Inside combat rescue-surgical cric

[Akulahawk]

From what I generally understand from some folks on the Trauma-List discussion group, the whole "Golden Hour" idea was mostly a marketing deal so that the Shock Trauma Center could be funded and built. It also wasn't meant to be a rigid thing... the less time an injured person gets to definitive care (including going through the ED if direct to OR is necessary) from the moment of injury, the more likely it is that the patient will survive.

As to the "Platinum 10 minutes" thing goes, that's probably even more so meant to get people to realize that the sooner injuries are attended to and bleeding slowed, the more likely it is that someone severely injured will survive. Most of the time, EMS won't be on scene at the moment of injury, so a LOT of those first few minutes, where there might be NO care given, are used up.

 

[Veneficus]

This is why taking a patient to a non-trauma ER (Cat 4 rural band aid station) sees the same care as a progressive EMS service?

Even many level IIIs are the same way.

Fortunately there is a major jump in care from level IIIs to level IIs.

Basically 4-3 are similar, 2-1 are similar.

 

[chaz90]

Even many level IIIs are the same way.

Fortunately there is a major jump in care from level IIIs to level IIs.

Basically 4-3 are similar, 2-1 are similar.

There seems to be a wide disparity in how Level IIIs function. I've seen one Level III that was only 15 minutes from a Level II under the same parent company that wanted nothing to do with trauma patients and would simply provide initial "stabilization" while arranging for a transfer. We were only allowed to bring critical trauma patients there if we were unable to obtain an airway, even if it occurred in the parking lot.

On the other hand, I've also seen Level III facilities function at a higher level when necessity dictates they must. Level III hospitals in this area are willing and able to provide rapid surgical intervention and intensive care because the nearest Level I is about 1.5 hrs away.

 

[Handsome Robb]

We're producing thousands of young people with battlefield medic training....

Not sure what you were trying to get at with this one.

We only have a level II and I've never been in a level I so I can't really comment as far as experiences when comparing the two but its pretty rare that the level II here can't handle something, even if there are multiple injured. (Read: Hawthorne USMC training incident among many other MCI situations they've had to deal with).

From what I understand the only real difference between a I and a II is having all services on campus 24/7 vs on call, research and education. They have IM residents here but no EM or Trauma residents.

 

[Meursault]

I've never been in a level I.

lol.

From what I understand the only real difference between a I and a II is having all services on campus 24/7 vs on call, research and education. They have IM residents here but no EM or Trauma residents.

Volume makes a huge difference. Around Boston, with four Level I adult trauma centers, most providers don't want to bring traumas to a Level II. As a result, the Level IIs here don't seem to be as capable as your Level II, regardless of what the ACS says. I assume that's because there's no substitute for ED and OR staff familiarity with trauma, while a lot of the criteria for being a Level I aren't very directly relevant to quality of care.

 

[KingCountyMedic]

We have our Level I in Seattle (Harborview) and while they are very, very good at trauma..........I to this day have never seen anyplace hold a candle to Madigan Army Medical Center in Pierce County. They do not get a Level I status due to the fact that they deploy in wartime, no University attatched etc. I worked in Pierce County in the 80's and 90's when we were dealing with all the Cali gang bangers that came here. It was not uncommon to have 2-3 shootings in a 24 hour shift and we took 'em all to Madigan, it was amazing to watch trauma care with the military chain of command in place.

 

[Handsome Robb]

lol.

Not sure what was funny about that but alright lol.

Volume makes a huge difference. Around Boston, with four Level I adult trauma centers, most providers don't want to bring traumas to a Level II. As a result, the Level IIs here don't seem to be as capable as your Level II, regardless of what the ACS says. I assume that's because there's no substitute for ED and OR staff familiarity with trauma, while a lot of the criteria for being a Level I aren't very directly relevant to quality of care.

That definitely makes sense. Like you said, there's no other option here so they're damn good at what they do, it's the only Trauma Center in Northern Nevada so they get all the urban stuff plus the outlying areas' patients as well.

Never seen trauma care in a military hospital but it's truly impressive to watch the trauma team here go to work on a sick patient.

 

[Grumpy]

False. Medical control comes from company or battalion-level medical officer, generally with fairly restrictive protocols (SF, PJs and independent duty corpsmen are the only ones I can think of). It is as dependent on training as the unit wants it, and can be extremely sporadic.

I should have been more specific I guess. There is no "online medical control" for PJs. these men are trained by doctors, independent medical corpsman and IDMTs do work under doctors. The post was a mere statement toward that specific question. It's been years since I was active duty and know military medics rely on the doctors they work beside. Been there done that. I was speaking from a USAF standpoint where battalions don't exist.