10:45 a.m.- The Paramedic contacts the Emergency Department (ED) Nurse and notifies her that he is in transit from a local elementary school where a seven year old boy fell and hit his head while playing at recess. His pupils are equal and reactive to light (PERL), and is awake and talking. Vital Signs are within normal limits (WNL). However, when he tried to stand, his balance was off. Mother had been contacted and she is on her way to the ED. Patient is not on any medications and has no allergies.

The ED Nurse contacts the ED Doctor and notifies him of the incoming patient. Meanwhile, the mother comes into the ED, and the Doctor speaks with her about the child’s history. The Nurse sends her to Registration to complete that information. 10:49 a.m.

The Ambulance shows up and brings the child in by gurney. After receiving report, the Doctor examines the child. The mother comes to the bedside as the doctor is having the child hop off the gurney and stand up. Surprised to see her child leaning to one side and nearly falling, she helped him back on the gurney asking him if he had done this on purpose. The child denies this, and the doctor tells his mother he would like to do a CT Scan of the head to see if there is any problems with bleeding or swelling. 10:55 a.m.

As the CT Tech takes the patient and mother to the CT Scanner for the Head CT of the child, the doctor contacts the Transfer Center and notifies them that he has seven year old with a head injury and needs a Pediatric Neurologist. He gives the patient’s signs and symptoms and that a CT Scan result is pending. 11:00 a.m.

The patient and mother are returned to the ED and the CT Tech notifies the Doctor that the CT Scan has been sent off to the Radiologist and requested a Stat (immediate) read. 11:08 a.m.

The Doctor reviews the CT himself and did not see any bleeding of the head, and he tells the mother this, but that he needs that Radiologist final read.11:12 a.m.

The phone rings in the ED Office and the Radiologist notifies the Doctor that there is swelling on one side of the brain due to the head trauma (which explains the patient difficulty on standing).11:14 a.m.

11:16- The phone rings again in the ED Nursing Station, it is the Pediatric Neurologist calling from UC San Francisco. The ED Doctor gives him the signs and symptoms, and the results of the CT Scan. The Neurologist suggests a Pediatric dose of IV Mannitol, and that the child should be transferred by helicopter as soon as possible.

The Doctor steps out and discusses the recommendations by the Pediatric Neurologist. Reluctantly, only because of distance, the mother agreed to transfer her son to San Francisco. The Doctor  notifies the ED Nurse and ED Tech to prepare the child for a helicopter transfer to UC San Francisco. 11:18 a.m.

Had the Ambulance had to transfer this patient to another facility, it would have taken 33 more minutes to begin assessing the patient with a head injury. As it is, in that 33 minutes, assessment and diagnosis was obtained, and treatment being started.

Keeping services like the CT Scanner available is very important at Orchard Hospital. Please vote “Yes” on Measure M.