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Adam,
I think the consensus of the responses from your original post is that this patient should go to a trauma center directly from the scene.
Bonus question? Yes, based on mechanism of injury the patient should go to the trauma center.
Can I ask why you felt you needed to modify or question??? 
Adam Oplinger <ajoplinger@FlightMedicMail.com> wrote:
OK!
I'm glad to see that my pt. scenario has generated some interesting discussion.
After having had the opportunity to read all of your comments back to back, I would like to modify the original question that I asked at the end of my original posting. First, however, I would like to comment on some of the prevalent themes that I have gleaned from your responses.
The most frequently repeated topic from many of your replies has been the community hospital vs. trauma center argument. Let me first of all state that it was not my intention to go this direction with this posting, but you raise some interesting points. I have had the opportunity to work with some folks at small, rural community hospitals who, because of their geographic location in relation to a trauma center or air-medical program, have become VERY adept at recieving trauma patients and performing initial stabilization because they have had no choice but to do so. There is no other hospital to take these patients to initially! Conversely, I have seen the exact opposite happen as well. I feel, however, that even though these facilities can do well at initial stabilization of seriously injured trauma patients, this type of patient is going to eat-up a lot of resources that many of these facilities are already short on, and therefore they should go directly to a trauma center, if that is at all possible.
Next, there seemed to be some discussion on the point of who is better trained and equipped to manage this type of patient in the pre-hospital setting, ground medics or air-medical providers. While I don't think that anyone could argue that air-medical providers, as a general rule, have larger armamentarium of skills and medications and more liberal protocols to draw from, there are many extremely capable ground providers of all levels of certification out there who, given the same tools that air-medical providers have the priviledge of being able to use, would be able to manage these patients as well if not better than many of us who fly for a living. While I do not advocate allowing all ground providers to practice the same skills that air-medical providers are allowed to perform for reasons of training, quality improvement, and volume vs. risk, I think we all need to remember that we started out in a ground ambulance or ICU as well.
So now, for the question. Based on the same scenario that I initially posted, use this as the question:
Is it appropriate to transport this patient by medical helicopter directly from the scene to a trauma center?
Bonus question:
Is it appropriate to transport a patient by medical helicopter directly from a scene to a trauma center based on mechansm of injury?
Take care all and keep the responses coming
Adam Oplinger NREMT-P
--- RNCCT@aol.com wrote:
>No, we don't know what the capabilities of any given facility are at any given time. But we do know that to be a designated trauma center there are many components that together make them a trauma center. Yes, the attending surgeon at the community facility may be board certified and the trauma centers fellow last year, but what good is he if the CT tech is 45 min away and the anesthesiologist is an hour away?
>Those are the things that aren't supposed to happen with a reputable trauma center
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