This blog posting was inspired by my favorite medical director along the Texas Gulf Coast…
As we all know, neither the “Golden Hour” nor the “Platinum Ten Minutes” have any empirical evidence to back them. However, in some cases, that doesn’t mean they’re not a good idea. Take, for instance, penetrating trauma. As we all know, there’s little that EMS can do outside of the hospital for penetrating trauma except for controlling any external bleeding. In fact, for the advanced providers, we’ve gone away from flooding the patient with IV fluids and instead maintain permission hypotension. Honestly, in the cases of shootings and stabbings, the definitive prehospital treatment is transport. That which delays transport to definitive care, IE, a surgeon, is bad.
So, here’s my question…. Assuming you know you’ve got a shooting or a stabbing, why bring anything with you besides a stretcher and possibly some basic trauma supplies? Backboarding isn’t indicated for penetrating trauma and applying a cardiac monitor on scene just delays treatment/transport. Everything else can be done in your MOBILE intensive care unit.
Sometimes, it pays dividends to your patients to do less. Knowing when to do less and when to do more is what the clinical judgment and professional knowledge is all about.
