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Please Wash Your Hands Before You Cut My Throat
p.bjorn trauma-list@trauma.orgThu, 3 Jul 2003 08:21:57 -0000
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This is a multi-part message in MIME format. ------=_NextPart_000_0009_01C3413C.2B9F28C0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Terry, You may recall that I'm a supporter of surgical airways in extreme = circumstances; but I think we should all note that even in very extreme = airway obstruction, a bag-valve-mask can have surprising efficacy. And referring to a field tracheotomy as a "minor procedure" is about as = valid as saying Saddam was an "imminent threat."=20 =20 So no, there's no reason to believe or suggest that medics are too = stupid to be trained in prehospital surgical procedures. But the costs = of adequate training can be high (especially when some of our rural = medics may do one or two in a career), and the risks of inadequate = training are astronomical. I once saw a seasoned EM physician intubate = a pig's carotid artery during an ATLS course. Ineffective, that. And = messy. Pret ----- Original Message -----=20 From: "T.A. Dinerman" <dinerman@computron.net> To: <trauma-list@trauma.org> Sent: Wednesday, July 02, 2003 7:40 PM Subject: Please Wash Your Hands Before You Cut My Throat=20 > Ben- >=20 > I am deeply sorry that you are so uncomfortable with the concept of = minor > surgical procedures being placed in the hands of us dirty ol' > Paramedics........... >=20 > If the occassion arose and my own airway was in such a sad state of = repair > that I coudl not be intubated, I would welcome the attention of Dr. = Crow. > His broad experience with mamaillian physiology and experience with a = knife > gives him a decided edge over those of us who specialize solely in = hominids, > and run into a truly mangled airway only infrequently. >=20 > Please endevour to avoid injury in Brazoria County Texas, as well as = Carson > City, for me and my ilk lie in wait for such as ye....... >=20 > Regards- >=20 > Terry Dinerman EMTP >=20 >=20 > ----- Original Message ----- > From: "Ben Reynolds" <aneurysm_42@yahoo.com> > To: <trauma-list@trauma.org> > Sent: Tuesday, July 01, 2003 7:36 PM > Subject: Re: Video education >=20 >=20 > > You are a very scary man. > > > > >From reading your posts it is apparent to me why you > > practice only on animals (with the exception of your > > EMT practice). If you are truly interested in > > performing surgical procedures on the species sapiens, > > I humbly suggest medical school. > > > > Until then, do MANkind a favor by recognizing that > > even the best and brightest of paramedics MUST have > > limitations on practice, not unlike all professions > > INCLUDING surgery. These limitations must include any > > procedure where a knife is put to flesh, ESPECIALLY if > > it is to be done in the back of an loud, bumpy, dirty, > > poorly lit, poorly equipped ambulance by someone who > > has been 'tested off' to do it after successfully > > completing the 'see one, do one, teach one' symposium. > > The variable phenotypy of trauma disease in humans is > > not something which can lend itself to be field > > treated per say on the observation of someone who > > doesn't do it several times a day, INCLUDING those who > > treat canine, bovine, porcine, and feline patients. > > > > It's simply not the same animal. > > > > Note to self: Don't get hurt in Carson City. > > > > Ben > > --- CROWEHOME@aol.com wrote: > > > Kate: I have some very good video on performing > > > surgical trachs and emergency > > > thoracotomies on the cadaver dog that I use to teach > > > emergency vets, > > > residents, EMTs, paramedics, etc. Let me know if > > > you would want copies. This is my > > > concern however.. there seems to be a big problem > > > with developing these tapes if > > > many of the trauma