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!