Seems the neato thing to do these days is get your hospital registered some kind of specialist center.  we have STEMI Centers, Stroke Centers, Trauma Centers, Burn Centers, Pediatric Centers and so on and so on.  Well, in my system we also have a microsurgery center.

So I got a text message on July 3rd from an old intern who had an interesting question:

John- “If I get a firework injury with fingers blown off, but there is burns, do I go to burn center, microsurg or trauma?”

HM- “You decide, because each of the decision matrix end with Paramedic Judgment. If the burns are considered extensive, go to the burn center, unless there is significant trauma, otherwise go to the trauma center.  BUT, if there is tissue that could be salvaged and repaired, immediate transport to the micro surg unit is warranted.”

John- “What about a peds?”

HM- “The system will implode.”

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