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Sun Apr 9 01:26:17 BST 2006

In a message dated 08-Apr-06 18:48:46 Central Daylight Time,  
aneurysm_42 at yahoo.com writes:

Though  no one has brought it up, I'm not sure why
people would bristle at the  suggestion.

Of all the prehospital interventions we've talked
about  thus far (intubation, needle decompression,
chest tubes, etc.) the one  thing we HAVEN'T discussed
which has been almost UNIVERSALLY shown to  be
associated with IMPROVED outcomes in the critically
injured is RAPID  transport to a trauma center.

Unfortunately, it's not a topic which  generates the
same sort of zeal or passion as intubation  does.

Agreed...now define "rapid transport" for  me...

and remember, not too long ago, I worked in an area where it  might take over 
45 minutes just for the ambulance to get to the patient...and  almost 3 hours 
by ground to get to the only Level 1 Trauma Center in the  area...

and I'll point out that frequently, patients who were brought  to me for 
stabilization ended up spending an extra hour or more *AFTER* they had  received 
their stabilization while I tried to comply with the requirements of  the 
resident on call for the trauma service...which more often than not included  over 
2 liters of crystalloid, CT head, chest, abdomen and pelvis (in a patient  
with a scalp laceration, two broken ribs and bilateral tib fib fractures who was  
GCS 15 and had been from the time of pick up) and requests that I intubate a  
patient with stable vital signs, GCS 14- this patient was a little sleepy  
due to the hour of the night (ca 0300) and treated bilat Tension  Pneumos....who 
was going by ground due to the weather...

And quoting Mattox on Trauma did not  help...

ck

Charles S. Krin, DO  FAAFP

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Clamp the the chest tube?