Recently we attended for a call at a marina for an unknown traumatic injury involving a PWC (personal water craft - SeaDoo). After assessing the patient and confirming the MOI from eye witnesses it was revealed that the patient was the driver of the PWC who struck a 20 foot fiberglass pleasure boat while both vessels were underway at "at least 50 K/H". It was unknown if the patient has a loss of consciousness however when the boat turned around to pick him up he was conscious but "dazed". The patient has no complaints when asked initially but it was quite obvious by his mangled left foot that it had likely been struck by the propeller. He had lost a significant amount of blood prior to EMS arrival and the bleeding was uncontrolled with a dressing and direct pressure. Our ambulance was more than 30 mins to transport the patient to the closest appropriate hospital so we decided to request for ORNGE based on motorcycle crash of equal to or greater than 30 km/hr as well as his injuries. When we met the ORNGE crew for a modified transport at the closest local hospital they declined to take the patient and one of the reasons was that he did not meet the FTTS as it was not a vehicle or motorcycle accident.

So the question is, are all other modes of transport/recreation not to be included in the FTTS? There are so many different types of recreational vehicles that I think the wording in the FTTS should be inclusive of all modes of transportation/recreational vehicles due to the inherent dangers associated with the speed they are capable of and the lack of safety, eg.- no helmet on a PWC.

This scenario highlights that the FTTS is not able to list all potential serious mechanisms of injury for trauma patients. The BLS PCS Field Trauma Triage Standard only speaks to Step 3, mechanism of injury (MOI) for “High risk auto crash” along with “Falls”, “Motorcycle crash” and “Pedestrian or cyclist struck by automobile”. By the word of the document, this patient did not meet criteria for FTTS by MOI. The FTTS does list other criteria to be considered including Physiologic (step 1), anatomic (Step 2) and Special Criteria (Step 4; i.e. Age). However, it seems like for this case in question, these criteria were also not met.

Only a finite number of circumstances can be listed in the Standard. The criteria listed within the FTTS help assess patients that would be better served being transported directly to a LTH. If patients do not meet these criteria, it is reasonable for them to be seen initially at the closest ED, then transferred to LTH as appropriate. Whether or not transport is required is dependent on a number of factors including local hospital resources as well as patient factors.

BLS,BLS-FTTS

AAUS, Air Ambulance, Air Ambulance Utilization Standard, Boat, Field Trauma Triage Standard, MOI, Ornge, SeaDoo, Trauma. Mechanism of Injury, Watercraft. FTTS

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