FRIDAY FORUM: Outcomes

Did they make it???

One of my greatest frustrations throughout my time in the fire service has been the lack of information on the outcomes of the casualties and patients we treat.  If they call it within an hour of arriving at the hospital, word usually makes it back to the firehouse.  But the bad traumas or truly sick folks who last long enough to get admitted often get lost in the ether, word of their recovery or death never leaving the halls of the ICU.

There is an unspoken intimacy about the shared experience of rescuing or treating someone at the point of injury.  Scenes are raw; manpower and equipment minimal. I’ve rarely felt this reality is grasped or appreciated by hospital staff.  You rush your patient into the trauma bay, slide them over, and then the curtain is closed.  If you stand in the corner to watch you feel out of place at best.  HIPPA rules seem to kick in within 90 seconds.  “What did that x-ray show?” “I can't tell you that.”

I believe there are professional and personal implications to this.  Professionally, it is difficult to judge the impact of your actions or improve upon them if you have zero end state data.  Did we extricate them fast enough?  Did we miss an injury?  I need to know my mistakes to fix them.  Personally, I’m curious about the mental health implications.  In a job filled with uncertainty, does the constant wondering about outcomes contribute to burnout or mental decline?  If they died, they died.  It's part of the process.  But I’d like to know either way.

I’ve only ever had one patient paralyzed at the point of injury.  An 11 year old Girl, the back seat passenger in an MVC.  I was alone in the back of an FD BLS Ambulance, doing what little I could to care for her on the way to the ER.  After turning over care, I asked the Doc about her prognosis.  Without looking up from his computer he confirmed a fractured spine, but wouldn’t tell me any more.  Did she ever walk again?  Is she in a wheelchair to this day?  I’ll never know the outcome.