"when to shoot a patient"

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As someone who works at this very hospital and will be working in the
JHB trauma unit in a few months I appreciate this post very much. For
two reasons. Firstly, it makes one feel better that there are people out
there that understand our limitations and appreciate that we are often
totally stretched. I have seen a full laparotomy done in the resus bay
because the operating theatres have been busy. That is unacceptable yet
understandable considering our circumstances. Nine or twelve patients
requiring surgery (often all with a RTS above 25) often happen to visit
us on a Saturday night - apart from the broken bones and walking
wounded.

Secondly, I appreciate this exchange for another reason. Despite our
resource limitations (RESOURCE - not ability) it is important to be told
occasionally that what we are doing is a compromise. That injuries which
would not be treated in our environment, are often treated with
fantastic results in an environment which can cope with it. There is no
excuse for mediocrity. For one, I appreciate being told that what we are
doing is second best (even though I realize it every day) - who knows
maybe one day we can get to a situation where the respect for human life
increases to a level where we don't have to have these protocols and we
have the resources to ventilate even a high quadriplegic...

Until then, you are all invited to sunny south Africa where the people
are fantastic and we have the dubious honour of giving great practical
trauma experience.

Dean Lutrin
South Africa

-----Original Message-----
From: trauma-list-admin@trauma.org [mailto:trauma-list-admin@trauma.org]
On Behalf Of Timothy Coats
Sent: 06 March 2002 12:29 AM
To: trauma-list@trauma.org
Subject: Re: "when to shoot a patient"

OK - the 'humor' may not be best on a public stage, but I would be a
little
hesitant in trashing the rest of the protocols. They are certainly not
what
I would use in London - BUT in the context that Baraguanath and Joberg
General are operating these are pretty reasonable. For example, no
ventilation for anyone with a GCS of 5 or less would not be acceptable
in
the UK, but within a high volume third world trauma system with
inadequate
resources this is a realistic protocol. They have what we in London
would
term a major incident happening every day of the year. Think battlefield
or
major incident triage and treatment to understand their protocols.
We have undertaken exchanges of trainees with this unit in the past, as
they
have an experience and knowledge of the disease of trauma that we could
all
learn from.
The protocols are not 'amusing' - they are disturbing for anyone
involved in
first world trauma care, and make me glad that I am not making such hard
decisions due to inadequate resources every day.
Tim.

> Caesar,
> 
> Couldn't agree more.  And you know, I might be more tolerant if it was
funny
> (I can forgive quite a lot for a good laugh).  It's significant that
their
> published trauma protocols are at least as amusing.
> 
> I took a moment to follow the "contact us" link, and offered my
opinion.
> Perhaps others will do the same.  Having been occasionally and
unknowingly
> insensitive (yup, me), I'm willing to believe that these people just
haven't
> paused to consider the impact of their thoughtless behavior.  For
those who
> wish to see it, I encourage haste: I expect the link to disappear
shortly.
> Call me naive.
> 
> At the very least, it's a fine example of how NOT to construct a
> professional-appearing web site.
> 
> Pret Bjorn
> Bangor, ME USA
> 
> -----Original Message-----
> From: caesar ursic [mailto:cmursic@yahoo.com]
> Sent: Tuesday, March 05, 2002 1:05 PM
> To: trauma-list@trauma.org
> Subject: "when to shoot a patient"
> 
> 
> One finds the damnedest things on the internet. I know
> this might be considered muckraking by some, but so be
> it.  One thing is for sure - if I (or most any of the
> participants on this list) had posted this on our
> official institutional websites, we could kiss our
> jobs goodbye.
> 
> Download the file labeled "when to shoot a patient" to
> see what I mean.
> 
> http://www.wits.ac.za/trauma/tra004.htm
> 
> C.M. Ursic, M.D.
> Dept. of Surgery
> UCSF-East Bay
> Oakland, California / USA
> 





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