surgeons can't agree on the roles > > > each part of the team > > > should play. At least here in the USA. As an > > > example we have some that say > > > "never should a surgical trach be done in the field > > > by paramedics" while others > > > teach and expect their paramedics to be doing such > > > procedures and then these > > > are done! I believe you still need to train the > > > trainer including some that > > > think its only their way that is correct (as > > > exemplified by the last two weeks of > > > dialog on the list). My thoughts are that when there > > > is no time for the > > > patient to make the trip to the hospital ER as will > > > a blocked airway that cannot be > > > remedied with Magill Forceps and laryngoscope that a > > > surgical CT or trach > > > should be done NOW as other wise the patient is > > > going to be a dead patient! You > > > better train those that are going to be there so > > > they can save the patient's > > > life and not have complications from doing it; > > > whether it be flight physician, > > > EMT, paramedic, nurse or other rescue personnel. You > > > don't have to be an MD or > > > DO to place a chest tube or do surgical tracheotomy > > > (as is what has been > > > proven in many rural areas of the US where the MD in > > > charge of the paramedic/EMT > > > training have been aggressive). You just have to be > > > trained properly and > > > regularly and then tested off that you can do the > > > procedures rapidly and safely. > > > Let me know. > > > > > > Dennis T. (Tim) Crowe, Jr., DVM, DACVS, DACVECC, > > > NREMT-II PI, FF > > > Veterinary Surgery and Emergency - Critical Care > > > Consulting > > > 2621 Simons Court, Carson City, Nevada 89703 > > > phone and fax 775-841-6821 crowehome@aol.com > > > <>< > > > Clinical Associate Professor, The Institute of > > > Critical Care Medicine > > > 1695 N Sunrise Way, Palm Springs, CA 92262 > > > 760-788-4911 > > > > > > > > > __________________________________ > > Do you Yahoo!? > > SBC Yahoo! DSL - Now only $29.95 per month! > > http://sbc.yahoo.com > > > > -- > > trauma-list : TRAUMA.ORG > > To change your settings or unsubscribe visit: > > http://www.trauma.org/traumalist.html > > >=20 >=20 > -- > trauma-list : TRAUMA.ORG > To change your settings or unsubscribe visit: > http://www.trauma.org/traumalist.html > ------=_NextPart_000_0009_01C3413C.2B9F28C0 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable <!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"> <HTML><HEAD> <META http-equiv=3DContent-Type content=3D"text/html; = charset=3Diso-8859-1"> <META content=3D"MSHTML 6.00.2800.1106" name=3DGENERATOR> <STYLE></STYLE> </HEAD> <BODY> <DIV><FONT face=3DArial color=3D#800000 size=3D2>Terry,</FONT></DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2></FONT> </DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2>You may recall that I'm = a supporter=20 of surgical airways in extreme circumstances; but I think we = should all=20 note that even in very extreme airway obstruction, a bag-valve-mask = can=20 have surprising efficacy.</FONT></DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2></FONT> </DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2>And referring to a = field tracheotomy=20 as a "minor procedure" is about as valid as saying Saddam was an = "imminent=20 threat." </FONT></DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2> </FONT><FONT = face=3DArial=20 color=3D#800000 size=3D2></FONT></DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2>So no, there's no = reason to believe=20 or suggest that medics are too stupid to be trained in prehospital = surgical=20 procedures. But the costs of adequate training can be high = (especially=20 when some of our rural medics may do one or two in a career), and the = risks of=20 inadequate training are astronomical. I once saw a seasoned EM = physician=20 intubate a pig's carotid artery during an ATLS course. = Ineffective,=20 that. And messy.