Date registered: Sep 2004
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Her fate was likely sealed when the first ambulance was turned away. It is unlikely that an incident like this could happen in the U.S. Paramedics should have made contact with the patient and established mental competency and had her sign a release. If she were not competent to sign then she would have been brought to the hospital against her will.
Now precisely which hospital she was taken to at the outset might very well have determined her outcome. I don’t know about Canada but the U.S. has a system of regional trauma centers. The criteria for diversion to a trauma center are based upon a tiered system of evaluations done at the scene. First a physiological assessment and the patient’s level of consciousness are established. Failing to meet these criteria the anatomy of the injury is determined (penetrating trauma to the torso, pelvic fracture etc). Failing this, the mechanism of injury is established (high speed MVA, rollover etc) Finally the existence of secondary criteria, such as advanced age or co-morbid conditions, is documented. The only accepted indication to transfer to the nearest (non trauma) facility would be a situation where active airway management was indicated but could not be accomplished in the field.
Without knowing what, precisely, was found at the scene, it is impossible to judge if she was a candidate for trauma center diversion or how close the nearest trauma center was.
As I’ve mentioned before, any regional trauma center would have been able to manage her epidural hematoma. Not even an operating room is needed for this and in emergent situations with impending brain herniation, trephination can even be done in the emergency department.