Login
Site Search
Trauma-List Subscription

Subscribe

Would you like to receive list emails batched into one daily digest?
No Yes

 

Modify Your Subscription

Modify

 

Home > List Archives

List Archives

For your convenience, find the Trauma List Archive Below

trauma-list Digest, Vol 22, Issue 24

Haleema Shakur Haleema.Shakur at lshtm.ac.uk
Tue Apr 19 09:55:00 BST 2005 

I am only a trial manager doing trials in trauma.  I have been watching this discussion of  Steroids and Spinal Cord Injury with interest - how about someone designing a study to finally answer this question rather than asking everyone else to accept opinions based on poorly designed trials. It is obvious that this question is open to debate, there is uncertainty and unless the evidence base is improved, it will remain debateable. Anyone out there willing to do such a trial?  Haleema Shakur
Trials Manager
haleema.shakur at lshtm.ac.uk 
 
>>> trauma-list-request at trauma.org 18 April 2005 12:00:15 >>>

Send trauma-list mailing list submissions to
    trauma-list at trauma.org

To subscribe or unsubscribe via the World Wide Web, visit
    http://list.mistral.net/mailman/listinfo/trauma-list
or, via email, send a message with subject or body 'help' to
    trauma-list-request at trauma.org

You can reach the person managing the list at
    trauma-list-owner at trauma.org

When replying, please edit your Subject line so it is more specific
than "Re: Contents of trauma-list digest..."


Today's Topics:

   1. Re: Apologies - Remove my name from open letter.  
      (Krin135 at aol.com)
   2. RE: Apologies - Remove my name from open letter. (Green, Brian)
   3. Re: SCI, Peer pressure, Standards, TROUBLE (DocRickFry at aol.com)
   4. Re: SCI, Peer pressure, Standards, TROUBLE (Keith D. Lamb)
   5. Pressures & 6 Core Competencies (KMATTOX at aol.com)
   6. Steroids, SCI, why? (Bryan Boling)
   7. Re: Steroids, SCI, why? (KMATTOX at aol.com)
   8. Re: Apologies - Remove my name from open letter.   (KPCRP at aol.com)
   9. RE: SCI, Peer pressure, Standards, TROUBLE (Karim Brohi)
  10. Re: SCI, Peer pressure, Standards, TROUBLE (Krin135 at aol.com)
  11. Re: SCI, Peer pressure, Standards, TROUBLE (Gordon S. Doig)
  12. Re: Not all helmets are equal (Ronald Gross)


----------------------------------------------------------------------

Message: 1
Date: Sun, 17 Apr 2005 07:20:36 EDT
From: Krin135 at aol.com
Subject: Re: Apologies - Remove my name from open letter.  
To: trauma-list at trauma.org
Message-ID: <f7.4ea2b0dd.2f93a084 at aol.com>
Content-Type: text/plain; charset="US-ASCII"

In a message dated 16-Apr-05 21:20:43 Central Daylight Time, 
traumawon at yahoo.com writes:

Dr. Karim:    Please remove my name from the open letter to the leadership of 
the American College of Surgeons regarding my concern that steroids do not 
have a functional benefit to patients with blunt spinal cord injury.     I have 
been told by my administrator, trauma director, trauma nurse coordinator, and 
chief of surgery that I have been to visible and I observe, but not take 
sides, even if I thought it was the right thing to do.   I have been informed that 
for this hospital and for the hospitals in this very large city and this 
state, it has been determined that methylprednisilone WILL be used in any case of 
SCI, including many with penetrating wounds.   I have been told that if I wish 
to continue to work in this hospital and in this city, I MUST follow their 
protocols.      So, Dr. Karim, I regret to inform you that I will become a lurker 
and read more than I write.   I was beginning to enjoy the communications.    
I hope that those who wrote the papers and reached the
conclusions that they made which seem NOT to be supported by the data 
recognize what they have done to the professionalism of surgery.   I have recently 
learned that professionalism is one of the core competencies.    I guess it is 
for Europe, but not for California and my hospital.   So I apologize for 
embarrassing my chief of surgery, my trauma chief, my administrator, and my trauma 
nurse coordinator.     I like it here, so I will now use the big doses of 
steroids in any patient with any spinal cord injury, just like the others in this 
city.   

