Do you emergent transport base off of mechanism?

[speedygodzilla]

I have notice a trend that I don't exactly understand the thought process. Transporting "stable" patients emergent to the local trauma center base off of mechanism. I do take mechanism in to mind but to be honest I look more at my patient. Any LOC changes, ABCs intact, vital signs stable. I guess I use stable loosely but I don't just want to transport a patient emergent base off of mechanism.

Am I thinking clearly or do I need to transport more "aggressively" based off of mechanism? I am still a new medic and want to make sure my reasoning is well reasonable.

Keep in mind where I work the most transport time will be is around 20 mins but is usually less than 10 mins. So my food for thought is that transporting emergent will not save much time but will vastly increase the danger! Thus I reserve emergent transport for unstable patients no matter what the mechanism is.

[Chief1C]

I guess it would depend on factors like, where we find the patient, what appears to have happened, degree of damage, age of the vehicle. The older the vehicle, the more damage, the greater the impact, sometimes. Nearest trauma center is about an hour and a half transport by ground, and about 45min to an ER. Not the kind of roads that make it safe to transport "emergent".

[croaker260]

I guess it would depend on factors like, where we find the patient, what appears to have happened, degree of damage, age of the vehicle. The older the vehicle, the more damage, the greater the impact, sometimes. Nearest trauma center is about an hour and a half transport by ground, and about 45min to an ER. Not the kind of roads that make it safe to transport "emergent".

Wow, such a hard thing to quantify on a forum like this...

This is exactly why medicine is an art masquerading as a science. SO may subtleties go into every descision.

[FireMedic65]

Mechanism of injury/illness is protocol for a reason. Even though they appear stable, they may not stay that way. Which is why you are to take them to a definitive facility. That is in the perfect world. We are trained to evaluate a patient by monitoring them and assessing frequently. So, that being said... it really depends on the situation, you location in relation to the patient and theirs to a hospital and that hospitals capability. When in doubt give a shout! (to medical command)

[aussiephil]

I have notice a trend that I don't exactly understand the thought process. Transporting "stable" patients emergent to the local trauma center base off of mechanism. I do take mechanism in to mind but to be honest I look more at my patient. Any LOC changes, ABCs intact, vital signs stable. I guess I use stable loosely but I don't just want to transport a patient emergent base off of mechanism.

Am I thinking clearly or do I need to transport more "aggressively" based off of mechanism? I am still a new medic and want to make sure my reasoning is well reasonable.

Keep in mind where I work the most transport time will be is around 20 mins but is usually less than 10 mins. So my food for thought is that transporting emergent will not save much time but will vastly increase the danger! Thus I reserve emergent transport for unstable patients no matter what the mechanism is.

Define stable.

I have seen patients with a decreased LOC that are stable.

The MOI should indicate to you what potential injuries the patient may have. It is reason to transport to a Trauma Centre. Last time I looked, we were not carrying X-ray, CT & Ultrasound for FAST in the ambulances. (If you dont know what FAST is, click here.)

Yes you need to look at your patient, but remember patients will compensate & in some cases deteriorate quickly if there is multi system trauma in place.

The MOI is the single most important piece of info you have to indicate the injury that may present in time.

[Chief1C]

Wow, such a hard thing to quantify on a forum like this...

This is exactly why medicine is an art masquerading as a science. SO may subtleties go into every decision.

So, are you trying to jab me... or...

[speedygodzilla]

Define stable.

I have seen patients with a decreased LOC that are stable.

The MOI should indicate to you what potential injuries the patient may have. It is reason to transport to a Trauma Centre. Last time I looked, we were not carrying X-ray, CT & Ultrasound for FAST in the ambulances. (If you dont know what FAST is, click here.)

Yes you need to look at your patient, but remember patients will compensate & in some cases deteriorate quickly if there is multi system trauma in place.

The MOI is the single most important piece of info you have to indicate the injury that may present in time.

I am going to go with stable being a providers discretion and that there is no set definition. Thus saying that I don't see much benifit especially where I work transporting "stable" patients emergent. Mainly due to my already short transport time. This being said if I was 30 mins out I would be more likely to upgrade my transport base off of mechanism. I think the main focus should be on scene time because that is where you can really gain time.

Thanks for everyone's input!

Edited June 4, 2010 by speedygodzilla

[Fox800]

As stated before, there are many variables to consider. One being transport time, another being how your patient presents, and the third being the mechanism itself. Should you be running to the trauma hospital hot just because your patient rolled their SUV and presents with neck pain? Probably not. Now the game might change if you're an hour+ from the trauma center and there are other factors to consider (alcohol, bystanders report they were unconscious prior to your arrival but are awake now, etc.) Use your best judgement. Don't hall butt based on mechanism alone, but make a smart decision. There's no need to run code 3 to the hospital with someone involved in an MVC above 40MPH because their arm hurts.

Of course, there are always those gray areas...do what's in your patient's best interest.

[DwayneEMTP]

I had an 86y/o woman roll her mini van 40 mins out on a country road. Despite the fact that she was calm, color appeared good, mentating normally, I chose to begin my transport emergently. After about 5-8 mins I downgraded to non emergent as the time to do a more thorough assessment revealed that despite mechanism I couldn't really find anything wrong with her.

Our protocols state specifically that mechanism alone is not justification to run emergent.

I disagree with Phil that mechanism alone is indication for emergent transport. A pt might fool me for a few minutes by compensating, but if it last longer than that, shame on me.

Use your judgement, intuition, full skill set, and then make an intelligent decision that weighs the time saved, the effect of coming in emergent on the hospital, against the danger of running lights and sirens.

Dwayne

[Paramagic]

Mechanism (in relatoin to motor vechicle collisions) is a poor predictor of injury. Mechanism alone is not sufficient to warrant the risk of running emergent to a trauma center. Mechanism should be used as a cue to alert you to look for specific patterns of injuries, not as a reason to not treat appropriately.