Harborview Medical Center

Advanced Trauma Life Support

An Intro to Seattle Medic One The year was 1969

No standardized system of prehospital care

Agreement between a University of Washington Cardiologist and the Seattle Fire Chief starts a wild experiment

A Historical Confluence

Seattle Medic One Early Directions

Address 2 questionsCan lives be saved?Can non-physicians be trained to provide

ALS satisfactorily?

Acquire a better understanding of sudden cardiac death

The Medic One Mantra

“To provide the quality of emergency care comparable to that by an appropriately

trained physician on the site”-Dr. Cobb

Objectives

Establish a Paramedic Training Program (Medic I)Teach cardiac arrest resuscitation

Teach the citizenry of Seattle “C.P.R.” (Medic II)

1971- Army Major Dr. Copass Arrives at Harborview

Dr. Copass directs the Paramedic Training Program and adds trauma care to the curriculum

Medic One Accomplishments VF survival to discharge rate ~45%

National ~3%

Amiodarone Prehospital Hypothermia after resuscitation

Initial trial 66% discharged alive (VF/VT)

Change from 15/2, stacked shocksContinuous CPR (2005 ACLS)Seattle VF/VT rate ~35% to ~45%

Paramedic Training

10 Months 2400 hrs (national average ~1000hrs) Based at Harborview Taught by Senior Paramedics & UW

Medical School FacultyAnesthesiaCardiologyPulmonarySurgeryEmergency MedicineOrthopedicsAnd many many more

Who are the MedicStudents?

Identified by their “White Coat” & gunner attitude

16-24 of them per year

October to July Rotate in the ER

when not in class or on the rigs

Teach them stuff!

The Trauma Doc

WAMI and You

The reality of Trauma Doc is you get called about every major trauma in 25% of the land mass of the USA!

Or about 8.3 million people who live in areas of those states who transfer to Harborview~ One Level 1 trauma center

for all of NYC

King County EMS

Seattle Shoreline Redmond Bellevue South King County

Seattle Medic Units

7 Medic units1101618283132

1 MSO Medic 44 Medical Director Medic 55

Seattle EMS: Who is Who? Tiered response system

Engine, Truck, or Aid CarAll Seattle Firefighters (EMT-B)Medics are ONLY dispatched on runs that

need ALS care or evaluationPractice makes perfect

○ In Seattle we have 86 medics total○ In some large EMS agencies paramedics treat

an average of 1 cardiac arrest per/year

Who is Who: Dispatch

When you call 911 you get a Medic One dispatcher

They can instruct telephone CPR and dispatch appropriate BLS &/or ALS units

They work for Seattle Fire and follow Seattle Fire Department protocols

They also page Trauma Doc/ Medic One DocYou may never meet them, but you will work

closely with them

Who’s Who: SFD BLS crews

Fire Engine, Ladder Trucks, and Aid UnitsAll trained to EMT-B level (~120hrs)~3 minute response timeRescue and extrication of patientsBB/CC and O2 prior to medic arrival

Transports are rare○ Aid Units

Who’s Who: AMR Ambulance

Private BLS AmbulanceAll trained to EMT-B level (~120hrs)Contracts with the City for BLS transportPatient is billed for transport<10 minute response timeTransport of BLS patients after evaluation by SFDUse their own company protocolsTransports are abundant

○ Will not call ahead○ Check in at back triage

Who’s Who: Medic One Paramedics

Seattle ALS TransportsTwo paramedics per Unit, (with two medic students)<5 minute response timeStart ALS care while BLS crews BB/CC, O2 , splinting

Transports frequent (but most are medicine)○ Will have dispatch page Trauma Doc○ Short report to Trauma Doc via Radio○ Need your permission for medications (FDA requirement)

Who’s Who: Medic One Paramedics

Trauma specific ALS skillsAirway: Intubation, RSI, TTJV*, Cricothyroidotomy*Breathing: Flutter ValvesCirculation: IV’s, EJ’s, IO’s*, CVC*, pericardiocentesis*Disability: GCS, avoiding: hypotension, hypoxia, & hypocapneaExposure: Patient will be naked for you

They will ask you for permission for all of these unless patient is UNSTABLECovered by Plan A-2 (Standing Order for Shock)

Drugs: Etomidate, Succinylcholine, Rocuronium, Midazolam, Morphine, Lactated Ringers

Trauma Scenario

MED-6 Response North Aurora & N Aloha E10, M1 Motorcycle vs. car Patient thrown 100ft Unconscious / is breathing

E-10 arrives at 3 minutes

PrioritiesHelmet removalBB/CCInitial examVital signs

○ BP, HR, RR, AVPU

They have about 2 minutes to do this

M1- Arrives at 5 minutes

Charge medic jumps out to eval the patient

Skills medic sets up for ALS procedures Once patient is BB/CC they go in the

back of the medic unit Once charge medic has an exam he will

call dispatch to page the Trauma Doc

Trauma Doc Gets a Page

Go to the radio room

The Radio SHORT Report

Age, gender, Mech, eval, injuries, BP, HR, RR, GCS Ask for:

IV, LR, NT, RSI Meds, IntubationBlood RunETA

Vital to REPEAT back to the medics

After the radio report

Medics start their treatment plan and begin to drive

Trauma doc has ~5 min to doRadio announcementHuddle with Charge RN to asses needsHeads to Resus 2 to set up for traumaMakes a plan with the trauma team for

arrival

Patient Arrival

Room should be quite Medic will give a FULL report in Resus 2

As patient is transferredMonitors are attached, blood drawMedics will take questions after reportThis is where ATLS begins!

Last thing!

YOU have the chance to help evaluate paramedic students on ride along

June through July You get paid Email sign up sheet Thanks!