PHTLS worth the two day course

I recently completed a Pre-Hospital Trauma Life Support (PHTLS) course taught by Backcountry Medical (www.backcountrymedical.com). This was an intensive course in trauma care which included a few things beyond my EMT-B scope of practice (cricotomy, needle thoracostomy, and endotracheal intubation). I found it good to have a knowledge and understanding of what an EMT-P would be doing so that I can better assist if needed.

The PHTLS course focuses on ABCDE’s of trauma. The “D&E” were somewhat new to the standard ABCs. The D & E stand for Disability (level of consciousness) and Exposure (visualize all the wounds, or the standard trauma, “strip & flip”). Of course the primary focus is still the ABC’s with management of the airway being paramount.

Another important focus of the course was minimizing prolonged scene times (greater than 10 min) for trauma patients. In order to pass the course, we had a scenario where we had to assess backboard & c-collar, treat major bleeding and be ready to transport in less than 10 minutes. This emphasis of reduced scene times forces the EMT to overlook distracting, non-life-threatening injuries and focus on getting the patient to definitive care.

I highly recommend the PHTLS course for EMT’s of any level. I also recommend the Backcountry Medical folks too. One of the instructors was a combat medic in Iraq with the Army and has a unique perspective on treating trauma patients. Additionally, the Backcountry Medical folks are all SAR volunteers so their understanding of the unique challenges of treating patients in the backcountry.

Well defined roles promote mission success

I was recently on a mission for a pack-out of a hiker with an injured leg. We were in the trees but above the snow line. The trail was compact snow and ice from the number of hikers on the trail the previous days. Our team treated the subject and packaged her for a long pack-out. Initially I set out roles of medical and rigging. We needed the rigging because of the steep snow/ice and management of the litter down the slope.

I quickly found myself jumping between setting up anchors, tending the main line, patient care and running the rigging. The initial patient care provider was much in the same assortment of roles as I was. Eventually, it was pointed out to me that it would be more efficient if I ran the rigging. I then appointed one team member to medical/patient care and the rest of the mission seemed to move more smoothly.

I should point out that patient care was always the primary focus but the swapping around of EMT’s providing care seemed to slow our progress.

My take away from this mission is to establish a Rescue Group Leader and have that person run the field portion of the mission ensuring the big picture is being managed. Additionally, assigning one person for medical and one for rigging would have helped in having a singular focus for each task.

Overall the mission was a success, however I felt there was room for improvement.