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Old May 11, 2019, 07:52 AM   #26
Mannlicher
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I feel that getting help sooner than later to the victims is being underplayed here. The lack of urgency of LEO to secure the site, such as what happened at the Parkland shooting, just has to be reducing the survival chances of those laying wounded on the floor.
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Old May 11, 2019, 12:19 PM   #27
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Last I checked there are approximately 200 Level 1 Trauma centers in the United States. Europe has even fewer. Very few hospitals are equipped to handle advanced trauma. As of 2014 only 2 Level 1 trauma centers existed in all of Europe.

Quote:
The introduction of a pilot trauma system in the United Kingdom seemed to halve the mortality rate in 6 years.
https://www.ncbi.nlm.nih.gov/m/pubmed/16292062/
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Old May 11, 2019, 12:39 PM   #28
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Originally Posted by davidsog View Post
Last I checked there are approximately 200 Level 1 Trauma centers in the United States. Europe has even fewer. Very few hospitals are equipped to handle advanced trauma. As of 2014 only 2 Level 1 trauma centers existed in all of Europe.



https://www.ncbi.nlm.nih.gov/m/pubmed/16292062/
Here in San Antonio Texas we have only two. We are like the 7th largest city in the Nation. We used to have three but than we lost the 3rd one Wilford Hall Medical Center when we merged the trauma care with Brooke Army Medical Center. According to the trauma surgeons in the medical community they said that the loss of Wilford Hall would not harm patient care.
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Old May 11, 2019, 12:47 PM   #29
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Last I checked there are approximately 200 Level 1 Trauma centers in the United States.
I was at my local hospital yesterday (wife is getting wound care for a leg injury -and healing well, thanks) so I spoke with the wound care specialists about Level 1 trauma care.

They told me that, yes, level 1 care is what you get at a level 1 facility. And that there is one (1) O-N-E, one level 1 facility in our STATE! (and, its about 250 miles away from where we were)

One nurse told me the sad story of a patient brought in who had "the kind of stroke where you need neurosurgery immediately, or you die". They didn't have a neurosurgeon there, the patient died.

Apparently to be a Level I Trauma center it must have ALL the possibly needed specialists, on staff and on site, 24/7. Not on call.

The next time you hear anyone talking about how "they would have lived had Level I trauma care been available", I suggest you check and see just how "available" it is to YOU, and those places you regularly go.

there are some good hospitals near where I live, and a fair one local to me, but the only Level I Trauma Center in my state is a 90+ minute med-evac chopper flight away. Think about that, and where you live.
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Old May 11, 2019, 01:48 PM   #30
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And that facility treats 80,000 patients thru the ER each year and treats 4,000 patients thru its outpatient clinics each day.....per the website.

8500 staff members.
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Old May 11, 2019, 06:54 PM   #31
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Trauma patients after triage will move thru a pipeline to the level of trauma care that is appropriate. Part of an casualty event is identifying the available facilities. If a victim requires level 1 care a plan to get them to an appropriate facility must be in place. That is the responsibility of responding agencies.

Yes, the nearest level 1 trauma center is briefed and the responding agencies are aware of their current status. Only saw one three letter agency drop the ball on that once.

If an agency does not have that information and pipeline established, they are simply wrong.

The golden hour is very important and responding LE must be aware of it. Life, limb, and eyesight must be their immediate priority. Clearing and securing an objective such as school does not take that long. Agencies must be proficient in multiple team, multiple room, and multiple building operations.
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Old May 11, 2019, 07:00 PM   #32
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44 AMP
Your post is kind of babbling and I am not sure what you are talking about.
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Old May 12, 2019, 09:25 AM   #33
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Quote:
Your post is kind of babbling and I am not sure what you are talking about.
What I'm babbling about was my quest to understand this statement..
Quote:
Out of the 44.6 people, 7 of them had wounds that would have been survivable had they had there been level 1 trauma care available.
I did not know what level 1 trauma care was, nor where it was available. This made me wonder, WHY level 1 care was not available to those 7 people who "would have survived" if it had been. Based on what I found out, it seems the most likely answer to that question is that level 1 care was too far away, and the victims simply didn't live long enough to get there.
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Old May 12, 2019, 12:30 PM   #34
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Which pretty much means, if you are one of those seven people, you're pretty much SOL, so the statement that there were 7 who could have survived is pretty much like saying you could survive being hung if the rope broke.

