Usef dr126.5

[ltmac]

Looking at that map makes me anxious. According to this website, aside from Idaho, there is at least one Level II trauma center in each state that lacks a Level I center at this time. But I’m not sure when that website was last updated because it lists the Fargo hospital as a Level II despite it having Level I verification since 2018. In an area with lengthy distances between higher level medical centers, there is a greater use of medical air transport anyways. Also, often times a patient is first taken to a Level II center due to proximity and need for stabilization before being transferred to a higher level of care (i.e. more resources).

A lack of having even a BLS rig on site of a horse show is grossly irresponsible. Health is wealth; cut corners and you’ll end up paying the price in more ways than one. Signed, your level I and II trauma center ER/trauma nurse.

[MorganSercu]

I don’t think this is going to make anyone feel much better - but maybe a little less anxious?

And this (still old but a little more optimistic):

https://www.sciencedirect.com/science/article/pii/S0020138317300086

More recent:

https://www.journalofsurgicalresearch.com/article/S0022-4804(20)30125-6/pdf

But hospitals in less populated/less densely populated areas are in trouble - I don’t know if there is any will to change this discouraging course.

[trubandloki]

@Cowgirl

No, actually. Horse sport is very dangerous. The shows make you sign a waiver. Why not make sure that you are going to have access to medical care in a fast enough window that you won’t end up a vegetable if it happens to you? I have always been stumped by the things that the organizations deem necessary for safety vs. those that are actually necessary for safety. AND FOR CRYING OUT LOUD, MAKE COMPETITIONS HAVE MOUNTING BLOCKS. (BTW, this is not how I was injured–I was trampled and injured while handwalking my GP horse in the early morning at a fairground facility where regional championships were being hosted, when kids from the local high school marched over in costumes for a fundraiser and scared my horse. My ankle was crushed. I was seen by a weekend intern who couldn’t read the xray and dispensed pain killers and a walking boot two sizes too big, and crutches by the Level IV three bed local hospital. Because of the misdiagnosis, I ended up with three surgeries over two years.)

Why not have people bring their own mounting equipment? That is what everyone I know does. I never expect anyplace I go to have a mounting block. Why is it something you feel so strongly about (all caps)?

I think incorrect diagnosis happen all over the place.

[K_VanOlst]

@trubandloki

Why not have people bring their own mounting equipment? That is what everyone I know does. I never expect anyplace I go to have a mounting block. Why is it something you feel so strongly about (all caps)?

I think incorrect diagnosis happen all over the place.

Right? I would never expect the facility to provide that for me, a mounting block lives in my trailer for that purpose

You can be misdiagnosed anywhere. Even in a level one trauma center, hate to break it to that poster.

[McGurk]

FWIW, that map is outdated. It is not accurate for Level I trauma centers in my state.

ETA: I love the idea of having a sponsor cover the cost of the EMTs. Great idea, and I think a really attractive sponsorship; more so than just a class or a trophy.

[K_VanOlst]

@McGurk

FWIW, that map is outdated. It is not accurate for Level I trauma centers in my state

The article it was published in was from 2022. Obviously some things could have changed since then but I figured it was reasonably accurate enough for the purposes of this discussion.

[McGurk]

Understood. Many hospitals are striving for the Level 1 Trauma designation as it allows them to be reimbursed at a higher rate through most insurances. There’s a distinct profit motive for a hospital to be certified as a Trauma Center.

Which is why a couple of former community hospitals around me now have the designation.

[McGurk]

Mosts shows have both EMTs and the ambulance on site. The utility of being able to immediately have the person assessed and transported cannot be overstated.

I agree, an EMT with a first aid kit is not as useful as a paramedic. But an EMT with a truck that can get the injured person to the people with the higher level of training is of critical importance.

ETA: I am well aware of the difference between an EMT and Paramedic, and the levels of certification in between. What’s needed on site is someone to assess, take care of the ABCs (Airway, breathing, circulation), stabilize and transport.

Most common problems at equine events are broken bones and head injuries. Broken bone? Splint and transport. Head injury? Stabilize and transport within the golden hour. Head injury with intracranial pressure? A paramedic could administer steriods, but as long as the person gets to that level of care within the golden hour, the outcome will be the same.

[trubandloki]

@Amberley

I think people are vastly overestimating the utility of an EMT on site or are confusing EMT with paramedic. EMT training is about 170 hrs and they are very limited in scope of practice

That is 170 hours more than most of the other people there so …

[McGurk]

Don’t know, I think that’s a question for the OP. I know our rated shows, local shows and local unrecognized events all have an ambulance and staff on site, I know our local Point to Point races won’t even run the children’s pony races without the ambulance on site.

