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Trauma destination legislation

trauma-list@trauma.org trauma-list@trauma.org
Fri, 04 Apr 2003 23:56:39 -0500

On Fri, 4 Apr 2003 15:29:18 -0800 (PST), "caesar ursic"
<cmursic@yahoo.com> said:
> --- htaed_rd@123mail.org wrote:
> > Why limit the flexibility of the medical command physician (or mobile
> > intensive care nurse) to make an intelligent decision about
> > destination?
> Because the medical command is not at the scene and the paramedic is,
> and it is the paramedic who is invoking the triage criteria.  Remember:
> there MUST be some overtriage to avoid undertriage.  Although
> overtriage certainly inconveniences, undertriage kills.

Invoking? The triage criteria do not leave much room for interpretation.
Do your paramedics provide unreliable information?

The same trauma patients are allowed to refuse care entirely. I do not
see the logic in this approach. They are well enough to refuse care, but
too sick to go to a community hospital.

Undertriage and overtriage will not be eliminated; overtriage is
necessary to avoid undertriage. I have no arguement with that.

> > Rules that restrict thinking often have broader consequences than
> > intended. If bad decisions are being made there are, in my opinion,
> > better ways of improving the decision making of those involved.
> If the trauma triage criteria are really not working, then, yes, they
> should be re-visited, re-evaluated and perhaps changed or eliminated.
> This process should take place within the framework of the EMS system
> in consultation with the EMS medical director, trauma center director
> and other members of the local/county EMS system, and should
> (hopefully) use locally-derived information from the trauma database.
> It should not be done on an individual case basis out on the streets.
> C.M. Ursic, M.D. Dept. of Surgery UCSF-East Bay Oakland, California

I did not say that the triage criteria are not working. I did say that
not allowing for flexibility is not a good idea.

However, changing the EMS rules does not appear to be something within
the discretion of any of the people you list, since you mentioned that it
is California state law.

Tim Noonan.