Seattle Fire Department Medic One
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Transcript of Seattle Fire Department Medic One
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Harborview Medical Center
Advanced Trauma Life Support
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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
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A Historical Confluence
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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
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The Medic One Mantra
“To provide the quality of emergency care comparable to that by an appropriately
trained physician on the site”-Dr. Cobb
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Objectives
Establish a Paramedic Training Program (Medic I)Teach cardiac arrest resuscitation
Teach the citizenry of Seattle “C.P.R.” (Medic II)
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1971- Army Major Dr. Copass Arrives at Harborview
Dr. Copass directs the Paramedic Training Program and adds trauma care to the curriculum
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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%
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Paramedic Training
10 Months 2400 hrs (national average ~1000hrs) Based at Harborview Taught by Senior Paramedics & UW
Medical School FacultyAnesthesiaCardiologyPulmonarySurgeryEmergency MedicineOrthopedicsAnd many many more
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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!
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The Trauma Doc
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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
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King County EMS
Seattle Shoreline Redmond Bellevue South King County
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Seattle Medic Units
7 Medic units1101618283132
1 MSO Medic 44 Medical Director Medic 55
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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
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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
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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
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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
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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)
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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
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Trauma Scenario
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MED-6 Response North Aurora & N Aloha E10, M1 Motorcycle vs. car Patient thrown 100ft Unconscious / is breathing
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E-10 arrives at 3 minutes
PrioritiesHelmet removalBB/CCInitial examVital signs
○ BP, HR, RR, AVPU
They have about 2 minutes to do this
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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
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Trauma Doc Gets a Page
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Go to the radio room
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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
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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
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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!
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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!