Etienne van der Linde Profile picture
Sep 22, 2022 11 tweets 6 min read Read on X
Interesting 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



1/11
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).

2/11
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

3/11
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.

4/11
Why ?

Tertiary trauma : based on mechanism alone = "pan CT".

No change in Mx.

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

Adjust or perish.

5/11
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 regulations = set in stone for a reason : flight safety = non-negotiable.

6/11
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.



7/11
Rural regional = local core resources to deal with < 10 critical cases. Don't need tertiary Trauma Teams, need (as per this case) a focus on effective / rapid delivery of expert HEMs for evac once stabilized = no loss ambus and RNs to transfer.

ornge.ca/about

8/11
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.

9/11
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.

10/11
You can read the unrolled version of this thread here: typefully.com/DrEvdLinde/pGZ…

11/11

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with Etienne van der Linde

Etienne van der Linde Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @DrEvdLinde

Aug 13, 2023
***URGENT*** = two weeks away !

#RuralMatters

HELP to keep our rural regional ER open in Sep / Oct.

Diversion NOT an option : next ER around 200 km away...

We'll fly you *AND* *YOUR* *FAMILY* in.

Amplify please 🙏

@alandrummond2 @CanadianKayMD @TrevorJain @TheSGEM
Join us for a working holiday experience our *beautiful* province !



DMs open, I will facilitate !

Image
Image
Details as per our RHA recruitment professionals :

We’ve introduced a number of new programs to meet the needs and expectations of physicians seeking permanent and locum opportunities.
Read 9 tweets
Sep 22, 2022
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
Read 10 tweets

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Don't want to be a Premium member but still want to support us?

Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!

Ethereum

0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy

Bitcoin

3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Follow Us!

:(