EM E1: Prehospital

Which level trauma center:

comprehensive regional resource that provides total care for every aspect of injury, from prevention to rehab

24 hr in-house coverage by gen surgeons

Level 1

Which level trauma center:

able to initiate definitive care for all injured pts; 24 hr coverage by gen surgeons; tertiary care needs (cardiac surgery, hemodialysis, etc) may be referred to high care

Level 2

Which level trauma center:

provides prompt assessment, resuscitation, surgery, intesive care, and stablization of injured pts and emergency operations; 24 hr coverage of ED physicians and prompt availability of surgeons

Level 3

Which level trauma center:

provides advanced trauma life support before transferring pts to a higher-level trauma center; basic ER facilities, 24 hr lab; transfer pts needed more comprehensive care

Level 4

Which level trauma center:

provides initial evaluation, stabilization, diagnostic capabilities, and prepares pt for transfer to higher lever; basic ER facilities, may provide surgery/critical-care if services available

Level 5

PED pt was hit by a car. Suffered massive internal bleeding and multiple fxs. Resp/cardiac arrest in field. Where do you transfer to?

Peds? Closest? Level 1?

any pt in resp or cardiac arrest are first stabilized at closest facility

What type of hospital:

non-teaching hospitals that serve local communities w/o federal funding; provide essential services to their population, typically general care -rural or urban

Community hospital

What type of hospital:

hospitals affiliated w/ medical schools that provide clinical education and training to future health professionals; conduct research and clinical trials; high V of pts, offer specialized care for complex conditions

Teaching hospitals

What type of hospital:

hospitals that focus on types of care, such as cardiac, orthopedic, or pediatric care; specialized services and treatments

Specialty hospitals

What type of hospital:

hospitals operated by federal, state, or local government; provide care for specific populations (veterans); funded through grants and public funds

Government hospitals

What type of hospital:

hospitals owned and operated by private entities or organizations; may offer advanced technology/services, high-quality care; can be for profit or non-profit

Private hospitals

What type of hospital:

hospitals located in rural areas, serving smaller communities; limited access to equipment/procedures, provide essential services to underserved populations

Rural hospitals

What type of hospital:

hospitals located in metropolitan areas, serving larger populations; wide range of medical services/tx, more resources and advanced technology

Urban hospitals

What type of hospital:

hospitals that provide extended medical and rehab care for pts w/ chronic illnesses or disabilities; focus on long-term tx and recovery for pts who no longer need acute care

Long-term Care hospitals

What type of hospital:

hospitals that specialize in tx of mental health conditions; inpt and outpt, provide care for pts w/ severe mental health issues (SA, anxiety, depression)

Psychiatric hospitals

What is the EMTALA act?

Act that governs Medicare program participating hospitals considering patient transfer

What is considered an EMTALA violation?

inappropriate transfer -pay civil penalty $$$ and/or lose Medicare certifications

Tertiary care facilities should be identified by EMS for what specialty care needs?

trauma, neonatal intensive care, high-risk OB, burns, spinal cord injury, cardiac care

What can be used to immobilize the spinal cord?

*preservation of spinal column/cord is important!

back boards & C-collars

T/F: C-collars are NOT adequate for cervical immobilization alone

True -requires lateral support/back board

T/F: You should keep a football helmet with shoulder pads ON for a trauma case, but take the face mask off

True -do NOT remove football helmet

T/F: You should remove other athletic helmets such as lacrosse/hockey helmets in a trauma case

False

T/F: You should NOT remove a motorcycle helmet in the field

False -remove, they do not maintain neutral spine position

What are air splints or circumferential bladders good for?

adequate for most distal fxs (upper and lower)

What are traction splints good for?

pelvic fractures & fractures of the femoral shaft

What is the preferred device for femur fractures?

femoral traction splint

What are leg traction splints good for?

tibial shaft fractures, NOT for fractures near the knee

What type of transport would be considered for critically ill patients when ground transport time would be too long or if terrain is difficult to navigate?

air transport

What type of transport allows for lifesaving maneuvers to be performed like BLS and ALS?

ground transport

Even though a pt can be safely transported by ground, what is a benefit of air transport that some pts may need?

able to provide additional medical care capabilities

Why do you need to be very cautious when transferring pts btwn facilities?

moving critically ill pts btwn hospitals invariably adds to the risk of illness or injury

What are neonatal conditions that deserve consideration when preparing for transport?

Hypothermia, Hypoxemia, Hypoglycemia, Vascular access, Infection, Viability, Stranger anxiety, Respiratory fatigue

What should be presumed as a cause of illness in any sick neonate?

infection

A neonate born at ___ weeks are capable of relatively good outcomes and should be supported aggressively

24+

When can the care of the patient be directed by the ER physician?

once communication has been established with the receiving facility

When can EMS bypass closer hospitals?

ONLY if a better-equipped facility is available