Rural Medicine: Mass Casualty Incident

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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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Alda M., MD -

This is in no way meant as a criticism, but why did they not double or triple up the patients in an ambulance for transfer to a higher level of care? eg, when the woman with the bowel evisceration was transferred from the scene directly to a trauma center, could they not have put 1-2 other patients (such as the 8 year old) in the ambulance with her? As I understand it, only basic life support was available at the scene and these patients were travelling together. It seems like needing to find 6 separate ambulances was burdensome and a delay in care.

Vanessa C. -

Thanks so much for listening and for the comments. I am forwarding this to check with the MDs and paramedics involved so they can answer for the specific context of the case. And now I am just projecting here based on my experience in remote part of Canada, but where I work the ambulance only has space for one stretcher so perhaps that was a similar case in Wawa that night. Let's see what the team from that night has to say. Thanks again for listening.
Vanessa

Jim J. -

When I was a paramedic, back when the ambulance was basically a horse and buggy :) We had the ability to transport 4 patients (two hung from the ceiling...literally). They stopped making ambulances with that ability quite a while ago. Its hard to clear an airway when someone is riding with their face 6 inches from the ceiling.

Vanessa C. -

Alda M, here is the reply from Derek the paramedic involved in the case.
We are generally only able to transport 1 code 4 (highest acuity) patient at a time but we can request for an exception under some circumstances. However, it is difficult to treat two critical patients in the back of the ambulance, you are alone with both patients, should they happen to code. The evisceration pt was also diverted to a hospital approximately 1.5 hrs away and in the case of the 8 yo was not stable enough to consider the extra transport time. The final 2 pts were carried on one ambulance as they were “stable”.

Robert A., DO -

This story hit home for me, I had to stop driving and listen. I have driven that road dozens of times on fishing trips to the WaWa area. We drive it at night and see Moose on the side of the road all the time. This is always our concern, hitting one in the dark. This team did an amazing job in saving the patients they did save. I am not sure I could have done better at one of our critical access sites in southern Indiana where I practice. I truly take my hat off to the tremendous team work displayed and the willingness of the trauma teams hundreds of miles away to help them. I wish I had that type of support from my consultants who are only a few blocks away.

Sheryl M. -

I am bawling after hearing this! I have been a critical care access PA in rural NE, a trauma team PA at a level 1 trauma center a critical care PA at a level II trauma center, and I am currently an ER PA at a level I trauma center: I am so appreciative of what this medical team did: Absolute praise of the entire teams efforts and zero criticism is warranted here! I have complete empathy for all involved! This story not hard for me too: Amazing job Wawa team.

Vanessa C. -

Thank you for listening and sending in your thoughts.

Vanessa C. -

Thank you so much for listening and for sharing your thoughts. I couldn't agree more- the Wawa team and all of their support in EMS and Virtual Critical Care did an amazing job.

Lucieanna M. -

Amazing Job to the wawa team , its amazing how we work miracles with what we have and who we have at that time.

Vanessa C. -

Thanks so much listening and for taking the time to comment.

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