What's best for your TBI pt.?

[gradygirl]

"The present study provides class II evidence that demonstrates a 50% increase in mortality associated with indirect transfer of TBI patients. Patients with severe TBI should be transported directly to a Level I or Level II trauma center with capabilities as delineated in the Guidelines for the Prehospital Management of Traumatic Brain Injury, even if this center may not be the closest hospital."

http://www.jtrauma.com/pt/re/jtrauma/abstract.00005373-200606000-00014.htm;jsessionid=GR5J6Q2JQqGvGKnsXtYqL1xvL3RgTKvxC93Rx2KqptQjJ9R2gmkh!-1110070904!-949856144!8091!-1

 

[Flight-LP]

No offense, but DUH!!!!

Common sense should tell you if you have a TBI, that stopping at your local doc in the box ER probably isn't too smart..........

Interesting study though....

 

[gradygirl]

No offense, but DUH!!!!

Common sense should tell you if you have a TBI...

Unfortunately, common sense isn't. But yes, I agree. Go figure that fewer TBI pts. die when taken to a Level 1 trauma center...

I just thought that the study was pretty interesting, if not utterly unsurprising.

 

[rescuecpt]

I'm still amazed that there are places in the US that allow ambulances to transport to doc-in-the-boxes.

 

[Flight-LP]

Why wouldn't they? They are still classified as an ER. It is the medic's responsibility to know what is and is not appropriate for their patients. In my area, we emphasize hospital capabilities to the local public. Hell they don't know any better, most think that if they are ill or injured they can go to the local ER and get fixed. Through education, we can change that. Eventually it will force ER to make a decision, either offer specialized services or reduce themselved to an urgent care clinic.

 

[Ridryder911]

That is why Regional Area Advisory Council (RAAC'S) are essential and should have already been in place. When I designed Trauma Systems, that is one of the first objectives is for the medical community to have trauma triage protocols in place. It was to be a Federal mandate by 2005 for states to have one in place. This was to be designed to have protocols "most appropriate facility, NOT the closest" .. this allowed for those that needed specialty i.e. burns to be deviated as well. These protocols should be developed in mind to reduce time for the patient. Transporting a patient to a level that is ill equipped or not able to handle is a delay in care, as well "over triaging" assuming gross injuries were there are not is "taxing" the systems as well. That is why good assessments and education is needed, in regards to appropriate trauma care.

Check with your local State EMS or Trauma Division and see what is occurring in your RAAC. Hopefully, they are working on such protocols.

As well, minor emergency care centers, clinics etc. should not be classified as ER's or Trauma Centers unless they want to be categorized as such i.e Level V (stand-by) again, all levels are defined in the National format.

Be safe,
R/r 911

 

[disassociative]

In my region; most TBI situations warrant LifeFlight via either Erlanger, UT, Vanderbilt, or Air Evac Lifeteam depending on 1 of 3 criteria:

1. Availability
2. Capability
3. Location


Most of the time our county tries to stick with the LifeFlight that is in our area;
however I have seen cases where either Erlanger was not available so Vandy had to respond(The recent tornadoes) or where the head injury was so massive that Vanderbilt was considered the most appropriate trauma 1.

 

[aline]

Where I work, we're lucky, we have four level I trauma centers and two level II's. One of those is a II only because of politics. And there are times when the choice of level I is politically driven. (sigh) I hate politics.
Remember, there are plenty of place that have no ground access to a level I. My home town is 2 1/2 hours from a trauma center, of any kind. If flights is grounded due to weather or whatever, they have no choice but to take a patient to one of the two local docs in a box.
There are places in Montana where you have to drive 60 minutes, emergent, just to get to a patient. Some places don't even have a doc in a box, all they have is a clinic. (If they're lucky.) Alaska is a prime example. Unless a trauma center has opened in the past few years, the closest one to Anywhere, Alaska is Seattle. Most areas up there don't even have a clinic and have to rely on the military for medevacs out of some very remote locations.
. Those of us that have direct access to a level I are very lucky

 

[disassociative]

...

In TN; people with large amounts of land that can be designated as landing zones are given a tax break each year under the agreement that at any time lifeflight should ever need clearance; they will not interfere.

Vandy also has a couple of Aeromedical Jets that can travel around the world to pick up patients. I am waiting on finishing up my NREMT-P then I am going to swtich from Erlanger to Vanderbilt.