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Home > List Archives

Trauma destination legislation

Bjorn, Pret trauma-list@trauma.org
Mon, 7 Apr 2003 08:03:08 -0400


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Avi,
=20
I think these observations are important.  In urban environments, =
they're
less compelling: Ken is probably correct that potentially serious =
injuries
in greater Houston are best treated at Ben Taub or Memorial
Hermann--although even there, some debate is permitted (
http://www.chron.com/cs/CDA/story.hts/metropolitan/1671238
<http://www.chron.com/cs/CDA/story.hts/metropolitan/1671238> ).  Ken =
and
others rightfully suggest that Houston's problems are less a matter of
triage than one of adequate resources.  But then, where resources are
abundant, who needs triage?
=20
By contrast, in Fort Kent, Maine, demanding triage sensitivity at the
expense of specificity may result in important services being dedicated =
to
an eight-hour round trip.  Even when flight is available, the aircraft =
are
themselves a finite resource.  And so the rural ED clinician struggles =
with
the fact that for every potentially unnecessary transfer, he or she may =
be
delaying or preventing the transfer of more appropriate cases that =
present
over the remainder of the shift: traumas, heart cath's, high-risk OB, =
and so
on.=20
=20
It's hard to argue for triage specificity without sounding like you're
tinkering with the best interests of "the patient."  But where the =
needs of
an individual equivocal trauma case impact the services available to an
entire community, the characteristics of appropriateness are more =
difficult
to describe.
=20
Just one more facet of the urban-rural disconnect, and another example =
of
how a common solution may elude us.
=20
Pret Bjorn
Trauma Coordinator
EMMC Trauma Program
489 State Street
Bangor, ME 04401
=20
207.973.7260 (office)
207.973.7673 (fax)
207.941.5085 (voice pager)
=20
-----Original Message-----
From: avir@bgumail.bgu.ac.il [  <mailto:avir@bgumail.bgu.ac.il>
mailto:avir@bgumail.bgu.ac.il]
Sent: Monday, April 07, 2003 6:36 AM
To: trauma-list@trauma.org
Subject: Re: Re: Trauma destination legislation


Ken,

I think that overtriage is a serious medical, not political economic,
problem.  Overtriage will cause death, by overwhelming the facilities. =
There
is even hard data to prove this.

It is a medical problem since patients are harmed by being over =
triaged, and
because triage is part of the medical decision making process

Avi



>
> From: KMATTOX@aol.com
> Date: 2003/04/05 =F9 AM 02:35:34 GMT+02:00
> To: trauma-list@trauma.org
> Subject: Re: Trauma destination legislation
>
> Overtriage is a political and economic issue
>
> Undertriage is a patient care issue. =20
>
> Pick your choice.   No system will even have balanced triage.=20
>
> k
>
>


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<DIV><FONT color=#800000 face=Arial size=2>Avi,</FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2>I think these observations are 
important.&nbsp; In urban environments, they're less compelling: Ken is probably 
correct that potentially serious injuries in greater Houston are best treated at 
Ben Taub or Memorial Hermann--although even there, some debate is permitted (<A 
href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2003-April/"http://www.chron.com/cs/CDA/story.hts/metropolitan/1671238">http://www.chron.com/cs/CDA/story.hts/metropolitan/1671238</A>).&nbsp; 
Ken and others rightfully suggest that Houston's problems are less a matter of 
triage than one of adequate&nbsp;resources.&nbsp; But then, where resources are 
abundant, who needs triage?</FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2>By contrast, in Fort Kent, Maine, 
demanding triage sensitivity at the expense of specificity may result in 
important services being dedicated to an eight-hour round trip.&nbsp; 
Even&nbsp;when flight is available, the aircraft are themselves a finite 
resource.&nbsp;&nbsp;And so the&nbsp;rural ED clinician struggles with the fact 
that for every potentially unnecessary transfer, he or she&nbsp;may 
be&nbsp;delaying or preventing the transfer of more appropriate cases that 
present&nbsp;over the remainder of the shift: traumas, heart cath's, high-risk 
OB, and so on. </FONT></DIV>
<DIV>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2>It's hard to argue for triage 
specificity without sounding like you're tinkering with the best interests of 
"the patient."&nbsp; But&nbsp;where the needs of an individual equivocal trauma 
case impact the services available to an entire community, the characteristics 
of appropriateness are more difficult to describe.</FONT></DIV>
<DIV>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2>Just one more facet of the 
urban-rural disconnect, and another example of how a common solution may elude 
us.</FONT></DIV>
<DIV>&nbsp;</DIV>
<DIV>
<DIV><FONT color=#800000 face=Arial size=2>
<DIV><FONT color=#800000 face=Arial size=2><SPAN class=030133519-19052000>Pret 
Bjorn</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN class=030133519-19052000>Trauma 
Coordinator</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN class=030133519-19052000>EMMC 
Trauma Program</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN class=030133519-19052000>489 
State Street</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=030133519-19052000>Bangor, ME 04401</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=030133519-19052000></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=030133519-19052000>207.973.7260 (office)</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=030133519-19052000>207.973.7673 (fax)</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=030133519-19052000>207.941.5085 (voice 
pager)</SPAN></FONT></DIV></FONT></DIV></DIV>
<DIV><FONT color=#800000 face=Arial size=2></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><FONT color=#000000>-----Original 
Message-----<BR>From: avir@bgumail.bgu.ac.il [</FONT></FONT><A 
href="mailto:avir@bgumail.bgu.ac.il"><FONT color=#000000 face=Arial 
size=2>mailto:avir@bgumail.bgu.ac.il</FONT></A><FONT face=Arial 
size=2>]<BR>Sent: Monday, April 07, 2003 6:36 AM<BR>To: 
trauma-list@trauma.org<BR>Subject: Re: Re: Trauma destination 
legislation<BR><BR><BR>Ken,<BR><BR>I think that overtriage is a serious medical, 
not political economic, problem.&nbsp; Overtriage will cause death, by 
overwhelming the facilities. There is even hard data to prove this.<BR><BR>It is 
a medical problem since patients are harmed by being over triaged, and because 
triage is part of the medical decision making 
process<BR><BR>Avi<BR><BR><BR><BR>&gt;<BR>&gt; From: KMATTOX@aol.com<BR>&gt; 
Date: 2003/04/05  AM 02:35:34 GMT+02:00<BR>&gt; To: 
trauma-list@trauma.org<BR>&gt; Subject: Re: Trauma destination 
legislation<BR>&gt;<BR>&gt; Overtriage is a political and economic 
issue<BR>&gt;<BR>&gt; Undertriage is a patient care 
issue.&nbsp;&nbsp;<BR>&gt;<BR>&gt; Pick your choice.&nbsp;&nbsp; No system will 
even have balanced triage.&nbsp;<BR>&gt;<BR>&gt; 
k<BR>&gt;<BR>&gt;<BR></DIV></FONT></BODY></HTML>

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