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Trauma Timelines

Question# 738

Working for Cornwall SDG, our trauma bypass have amendments extending our transport time from 30 minutes to 60 minutes. In the contraindication for Trauma TOR, it states “patients with penetrating trauma to the torso or head/neck and Lead Trauma Hospital < 30 min transport away”.

Does this 30 minutes also fall under the amendment to 60 minutes? As these two statement now contradicts themselves.

Answer:

The Paramedic Prompt Card for Field Trauma Triage (FTT) Standard in the BLS states, "The 30 minute transport time may be amended up to 60 minutes as per an ambulance service PPS, but may not exceed 60 minutes." This is only for those patients who are not in cardiac arrest and meet the FTT guidelines. As for the Trauma Cardiac Arrest Medical Directive in the ALS PCS, 30 minutes is utilized for transport time and TOR criteria. This will be addressed in Dr. Austin's welcome video for 2023 spring CME which launches tomorrow on MedicLEARN. Here is a snapshot of what Dr. Austin states regarding the Trauma Cardiac Arrest TOR:

"This year, the Ministry of Health updated your Medical Directive for Traumatic Cardiac Arrest with new contraindications for Termination of Resuscitation.

When managing cardiac arrest due to penetrating neck, face, or torso trauma, you’re now asked to transport those patients who are less than 30 minutes away from the Lead Trauma Hospital.

This change happened because the provincial Medical Advisory Committee that I sit on recognized that penetrating trauma patients are a special subgroup of trauma patients. They’re often young and otherwise healthy, and they tolerate poor perfusion for longer than expected.

You do a great job of managing medical cardiac arrest in the field, offering nearly everything that could be done in hospital.

But, penetrating trauma arrest needs the trauma team. This is the only hope for survival for these patients. And, unlike most traumatic cardiac arrests, there is a decent measurable survival rate if we get penetrating trauma cardiac arrest patients to the hospital.

Epinephrine does NOT have a role here.

We’ve seen a few situations where people in traumatic arrest were given epinephrine, but your medical directives and existing evidence do not indicate epinephrine in traumatic cardiac arrest.

What does have a role in traumatic cardiac arrest is a rapid search for reversible causes.

Here are 3 of the most common causes of preventable death in trauma that you’re on alert for: external bleeding, uncorrected airway obstruction or apnea, and tension pneumothorax. Treat these causes as you find them.

There is no rush to patch to a BHP for TOR until you have satisfied yourself, with a thorough assessment, that these potentially reversible causes are addressed.

Address external bleeding. Attempt CPR with careful attention to airway management. Decompress the chest if the mechanism or physical exam is consistent with serious chest injuries. Also, consider whether the patient is eligible for a thoracotomy. For a thoracotomy to be a viable option, the transport time to the trauma centre needs to short, in the neighbourhood of 15 minutes or less.

If the patient does not respond to these interventions, and they are not eligible for ED thoracotomy by a trauma team, it is likely futile to continue the resuscitation. Before determining futility, the BHP will want to know that reversible causes have been considered and addressed."

Medical Directive Category

Patient Transport & Disposition

Published

16 October 2023

ALSPCS Version

5.2

Views

217

Please reference the MOST RECENT ALS PCS for updates and changes to these directives.