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Thu Aug 28 21:10:41 BST 2003

Hi:

As a medical "ethnic group" we are educated quite different from the rest of
the people. We can't just say "if I was the patient I would hope this or
this". Even as patients we think as health community people because this is
what we do all the time. In this way, we are able to understand and judge
everything with the eyes of a health worker. For example, look into the
grieving process of general people and compare it with the same situation in
a member of the medical community; even if you can identify the same steps,
the evolution is quite different in the later. This is also one of the
reasons the general people is so prone to start a legal process when the
results of our treatments are not the their expected ones even if those
outcomes are between normal limits to us. Do not expect the general people
to view things the way we do. We do not have the right to disturb their
already shaken lifes with our personal hopes. The trauma incident has
already hurted enough this people.
I know a lot about this because I work in a General Hospital were we treat
most of the poorest people in Chihuahua, México, like tarahumara natives
from the Copper's canyon. Most of this people can't read or write but they
watch TV, which under that circumstances creates an unrealistic view of life
in their minds. I am performing research regarding the informed consent
process in this kind of people.
I agree with everybody regarding the futillity of CPR in trauma and that is
the reason to be in disagreement with the "training view" shown in this
discussion. I believe in the need for training in every health worker BUT
BEFORE being in the hospital or in the field. The very first time I
performed an emergent orotracheal intubation was during a cardiac arrest, in
a real patient but alone with two nurses younger than me. The patient did
well but I don't want any of my students today to be in that same situation.
The emergency room is not the place to have a long talk with the grieving
familiy of the victim regarding this "training session". I am quite shure
that in any of our emergency places I will be able to find some other
"training experiences" under a more ethical background and specially, with
more recoverable patients instead of spending time obtaining an informed
consent to perform a procedure on a virtually death patient.

Respectfully:

Manuel Sáenz-Terrazas, M.D.
Staff Surgeon
Hospital General de Chihuahua Salvador Zubirán
Chihuahua, Chih. México
  -----Mensaje original-----
  De: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]En nombre de Stephen R.
  Enviado el: Jueves, 28 de Agosto de 2003 02:00 p.m.
  Para: trauma-list at trauma.org
  Asunto: AW: CPR in Traumatic Arrest and a Question for Dr. Frykberg

  Firstly, a very wise surgeon whom I worked with told me that you should
use every opportunity to learn and practice your skills even if it may not
benefit the patient directly, it will benefit others directly when they are
in need of that skill.  I see more problems with not utilizing a poor soul
who is mortally wounded for practice, than I do with not doing anything.
Remember that we have implied consent to perform potentially lifesaving
actions in cases such as this, so the issue of consent is neglible at best.
If I was the patient I certainly would hope that they would use me in any
manner possible to improve others care, even if they couldn't save me.

  Secondly, Dr. Frykberg where are you from?  I noticed you made a comment
about the difference between US and German trauma ("unfall").  I was just
curious as to whether you were in the States or Germany.

  Stephen L. Richey, CRT, EMT-I/D, ERT, FF

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