Trauma VSA Transport Times
Question# 747
Currently in our OPCG Base Hospital app in the Destination Guidelines under Pediatric Bypass, there is a category for "greater than or equal to 16 years old, penetrating trauma VSA, 60 minute bypass to the Civic."
This is a written bypass by our base hospital that is directly referring to a penetrating trauma VSA, as opposed to just the amended trauma bypass from 30 minutes to 60 minutes. This is describing the exact situation from the other question with a completely opposite answer directly in our reference material making it hard to understand. I am hoping to have this clarified even if it is simply a reply of "30 minutes always for penetrating trauma VSA" and if that is the case should it be removed from our main source of medical referencing.
Answer:
Thank you for following up on the previous MedicASK regarding trauma patients and transport time and, more importantly, thank you for your patience while we investigated this further. We hear your frustration as you try to follow the standards in the face of sometimes conflicting information.
For your awareness, bypass agreements are not set out by the RPPEO. The MOH sets the foundation of these agreements which are then mutually agreed upon between your paramedic service and the hospitals. This is why each paramedic service may have slightly different bypass agreements with distinct hospitals in their catchment areas. That said, we are always happy to assist in seeking out an answer for you however, clarifying with your service would ultimately be the best source.
As you can appreciate, with all of the ongoing changes as well as the uniqueness of each of the nine individual paramedic services just in our region, it can be quite difficult to update everything in the app each time. For these reasons, we have engaged the app working group to better understand how paramedics can access up to date bypass agreements.
Please know that we have engaged your upper management to know which bypasses are currently being used by your service. We have also created a working document in order to understand which bypass agreements are actively in place with each paramedic service in order to better answer your questions moving forward. So, thank you for being do diligent and bringing this to our attention!
As it stands, bypass agreements are technically associated with the BLS PCS and should work in conjunction with the ALS PCS, not conflict it. That said, we will be using 30 minutes for TOR/transport of traumatic VSA patients (blunt/penetrating) who are ≥16 years of age. Should you choose to transport a penetrating trauma VSA patient, and the lead trauma hospital (LTH) is greater or equal to 30 minutes transport time, you would transport to the closest facility.
To recap, your chart would look a little something like this now:
Penetrating Trauma VSA ≥ 16 y/o - Civic if under 30 min. transport time otherwise TOR or closest facility.
Blunt Trauma VSA ≥ 16 y/o - Closest ED if under 30 min. transport time otherwise TOR.
We have reached out to the TOH Trauma Program and they have assured us that this aligns with their current practice, which should put any confusion to rest. We will also make the affected paramedic services aware of this for distribution to paramedics.
Thank you again for bringing this to light and we hope this helps you in your practice moving forward!