Looking back on my call last Friday night, I'm wondering if I could have done some things better.
We loaded the patient almost right away. In retrospect, I was thinking that perhaps I should have put a good dressing on his abdominal wound and stabilized that before we moved him. As it was, his intestines were coming out bit by bit from the movement in the ambulance. Perhaps the dressing would not have prevented that but, it would have kept the bleeding under more control. It just seems to me that I should have stabilized his wound before we did the ol' "load and go."
Mind you, I was by no mean the only EMT there and certainly not the most "senior." The patient was lying between two parked cars and surrounded by a knot of people. I would have needed to be really bossy but, I keep thinking, "Patient first."
Should I have been more assertive? Should I have had the FFs who were standing around give me some lighting and then just gone ahead, cut off the clothes, assessed, dressed, gotten a baseline and then loaded? I don't think the delay would have created too much worsening of the patient's condition. Our transport time from the scene to Trauma, including rendezvous with the Medics, was only 10 minutes.
On the other hand, our not doing all that didn't seem to affect his condition much either. Trauma was ready for us and they took over the minute we got him in the door.
I suppose I should have treated him on scene a bit more. I didn't know how long we might have been delayed in transit or if there would be any further complications. If the evisceration was properly dressed, he would have been better protected from all the movement of the ambulance and if he had become even more combative, it might have prevented some further injury.
You more senior medics who read this: What do you think?