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Sat, 5 Apr 2003 11:55:10 -0600

Excellent description of the concept Dr. Mattox.

Ironically I have an example of this type of situation that just
occurred one week ago.  45 year old guy single car accident rollover was
ejected about 20 feet at highway speeds.  The patient did not want to go
to the trauma center because of all the "homeless people" there.  His
only complaint was some lower back pain.  Paramedics agreed to take him
to a smaller hospital since his complaint was minor.  The ER physician
reluctantly accepted the patient.  One hour later, Grade 3 liver lac,
called another ambulance to transport the patient to the local trauma
center.  Although many trauma patients transported to Level 1 centers by
mechanism only are discharged, some will fool ya.

-----Original Message-----
From: trauma-list-admin@trauma.org [mailto:trauma-list-admin@trauma.org]
On Behalf Of htaed_rd@123mail.org
Sent: Friday, April 04, 2003 12:39 PM
To: trauma-list
Subject: Re: Trauma destination legislation

As you know, there are many patients who are taken to a trauma center
for mechanism criteria only and are discharged within an hour of
arrival. To tell these patients that the ambulance will only transport
them to a trauma center, but they may refuse care and drive on their own
to a community hospital is not in the best interest of the patient.

Why limit the flexibility of the medical command physician (or mobile
intensive care nurse) to make an intelligent decision about destination?

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 you feel that your paramedics cannot make an appropriate decision in
consultation with medical control (I think they can) then what decisions
do you trust them to make (with or without medical command contact)?

Tim Noonan.

On Fri, 4 Apr 2003 07:55:37 -0800 (PST), "caesar ursic"
<cmursic@yahoo.com> said:
> --- htaed_rd@123mail.org wrote:
> > Seems as if the law eliminates some flexibility that might work in 
> > the patient's best interest. Does "major trauma victim" include 
> > those who meet mechanism criteria only? Limiting options in patient 
> > care does not sound like good patient care.
>
> Yes, mechanism also is included in the field triage criteria.  Why do 
> you feel that ignoring EMS field criteria and transporting to a 
> non-trauma hospital because that is the patient's wish actually "might

> work in the patient's best interest?"  I'm confused.
>
> C.M. Ursic, M.D. Dept. of Surgery UCSF-East Bay Oakland, California
>
>
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