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
Sounds great, right ?
#Controversial ?
@SRPCanada @alandrummond2 @snewbery1 @ElaineBlau
@SarahGiles10 @TheSGEM
https://twitter.com/DrEvdLinde/status/1570245010888753152
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).
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
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.
5/5 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.
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.
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
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.
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.
Because that helps not only for disasters, but the average daily critical care needs in rural Canada.
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