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Mon, 28 Apr 2003 06:57:49 -0400

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Regional EMS Medical Director and/or Performance Improvement Committee, with
input from medical control at either facility.  This is a system issue, so
make the system fix it.  

Failing that, you have bigger problems than who takes the penetrated trunks.
And in neither case is an individual apt to create change by himself.

Pret Bjorn
Trauma Coordinator
EMMC Trauma Program
489 State Street
Bangor, ME 04401

207.973.7260 (office)
207.973.7673 (fax)
207.941.5085 (voice pager)

-----Original Message-----
From: Andrew J Bowman [mailto:sumieb@compuserve.com]
Sent: Monday, April 28, 2003 12:00 AM
To: Trauma List
Subject: Penetrating Chest Trauma

Well, they did it again.  

A while back I presented a case of penetrating chest trauma in a community
with 2 corporate sister hospitals (1 with cardiac bypass and 1 without).
Emergency departments are staffed the same, board certified emergency
medicine physicians and experienced nursing staffs.  Any after hours surgery
requires a call in of surgeon, anesthesia and staff (they have 1 hour to
arrive).

Friday night, GSW to the chest, unstable and near arrest in the field.
medics drove right past the non bypass hospital to get to the hospital with
bypass.  Patient died in the ER shortly after arrival.  (by the way, at 12
midnight, the cardiac suite is closed!)

I have talked with EMS and their director until blue in face that there is
no evidence that support driving past 1 ER to another just for the sake of
"maybe" needing bypass (big maybe).  Most (far and away most) trauma
patients will not need bypass and patient may die getting to the other
place.

Any suggestions for how to proceed?????

Andrew J. Bowman, RN, CEN, CCRN, NREMT-P
Patient Care Coordinator
Education Coordinator (Trauma & Emergency Cardiovascular Care)
Emergency Department
Home Hospital Campus
Greater Lafayette Health Services, Inc.
2400 South Street
Lafayette, Indiana  47904 

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<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=090194710-28042003>Regional EMS Medical Director and/or Performance 
Improvement Committee, with input from medical control at either facility.&nbsp; 
This is a system issue, so make the system fix it.&nbsp; </SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=090194710-28042003></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=090194710-28042003>Failing that, you have bigger problems than who takes 
the penetrated trunks.&nbsp; And in neither case is an individual apt to create 
change by himself.</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=090194710-28042003></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN class=090194710-28042003>
<DIV><FONT color=#800000 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 size=2><SPAN 
class=030133519-19052000></SPAN></FONT><FONT face=Arial>&nbsp;</FONT></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></FONT></SPAN></FONT></DIV></DIV></DIV>
<BLOCKQUOTE style="MARGIN-RIGHT: 0px">
  <DIV align=left class=OutlookMessageHeader dir=ltr><FONT face=Tahoma 
  size=2>-----Original Message-----<BR><B>From:</B> Andrew J Bowman 
  [mailto:sumieb@compuserve.com]<BR><B>Sent:</B> Monday, April 28, 2003 12:00 
  AM<BR><B>To:</B> Trauma List<BR><B>Subject:</B> Penetrating Chest 
  Trauma<BR><BR></DIV></FONT>
  <DIV><STRONG><FONT face=Tahoma size=2>Well, they did it again.&nbsp; 
  </FONT></STRONG></DIV>
  <DIV><STRONG><FONT face=Tahoma size=2></FONT></STRONG>&nbsp;</DIV>
  <DIV><STRONG><FONT face=Tahoma size=2>A while back I presented a case of 
  penetrating chest trauma in a community with 2 corporate sister hospitals (1 
  with cardiac bypass and 1 without).&nbsp; Emergency departments are staffed 
  the same, board certified emergency medicine physicians and experienced 
  nursing staffs.&nbsp; Any after hours surgery requires a call in of surgeon, 
  anesthesia and staff (they have 1 hour to arrive).</FONT></STRONG></DIV>
  <DIV><STRONG><FONT face=Tahoma size=2></FONT></STRONG>&nbsp;</DIV>
  <DIV><STRONG><FONT face=Tahoma size=2>Friday night, GSW to the chest, unstable 
  and near arrest in the field.&nbsp; medics drove right past the non bypass 
  hospital to get to the hospital with bypass.&nbsp; Patient died in the ER 
  shortly after arrival.&nbsp; (by the way, at 12 midnight, the cardiac suite is 
  closed!)</FONT></STRONG></DIV>
  <DIV><STRONG><FONT face=Tahoma size=2></FONT></STRONG>&nbsp;</DIV>
  <DIV><STRONG><FONT face=Tahoma size=2>I have talked with EMS and their 
  director until blue in face that there is no evidence that support driving 
  past 1 ER to another just for the sake of "maybe" needing&nbsp;bypass (big 
  maybe).&nbsp; Most (far and away most) trauma patients will not need bypass 
  and patient may die getting to the other place.</FONT></STRONG></DIV>
  <DIV><STRONG><FONT face=Tahoma size=2></FONT></STRONG>&nbsp;</DIV>
  <DIV><STRONG><FONT face=Tahoma size=2>Any suggestions for how to 
  proceed?????</FONT></STRONG></DIV>
  <DIV><STRONG><FONT face=Tahoma size=2></FONT></STRONG>&nbsp;</DIV>
  <DIV><STRONG><FONT face=Tahoma size=2>Andrew J. Bowman, RN, CEN, CCRN, 
  NREMT-P<BR>Patient Care Coordinator<BR>Education Coordinator (Trauma &amp; 
  Emergency Cardiovascular Care)<BR>Emergency Department<BR>Home Hospital 
  Campus<BR>Greater Lafayette Health Services, Inc.<BR>2400 South 
  Street<BR>Lafayette, Indiana&nbsp; 47904 
</FONT></STRONG></DIV></BLOCKQUOTE></BODY></HTML>

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Penetrating Chest Trauma