What do you think of 6 hr transport time from Aspen X-games?

Specialties Emergency

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Specializes in ER.

X-games snowmobiler Caleb Moore died from a cardiac tamponade a year ago, after an accident at the games in Aspen Colorado. There was a 6 hr transport to St Mary's in Denver, the length of which contributed to his death.

Here is the results of the autopsy.

http://xgames.espn.go.com/article/9252843/autopsy-x-games-snowmobiler-caleb-moore-died-blunt-chest-trauma

I'd like to know why an elite site such as Aspen Colorado doesn't have an elite EMS system? I'm, frankly, appalled.

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X-games snowmobiler Caleb Moore died from a cardiac tamponade a year ago after an accident at the games in Aspen Colorado. There was a 6 hr transport to St Mary's in Denver, the length of which contributed to his death. Here is the results of the autopsy. http://xgames.espn.go.com/article/9252843/autopsy-x-games-snowmobiler-caleb-moore-died-blunt-chest-trauma I'd like to know why an elite site such as Aspen Colorado doesn't have an elite EMS system? I'm, frankly, appalled.

He went to Grand Junction, which is a bit closer to Aspen.

I don't think it was an EMS delay, as it was a diagnosis and send to a more appropriate facility type of delay. If Flight for Life took off from Saint Mary's it could have bee an hour before departure from Grand Junction, flight time, load time at hospital, transport time to landing pad/airport (if it was a fixed wing) flight time back to GJ. 6 hours easy. I don't know for sure the rating of Aspen Hospital, but I would not put it above a Level Three, and then you have to think about the skill of the ER docs. A lot adopt a wait and see before calling the Calvary.

ETA: Are you familiar with that area? Mountainous and remote. I am not familiar with the story, but I would be surprised if he went by Ground, unless they were worried about thoracic pressures during flight.

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Specializes in ER.

I'm very familiar with mountainous terrain, living in Washington State and being an avid skier/snowboarder.

Six hours is absolutely unacceptable. Here in the Pacific NW, the patient would have been airlifted to Harborview.

Aspen is a major ski venue. The X-games are the ultimate ski/snowboard/snowmobile acrobatic, and dangerous event.

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I am not saying there isn't room for improvement or that their protocols don't need to changed, however, you also have to look at resources.

I just looked at Aspen Valley Hospitals website. It is a 25 bed total Critical Access hospital with two Cards on call. No Cardiothoracic Surgeons available. It takes time to get a fixed wing or Helicopter in when it isn't already there, and it takes time for diagnosis and transport. St. Mary's is the closest Level II, and if it was CareFlight, it would have taken time to get off the ground.

Why hold the games there? Why not hold them at Copper or Vail, which would have closer access to Denver and a Helicopter?

It will be something that they need to plan for in the future.

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Specializes in Critical Care.
I'm very familiar with mountainous terrain, living in Washington State and being an avid skier/snowboarder.

Six hours is absolutely unacceptable. Here in the Pacific NW, the patient would have been airlifted to Harborview.

Aspen is a major ski venue. The X-games are the ultimate ski/snowboard/snowmobile acrobatic, and dangerous event.

So long as they can fly they will get airlifted to harborview, although it's not at all unusual, particularly during the winter, for people to have to go by road at least part if not all the way to the proper facility due to grounded helicopter conditions.

You also have to remember that Harborview and other hospitals in Washington serve Southeast Alaska, so even by helicopter or fixed wing it can take hours for a patient to get transported.

Caleb Moore wasn't in transport for six hours, it was six hours from the time of injury to arrival at a higher level center. I would guess they initially were concerned mainly with the head injury and the pericardial effusion diagnoses was secondary. Obviously in retrospect they should have performed needle centisis prior to transport, which doesn't require a CT surgeon and should be in the scope of any ER doc in a facility without CT surgeon services.

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Muno,

I think the key phrase is "should be." My experience with the smaller hospitals is that it isn't always the case.

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Specializes in Critical Care.
Muno,

I think the key phrase is "should be." My experience with the smaller hospitals is that it isn't always the case.

No argument there, and it might be more understandable in a 'typical' small town hospital where each ER doc might see acute tamponade requiring immediate intervention once every 10 years. But in Aspen, which probably sees more trauma in their ER than a medium sized city, at least temporary trauma interventions should be available. But yes, 'should be' is the key part. Plus, it's supposedly level III, which should include this level of trauma stabilization.

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Specializes in ER.

It just really upsets me that a prestigious event such as the X-games wasn't more prepared. You can google the accident video, it's obvious that chest trauma occurred, with the snowmobile landing on Caleb's chest.

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With Aspen, I agree, especially since they tout that they are connected with Mayo and is in the top 100 of Critical Care Access. But at this point it is a could have, would have, should have moment.

Take what you can from it and learn.

May I be so bold to add: it doesn't seem like catching "Big Air" with a snowmobile is the smart thing to do. I am not blaming Caleb, but it just doesn't seem like they were made for that.

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Specializes in ER.

I guess I'm wondering what sort of EMS preparations they have for these games? As an example, car racing is a dangerous sport. They have fire and EMS crews trained in jaws of life extractions on scene.

It seems for the X-games, the risk is for head, spine injuries, and crush injuries in the snow mobile competitions. It's a 2 hr 11 min drive to Grand Junction. But, this young man should have been brought by helicopter. The games should have plans for this.

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Specializes in ED, OR, Oncology.

If there's not a Helo based in Aspen, having one sit on the ground for events like this is going to get expensive for somebody. There is risk of big traumas all the time at a place like that, but if they aren't doing the volume that someone thinks it is profitable to station air transport there (with crew), paying one to sit there on standby is going to be pricey.

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I guess I'm wondering what sort of EMS preparations they have for these games?

It seems for the X-games, the risk is for head, spine injuries, and crush injuries in the snow mobile competitions. It's a 2 hr 11 min drive to Grand Junction. But, this young man should have been brought by helicopter. The games should have plans for this.

"The Games" might have had plans for that. It seems that Caleb was transported from the venue to the CAH, at which point all the planning that The X-Games has done for injury prevention, treatment and transport goes out the window and the burden now falls on the shoulders of the CAH that he was transported to. Caleb had a timely extrication from the venue to the CAH thanks to The X-Games and local/contracted EMS arranged by the event planners, but if the ED MD does not identify the need for a higher level of care, or arrange the proper transport to the facility of choice then that can have a worse effect than a slow extrication from the scene of the original injury.

It seems like one of three things happened:

1) The doctor at the CAH noticed the need for a higher level of care but did not think that heli transport was necessary and that the given the severity of Caleb's injuries as they presented to him in the ED he would be okay with ground transport. Or...

2) The doctor at the CAH noticed the need for a higher level of care and called for heli transport, but they were unavailable for calls at the time so the MD opted to transfer by ground. Or...

3) The doctor at the CAH noticed the need for a higher level of care and called for heli transport, but due to severe weather conditions (in Aspen or on the way to Aspen) they were grounded necessitating the transfer to a higher level of care via ground transport.

Whatever the case may be on that particular day, it seems like the X-Games followed their EAP (Emergency Action Plan) and transported to the closest ED. It seems like the break in the chain of survival happened at the CAH when the ED MD was arranging transport to the trauma center.

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