XII

XII. INJURY PREVENTION AFTER THE FACT:

SPEEDING UP TRAUMA AND PEDIATRIC EMERGENCY CARE ON THE EMS FRONTIER

Reducing the amount of time before an operable trauma patient receives surgery is the primary purpose of regional trauma systems. Rural EMS programs can improve their ability to gain access to these systems in the following ways:

Make sure that the EMS system is responding to critical trauma and pediatric trauma quickly, appropriately, and with the minimum of delay

Assure that EMS resources are properly positioned in the district to provide the quickest possible response times to the majority of patients

Assure that communications between all agencies are effective and cooperative

Assure that local first responder agencies are responded immediately whenever an emergency call is received by the EMS program

Identify and correct areas of the EMS district where communications dead spots exist.

Identify and pre-designate areas where communications are the most reliable throughout the district and mark them on maps for the EMS units

Coordinate, cooperate and train with local first responder agencies and hospital personnel, to provide the most efficient possible response to critical trauma

Provide and train with all the appropriate pediatric equipment

Assure that every EMT, especially Basic level EMTs, has the best possible pediatric emergency training that is appropriate to their skill level. (For information on pediatric training and equipment go to http://www.ems-c.org).

Develop written protocols and clear guidelines between EMS and local medical control physicians that define procedures and requirements for activating trauma teams, pediatric specialists, and air-medical services in cases of critical and pediatric trauma

Provide check off sheets for use by EMTs in the field that are acceptable and available to the medical control personnel at the base hospital. (These can help in making the determination of need for surgical intervention quickly, without errors. An excellent resource for information on this subject is available in the Journal of Trauma article: Karsteadt L, Larsen C, Farmer P. Analysis of a rural trauma program using the TRISS methodology: a 3-year retrospective study. Journal of Trauma. 1994;36:395 – 400)

Designate the types of patients who should bypass the local emergency facility and be transported immediately to the nearest trauma facility

Develop memoranda of understanding with emergency air resources that assure the fastest possible response by them Establish pre-designated landing zones with pre-calculated and confirmed latitude and longitude designations throughout the EMS district. Make these available in every ambulance and every med-evac helicopter

Develop procedures for the hospital personnel to assist the EMTs with coordination of Air-evac services

Develop "John and Jane Doe" paperwork procedures to speed up patient intake and transfer procedures with fewer delays for identification of the patients

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