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Sun Jun 10 22:37:26 BST 2007

 I am also from Iowa, as well as a rural area similar to Keokuk..I agree with Rob, as I have learned and taught the OOHTTP in Iowa, they did as the protocol directed, and as we would have done on the NW side, with only Level IV and maybe a level III, almost as close as the Level II....

We also call trauma alerts that can and often are not utilized after further scene evaluation that indicates perhaps scene flight. ...

Jules

-----Original Message-----
From: Rob Farnum <latigo at firehousemail.com>
To: trauma-list at trauma.org
Sent: Sun, 10 Jun 2007 10:58 am
Subject: re:EMS management/crush injury

I think in this case, you should look at the Iowa Bureau of EMS Out of Hospital Trauma Triage Protocol.? This is a state protocol, not local, and could shed some light on the decisions made for you.? It would appear this Pt falls out in 2 categories:? "Suspected 2 or more Long Bone Fx", and "Extrication time > 20 minutes".? Both of these direct the crew to expedite transfer to a Trauma Care Facility.? It does state in the Protocol that "If time can be saved, or level of care needs exist, tier with ground or air ALS service." with the suspected 2 or more long bone Fx.
According to the Iowa Department of Public Health, the hospital in Keokuk is an "Area Trauma Facility" which appears to translate into a Level III Facility.? With some knowledge of your area, knowing how far it is the the University by ground, I would have probably done the same thing.? If you feel there was "Over-triage on scene" then you should approach the ambulance director for the service FIRST.? I work in a Level 4 facility in Iowa, and I would without a doubt call for a chopper, and a scene flight is a good option here.? Even after calling a trauma alert.? It isn't unknown for us to call one and then stand down when we get on scene and perform a scene flight due to extended extrication.? If you feel the crew doesn't understand the Out of Hospital Trauma Triage Protocol, then by all means offer to give more education on it.? But, from your description of events, it sounds to me like they performed correctly.

?

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EMS management/crush injury