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Transfer of emergency patients
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| maroju |
Posted on 26-02-2008 16:31
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Senior Captain
Posts: 91
Joined: 27/08/2007 02:04
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In a patient with polytrauma who has suffered significant injuries, which is the best way to organise definitive care? (see scenario in 'Should doctors...' under the EMS thread)...
Many studies suggest that multiple transfers are not entirely productive and that they would actually have adverse effects on the eventual outcome of the patient. Also the idea that longer distances/times of travel have adverse effects is a no brainer!!!
How do we balance these arguments? What is an ideal solution? The simplest answer would be to set-up several 'regional polytrauma centres' spread evenly through the country rather than have them concentrated in the major metros... this may not make business sense... but the government has to step-in to support public interest.
If a patient has a vascular problem and neuro-surgical problem, and both these specialties are not available in one centre, then the poor patient is at best doomed!!!
The other question is what transport platform would you choose in which situation? What would guide you in making this very crucial decision?
Edited by maroju on 26-02-2008 16:32
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| dr_seem |
Posted on 27-02-2008 12:01
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Newcomer
Posts: 9
Joined: 24/10/2007 16:38
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Hi,
Most of the times when we recieve a patient information in ER...its a smart one word answer for eg...UNCONSCIOUS/CHEST PAIN/RTA/SEIZURES etc and not really the cause what might have lead to that situation.
With the given scenario it wud be wise to have a doctor on-site so as to triage and initiate patient care starting from managing immediate life threatening conditions on site to a decision abt what further speciality/treatment that patient may require,by this,the patient transport is quick and towards right place.
The choice of transport would be entirely depending upon what options we have got..realistically,in india,who wud wanna fly a helicopter for a vendor who was knocked down by a fast moving truck.{My thread abt "Affordability...." is searching for an answer !!}
Expecting a paramedic to diagnose the cause on-site and passing the info is too much of asking.
Dr.Shahab. |
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| imron |
Posted on 27-02-2008 20:17
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Senior Captain
Posts: 52
Joined: 17/06/2007 20:52
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I think we ahould see what is there in a paramedic's curriculum before we start judging them.
Emergency Medical Technicians are what are needed in the field. A properly trained EMT can manage any case in the prehospital environment as good as (if not better) than a doctor.
A doctor not trained in prehospital emergency care is no better than an onlooker.
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| dr_seem |
Posted on 28-02-2008 18:32
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Newcomer
Posts: 9
Joined: 24/10/2007 16:38
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Hi,
The above reply wasnt at all based on assumptions or meant to judje anyone.I wanted to bring abt the facts which we face in india in general{excluding some leading corporate hospitals}.I completely agree that a trained paramedic is always a boon.But i personally feel, a doctor wud always have an upper hand over the trained staff as he wud hv his basic knowledge to his rescue...be it prehospital..ER..post care.
Dr.Shahab. |
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| maroju |
Posted on 02-04-2008 14:57
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Senior Captain
Posts: 91
Joined: 27/08/2007 02:04
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Got this PM from one of the members
"in our hospital we have an ambulance that is constructed as per western stds with the help of GWU USA
we call it not an ambulance but mobile ICU
usually it is used to transfer sick pts from and to our hospital
usualy an EM fellow accompanies the [atient and he intubates the pt/resuscitaes pt if needed"
I presume GWU is 'George Washington University'.
Has any one else got such a system of 'mobile ICU'
Are the EM fellows trained to undertake 'pre-hospital emergency anaesthesia'?? |
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| imron |
Posted on 03-04-2008 02:45
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Senior Captain
Posts: 52
Joined: 17/06/2007 20:52
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Ah Maroju! It is so difficult to train our people in emergency medicine due to lack of faculty. It is too much if you're asking whether training in prehospital emergency anaesthesia is available!
The concept of a mobile ICU is just a marketing gimmick. (Most of the time, not always)
What you are talking about is known as Critical Care Transfer Unit or Critical Patient Transfer Unit.
Now, just fitting the ambulance with Western stuff by Western people doesnt make it into a CCTU.
A CCTU has a medical director overseeing the operations, clinical and transfer coordinators, CCTU registrars (who may be registrars/residents from either EM or anesthesia with good ICU experience), EMTs and drivers.
The vehicle should be appropriate with necessary equipment & drugs to
sustain the patient for anywhere between 4-24 hours.
There is a system in place which takes a decision on whether a particular patient can be transferred or not, what mode of transport, what is needed and what interventions need to done enroute. Logistics of transferring critically ill patients are clear.
Data is logged. Auditing is done.
Most of the time the residents who go on long trips, are the ones who
just love to do it. For this reason they would have accumulated significant experience of prehospital transport of critical patients.
I'm talking about 15 - 35 long distance transfers a month.
Although a structured training program in critical transfer doesn't exist, they do quite a job with the limited resources available to them.
Our center has a CCTU for quite sometime now. But dont think I'm trying to market it!  |
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| maroju |
Posted on 03-04-2008 17:07
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Senior Captain
Posts: 91
Joined: 27/08/2007 02:04
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Imron, we are talking of two entirely different 'kettles of fish'...
The concept of CCTU/CPTU, I think has been around in India for nearly a decade now (or possibly even longer!!!) in some major centers. In these cases, patients are stabilized usually in one hospital (controlled environment) and either transferred to a point of definitive care or to a place which is logistically convenient to the patient's family or for various other reasons. These are usually planned and arranged by anaesthetists / intensivists in liaison with the relevant specialists. We certainly would not be interested in such semi-planned/scheduled tasks as emergency physicians.
I am interested in 'Emergency Transport' platforms and 'emergency pre-hospital interventions'. Like say for example a seriously injured patient. What kind of interventions are the EM fellows/EMTs trained to perform out of hospital? What systems do we have in place to deal with this?
The reason I asked the question as to whether any training is provided in PHEA (pre-hospital emergency anaesthesia) or not is because of the innate risk it has even in the best hands. Callousness withstanding, it would be next to negligence if one undertook this without adequate training or governance. Not having the faculty or the resources may not be good enough excuses when things don't go per plan.
Edited by maroju on 06-04-2008 01:45
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| maroju |
Posted on 12-07-2008 05:20
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Senior Captain
Posts: 91
Joined: 27/08/2007 02:04
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This is a private message sent by one of the members to me in response to my query regarding their 'mobile ICU' and training provided for pre-hospital anaesthesia. The said institute is in South India (sorry for anonymising the names of the member and the institute!!!)
sir,
mobile icu is different from other ambulances in many ways
1. its a complete setup equipped with even ventilators, monitors defibs,suction, most emergency drugs etc
2.paramedics are given good training before sending them out as independant ems
3.fellows here have 1 month anaesthesia postings to observe intubation and they get chanvce s to intubate which will help them gain expertise
It would be interesting to see if this kind of training and setup in pre-hospital care is present in any of the other places as well....
Edited by maroju on 12-07-2008 05:21
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