Shootings and Seizures

I still get excited about shootings.  I don’t know why, and am frankly a little embarrassed about it.  I’ve been on about 80 or so in the past twelve years.  The novelty has certainly worn off, but for some reason I walk a little faster to the truck and must resist the urge to drive faster to get there.

I thought about this after reading TOTWTYTR‘s post about how shootings are really a BLS call, and Rogue Medic‘s post about shooting victims transported by police in Philadelphia. It’s not the skills that I get excited about.  I’ve intubated a few patients and decompressed a few chests, but most of these patients died anyway.  I  usually start an IV and draw blood as a courtesy to the hospital, but doubt it affects anyone’s length of hospital stay or 30-day mortality.   Giving Fentanyl probably helps shooting victims more than anything else.

Until recently, shootings to an extremity or unknown body location were BLS calls.  ALS was frequently requested after BLS arrived, and there was a push from medics to be dispatched to all shootings.  So now we are.

Which brings me to seizures, which paramedics have a silver bullet to fix.  Seizure medications It is only needed about 15% of the time, but it is a true emergency when it is.  The administration of benzodiazepines to patients actively seizing is one of the EMS system benchmarks that the Eagles proposed in 2007.

Seizure calls in my area are BLS if the patient has finished seizing or if the status is not known.  ALS is frequently requested by BLS for this also, either because the patient is still seizing when they arrive or the seizure was caused by something other than epilepsy.

This is not surprising, because a  2007 study of the Priority Medical Dispatch codes (the system used in my area) showed that Midazolam was administered equally as often for BLS and ALS calls.  The authors recommend that ALS be dispatched to all seizure calls.

Patients who are shot need a ride to a trauma center more than any skill that can be done in an ambulance.  Patients who are seizing need a medication carried by ALS that can prevent or limit brain damage.  We know that a certain percentage of seizing patients will be under-triaged and wait longer than necessary for seizure medication.  Unlike for shootings, there was no push for ALS to be dispatch to all seizure calls.

As a profession, we have not yet grasped where we make a difference and where we don’t. Certain calls are more exciting to go on than others.  Some interventions are more fun to perform than others.  As our profession grows up, I hope that decisions about resource allocation are based more on effectiveness than fun and excitement.


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