Even through your turgid prose, I shall respond to your post. First, you really know "plenty" of trauma surgeons, and you have spoken with all of them about this specific topic? And all written sources I've seen state a "proper" indication is having surgery available immediately. Now, since you advocate not reading any books, but discarding the books and "making your own opinions" (and, if you want me to remind you, I would show you the posts where you did this), you make a disingenuous statement that "that makes no sense".
You're maybe speaking of residents on trauma - while you were in residency. Or, even if not, if you're somewhere with dedicated trauma surgeons, then you're at a trauma center. That eliminates most hospitals in the US.
As you are prone to nitpick, if not "CT surgeon", how about "surgeon well-versed and comfortable operating on the chest"? You make it sound so simple - a pericardial tamponade. Sure, I can cut the chest, and cut a window - but what about the cause, like a ventricular laceration, or coronary artery injury? What about other vessels lacerated, causing a hemothorax? What can I do with that? I'll give you a hint - not much. But, I do it - and I don't have CT on call, since I am in the community, or, if I do, they're not in-house. What is the general surgeon going to say when I tell them I opened the chest? What if the CT surgeon hasn't done trauma since they were a resident? They're going to have kittens.
When I was a resident, our division chief told a story of when she was moonlighting as a resident, and she cracked a chest, and cross-clamped the aorta, and, then...then what? She had nowhere to go. That's the common-sense answer that you can't understand. What do you do with the open chest after you've opened it? EM docs don't close it, and good luck with getting an ambulance to transfer a patient with an open chest to the trauma center.
Another case - one attending when I was a resident (who is now chair of one of the "bigger name" EM departments) was on when a patient came into the ED, as a reported GSW, but they couldn't figure out why the guy was out, until, finally (more or less), a tiny hole just posterior to the axilla was noted. It was called as a trauma, so surgery was there. They decided to crack the chest, and, what did they find? The PA was completely obliterated. There was nothing left to put back together.
If I cracked the chest in the community, and found a possibly repairable injury to the cardiac vasculature, and nobody to take that to the OR, I would be up the creek.