I have a level 1 hospital just on the other side of town, but there would still be no guarantee that I would get there in time. The medics could also take me to one of the two level 3 hospitals in the city (which are closer), not realizing that I needed level 1 care right away.
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Old May 12, 2019, 02:09 PM   #35
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Ok

Teaching trauma medicine is far beyond the scope of the thread. Stabilization and transportation is a thing and works so it is not at all like saying “being hung and blah blah with the rope”.

You MUST have good well trained first responders with proper equipment to work the ABC’s in the golden hour. That is what that statement says....

7 people died because they did not have trained and equipped first responders in the golden hour.

For example...

One my colleagues shot in the face with a 7mm magnum survived the hour and a half trip to level 1 trauma ONLY because the medic did an immediate cut down of his carotid artery and controlled the bleed manually for that hour and a half.
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Old May 12, 2019, 06:08 PM   #36
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davidsog, I am happy to hear that your buddy survived and that the high initial and continued level of care necessary for his survival was available, but in most cases, that level of care will not be available for most people.

Since I was an EMT (up to intermediate level and was in paramedic training when a family problem interrupted), I can fill you in on that side of it.

First of all, most people are not cut out for emergency medical training of any sort. They don't/can't bring themselves to be near people who are in pain, bleeding or have open wounds etc.. There is also the money and time involved in being trained and the continuing education required after the initial training. In some states, you need to belong to an ambulance service in order to qualify for EMT training. A large amount of money and time is involved as well.

Even trained, certified EMS people have their problems. I had a trained, licensed EMT freeze up when he saw a pool of blood by a patient who had been shot. When I was a crew chief, I had an EMT on my crew tell me that she would not be able to help on a SIDS call (sudden infant death syndrome) because she had had a baby die that way. The first person I never trusted after that, but the second I thanked for telling me beforehand so I wouldn't put her in a situation which would put her in a highly stressful position.

There are many different levels of EMS:

There is first responder level of trained people (Red Cross, Boy Scouts, etc.) who are trained in just the basics of emergency treatment, or the basic ABCs (airway, breathing, circulation). They can clear an airway by pulling the tongue or a foreign object out of the area of the mouth or perform the Heimlich maneuver. They can control bleeding to a certain extent and they can perform CPR (oops, it's now CCR I guess).

Here are the levels of emergency medical responder training levels of various states around the country:

Minnesota
Emergency Medical Responder*
EMT-Basic
AEMT
EMT-Paramedic*
Community Paramedic
Registered Nurse-EMT
Registered Physician Assistant-EMT

Pennsylvania
BLS
Emergency Medical Responder (EMR)
Emergency Medical Technician (EMT)
ALS
Advanced EMT (AEMT)
Paramedic
Prehospital Registered Nurse (PHRN)
Prehospital Physician Extender (PHPE)
Prehospital Physician

Texas
Emergency Care Attendant
EMT-Basic
Advanced EMT (formerly EMT-Intermediate)
EMT-Paramedic
Licensed Paramedic (paramedic with a college degree)

Wisconsin
EMR (Emergency Medical Responder)
EMT (Emergency Medical Technician)
AEMT (Advanced Emergency Medical Technician)
EMT-Intermediate (Emergency Medical Technicial Intermediate)
EMT-Paramedic
Critical Care Paramedic Endorsement
TEMS (Tactical Emergency Medical Service Endorsement) Primarily for SWAT teams

As you can see, there are quite a variety of levels of treatment available. In most cases, the needed level of training to keep one of your 7 people alive until they could reach a level 1 trauma center would be probably an EMT Intermediate or above (ALS). I say that because the victim is going to need an IV started at a minimum to stay viable.

In most rural areas, the highest level of training that you are going to find on an ambulance crew will be a basic EMT. The reason is that it costs money to train these people and it costs time and money to keep up their skills. The higher the training, the more money and time involved. Most rural EMS ambulance services can't afford that kind of money. If these services need advanced care, they will ask for a perimedic service to meet them at scene/during transport or, if available, a medical helicopter.