Mohamed
Mohamed:

I am sorry that you got whacked like this for trying to do what is right, 
especially since there are *TWO* issues here: First, your following their 
protocols in patient care, which is something that is probably a contract matter, 
even if those protocols are questionably on the side of 'best patient care' and 
'best industry standards."

Second, your right of free speech...which is should not be a matter of 
contract standards in many cases. I'd be rather surprised to find out that your 
contract gives your employer the right to quash you for trying to change the 
standards and protcols to more closely resemble something that does resemble best 
industry standards and practices. While I can understand that there may be 
other ways that your hospital can make your life miserable, I am incensed that 
they chose to force you to retract a stand, even a public one, as long as you 
were not violating any contract terms while doing patient care.

If you are feeling pressure from the hospital and your administration on this 
matter, and since you are in California, I would consider talking to a lawyer 
associated with the American Civil Liberties Union forthwith. I may not 
admire their rather limitations of what is a civil liberty, but they do champion 
those that they espouse quite well.

I would also hope that if push came to shove, and you were threatened with 
termination because of your association with this list, that Drs Frykberg, 
Mattox et al would be willing to testify pro bono publico on your behalf about the 
need for continuous improvement in our chosen profession.

ck



`


------------------------------

Message: 2
Date: Sun, 17 Apr 2005 09:17:08 -0400
From: "Green, Brian" <Brian.Green at stjohn.org>
Subject: RE: Apologies - Remove my name from open letter.
To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
Message-ID:
    <814E08B666D8D647AA5C24BF99A0076001B3E704 at hssjex10.SJHS.DS.sjhs.com>
Content-Type: text/plain; charset="utf-8"

the day I allow any one to deny me the right to an opinion or to write down, even if it is the President of my organization, is the day that I tell them to bag it, and go on to something else......
Sorry Mohamed that it came to this point for you.
BJG

    -----Original Message----- 
    From: Mohamed al Malik [mailto:traumawon at yahoo.com] 
    Sent: Sat 4/16/2005 10:20 PM 
    To: Trauma & Critical Care mailing list 
    Cc: ccm-l at ccm-l.org 
    Subject: Apologies - Remove my name from open letter. 
    
    


    Dr. Karim:    Please remove my name from the open letter to the leadership of the American College of Surgeons regarding my concern that steroids do not have a functional benefit to patients with blunt spinal cord injury.     I have been told by my administrator, trauma director, trauma nurse coordinator, and chief of surgery that I have been to visible and I observe, but not take sides, even if I thought it was the right thing to do.   I have been informed that for this hospital and for the hospitals in this very large city and this state, it has been determined that methylprednisilone WILL be used in any case of SCI, including many with penetrating wounds.   I have been told that if I wish to continue to work in this hospital and in this city, I MUST follow their protocols.      So, Dr. Karim, I regret to inform you that I will become a lurker and read more than I write.   I was beginning to enjoy the communications.    I hope that those who wrote the papers and reached th
e
    conclusions that they made which seem NOT to be supported by the data recognize what they have done to the professionalism of surgery.   I have recently learned that professionalism is one of the core competencies.    I guess it is for Europe, but not for California and my hospital.   So I apologize for embarrassing my chief of surgery, my trauma chief, my administrator, and my trauma nurse coordinator.     I like it here, so I will now use the big doses of steroids in any patient with any spinal cord injury, just like the others in this city.  
    
