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).