Second Guessing.

I'm in a unique place.

One of my students is also a member at my volunteer firehouse (where I am the EMS Sergeant). She has another four months until she becomes my student (begins field clinicals) but she's still "one of mine."

She came to me with a rather prescient question today. She had been the primary provider on an accident. She was riding the ambulance and the fire engine (with our station officer on board) had been dispatched on the call too.

It was an auto accident with very minimal car damage. There was a "star" on the windshield but not in the typical place for head impact. Relevant too, was the fact that the driver (my student's patient) was seatbelted. No airbags installed on his car.

He was also "altered." This means the person driving the car was in an altered mental status, or was so out of it that he did not remember the question that was asked of him 2 minutes before.

My student said, "Off to the trauma center you go!!!" In fact, as she arrived on scene, she asked for the status of the local trauma center.

The officer, however (someone who is primarily involved in fire suppression), said, "No, you should go to XXX hospital" (the closest but NOT a Trauma center).

60 hours later, she catches me in the Chief's office and asks me if she made the right decision.

Now, understand that these "questions" are never asked. They are always prefaced by a story. She's telling me the story and when she gets to the part about "star on the windshield + altered mental status" I interrupt and say, "Trauma Center!"

She counters with, "What if it's a seizure or EToH?"

I respond with, "Look, If its a seizure, EToH or a stroke, the local trauma center can handle that. If it's an altered mental status due to a stroke or an epidural bleed, for example, then the local "community" hospital is going to transfer them to the trauma or the stroke center (both in the same place) and that will delay care.

I tell her, "I would have made the same decision. Fire donkeys and cranky nurses be damned."

She sighs her relief.

I asked her if that's where her patient went. (To the Trauma Center) Yes, but she feels bad about "second guessing" the officer on the call.

I ask her, "Who's in charge of patient care?"

Her shoulders drop and I can visibly see the stress fall away...."Me!"

"Then it's your call and you made the right one."

"Thanks, Sarge!" A flip of a wave and a spring in her step and she's gone.

She's ready for the next one.