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Sun Jun 10 23:00:12 BST 2007

Thanks for the note, Jules. I wish that I could give you more information, but I
suppose it's the only conclusion that can be made: >20 minutes extrication and
two long bone fractures, go to the level 1. Now, I don't know where the two
fractures came from. Perhaps, it's an assumption. I hope to get some info from
UIHC. 
If you are calling trauma alerts often and not utilizing them, I hope that such
events are being analyzed. You can do only so many drills. I do know your part
of the state, and was involved in the verification of St.Luke's. Iowa is rural
and similar. But everything may not be the same. Are you 100 miles from your
level 2's? You're right: I would never to past a level 2 to get to a level 3.
With the protocols not ignored in the least, the questions remain: what were the
injuries, what were the indications for
transfer, who has authority for transfer, and what were the benefits and risks
of the management selected. I hope that I will be able to provide these answers
when I can get followup.

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

----------------------  Original Message:  ---------------------
From:    "Jules K. Scadden" <jkaymdc at aim.com>
To:      trauma-list at trauma.org
Subject: Re: EMS management/crush injury
Date:    Sun, 10 Jun 2007 21:37:44 +0000

> 
>  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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