Question#: 616

Question:

When treating a pt who is VSA due to blunt trauma, if they remain VSA we transport to the nearest hospital. If we get a ROSC on this patient do we now divert as a trauma bypass to the Civic or continue to the closest hospital knowing they have a high likelihood of re-arresting?

Answer:

Continue to the closest hospital as described in Field Trauma Triage Standard, clause 5: if "survival to the LTH or regionally designated equivalent hospital is unlikely, transport the patient to the closest emergency department"

The American Heart Association CPR Guidelines do not provide any evidence for, or guidance on, initial transportation of blunt trauma VSA patients to a trauma hospital. They do, however, recommend that reversible causes (such as hypoxia, hypovolemia, diminished cardiac output secondary to pneumothorax or pericardial tamponade, and hypothermia) be managed and the patient then be rapidly transferred to a trauma centre. In our system that would usually suggest transport to the closest emergency department with rapid stabilisation and onward transport to a trauma centre.

References
* Part 10.7: Cardiac Arrest Associated With Trauma: 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
* Part 12: Cardiac Arrest in Special Situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
* Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care