22 years old male hit from a car on the roadside of an urban area.

The ground EMS ambulance (physician, nurse staffed), dispatched on scene, find the patient alert, oriented and spontaneously breathing. His vitals are:

GCS 15 , RR 20, SaO2 95, HR 85, SBP 110

No mention of head trauma.

Chest no sign of trauma, bilateral and equal expansion and air entry.

Pulse is strong.

He has a profound laceration with loss of substance but not evisceration on left flank and no external bleeding from the wound.

The abdomen is painful and resistant to palpation in left flank.

There is an open fracture to left tibia (VNS 9).

The ground team, after the primary survey, activates the local medical helicopter.

The place is 10 k from a level 1 Trauma Center on a local road in an urban area and the helicopter is at 10 minutes flight distance…