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EMS management/crush injury

Jules K. Scadden jkaymdc at aim.com
Sun Jun 10 22:16:52 BST 2007


 


? Where they maybe following Iowa's Out of Hospital Trauma Triage Protocol, in their opinion?
?


Jules

 


 

-----Original Message-----
From: pjcabdds at mchsi.com
To: Trauma &amp; Critical Care mailing list <trauma-list at trauma.org>
Sent: Sat, 9 Jun 2007 7:47 pm
Subject: RE: EMS management/crush injury










Dave, and Steve,
Thanks for your responses. I was there, but I never got to see the patient. I
wish that I had more information. My initial reaction is probable over triage,
at least from the scene. It was less than five minutes to the hospital, where
everyone, who is experienced, was waiting. If the injuries were determined to be
 "not as severe", the patient perhaps could have stayed locally. If more severe,
then stabilization could have been accomplished, including volume, diuresis, and
even fasciotomies. There was a call from the field to mobilize a trauma team
(ortho is available), but no additional call for input from the physicians, who
were a few minutes away, before the decision was made to transfer from the
scene. It seems inconsistent to me at the least. Time in the local ED would not
have been wasted.

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


----------------------  Original Message:  ---------------------
From:    David Sullivan <fpcems at yahoo.com>
To:      "Trauma &, Critical Care mailing list" <trauma-list at trauma.org>
Subject: RE: EMS management/crush injury
Date:    Sat, 9 Jun 2007 23:47:40 +0000

> 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
> 
> 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
> --
> trauma-list : TRAUMA.ORG
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