The protocol states that pediatric trauma should be delivered to a LEVEL 1-2 trauma with a PICU. Does Danbury have a PICU? No. So therefore PROTOCOL was violated. If you read the proto
Read 4 and 5 again. 4. A child less then 13 should be taken to a facility with a PICU (pediatric ICU) 5. If that can't be done in 20 minutes patient care should be referred to local medical direction (call dr and find out where they need to go). Hope that clarifies. The protocol for the medics is 4. The 5. is if 4 can't be done. 5. Would be a violation of 4 if instructed differently. Perhaps I should have used deviation rather then violation due to the negative connotation. That deviation would however be a violation if medical control was not contacted. We have no written evidence of that deviation approval because the PCR has not been released.
I think you're missing two key points.
Firstly, point 5 is not tied to point 4, it's at the same level as all other points in that section, and referes only to Lvl I or II trauma centres, not paediatric trauma centres specifically.
Secondly, "shall" and "should". As I said before, these aren't just arbitrary terms, at least not when used in official documents, they're defined when used in
law, regulation and standards. "Shall" traditionally meant "must" (although it's actually being replaced by "must" due to some ambiguity with "should"). The meaning of "should" however has been pretty constant and well understood - it implies a recommendation.
Just in case there was some subtle difference in the USA, I looked for evidence of usage, in law and standards it's much the same, but most usefully I found an excellent source in the
"Federal Plain Language Guidelines" which provides guidance to agencies under the "Plain Writing Act of 2010" site. Who says bureaucracy doesn't have it's uses?
If that is the case, which given the nature of the document and the differing uses of the terms looks likely, then as the protocol reads there is a
recommendation to transfer minors to a paediatric ICU, not an
obligation.
Of course, this makes perfect sense - as Deirdre pointed out what wouldn't make sense is that EMTs would be subject to a hard and fast rule that meant a badly injured child
had to be transported to a "PICU" even though there were a closer (though non-paediatric) trauma centre nearby.
Ray Von