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Penetrating Chest Trauma

Andrew J Bowman trauma-list@trauma.org
Mon, 28 Apr 2003 09:53:28 -0500


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Pret,

Protocol states "threat to life or limb goes to closest facility".

Later found out that wife of patient threatened to sue if medics took to =
the closest facility because she works at the more distant one.

What a fun time for the medics. Feel sorry for them in this situation.

But protocol is protocol.

Andrew
  ----- Original Message -----=20
  From: Bjorn, Pret=20
  To: 'trauma-list@trauma.org'=20
  Sent: Monday, April 28, 2003 8:51 AM
  Subject: RE: Penetrating Chest Trauma


  Jeff,

  Beg to differ.  It's Monday, and I'm intolerant.

  Destination decisions must be driven by adherence to protocol, not by =
any given medic's education, experience or perceived situational =
awareness.  The capability and capacity of any given trauma system =
hospital cannot be left for each prehospital provider to reckon.  This =
is not a time to reflect what one thinks is best; it's a time to look at =
the protocol and do what it says.  Assuming, of course, that Lafayette's =
protocol coincides with Andrew's opinion...

  Someone in authority must determine whether this was a =
misunderstanding or a violation.  If a Bowmanesque protocol is in the =
books, then the medics broke it, and their actions should be recorded, =
with a plan to remediate and monitor them.  That's where the positive, =
constructive, self-affirming phototropism comes into play. =20

  But unless he works from the framework of local rules, then Andrew's =
advice will merely be digested along with all the other opinions and =
folklore in the community, and the system will decay from lack of =
attention.

  Pret


  ----Original Message-----
  From: Jeff Brosius [mailto:medic245@mindspring.com]
  Sent: Monday, April 28, 2003 8:05 AM
  To: trauma-list@trauma.org
  Subject: Re: Penetrating Chest Trauma

  ...Find out WHY the medics think that bypass will be needed for =
thoracic trauma patients... teach them the truth, in a constructive, =
positive manner, and offer to help them see the light.  Then request to =
be part of a review committee, such as Pret suggested.

  Also, this situation tells me they have some SERIOUS problems in the =
CQI department.  That will be much harder to fix, I think... and I'm not =
sure where you'd begin.

  Not much help, I'm afraid.  To me, it sounds like an educational =
issue.


  Best,

  Jeff Brosius
  Paramedic, etc.
  Atlanta, GA
  brosius@prehospitalperspective.com
  http://www.prehospitalperspective.com
  "...deliver them that are drawn unto death."
  Proverbs 24:11 (NIV)