In my earlier post, I mentioned that my service (basic EMT at the time) had a gunshot patient who wasn't seen until the building was cleared and we were called in, which took some time. Even though we had a level 1 trauma hospital within 15 minutes of where we were, and two level 3 hospitals within 5 minutes, the crew chief called in a paramedic unit because of the time situation involved.

I remember reading somewhere/sometime that medics and corpsmen weren't recognized by some states as legal emergency medical providers, even though their training was at a paramedic level or above!

I will continue to say that the 7 victims are not likely to receive the necessary initial treatment they need, nor is there likely to be a level 1 trauma center available to continue the level of treatment needed within the necessary time frame. I know that my remark about the rope breaking could offend some people, but I wanted to make the point that in most instances, those seven people were more likely to die without extraordinary means available, which isn't likely to happen in most areas of the US.

By the way, while I was an EMT, I was able to talk to some ER and ICU nurses. Most of the ones that I talked to said that they would never work on an ambulance! I thought that was pretty interesting.

Again, I am thankful that your buddy was able to get the level of care he needed to survive.
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Old May 12, 2019, 06:27 PM   #37
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Ok

Then why am I having to explain that a survivable is survivable?

You are correct and make my point that if we are to increase the number of survivable wounds that survive....

We need to increase training and have equipment available.
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Old May 12, 2019, 07:42 PM   #38
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davidsog, please believe me when I say that I am not trying to be argumentative, but I will continue to point out that, for those seven victims to survive, they need immediate ALS treatment to have a chance at arriving at a level 1 trauma center. If every person in the country were trained to the level of an EMT basic, which is extremely unreasonable to believe would happen in any case, it would still be very unlikely that the seven 'survivable' victims would get the initial treatment needed to survive. The article supposes that the level of treatment needed for those seven to survive would be available every time, all the time, everywhere. It is a very unreasonable assumption on their part. It just is not possible in the real world, but it sure would be nice if it were so!
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Old May 12, 2019, 09:05 PM   #39
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Level I Trauma Center
Provides comprehensive trauma care, serves as a regional resource, and provides leadership in education, research, and system planning.
A level I center is required to have immediate availability of trauma surgeons, anesthesiologists, physician specialists, nurses, and resuscitation equipment. American College of Surgeons' volume performance criteria further stipulate that level I centers treat 1200 admissions a year or 240 major trauma patients per year or an average of 35 major trauma patients per surgeon.

Story about level 1 trauma centers...mass shooting in Las Vegas
https://www.usatoday.com/story/news/...ans/727100001/

https://www.nremt.org/rwd/public/data/maps

Total Nationally Certified EMS Personnel In US
BLS...EMR – 11,430.....EMT – 247,679.......................Total BLS – 259,109
ALS...AEMT – 15,604....Paramedic - 101,174..............Total ALS – 116,778
Total all levels...375,887
Population of US....327.2 million

The actual math confirms my point. At this time, there are a total of 375,887 EMS personnel and a population of 327.2 million. It gets even worse if you take the number of ALS personnel, the minimum training level needed for a victim who needs level 1 trauma care to still have a chance of arriving at that trauma center in a viable condition. If you take the number of paramedics alone, which gives you the absolute best chance of survival, your chances become extremely bleak indeed!
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Last edited by blackwidowp61; May 12, 2019 at 09:32 PM.
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Old May 13, 2019, 04:15 AM   #40
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You should be familiar with triage. A survivable wound is simply survivable.

That they did not survive indicates a failure on the part of medical care and an indication to do better.
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Old May 13, 2019, 07:04 AM   #41
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This discussion seems to have gone off the rails, and nothing constructive has been offered. The question asked by Bartholomew Roberts in the opening post was:

Quote:
[W]hat does this suggest for strategies to survive mass shooting events?
We are in the Tactics and Training discussion area. A debate about exactly what constitutes a "survivable" wound may be of interest to a trauma physician, but it offers us nothing useful with respect to discerning any strategy to survive (other than the early comment, "Don't get shot").

Closed for being off topic.
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