1. Imperial County REACH field transport to RCHSD CASE Study Field transport of 2 year old 24% 77% 52%

2. - Child injured approximately 1930. -Child arrived at RCHSD Trauma room at 2123 (< 2 hours) -2150 In CT -2200 In PICU Timeline

3. Primary survey: A&B=BVM Ventilation Breath sounds = and O2 Sats 100, C=HR 140, BP 88/34, Pulses palpable, CRT 2 sec Neuro exam: Pupils equal 6 and sluggishly reactive to 5 bilaterally. Moves all extremities to pain. Secondary survey: Bogginess behind both ears, stepoff behind R ear, bloody discharge from left ear. No other obvious injuries. Resus room imaging: Lateral c-spine XR and CXR negative. Resuscitation Phase of Care

4. Head: -Multiple skull fractures including BSF and longitudinal temporal bone fracture with disruption of ossicles and CSF otorrhea. -Facial nerve disruption. -Subdural hemorrhage Chest: Bilateral small pneumothoraces and multiple pulmonary contusions. Pelvis: Buckle fracture of the R iliac bone. Spine/Extremities: No injuries found. Identified Injuries on imaging:

5. PICU Days: 10 Hospital days: 12 Specialists involved: Trauma Ophthalomology Intensive care Audiology Orthopedics OR team (2 operations) Infectious Disease ENT Neurosurgery Neurology Hospital Course

6. -Developmentally back to baseline. -Improving facial palsy-full resolution will take approximately one year (now able to close her eyes at night.) -Mixed hearing loss in one ear-especially at high frequency. -Limp from iliac buckle fracture resolved completely. Outcome

7. REACH/RCHSD collaboration REACH services facilitates direct transports from scene-decreasing time to pediatric trauma center for critical patients. A goal we had been working toward for many years!! This effort requires: Refined communication with San Diego base stations to optimize communication with receiving hospital prior to arrival. Effective system for REACH documentation to be available to the receiving hospital team and medical record. An open and collaborative approach to PI follow- up. All Achieved!!

8. REACH/RCHSD collaboration for the future Joint Imperial County education offerings Joint field care audit case presentations

9. Imperial County Transfers to RCHSC, a historical perspective….. Imperial County

10. Imperial County IFTs to RCHSD 1/00 through 7/09 N=430 77% 23%

11. Imperial County IFTs to RCHSD by Gender 01/00-07/09 N=430 24% 32% 68%

12. Imperial County IFTs to RCHSD by Age 01/00-07/09 N=430 24%

13. Imperial County IFTs to RCHSD Blunt vs Penetrating 01/00-07/09 N=430 24% 96.3%

14. Imperial County IFTs to RCHSD By Ethnicity 01/00-07/09 N=430 24% 77% 52% White Hispanic Black AsianPac Native Am Other

15. Imperial County IFTs to RCHSD By Mechanism of Injury 01/00-07/09 N=430 24% 77% 52%

16. Imperial County IFTs to RCHSD Deaths by Mechanism of Injury 01/00-07/09 N=7 24% 77% 52%

17. Imperial County IFTs to RCHSD By Time of presentation to RCHSD 01/00-07/09 N=430 24% 77% 52%

18. Imperial County IFTs to RCHSD By Day of presentation to RCHSD 01/00-07/09 N=430 24% 77% 52%

19. Imperial County IFTs to RCHSD by Physician Specialty Consultations 01/00-07/09 N=430 24% 77% 52%

20. Imperial County IFTs to RCHSD by ED disposition 01/00-07/09 N=430 24% 77%

21. Imperial County IFTs to RCHSD Severity of Injury 01/00-07/09 N=430 24% 77% 52%

22. Imperial County IFTs to RCHSD by Total Hospital Days 01/00-07/09 N=430 24% 77% 52%

23. Imperial County IFTs to RCHSD Discharge Disposition 01/00-07/09 N=430 24% 77% 52%

24. Questions? 24% 77% 52%