Re: Pt. Scenario

[Bob Licata <blicata@ruralhealth.org>]

I have a few questions. What were the clinical capabilities of the Community Hospital (in CO we have Community hospitals that are Level III and Level IV trauma centers)? What were the capabilities of the "Trauma Center"? Were both modes of transportation available at the same time? Did the ground crews contact medical control for direction? If the helicopter was not on the scene prior to the patient being extricated and transported what was their ETA
(assuming this patient was transported to the community hospital)? What are the triage, transport, and destination guidelines for the area?
I have been on flights when the ground crews have bypassed a Level IV Trauma Center to rendezvous with a helicopter who then transports the patient to a Level II Trauma Center. There have also been flights when we met the ground crews at a Level IV Center and the doctor came out and evaluated the patient in the ambulance and sent them on to the Level II by helicopter.
With all that said this patient needs a Trauma Center, but what level. We have lower level centers that say they can adequately take care of this patient and higher level centers that say this patient should be evaluated at their facility.
Most of these scenarios can be avoided by good pre-planning and clear guidelines for agencies to follow.
Just a few thoughts.

Bob Licata EMT-P
St. Mary's CareFlight
Grand Junction, CO

Adam Oplinger wrote:

> 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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