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Sun Jun 10 06:39:00 BST 2007

Phil

We need more info - but if it has decreased time to definitive care (i.e. your hospital would refer on) then there is no major critique. Having said that you did have a team on standby and since this was a lim-only injury by description, may have been managed by you definitively. Would take this up with the EMS-medical director, since this would constitute an EMS crew overriding their Medical Control (you - they put you on standby; you should make the call!). Having said all this I'm in another country, with different rules!

Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS  instructor and DSTC Cape Town Course Director
Intern program Coordinator: Surgery
M.Med (Emergency Medicine) Executive Committee member
Clinical Head (Director): Diana Princess of Wales Trauma Unit
Division of Surgery (General) Room 4064
Department of Surgical Sciences
Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of pjcabdds at mchsi.com
Sent: Saturday, June 09, 2007 11:06 PM
To: trauma-list at trauma.org
Subject: EMS management/crush injury

Colleagues, 
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
Phil Caropreso, MD, FACS
1813 Grand Avenue
Keokuk, Iowa, USA, 52632
pjcabdds at mchsi.com
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EMS management/crush injury