For surgical vs medicine admissions, see Surgical Subspecialty Admissions Guidelines under Admission Guidelines.
For ALL surgical transfers out, ED Attending needs to speak to Surgical Subspecialty Attending
To be used for trauma patients brought in by EMS by mistake or walk-in/drop-off patients with life-threatening traumatic injuries requiring EMERGENT (aka immediate) surgical intervention that we do not have at<unk>  e.g. neurosurgical
Other EMERGENT surgical cases such as stab wounds or GSWs should be evaluated with the consult surgical resident (and Attending as needed) on a case by case basis as many of these such as abdominal trauma may be able to be cared for here at<unk>  by the Dept of Surgery
Please, if possible, ensure the Surgical Attending on-call is aware of the case. We have transferred trauma patients out that could have been taken care of by our Surgery Dept.
Step 1:  You MUST HAVE an ACCEPTING PHYSICIAN (new EMS policy Sept 2020)
Adult Patients
Holy Cross, by Trauma Center policy, is<unk> 's designated Trauma Center.
Call Holy Cross, ask for Charge RN and get an accepting physician;  Holy Cross ED # 818-496-3302
Pediatric Patients, 14 yrs old or younger
Call Northridge Hospital, ask for Charge RN and get an accepting physician; Northridge ED #818-885-5396
Step 2:  Call 911 and tell them you have a "Trauma Re-Triage" patient
Do NOT call the MAC Center
Copy all records and imaging but do not delay transfer
Because of the limited scope of practice by the paramedics, if the patient has blood hanging or has any drips, then our<unk>  Critical Care Transport team will accompany the patient in the EMS ambulance to Holy Cross.
Adult Patients
Holy Cross, by Trauma Center policy, is<unk> 's designated Trauma Center.
Call Holy Cross, ask for Charge RN and get an accepting physician;  Holy Cross ED # 818-496-3302
Pediatric Patients, 14 yrs old or younger
Call Northridge Hospital, ask for Charge RN and get an accepting physician; Northridge ED #818-885-5396
Holy Cross, by Trauma Center policy, is<unk> 's designated Trauma Center.
Call Holy Cross, ask for Charge RN and get an accepting physician;  Holy Cross ED # 818-496-3302
Call Northridge Hospital, ask for Charge RN and get an accepting physician; Northridge ED #818-885-5396
Do NOT call the MAC Center
County Policy:  9-1-1 Trauma Re-Triage – This section applies to injured patients in emergency departments of non-trauma centers whose injuries were initially estimated by EMS to be less serious (under triaged) or patients who self-transported (walk-in) to a non-trauma center, and subsequently assessed by the non-trauma center physician to require immediate trauma center care. The referring facility shall utilize the procedure outlined below to expedite transfer arrangements and rapid transport to the trauma center. This process should be reserved for patients with life-threatening traumatic injuries requiring emergent surgical intervention.
A. Determine if the injured patient meets any of the following 9-1-1 Trauma Re- Triage criteria:
1. Persistent signs of poor perfusion
2. Need for immediate blood replacement therapy
3. Intubation required
4. Glasgow Coma Score less than 9
5. Glasgow Coma Score deteriorating by 2 or more points during observation
6. Penetrating injuries to head, neck and torso
7. Extremity injury with neurovascular compromise or loss of pulses
8. Patients, who in the judgment of the evaluating emergency physician, have high likelihood of requiring emergent life- or limb-saving intervention within two (2) hours.
B. Contact the designated receiving trauma center or pediatric trauma center if the patient is less than or equal to 14 years of age and transport does not exceed 30 min. Do not delay transfer by initiating any diagnostic procedures that do not have direct impact on immediate resuscitative measures.
C. Contact 9-1-1 for transportation. The paramedic scope of practice (Ref. No. 803) does not include paralyzing agents and blood products.
D. Prepare patient and available medical records for immediate transport. Do not delay transport for medical records which could be sent at a later time.
E. EMS has no immediate solution if there is refusal by the Trauma Center;  remind them of the EMS 911 Trauma Re-Triage Policy, that they are our receiving facility;  please let McCollough know about any refusals
A. Determine if the injured patient meets any of the following 9-1-1 Trauma Re- Triage criteria:
1. Persistent signs of poor perfusion
2. Need for immediate blood replacement therapy
3. Intubation required
4. Glasgow Coma Score less than 9
5. Glasgow Coma Score deteriorating by 2 or more points during observation
6. Penetrating injuries to head, neck and torso
7. Extremity injury with neurovascular compromise or loss of pulses
8. Patients, who in the judgment of the evaluating emergency physician, have high likelihood of requiring emergent life- or limb-saving intervention within two (2) hours.
B. Contact the designated receiving trauma center or pediatric trauma center if the patient is less than or equal to 14 years of age and transport does not exceed 30 min. Do not delay transfer by initiating any diagnostic procedures that do not have direct impact on immediate resuscitative measures.
C. Contact 9-1-1 for transportation. The paramedic scope of practice (Ref. No. 803) does not include paralyzing agents and blood products.
D. Prepare patient and available medical records for immediate transport. Do not delay transport for medical records which could be sent at a later time.
E. EMS has no immediate solution if there is refusal by the Trauma Center;  remind them of the EMS 911 Trauma Re-Triage Policy, that they are our receiving facility;  please let McCollough know about any refusals
1. Persistent signs of poor perfusion
2. Need for immediate blood replacement therapy
3. Intubation required
4. Glasgow Coma Score less than 9
5. Glasgow Coma Score deteriorating by 2 or more points during observation
6. Penetrating injuries to head, neck and torso
7. Extremity injury with neurovascular compromise or loss of pulses
8. Patients, who in the judgment of the evaluating emergency physician, have high likelihood of requiring emergent life- or limb-saving intervention within two (2) hours.
Econsult:  All hernias and gallbladders need the hernia/chole form filled out - asks about BMI and cigarette smoking
Surgery will not perform hernia repair or cholecystectomy if BMI >35
Surgery will not perform hernia repair if patient smokes
For breast cases, see WikEM<unk> ....Radiology....Breast imaging
For breast cases, see WikEM<unk> ....Radiology....Breast imaging
We have non-cardiac Cardiothoracic Surgery at<unk> .  If you have a case, consult General Surgery who will consult with Cardiothoracic Fellow/Attending
See Transfers...Higher Level of Care....Neurosurgery
No update
OVMC:ED
RRMC:ED
SCVMC:ED
SCVMC:EXC
SCVMC:Main
MHH-TMC
Tdap
Harbor Macros: AMA