  --
  trauma-list : TRAUMA.ORG
  To change your settings or unsubscribe visit:
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<DIV><STRONG><FONT face=3DTahoma size=3D2>Pret,</FONT></STRONG></DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2></FONT></STRONG>&nbsp;</DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2>Protocol states "threat to =
life or limb=20
goes to closest facility".</FONT></STRONG></DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2></FONT></STRONG>&nbsp;</DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2>Later found out that wife of =
patient=20
threatened to sue if medics took to the closest facility because she =
works at=20
the more distant one.</FONT></STRONG></DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2></FONT></STRONG>&nbsp;</DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2>What a fun time for the =
medics. Feel sorry=20
for them in this situation.</FONT></STRONG></DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2></FONT></STRONG>&nbsp;</DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2>But protocol is=20
protocol.</FONT></STRONG></DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2></FONT></STRONG>&nbsp;</DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2>Andrew</FONT></STRONG></DIV>
<BLOCKQUOTE dir=3Dltr=20
style=3D"PADDING-RIGHT: 0px; PADDING-LEFT: 5px; MARGIN-LEFT: 5px; =
BORDER-LEFT: #000000 2px solid; MARGIN-RIGHT: 0px">
  <DIV style=3D"FONT: 10pt arial">----- Original Message ----- </DIV>
  <DIV=20
  style=3D"BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: =
black"><B>From:</B>=20
  <A title=3Dpbjorn@emh.org href=3D"mailto:pbjorn@emh.org">Bjorn, =
Pret</A> </DIV>
  <DIV style=3D"FONT: 10pt arial"><B>To:</B> <A =
title=3Dtrauma-list@trauma.org=20
  href=3D"mailto:'trauma-list@trauma.org'">'trauma-list@trauma.org'</A> =
</DIV>
  <DIV style=3D"FONT: 10pt arial"><B>Sent:</B> Monday, April 28, 2003 =
8:51=20
AM</DIV>
  <DIV style=3D"FONT: 10pt arial"><B>Subject:</B> RE: Penetrating Chest=20
  Trauma</DIV>
  <DIV><BR></DIV>
  <DIV><FONT face=3DArial color=3D#800000 size=3D2>Jeff,</FONT></DIV>
  <DIV><FONT face=3DArial color=3D#800000 size=3D2></FONT>&nbsp;</DIV>
  <DIV><FONT face=3DArial color=3D#800000 size=3D2>Beg to differ.&nbsp; =
It's Monday,=20
  and I'm intolerant.</FONT></DIV>
  <DIV><FONT face=3DArial color=3D#800000 size=3D2></FONT>&nbsp;</DIV>
  <DIV><FONT face=3DArial color=3D#800000 size=3D2>Destination decisions =
must be=20
  driven by adherence to protocol, not by any given medic's education,=20
  experience or perceived situational awareness.&nbsp; The capability =
and=20
  capacity of any given trauma system hospital cannot be left for each=20
  prehospital provider to reckon.&nbsp; This is not a time to reflect =
what one=20
  thinks is best; it's a time to look at the protocol and do what it =
says.&nbsp;=20
  </FONT><FONT face=3DArial color=3D#800000 size=3D2>Assuming, of =
course, that=20
  Lafayette's protocol coincides with Andrew's opinion...</FONT></DIV>
  <DIV>&nbsp;</DIV>
  <DIV><FONT face=3DArial color=3D#800000 size=3D2>Someone in authority =
must determine=20
  whether this was a misunderstanding or a violation.&nbsp; If a =
Bowmanesque=20
  protocol is in the books, then the medics broke it, and&nbsp;their =
actions=20
  should be recor</FONT><FONT face=3DArial color=3D#800000 size=3D2>ded, =
with a plan=20
  to remediate and monitor them.&nbsp; That's where the positive, =
constructive,=20
  self-affirming phototropism comes into play.&nbsp; </FONT></DIV>
  <DIV><FONT face=3DArial color=3D#800000 size=3D2></FONT>&nbsp;</DIV>
  <DIV><FONT face=3DArial color=3D#800000 size=3D2>But unless he works =
from the=20
  framework of local rules, then Andrew's advice will merely be digested =
along=20
  with all the other opinions and folklore in the community, and the =
system will=20
  decay from lack of attention.</FONT></DIV>
  <DIV>&nbsp;</DIV>
  <DIV><FONT face=3DArial color=3D#800000 size=3D2>Pret</FONT></DIV>
  <DIV>&nbsp;</DIV>
  <DIV>&nbsp;</DIV>
  <DIV><FONT face=3DArial color=3D#800000 size=3D2><FONT =
color=3D#000000>----Original=20
  Message-----<BR>From: Jeff Brosius [</FONT></FONT><A=20
  href=3D"mailto:medic245@mindspring.com"><FONT face=3DArial =
color=3D#000000=20
  size=3D2>mailto:medic245@mindspring.com</FONT></A><FONT face=3DArial=20
  size=3D2>]<BR>Sent: Monday, April 28, 2003 8:05 AM<BR>To:=20
  trauma-list@trauma.org<BR>Subject: Re: Penetrating Chest =
Trauma<BR><BR>...Find=20
  out WHY the medics think that bypass will be needed for thoracic =
trauma=20
  patients... teach them the truth, in a constructive, positive manner, =
and=20
  offer to help them see the light.&nbsp; Then request to be part of a =
review=20
  committee, such as Pret suggested.<BR><BR>Also, this situation tells =
me they=20
  have some SERIOUS problems in the CQI department.&nbsp; That will be =
much=20
  harder to fix, I think... and I'm not sure where you'd =
begin.<BR><BR>Not much=20
  help, I'm afraid.&nbsp; To me, it sounds like an educational=20
  issue.<BR><BR><BR>Best,<BR><BR>Jeff Brosius<BR>Paramedic, =
etc.<BR>Atlanta,=20
  GA<BR>brosius@prehospitalperspective.com<BR></FONT><A=20
  href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2003-April/3D"http://www.prehospitalperspective.com" target=3D_blank><FONT =
face=3DArial=20
  color=3D#000000 =
size=3D2>http://www.prehospitalperspective.com</FONT></A><BR><FONT=20
  face=3DArial size=3D2>"...deliver them that are drawn unto =
death."<BR>Proverbs=20
  24:11 (NIV)<BR><BR><BR><BR>--<BR>trauma-list : TRAUMA.ORG<BR>To change =
your=20
  settings or unsubscribe visit:<BR></FONT><A=20
  href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2003-April/3D"http://www.trauma.org/traumalist.html" target=3D_blank><FONT =
face=3DArial=20
  color=3D#000000=20
size=3D2>http://www.trauma.org/traumalist.html</FONT></A><BR></DIV></BLOC=
KQUOTE></BODY></HTML>

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