First Responder
Transcript: Overlapping Needs 8/2/2014 0430: A representative from DNA met with the patient's husband. -The patient was a registered organ and tissue donor. -He wanted to honor her wish to save lives, if at all possible. Treatment was escalated to honor their wish Collaboration & Communication How can I & how do I impact others? Who's in the know First Responder Real life experience Rapid Support & Discussion Emergency room physicians, nurses, and paramedics provide aggressive interventions to stabilize our sickest patients Gaps in Communication & Fears Evidence Based Kristin Schwartz, MC, PsyD Goals & Objectives EMS/Pre-hospital Hospital ~Emergency Department ~Intensive Care Unit ~Operating Rooms Donor Network of Arizona Family, Financial, and Patient Outcomes ~Aggressive intervention for patient's with low GCS -Blood transfusions -T4 protocol ~$$$ ~Ethics of early/aggressive intervention ~Organ donation as a viable, positive outcome ~Timeliness UAMC ED began evaluating the patient at 0030 on 8/2/2014 Systolic blood pressure was dropping into the 40s The patient required transfusions and aggressive support (<12hrs 7 units of PRBs & 6 of FFP) Her injury was determined to be nonsurvivable Her husband decided to allow natural death Donor Network was notified @ 0310 on 8/2/2014 Hemodynamics Electrolytes Blood Gases Glucose Urine Output Ejection Fraction Questions? Continuation of care UAMC medical complex The gift of organ and tissue donation touches not just those who receive transplants, but their families, friends, and communities +Provider names (Notes & Run sheets) -Documentation -Provider follow up +Hemodilution -What fluids -How much -When +Early communication -ED referral -Preserve options Patient Care Outcomes Closure Donation Conversation Family Dynamics Communication/Understanding Social Support Family Advocates Timelines *Joseph, et al (2014) *Raoof, et al (2011) Her life. His choice. Their gratitude. The moment of generosity belongs to the family Shared Meaning ~Identify the benefit of aggressive care for patients as it relates to donation options ~Recognize the potential impact of timeliness on donation options ~Recognize the need for clear, concise, and complete communication as to patient care EMS crews are often the only sources of information on circumstances surrounding a patient's cause for admission 8/1/2014 23:23: EMS crew is dispatched to a rollover MVC - Upon arrival, the patient was breathing, had a weak pulse, and was unresponsive. -An IV was started, her breathing was facilitated by BVM, and she had standard c-spine precautions. While in route to UAMC, her breathing became increasingly labored and she became hypertensive. Care was transferred to ED providers between 0030 and 0112 on 8/2/2014 The gift of life has offered a 68-year old man, who was awaiting a liver transplant, a second chance. The gift of the right kidney transplant has offered a 60-year old Arizonan a new beginning A 68-year old woman received the left kidney transplant. Vision was restored for two individuals Those in need received the gift of skin & bone grafts Clinical Goals