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. 

Patients with penetrating injuries to the head, neck, or torso may have a chance of survival following hospital transfer due to the availability of surgical interventions that are not feasible in a prehospital setting or even non-LTHs. A notable example is thoracotomy for penetrating central injuries. The direction to transport these patients aims to maximize their opportunity for further resuscitation by ensuring timely access to the trauma team. While many individuals with such injuries may not ultimately receive any intervention, the Standards and Medical Directives are designed to optimize survival outcomes for the greatest number of patients. Given the complexity of trauma management, it is not feasible to encapsulate all the factors considered by the trauma team in determining the appropriateness of an intervention while maintaining the directive’s practicality and applicability. 

Cardiac/Circulation,Trauma Cardiac Arrest

Field Trauma Triage Standard, FTTS, Lead Trauma Hospital, LTH, Penetrating Trauma, Traumatic arrest

Godbole M, et al. Eastern Association for the Surgery of Trauma (EAST) vs Western Trauma Association (WTA): How a Level 1 Trauma Center Splits the Difference in Resuscitative Thoracotomy. Cureus. 2024 Mar 20;16(3):e56521. doi: 10.7759/cureus.56521. PMID: 38646323; PMCID: PMC11026983. https://pmc.ncbi.nlm.nih.gov/articles/PMC11026983/