SEAEMS TRAUMA FEBRUARY 16 2016 TRAUMA SYSTEM TURNED

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 1/3 @ 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 MUST BE PAID , LENGTHENS HOSPITAL STAY , COMPLICATIONS, DEATH

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

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