    Mohamed
    
    
    
    
    
                   
    ---------------------------------
    Do you Yahoo!?
    Plan great trips with Yahoo! Travel: Now over 17,000 guides!
    --
    trauma-list : TRAUMA.ORG
    To change your settings or unsubscribe visit:
    http://www.trauma.org/traumalist.html
    



CONFIDENTIALITY NOTICE:  This email message and any accompanying data are confidential, and intended only for the named recipient(s).  If you are not the intended recipient(s), you are hereby notified that the dissemination, distribution, and or copying of this message is strictly prohibited.  If you receive this message in error, or are not the named recipient(s), please notify the sender at the email address above, delete this email from your computer, and destroy any copies in any form immediately.
-------------- next part --------------
A non-text attachment was scrubbed...
Name: not available
Type: application/ms-tnef
Size: 5422 bytes
Desc: not available
Url : http://list.mistral.net/pipermail/trauma-list/attachments/20050417/9262787c/attachment-0001.bin

------------------------------

Message: 3
Date: Sun, 17 Apr 2005 10:23:27 EDT
From: DocRickFry at aol.com
Subject: Re: SCI, Peer pressure, Standards, TROUBLE
To: trauma-list at trauma.org
Message-ID: <bd.55eae12d.2f93cb5f at aol.com>
Content-Type: text/plain; charset="US-ASCII"


In a message dated 4/16/2005 3:52:33 P.M. Eastern Daylight Time,  
traumawon at yahoo.com writes:

Can my  hospital fire me for expressing my views and my evaluation of the 
literature  (Dr. Karim, I really appreciate the very good summary of ALL the 
trials on  your web site, )  if my views are counter to the "protocols" of the  
hospital.    Why did the ACS COT put us in this confusing  situation?   If my 
hospital fires me, do I have a recourse to force  them to take me back and pay 
for my lost wages and time off.    I  thought this was America, where quality 
medicine and evidence based medicine  could be practiced intellectually.   I 
have benefited from the  discussions on these sites, even those which are 
hostile and are different  from my views.   BUT NOW I AM IN TROUBLE in a hospital 
where I like  to work and had really enjoyed the intellectual freedom.     Do  I 
need a lawyer?

Mohamed



Oh, Please!  It has just dawned on me, fellow list members, that we  are all 
being taken for a ride by this member calling himself Mohamed--no  physician 
or human being can really be this dense
ERF


------------------------------

Message: 4
Date: Sun, 17 Apr 2005 07:39:56 -0700 (PDT)
From: "Keith D. Lamb" <kdlamb at prodigy.net>
Subject: Re: SCI, Peer pressure, Standards, TROUBLE
To: Trauma & Critical Care mailing list <trauma-list at trauma.org>
Message-ID: <20050417143956.25295.qmail at web80505.mail.yahoo.com>
Content-Type: text/plain; charset=us-ascii

Not on the same level....but I have recently been asked to NOT apply my professional affiliation to my signature line at the end of my posts. My boss is the one that asked me to stop, AFTER speaking to "risk management" and "human resources". I was told that if I didnt that "disciplinary" action would certainly follow. 

Keith

DocRickFry at aol.com wrote:



Oh, Please! It has just dawned on me, fellow list members, that we are all 
being taken for a ride by this member calling himself Mohamed--no physician 
or human being can really be this dense
ERF
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/traumalist.html


Keith D. Lamb, RCP, RRT 
Newark, Delaware










------------------------------

Message: 5
Date: Sun, 17 Apr 2005 11:00:32 EDT
From: KMATTOX at aol.com
Subject: Pressures & 6 Core Competencies
To: trauma-list at trauma.org, ccm-l at ccm-l.org
Message-ID: <f4.4f007cf1.2f93d410 at aol.com>
Content-Type: text/plain; charset="UTF-8"



•

We all are being guided by the specialty  RRCs and our professional 
organizations to live and teach according to 6 core  competencies:
Patient care, medical knowledge, practice  based learning, communication, 
system based learning, and  professionalism.    

I suggest that economic, political,  organizational, and system pressures 
lead us AWAY from these 6 core  competencies.    I am told by many in private 
practice, that  such pressures can be much greater than in an academic setting, 
especially for  younger physicians.   

We have seen dialogue on this site  regarding system, professional 
organization, and peer pressure for physicians to  conform to one form of treatment, in 
this instance use of steroids in patients  with spinal cord injury.    

