Thread by @DrEvdLinde

1 of 10 Interesting in f/up = proposed Trauma Team (tertiary sourced & based : ERPs / Surgeons / RNs / RTs), flown out to a rural site.

Sounds great, right ?

#Controversial ?

@SRPCanada @alandrummond2 @snewbery1 @ElaineBlau
@SarahGiles10 @TheSGEM

2 of 10 No, not necessarily.

As always, it depends.

Tertiary ≠ Rural = simple fact.

Cardinal rule = you have to know your local milieu & challenges intimately.

Relative risk : tertiary = potentially in deep water rurally, if no recent hands on exposure (and vice-versa).

3 of 10 Again, the rural mantra, which we live or die by : resources, distance, geography, weather, time.

Less relevant for tertiary teams = the latter four (and how you need to adjust to wisely utilize the first).

Prime example : the simple availability of a CT scanner

4 of 10 We have CT scanner. Used 0/8 cases, focused on that only essential to the task at hand for transfers : HR/BP stable, clinical judgement / PoCUS portable CxRs for tube confirmation & ventilation.

5/5 transfers had pan-CTs at tertiary. No change in Mx.

5 of 10 Why ?

Tertiary trauma recommendations based on mechanism = "pan CT".

Realities : rurally, solo X Ray tech on duty = portable X Ray tech and functions as CT Tech as well. Deploy wisely : the multiple repeat portable CXRs post intubation, trump.

Adjust or perish.

6 of 10 Don't do CTs rurally, unless they directly immediately change Mx, & carefully consider the impact : = time, = in turn impacting medevac time & weather windows.

Pilot / medevac staff regs = set in stone for a reason : flight safety = non-negotiable, for pts & staff.

7 of 10 So = the last thing you may actually want in your rural ER are (well intentioned) tertiary folks brothers & sisters in arms, simply by the nature of the beast, are not familiar / comfortable with the rural paradigm.

8 of 10 Rural regional = (in general) local core resources to deal with < 10 critical cases. Don't need tertiary Trauma Teams flown in, what we need (as per this case) is a focus on effective and rapid delivery of expert HEMs for evac once stabilized.

ornge.ca/about

9 of 10 Remember the "it depends" in 2. above ?

Yep, the concept could indeed be a great central rapid response resource, for e.g. cutoffs > 10 simultaneous critical mass casualties presenting to the average regional rural hospital.

But those events are luckily indeed rare.

10 of 10 Time, effort and expense related to the establishment & maintenance of such a proposed concept, = better spent on upgrading core HEMs resources to rural locations.

Because that helps not only for disasters, but the average daily critical care needs in rural Canada.