Maximize the `Platinum 10 Minutes`
EMS has come a long way from its early days.
"Back then we had two treatment options—oxygen and velocity," says Jon Politis, MPA, NREMT-P, and an EMT with more than 40 years of experience at all levels.
Decades of advancements have greatly expanded those treatment options, multiplying the decisions EMS providers need to make on the scene, all while navigating the same old obstacles to patient care. Which makes it all the more difficult to get trauma patients off an emergency scene in 10 minutes or less, common protocol for many systems.
In his presentation "Maximizing the Platinum 10 Minutes" during the Wisconsin EMS Association's Working Together: Emergency Services Midwest Conference and Exposition, January 25-28, Politis discussed the techniques all levels of EMS providers can use to get off the scene faster.
The big decision, says Politis, is whether to fast track the patient or "stay and play."
"It's in the trauma patient's best interest for us to treat them well, do our job and be nice," Politis explains. "But that can be exceptionally difficult because of the logistics involved to get off the scene in 10 minutes. Sometimes you can make some really big mistakes by going too fast."
To combat those errors made in well-intentioned haste, Politis offered a mantra: "Slow is smooth and smooth is fast." What that means is if you do it right the first time you won't have to do it again.
Begin by assessing the level of care the patient will require—is the person having breathing problems or is this a patient with advanced trauma? Then ask yourself, what does the patient need and what can I provide? If you can do something to help the patient on the scene, do it. If you can't, then get them to the hospital as fast as conditions allow. "It's called 'diesel therapy,'" Politis jokes.
ALS crews can provide treatments for, among others, the following ailments: seizing or altered mental status; respiratory failure; cardiac arrest; and unstable dysrhythmias. These are all medical conditions which, while still requiring transport to the hospital, can begin to be treated in the field. One of the most important treatments ALS providers have in their arsenal, especially for patients in pain, is analgesia or sedation. If the fastest way to get ALS for the patient is to begin treating them on scene, clearly you do it. However, sometimes it's faster just to go to the hospital.
Standard protocol for many systems dictates that for major trauma you're off the scene in 10 minutes. Protocols are in place for a reason, so providers should always strive to adhere to them first. But sometimes there are complicating factors—the patient is in a difficult spot or extrication is required. Having a game plan in place, which is followed for every patient, can greatly reduce the time providers spend on scene and maximize their efficiency in the field. "It's about elegant simplicity," says Politis. "Everybody works as a team and everybody has a job."
For a single patient trauma, assign a team leader. That person will do the assessment and the talking, as well as write up the report. The other member(s) of the team can be utilized for their specific skills or as a go-fer. On the next call you can switch roles.
Good decisions come from a good assessment. When things go wrong it almost always comes down to a poor assessment, so get it right the first time. Remember, "slow is smooth and smooth is fast." A good provider should be able to get an assessment done in two minutes or less. Practice until you've got it down.
For a multiple patient trauma establish an incident command system (ICS). Begin with a START plan—Simple Triage and Rapid Treatment. When you arrive on scene establish the chain of command for that call. Size the scene up, do a quick arrival report to record what you see and begin triaging patients. Get on the radio and request any additional resources you may need, stay on task while triaging patients and begin treatment for those most in need until backup arrives.
It's important to remember that triage and tagging are crucial when responding to a multiple patient trauma. It prevents "re-triage" and better enables you to "get the red out"—get the critical patients off scene first.
Once your roles are defined, lighten up! Carefully think about the things you need to bring with you when you respond to a scene and leave the ambulance. Carry only what you need; don't carry what you don't need. Stack the deck—put your bags on the stretcher before a call and be ready to roll once you get there. And when you arrive on the scene, park like you're planning to leave.
With a trauma patient time is of the essence. "But when it comes to speed, sometimes less is more," Politis says. You want to get off scene fast, but you want to do it right the first time.
"Slow is smooth and smooth is fast."