</FONT></DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2></FONT> </DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2>Pret</FONT></DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2></FONT> </DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2></FONT> </DIV> <DIV><FONT face=3DArial size=3D2>----- Original Message ----- </FONT> <DIV><FONT face=3DArial size=3D2>From: "T.A. Dinerman" <</FONT><A=20 href=3D"mailto:dinerman@computron.net"><FONT face=3DArial=20 size=3D2>dinerman@computron.net</FONT></A><FONT face=3DArial=20 size=3D2>></FONT></DIV> <DIV><FONT face=3DArial size=3D2>To: <</FONT><A=20 href=3D"mailto:trauma-list@trauma.org"><FONT face=3DArial=20 size=3D2>trauma-list@trauma.org</FONT></A><FONT face=3DArial=20 size=3D2>></FONT></DIV> <DIV><FONT face=3DArial size=3D2>Sent: Wednesday, July 02, 2003 7:40 = PM</FONT></DIV> <DIV><FONT face=3DArial size=3D2>Subject: Please Wash Your Hands Before = You Cut My=20 Throat </FONT></DIV></DIV> <DIV><FONT face=3DArial><BR><FONT size=3D2></FONT></FONT></DIV><FONT = face=3DArial=20 size=3D2>> Ben-<BR>> <BR>> I am deeply sorry that you are so=20 uncomfortable with the concept of minor<BR>> surgical procedures = being placed=20 in the hands of us dirty ol'<BR>> Paramedics...........<BR>> = <BR>> If=20 the occassion arose and my own airway was in such a sad state of = repair<BR>>=20 that I coudl not be intubated, I would welcome the attention = of Dr.=20 Crow.<BR>> His broad experience with mamaillian physiology and = experience=20 with a knife<BR>> gives him a decided edge over those of us who = specialize=20 solely in hominids,<BR>> and run into a truly mangled airway only=20 infrequently.<BR>> <BR>> Please endevour to avoid injury in = Brazoria=20 County Texas, as well as Carson<BR>> City, for me and my ilk = lie in=20 wait for such as ye.......<BR>> <BR>> Regards-<BR>> <BR>> = Terry=20 Dinerman EMTP<BR>> <BR>> <BR>> ----- Original Message = -----<BR>>=20 From: "Ben Reynolds" <</FONT><A = href=3D"mailto:aneurysm_42@yahoo.com"><FONT=20 face=3DArial size=3D2>aneurysm_42@yahoo.com</FONT></A><FONT face=3DArial = size=3D2>><BR>> To: <</FONT><A = href=3D"mailto:trauma-list@trauma.org"><FONT=20 face=3DArial size=3D2>trauma-list@trauma.org</FONT></A><FONT = face=3DArial=20 size=3D2>><BR>> Sent: Tuesday, July 01, 2003 7:36 PM<BR>> = Subject: Re:=20 Video education<BR>> <BR>> <BR>> > You are a very scary = man.<BR>>=20 ><BR>> > >From reading your posts it is apparent to me why=20 you<BR>> > practice only on animals (with the exception of = your<BR>>=20 > EMT practice). If you are truly interested in<BR>> > = performing=20 surgical procedures on the species sapiens,<BR>> > I humbly = suggest=20 medical school.<BR>> ><BR>> > Until then, do MANkind a favor = by=20 recognizing that<BR>> > even the best and brightest of paramedics = MUST=20 have<BR>> > limitations on practice, not unlike all = professions<BR>>=20 > INCLUDING surgery. These limitations must include any<BR>> = >=20 procedure where a knife is put to flesh, ESPECIALLY if<BR>> > it = is to be=20 done in the back of an loud, bumpy, dirty,<BR>> > poorly lit, = poorly=20 equipped ambulance by someone who<BR>> > has been 'tested off' to = do it=20 after successfully<BR>> > completing the 'see one, do one, teach = one'=20 symposium.<BR>> > The variable phenotypy of trauma disease = in humans=20 is<BR>> > not something which can lend itself to be field<BR>> = >=20 treated per say on the observation of someone who<BR>> > doesn't = do it=20 several times a day, INCLUDING those who<BR>> > treat canine, = bovine,=20 porcine, and feline patients.<BR>> ><BR>> > It's simply not = the same=20 animal.<BR>> ><BR>> > Note to self: Don't get hurt in = Carson=20 City.