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Mon Sep 28 14:03:24 BST 2009

A couple of thoughts:

1)  Give this the Daughter Test: if she's my daughter, and you're
offering me thirty minutes' faster access to a fragment of a percent of
a chance at functional recovery, then plot the fastest trajectory and
get out of the way.

2)  In this scenario, I'm not even sure why she was scanned at the local
hospital.  In a teenage female, dramatic ALOC and focal signs, the
chances of an embolic event (and thus any type of local treatment) are
about zero.  The triage process should be rocketing her toward a big
hospital with a bold neurosurgeon -- so much the better if there's
strong interventional radiology.  And do the scans THERE.

3)  Likewise, there is every justification for activating the CC
transport team based on the clinical exam.  Waiting for the local scan
and the local consultant were clearly mistakes, at least in hindsight.

Just me, just now.

Pret Bjorn, RN
Bangor, ME USA

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Doc Holiday
Sent: Monday, September 28, 2009 8:02 AM
To: .Trauma List
Subject: RE: Question

Interesting question.

As an amateur, could I first clarify whether I understand the question
correctly. Please tell me whether I have summarised it well:

1. Under the circumsatnces as described, is there evidence that a
potential time saving of 30 minutes (going by air vs. road) will make a
significant difference to the outcome of this case?

Is that about right?

And here's another point I've just thought of:

2. If the road vehicle which brought the patient in was HELD at the ED
while the patient was received, intubated, stabilised and scanned (just
in case a decorticate patient required transfer) it would have been
there to get the patient to neurosurgeon in 30 minutes - would that be
"close enough" to the helicopter transfer times you quoted to make the
flight unnecessary?

------------------

From: cadeth66 at aol.com
> Date: Mon, 28 Sep 2009 11:46:01 +0000
> 
> In light of the recent EMS Helicopter crash I extend my condolences to
their families. 
> 
> 
> But I want to pose a question to the list if you would have or would
have not airlifted this patient?
> 
> 17 y/o caucasian female calls 9-1-1 with "severe headache and left
sided numbness" local BLS arrives begins assesment, ALS arrives but is
cxl'd by BLS "services not needed" pt is brought into ED unresponsive
and decorticate posturing. Pt intubated w/in 5 min of arrival in ED. Pt
sent to CT head which shows intracranial bleed 8mm, midline shift w/
mass effect ( forgive me if this is wrong) pt begins to become unstable
bp tanks etc etc..... Neuro consult wants immed transfer. Ground or Air?
Ground will take 30 min to get to hosp and another 30 to transferr to
neuro institute. Helo takes 15 eta to hosp, hot load, 15 min to neuro
institute....
> 
> 
> Weather clear and its roughly 2 AM
> 

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