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%