso at least two inches deep, twice a second, for even two minutes, is a fucking workout.

    Quote Originally Posted by Dan Lehr
    Ballistic vests;
    Improvements in the EMS system springboarding off lessons learned in VN;
    Improvement in communications - many officers in the early 70's didn't have portables;
    Computerized record checks - manual in the 70's almost instantaneous today;
    Semi-auto pistols - not a major lifesaver, but makes a difference.
    Computer-Aided Dispatch (CAD) is a monumental lifesaver. Officer goes to a disturbance at a residence? Boom, instant premise history available, send the guy a heads-up that that address has an extensive mental health/intox/DV/whatever history, notify the sergeant, dispatch additional u/s. Same thing with EMS, patients with a history of fighting with the medics get a flag and an automatic police dispatch. Traffic stops are logged with location and plate info before the cop gets out of the car. If the agency can afford plate readers, they don't even have to take their eyes off the subject vehicle. CAD does so much cool shit, if any moderately-sized agency that does its own dispatching doesn't have it, you need a new chief LEO. And yeah, I know places that were still using pen-and-fucking-paper through at least 2018-2019.

    AVL--advanced vehicle locator--is massive. Especially when combined with addressable radios. An officer an start fighting a dude, and all he has to do is hit the panic button on the radio. Dispatch gets an alarm, maybe even a brief open mike period, and you can flood help to him immediately without even having to think about it.

    I think the Big Thing at the moment is CAD compatibility and AVL data sharing. I don't think the problem at the moment is technological, but it's very political.

  6. #26
    Quote Originally Posted by Wise_A View Post
    I started hanging out with a bunch of professional EMTs. The amount of stuff that can be performed in the field is absolutely astonishing. Ditto for emergency medical air transport--yeah, it's a $20k-$50k helicopter ride, but the capabilities it delivers to the field make a big difference. It definitely led me to realize that I should up my medical training game--professional CPR instruction (recognizing agonal breathing, *effective* CPR application), tourniquet application, etc.

    One thing I would suggest is that the non-glamour training is frankly what's most likely to pay off. Yeah, cool, tourniquets save lives. Really good CPR training--protip: gasping for air is not breathing--is useful in much more common situations, and potentially saves the patient all sorts of permanent or long-term damage. And providing good, effective CPR is not fucking easy. For instance, it's not uncommon for people with non-working hearts to flail a little as they're, you know, dying. They're not conscious, they're not breathing, but they'll whack you. Even trained people will sometimes stop performing chest compressions when that happens. Not to mention that compressing a human torso at least two inches deep, twice a second, for even two minutes, is a fucking workout.



    Computer-Aided Dispatch (CAD) is a monumental lifesaver. Officer goes to a disturbance at a residence? Boom, instant premise history available, send the guy a heads-up that that address has an extensive mental health/intox/DV/whatever history, notify the sergeant, dispatch additional u/s. Same thing with EMS, patients with a history of fighting with the medics get a flag and an automatic police dispatch. Traffic stops are logged with location and plate info before the cop gets out of the car. If the agency can afford plate readers, they don't even have to take their eyes off the subject vehicle. CAD does so much cool shit, if any moderately-sized agency that does its own dispatching doesn't have it, you need a new chief LEO. And yeah, I know places that were still using pen-and-fucking-paper through at least 2018-2019.

    AVL--advanced vehicle locator--is massive. Especially when combined with addressable radios. An officer an start fighting a dude, and all he has to do is hit the panic button on the radio. Dispatch gets an alarm, maybe even a brief open mike period, and you can flood help to him immediately without even having to think about it.

    I think the Big Thing at the moment is CAD compatibility and AVL data sharing. I don't think the problem at the moment is technological, but it's very political.
    I absolutely agree with everything you say.

    As a trainer it was always somewhat disheartening to realize that the basic things you preached were ignored in the field - officers run their first year off what they got from academy and FTO's they run their second year off their peers and their experiences in the first year, and so on. Each year it seems they shed basic safety rules because they haven't experienced bad things happening. As the saying goes, one year of experience, repeated twenty times.

    Officer survival is too often based on technology rather than the officers applying the basic rules of cop kindergarten.

  7. #27
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    Quote Originally Posted by randyho View Post
    Why Baltimore, with Johns Hopkins, is not kicking Chicago's ass. So unfair!
    John's Hopkins is Level I for Pediatrics in Baltimore, but if you're an adult victim of the knife/gun club in Baltimore they send you to the University of Maryland's world famous Shock Trauma Institute. Shock Trauma was established by Surgeon, Dr. R. Adams Cowley, who created the concept of the "golden hour."

  8. #28
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    I remember hearing the same thing about getting back to basic first aid and trauma care from Corpsman and Field Medics from back when I was in the service. Maybe it's just when panic sets in people tend to lose their heads.

  9. #29
    I've already the experience: "This is [unitname], send me more, I'm fighting *click* by the church and dentist". Not from our agency, no AVL, never called off. Couldn't raise him again. Called his agency on radio, they had no idea where he was either. Our jurisdiction is over 800 square miles. Their dispatch gave me his car number. A CAD history for the car number showed him responding to a particular zone. I took a WAG on the location based on some local knowledge, and just happened to be right. While I was doing this, I thought that it was all my fault, and that I had gotten an officer killed. Totally irrational, and we had backup arriving in under two minutes, but it was two minutes of my worst nightmare.

    Honestly, I think that trainees should spend at least a shift or two at their dispatch, just to learn what a big deal some of this stuff is. Basic things--don't mumble, speak clearly. Hold the mic up to your mouth. If I ask you to repeat what you said, it's not because I wasn't listening or--it's because I'm not willing to bet your life that I heard you right. For ever 10 times I ask a unit to repeat traffic, I maybe legitimately didn't hear it once. If your radio is static-y as shit, put in a damn repair ticket.

  10. #30
    Site Supporter Sensei's Avatar
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    Quote Originally Posted by BrassSlapper View Post
    I remember hearing the same thing about getting back to basic first aid and trauma care from Corpsman and Field Medics from back when I was in the service. Maybe it's just when panic sets in people tend to lose their heads.
    There are a very basic principles that save lives. For adult medical cardiac arrest, the key is effective chest compressions as a bridge to rapid AED for shockable rhythms. For trauma, immediate control of bleeding with rapid transport to a trauma center. By immediate, it could be as simple as direct pressure on a single wound or a TQ for multi/major bleeding that wonít stop. For pediatric, it is rapid availability of BLS airway and rescue breathing with a BVM.

    Prehospital gadgets like IVs, ET tubes, and ACLS drugs do little to improve functional survival at 30 days after a cardiac arrest. In fact, these gadget may cause harm by distracting providers from basics - like interrupting CPR for 30 sec to intubate someone...especially when the tube lands in the esophagus.
    I like my rifles like my women - short, light, fast, brown, and suppressed.

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