First of all, if you have never worked in EMS (and it appears by the original comments starting this form, that you haven't) there is a lot of things that go into the decision of how and where a patient is trasnported to in time of injury or illness. While some patients obviously need a Level I trauma center (Huntsville, UAB, Vandy, etc.) others can go to a Level II or Level III trauma center, depending on the severity of injuries. Things such as mechanism of injury (how they were injured), age, other medical problems that the patient has that may affect the injuries they are suffering from, etc. are all things that will initially come into play along with what injuries they are actually suffering from. Then, you have the time factor and weather? Can the aircraft make it from the scene to the trauma center or will they not be able to fly due to weather? What kind of ground transport times do you have?. . . and this could go on and on. I can understand how the general public perseves this "sitting on scene" or "wasting time", but I can assure you that the time is being spent either stabilizing and preparing the patient for transport or waiting on the aircraft to arrive to transport the patient on because that is ultimately what the patient needs. Simply put, some patients just need a trauma center. There have been patients that have been flown from as close as 1 to 2 miles from ECM hospital because that is what they needed. I agree with MLentz, ECM is a very good hospital and can handle a lot of emergencies but they are not a Level I trauma center and there is a big difference.
The hosptials participating in the ATS (Alabama Trauma System) and that are working with the TCC (Trauma Communications Center) have been categorized in either Level I, II, or III and will assist the ground and air units to determine what the patient needs and the availability of these hospitals. This is all going on while patient care is taking place. A lot of people still have the idea of "just get them to a hospital" and that is not an accurate way of thinking in concordance with what many patients need. When these decisions are made on scene, they are made by making the best physical assessment and applying that to the mechanism of injury, what the patient is complaining of, and the injuries they have and those things are all put together to determine where the patient needs to go. All EMT's, Medics, and Nurses that work in prehospital medicine are trained to take these things and make the most appropriate decision possible. Do we carry X-ray machines or CT scanners on the ambulance or on the helicopters??? Of course not. We can't see exactly what is going on inside the body, we can only take the assessment items mentioned above along with their vital signs and the other signs and symptoms of injuries and make the best decision we can. I know a lot of you have never been in a situation or had a family member in one of these situations and I hope you never do. I can assure you the State of Alabama Department of Public Health hold those working in prehospital medicine to standards of being in the best position with the skills and knowledge to take care of the most ill and injuried patients to get them to the most appropriate facility.
I can understand how never working in EMS or a hospital setting can make it hard to understand why some of the things happen like they do. Just rest assured that the men and women working in this field do this job because they care and want to provide the best they can for their patients. There are a lot of factors in the thought process of this job and I havent really even gotten that far into it. This is just a general overview of typically how things work. In the emergency world, you have to adapt and overcome to the situation at hand and it may not be clear to those that arent in the decision making process at that time, but rest assured the patient's best interest is #1 priority during these times.
Also, the "Golden Hour" was mentioned and when a patient is transported to one factility and has to wait for a transport on to the most appropriate facility, this eats up their "Golden Hour" and that is why a lot of times it is best to wait on the aircraft on scene. . .to get them to the MOST APPROPRIATE FACILITY.