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Penetrating Chest Trauma
Bjorn, Pret trauma-list@trauma.orgTue, 29 Apr 2003 08:02:57 -0400
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This message is in MIME format. Since your mail reader does not understand this format, some or all of this message may not be legible. ------_=_NextPart_001_01C30E47.45E1F910 Content-Type: text/plain; charset="iso-8859-1" Not that outcome was at stake, but there's a lesson here: you and your patient are both better off obeying EMS rules than the emotional demands of next of kin--especially next of kin encountered at the scene of an apparent attempted homicide. All the more reason to assure these medics and their peers that the EMS system is watching, every bit as carefully as the civil litigation system. Message being, the prehospital provider's legal responsibilities start and stop at the level of local protocols. My initial recommendations stand. And my sympathy for these medics is tempered by the fact that they chose to ignore a simple and crucial mandate in the misguided notion that it would cover their asses. Pret -----Original Message----- From: Andrew J Bowman [mailto:sumieb@compuserve.com] Sent: Monday, April 28, 2003 10:53 AM To: trauma-list@trauma.org Subject: Re: Penetrating Chest Trauma 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 ----- From: Bjorn, Pret <mailto:pbjorn@emh.org> To: 'trauma-list@trauma.org' <mailto:'trauma-list@trauma.org'> 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. 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> 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> 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: <http://www.trauma.org/traumalist.html> http://www.trauma.org/traumalist.html ------_=_NextPart_001_01C30E47.45E1F910 Content-Type: text/html; charset="iso-8859-1" <!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"> <HTML><HEAD> <META HTTP-EQUIV="Content-Type" CONTENT="text/html; charset=iso-8859-1"> <TITLE></TITLE> <META content="MSHTML 5.00.2919.6307" name=GENERATOR> <STYLE></STYLE> </HEAD> <BODY bgColor=#ffffff> <DIV><FONT color=#800000 face=Arial size=2><SPAN class=070580515-28042003>Not that outcome was at stake, but there's a lesson here: you and your patient are both better off obeying EMS rules than the emotional demands of next of kin--especially next of kin encountered at the scene of an apparent attempted homicide.</SPAN></FONT></DIV> <DIV><FONT color=#800000 face=Arial size=2><SPAN class=070580515-28042003></SPAN></FONT> </DIV> <DIV><FONT color=#800000 face=Arial size=2><SPAN class=070580515-28042003>All the more reason to assure these medics and their peers that the EMS system is watching, every bit as carefully as the civil litigation system. Message being, the prehospital provider's legal responsibilities start and stop at the level of local protocols.</SPAN></FONT></DIV> <DIV><FONT color=#800000 face=Arial size=2><SPAN class=070580515-28042003></SPAN></FONT> </DIV> <DIV><FONT color=#800000 face=Arial size=2><SPAN class=070580515-28042003>My initial recommendations stand. And my sympathy for these medics is tempered by the fact that they chose to ignore a simple and crucial mandate in the misguided notion that it would cover their asses.</SPAN></FONT></DIV> <DIV><FONT color=#800000 face=Arial size=2><SPAN class=070580515-28042003></SPAN></FONT> </DIV> <DIV><FONT color=#800000 face=Arial size=2><SPAN class=070580515-28042003>Pret</SPAN></FONT></DIV> <DIV><SPAN class=070580515-28042003></SPAN><FONT face=Tahoma><FONT size=2><SPAN class=070580515-28042003><FONT color=#800000 face=Arial> </FONT></SPAN></FONT></FONT></DIV> <DIV><FONT face=Tahoma><FONT size=2><SPAN class=070580515-28042003></SPAN></FONT></FONT> </DIV> <DIV><FONT face=Tahoma><FONT size=2><SPAN class=070580515-28042003> </SPAN>-----Original Message-----<BR><B>From:</B> Andrew J Bowman [mailto:sumieb@compuserve.com]<BR><B>Sent:</B> Monday, April 28, 2003 10:53 AM<BR><B>To:</B> trauma-list@trauma.org<BR><B>Subject:</B> Re: Penetrating Chest Trauma<BR><BR></DIV></FONT> <BLOCKQUOTE dir=ltr style="MARGIN-RIGHT: 0px"></FONT> <DIV><STRONG><FONT face=Tahoma size=2>Pret,</FONT></STRONG></DIV> <DIV><STRONG><FONT face=Tahoma size=2></FONT></STRONG> </DIV> <DIV><STRONG><FONT face=Tahoma size=2>Protocol states "threat to life or limb goes to closest facility".