Transport Decisions - Yonkers to Jacobi or WMC?

[EXDC203 38]

Why does Empress transport most patients out of Yonkers? 2-3 blocks from a hospital & they transport to Jacobi or WMC. I dont want start a pissing match here. I would just like a valid answer.

[helicopper 1,050]

Candidates for a trauma center, burn center, or other specialty service should be transported to such a facility. None of the local hospitals within the City of Yonkers (or Bronxville) are trauma centers or have burn units requiring transportation out of the city for such services.

Statistically I doubt the "majority" are transported out of the city; it is just the noteworthy cases going to trauma/burn centers that call attention to the process.

This is not an Empress practice; it is compliance with NYS EMS protocols.

Applicable excerpt from NYS Protocol (emphasis added)

Transport

A. Transport the patient as soon as possible to the nearest appropriate hospital.

1. If mechanism of illness/injury and/or historical/physical findings do not indicate

major trauma:

a. Transport the patient to the nearest regionally approved1 hospital

emergency department (ED); or

b. Transport the patient to a regionally approved1 alternative destination if:

(1) The patient remains stable throughout transport, and

the patient requests treatment, or receives regular medical/surgical

care, at the alternative destination, and the additional transport

time to the alternative destination is less than 20 minutes; or

(2) The patient requires specialty care available at the alternative

destination that is unavailable at the nearest hospital; or

(3) An on-line medical control physician so directs.

2. If mechanism of injury and/or physical findings do indicate major trauma:

a. Transport the patient to the nearest designated Regional or Area Trauma

Center if the total time elapsed between the estimated time of injury and

the estimated time of arrival at the Trauma Center is less than one hour

(see Appendices for a list of the New York State Designated Trauma

Centers); or

b. Transport the patient to the nearest hospital emergency department if:

(1) The patient is in cardiac arrest; or

(2) The patient has an unmanageable airway; or

(3) An on-line medical control physician so directs.

(4) If total time elapsed between estimated time of injury and

estimated time of arrival to the trauma center is more than one hour

or if transport time from the scene to the trauma center is more

than 30 minutes , contact medical control.

[EXDC203 38]

Candidates for a trauma center, burn center, or other specialty service should be transported to such a facility. None of the local hospitals within the City of Yonkers (or Bronxville) are trauma centers or have burn units requiring transportation out of the city for such services.

Statistically I doubt the "majority" are transported out of the city; it is just the noteworthy cases going to trauma/burn centers that call attention to the process.

This is not an Empress practice; it is compliance with NYS EMS protocols.

Applicable excerpt from NYS Protocol (emphasis added)

Check the Majority figures........then get back to me.

[EXDC203 38]

A. Transport the patient as soon as possible to the nearest appropriate hospital.

If you are two blocks away from a hospital, any hospital, do you think its better to go to that facility & stabalize, then move to a trama center or put in a ambulance and drive 15-20 minutes, then try to save them? Give me your HONEST opinion, not NYS protocal.

Edited March 7, 2009 by EXDC203

[x129K 1,393]

I did ALOT of trauma when I worked at the Big E...I was no FAC911, but I got my fair share...

If the patient met the requirements for a trauma center - they went...either north or south...depending on the place of occurance. 95 percent of the time by ground, but occasionally via air....seeing a helo land on South Broadway is pretty damn neat..

If the patient did not require a TC - they went locally..

With 2 great TC's so close to the city - why NOT use them? After all - its about the patient right?

[Medic137 6]

The vast majority of patients in Yonkers are transported to Yonkers hospitals.

This is because:

1. NYS protocol.

2. Most patients express a preference for one of the local hospitals.

3. Transporting to a local hospital allows a shorter turnaround time for the ambulance.

4. The more patients a service brings into a hospital, the more likely it will be called for the outgoing transfers.

The patients that are transported to Jacoby or WMC need the specialty services that the local hospitals can't provide:

Trauma, Burns, High risk pregnancy.

The "cure" for trauma is surgery. For surgery to be effective, it should take place during the first "Golden Hour" after the injury.

