Trauma.

NomadicMedic

NomadicMedic

I know a guy who knows a guy.
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Let me throw a hypothetical situation out there for you, get some input and then I'll fill in the backstory.

You're dispatched (AEMT and a Medic) to a 1 car MVA into a tree.

On arrival you find a patient who has been ambulatory at the scene, with a cop, for the last 10 minutes or so. This guy was the driver, and after the crash he just opened the drivers door and climbed out. He has a couple of lacs and abrasions, but no other injury or complaint. No drugs or alcohol on board. Remembers the whole event. No LOC. He says they were traveling about 50 mph when he over corrected on a corner and lost control. No driver airbag deployment. He was belted.

You look to the left and see a vehicle into a stand of trees with significant damage to the vehicle and a patient in the passenger seat. There a couple of first responders in there holding cSpine. She's not injured, but the roof has been deformed and she can't get out without Fire cutting up the car. No pain, no complaints. No LOC. The extrication takes about 20 minutes before she's disentangled. The airbag did deploy on her side.

There is a community hospital <10 minutes away. The trauma center is about 60 minutes by ground. There is an airship that can be on the ground in 20 minutes.

What do you want to know? What do you do? Where do you go?
 
Vitals for both patients. I'd do a quick head to toe just to rule out any other injuries may not have noticed.

For the passanger, no injury, no complaints, no head, neck or back pain, no acute neurologic deficits, ambulatory once extricated, etc, we'd clear C-spine.

Local protocols do dictate 12 inches of passenger space intrusion equals trauma center transport (if no 12 inches, protocol does still highly encourage trauma center for anyone needing extrication).

But otherwise, if vitals are stable and WNL, sounds like many a patient we've AMA'd here...but transport to the local hospital POC
 
Let me get a good physical exam on both of them, with more focus on the passenger. Full set of vitals on both (BP, pulse, respiratory rate and effort/lung sounds, SPO2/etco2, skin, pupils).
Do they want to be transported? If I've got time I'll get a lock on the entrapped passenger.
Without any significant findings in that physical exam or vitals, I'm comfortable taking both code 2 by ground to the nearest ER.
That would be a step 3 trauma activation by my protocols (12" passenger space intrusion, and the extrication time), but those go to the local community hospital regularly.
Did anyone witness the crash? Does PD/FD have any relevant to tell me if I asked?
And CAOx4 with no complaint, clear c-spine on both.
Or what Jim said before I could post...
 
Nobody saw it. Cops arrived after the fact.

Head to toe on driver is unremarkable aside from small lac on arm, abrasion on right shin and left hand. HR 90, 126/70, resp 20.

Passenger extricated to LSB and collar. Head to toe unremarkable aside from some soreness in her head and neck from the position she was in. She said her pain is. 2 out of 10. Nothing acute on palpation. Abd soft/non tender. Pelvis intact. No obvious fx, deformity or external bleeding. HR 94, 130/80 resp 18.

Again, here's the choices:

Level 1 Trauma center is about an hour down the highway, community hospital with a doc, X-rays and CT 10 minutes away or get a helo on the ground in 18 minutes that'll fly to the same level I it'll take you an hour to drive to.

Does the trauma transport tool come into play here?
 
Screenshot_2015-05-25-14-02-12.png
For my area we would most likely be going to the trauma center. I would do a call in and talk to the doc and make sure they don't want me to transport to the community ED. As of right now I am not seeing a reason to call a bird out and have the patient charged $20,000+
 
Because of 12" passenger space intrusion (I assume) and >20 min extrication time it would be a step 3 trauma activation where I'm at. I'd get a consult with the trauma center and push hard to transport to the community hospital, and I wouldn't expect them to disagree. I can't find anything wrong wrong with either patient.
This almost feels too straight forward for you to be posting it as a scenario.
 
Step 3 for us. Which means you CAN do a trauma consult you don't have to though. And can transport to a local ED.
 
Is this even a transport?
 
50 mph into a tree? No airbag on the driver? 20 minute extrication? I would not be excited about AMAing.

As for transport decision, I would base solely on trauma protocols. Given the vitals and PE I would be comfortable transporting to local ED.
 
This is a bit of a grey area, so like the other posters, you could make an argument for either a trauma center or a community hospital.

Cars have become so much safer, and they continue to improve. This factors into our thinking about mechanism of injury, which is of course one of the things we consider when we consider trauma criteria, such as in this scenario. A 1970s or 80s sedan with major front end damage, for example, would lead you to be suspicious for the patient having possibly suffered injuries related to sudden deceleration, whereas the same damage on a brand new car tells you that the car did what it was designed to do--absorb the energy of the impact. Likewise, rollover protection has gone from non-existent in the 1970s to quite advanced today, and that has changed our thinking about trauma criteria as well. Not to mention air bags, side-impact protection, and so on.
 
local community hospital declined to accept these patients based solely on mechanism.
 
DEmedic said:
local community hospital declined to accept these patients based solely on mechanism.
Click to expand...
Hah I deal with this all the time, and was going to write a post about it.

But yea, sucks.
 
Luckily for me, if base contact was made vs. just BLS it and the MICN at base insisted on going to the Level I Trauma Center, it's only about 20 min away lol (As they did the one time we had an auto vs bicycle, where the car was making a right turn and knocked the guy on the bike in the crosswalk to the ground, about 5-10mph max, getting ready to BLS to the local hospital 2 min away, the base hospital had us go to said Level 1 that for us is as far away as the community hospital in the OP scenario, but oh well lol)
 
We can call two types of "trauma alerts".

First type - "Limited Trauma".
This means there was a significant mechanism of injury, but the patient is stable. It's pretty much a "cover my butt" kind of thing. It pretty much tells the hospital that they were in a pretty gnarly accident, or whatever the mechanism was, but the patient is fine. Most hospitals can and will accept a limited trauma if they have some/any form of trauma accreditation and/or doctor willing to accept.

Second type "Full trauma Activation".
This is for a patient that actually needs a trauma activation. They go to legit trauma center.
 
COmedic17 said:
We can call two types of "trauma alerts".

First type - "Limited Trauma".
This means there was a significant mechanism of injury, but the patient is stable. It's pretty much a "cover my butt" kind of thing. It pretty much tells the hospital that they were in a pretty gnarly accident, or whatever the mechanism was, but the patient is fine. Most hospitals can and will accept a limited trauma if they have some/any form of trauma accreditation and/or doctor willing to accept.

Second type "Full trauma Activation".
This is for a patient that actually needs a trauma activation. They go to legit trauma center.
Click to expand...


I work in 2 places, both have 2 trauma levels.
In one we have Level 1 and Level 2, in the other is an 811 or 911.
One is based on MOI, the other is based on the actual patient condition.
 
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