designation protocols

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There were a lot of exchanges last week about triage of patients to
hospitals vs trauma centers. As information for those interested, I have
included below the protocol that we use in SE Louisiana. We had this in
place before Katrina for several years and have recently reinstituted it
for all of SE Louisiana (10 parishes/counties). If you look at a
Louisiana map it is all of the toe of the boot. We have about 10 years
experience with it and it works very well by our own in-depth PI within
the hospital. Unfortunately we do not have PI information on patients
that went to other hospitals because they did not meet immediate
transportation to trauma center criteria

EMS transports all severely injured patient directly to The Trauma
Center in New Orleans. (Charity Hospital as you know it). Level I ACS
verification with in- house trauma surgeons and 10 minute response time
to the Resuscitation room.  All other hospitals are bypassed. Decision
is a field decision made by the prehospital provider, usually EMT-P but
maybe EMT-B. The Trauma Center becomes the medical control for all such
transports. This protocol does not address hospital to hospital
transfers except resuscitations.

*	Direct transports to all patients who meet anatomic or
physiologic criteria
o	(this is step I & 2 in the new CDC National Triage system)
*	All other patient go to closest appropriate hospital
*	If: 
o	a) transport time is > 50 minutes, or
o	 b) hemodynamic instability, or, 
o	c)  inability of EMS to adequately management of airway, 
o	 patient goes to closest hospital and after stabilization
continuously on to The Trauma Center
*	If EMS believes that the trauma patient needs the expertise of
the trauma center and anatomic or physiologic criteria are not met, then
the decisions of destination is made by the physician in medical control
(direct prehospital provider to physician discussion)

The Trauma Center attempts NOT to go on "trauma diversion". In the last
two years "trauma diversion" has been activated only twice. Once when we
got 3  simultaneous GSW's that all required immediate explorations (2
hours of diversion) and once when there was outside system power failure
(3 hours of diversion)  That is only 5 hours of diversion in 2 years. 

We have been on cardiac and ICU diversion but this was not allowed to
produce trauma diversion. We compensated so as not to impact the trauma
system in SE Louisiana

As a reference point, we have > 3000 trauma admissions each year.  >65%
are penetrating trauma

For those struggling with trauma destination guidelines, I hope that
this helps



Norman

Norman McSwain Jr, MD FACS
Trauma Director Charity Hospital
Professor of Surgery
Tulane University School of Medicine
504 988 5111

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