Such pressures do exist in many economic  based health systems and we all  
have witnessed  examples:

"deselection of a physician from an HMO  panel because they ordered tests not 
on the approved list of indicated  reimbursable items and that they cost too 
much."

"removal from an HMO, because of too long  of hospital length of stays."

"economic profiling of  physicians"

"Pressure to use CT helical scanning for  possible thoracic aortic injury, 
prior to aortogram"

"Forcing a physician to use a hospital and  program protocols, practice 
guidelines, and best practices, and harassment in  multiple committees, if they did 
not"

"Forced to use a particular laboratory or  imaging service, because it had a 
cheaper contract with the HMO or hospital,  even though the quality was 
perceived to be better in out of system  facilities"

"Forced to use a generic, therapeutic  equivalent drug, which was purchased 
by the bulk buying contractor (I have had  difficulty in this regard with a 
cheaper Coumadin.   When the patient  purchased their Coumadin out of system, 
their problems with clotting studies  went away)"

and most recently......we have seen on this  list great discussion relating 
to governmental agents getting involved in  potentially forcing a physician or 
nurse to put in a gastrostomy  tube.     

Some of the many regulations from multiple  federal, state, and 
organizational groups (such as JCAHO, etc) have "standards"  which limit our practice.   
Think about it,   Medicine is  the most regulated profession on the face of the 
earth.  

Many other  examples........................................

Should we read the literature, discover  outcomes from our practice and 
system analysis and come to a treatment decision,  we should not be under pressure 
to do something, or refrain from doing something  because of an externally 
imposed protocol.   Each of us every  week, perhaps every day have some small or 
large example of such  activity.    I propose that we must re-assert our  
professionalism.     Should anyone be under pressure to  practice by protocol, 
then every state board of medical examiners, every  professional health 
organization, and every physician, nurse, and other health  professionals should be 
ready to say enough and come to the aid of our  professions.    

While others disagree and find some benefit  in using steroids in SCI,  in my 
review of the literature, I cannot find  any functional benefit from such 
use, and as everyone knows, we all have had  patients who have suffered because 
of steroid use.     Since  this subject has come up, I have been under some 
pressure even locally, to leave  this subject just be and let the existing 
protocols continue.     I do think nationally standardized courses, like the ATLS 
and TNCC need to be  careful, that when a controversial treatment is presented, 
it be cited as  controversial and not be presented as gospel.    

k





------------------------------

Message: 6
Date: Sun, 17 Apr 2005 11:01:35 -0400
From: Bryan Boling <bryanboling at gmail.com>
Subject: Steroids, SCI, why?
To: Trauma & Critical Care mailing list <trauma-list at trauma.org>
Message-ID: <af441c0a05041708012fa4340b at mail.gmail.com>
Content-Type: text/plain; charset=ISO-8859-1

OK, I'm just a student but I've been trying to follow this debate over
the use of steroids in SCI.  I know that many here say there's no
proven benefit.  I also know that I aked one of our surgeons about it
and he agreed but said that as long as it was "the standard" he'd
prescribe them for fear of being sued.  That seems wrong to me.  What
I don't understand is, if there's no proven benefit, how did this
become the "standard" to begin with?


------------------------------

Message: 7
Date: Sun, 17 Apr 2005 11:06:31 EDT
From: KMATTOX at aol.com
Subject: Re: Steroids, SCI, why?
To: trauma-list at trauma.org
Message-ID: <fe.11b40a81.2f93d577 at aol.com>
Content-Type: text/plain; charset="US-ASCII"


In a message dated 4/17/2005 10:01:53 A.M. Central Standard Time,  
bryanboling at gmail.com writes:

if  there's no proven benefit, how did this
become the "standard" to begin  with?



