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Imperial County REACH field transport to RCHSD CASE Study Field transport of 2 year old

Imperial County REACH field transport to RCHSD CASE Study Field transport of 2 year old. 24%. 52%. 77%. Timeline. - Child injured approximately 1930. -Child arrived at RCHSD Trauma room at 2123 (< 2 hours) -2150 In CT -2200 In PICU. Resuscitation Phase of Care.

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Imperial County REACH field transport to RCHSD CASE Study Field transport of 2 year old

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  1. Imperial County REACH field transport to RCHSDCASE Study Field transport of 2 year old 24% 52% 77%

  2. Timeline -Child injured approximately 1930. -Child arrived at RCHSD Trauma room at 2123 (< 2 hours) -2150 In CT -2200 In PICU

  3. Resuscitation Phase of Care Primary survey:A&B=BVM Ventilation Breath sounds = and O2 Sats 100, C=HR 140, BP 88/34, Pulses palpable, CRT 2 sec Neuro 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.

  4. Identified Injuries on imaging: 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.

  5. Hospital Course PICU Days: 10 Hospital days: 12 Specialists involved: Trauma Ophthalomology Intensive care Audiology Orthopedics OR team (2 operations) Infectious Disease ENT Neurosurgery Neurology

  6. Outcome -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.

  7. 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!!

  8. REACH/RCHSD collaborationfor the future • Joint Imperial County education offerings • Joint field care audit case presentations

  9. Imperial County Transfers to RCHSC, a historical perspective….. Imperial County

  10. Imperial County IFTs to RCHSD1/00 through 7/09 N=430 23% 77%

  11. Imperial County IFTs to RCHSDby Gender 01/00-07/09 N=430 24% 32% 68%

  12. Imperial County IFTs to RCHSDby Age 01/00-07/09 N=430 24%

  13. Imperial County IFTs to RCHSDBlunt vs Penetrating 01/00-07/09 N=430 24% 96.3%

  14. Imperial County IFTs to RCHSDBy Ethnicity 01/00-07/09 N=430 24% 52% 77% White Hispanic Black AsianPac Native Am Other

  15. Imperial County IFTs to RCHSDBy Mechanism of Injury 01/00-07/09 N=430 24% 52% 77%

  16. Imperial County IFTs to RCHSDDeaths by Mechanism of Injury 01/00-07/09 N=7 24% 52% 77%

  17. Imperial County IFTs to RCHSDBy Time of presentation to RCHSD 01/00-07/09 N=430 24% 52% 77%

  18. Imperial County IFTs to RCHSDBy Day of presentation to RCHSD 01/00-07/09 N=430 24% 52% 77%

  19. Imperial County IFTs to RCHSDby Physician Specialty Consultations 01/00-07/09 N=430 24% 52% 77%

  20. Imperial County IFTs to RCHSDby ED disposition 01/00-07/09 N=430 24% 77%

  21. Imperial County IFTs to RCHSDSeverity of Injury 01/00-07/09 N=430 24% 52% 77%

  22. Imperial County IFTs to RCHSDby Total Hospital Days 01/00-07/09 N=430 24% 52% 77%

  23. Imperial County IFTs to RCHSDDischarge Disposition 01/00-07/09 N=430 24% 52% 77%

  24. Questions? 24% 52% 77%

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