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Wed Apr 6 21:53:16 BST 2005

Rick,

A couple of questions:

First, which of your lawsuits had anything to do with methylprednisolone in
acute SCI, and what was their outcome?

Then, clarify for me: your ED doc got dinged for not following a trauma
diagnostic protocol, constructed at the behest of the TMD, so that the TMD
could have tons of predictably negative (and likewise noncontributory)
results handed to him on his arrival?  Plain films of the c-spine, and tox
screens, and a UA on every trauma alert?  What level trauma center is this?

"...While I agree that these may be unnecessary all the time at this point
our system is to do them.  It's much easier to defend an action that
followed protocol than to defend one that didn't."

Well, if it's all about what's easiest, you've got me.  But consider for a
moment that your system--fundamental parts of it, at least--might suck.  I'm
not seeing why you expect people to respect or defer to it just because it's
your system.

Pret

----- Original Message -----
From: "Moore Rick" <Rick.Moore at TriadHospitals.com>
To: "'Trauma & Critical Care mailing list'" <trauma-list at trauma.org>
Sent: Wednesday, April 06, 2005 9:25 PM
Subject: RE: Steroids Protocols, QA, Pressure, NEED ADVICE

> Phil,
> Glad you asked! The recommendation of our state trauma system, backed up
by
> the surveyors that surveyed this facility (Trauma Program Manager at a
large
> Level 1 Center and Chief of Trauma Surgery at large University operated
> Level 1 center), is that every trauma patient receive a minimum of UA, Tox
> screen, Etoh, CBC, and C-spine, Chest and Pelvis plain films. Our policy
is
> that any level II activation (which this patient was) have a CBC, Chem 12,
> Etoh and UA and a chest xray with any other exam or injury specific
> diagnostics added. This policy was formulated at the request of the Trauma
> Medical Director and his associates, because they were getting activated
by
> the ED physicians and the diagnostics they wanted were not completed when
> they arrived. One of the trauma surgeons has stated "a trauma surgeon
should
> never ever be called for blunt trauma without a chest film being done".
The
> ED doc felt that he was saving the patient money by not ordering these
> tests. While I agree that these may be unnecessary all the time at this
> point our system is to do them. It's much easier to defend an action that
> followed protocol than to defend one that didn't.
> I am also not sure that everytime a new study is released that we should
> believe it's gospel and start zealously following it. How many times have
we
> discontinued a practice based on study results only to have another study
a
> few years later that says oops, we were wrong first study was flawed.
> REM
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org]On Behalf Of P. Hoffman
> Sent: Wednesday, April 06, 2005 3:53 PM
> To: Trauma & Critical Care mailing list
> Subject: RE: Steroids Protocols, QA, Pressure, NEED ADVICE
>
>
> Rick,
>
> Maybe I am getting too specific for this list, but can you help us to
> understand why your protocol required the lab tests and the x-rays, yet
the
> physician did not feel that they were warranted.
>
> Is this a CYA mentality on the part of the SYSTEM under which you operate?
> Are there sound medical reasons for each of these tests for every trauma
> patient?  Did the physician (ER Doc) have a brain-fart and he/she should
> have requested these tests?  Does the hospital generate additional revenue
> by having unnecessary tests performed, thus increasing health care costs
for
> the rest of us...
>
> I'm not attacking you personally.  Just curious about the SYSTEM.
>
> Phil Hoffman
> EMTP

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