Why would an
ambulance service provider serving Duneland ever transport a seriously
injured person, in grave danger of dying, to a hospital outside Duneland, to
one, say, in Lake County?
That was the
question an indignant reader put to the Chesterton Tribune on Friday
afternoon, prompted by Thursday’s story on the elderly Porter woman who was
struck by a freight train on June 22 at the North Jackson Blvd.
grade-crossing. That woman was transported from the scene directly to
Methodist Hospital Northlake Campus in Gary, where she later succumbed to
her injuries.
Why, the reader
wanted to know, was the woman transported to a facility in Gary and not to
Porter Regional Hospital (PRH), located as it is just down the road on U.S.
Highway 6 in Liberty Township, where more immediate access to medical
treatment might potentially have saved her life?
The short answer to
that question is this: because the paramedics had no choice in the matter,
were legally obligated to transport their grievously injured patient to
Methodist Northlake, and would have exposed themselves to liability had they
not done so.
Under the “Trauma
Field Triage and Transport Destination Protocol” established by 836 Indiana
Administrative Code 1-2.1, ambulance service providers are required to (1)
assess the condition of an injured person using “Guidelines for Field
Triage,” then (2) determine whether that person needs “trauma center care,”
and finally (3) transport that person to the nearest trauma center,
unless transport time exceeds 45 minutes or in a paramedic’s judgment
the person’s “life will be endangered if care is delayed by going directly
to a trauma center.
PRH is not an
officially designated trauma center. The nearest one to Chesterton--by
ground transport--is Methodist Northlake. There are three others to which
persons who sustain traumatic injuries in Porter County might also be
transported by air: the University of Chicago Medical Center; Advocate
Christ Medical Center in Oak Lawn, Ill.; and Memorial Hospital of South
Bend.
The following
injuries automatically trigger a patient’s transport to the nearest trauma
center:
* All penetrating
injuries to head, neck, torso, and extremities proximal to elbow or knee.
* Chest wall
instability or deformity.
* Two or more
proximal long-bone fractures.
* Crushed, degloved,
mangled, or pulseless extremity.
* Amputation
proximal to wrist or ankle.
* Pelvic fractures.
* Open or depressed
skull fracture.
* Paralysis.
* Falls of 20 feet
or more (or of 10 feet for children).
* High-risk auto
crash in which there’s been ejection or another occupant’s death in the same
passenger compartment.
* Auto vs.
pedestrian/bicyclist thrown or run over or hit by a vehicle traveling at
speeds greater than 20 miles per hour.
* Motorcycle crash
at speeds greater than 20 mph.
The following
factors could cause paramedics to decide to transport an injured person to a
trauma center even if none of the preceding conditions is altogether
applicable:
* The patient is
older than 55.
* The patient is a
child.
* The patient has a
bleeding disorder or is prescribed anticoagulants.
* The injuries
include burns.
* The patient is
more than 20 weeks pregnant.
“The bottom line is
that the paramedic must follow protocol (and there is protocol for
everything),” Chesterton Fire Chief John Jarka told the Chesterton
Tribune. “Paramedics must make the decision on transport while knowing
their license could be taken away if the wrong decision is made.”
A trauma center
officially designated as such by the American College of Surgeons (ACS) must
fulfill hundreds of medical, bureaucratic, and organizational criteria. Just
a few of them:
* An ACS-certified
trauma center must care for a minimum of 1,200 trauma patients per year or
admit at least 240 patients with a high “Injury Severity Score.”
* Its on-call
trauma surgeon must be dedicated to a single trauma center while on duty.
* It must
participate in regional disaster management plans and exercises.
* An emergency
physician must be present in the department at all times.
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