</FONT></STRONG></DIV> <DIV><STRONG><FONT face=Tahoma size=2></FONT></STRONG> </DIV> <DIV><STRONG><FONT face=Tahoma size=2>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.</FONT></STRONG></DIV> <DIV><STRONG><FONT face=Tahoma size=2></FONT></STRONG> </DIV> <DIV><STRONG><FONT face=Tahoma size=2>What a fun time for the medics. Feel sorry for them in this situation.</FONT></STRONG></DIV> <DIV><STRONG><FONT face=Tahoma size=2></FONT></STRONG> </DIV> <DIV><STRONG><FONT face=Tahoma size=2>But protocol is protocol.</FONT></STRONG></DIV> <DIV><STRONG><FONT face=Tahoma size=2></FONT></STRONG> </DIV> <DIV><STRONG><FONT face=Tahoma size=2>Andrew</FONT></STRONG></DIV> <BLOCKQUOTE dir=ltr style="BORDER-LEFT: #000000 2px solid; MARGIN-LEFT: 5px; MARGIN-RIGHT: 0px; PADDING-LEFT: 5px; PADDING-RIGHT: 0px"> <DIV style="FONT: 10pt arial">----- Original Message ----- </DIV> <DIV style="BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: black"><B>From:</B> <A href="mailto:pbjorn@emh.org" title=pbjorn@emh.org>Bjorn, Pret</A> </DIV> <DIV style="FONT: 10pt arial"><B>To:</B> <A href="mailto:'trauma-list@trauma.org'" title=trauma-list@trauma.org>'trauma-list@trauma.org'</A> </DIV> <DIV style="FONT: 10pt arial"><B>Sent:</B> Monday, April 28, 2003 8:51 AM</DIV> <DIV style="FONT: 10pt arial"><B>Subject:</B> RE: Penetrating Chest Trauma</DIV> <DIV><BR></DIV> <DIV><FONT color=#800000 face=Arial size=2>Jeff,</FONT></DIV> <DIV><FONT color=#800000 face=Arial size=2></FONT> </DIV> <DIV><FONT color=#800000 face=Arial size=2>Beg to differ. It's Monday, and I'm intolerant.</FONT></DIV> <DIV><FONT color=#800000 face=Arial size=2></FONT> </DIV> <DIV><FONT color=#800000 face=Arial size=2>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. </FONT><FONT color=#800000 face=Arial size=2>Assuming, of course, that Lafayette's protocol coincides with Andrew's opinion...</FONT></DIV> <DIV> </DIV> <DIV><FONT color=#800000 face=Arial size=2>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 recor</FONT><FONT color=#800000 face=Arial size=2>ded, with a plan to remediate and monitor them. That's where the positive, constructive, self-affirming phototropism comes into play. </FONT></DIV> <DIV><FONT color=#800000 face=Arial size=2></FONT> </DIV> <DIV><FONT color=#800000 face=Arial size=2>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.</FONT></DIV> <DIV> </DIV> <DIV><FONT color=#800000 face=Arial size=2>Pret</FONT></DIV> <DIV> </DIV> <DIV> </DIV> <DIV><FONT color=#800000 face=Arial size=2><FONT color=#000000>----Original Message-----<BR>From: Jeff Brosius [</FONT></FONT><A href="mailto:medic245@mindspring.com"><FONT color=#000000 face=Arial size=2>mailto:medic245@mindspring.com</FONT></A><FONT face=Arial size=2>]<BR>Sent: Monday, April 28, 2003 8:05 AM<BR>To: trauma-list@trauma.org<BR>Subject: Re: Penetrating Chest Trauma<BR><BR>...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.<BR><BR>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.<BR><BR>Not much help, I'm afraid. To me, it sounds like an educational issue.<BR><BR><BR>Best,<BR><BR>Jeff Brosius<BR>Paramedic, etc.<BR>Atlanta, GA<BR>brosius@prehospitalperspective.com<BR></FONT><A href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2003-April/"http://www.prehospitalperspective.com" target=_blank><FONT color=#000000 face=Arial size=2>http://www.prehospitalperspective.com</FONT></A><BR><FONT face=Arial size=2>"...deliver them that are drawn unto death."<BR>Proverbs 24:11 (NIV)<BR><BR><BR><BR>--<BR>trauma-list : TRAUMA.ORG<BR>To change your settings or unsubscribe visit:<BR></FONT><A href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2003-April/"http://www.trauma.org/traumalist.html" target=_blank><FONT color=#000000 face=Arial size=2>http://www.trauma.org/traumalist.html</FONT></A><BR></DIV></BLOCKQUOTE></BLOCKQUOTE></BODY></HTML> ------_=_NextPart_001_01C30E47.45E1F910--
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