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<BODY lang=EN-US style="tab-interval: 36.0pt" vLink=purple link=blue>
<DIV><FONT face=Arial color=#0000ff size=2><SPAN
class=222235312-12072003>John</SPAN></FONT></DIV>
<DIV><FONT face=Arial color=#0000ff size=2><SPAN
class=222235312-12072003></SPAN></FONT> </DIV>
<DIV><FONT face=Arial color=#0000ff size=2><SPAN class=222235312-12072003>Under
the Victorian state trauma system in our part of Australia the patient would go
via the shortest means to the largets/best equipped hospital, given that
scenario the patient would go the 20 mins by air to the better equipped
centre.</SPAN></FONT></DIV>
<DIV><FONT face=Arial color=#0000ff size=2><SPAN
class=222235312-12072003></SPAN></FONT> </DIV>
<DIV><FONT face=Arial color=#0000ff size=2><SPAN class=222235312-12072003>The
ambulance here use a rough rule of 30 mins transport (give or take a few
minutes either side), to whatever is the largest designated trauma recieving
hospital in that radius unless they have a major issue en route ie dieing
patieng, lost airway etc then will go to closest centre with access to a
doctor. </SPAN></FONT></DIV>
<DIV><FONT face=Arial color=#0000ff size=2><SPAN
class=222235312-12072003></SPAN></FONT> </DIV>
<DIV><FONT face=Arial color=#0000ff size=2><SPAN
class=222235312-12072003>Interventions at scene are limited to ABC, with a GCS 9
and dodgy airway with mediocre Sa02 I would venture to say most of our MICA (ICU
ambo's) would sedate and intubate according to their protocols (but I could be
wrong about that, I am sure they will correct if mistaken). Chest decompression
if needed for tension pneumo otherwise load and go. No prehospital doc's so
limited capacity for anything more interventional, and given the multiple posts
on the subject one could probably argue thats the right way to go in most
instances.</SPAN></FONT></DIV>
<DIV><FONT face=Arial color=#0000ff size=2><SPAN
class=222235312-12072003></SPAN></FONT> </DIV>
<DIV><FONT face=Arial color=#0000ff size=2><SPAN
class=222235312-12072003>cheers</SPAN></FONT></DIV>
<DIV><FONT face=Arial color=#0000ff size=2><SPAN
class=222235312-12072003></SPAN></FONT> </DIV>
<DIV><FONT face=Arial color=#0000ff size=2><SPAN
class=222235312-12072003>Greg</SPAN></FONT></DIV>
<DIV><FONT face=Arial color=#0000ff size=2><SPAN class=222235312-12072003>ED
Nurse Unit Manager etc</SPAN></FONT></DIV>
<BLOCKQUOTE dir=ltr style="MARGIN-RIGHT: 0px">
<DIV class=OutlookMessageHeader dir=ltr align=left><FONT face=Tahoma
size=2>-----Original Message-----<BR><B>From:</B>
trauma-list-bounces@trauma.org [mailto:trauma-list-bounces@trauma.org]<B>On
Behalf Of </B>Black, John<BR><B>Sent:</B> Saturday, 12 July 2003 6:27
PM<BR><B>To:</B> 'trauma-list@trauma.org'<BR><B>Subject:</B> Transport
scenario<BR><BR></FONT></DIV>
<DIV class=Section1>
<P class=MsoNormal><SPAN class=GramE><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">30 year
old</SPAN></FONT></SPAN><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial"> unconscious motor cyclist injured
in high speed collision. Significant impact damage to helmet. <SPAN
class=GramE>Has vomited at the scene.</SPAN> <o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial"><o:p> </o:p></SPAN></FONT></P>
<P class=MsoNormal><SPAN class=GramE><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">Requiring nasal airway for airway
maintenance.</SPAN></FONT></SPAN><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial"> SaO2 85% on non-rebreathing mask
fair bilateral air entry with upper airway coarse crackles bilaterally. <SPAN
class=GramE>A right needle thoracocentesis has previously been undertaken by
the first responder with no effect</SPAN>. Pale and sweaty, cool peripheries
but BP maintained >90 systolic. Pupils equal and reactive, AVPU: V<SPAN
class=GramE>, <SPAN style="mso-spacerun: yes"> </SPAN>GCS</SPAN> 9 (E2,
V2, M5), moving all 4 limbs. No other clinically overt injuries
identified.<o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial"><o:p> </o:p></SPAN></FONT></P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-no-proof: yes">Nearest ED
