Trauma Pt. Destination

Jon

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I'm seeing an increasing trend in my county for the community hospitals (all rather large, all with CT and other "up-to-date" stuff) to refuse to accept a patient that even comes close to maybe meeting the low end of the Trauma Triage scores and injuries. We are anywhere from 5-15 minutes to the local ED, and 35+ to the closest trauma center by ground, on a good day, in the right end of our turf.

I've been hearing BLS crews tranporting these patients who "Need a trauma evaluation" without medics. I asked an EMT who ran one of these... BS MVC, "The Doc states Pt. needs a trauma Evaluation, but not ALS."

Also, seeing an increase of the 35-45 minute grounding to Trauma Centers by ALS crews, depriving my hometown of an ambulance and Medic for 90+ minutes while they go and play trauma, as opposed to transferring care to aeromedical (really fast ALS ambulance with cool drugs... no more) and being clear in 30 or 45 minutes. this is on CLEAR DAYS - not nasty foggy ones. And it isn't because aeromedical isn't availible, it's the Doc's choice....

Oh, I didn't mention. we have 3 helicopters in the county, 2 of which are based in our local (or on the borderline). The county flies about 400 pt's a year, I think... mybe closer to 600, but still - 2 flights a day.

I thought all Trauma Transports and Alerts should be ALS.

Anyone else see this?

Jon
 

rescuecpt

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I've had plenty of patients who meet NYS trauma criteria, who really have nothing wrong with them and don't need ALS. For example: speed > 40mph? Trauma. Even if they were belted and the airbag went off and they have no cuts, bruises, bumps, etc. What am I going to do for them as ALS? Start an IV of NS, that's it. Yeah, the call could go bad, but there's not much I could do for that anyway.
 
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Jon

Jon

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Originally posted by rescuecpt@May 27 2005, 10:15 AM
I've had plenty of patients who meet NYS trauma criteria, who really have nothing wrong with them and don't need ALS. For example: speed > 40mph? Trauma. Even if they were belted and the airbag went off and they have no cuts, bruises, bumps, etc. What am I going to do for them as ALS? Start an IV of NS, that's it. Yeah, the call could go bad, but there's not much I could do for that anyway.
Yeah, but if you must ground the pt. 45 minutes vs. 10 minutes, I'd REALLY want the medic, in case pt. became Hemodynamicly unstable.

Remember, most healthy folks can maintain their B/P for an hour (Golden Hour :rolleyes:) before suddenly becoming unstable, sometimes without warning.

Jon
 

MMiz

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I'm one that believes that all traumas should go ALS. As a BLS unit that's hard for me to take, but due to the instability of the patient, an IV should be in, and a medic should be on board with additional diagnostic and treatment equipment.

That said, I've weighed the options before, and have transported a trauma patient BLS. We had an ALS unit 5 minutes away, and the trauma center ten minutes away. We transported RLS, which when doing BLS automatically calls for an ALS intercept at my company, and had to specifically radio a couple times that we did not want an ALS intercept.

In rural areas where ALS isn't readily available, I can see see trauma pts going BLS.

If you don't mind me taking this slightly off-topic, what are protocols for transport via helicopter?
 

rescuecpt

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Originally posted by MMiz@May 27 2005, 09:54 AM
I'm one that believes that all traumas should go ALS. As a BLS unit that's hard for me to take, but due to the instability of the patient, an IV should be in, and a medic should be on board with additional diagnostic and treatment equipment.

That said, I've weighed the options before, and have transported a trauma patient BLS. We had an ALS unit 5 minutes away, and the trauma center ten minutes away. We transported RLS, which when doing BLS automatically calls for an ALS intercept at my company, and had to specifically radio a couple times that we did not want an ALS intercept.

In rural areas where ALS isn't readily available, I can see see trauma pts going BLS.

If you don't mind me taking this slightly off-topic, what are protocols for transport via helicopter?
In theory, anytime I want to... but it had better be worth it or your name will be mud. I'll look them up later and post the specifics for ya.
 
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Jon

Jon

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Originally posted by rescuecpt+May 27 2005, 11:09 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (rescuecpt @ May 27 2005, 11:09 AM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-MMiz@May 27 2005, 09:54 AM
I'm one that believes that all traumas should go ALS. As a BLS unit that's hard for me to take, but due to the instability of the patient, an IV should be in, and a medic should be on board with additional diagnostic and treatment equipment.