Despite what you see on "ER", surgery is not done in the Emergency Department. Trauma centers are prepared to fire up an

operating room within minutes of a trauma patient arriving at the hospital. A local non trauma hospital might need hours to assemble an OR staff. They may not be able to do neurosurgery at all. Therefore, bringing a trauma patient to a non trauma hospital delays definitive care and leads to poorer outcomes.

Edited March 7, 2009 by Medic137

[Bnechis 3,961]

If you are two blocks away from a hospital, any hospital, do you think its better to go to that facility & stabalize, then move to a trama center or put in a ambulance and drive 15-20 minutes, then try to save them? Give me your HONEST opinion, not NYS protocal.

Its NYS protocol for a reason, half a dozen national studies and years of statistical data show your chances drop if you go to the local to "stabilize" unless the transport time will be more than an hour.

In my experience, I have only seen one local hospital "stabalize" and transport within 15-20 minutes. I've seen a number of ER's staibilize for and hour or more until the patient is completely stable and will never get worst (read dead). Once in a facility most try to do there best, but transfering to another facility does not happen for hours.

[Guest alsfirefighter]

A. Transport the patient as soon as possible to the nearest appropriate hospital.

If you are two blocks away from a hospital, any hospital, do you think its better to go to that facility & stabalize, then move to a trama center or put in a ambulance and drive 15-20 minutes, then try to save them? Give me your HONEST opinion, not NYS protocal.

Opinion has nothing do with the question you asked. Opinion is why you're more then likely even asking the question you are as most that don't understand why trauma centers are what they are and why local hospitals are what they are and also as you even put what it means to "transport the patient as soon as possible to the nearest appropriate hospital." I'm not trying to sound pointed...but those who are not medically trained have opinions about care and treatment. Those of us that are have knowledge and facts. So it is of my medical knowledge, experience and practice that no it is not better to go to the local facility if they are not equipped to handle the case you have.

Local hospitals who are not designated as trauma receiving facilities at least as a level 2 are not "appropriate" for any trauma patient unless there is difficulty in securing an airway or they are in traumatic arrest. Local "community" hospitals are not equipped in most cases to be able to promptly stabilize a trauma case to begin with...that is what trauma centers are for and what occurs when you walk through the door and walk into a trauma room with a patient. I have seen the pitfalls of local hospitals and their "stabilization" attempts and very few were successful outcomes. If you were having a stroke...would you want me to bring you to the "local" hospital if they weren't a "stroke" center? If my closest facility was on diversion and you were having a massive MI would you want me to bring you to the next "local" hospital or right to the facility with the cath lab?

I can pretty much say that the majority of patients do not go to WMC or Jacobi with Empress...the majority of the trauma/burn cases go there and that is the correct choice....not just within protocol...but within accepted medical practice. 911 wise most people go to 1 of the big 3 in the area.

[crcocr1 8]

Further local hospitals do not have a trauma surgeon on call on in-house, nor a fully equipped operating room, with all necessary tools and instruments to effectively treat the trauma patient. You can give a patient all the fluids you want, but they will need surgery as soon as possible to live.

[emp305 32]

Why does Empress transport most patients out of Yonkers? 2-3 blocks from a hospital & they transport to Jacobi or WMC. I dont want start a pissing match here. I would just like a valid answer.

Most of the posts in regards to this question have been correct and valid.

First let me be clear Empress does not transport most Pt's out of Yonkers, period (I know the numbers). There is no pissing match.

Empress follows NYS and regional protocol because it has too and it makes sense!! All Pt's every single one that meets the criteria for a specialty care facility, Trauma or Burn will leave Yonkers and go to that facility. By, the way in such cases JHMC or WCMC are the closest appropriate facilities. As for being two or three blocks from a hospital, it could not matter any less. If the job is a trauma and it's within sight of a yonkers hospital they Empress will not violate the protocols or fail to act in the best interest of the Pt.

