My question is in regards to our traumatic TOR protocol – more specifically, why is a trauma TOR ALWAYS contraindicated for penetrating trauma to the torso or head/neck when the LTC is <30mins away? I am looking for clarification and rationale on this because this contraindication seems to be all-encompassing without taking other clinical factors into account (ie. extent of injuries, pts age, complications of resuscitation, presenting rhythm, medical hx, etc.) For example: I attended a traumatic VSA, <30mins from the LTH. Pt was 90yo with a suspected self inflicted gsw to the head. In this incident there was no definitive time of arrest and the pts presenting rhythm was asystole. Entry wound identified to the head, no exit wound and no gross distortion of anatomy (did not meet any obviously deceased standards). The initial crew was unable to secure/maintain the pts airway due to bleeding in the pts airway - indicating that there was no oxygenation/ventilation during the initial resuscitative efforts. I may be wrong but I believe that this pt arrested due to anatomical injuries rather than exsanguination. This pt sustained grievous injury not conducive to life for which there is no definitive tx. This pt is an extreme case; pt was elderly, on blood thinners, sustained irreversible injury, asystolic arrest with complications during care. However, none of these clinical factors are applied to our trauma TOR. I am reaching out for clarification/rationale as to why this pt should not be routinely considered for a trauma TOR.

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.

If a patient is VSA due to a trauma related mechanism, do you still trauma bypass to a LTH (lead trauma hospital).