OR resus/ed bypass

Brandon Oto said:
Presumably the trauma surgeon isn't down in the waiting room, rolling around an empty wheelchair and looking for blood.
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:)

I never thought to look for one there...
 
Av8or007 said:
For the purposes of academic discussion, do you think there would ever be a possibility of a ED bypass for trauma, going directly to an OR sort of like a STEMI ed bypass.
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At the HEMS program I left last year, we went straight to the OR for dissecting aortic aneurysms. The pt had to have a known aneurysm and have ongoing hypotension for us. We would notify dispatch that the patient met "direct OR criteria" and they would alert the OR and the surgical team, and would also alert the ED that we would be bypassing them. Basically the same exact process as for a STEMI going straight from the field to cath lab.

Occasionally we would go straight to the OR when doing an interfacility. I've done a handful of OR --> OR transports, and a handful of ED --> OR transports. I think that basically just comes down to whether the receiving surgeon trusts the referring doc's judgement that the patient really needs to go to the OR immediately.

The problem with trauma from the field going straight to OR is that, like others have said, very few traumas need to go straight to the OR. And from the field it's impossible to say which ones need to go right to OR vs. radiology vs. ICU vs. not really needing any intervention at all.

And at the trauma center that received most of our patients, virtually E-V-E-R-Y-B-O-D-Y who came in as a trauma alert got a head/neck/chest/abd/pelvic CT in the ED CT scanner.

So rather than activating the on-call trauma OR, it makes sense to just have the ED doc and trauma surgeon evaluate the patient in the ED on arrival, and make that decision then.
 
There are hospitals in the US that already bypass trauma bay and go dirtectly to the OR. I recently attended a lecture by Dr. Kenneth Mattox of Baylor University School of Medicine in Texas where he lectured about his trauma service. When a pt is brought in via EMS, the attending trauma surgeon meets the crew in the ambulance. A quick assessment is compeleted and determined if the pt goes to the trauma bay or the OR. Altered mental Status in the absence of head injury, absent radial or pedal pulses, or massive bleeding in the abscence of head injury, all bypass trauma and go directly to the OR. By taking these unstable, critically ill pts to the trauma bay and getting labs, FAST exam, CT, etc., you are wasting time on a pt who will end up in the OR for an exploratory lap anyway. As mentioned above, this is all in the absence of head injury, as head injuries obviously still need CT imaging completed. They have shown a signifcant survival rate in thier unstable trauma pts.
 
Dr. Mattox is at the bleeding edge of modern trauma care, but unfortunately few centers are practicing this type of aggressive, clinically-driven (versus diagnostically-) trauma resuscitation. Hopefully we'll all get on board pretty soon.
 
Check out Trauma Room 10 (T-10) at St. Anthony Central Hospital in Denver. This OR is a dedicated field to surgery bypass. IIRC, imaging is available in the room/directly across the hallway. There's an elevator right near the ED that ED staff can direct EMS to take their patients that goes directly to this room, and in some cases they will tell incoming crews to go directly to T-10. I think some of the stuff they put out may be part marketing gimmick, but I have some friends who have transported unstable trauma patients directly to this room and have been more than impressed. I only transported to Central a couple times so don't have first hand experience, but I know the hospital is very serious about it. Very cool concept at least!
 
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