I was merely responding to Boo's comment "No way to get the patient to (the Canadian equivalent a U.S) trauma center in a timely enough matter to save her life."regarding what he was suggesting is a Level 1 Trauma Center. And those aren't in towns of 50-60K people. It is why most major cities have Level 1 and smaller communities [50K] have Level 3. Kentucky only has two Level 1 centers in the entire state [Lexington and Louisville] though NoKY is covered by a third in Cincinnati.
It has nothing to do with me suggesting that only metro areas "NEED" Level 1 centers, it has to do with only large metropolitan areas able to AFFORD them.
There you go, again, mcbear: obfuscate the issue until it is unrecognizable and then proceed with fanfare to demolish an argument that nobody made. This, by now, has become your signature debating style.
The issue here is not that Canada fails to have a Level 1 trauma center in a small municipality. Many towns in the U.S. do not either. The issue here (and pay attention this time) is that generally accepted principles of trauma diversion were ignored in this case. The patient clearly met criteria for immediate transport to a level 1 trauma center and never should have been brought to the local ER at all.
A lot more information is now available about the condition in which she was found during the second ambulance run that allows us to make informed conclusions about the appropriateness of her care. We now know, e.g., that her GCS (Glasgow Coma Score) was 12 at the time of initial transport (about 3 pm). The GCS (which ranges from 3 to 15) has prognostic implications in head injury. Specifically scores of 14 â€“ 15 constitute mild, 9 â€“ 13 moderate and 3- 8 severe head injury respectively. The likelihood of having an intracranial or extraxial injury requiring neurosurgical intervention increases as the score decreases. The ultimate prognosis is also inversely proportional to the score. In a previous post I mentioned the commonly accepted indications for trauma diversion. The first criterion are physiological parameters. A GCS score of less than 14 (as in this case) is an indication to bypass the nearest hospital
and proceed directly to the nearest level 1 trauma center.
This was not done. Since ground transport times were in excess of 30 minutes to the nearest Level 1 center, this would constitute a clear indication for air ambulance evacuation.
We also know that her initial vital signs and oxygenation were excellent, all of which portend a more favorable prognosis.
At autopsy she was found to have died of epidural hemorrhage, an imminently treatable condition particularly for a patient with an initial GCS of 12 as in this case.
So it is not true that her initial refusal to accept transport doomed her to this outcome. Even with the initial delay in care she likely could have been salvaged had she (expeditiously) been taken to a source of definitive care.
If you donâ€™t believe me then at least accept the observations of the Canadian trauma doctor I previously mentioned who noted that trauma care in rural areas of Canada are simply not up to the standards of the U.S. Canada apparently has decided, not to provide air ambulance transport for these rural locations. Evidently this is an economic decision they have made. Personally I donâ€™t have a stake in the inevitable debate that this is going to provoke in Canada.
Sorry for this factual diversion.
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