.........   and one could rapidly ask, on some other areas where  there is a 
great deal of class I evidence, and beneficial outcome data, did a  particular 
treatment NOT become a "standard."    One of the  members of this list has 
spent a lifetime researching hypertonic saline,  especially in special groups of 
trauma patients, and even today it is not  approved by the FDA.   I have 
created a long list of "standards" which  are approved by national organizations 
in their courses, but for which there are  NO data to really demonstrate 
benefit, but that have been approved by the FDA,  etc, etc.     I also have a long 
list of things that  definitely HAVE benefit, but that some committees of 
national orgainzations, for  their own reasons, have helped to encourage FDA, and 
other organizations NOT to  approve.      

Go figure........................................................

k


------------------------------

Message: 8
Date: Sun, 17 Apr 2005 13:17:20 EDT
From: KPCRP at aol.com
Subject: Re: Apologies - Remove my name from open letter.  
To: trauma-list at trauma.org
Message-ID: <158.4f011db6.2f93f420 at aol.com>
Content-Type: text/plain; charset="US-ASCII"

Mohammed,
I offer my empathies and the following:

Courage does not always roar. Sometimes, it is the quiet voice at the end of 
the day saying, "I will try again tomorrow".  -Anonymous 

Kat Rickey
NREMT-P; EMS I/C
NH/USA


------------------------------

Message: 9
Date: Sun, 17 Apr 2005 23:14:44 +0100
From: "Karim Brohi" <karim at trauma.org>
Subject: RE: SCI, Peer pressure, Standards, TROUBLE
To: "'Trauma & Critical Care mailing list'" <trauma-list at trauma.org>
Message-ID: <08bc01c5439a$dd2c26d0$96f1fea9 at ULTIMATE2>
Content-Type: text/plain;    charset="iso-8859-1"

Mohammed and others

Apologies for coming back to this late - more aeroplanes.

There are two issues here which should be kept very separate.

1. Should I go against a current hospital protocol and (for example) refuse to prescribe steroids to patients with SCI.

The answer to this is absolutely not.  If there is a protocol in place then, as Errington and others have suggested, the protocol
must be revisited by your hospital's trauma committee with the evidence in front of them. If the decision of the committee is that
steroids should stay, then you should continue to prescribe them - and revisit the issue again in the future.

2. Am I allowed to express my opinions about medical practice in open debate?  

The answer to this is absolutely - YES. Whether you are in the US, the UK, or anywhere else with some sign-up to free speech
regulations.

However - You must be debating the literature, available medical evidence, expert opinion - whatever - and coming to a conclusion
based on this.

What you cannot and should not do is say 'In my hospital everything is terrible and people are dying every day because X is not
happening or Dr Y won't do this or Department Z has this policy which is unacceptable.'  This is exposing internal deficiencies in a
system to outside scrutiny without first discussing this within your institution.  This is really rather naïve, irresponsible, and
almost certainly counter-productive.  I would hazard Mohammed that this is what your hospital is upset about, and not about you
putting your name to the letter.  There has been a lot of this sort of conversation on the list recently - even with specific people
or departments mentioned.

I have a couple of other points to make about the steroid issue and the letter.  I've received a couple of private emails with
points I'll address openly:

* I want to reinforce that the decision whether or not to use steroids in your hospital is an institution-specific one that should
be agreed upon by all parties involved in care.

* "There's no evidence for anything we do - why pick on steroids?"

    1. There is no evidence that steroids do any good - and there is similar level evidence to sugest that they may do harm.
Most people who have prescribed these high dose steroids to multiply injured patients will have one story where this is the case.

    2. Because many organisations have removed steroids from their list of recommendations and, at minimum, downgraded them to
an option to be used with caution.  However the new ATLS will last us at least 4 years (and possibly 7!).  We are urging the
committee to revisit the issue and at least downgrade the recommendation.  This is our recommendation - the committee may or may not
follow it - that will be their decision.

* Is this the way to change practice?

Well, no doubt that after this exchange of emails many of you will be extremely wary of putting your name to anything - and
certainly not to this letter.  However I would urge you to consider the alternative.  That at no insitutional, local, regional,
national or international meeting will you ever raise your hand and say 'I disagree'.  That you will never question or discuss
protocols and guidelines handed down to you by others.  That you essentially will give over responsibility for the practice of
medicine to others.

