Trauma, choosing the right transport destination.

[LanceCorpsman]

Hello everyone, I'm fairly new to the EMS scene, just got my AEMT and now working on my EMT-I in the state of Oregon.
I wanted to get some opinions on deciding which hospital to transport to, my agency is located in rural Oregon. The city I live in has a Level III Trauma center without a neurosurgeon, so every neurological or complex trauma cases we fly out of town. My district covers a large portion of a highway that connects to a town that has another Level III facility with neurosurgeons on staff.
I typically get quite of few MVCs on a specific portion of the highway about 35 miles from the hospital that is in my city. 35 miles from our trauma center, would make the other facility about 45 minutes away at a lower altitude ( I mention this because during the winter, it might be faster to drive to the further one).
The question I have is that if I'm 45 miles away from the hospital with nuero capabilities, would it make sense to transport to that facility even if it takes 10 mins longer? This is of course after seeing if the air ambulance is available or not.

I had an incident when an air ambulance picked up a pt with neurological trauma, transported to the closest hospital, then 45 mins later going over our head again to transport to the facility with neuro capabilities.

Keep in mind, I am at an all volunteer agency with NO medics, just one other Intermediate.

 

[RedAirplane]

I'm a rookie here and don't usually engage in transport of patients, but if I were in this situation, here are my thoughts:

1. Time permitting, call medical control if there is a doubt.

2. Does this patient need the neurological capability? I could be mistaken, but for a patient with an uncontrolled hemorrhage from the extremities and no head injury, I'd go with the closer one. If a pile of bricks fell on the victim's head causing ALOC, I might want the neuro capability.

(Someone more expert please come and correct me if I'm wrong).

 

[NomadicMedic]

The CDC Trauma Transport Decision Tool takes away most of the guess work on this. http://www.cdc.gov/mmwr/pdf/rr/rr5801.pdf

Obviously, follow your local protocols, but the quick takeaway is; take them to the place they MOST need to go.

 

[Summit]

Closest APPROPRIATE trauma center is how most algorithms close out.

For pt with suspected significant neurotrauma, yea I'd absolutely pick the NS capable III over a III without it unless I felt that the patient wouldn't make it that extra 10 minutes for reasons the non-NS III can fix.

 

[Handsome Robb]

I'm a rookie here and don't usually engage in transport of patients, but if I were in this situation, here are my thoughts:

1. Time permitting, call medical control if there is a doubt.

2. Does this patient need the neurological capability? I could be mistaken, but for a patient with an uncontrolled hemorrhage from the extremities and no head injury, I'd go with the closer one. If a pile of bricks fell on the victim's head causing ALOC, I might want the neuro capability.

(Someone more expert please come and correct me if I'm wrong).

You should never have a patient with uncontrolled extremity hemorrhage. That's what TQs are for.


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[cprted]

Ok, they have neurosurgery there, but is it always available? They're a level 3 centre, I doubt neuro is available on an emergent basis outside regular business hours.

Really, your medical director should, in consultation with the local receiving facilities, create a Trauma Destination Guideline to follow.

 

[LanceCorpsman]

Ok, they have neurosurgery there, but is it always available? They're a level 3 centre, I doubt neuro is available on an emergent basis outside regular business hours.

Really, your medical director should, in consultation with the local receiving facilities, create a Trauma Destination Guideline to follow.

I actually called that ER and asked, and yes they always have a neurosurgeon on trauma call.

 

[Tigger]

You should never have a patient with uncontrolled extremity hemorrhage. That's what TQs are for.


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Except when they shoot themselves so high on the leg there is no room for the tourniquet...

 

[RedAirplane]

Except when they shoot themselves so high on the leg there is no room for the tourniquet...

I was just trying to think of a non-neurological but definitely trauma situation for the sake of the discussion.

Although now that you bring it up... at a demo I once had the pleasure of playing around with some of those tourniquets that attach to the torso and can cut off circulation to a particular extremity... never seen anyone actually stock one though. Would probably be the only thing to use in your high leg scenario.

 

[cruiseforever]

You should never have a patient with uncontrolled extremity hemorrhage. That's what TQs are for.

Except when they shoot themselves so high on the leg there is no room for the tourniquet...

The only time one should say never, is to never say never.

 

[Handsome Robb]

Except when they shoot themselves so high on the leg there is no room for the tourniquet...

That's not an extremity bleed though...that's a junctional injury


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[NomadicMedic]

That would be a trunk injury. . In that case, TQ around the middle, like a belt.

 

[Flying]

That would be a trunk injury. . In that case, TQ around the middle, like a belt.

Maybe this, but lower?

 

[Handsome Robb]

That would be a trunk injury. . In that case, TQ around the middle, like a belt.

Or a necklace if they're bleeding from the head...


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[VFlutter]

That would be a trunk injury. . In that case, TQ around the middle, like a belt.

Or REBOA

 

[NomadicMedic]

Or REBOA

Anyone in the states doing that?

 

[MonkeyArrow]

Anyone in the states doing that?

Prehospital or trauma center? I know most of the larger, big name trauma centers have REBOA now, more or less. There are about 100 facilities that have the Prytime Medical REBOA catheter.

 

[NomadicMedic]

Prehospital or trauma center? I know most of the larger, big name trauma centers have REBOA now, more or less. There are about 100 facilities that have the Prytime Medical REBOA catheter.

Sorry, I mean prehospital.

 

[Bullets]

If they have a neurological deficit them go to the surgeons otherwise go closer