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I recently had the opportunity to attend a great seminar at the local trauma center.  Monthly, the trauma docs get all the trauma residents together to talk through a case from the previous month.  It sounds pretty dry until you realize how they present the case.

It starts with the Doctor playing the initial radio report recording.  Then he looks to his residents and asks “So, what positions are you assigning, who do you page, what are your chief concerns?”

I always knew the thousands of people in the trauma room when we arrive are important, but I never thought through that there was one person in charge of that room that asked them all to be there based on my report.  It makes perfect sense in retrospect.

In this particular case our medic made a near textbook MVIT truama radio report and had an ETA of 8-10 minutes.  A lot can happen in 8-10 minutes.

The Doctors discussed different concerns for maybe 5 minutes, then they went to the video.

In the corner of all the trauma rooms are cameras.  I always thought they were security cameras, but how great to be able to critique in real time referring to video!  The room is packed with gowns and masks, all awaiting the patient and the Doc stopped the video again.  “Who is missing?” He asked and the residents began to identify all the persons and departments in the room.  No one was missing.  Trick question, but I was impressed that everyone knew everyone else by sight.  a good sign of a team that works well together.

The video started back up and here comes the moment of truth for me, the CQI guy sitting on the side of the room:  The medics have arrived.

His tone was clear and even and he began his report with “Hello everyone this is Erma…”  My favorite way to start a report.  Put the team at ease and calmly describe your findings.  He went on to multi-task, describing the patient’s mechanism, vitals, his interventions and treatments, as well as his reassessment after the interventions.  As the patient was transferred and the swarm of gowns came in, the video stopped again and I was beaming with pride.  I know because the person next to me asked “How come all the reports aren’t like that?”

The Doc went on the quiz the residents about what their first assessments should be and he finished that discussion with “What else do you want to know before EMS leaves the room?”  his laser pointer now shows my guy standing in the doorway out of the way and removing his gloves.  They had nothing more to ask, he had covered it all. 22 seconds.  22 seconds was the length of his in person trauma report.  As the video picked back up he states over the heads of the crowd “you have access left AC 16g TKO on transfer and we put her back on the NRB at 15, I’ll be outside.”

I wanted to do the slow clap until I realized that this should be happening each and every time and, judging by the reaction of the room, it doesn’t.

 

The seminar continued to show the entire time this patient was in the trauma room, including the chest X-ray (then we all looked at it on the big screen), the abdominal and chest ultrasounds (interpreted by the residents) and even to the results of the CT.

 

Near the end of the discussion the presenter asked why no one was so quick to intervene on what they were finding.  Their answer?

 

“EMS is calm, we can take our time and see things through.  When the patients are bad these guys start to sweat.  This guy is calm.”

 

Awesome.

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3 Comments

  1. Hilinda February 28, 2012 12:53 pm

    Sounds like a great learning opportunity! I”m glad “your guy” did so well, not because he’s yours, or “one of us” but because it sounds like he did a great job for the patient.
    I do have to mention that I know two medics who stay so calm all the time that they have had docs mention it to them, that it is more difficult to “read” the condition of the patient because most people would be sweating bullets, and these guys aren’t. I learned this hearing a discussion between them, where the more experienced one was telling the other guy that he learned to add a line into his radio report to specifically tell them when the level of concern should be higher than usual.

  2. Brandon Oto February 29, 2012 7:23 am

    “Pucker sign is positive. We’ll see you in a few.”

  3. J.A.M.B-er February 29, 2012 12:28 pm

    Great post! We (EMS) need to be involved like this more. It can teach us a lot about about a lot.

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