(</SPAN></FONT><st1:place><st1:PlaceType><FONT face=Arial size=2><SPAN
lang=EN-GB
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-no-proof: yes">District</SPAN></FONT></st1:PlaceType><FONT
face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-no-proof: yes">
</SPAN></FONT><st1:PlaceName><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-no-proof: yes">General</SPAN></FONT></st1:PlaceName><FONT
face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-no-proof: yes">
</SPAN></FONT><st1:PlaceType><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-no-proof: yes">Hospital</SPAN></FONT></st1:PlaceType></st1:place><FONT
face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-no-proof: yes"> with
anaesthesia & general surgery/orthopaedics/ENT surgical services on site)
10 minutes by road. Nearest multidisciplinary trauma centre (with all surgical
disciplines) 40 minutes by road, 20 minutes by air
ambulance.<o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-no-proof: yes"><o:p> </o:p></SPAN></FONT></P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-no-proof: yes">Both forms of
transport are immediately available and in close proximity to the ambulance
services at the scene.<o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-no-proof: yes"><o:p> </o:p></SPAN></FONT></P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-no-proof: yes"><o:p> </o:p></SPAN></FONT></P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-no-proof: yes">Questions:<o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-no-proof: yes"><o:p> </o:p></SPAN></FONT></P>
<OL style="mso-margin-top-alt: 0cm" type=1>
<LI class=MsoNormal
style="mso-list: l0 level1 lfo1; tab-stops: list 36.0pt"><FONT face=Arial
size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-no-proof: yes">What clinical
interventions should be undertaken at the scene?<o:p></o:p></SPAN></FONT>
</LI></OL>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-no-proof: yes"><o:p> </o:p></SPAN></FONT></P>
<OL style="mso-margin-top-alt: 0cm" type=1 start=2>
<LI class=MsoNormal
style="mso-list: l0 level1 lfo1; tab-stops: list 36.0pt"><FONT face=Arial
size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-no-proof: yes">Under what
circumstances should the nearest hospital be
bypassed?<o:p></o:p></SPAN></FONT> </LI></OL>
<P class=MsoNormal><FONT face="Times New Roman" size=3><SPAN lang=EN-GB
style="FONT-SIZE: 12pt"><o:p> </o:p></SPAN></FONT></P>
<OL style="mso-margin-top-alt: 0cm" type=1 start=3>
<LI class=MsoNormal
style="mso-list: l0 level1 lfo1; tab-stops: list 36.0pt"><FONT face=Arial
size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-no-proof: yes">How should
the patient be transported to hospital?</SPAN></FONT><SPAN
lang=EN-GB><o:p></o:p></SPAN> </LI></OL>
<P class=MsoNormal><FONT face="Times New Roman" size=3><SPAN lang=EN-GB
style="FONT-SIZE: 12pt"><o:p> </o:p></SPAN></FONT></P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-no-proof: yes"><o:p> </o:p></SPAN></FONT></P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-no-proof: yes">I would be
particularly interested to learn of any algorithims you would use to guide
your decision making.........<o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-no-proof: yes"><o:p> </o:p></SPAN></FONT></P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-no-proof: yes"><o:p> </o:p></SPAN></FONT></P>
<P class=MsoNormal><st1:PersonName><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-no-proof: yes">John
Black</SPAN></FONT></st1:PersonName><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-no-proof: yes"><o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal><st1:place><st1:City><FONT face=Arial size=2><SPAN
lang=EN-GB
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-no-proof: yes">Oxford</SPAN></FONT></st1:City><FONT
face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-no-proof: yes">,
</SPAN></FONT><st1:country-region><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial; mso-no-proof: yes">UK</SPAN></FONT></st1:country-region></st1:place><SPAN
lang=EN-GB><o:p></o:p></SPAN></P></DIV></BLOCKQUOTE></BODY></HTML>