That said, I've weighed the options before, and have transported a trauma patient BLS. We had an ALS unit 5 minutes away, and the trauma center ten minutes away. We transported RLS, which when doing BLS automatically calls for an ALS intercept at my company, and had to specifically radio a couple times that we did not want an ALS intercept.

In rural areas where ALS isn't readily available, I can see see trauma pts going BLS.

If you don't mind me taking this slightly off-topic, what are protocols for transport via helicopter?
In theory, anytime I want to... but it had better be worth it or your name will be mud. I'll look them up later and post the specifics for ya. [/b][/quote]
Aeromedical Protocols In PA - one of the lines is "if Ground Transport time is >30 minutes for anyone going to a Trauma Center, or for the "Oh, Sh*t" cases, "if areomedical could arrive at TC faster than ground ambulance.

Jon
 

TTLWHKR

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Originally posted by MedicStudentJon+May 27 2005, 10:29 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (MedicStudentJon @ May 27 2005, 10:29 AM)</td></tr><tr><td id='QUOTE'>
Originally posted by rescuecpt@May 27 2005, 11:09 AM
<!--QuoteBegin-MMiz
@May 27 2005, 09:54 AM
I'm one that believes that all traumas should go ALS.  As a BLS unit that's hard for me to take, but due to the instability of the patient, an IV should be in, and a medic should be on board with additional diagnostic and treatment equipment.

That said, I've weighed the options before, and have transported a trauma patient BLS.  We had an ALS unit 5 minutes away, and the trauma center ten minutes away.  We transported RLS, which when doing BLS automatically calls for an ALS intercept at my company, and had to specifically radio a couple times that we did not want an ALS intercept. 

In rural areas where ALS isn't readily available, I can see see trauma pts going BLS.

If you don't mind me taking this slightly off-topic, what are protocols for transport via helicopter?

In theory, anytime I want to... but it had better be worth it or your name will be mud. I'll look them up later and post the specifics for ya.
Aeromedical Protocols In PA - one of the lines is "if Ground Transport time is >30 minutes for anyone going to a Trauma Center, or for the "Oh, Sh*t" cases, "if areomedical could arrive at TC faster than ground ambulance.

Jon [/b][/quote]
I don't know how close the nearest trauma center is. The helicopter crew usually takes the patient back to their base hospital. When I worked in the city, the only patients that we flew were burn cases. They went to the Lehigh Valley Burn Center, which was about 150-200 miles to the east.
 
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Jon

Jon

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Originally posted by TTLWHKR@May 27 2005, 01:27 PM

I don't know how close the nearest trauma center is. The helicopter crew usually takes the patient back to their base hospital. When I worked in the city, the only patients that we flew were burn cases. They went to the Lehigh Valley Burn Center, which was about 150-200 miles to the east.
Is that Lehigh Valley Hospital in Allentown?
 

rescuecpt

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Originally posted by TTLWHKR@May 27 2005, 12:27 PM
I don't know how close the nearest trauma center is. The helicopter crew usually takes the patient back to their base hospital. When I worked in the city, the only patients that we flew were burn cases. They went to the Lehigh Valley Burn Center, which was about 150-200 miles to the east.
Where do your patients usually go?
 

TTLWHKR

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Originally posted by rescuecpt+May 27 2005, 12:43 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (rescuecpt @ May 27 2005, 12:43 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-TTLWHKR@May 27 2005, 12:27 PM
I don't know how close the nearest trauma center is. The helicopter crew usually takes the patient back to their base hospital. When I worked in the city, the only patients that we flew were burn cases. They went to the Lehigh Valley Burn Center, which was about 150-200 miles to the east.
Where do your patients usually go? [/b][/quote]
Yes, Allentown. Also flew a few to TJU w/ spinal injuries.


Traumas go to U of Pitt Medical Center or Childrens Hospital. I don't work w/ any local ambulances, so the only local hospital I know of is Soldiers & Sailors in Wellsboro. But that's like Mayberry RFD Hospital.
 
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Jon

Jon

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Used to work at TJUH. Got to go up and land helocopters a few times... once was Medevac out of pittsburg, flying someone out of the Erie PA...

