Sunil,
Emphasis should move away from time spent travelling to time to definitive care.
For acute MI - thrombolysis - pre-hosp thrombolysis is invariably faster than in-hosp thrombolysis (though we have debated this before). Interestingly, Swedes are quoting a 26% referral rate to cath labs for failed reperfusion following primary thrombolysis.
For internal haemorrhage secondary to trauma - 10% of blunt ISS >15 trauma - time to operative intervention - probably better to travel longer distance to centre with on-site surgeon.
For CVA less than 3 hours less than 65 years of age - travel longer distance straight to neurologists for CT and ?thrombolysis.
For acute subdural - surgery within 4 hours from time of injury (Becker, et al) - again, probably better to travel straight to neurosurgical centre.
Anton
In message <[log in to unmask]> Sunil Dasan <[log in to unmask]> writes:
> Does anyone have any information regarding increased ambulance travelling
> times and any potential associated adverse outcomes? We are currently
> moving services within our Trust so that all acute services are on one site.
> This could add anything upto 30 minutes to travelling time for ambulance
> trying to get to us. The public in some areas of our patch are
> understandably concerned about the problems this may cause. There is
> probably a wealth of evidence out there, but I was hoping for a few
> pointers!
>
>
>
> Sunil
>
>
>
>
> http://www.surreyandsussex.nhs.uk
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