: Patient in traumatic cardiac arrest - trauma centre diversion QUESTION AT THE BOTTOM I am from Hong Kong and for injured patients who are treated by paramedics and need transport to hospital for treatment they have a trauma

Vote Up Vote Down   0 Reactions

Login to give Reaction!

The reasons can be found in the training of Hong Kong paramedics. Their training is roughly comparable to the EMT-Intermediate level in the US. According to the Hong Kong Fire Service, which provides emergency medical services (EMS) in the city, their capabilities are as follows:
www.hkfsd.gov.hk/eng/source/safety/paramedic_amb.html

Defibrillator
To salvage patients in non-traumatic cardiac arrest.
Nitroglycerin (NTG)
To reduce angina pain.
Ventolin & Atrovent To ease shortness of breath in patients having asthma / emphysema / chronic bronchitis.
Intravenous infusion of Dextrose 10% in Water (D10W)
To correct the decreased level of consciousness in patients suffering
from hypoglycemia.
Glucagon
To correct the decreased level of consciousness in patients suffering from hypoglycemia.
Intravenous infusion of Normal Saline
To replenish body fluid in patients suffering from severe blood loss in accidents or other medical emergencies.
Entonox
To reduce pain through patient-controlled inhalation.
Naloxone
To revive patients suffering from narcotic overdose.


In addition, some ambulances are equipped with more
sophisticated drugs and equipment:


Adrenaline
To treat anaphylaxis through correcting shock and breathing difficulty.
Valium To treat convulsion in epileptic children.
Laryngeal-Mask Airway and Combitube To provide better airway management and artificial ventilation for patients in cardiac arrest.

You'll notice that what's missing from the list are intubation and cricothyroidotomy, so they're not well prepared to handle a trauma arrest. The logic behind diverting to the nearest hospital is that without definitive airway control the patient is unlikely to survive a trip any longer than absolutely necessary.

There is an interesting review of traumatic arrest literature that draws this conclusion:

Should you transport the patient in cardiac arrest if the nearest
trauma center is 5 minutes away? Yes. Transport in this case may
provide benefit to the patient as they may be a candidate for
thoracotomy or other advanced surgical procedures.

What about 20 minutes away? Likely no. The patient is unlikely to be a
candidate for thoractomy and aggressive resuscitation should be done
on scene with transport only with ROSC due to the risk to providers
and predicted worse outcome.

It's worth noting that even though American paramedics are trained to perform endotracheal intubation and cricothyroidotomy, trauma arrests are often not transported at all. Where I live, an adult arrest due to blunt or penetrating injury will generally receive three rounds of ACLS on scene. If no pulse is restored, they are not transported.