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Home > List Archives

Penetrating Chest Trauma

Andrew J Bowman trauma-list@trauma.org
Tue, 29 Apr 2003 14:04:05 -0500


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One of the problems is that I cannot get administration to commit to a =
"trauma center" status for either hospital.  One of the local =
neurosurgeons wanted to pursue this but again administration balked.  =
For now this is what happens to a "Trauma One" patient.

Our "trauma One" follows ACS guidelines for "Level One" trauma center.

Nearest true Level 1 is over 1 hour away by ground.

EMS calls report and often calls as "Trauma One"

ED mobilizes along with radiology, respiratory, blood bank, admissions.
    EDP may call surgeon if EMS report sounds unstable, surgeon may or =
may not respond based on this.

Patient arrives and receives ATLS by EDP and ED staff.

If stable and if indicated off to CT and then call surgeon.

If unstable call surgeon and "plug the leaks and pray" until he/she gets =
to the ED.

Disposition is one of the following:

Discharged (overtriaged as "Trauma One")
Admit to floor
Admit to ICU
Off to OR
Transfer out by air/ground
Dies


  I am truly sorry that your surgeons are not committed to quality care =
for the patients that your serve.   Every document that I have read =
about systems approach to trauma care, mandates that the surgeon be =
involved at all levels.  The ACS requires that patients meeting your =
local trauma activation criteria, be present upon the patients arrival =
at the EC.    To want to be called AFTER CTs are performed is simply to =
not understand the problem.   I do not know what community you =
represent, but I also now know what community I do not want to be =
traumatized in.    Thanks for sharing some of the issues which beg for a =
trauma system  solution. =20

  k=20

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<DIV><STRONG><FONT face=3DTahoma size=3D2>One of the problems is that I =
cannot get=20
administration to commit to a "trauma center" status for either =
hospital.&nbsp;=20
One of the local neurosurgeons wanted to pursue this but again =
administration=20
balked.&nbsp; For now this is what happens to a "Trauma One"=20
patient.</FONT></STRONG></DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2></FONT></STRONG>&nbsp;</DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2>Our "trauma One" follows ACS =
guidelines=20
for "Level One" trauma center.</FONT></STRONG></DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2></FONT></STRONG>&nbsp;</DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2>Nearest true Level 1 is over 1 =
hour away=20
by ground.</FONT></STRONG></DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2></FONT></STRONG>&nbsp;</DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2>EMS calls report and often =
calls as=20
"Trauma One"</FONT></STRONG></DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2></FONT></STRONG>&nbsp;</DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2>ED mobilizes along with =
radiology,=20
respiratory, blood bank, admissions.</FONT></STRONG></DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2>&nbsp;&nbsp;&nbsp; EDP may =
call surgeon if=20
EMS report sounds unstable, surgeon may or may not respond based on=20
this.</FONT></STRONG></DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2></FONT></STRONG>&nbsp;</DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2>Patient arrives and receives =
ATLS by EDP=20
and ED staff.</FONT></STRONG></DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2></FONT></STRONG>&nbsp;</DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2>If stable and if indicated off =
to CT and=20
then call surgeon.</FONT></STRONG></DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2></FONT></STRONG>&nbsp;</DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2>If unstable call surgeon and =
"plug the=20
leaks and pray" until he/she gets to the ED.</FONT></STRONG></DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2></FONT></STRONG>&nbsp;</DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2>Disposition is one of the=20
following:</FONT></STRONG></DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2></FONT></STRONG>&nbsp;</DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2>Discharged (overtriaged as =
"Trauma=20
One")</FONT></STRONG></DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2>Admit to =
floor</FONT></STRONG></DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2>Admit to =
ICU</FONT></STRONG></DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2>Off to =
OR</FONT></STRONG></DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2>Transfer out by=20
air/ground</FONT></STRONG></DIV>
<DIV><STRONG><FONT face=3DTahoma size=3D2>Dies</FONT></STRONG></DIV>
<BLOCKQUOTE=20
style=3D"PADDING-RIGHT: 0px; PADDING-LEFT: 5px; MARGIN-LEFT: 5px; =
BORDER-LEFT: #000000 2px solid; MARGIN-RIGHT: 0px"><FONT=20
  face=3Darial,helvetica><FONT lang=3D0 style=3D"BACKGROUND-COLOR: =
#ffffff" face=3DArial=20
  color=3D#000000 size=3D3 FAMILY=3D"SANSSERIF"><BR></FONT><FONT =
lang=3D0=20
  style=3D"BACKGROUND-COLOR: #ffffff" face=3DArial color=3D#000000 =
size=3D2=20
  FAMILY=3D"SANSSERIF"><BR>I am truly sorry that your surgeons are not =
committed=20
  to quality care for the patients that your serve.&nbsp;&nbsp; Every =
document=20
  that I have read about systems approach to trauma care, mandates that =
the=20
  surgeon be involved at all levels.&nbsp; The ACS requires that =
patients=20
  meeting your local trauma activation criteria, be present upon the =
patients=20
  arrival at the EC.&nbsp;&nbsp;&nbsp; To want to be called AFTER CTs =
are=20
  performed is simply to not understand the problem.&nbsp;&nbsp; I do =
not know=20
  what community you represent, but I also now know what community I do =
not want=20
  to be traumatized in.&nbsp;&nbsp;&nbsp; Thanks for sharing some of the =
issues=20
  which beg for a trauma system&nbsp; solution.&nbsp; <BR><BR>k</FONT>=20
</FONT></BLOCKQUOTE></BODY></HTML>

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