Treatment of tanker driver raises question of hospital choice

December 20, 2018

When a truck hauling water on the south side of town tipped over on Beckner Road late last week, police and fire personnel flocked to the scene.

The driver, Julian Barela, was assessed by emergency responders, then transported by ambulance away from Presbyterian Santa Fe Medical Center — just down the street — to Christus St. Vincent Regional Medical Center on the other end of town.

The decision raised questions about how emergency cases are handled and where they are treated.

“Who and how is it determined here in Santa Fe which hospital you are taken to?” one reader asked on The New Mexican’s website. “I always heard you’d be taken to the CLOSEST possible hospital.”

Not necessarily.

Greg Cliburn, medical officer for the Santa Fe Fire Department, said paramedics and EMTs who respond to emergency medical situations make the decision on where patients are sent.

That decision, Cliburn said, comes down to a number of factors, including proximity, a patient’s particular needs and the patient’s preference.

“We worked with emergency department leadership at both facilities to work out these destination decision guidelines,” Cliburn said. “That’s been agreed on by all of us in the EMS community, and it will evolve over time as services are added.”

Here’s how it works:

When emergency responders are deciding where to take someone for treatment, three layers of decision-making come into play, Cliburn said.

• The first is the immediate need of the patient. If paramedics respond to someone in critical need of help — for example, someone “whose vitals are deteriorating despite our interventions” — that patient gets transported to the nearest hospital available.

• If a patient’s condition is not quite that severe, Cliburn said, the next question is whether the person needs specialty care of some sort.

At the moment, Cliburn said, Christus St. Vincent is the only hospital in town with a trauma center and a catheterization laboratory for heart imaging. St. Vincent is also the only option right now for emergency labor and delivery services, he said.

• Finally, if a patient is not in a dire state, and doesn’t need specialty treatment, Cliburn said the paramedics try to give a patient his or her choice of hospital.

“If we pass those first two layers of decision-making, and if a patient is capable of making a decision and has a preference, we try to honor the facility the patient wants to go to,” Cliburn said.

While Cliburn couldn’t discuss the specific injuries of the water-tanker driver, he did say the paramedics on scene followed the three-part guidelines when deciding where the man should be treated.

Ultimately, Cliburn said, emergency responders decided the driver needed a trauma center, making Christus St. Vincent the destination.

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