Tertiary Trauma Teams to rural locations ?

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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. youtube.com/watch?v=jhdFe3evXpk

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.