It's called the Golden Hour -- the most critical time for someone who has suffered a traumatic injury. Local emergency medics and hospital staff use their experience and a detailed protocol to make the best of those valuable 60 minutes.
"In the case of a car accident, for instance, our paramedics will look at a situation and based on what they see, will make a decision as to whether a person should be flown to a type one trauma center or be treated at the emergency room," Payson Fire Chief Marty deMasi said.
Jim Heskett is pre-hospital manager for Payson Regional Medical Center and coordinates the policies and procedures that deal with potential patients and gives direction to paramedics and EMTs.
According to Heskett, emergency medical personnel follow something similar to a flow chart that helps them determine whether someone needs to go to a trauma center.
Not only do they examine the injuries, but also the mechanism of the trauma.
"Was it a rollover, were they ejected from the car, what is the damage to the car -- these are the things paramedics are taught to look at," he said.
An EMT or paramedic also can contact the ER physician for an opinion on the patient.
Classifications of trauma centers
"The state and the American College of Surgeons classify hospitals according to their capability of handling trauma patients on a one, two, or three level," Heskett said. "The state has similar standards and also classifies trauma centers as level one, two, three, or four. PRMC is considered a level three trauma hospital."
Heskett said to be classified as a type-one trauma center, a hospital is required to have 24-hour-a-day on-site anesthesia, trauma surgeons, neurosurgeons and also must be a teaching hospital, among other things.
It must also have the population to support it, Heskett said.
"Flagstaff Medical Center will take trauma patients, but they are not even at a population where they could be a level-one trauma center," Heskett said. "They are a level-two right now."
There are five state-designated level-one trauma centers in the Valley. The one closest to Payson is Scottsdale Osborne Healthcare, but if the patient is a child, he or she is flown to a trauma center with a pediatric unit such as Good Samaritan.
When it is determined by paramedics or physicians that a patient needs to go to a trauma center, the transportation of choice is by air.
PRMC contracts with Native Air for helicopter transports.
"Native Air has a computer program that shows them which trauma centers are open and which are diverting patients," Heskett said. "They have a nurse and a paramedic on board the flight."
Occasionally, deMasi said, weather or other circumstances may prohibit air evacuations.
"If weather doesn't permit, or maybe there is an airway problem, we can take them to the emergency room to be stabilized and treated," deMasi said.
Heskett said PRMC has on-call staff available to deal with instances in which a patient cannot go to a trauma center immediately.
"We have surgeons who are on-call and operating crews," Heskett said. "But there are certain types of operations we just couldn't do here like brain surgery. We would stabilize the patient and transport them to the Valley."
According to deMasi and Heskett, from the moment the fire department is notified of a serious accident, those who respond have one goal in mind -- to get the patient to a level-one trauma center within one hour.