RE: Pt. Scenario

[Robert Cole <EMCOLERS@adaweb.net>]

I agree on all counts with M. Snow, Even if the Air Medical Ship wasn't on
the ground when the patient was free, the extra 10 minutes to wait for the
aircraft could be used to fully assess and expose the patient, start your
lines (if not done already, and head to the PZ (If not on the scene).  The
benefit of a trauma center in this case far outweighs the lost time to await
for an aircraft.  This is especially for the possible hypothermic patient
(considering hypothermia's effect on coagulation)   In reality I hope the
crew had the foresight to call for the crew before the patient as
extricated.
Now I have heard physicians and others say "well so and so could be
transported to the local medical center and they can call for the air
medical ship, and no time would be lost." 
So not true.  I am sure that many people on this forum have seen the little
studied but often seen phenomena on the trauma time line known as "turning
gold to lead".  Specifically Cowley's golden hour to a trauma center
strangely turns into the lead 5 hours, once a patient enters the doors of
many local hospitals, you lose the patient for at least two or three hours
before they are shipped!'
This is in part to a facilities fear of litigation if they do not "fully
assess" a patient before shipping him on.  Then COBRA regs have to be met,
consults have to be called, a receiving physician found, etc, etc... Just
like on scene, its the little things that add up.
The above is based on my personal experience only, I mean no offense.  My
point is that even Stable major trauma patients benefit from going straight
to a trauma center.
Hope I did not ramble too much.
Robert S. "Steve" Cole
Paramedic, CCEMTP
Education Department
Ada County Paramedics 
208-375-7079
emcolers@adaweb.net

"...A mind stretched with new ideas never regains its former shape"


-----Original Message-----
From: Adam Oplinger [mailto:ajoplinger@FlightMedicMail.com]
Sent: Monday, December 31, 2001 7:15 AM
To: flightmed@flightweb.com
Subject: Pt. Scenario


Hi all.

I would appreciate any feedback that you all might have to offer on this
scenario:

Pt. is a mid-thirties female, involved in MVC, unknown if restrained. Pt. is
apparently the driver. Pt. vehicle hits utility pole at greater than 55mph
producing significant damage to vehicle. (You later find out that the
vehicle has also rolled over.) Approximately 20 minutes of extrication are
required to disentangle the patient. Ambient air temperature is approx. 20
to 25 degrees F.

Pt. does not remember the crash. ETOH on board. Pt. oriented to person only.
Pt. has a one inch laceration to the left temporal region and active
bleeding from both nares. Pt. also c/o pain on palpation to the chest. Chest
wall is intact with bilateral breath sounds clear and equal. Pt. co
genralized ABD pain with increase on palpation of all quadrants. Pt. also
c/o lower back pain. Pt. is slightly tachycardic with evelvated B/P. Resps
and Sats WNL.

Transport times as follows:

By ground to trauma center: 30-40 minutes
By air to trauma center: 10 minutes
By ground to local community hospital: 10 minutes

Does anybody feel that this particular patient recieves any benefit from
going to the community hospital by ground?

Thanks a lot and have a happy and safe new year!

Adam Oplinger NREMT-P



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