I agree with part of your point, just an EMT, with no truck, is not that useful. I mean, the EMT will prevent the anxious mother from pulling the new boots off a a kid with a fracture (that happened) and control bleeding or splint something, but I would guess that the insurance company would require the truck on site as well.

A truck on site requires 2 EMTs to staff it.

[yaya]

@ltmac

A lack of having even a BLS rig on site of a horse show is grossly irresponsible.

What is a BLS rig???

[McGurk]

Basic Life Support.

Meaning an ambulance without a drug box or intubation kit, because those things require a higher level of training than EMT.

[MorganSercu]

I suspect even if USEF didn’t require an EMT & ambulance on the grounds the owner of the site may require it. Without it and in the event of an accident with a bad outcome the owner would lose their insurance. Or worse, if they don’t have the venue insured, the owner could be sued into oblivion.

[McGurk]

@K_VanOlst

You can be misdiagnosed anywhere. Even in a level one trauma center, hate to break it to that poster.

Yes, you can be misdiagnosed anywhere, but if you go to a local ER with a non displaced fracture, the doctor who sees you in the ER may be a generalist or internist, not an orthopedist, which makes the likelihood of his or her misreading the xray a little higher.
A Level I trauma center must have 24-hour in-house coverage by general surgeons, and prompt availability of care in specialties such as orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology, internal medicine, plastic surgery, oral and maxillofacial, pediatric and critical care.

So your xray is going to be read by a radiologist and an ortho surgeon, and the fracture is much less likely to be missed.

[DownYonder]

@Amberley

If I have a bad accident please don’t screw around with the onsite EMT, just call an ambulance.

And who is going to stabilize you while waiting for the ambulance? I can see the conversation now. “Nope, Ms. EMT, we don’t need your help. The rider may be bleeding profusely and may have a compound fracture and may be comatose or unable to move anything, but she is breathing, so we will just wait for the ambulance.”

[trubandloki]

@McGurk

@K_VanOlst

You can be misdiagnosed anywhere. Even in a level one trauma center, hate to break it to that poster.

Yes, you can be misdiagnosed anywhere, but if you go to a local ER with a non displaced fracture, the doctor who sees you in the ER may be a generalist or internist, not an orthopedist, which makes the likelihood of his or her misreading the xray a little higher.
A Level I trauma center must have 24-hour in-house coverage by general surgeons, and prompt availability of care in specialties such as orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology, internal medicine, plastic surgery, oral and maxillofacial, pediatric and critical care.

So your xray is going to be read by a radiologist and an ortho surgeon, and the fracture is much less likely to be missed.

I am not saying what you are saying is wrong. But…

I am going to add a HUGE “it depends”.

Yes, they have to have those people on call, but that does not mean they have to call them in for your X-ray if the person on duty at the time reads the X-ray and does not think it is necessary.
It will get reread, but that might be not until after you went home with your walking cast.

[McGurk]

Agreed! Absolutely, it depends!

Also, if you go to a Level I Trauma Center, particularly in a large urban area, and you have something simple, not a major trauma, you are not going to be prioritized for care, and you might, in fact, get better care at a community hospital. Certainly prompter care.

However, on one of the worst calls I ever ran, person kicked in the side of the head by a shod horse, depressed skull fracture, TBI, severed temporal artery, the trauma team met us in the ambulance bay and were working on him while we wheeled the gurney into the hospital, and it was amazingly gratifying for the crew that agonized over the patient and wondered whether we should have called the chopper.

[Doberpei]

Many years ago, the barn where I kept my horse (primarily an eventing barn), wanted to diversify, so they agreed to host a local H/J association’s show. The association did not require an EMT on site, but the barn required it, with much gnashing of teeth and wailing on the part of the show organizers. By the end of the first day of the show, two competitors were airlifted out after bad falls, and a few other riders were sent out by ambulance. The barn never hosted the association’s shows again

[Snow_Mass]

Unfortunately, in our state, your medical personnel examples are not qualified or licensed to perform the role of on site medical staff at sporting events.

[Snow_Mass]

The OP is suggesting that shows that are a distance away from others have less EMT support.
Incorrect statement.
Show facility is 15 minutes from the Regional Trauma center for 4 states.
We are hours from judges, TD’s, and other licensed dressage shows.