Jon
 

ECC

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Sometimes $$$ makes the call. A Transport via helicopter runs atleast $3K
 

rescuemedic7306

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Out here, everything goes BLS, unless we have a prolonged extrication or Dustoff is already in the area since they have a 30 minute flight time to us on a good. clear day. Otherwise, they get transported ASAP to the ER and the Dustoff picks them up from there after stabilization. it's not perfect, but it's the best we can do in the circumstances.
 

TTLWHKR

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:angry:

Once I heard an EMT recall a paramedic for a critical patient because he told the patient it was their decision (the patients) if they wanted medics or not; and told them it would cost too much. He estimation was like 1,000 more than it actually was, and was immaterial anyway.

I physically grabbed him, and escorted him out of the ambulance; and told him to turn in his gear and pager.

We aren't here to send people to the hospital the cheapest way possible. What does it matter if we same someone a buck if they die?

That's not what we're about. Save the life first, and woory about how to pay for it later!
 

TTLWHKR

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Originally posted by TTLWHKR@May 29 2005, 04:46 PM

:angry:

Once I heard an EMT recall a paramedic for a critical patient because he told the patient it was their decision (the patients) if they wanted medics or not; and told them it would cost too much. He estimation was like 1,000 more than it actually was, and was immaterial anyway.

I physically grabbed him, and escorted him out of the ambulance; and told him to turn in his gear and pager.

We aren't here to send people to the hospital the cheapest way possible. What does it matter if we same someone a buck if they die?

That's not what we're about. Save the life first, and woory about how to pay for it later!
Darn I can't type, I took a pain pill and boy is it makin ME wacky in the head meat.

That post was supposed to say:

Once I heard an EMT recall a paramedic for a critical patient because he told the patient it was their decision (the patients) if they wanted medics or not; and told them it would cost too much. HIS estimation was like 1,000 more than it actually was, and was immaterial anyway.

I physically grabbed him, and escorted him out of the ambulance; and told him to turn in his gear and pager.

We aren't here to send people to the hospital the cheapest way possible. What does it matter if we
SAVE someone a buck if they die?

That's not what we're about. Save the life first, and woory about how to pay for it later!
 

ECC

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Originally posted by TTLWHKR+May 29 2005, 04:46 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (TTLWHKR @ May 29 2005, 04:46 PM)</td></tr><tr><td id='QUOTE'>

:angry:

Once I heard an EMT recall a paramedic for a critical patient because he told the patient it was their decision (the patients) if they wanted medics or not; and told them it would cost too much. He estimation was like 1,000 more than it actually was, and was immaterial anyway.

I physically grabbed him, and escorted him out of the ambulance; and told him to turn in his gear and pager.

We aren't here to send people to the hospital the cheapest way possible. What does it matter if we same someone a buck if they die?

That's not what we're about. Save the life first, and woory about how to pay for it later! [/b]

<!--QuoteBegin-MedicStudentJon

And it isn't because aeromedical isn't availible, it's the Doc's choice....[/quote]

My post was in direct response to this statement.

If you are going to quote me...may as well quote the entire post. :rolleyes:

If you read any of the ALS+some thread, you will see I am AGAINST medicine being big business. Unfortunately, and especially for some aspects of medicine, it most certainly is a BIG business. I have been a municipal paramedic almost my entire career. I call for what I need, when I need it, without regard for how it gets paid for. My only drive is what is in my patient's best interests. Let me restate that: There is no motive other than what is best for the patient which drives my decision making.

Thank you for allowing me to clear that up.

As for my comment about $$$ making the decisions: it is the undeniable, unmitigated fact that some medical decisions are made as a result of economic reasons.

I may not like this fact, but as a fact, I must also accept it.
 

KEVD18

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around here, i can fly pt's out at my discretion. anytime i want. although as someone mentioned, it better be warranted or i'm knee deep in brown squishy stuff
 
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Jon

Jon

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Originally posted by KEVD18@May 31 2005, 10:55 AM
around here, i can fly pt's out at my discretion. anytime i want. although as someone mentioned, it better be warranted or i'm knee deep in brown squishy stuff
That's how things are here too.... BLS, PD, or Chief officer can request it, and so long as we can REALLY justify it to QA and ALS, we don't get crap for it...
 
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