<BR>> ><BR>> > Ben<BR>> > --- </FONT><A=20 href=3D"mailto:CROWEHOME@aol.com"><FONT face=3DArial=20 size=3D2>CROWEHOME@aol.com</FONT></A><FONT face=3DArial size=3D2> = wrote:<BR>> >=20 > Kate: I have some very good video on performing<BR>> > > = surgical=20 trachs and emergency<BR>> > > thoracotomies on the cadaver dog = that I=20 use to teach<BR>> > > emergency vets,<BR>> > > = residents,=20 EMTs, paramedics, etc. Let me know if<BR>> > > you would = want=20 copies. This is my<BR>> > > concern however.. there seems to be = a big=20 problem<BR>> > > with developing these tapes if<BR>> > = > many=20 of the trauma surgeons can't agree on the roles<BR>> > > each = part of=20 the team<BR>> > > should play. At least here in the = USA. As=20 an<BR>> > > example we have some that say<BR>> > > = "never=20 should a surgical trach be done in the field<BR>> > > by = paramedics"=20 while others<BR>> > > teach and expect their paramedics to be = doing=20 such<BR>> > > procedures and then these<BR>> > > are=20 done! I believe you still need to train the<BR>> > > = trainer=20 including some that<BR>> > > think its only their way that is = correct=20 (as<BR>> > > exemplified by the last two weeks of<BR>> > = >=20 dialog on the list). My thoughts are that when there<BR>> > > = is no=20 time for the<BR>> > > patient to make the trip to the hospital = ER as=20 will<BR>> > > a blocked airway that cannot be<BR>> > > = remedied with Magill Forceps and laryngoscope that a<BR>> > > = surgical=20 CT or trach<BR>> > > should be done NOW as other wise the = patient=20 is<BR>> > > going to be a dead patient! You<BR>> > = >=20 better train those that are going to be there so<BR>> > > they = can save=20 the patient's<BR>> > > life and not have complications from = doing=20 it;<BR>> > > whether it be flight physician,<BR>> > > = EMT,=20 paramedic, nurse or other rescue personnel. You<BR>> > > don't = have to=20 be an MD or<BR>> > > DO to place a chest tube or do surgical=20 tracheotomy<BR>> > > (as is what has been<BR>> > > = proven in=20 many rural areas of the US where the MD in<BR>> > > charge of = the=20 paramedic/EMT<BR>> > > training have been aggressive). You just = have to=20 be<BR>> > > trained properly and<BR>> > > regularly = and then=20 tested off that you can do the<BR>> > > procedures rapidly and=20 safely.<BR>> > > Let me know.<BR>> > ><BR>> > = >=20 Dennis T. (Tim) Crowe, Jr., DVM, DACVS, DACVECC,<BR>> > > = NREMT-II PI,=20 FF<BR>> > > Veterinary Surgery and Emergency - Critical = Care<BR>>=20 > > Consulting<BR>> > > 2621 Simons Court, Carson City, = Nevada=20 89703<BR>> > > phone and fax 775-841-6821 </FONT><A=20 href=3D"mailto:crowehome@aol.com"><FONT face=3DArial=20 size=3D2>crowehome@aol.com</FONT></A><BR><FONT face=3DArial = size=3D2>> > >=20 <><<BR>> > > Clinical Associate Professor, The = Institute=20 of<BR>> > > Critical Care Medicine<BR>> > > 1695 N = Sunrise=20 Way, Palm Springs, CA 92262<BR>> > > 760-788-4911<BR>> >=20 ><BR>> ><BR>> ><BR>> >=20 __________________________________<BR>> > Do you Yahoo!?<BR>> = > SBC=20 Yahoo! DSL - Now only $29.95 per month!<BR>> > </FONT><A=20 href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2003-July/3D"http://sbc.yahoo.com"><FONT face=3DArial=20 size=3D2>http://sbc.yahoo.com</FONT></A><BR><FONT face=3DArial = size=3D2>>=20 ><BR>> > --<BR>> > trauma-list : TRAUMA.ORG<BR>> > = To=20 change your 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-July/3D"http://www.trauma.org/traumalist.html"><FONT face=3DArial=20 size=3D2>http://www.trauma.org/traumalist.html</FONT></A><BR><FONT = face=3DArial=20 size=3D2>> ><BR>> <BR>> <BR>> --<BR>> trauma-list :=20 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-July/3D"http://www.trauma.org/traumalist.html"><FONT = face=3DArial=20 size=3D2>http://www.trauma.org/traumalist.html</FONT></A><BR><FONT = face=3DArial=20 size=3D2>> </FONT></BODY></HTML> ------=_NextPart_000_0009_01C3413C.2B9F28C0--
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