Specialty Centers Text Discussion

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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9 thoughts on “Specialty Centers Text Discussion”

  1. That’s a very good and interesting question. Coming from an area that had a plethora of “specialty resource centers”, it always made for an interesting discussion over a patient who could go to any of them. Take for example a trauma patient I had a few years ago:

    15 y/o female was enroute to the local L&D hospital because was pregnant and getting a check up. Her 22 year old sister was driving her, she was also pregnant. The vehicle crashed. My patient was the 15 year old and her water broke sometime in the midst of the crash, yet she was between 4 and 6 weeks premature. Did she go to the Pediatric Trauma? Regular Trauma? Hospital with the NeoNate unit (Premie?) or the regular L&D hospital?

    My head nearly imploded over the decision, but we decided to take her to the Peds Trauma hospital due to its location being so close to the regular L&D hospital. That hospital has a phenominal NeoNate team that could and would transfer the baby out to the hospital with the bigger unit if need be.

    But still an awesome question.

  2. That's a very good and interesting question. Coming from an area that had a plethora of “specialty resource centers”, it always made for an interesting discussion over a patient who could go to any of them. Take for example a trauma patient I had a few years ago:

    15 y/o female was enroute to the local L&D hospital because was pregnant and getting a check up. Her 22 year old sister was driving her, she was also pregnant. The vehicle crashed. My patient was the 15 year old and her water broke sometime in the midst of the crash, yet she was between 4 and 6 weeks premature. Did she go to the Pediatric Trauma? Regular Trauma? Hospital with the NeoNate unit (Premie?) or the regular L&D hospital?

    My head nearly imploded over the decision, but we decided to take her to the Peds Trauma hospital due to its location being so close to the regular L&D hospital. That hospital has a phenominal NeoNate team that could and would transfer the baby out to the hospital with the bigger unit if need be.

    But still an awesome question.

  3. That last line had me rolling on the floor laughing. It’s a good point to bring up though. In Virginia, we actually had a free-standing ER that was a certified/accredited stroke center. So if you had a possible stroke to transport, in some areas it was closer to take them to the free-standing ER, (but would you rather take them 8 more minutes east to a place with a brick-and-mortar ICU to avoid needing interfacility transport later?). As far as the trauma, we were lucky that our Trauma, Peds Trauma, Level III NICU, Vascular Surg. and Neurosurg. referral centers were at the same place, but then the Hyperbaric Chamber is off in a community hospital.

  4. That last line had me rolling on the floor laughing. It's a good point to bring up though. In Virginia, we actually had a free-standing ER that was a certified/accredited stroke center. So if you had a possible stroke to transport, in some areas it was closer to take them to the free-standing ER, (but would you rather take them 8 more minutes east to a place with a brick-and-mortar ICU to avoid needing interfacility transport later?). As far as the trauma, we were lucky that our Trauma, Peds Trauma, Level III NICU, Vascular Surg. and Neurosurg. referral centers were at the same place, but then the Hyperbaric Chamber is off in a community hospital.

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