Should we do this by petition?  Why not just get everyone to send their own letters? - Well because for most people it's too much
effort - it's much easier to add you rname to a letter than to write one.  And their is weight in numbers, as has been discussed.
By all means if you would like to write a letter or email yourself please do so.

Remember that the letter is expressing the signatories views on the literature and urging a revisit of the situation by the ACS
committee on trauma & ATLS subcommittee.  There is no claim of wrongdoing, malpractice or of any legal intervention.  This is an
appraisal of scientific evidence and a recommendation - no more and no less.

It is interesting that there are 2100 people reading this emails and only about 30 signatories so far - and these are primarily the
people that have been involved in the discussion.  So what does this mean?  Voter apathy? Fear of reprisals?  Or people out there
are comfortable prescribing steroids for SCI and it is only this vocal minority which is creating a stir?  Who knows?  This has been
a very one-sided discussion - I do wonder where the steroid believers are.

Karim



------------------------------

Message: 10
Date: Sun, 17 Apr 2005 18:36:25 EDT
From: Krin135 at aol.com
Subject: Re: SCI, Peer pressure, Standards, TROUBLE
To: trauma-list at trauma.org
Message-ID: <9b.5daf5988.2f943ee9 at aol.com>
Content-Type: text/plain; charset="US-ASCII"

In a message dated 17-Apr-05 17:15:11 Central Daylight Time, karim at trauma.org 
writes:

It is interesting that there are 2100 people reading this emails and only 
about 30 signatories so far - and these are primarily the
people that have been involved in the discussion.  So what does this mean? 
I'm having trouble loading the edit page to sign the letter. I'll try again 
in the am when I have a different connection.

ck


------------------------------

Message: 11
Date: Mon, 18 Apr 2005 09:59:34 +1000
From: "Gordon S. Doig" <gdoig at med.usyd.edu.au>
Subject: Re: SCI, Peer pressure, Standards, TROUBLE
To: Trauma & Critical Care mailing list <trauma-list at trauma.org>
Message-ID: <4262F866.2080201 at med.usyd.edu.au>
Content-Type: text/plain; charset=ISO-8859-1; format=flowed


Hi Karim

Welcome back....

With regards to the evidence driving this discussion, I have conducted a 
quick Medline search and can find no new landmark trials of steroids in 
SCI (Pubmed Clinical Queries using the terms steroids and spinal cord 
trauma).

Although the CRASH study has provided some interesting information on 
this topic (See www.EvidenceBased.net 
<http://icu-10.med.usyd.edu.au/ebdm/journalnew5.shtml>,  for a review of 
the trial) I am not aware of the release of the 6 month outcomes. Has 
anyone seen the 6mth outcomes? Are there any other new Level 1 trials 
that I am missing? If there are no additional outcomes, or other trials 
on this topic, you need to be VERY cautious driving major decisions 
based on 14 day follow-up.

Gordon



Karim Brohi wrote:

