Improving air medical transport of the trauma patient from the ground

Abstract

Seriously injured patients often require transfer from a community hospital to a trauma centre, a hospital that is also an academic centre. Therefore, emergency medicine and general surgery trainees often participate in the air medical transport of trauma patients. The air ambulance process is recognized as a high-risk environment in which unstable patients are transported in resource-limited settings and poses a number of challenges.1 These include guiding management prior to transport, arranging interfacility transport, and coordinating medical management on arrival at the tertiary trauma centre.Typically, the resident becomes involved as a remote trauma team member at the tertiary centre once the transfer decision and means of transport (rotary, fixed wing, or land) have already been determined. This is a challenging role for a number of reasons: geographic boundaries and time constraints affect communication; the scope of practice of the sending facility is variable and often not understood; and allied health professionals possessing varying scopes of practice are often independently involved in the active transport. With the addition of fatigue, stress, and other unidentified factors, a collaborative approach to patient care is often difficult.As residents in emergency medicine, it is imperative that we understand how both community and academic hospitals manage trauma to facilitate transport between centres. This commentary uses a case-based approach to suggest strategies for residents to successfully coordinate air medical transport of trauma victims and improve collaboration between community and tertiary trauma physicians. Approaches include optimized communication, effective use of sending facility resources, and planning to maximize patient care during transfer. CASEA 23-year-old male, the sole passenger in a single rollover motor vehicle crash (MVC), was transported by emergency medical services to a suburban nontrauma hospital. On arrival, his heart rate was 110 beats/min and his blood pressure was 98/60 mm Hg with a respiratory rate of 20 breaths per minute and an oxygenation saturation of 99% on 10 L/min O 2 via a nonrebreather facemask. He was agitated with a Glasgow Coma Scale (GCS) score of 9 (E3 V2 M4). Completion of the primary and secondary survey showed extensive bruising along the left side of his chest, subcutaneous emphysema, and an unstable pelvis. The emergency physician initiated resuscitation and decided that the patient required definitive treatment beyond the capabilities of the hospital. He contacted the closest designated trauma centre (130 km away) and spoke with the emergency medicine resident on duty to coordinate transfer for definitive care while rotary air medical transport was being arranged. COMMUNICATIONTelephone discussions between physicians involving the management of critically ill or injured patients are intrinsically difficult. Despite this, telecommunication remains the standard method of interaction used to coordinate interfacility air medical transport. Although...