SEAEMS TRAUMA FEBRUARY 16,2016

TRAUMA ---  SYSTEM TURNED ON AUGUST 21,2014  MONTGOMERY 1 LEVEL TWO, 1 LEVEL THREE  DOTHAN 1 LEVEL TWO & 1 LEVEL 3  REMAINDER OF REGION 10 LEVEL THREE’S AND 3 COMMUNITY HOSPITALS  HOPE FOR COLUMBUS AS TRAUMA  PROJECTED ATS ENTRIES IN SEAEMS 2452 (2479)OR 15 PER 24 HOURS AVERAGE

TRAUMA CHANGES  CALL FROM SCENE BEFORE TRANSPORT BEGUN  CLOSEST HOSPITAL IS NOT ALWAYS THE BEST HOSPITAL  TRANSPORTATION MODE

CALL ATCC EARLY  DIRECTION TO LEAVE SCENE & TRANSPORTATION MODALITY  NOTIFY LAW ENFORCEMENT & FAMILY  TRAUMA TEAM IN WAITING  ONE SCENE IS ONE PIECE OF THE PUZZLE /INTEGRATE FOR RESOURCE USE  PROTOCOL COMPLIANCE

BEST HOSPITAL – TRI-MODAL DEATH  SCENE  1/3 FIRST HOUR  1/3 TWO OR MORE WEEKS POST TRAUMA

BEST HOSPITAL -- SHOCK  FIRST SIGNS OF SHOCK --- AMS & HEART RATE  SHOCK BUILDS DEBT  DEBT MUST BE PAID,LENGTHENS HOSPITAL STAY,COMPLICATIONS, DEATH

BEST HOSPITAL SHOCK – INTERVENTION HOSPITAL  PREVENTION – HYPOXIA,HEMORRHAGE,CNS  INTERVENTION  IMMEDIATE  A SECURE  B VENTILATE  C CRYSTALOID (2)AND BLOOD  D TESTS & SURGICAL INTERVENTION ALS AMBULANCE  PREVENTION – HYPOXIA,HEMORRHAGE,CNS  INTERVENTION  TRANSPORT  A SECURE  B VENTILATE  C CRYSTALOID (2)

HOSPITAL COMPARISON Level 2  SURGERY REQUIRED  ANESTHIA REQUIRED  X RAY REQUIRED  RESPIRATORY REQUIRED Level 3  SURGERY DESIRED  ANESTHIA DESIRED  X RAY DESIRED  RESPIRATORY DESIRED

TRANSPORT BY ALS AMBULANCE IS A FORM OF VERY EFFECTIVE CARE  PHYSIOLOGIC 60 MINUTES OR LESS A LEVEL TWO  ANATOMIC 60 MINUTES OR LESS A LEVEL TWO  ERR ON THE SIDE OF PATIENT CARE  TBI OR AMS LEVEL TWO WITH NS UNDER STROKE RESOURCES  FAMILIES STAY TOGETHER

HOSPITAL DESTINATION DECISIONS  PATIENT (NOT FAMILY ) ALWAYS HAS A RIGHT UNLESS UNDER ARREST  ATCC RECOMMENDS BASED ON REGIONS TRAUMA PLAN AND EMSP ESTIMATE OF TX TIME  RECOMMENDATION NOT BINDING BUT WILL PRODUCE AN ISSUE TO REGION  BINDING IF HOSPITAL IS RED AND NOT PATIENT CHOICE  CLOSEST HOSPITAL IF AIRWAY /BREATHING NOT ABLE TO BE SUPPORTED,BLEEDING EXTERNAL UNCONTROLLED, BP< 90 NO IV ACCESS. WAIT TO MOVE TO LEVEL TWO

SEAEMS PERFORMANCE  91 % HOSPITAL OUTCOME REPORTS  48% EMSP DISCRETION  27% EMSP ADMIT ( SYSTEM IS 49%)  13% TRANSFER RATE (ALL ENTRIES ) --- ONE County 23% transfer rate  Level 2’s RED less than one % of time

DISCUSSION

SUMMARY ISSUES  LIFE IS SAVED BY RIGHT HOSPITAL AS THE FIRST TX DESTINATION  CANNOT ENTER A PATIENT WITHIN 250 FEET OF HOSPITAL  HOSPITALS CAN ENTER PATIENTS  ISSUES WITH ATCC CALL SEAEMS  IF IN DOUBT ERR IN FAVOR OF THE PATIENT.  EMS DESTINATION FOR THE PATIENT NOT EMS CONVENIENCE