Interesting in f/up = proposed Trauma Team (tertiary sourced & based : ERPs / Surgeons / RNs / RTs), flown out to a rural site.
Sounds great, right ?
#Controversial ?
@SRPCanada @alandrummond2 @snewbery1 @ElaineBlau
@SarahGiles10 @TheSGEM
twitter.com/DrEvdLinde/status/1570245010888753152
No, not necessarily.
As always, it depends.
Tertiary ≠ Rural = simple fact.
Cardinal rule = you have to know your local milieu & challenges intimately.
Relative risk : tertiary = potentially in deep water rurally, if no recent hands on exposure (and vice-versa).
Again, the rural mantra, which we live or die by : resources, distance, geography, weather, time.
Less relevant for tertiary teams = the latter four (and how you need to adjust to wisely utilize the first).
Prime example : the simple availability of a CT scanner
We have CT scanner. Used 0/8 cases, focused on that only essential to the task at hand for transfers : HR/BP stable, clinical judgement / PoCUS portable CxRs for tube confirmation & ventilation.
5/5 transfers had pan-CTs at tertiary. No change in Mx.
Why ?
Tertiary trauma recommendations based on mechanism = "pan CT".
Realities : rurally, solo X Ray tech on duty = portable X Ray tech and functions as CT Tech as well. Deploy them wisely : the multiple repeat portable CXRs post intubation, trump.
Adjust or perish.
Don't do CTs rurally, unless they directly immediately change Mx, & carefully considered the impact : = time, = in turn impacting medevac time & weather windows.
Pilot / medevac staff regulations = set in stone for a reason : flight safety = non-negotiable, for pts & staff.
So = the last thing you may actually want in your rural ER are (well intentioned) tertiary folks brothers & sisters in arms, simply by the nature of the beast, are not familiar / comfortable with the rural paradigm.
Rural regional = (in general) local core resources to deal with < 10 critical cases. We don't need tertiary Trauma Teams flown in, what we need (as per this case) is a focus on effective and rapid delivery of expert HEMs for evac once stabilized.
ornge.ca/about
Remember the "it depends" in 2. above ?
Yep, the concept could indeed be a great central rapid response resource, for e.g. cutoffs > 10 simultaneous critical mass casualties presenting to the average regional rural hospital.
But those events are luckily indeed rare.
The time, effort and expense related to the establishment & maintenance of such a proposed concept, = better spent on upgrading core HEMs resources to rural locations.
Because that helps not only for disasters, but the average daily critical care needs in rural Canada.