If you give it some thought it doesn't help Empress to transport to JHMC or WCMC or even SSMC (level 2 TC), in fact it can have a negitive impact on local operations if an incident dictates that numerous Pt's must leave the city at one time, the more units out of the city the less there are inside.

Pt's leave Yonkers only when it's appropriate it does no good to take a trauma Pt to a local hospital, to start with the Pt. will suffer, the resources of the hospital will suffer, the other Pt's in the ED will suffer, and the Medic will suffer becuase thier actions will be called into question by thier Supervisors, the Doctor in the local ED, and even the agency Medical director.

Your question is based on a very false assumption, one which I doubt you actualy beleive....

[INIT915 1,119]

Why does Empress transport most patients out of Yonkers? 2-3 blocks from a hospital & they transport to Jacobi or WMC. I dont want start a pissing match here. I would just like a valid answer.

I left Empress +/- 9 years ago, but at that time, all patients went to Local ED's (except Traumas).

[emp305 32]

Why does Empress transport most patients out of Yonkers? 2-3 blocks from a hospital & they transport to Jacobi or WMC. I dont want start a pissing match here. I would just like a valid answer.

Did you get your "valid anwser" yet?

[StOpGoBlUE 11]

i have been at The BIG E for a while now and i have yet to transport to jacobi or wcmc for any BS job majority of the people goto St joes St johns Lawernce Or Mt vernon all dependS on were you are in the city or patient request.. i have only seen jobs goto wcmc and jacobi for major traumas that meet protocol to go ther soo i dont see what your fuss is all about here.... GET YOUR VALID ANWSER YET?

[NJMedic 96]

A. Transport the patient as soon as possible to the nearest appropriate hospital.

If you are two blocks away from a hospital, any hospital, do you think its better to go to that facility & stabalize, then move to a trama center or put in a ambulance and drive 15-20 minutes, then try to save them? Give me your HONEST opinion, not NYS protocal.

If it a trauma patient...yes. I would rather transport a patient 20 minutes to a trauma center then go 5 minutes to a general hospital. The only method to stablize a significant trauma patient is with surgery. Most general hospital are not set up to do immediate surgery. Most non-trauma center hospitals I deal with freak out with you bring them a trauma patient, they certainly don't want them. Pretty much the same with burn patients.

[ny10570 745]

While there is more and more evidence debunking the "golden hour", there is much more evidence showing that the right facility is much better than the closest facility. Its getting to the point where anything above BS is going to have a specialty facility. Right now NYS recognizes Burn, Adult Trauma, Pediatric Trauma, Psychological, Stroke, Envenomation, and Re-implantation as specialty referrals. NYC has added post arrest, Cath Labs, sexual assault, and soon to come child abuse. (I think I got all of them)

[firecoins 2]

I would rather transport to a trauma center 20 minutes away than a closer local hospital.

[helicopper 1,050]

A. Transport the patient as soon as possible to the nearest appropriate hospital.

If you are two blocks away from a hospital, any hospital, do you think its better to go to that facility & stabalize, then move to a trama center or put in a ambulance and drive 15-20 minutes, then try to save them? Give me your HONEST opinion, not NYS protocal.

Honest opinion, you're better off going directly to a trauma center (do not pass go, do not collect $200) unless there are compelling reasons not to (such as an unmanageable airway, cardiac arrest, etc.). The scenario becomes far more complicated if you go first to a local hospital. Now its an interfacility transport with all the attendant regulations, requirements, and BS. And even if my opinion were to the contrary, protocol is protocol.

Trauma centers guarantee levels of service that are simply not avialable in community hospitals. Surgeons, C-T/MRI scanners, etc.

ny10570 - I think you got 'em all!

Check the Majority figures........then get back to me.

You asked the question. You got answers from past and present Empress employees plus others knowledgable on the subject and you want us to get back to you? Come on, really? Honestly, what's your problem with Empress transporting from Yonkers to the right place?

Feel free to request the statistics from the Department of Health if you don't believe us but I'm at a loss for why the "numbers" are such an issue for you - unless you were just hired as VP of Marketing at one of the Yonkers hospitals...

