22-Aug-2013 | SWORBHP Ask MAC

Date Archives: 22-Aug-2013

August 22, 2013 SWORBHP Category: Trauma Patient | Date: 22-Aug-2013

Question: In the BLS Standards I found in Section 1, General Standard of Care, Directive H. Patient Transport, the following statement in subsection 1 "in the absence of direction, transport to the closest or most appropriate hospital emergency unit capable of providing the medical care apparently required by the patient." So one question I have is the trauma patient, if they needed care above the capabilities of the closest hospital emergency unit, do we transport the patient to the closest hospital emergency unit that has these capabilities?

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Answer: Great question! The real issue is how you define the trauma patient. The BLS Patient Care Standards in Section 1- General Standards of Care have described a set of criteria which are known as the Field Trauma Triage Guidelines. The closest most appropriate hospital for on-scene call patients assessed as meeting the Field Trauma Triage Guidelines is the closest Lead Trauma Hospital. The page reference is Section 1-25.

On-scene call patients assessed as meeting the Field Trauma Triage Guidelines (FTTG) will bypass other hospitals to go to the closest Lead Trauma Hospital if the closest Lead Trauma Hospital is less than thirty minutes away by land ambulance. It is essential to note however that the FTTG does not include every patient that has been injured by a traumatic mechanism: there are specific criteria that need to be met and these are described in the BLS PCS.

Note that paramedics will divert to the closest hospital with an emergency department when, in their judgment, the patient could not survive transport to the nearest Lead Trauma Hospital (complete airway obstruction, no spontaneous respirations, no palpable carotid pulse). The 30 minutes in an approximation and includes extrication time, traffic and road/weather conditions, and those factors which affect response/transport time but cannot be predetermined.

One of the confusing components of the BLS PCS is the definition of the Lead Trauma Hospital. Officially at the moment, London Health Sciences Centre (LHSC) Victoria Hospital is considered a Level I LTH and Hotel Dieu in Windsor is considered a Level II. For the majority of paramedics in the Southwest however, the closest ED becomes the destination since these two LTH’s fall outside the 30min transport window. Therefore, in practicality, all hospitals play a role in the management of the trauma patient. It is also essential for paramedics to follow their local destination protocols which may have addressed these scenarios in collaboration with the Base Hospital.

The Trauma Association of Canada, has gone through a two year process where, Accreditation Canada will now accredit the trauma programs through a trauma distinction program. Windsor will be going through the pilot process in November. Interestingly they will be looking at three local hospitals, and the level of trauma care provided.

In the future, it is possible that all of the hospitals will have a level, and paramedics could possibly be bypassing lower level centers for those with a surgeon and scanner in rural areas. This is where destination policies and local trauma networks come into play: stay tuned!

The Ontario Base Hospital Group (OBHG) along with Ornge and the Ontario Trauma Advisory Committee (OTAC) have revised the Field Trauma Triage Guidelines within the last few years. The revised versions of these guidelines are anticipated to be released shortly from the MOHLTC.

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Trauma Patient

August 22, 2013 SWORBHP Category: Cardiac Ischemia, STEMI Bypass | Date: 22-Aug-2013

Question: My question is in regards when a crew has a positive STEMI result on a cardiac ischemia call. I noticed that on these types of calls there has been incidents where patients have been going in lethal dysrhythmias as crews are trying to deliver the patient to the cath lab. Most recently I was at a hospital and as a crew was entering the elevator the patient went into V-Tach and there was a delay to defibrillating because the crew had to attach the defib pads.

I noticed myself when entering the cath lab the first thing the staff does before even accepting the patient and allowing crews to disconnect the cardiac monitor is attach defib pads. Due to the high mortality rates (5%) of STEMI patients transported by EMS and the time it takes to attach the defib pads when the patient enters the lethal rhythm, would it be wise to attach the defib pads on positive STEMI patients during transport(even though they have not gone VSA) to decrease the time to defibrillated the patient if in fact the patient enters the letahal rhythm.

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August 22, 2013 SWORBHP Category: Miscellaneous | Date: 22-Aug-2013

Question: Would SWORBHP ever consider putting a system in place for medics to learn the in hospital diagnosis of patients they transported. There are times when we transport patients and never learn what was causing them to present as they did. I think it would be beneficial to learn what the cause of the patient's condition in those instances for our own improvement and growth. I understand it would be unreasonable to do this for every patient but it would not be difficult to set up a flagging system to tag specific interesting calls. A system similar to the follow up after a ROSC may be a model to base it on.

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Miscellaneous