Patient in traumatic cardiac arrest - trauma centre diversion?

Question

I am from Hong Kong and for injured patients who are treated by paramedics and need transport to hospital for treatment they have a trauma diversion guide. This is for patients with major trauma, designed to go direct to a trauma centre, instead of the nearest hospital. The trauma diversion guide is as follows: If the patient is in cardiac arrest OR cannot maintain airway or breathing they are to go to the CLOSEST hospital regardless if it is a trauma centre or not. If patient is not in cardiac arrest and can maintain airway or breathing, physiological and anatomical criteria will be applied to decide if they need to go to a trauma centre. If they fit ANY of the criteria below, they will be transported to a trauma centre. Physiological Criteria: 1. GCS < 14 2. systolic BP < 90 3. Respiratory rate < 10 or > 29 per minute Anatomical Criteria: 1. Flail chest 2. 2 or more long bone fractures 3. amputation proximal to wrist or ankle 4. penetrating trauma to head, neck or torso 5. limb paralysis 6. pelvic fracture 7. combined trauma/burn (equal to or greater than 2nd degree or equal to or greater than 20%) My question is, if the patient is in cardiac arrest why does the Hong Kong trauma diversion guide state that they need to go to the closest hospital? Wouldn't it be better for them to travel to a hospital in which a resuscitative thoracotomy can be performed?

Answer 1

Here in the United States we have very similar protocols. The rational is that you want to stabilize the patient as quickly as possible. If the patient is in cardiac arrest, the first priority to to achieve return of circulation. Even if they were transported to a hospital where a thoracotomy can be performed, they would be unable to do so during a cardiac arrest. During cardiac arrest the first priority is to return spontaneous circulation in order to protect the vital organs (brain, heart). The goal is to get the patient to the nearest hospital in order to stabilize the patient and achieve ROSC. By traveling further to another hospital, the patient may be brain dead upon arrival or still in cardiac arrest and unable to perform the thoracotomy.