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EMS management/crush injury

David Sullivan fpcems at yahoo.com
Sun Jun 10 00:45:18 BST 2007

Without actually being at the scene it is tough to play "monday morning quaterback" I guess the on scene paramedics felt that she needed too be transfered by medivac. Maybe b/c of the time, 30min extrication, transport to ED for eval, then approx 45 min flight to tertiary care, could in theory be about 2 hrs, where extrication time+flight time is approx 75mins.
  dave sullivan BA NREMT/P

Steve Urszenyi <medic.steve at rogers.com> wrote:
  Sounds like a little over-triage was performed. Was the leg injury isolated or was there other trauma? Is your center capable of performing the ortho care (i.e. Microvascular repair, amputation care, etc.), or could that be another factor that went into the triage/transport decision?

My usual caveat of "I wasn't there" may apply. That is, what seems bizzare retrospectively may have made complete sense at the time, given what may have been known or suspected on scene.

Steve Urszenyi
Advanced Care Paramedic/
Tactical Medic
Toronto, Ontario, Canada

[This email has been sent via a Palm Treo 700wx on the Telus Mobility network.]

-----Original Message-----
From: pjcabdds at mchsi.com
To: trauma-list at trauma.org
Sent: 07-06-09 17:05
Subject: EMS management/crush injury

Opinions, comments, analysis, advice would be appreciated on the pre-hospital
management of this case: 
Adult woman, driver of a motorcycle, which was stopped at an intersection in
town (10,000 pop). Seven blocks from the hospital. A semi truck, hauling a
bulldozer type, heavy equipment, pulled up along side of the motorcycle.
Restraining chain broke and the implement fell off of the truck, crushing the
woman's right leg beneath the tread of the equipment. Unable to get VS. IV
started. Patient awake. At least 30 minute extrication. Local, ground EMS advise
trauma alert. A full trauma team (boarded ERP, GS, anesthesia, OR crew) all in
house and waiting for patient. A helicopter was dispatched to the hospital for
likely transfer, after local evaluation and stabilization, to tertiary center,
45 air minutes away. Ground EMS personnel diverted the helicopter to the scene.
The patient was transferred from the site. I have no other details.
I will present this case at the local trauma committee meeting. I am looking for
help in organizing my thoughts. Thank in advance. 

Kind regards,
Phil Caropreso, MD, FACS
1813 Grand Avenue
Keokuk, Iowa, USA, 52632
pjcabdds at mchsi.com
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