Destination for trauma patients?

[EpiEMS]

For the use of mechanism of injury as an effective triage tool, I would reference this fine study. By way of a brief summary:

Death of another occupant, fall distance, and extrication time were found to be good predictors of trauma center need when a patient does not meet the anatomic or physiologic criteria. Intrusion, ejection, and vehicle deformity were found to be moderate predictors. The remaining mechanism of injury criteria were found to be poor predictors; motor vehicle crash speed, rollover, pedestrian or bicyclist thrown or run over, pedestrian or bicyclist striking vehicle speed, motorcycle crash speed, and separation of rider from motorcycle.

 

[RedAirplane]

Sorry all. My original post seems to be a bit unclear or misleading.

The situation I gave was from the perspective of me as a patient. Namely, the system that would save me if I were in a crash, not the system I currently or would work for.

It was a spot of curiosity given the strange place I live.

However the answers seem to make sense. I guess what confused me is that the PHTLS book showed a diagram of how long it would take from door to definitive care at either a regular hospital or a trauma center, and a breakdown of what all that time meant. Most of it was prepping an OR and calling specialists. So I figured if you had enough notice, couldn't a regular hospital provide definitive trauma care? I'm guessing that te diagram was just overly simplistic.

Incidentally, I have asked my local fire people and they would transport by ground to the Level I that's about 30 minutes away.

 

[VentMonkey]

couldn't a regular hospital provide definitive trauma care?

Just so we're (all) clear, are you still under this impression?

 

[RedAirplane]

Op, first tell me what "reall 911" is to you. Second, it's a trauma patient, take them to a trauma center with trauma capabilities assuming they aren't "in extremis", and even then you can still work around things.

Like @gotshirtz001 mentioned that isn't a true "scratch my head at this" medical patient, though it is the majority of our calls, that's ok. A true medical case leaves you thinking "I wonder what was wrong", or "what could I have done better".

Trauma patients---> ABC's, good and early bleeding control, safe and efficient transport to the appropriate facility.

Again, I ask what's a "reall 911" service?...

I really shouldn't have included the preamble about changing positions and all that because it only is relevant to why I was reading a PHTLS book, not to my actual question.

But in essence I live in area A and work in area B as an event EMT. So lots of public service and "first on scene" for patients with medical complaints before they get transported, but almost no trauma (I think I had one in the last three years) and nothing in the back of the ambulance at all.

For job and family reasons I'm moving across the country to area X where the 911 ground ALS/BLS ambulances are volunteer. Hence what I meant by transitioning to "real" 911. You take people to the hospital.

 

[DesertMedic66]

Sorry all. My original post seems to be a bit unclear or misleading.

The situation I gave was from the perspective of me as a patient. Namely, the system that would save me if I were in a crash, not the system I currently or would work for.

It was a spot of curiosity given the strange place I live.

However the answers seem to make sense. I guess what confused me is that the PHTLS book showed a diagram of how long it would take from door to definitive care at either a regular hospital or a trauma center, and a breakdown of what all that time meant. Most of it was prepping an OR and calling specialists. So I figured if you had enough notice, couldn't a regular hospital provide definitive trauma care? I'm guessing that te diagram was just overly simplistic.

Incidentally, I have asked my local fire people and they would transport by ground to the Level I that's about 30 minutes away.

A hospital can not just get the providers needed. They either have them on their team or they don't. You can give the hospital a 12 hour notice and that is not going to change that they are not a trauma equipped hospital.

 

[VentMonkey]

I really shouldn't have included the preamble about changing positions and all that because it only is relevant to why I was reading a PHTLS book, not to my actual question.

But in essence I live in area A and work in area B as an event EMT. So lots of public service and "first on scene" for patients with medical complaints before they get transported, but almost no trauma (I think I had one in the last three years) and nothing in the back of the ambulance at all.

For job and family reasons I'm moving across the country to area X where the 911 ground ALS/BLS ambulances are volunteer. Hence what I meant by transitioning to "real" 911. You take people to the hospital.

