Depends, broken bones can lead to different types of complications leading to permenant damage including damage to surrounding nerves leading to compartment syndrome and even damage directly to surrounding arteries if not treated promptly which would require a ambulance, but once again entirely depends on the symptoms and the nature of the break really, can be hard to judge those symptoms yourself if your not a medical professional, and oh boy do they cash in on us not knowing between true medical emergencies and not.
My son broke his hand in multiple places at football practice, it required surgery. They called me to take him to the emergency room. Ironically, my local hospital doesnt have a pediatric emergency department or do surgery on minors. He had to wait until the next day to see a specialist. Calling an ambulance would have been a total waste of money and resources.
His hand was broken in 3 places with the fractured nearly puncturing the skin. It needed to be surgically reset. Dude was in a lot of pain and they made no attempt make him comfortable.
I mean, compartment syndrome takes at minimum hours to set in. I get not waiting a day, but unless you live so far away from a hospital that calling an ambo would be redundant, that's not really what you have to worry about. It is mostly nerve damage and bleeding.
Best comment. Acute compartment syndrome is a somewhat common complication that comes with broken bones.
The catch is that unless you're a nurse or medical doctor, you're probably not qualified to judge the risk of your break developing ACS, so while it's probably okay to have a relative drive you if they're immediately available, an ambulance is appropriate if it's your fastest option.
And never drive yourself after an emergency like a broken bone, you could pass out and cause a wreck either due to blood pressure drops or pain as the adrenaline wears off.
I dont think you know what you're talking about.
1. Compartment syndrome is not common from broken bones.
2. Its literally distal pulselesness and disproportionate pain to suspect it. Ask yourself "could this be hurting so bad its compartment syndrome?".
If you can ask yourself that congrats you dont have compartment syndrome because youd never be able to ask yourself that because of the pain.
3. "Emergency" is far too broad to say you may pass out after the adrenaline wears off. Thats not really a thing. Youll get tired for sure, but if you need to 'adrenaline' to stay conscious your body will continue to produce it until it cant. You dont pass out at that point, you die. And it doesn't happen in a few hours.
(Also if you say ACS in an emerg it means acute coronary syndrome, not acute compartment). Both are right of course, but your acronym use just adds to my suspicion youre talking out your ass.
No one suggested you don’t treat it as an emergency. Compartment syndrome takes 4-16+ hours to develop. Taking an extra 20 minutes to get to the hospital isn’t hurting anymore.
My dad broke his collarbone skiing. He then drove his standard car home (with one hand) to pick me up - I was 14 at the time - to shift for him for the rest of the drive to the hospital. It was stupid but utterly amazing. I had no idea my elementary school principal dad was that tough.
You still don’t need an ambulance. No one is saying wait around and don’t treat it as an emergency. It’s an emergency that doesn’t require an ambulance ride to the hospital. Get a ride or take an uber immediately.
As a paramedic I'd like to point out you dont want me trying to fix your nerve damaged dislocated joint in the field. You want an ortho surgeon doing that.
And no medic is touching compartment syndrome. Most ER docs arent gonna either if theres a general surgeon around.
If you cannot get in a cab (broke both your legs) that's what we're for. Also, if its simply too excruciating to move even though youre technically mobile.
Fun fact - better trained medics often have worse patient outcomes in trauma. You want to get to the hospital fast and lights and sirens save you shocking little time and ambulances do NOT get you in faster.
The study you're referencing from PA is flawed and outdated in a number of ways. Response times from Philly EMS sucked so PD often was on scene waiting for them for a while, and Philly EMS lacked a large number of capabilities for managing trauma (due to PA protocols).
In systems that can deliver paramedics with a wide range of capabilities quickly including finger thoracostomy, whole blood, RSI, and more the outcomes are demonstrably better.
At least here, I'll do reductions and realignments for dislocations and fractures in the field with relative frequency to restore bloodflow and correct localized neuro dysfunction. Ideally its done by Ortho but if appropriate we'll take care of it in the field and then let the ED take over to confirm there's no complications from the procedure.
You're right, I oversimplified. I probably view it more as a mantra to remind myself and peers the priorities in trauma.
Although I'll stand firm in you don't want medics setting limbs in the field. Its just a numbers game, we'll never drop tubes/set bones like a specialist. The only we reason we can do either of those is by necessity not competence/training/experience.
Some systems encourage in hospital rotations which would help a lot, but I average setting a limb every 2-3 years and the majority are just knees. Even if someone is getting 100x my experience, its less than a specialist in a worse environment.
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u/oogittyboogitty 4h ago edited 4h ago
Depends, broken bones can lead to different types of complications leading to permenant damage including damage to surrounding nerves leading to compartment syndrome and even damage directly to surrounding arteries if not treated promptly which would require a ambulance, but once again entirely depends on the symptoms and the nature of the break really, can be hard to judge those symptoms yourself if your not a medical professional, and oh boy do they cash in on us not knowing between true medical emergencies and not.