Mike Murray
Just to be clear, an auto vs. bicycle accident is NOT an automatic trauma
system entry, nor should it be. At one point in or EMS system it was and,
like other mechanism of injury issues, it lead to a significant amount of
over triage, something that continues to be a problem in our system. The
trauma system entry criteria are:
A. Physiological criteria:
1. A systolic blood pressure of less than 90 mm/Hg.
2. Respiratory distress as evidenced by a respiratory rate of less
than 10 or greater than 29.
3. Altered mental status as evidenced by a Glasgow Coma Scale score
of 13 or less.
B. Anatomical Criteria:
1. The patient has a flail chest.
2. The patient has two or more obvious proximal long bone fractures
(humerus, femur).
3. The patient has a penetrating injury of the head, neck, torso,
or groin associated with transfer of energy.
4. The patient has an amputation proximal to the wrist or ankle.
5. The patient has numbness or paralysis in one or more limbs which
is associated with a suspected spinal cord injury.
C. Mechanism of injury:
1. Extrication from a motor vehicle which takes greater than 20
minutes and uses heavy extrication tools.
2. Death of an occupant in the same vehicle as the patient.
3. Ejection of the patient from an enclosed vehicle.
D. EMT Discretion:
1. If in the EMT's judgment, the patient has been involved in a
trauma incident that, because of a high energy exchange, causes the EMT to
be highly suspicious that the patient is severely injured, the patient
should be entered into the Trauma System. These may include:
a. Falls greater than 20 feet.
b. Pedestrian struck at greater than 20 mph or thrown more
than 15 feet.
c. Rollover motor vehicle accident.
d. Motorcycle, ATV, or bicycle accident.
e. Significant intrusion into occupant space of vehicle.
2. The EMT's index of suspicion for trauma injury should be raised
by the following factors:
a. Age less than 12 or greater than 60.
b. Presence of intoxicants.
c. Patient has been exposed to extremes of environment (hot
or cold).
d. Patient's previous medical history.
e. Pregnancy.
Most bike accidents, even those involving cars, will not meet these criteria
except for the discretionary ones.
I have been recently informed that Portland Police are using trauma system
entry as a criteria for deciding whether a traffic accident is investigated.
This is an inappropriate use of this tool since it is designed and studied
to identify patients that would benefit from immediate access to surgical
facilities and not as any sort of measure of the significance of the injury
in terms of cost, liability or any other of that factors that should
properly fit into a consideration of whether a traffic accident should be
investigated or not.
Mike Murray
-----Original Message-----
From: obra-bounces@list.obra.org [mailto:obra-bounces@list.obra.org] On
Behalf Of Doug Hormann
Sent: Monday, June 12, 2006 21:39 PM
To: Susan Otcenas
Cc: obra@list.obra.org
Subject: Re: [OBRA Chat] Lessons learned from witnessing a hit-and-run
Susan,
You are my new hero! As a cop, we live for the day that a witness has
information like you had. Well done! As far as the cyclists injuries, this
type of an accident is an automatic trauma system entry and will likely
result in going to Emmanuel or OHSU unless the victim has clearly only minor
injuries. It doesn't necessarily mean the injuries are life threatening,
only that there is a high probability that they might be. In addition to the
Felony HR, he could also be charged with vehicular assault, which depending
on the injuries would also likely be a Felony. Again, you did exactly the
right thing! Is everyone out in OBRA land taking notes???
Doug
-----Original Message-----
From: obra-bounces@list.obra.org [mailto:obra-bounces@list.obra.org]On
Behalf Of Susan Otcenas
Sent: Monday, June 12, 2006 9:16 AM
To: 'shift list'; obra@list.obra.org
Subject: [OBRA Chat] Lessons learned from witnessing a hit-and-run
Apologies for the cross-post.
Last night I witnessed a hit-and-run. Motorist mowed down a cyclist riding
in a bike lane. Without going into great detail about the incident, I
learned a few lessons I wanted to share.
1) I knew license plate number, make, model and color of vehicle, etc. But
the officers responding on the scene asked several times "Can you describe
the driver?" Other than the briefest of descriptions (like "male, olive
complexion"), I couldn't. So if you can get a good look at the driver, be
sure to do so.
2) If you see someone driving erratically, call 911. In this case, I had
explicit information on the vehicle, because I was *already* in the process
of calling the police when he hit the cyclist. I'd been observing the
vehicle for about a mile (I was driving, and he was in the adjacent lane),
and I could tell the driver was impaired. As we approached the cyclist, it
was like a horror movie unfolding. I KNEW he was going to hit the cyclst.
I could see it coming but was powerless to stop it. So, if you ever see
someone driving suspiciously, don't hesitate - you should call it in. You
could be saving someone else's life.
3) Carry a cell phone. The cyclist was coherent enough to dial his wife.
I spoke with her and reassured her that he was conscious, that the ambulance
had arrived, and kept her updated on where the ambulance was taking him. I
was wishing for a camera-phone, so I could take a photo of his position,
where the bike landed, etc. You just never know when that info might be
useful to prosecutors.
4) There are some things we can not "protect" ourselves from. So often in
these cases, non-cyclists, reporters, etc. ask "what can cyclists do to be
safer on the roads?". And sometimes, the answer is Nothing. This cyclist
was wearing a screaming yellow jersey, in broad daylight, in a bike lane,
and was wearing a helmet. He had the misfortune of being on the road at the
same time as a driver with very little respect for human life. While I
consider myself to be a relatively skilled and observant cyclist, I never
assume that I'm safe out there. I pay up for a comprehensive health
insurance plan.
Now, the "good" news. The driver was apprehended! He hit a vehicle a few
miles away. Apaprently attempted to abandon his vehicle, but was caught
first. Guy was drunk. He reportedly had multiple previous DUIs. The
police office on the scene told me the charge for hitting the cyclist would
be felony hit-and-run, and with so many witnesses (there were others besides
me), a second collision, and apprehension while still under the influence, I
have to believe the guy will get convicted, and hopefully some jail time.
The bad news, of course, is that the cyclist was pretty banged up. Multiple
lacerations, huge hematoma on his leg, dislocated shoulder (or broken collar
bone, uncertain at scene) and head trauma sufficient to have him sent to
Legacy instead of St Vincents.
Susan
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