Cool beans, good luck in your endeavors.

 

[RedAirplane]

Just so we're (all) clear, are you still under this impression?

No

 

[VentMonkey]

No

 

[phideux]

Sorry all. My original post seems to be a bit unclear or misleading.

The situation I gave was from the perspective of me as a patient. Namely, the system that would save me if I were in a crash, not the system I currently or would work for.

It was a spot of curiosity given the strange place I live.

However the answers seem to make sense. I guess what confused me is that the PHTLS book showed a diagram of how long it would take from door to definitive care at either a regular hospital or a trauma center, and a breakdown of what all that time meant. Most of it was prepping an OR and calling specialists. So I figured if you had enough notice, couldn't a regular hospital provide definitive trauma care? I'm guessing that te diagram was just overly simplistic.

Incidentally, I have asked my local fire people and they would transport by ground to the Level I that's about 30 minutes away.

I would roll you across the street to your local hospital, which you say is pretty big with lots of specialties. They can assess and stabilize you there, if you need to go to the Trauma Center, they probably have a Heli-pad or a spot of parking lot big enough to set down a chopper.

 

[SpecialK]

I would roll you across the street to your local hospital, which you say is pretty big with lots of specialties. They can assess and stabilize you there, if you need to go to the Trauma Center, they probably have a Heli-pad or a spot of parking lot big enough to set down a chopper.

Why would you do this? You are just wasting time no? Unless your major trauma hospital is hours away ....

First of all; and I make no apologies for sounding like I am being picky:it is important to be specific and use the correct language; it is not a "head injury"; it is a traumatic brain injury. Just like a stroke is not a "CVA" (most strokes are not accidents and are preventable) a head injury and a brain injury are two different things. If you told me you were bringing a patient in with a "head injury" I would think somebody has a cut to their scalp or something.

Patients with major trauma need to go directly to a major trauma hospital, the evidence is overwhelming and irrefutable. As an example, in its first year of operation the London Major Trauma System saved the lives of approximately 60 people who would have otherwise died had they not been taken to a major trauma hospital. Victoria has managed to hold it's trauma mortality constant for the past five years using the State Major Trauma System.

If a major trauma hospital is one hour away by road; then by the time you take the patient to the closer non-major trauma hospital, they look at them and do something if they think it is necessary, then the patient is transported to the major trauma hospital they could have already been at the major trauma hospital ages ago. The only role for transporting somebody to a non-major trauma hospital is if they are going to die from an airway, breathing or circulation problem you cannot fix and the non-major trauma hospital is significantly closer.

 

[Bullets]

Just like a stroke is not a "CVA" (most strokes are not accidents and are preventable)

One of my ER docs doesnt like "stroke" so he says CVA stands for cerebrovascular attack/assault....

 

[phideux]

Why would you do this? You are just wasting time no? Unless your major trauma hospital is hours away ....

First of all; and I make no apologies for sounding like I am being picky:it is important to be specific and use the correct language; it is not a "head injury"; it is a traumatic brain injury. Just like a stroke is not a "CVA" (most strokes are not accidents and are preventable) a head injury and a brain injury are two different things. If you told me you were bringing a patient in with a "head injury" I would think somebody has a cut to their scalp or something.

Patients with major trauma need to go directly to a major trauma hospital, the evidence is overwhelming and irrefutable. As an example, in its first year of operation the London Major Trauma System saved the lives of approximately 60 people who would have otherwise died had they not been taken to a major trauma hospital. Victoria has managed to hold it's trauma mortality constant for the past five years using the State Major Trauma System.

If a major trauma hospital is one hour away by road; then by the time you take the patient to the closer non-major trauma hospital, they look at them and do something if they think it is necessary, then the patient is transported to the major trauma hospital they could have already been at the major trauma hospital ages ago. The only role for transporting somebody to a non-major trauma hospital is if they are going to die from an airway, breathing or circulation problem you cannot fix and the non-major trauma hospital is significantly closer.

