Imperial County REACH field transport to RCHSD CASE Study Field transport of 2 year old 24% 77% 52%
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Transcript of Imperial County REACH field transport to RCHSD CASE Study Field transport of 2 year old 24% 77% 52%
Imperial County REACH field transport to RCHSD
CASE Study
Field transport of 2 year old
24%
77%
52%
-Child injured approximately 1930.
-Child arrived at RCHSD Trauma room at 2123 (< 2 hours)
-2150 In CT
-2200 In PICU
Timeline
Primary survey: A&B=BVM VentilationBreath sounds = and O2 Sats 100, C=HR 140, BP 88/34, Pulses palpable, CRT 2 secNeuro exam: Pupils equal 6 and sluggishly reactive to 5
bilaterally. Moves all extremities to pain. Secondary survey: Bogginess behind both ears, stepoff
behind R ear, bloody discharge from left ear. No other obvious injuries.
Resus room imaging: Lateral c-spine XR and CXR negative.
Resuscitation Phase of Care
Head: -Multiple skull fractures including BSF and
longitudinal temporal bone fracture with disruption of ossicles and CSF otorrhea.
-Facial nerve disruption.-Subdural hemorrhage Chest: Bilateral small pneumothoraces and
multiple pulmonary contusions.Pelvis: Buckle fracture of the R iliac bone.Spine/Extremities: No injuries found.
Identified Injuries on imaging:
PICU Days: 10Hospital days: 12Specialists involved:Trauma OphthalomologyIntensive care AudiologyOrthopedics OR team (2 operations)Infectious DiseaseENTNeurosurgeryNeurology
Hospital Course
-Developmentally back to baseline.
-Improving facial palsy-full resolution will take approximately one year (now able to close her eyes at night.)
-Mixed hearing loss in one ear-especially at high frequency.
-Limp from iliac buckle fracture resolved completely.
Outcome
REACH/RCHSD collaboration REACH services facilitates direct transports from
scene-decreasing time to pediatric trauma center for critical patients. A goal we had been working toward for many years!!
This effort requires:• Refined communication with San Diego base
stations to optimize communication with receiving hospital prior to arrival.
• Effective system for REACH documentation to be available to the receiving hospital team and medical record.
• An open and collaborative approach to PI follow-up.
All Achieved!!
REACH/RCHSD collaborationfor the future
• Joint Imperial County education offerings
• Joint field care audit case presentations
Imperial County Transfers to RCHSC, a historical perspective…..
Imperial
County
Imperial County IFTs to RCHSD1/00 through 7/09 N=430
Air
Ground
77%
23%
Imperial County IFTs to RCHSDby Gender 01/00-07/09 N=430
24%
Male
Female
32%
68%
Imperial County IFTs to RCHSDby Age 01/00-07/09 N=430
24%
0
50
100
150
200
250
300
0-9 years 10-19 years
Imperial County IFTs to RCHSDBlunt vs Penetrating 01/00-07/09 N=430
24%
Blunt
Penetrating
96.3%
Imperial County IFTs to RCHSDBy Ethnicity
01/00-07/09 N=430
24%
77%
52%
0
50
100
150
200
250
White Hispanic Black AsianPac Native Am Other
Imperial County IFTs to RCHSDBy Mechanism of Injury
01/00-07/09 N=430
24%
77%
52%
MVC
PedvsMV
Bicycle
Fall
ATV/MC
Other
Assault
Imperial County IFTs to RCHSDDeaths by Mechanism of Injury
01/00-07/09 N=7
24%
77%
52% MVC
Child Abuse
Imperial County IFTs to RCHSDBy Time of presentation to RCHSD
01/00-07/09 N=430
24%
77%
52%
0
50
100
150
200
250
Days PMS Nights
Days
PMS
Nights
Imperial County IFTs to RCHSDBy Day of presentation to RCHSD
01/00-07/09 N=430
24%
77%
52%
0
20
40
60
80
100
120
Sun Mon Tues Wed Thur Fri Sat
Sun
Mon
Tues
Wed
Thur
Fri
Sat
Imperial County IFTs to RCHSDby Physician Specialty Consultations
01/00-07/09 N=430
24%
77%
52%
050
100150200250300350400450
Neuro
surg
ery
Orth
oped
ics
Traum
a
Neurosurgery
Orthopedics
Trauma
Imperial County IFTs to RCHSDby ED disposition
01/00-07/09 N=430
24%
77%
Obs/Home
Admit ICU
Admit IMU
Admit Flr
OR
Imperial County IFTs to RCHSDSeverity of Injury
01/00-07/09 N=430
24%
77%
52%
0 100 200 300
0 to 9
10 to 14
>15
>15
10 to 14
0 to 9
Imperial County IFTs to RCHSDby Total Hospital Days 01/00-07/09 N=430
24%
77%
52%
0 50 100 150 200
0 to 1
3
4
6
8 to 14
> 22 days > 22 days
15 to 21
8 to 14
7
6
5
4
4
3
2
0 to 1
Imperial County IFTs to RCHSDDischarge Disposition 01/00-07/09 N=430
24%
77%
52%
Home
Med.Facility
NonMedFac
Rehab
LT Care
Died
Questions?24%
77%
52%