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Tue, 5 Mar 2002 12:40:20 -0500

Could it be based on the acute care foundation of "airway / breathing /
circulation" as it pertains to these patients?  It would be more
difficult (if not imposible) to intubate, perform chest compressions,
perform a DPL, get large bore IV access (IJ, Fem v.), etc., if the need
arose.

Patrick J. O'Neill, Ph.D., M.D.
Chief Resident
Department of Surgery
University of Virginia
Charlottesville, VA

-----Original Message-----
From: San namir [mailto:sody@gotomy.com]
Sent: Tuesday, March 05, 2002 10:36 AM
To: trauma-list@trauma.org
Subject: Why do we uniformly lay victims and patients on their backs

wgh

Does anyone on the list have any information on whether historically or
currently evaluation has been performed as to if it is always beneficial
to lie patients and victims on their backs?
HOW  old is this custom and has it ever been challenged?
Aside from asthma, CHF where sitting recommended, vomiting and
unilateral pneumothorax on the side , and the back for newborns, is any
other condition dealt with always on the back? Any seen any literature
on this topic??

>
>
>Dear Colleagues,=20
>   You receive a call that there's been shooting rounds heard on the
main road you normally take home to reach year village. The only vital
route for commuting from your village to the rest of the country. You
jump into your car and are informed that an arab terrorist has attacked
a number of vehicles on the road and the wounded are lying there. You
speed to where all the action is flying and are faced with the body of a
30 year old mother of two (your regular family practice patient) in a
puddle of blood with two penetrating bullet wounds of the right chest,
not breathing and pulseless being bagged by a volunteer. In front is a
one arm amputee who sustained bullet wounds to the palm of his only hand
and a short range wound of his leg in stable condition. You are radioed
that further down this road , on an ambulance lies a wounded 18 year old
with a penetrating wound of the right lower abdomen, without spontaneous
breathing but maintaining a radial pulse.=20
>  Next to you, you find the body of what must be that of the assailant
and another two of his victims while at least two hand grenades were
visible lying on the ground , security won't let any vehicle further
down the road until sappers approve. |I figure at this point it better
(to save from any further delay)to send the ambulance carrying the
shocky patient with staff qualified to do nothing more than bag and
infuse on their way, unescorted by a physician.  This alternative
preferable than waiting a further 5 minutes till running  all the way up
the road..
>
>Some ambulance drivers will argue they don't want to take the
responsibility of evacuating such an unstable case to a medical centre
25 minutes away. I feel this the only way to give the guy a fighting
chance.=20
>   Not a hypothetical case, but what we  have to tolerate here,fresh
from this week.
>    What would you do? Do you think such a stance is medicolegally
defensible? Unfortunately we recognize that in many situations the best
for the patient may be outlawed especially with a rigid judicial system/

>
>
>    |In prayer for better times and anticipating your opinions...
>
>> "

Sody Naimer
Goosh Katif Emergency Ambulance Team=20
Israel 79779
Fax. 972-8-6846329
=E1=F8=E5=EA =E4=F9=ED =E0=F0=E9 =F0=E5=F9=ED

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Why do we uniformly lay victims and patients on their backs