[Guest EFFP411]

Even IF you have the numbers from transports out of Yonkers, do you have the information about each call, whether medical control was contacted for advice and to see if the "closest Facility" could handle this patient or that? Do you know the extent of each case that was transported to Jacobi or WMC? Why it is such an issue to you is beyond me, but until you have presenting problems, extenuating circumstances, and deeper knowledge of each patient that was brought somewhere OTHER than a local facility on hand, you shouldn't question the reason, just know that the decision and outcome were best for the patient. And while i do not work in the area in question I don't doubt one bit the reasoning and experience of the medics/EMTs working the area that led them to make the decision to transport wherever they did at the time... Unless of course you were either there, or were one of the patient's that was taken somewhere else and you don't feel the right decision was made, but that is a whole different ballgame

Edited March 8, 2009 by EFFP411

[Noula 0]

A. Transport the patient as soon as possible to the nearest appropriate hospital.

If you are two blocks away from a hospital, any hospital, do you think its better to go to that facility & stabalize, then move to a trama center or put in a ambulance and drive 15-20 minutes, then try to save them? Give me your HONEST opinion, not NYS protocal.

No offense, but it sounds to me like you don't have much if any experience in medicine, much less emergency medicine. I know shows like ER show trauma means someone bleeding out every possible place, with crush injuries, two collapsed lungs and major airway compromise. Well, I'm relatively new, but I've yet to encounter a trauma patient like that. There's a certain amount of "stabilization" one can do in the ambulance. If you manage the pt's injuries/condition then another 15-30 minutes to a different hospital isn't really going to change much. What will hurt the patient is going to a facility that can't treat their injuries, having to wait to get triaged, wait to get assessed by those doctors, then wait for a transport bus (usually at least an hour from when it's called) to go to the appropriate facility.

You are also spoiled by living in an area dense with hospitals. The fact that in westchester county the closest trauma center is usually only 20-30 minutes away is fantastic. Go live in other parts of the country and sometimes the closest HOSPITAL period is 30-40 minutes away.

All in all, you can say you want opinions instead of protocol, but any EMT/medic that ignore protocol and does what they think will wind up with their license revoked sooner or later. Protocols are there for a reason.

[Guest alsfirefighter]

Not that I'm shocked...but I guess we won't be hearing any additional comments back.

[Oswegowind 17]

A. Transport the patient as soon as possible to the nearest appropriate hospital.

If you are two blocks away from a hospital, any hospital, do you think its better to go to that facility & stabalize, then move to a trama center or put in a ambulance and drive 15-20 minutes, then try to save them? Give me your HONEST opinion, not NYS protocal.

A little late to this...but ARE YOU KIDDING ME!!! Please don't ever be responding to the job that I am the patient and need real help! Besides St. Joes, the other 2 "Yonkers" hospitals are not nearly ready for trauma. St. Joes isn't ready either, but they get more traumatic cardiac arrests and serious cases than the other 2. Jacobi is not 20 minutes away...I am sure we all got there in about 10...especially if you knew how to get there. You have to get someone to DEFINITIVE care...not well we patched him, take him elsewhere care!

But, thank you for reminding us how much people actually know...I think a few of us forget from time to time how people have no clue and post things like this trying to "call out" a number of people who are damn good at what they do or did in Yonkers. And as for transporting out of the city...that was a cardinal sin at empress unless they paid up front so take your GUESS and go find another place to voice it!

And that is my honest OPINION!

[Guest TOYBUFF911]

Empress does a good job and follows protocol and always goes to a trauma center when iffy. Majority of patients are kept local.

[chovesh 1]

With all due respect, what will transporting to the nearest hospital do for a patient with major trauma? The patient doesn't need an ER. The patient needs an OR. Only a trauma center has an OR and team ready all the time. Think about it, the normal ER won't do MUCH more than EMS to stabilize the patient enough for surgery. Think back to the golden hour: from trauma to definitive care whereas definitive care is surgery.