DEAD MAN WALKING?
April 10, 2014
By Jeff Clawson, M.D.
Dear Tech Support:
I have a question. It has really happened. I’m not sure if this should be a PFC or what the rationale behind it is. So can you help me please? It concerns Protocol 17: Falls used in ProQA Paramount 220.127.116.115.
Fall from 12 meters (about 39 feet)
The caller there when it happened
CE5 – Not awake
CE6 – Breathing
KQ1 – ≥10m/30ft (3 stories) or more
KQ2 – Accidental
KQ3 – No bleeding now
SEND 17-D-1: EXTREME FALL
This means in this system: 2 ambulances, 1 police car, 1 fire truck, and 1 medical helicopter.
Then another caller rings and says that the patient is awake, and that the fall was into a pile of cardboard boxes, and that the patient has no injuries. The caller adds that the patient has been lucky and is walking around. It’s then not possible to reconfigure into P17 itself or change the CE5 into “yes.” That’s because I now have only one ambulance that was needed for a checkup.
However, in Protocol 9: Cardiac or Respiratory Arrest/Death, with the ECHO codes, it’s possible when the situation changes, but not in 17-D-1. And in this protocol code, it’s not possible. Is this a hiccup in Paramount or is it deliberately blocked?
Can you please help me out on this one?
I have included Pam Stewart as this is more of a protocol question.
I can tell you that the DELTA-1 is based on the EXTREME Fall (≥ 10m) regardless of whether the patient was awake/not awake or that he fell into cardboard boxes; thus the software is working correctly. Pam will have someone supply the clinical rationale on this from the Academy’s perspective.
Technical Support Supervisor
Priority Dispatch Corp.
The 17-D-1 logic is based simply on the distance of the fall being more than 10 meters (30 feet). It doesn’t matter whether the patient and/or caller says they are OK or not. They still fell that distance. Occult (hidden) injuries are not uncommon in patients involved in high mechanism of injury (MOI) conditions. The fact that the patient regained consciousness may be completely (and likely) separate from any potential internal injuries or bleeding in the body or brain not manifest early on. Those of us involved in respecting high MOIs are not deterred by the apparent “wellness” of the patient—especially in the few minutes after the event (as reported here by the caller that he was “better”). Walking around doesn’t rule out a ruptured spleen, liver, or other internal injury. There is a reason for the common (American?) phrase—“Dead man walking.”
17-D-1 is what it was—a high MOI EXTREME Fall. Nothing changes that until the patient is evaluated in person. The main problem here appears to be, in my humble opinion, a significant over response assigned to D-1 initially: 2 ambulances, 1 police car, 1 fire truck, 1 medical helicopter—5 units for a single patient! The MPDS can’t account for the way folks respond locally.
Finally, such situations, where the patient “appears” to have been very lucky after an EXTREME fall, should not change the way we practice medicine or design the protocol. The high MOI rules exist because we get fooled all too often.
I hope this helps to clarify the reason the protocol functions as it does in this regard. In this case, it is functioning as clinically designed.
All the best,