The Time Period on inserting an exterior shunt

[BillG]

My 18 year old had an automobile accident only minutes from a hospital; she was transport by ambulance to that hospital. Upon arriving at the hospital I was confronted by a doctor in charge of the emergency room, another doctor in charge of ICU, and a neurologist. They inform me that her brain had swollen up to take over the complete interior of the skull and they did not know the out come. When ask by them if I want to transport her to another hospital (at close to midnight that night), I was advise by them to leave her there till morning to stabilize her. I spent the night at the hospital, and the next morning I was told that the swelling had come down a little, but the doctor that advise me to leave her there then felt that she should be moved to a larger hospital. Which we did, upon arriving at the larger hospital she was given an external shunt on the top/side of her skull to release fluids, which the nurses believe should have been done the night of the accident. My questions is two fold (1) should this been done the night of the accident ???? (the hospital that had her the first night was, I believe, able to do that) (2) is their a possibility that additional harm could have come to her due to the fact this action was not taken??? Thank you for taking the time to answer this question........

[caregiver222]

You ask some complicated questions that have been around for a long time. When there is fluid/blood accumulation after a head injury, it is standard procedure to drain this fluid immediately upon arrival at a hospital. These operations have been performed for thousands of years, and go back to the Egyptians. It was called trephaning. Several "weep" holes are drilled in the skull. Many hospitals, for various reasons, do not have a trained physician available to perform this procedure. The procedure is simple and can be performed with a dental drill. That is why certain hospitals are designated trauma centers.  The closest hospital is not always the best one. In many cities ambulances will bypass several hospitals routinely to get to one that is a designated a "trauma center". And it is why that "Emergency Medicine" has now become a specialty.  If this procedure was indicated, and not performed at the hospital of initial entry, there is potential for a tort action of negligence. Yes, permanant brain damage can result from not draining blood/fluid within the "window of opportunity". It appears that there was disagreement between physicians, because one suggested she be moved at midnight (the time was  and someone else suggested she stay and be "stabilized". This was nonsense in a cup, because stabilization would involve draining fluid/blood, not sitting on your hands playing games. To be fair, it is easy to Monday-morning quarterback. Once a patient passes through hospital doors, they are often reluctant to transfer a patient, even when it is in the patients best interests, because someone feels there are "liability problems".

[caregiver222]

There is another "elephant in the closet". That elephant is the ambulance crew. Hospitals that run their own ambulances make money when patients get directed to their ER's. They often discourage crews from bringing a patient to another facility, even if another hospital is a trauma center and their hospital is not. Ambulance crews are rewarded for bringing in patients to poorly staffed hospitals by giving the crews free food, free equipment (stethascopes) and sometimes cash kickbacks. In some communities there are municipal Fire Department ambulances and private ambulances run by the hospitals. They often have overlapping response areas. If you get a Fire Department ambulance you go to the trauma center, bypassing the less equipped facility. If, however you get picked up by the ambulance what works for the hospital, you go to their ER to be "stabilized" regardless of whether or not this is best.