Personal Responsibility and Patient Care.

[ERDoc]

Keep in mind that just because a hospital isn't a "trauma center," doesn't mean that they cannot handle the pt. You know your local resources better than I do obviously. If you have an EM residency trained physician at your local hospital they will be able to handle it just as well as the trauma center. True, the pt will probably end up being transferred because of unavailable resources. There is a difference in a fall from a standing height versus a fall from 4' up, especially with a pt of this age. I understand that you have to operate under your protocols but don't let them interfere with quality patient care and good judgement. Good judgement will come with more experience. If in doubt, contact the local hospital to see what they think. The rural hospital I work at does not have orthopedics on-call at times. Our providers will call to see if we are able to care for the pt before them come to us. In most cases we can take the pt. About the only pt we can't take at those times is pts with open fractures. We reduce most things in the ER and things that do need ortho but don't need to go to the OR right away can be admitted to the medicine guys who will consult ortho the next day. Long story short (too late) your local hospital may be able to do more than you think.