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Care within ‘golden hour’ crucial

John HartMedical personnel at Sutter Roseville Medical Center's trauma center examine a patient's X-rays Tuesday.
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Among trauma personnel and field-level paramedics, it’s often referred to as “the golden hour,” the first 60 minutes of care a patient receives after being critically injured in an auto accident or violent-force trauma.

It’s during this time that on-scene emergency personnel must make instant decisions regarding how patients are treated at the scene, how they will be transported to a medical facility, and the treatment they’ll receive from emergency-room or trauma specialists when they arrive at the hospital.



In western Nevada County, where remote and winding roads and sometimes unpaved paths can provide the only means of transport for seriously injured victims, how patients arrive at medical facilities is often a more critical decision than the treatment they receive.




Normally, the type of treatment depends on where you’re going and how you will get there, said Wendy Nugent, a registered nurse and University of California at Davis Medical Center’s trauma program manager.

Most likely, to preserve as much of the “golden hour” as possible, those injured in western Nevada County who require the most complex care are airlifted to the Sacramento medical center even if another hospital is physically closer via ambulance.

“Sometimes, if you spend 10 minutes extra in the air, the patient can receive, in-flight, the definitive care they need,” she said.

Protocol as to where injured patients go is determined by the Sierra-Sacramento Valley Emergency Medical Services Agency, a joint-powers authority that outlines trauma-center guidelines for hospitals in Placer, Sutter, Yuba, Nevada and Yolo counties.

Trauma centers in the area include Davis, which treats the most critically injured; Sutter Roseville Medical Center; and Rideout Hospital in Marysville. Patients can be stabilized at nearby hospitals, including Sierra Nevada Memorial Hospital in Grass Valley and Tahoe Forest Hospital in Truckee, before being transferred.

In many cases, where a patient goes for treatment depends on if they’re breathing.

“It’s not a fail-proof system, because of the human element,” Nugent said. “A trauma patient’s condition can change instantly.”

A patient who needs cardiopulmonary resuscitation, for example, is not a good candidate for air transport. Those with stab or gunshot wounds penetrating an artery are also not good candidates for air transport because they can risk losing too much blood.

“It’s a judgment call. You just have to make a decision as to what will best help the patient,” said Nugent, whose trauma center saw 8,000 trauma patients in 2001, 3,000 of whom stayed at the hospital for more than 24 hours.

Cheri White, Sutter Roseville’s trauma program manager, said the majority of Roseville’s trauma patients – most of whom suffer blunt, not penetrating trauma – come via ambulance.

“Sometimes, by the time you mobilize the aircraft and search for a place to land, it might be faster to use ground transport,” she said, adding that helicopter personnel can provide critical care in the air when needed.

Sierra Nevada Memorial Hospital can serve as a triage center of sorts, as it did during the Jan. 10, 2001, shootings at Lyon’s Restaurant and the county Behavioral Health Department.

“The emergency room is the doorway to more than 50 percent of our admissions,” said hospital spokesman Gary Cooke.

Transport, however, is primarily at the discretion of first responders, SSV executive director Leonard Inch said. “They have the best idea as to what kind of injuries they have and the treatment required. As a general rule, we send patients to the closest hospital.”

Sierra Nevada Ambulance provides service to an area stretching from North San Juan to the Bear River border with Placer County.

Collin Bryant is a firefighter-engineer and emergency medical technician with the Higgins Fire Department, an agency that responded to 900 emergency calls in 2001 within a 100-square-mile area that includes Dog Bar, Camp Far West and Lake of the Pines.

If the call is near the Cherry Creek complex on Highway 49 just north of Lake of the Pines, a Sierra Nevada ambulance stationed there 24 hours a day can choose between either Sutter Auburn Faith Hospital 12 miles away, or SNMH, which is 13 miles away.

“From a firefighter’s standpoint, it’s not so much where you go, but taking them to a place where you can get them stabilized,” Bryant said.

In many cases, where a patient goes is up to them, Bryant said.

“If it’s not life-threatening but way far out, they’ll start the air ambulance right away,” he said.


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