I can agree with that, But the OP said a "head Injury" and he was "trapped under something for 30-45minutes". Just a vague head injury and entrapment shouldn't mean a 30-60 minute transport. If he definitely had signs of a TBI(LOC, AMS, weird pupils, etc), or other traumatic injuries I would call in and land the chopper somewhere in that Large Hospitals parking lot across the street during that 45 minute extrication and fly him to the level 1.

 

[SpecialK]

I can agree with that, But the OP said a "head Injury" and he was "trapped under something for 30-45minutes". Just a vague head injury and entrapment shouldn't mean a 30-60 minute transport. If he definitely had signs of a TBI(LOC, AMS, weird pupils, etc), or other traumatic injuries I would call in and land the chopper somewhere in that Large Hospitals parking lot across the street during that 45 minute extrication and fly him to the level 1.

If the patient meets major trauma criteria then they need to go to a major trauma hospital. End of story.

Let's say this patient meets major trauma criteria and there is a non major trauma hospital 10 minutes away, and the major trauma hospital is one hour away by road. By the time you package and load the patient, drive them 10 minutes to the non MTH, spend the 5 minutes unloading them, getting them inside, handed over, they do whatever they feel needs to be done (intubation, CT scan, x-rays, ultrasound or whatever) then they are packaged, taken back to the ambulance and driven the hour to the MTH, well that's probably two hours used right there and we could have been at the MTH an hour ago.

All hospitals are not created equal. I've heard from some people who started in the 1980s or 90s that we should be more concerned about just "taking people to the hospital" because twenty or thirty years ago it was the job of ambulance personnel to simply do a bit of treatment and take people to the hospital and the local hospital was as good as any because it wasn't the ambulance officer's job to think any more than that. Times have changed and the medical world has moved on. There is very clear evidence particularly from the United States but also from England and Australia that people with major trauma do best when taken directly to a major trauma hospital even if it is further away than the local hospital.

Yes, there absolutely is a role for taking people with major trauma to a non-major trauma hospital. That is when the patient is likely to die from an immediately life-threatening problem you cannot fix and cannot wait for the transport to a major trauma hospital. Examples of this would be unmanageable airway, inadequate breathing and inability to oxygenate, or haemorrhage uncontrollably by good hard pressure or a CAT.

 

[GBev]

In Louisiana we have a phone line called LERN -- Louisiana Emergency Response Network. If a PT meets certain criteria (trauma, but also stroke and STEMI), the medic calls LERN where someone in the call center will direct the medic to the most appropriate facility based upon the services the PT needs and the services available at the facility. While LERN directs most of these PTs to the highest level trauma center in the area, if that trauma center is too busy to accept the PT, he or she can be diverted to another area trauma center capable of handling the PT.

In addition to being able to dispatch a bird, LERN is also useful for when a medic doesn't know if a facility has certain services available. For example, if a hospital only has a cath team on call during certain hours, LERN could tell you if the cath team is available or not. If not, they can direct you to an area facility that does. Again, this is only used for serious PTs who meet the criteria. I'd be interested to know if there's something like LERN in other states.

 

[MSDeltaFlt]

Hopefully your protocols include some destination guidelines...

And if not your local protocols, then at least your state might have a guideline as well. Check their website. It's pretty straightforward reading. "If these are broken, you go here. No questions, ifs , ands, or buts. Period. However, if THESE are broken, you can go to either place. Whichever is the closest APPROPRIATE.

 

[MSDeltaFlt]

When in doubt click transmit/send and ask. Questions are free.

 

[Handsome Robb]

And if not your local protocols, then at least your state might have a guideline as well. Check their website. It's pretty straightforward reading. "If these are broken, you go here. No questions, ifs , ands, or buts. Period. However, if THESE are broken, you can go to either place. Whichever is the closest APPROPRIATE.

Uh oh...look who's back!


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