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Discussion

Level III trauma

     I am an RN and have extensive surgical experience in Level I trauma facilities.  For the last several years though, I have worked in the OR of a Level III hospital and have been glad not to have the stress and chaos of surgical trauma.  Recently, however, my last few nights of call have been a stab wound to the abdomen (with liver and renal lacerations), splenic fracture, and this past weekend, GSW to the abdomen with active CPR, multiple blood products....pt. expired on the table.  This seems to becoming a new trend and mind you, this is a Level III hospital.  We have an old cell saver and Belmont infuser (similar to a rapid infuser), but the ancillary staff don't really know how to set up or operate.  Plain and simple, this hospital is ill-equipped and has no business accepting patients requiring this level of care.  What would you advise? I have an interview at another local hospital (also Level III) that I know doesn't have these types of patients.  

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    What you do not see is that often these types of injuries will arrive at ED at your facility before being transferred to a level I facility.  There are times that the surgeon has no choice but to take the patient to the OR at the level III because the patient can not wait for the transfer to a level I because their only chance is to go to your OR.  There was no way the patient with the GSW could have been transferred out even if a helicopter was sitting on the pad at your facility with active CPR.  

    I have worked at level III's both in the ER and OR, both in the south & north, and at times there was no way to transfer patients out because of weather.  

     

     

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    We are lvl III and from time to time we do stabs and GSW. I think it depends on the surgeon who im on call with honestly. Some won’t operate and fly out immediately and some will take the ones that are less severe to the OR- like maybe a liver laceration or soft tissue damage. We have done emergent splenectomies too for MVA’s. We have 6 general surgeons that all rotate call. 

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