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Thu Dec 7 17:40:10 GMT 2006

In a message dated 12/7/2006 11:07:20 AM Central Standard Time, 
rfsmithmd at comcast.net writes:
Patients "who won't survive transport to Level I centers" is one of my
pet peeves. If some one is dieing from an injury that requires immediate
surgical intervention and they won't live through a transport then they
won't survive waiting for the traveling surgeons to save the day either. How
does this save lives? Am I missing something? However long it takes the
traveling team to get there is how long it would take the patient to get to
an actual trauma center isn't it?

Rob Smith
You are correct, as there are many patients that will die.  The dilemma is 
deciding which patients will benefit from the transport team?  Please keep in 
mind that many small hospitals do not have the personnel or the resources to 
aggressively resuscitate a severely injured patient.  Also, it is not uncommon to 
have delays of several hours from time of initial injury to actual arrival to 
the Level I.  These contribute to a very high mortality that might be averted 
with prompt arrival of an experienced critical care surgeon.  The list below 
is taken from Dr. Long, and while we don't necessarily agree with all of the 
indications, several deserve serious consideration...................we have 
had several cases this year where we feel we could have saved some lives!   

Dell  

INDICATION FOR ACTIVATION Any critically ill patient who would benefit from 
rapid surgical intervention or resuscitation that is not readily available at 
the referral hospital is a candidate for help from the MSTT. The MSTT can offer 
level I trauma resuscitation and surgical and bypass intervention to patients 
who otherwise might not survive transport to a trauma center due to injuries 
that may include:
- suspected ruptured aortas (thoracic) in combination with other injuries;
- cardiac injuries, temporarily repaired but leaking;
- penetrating trauma-impalement with a retained object that makes transport 
difficult or requires vascular repair;
- major pulmonary injuries with hypoxemia;
- major liver, inferior vena cava, or pancreatic injuries;
- massive pelvic injuries;
- major vascular problems (ie, leaking abdominal aortic aneurysms);
- profound hypothermia requiring cardiopulmonary bypass;
- respiratory distress syndrome requiring extracorporeal membrane oxygenation 
(ECMO); and
- traumatic amputations from wreckage extrication measures.

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