>Mohammed and others
>
>Apologies for coming back to this late - more aeroplanes.
>
>There are two issues here which should be kept very separate.
>
>1. Should I go against a current hospital protocol and (for example) refuse to prescribe steroids to patients with SCI.
>
>The answer to this is absolutely not.  If there is a protocol in place then, as Errington and others have suggested, the protocol
>must be revisited by your hospital's trauma committee with the evidence in front of them. If the decision of the committee is that
>steroids should stay, then you should continue to prescribe them - and revisit the issue again in the future.
>
>2. Am I allowed to express my opinions about medical practice in open debate?  
>
>The answer to this is absolutely - YES. Whether you are in the US, the UK, or anywhere else with some sign-up to free speech
>regulations.
>
>However - You must be debating the literature, available medical evidence, expert opinion - whatever - and coming to a conclusion
>based on this.
>
>What you cannot and should not do is say 'In my hospital everything is terrible and people are dying every day because X is not
>happening or Dr Y won't do this or Department Z has this policy which is unacceptable.'  This is exposing internal deficiencies in a
>system to outside scrutiny without first discussing this within your institution.  This is really rather naïve, irresponsible, and
>almost certainly counter-productive.  I would hazard Mohammed that this is what your hospital is upset about, and not about you
>putting your name to the letter.  There has been a lot of this sort of conversation on the list recently - even with specific people
>or departments mentioned.
>
>I have a couple of other points to make about the steroid issue and the letter.  I've received a couple of private emails with
>points I'll address openly:
>
>* I want to reinforce that the decision whether or not to use steroids in your hospital is an institution-specific one that should
>be agreed upon by all parties involved in care.
>
>* "There's no evidence for anything we do - why pick on steroids?"
>
>    1. There is no evidence that steroids do any good - and there is similar level evidence to sugest that they may do harm.
>Most people who have prescribed these high dose steroids to multiply injured patients will have one story where this is the case.
>
>    2. Because many organisations have removed steroids from their list of recommendations and, at minimum, downgraded them to
>an option to be used with caution.  However the new ATLS will last us at least 4 years (and possibly 7!).  We are urging the
>committee to revisit the issue and at least downgrade the recommendation.  This is our recommendation - the committee may or may not
>follow it - that will be their decision.
>
>* Is this the way to change practice?
>
>Well, no doubt that after this exchange of emails many of you will be extremely wary of putting your name to anything - and
>certainly not to this letter.  However I would urge you to consider the alternative.  That at no insitutional, local, regional,
>national or international meeting will you ever raise your hand and say 'I disagree'.  That you will never question or discuss
>protocols and guidelines handed down to you by others.  That you essentially will give over responsibility for the practice of
>medicine to others.
>
>Should we do this by petition?  Why not just get everyone to send their own letters? - Well because for most people it's too much
>effort - it's much easier to add you rname to a letter than to write one.  And their is weight in numbers, as has been discussed.
>By all means if you would like to write a letter or email yourself please do so.
>
>Remember that the letter is expressing the signatories views on the literature and urging a revisit of the situation by the ACS
>committee on trauma & ATLS subcommittee.  There is no claim of wrongdoing, malpractice or of any legal intervention.  This is an
>appraisal of scientific evidence and a recommendation - no more and no less.
>
>It is interesting that there are 2100 people reading this emails and only about 30 signatories so far - and these are primarily the
>people that have been involved in the discussion.  So what does this mean?  Voter apathy? Fear of reprisals?  Or people out there
>are comfortable prescribing steroids for SCI and it is only this vocal minority which is creating a stir?  Who knows?  This has been
>a very one-sided discussion - I do wonder where the steroid believers are.
>
>Karim
>
>--
>trauma-list : TRAUMA.ORG
>To change your settings or unsubscribe visit:
>http://www.trauma.org/traumalist.html
>
>  
>

-- 
-------------
Evidence-based Decision Making http://www.EvidenceBased.net
Patient-based Teaching Cases http://www.AcademicHealthScience.net/ce
Outcomes Research http://www.AcademicHealthScience.net/UM
RNSH ICU Home Page http://icu-web.org



------------------------------

Message: 12
Date: Mon, 18 Apr 2005 07:02:28 -0400
From: "Ronald Gross" <Rgross at harthosp.org>
Subject: Re: Not all helmets are equal
To: <trauma-list at trauma.org>
Message-ID: <s2635b94.063 at hcnwgwds01.hh.chs>
Content-Type: text/plain; charset=US-ASCII

Susanna,
I too have my three deductions and my better half.  Please tell me what
kind of an example I am setting for them if I fail to honor my
principals, ignore my convictions, and do something that I know is wrong
because I "Might" get sued.
Remember that old question your mother used to ask when you did
something wrong "because everyone else was doing it"-----"And if
everyone were to to jump off the bridge, would you do that too?"
Just my thoughts,
Ron

>>> orthodiva at hotmail.com 4/15/2005 8:24:39 PM >>>
Steve,
     I can assume you are insured?  Then go ahead.  Anyone who can be
FULLY responsible for his/her own actions is free to do so, I believe. 
Few are.
Susanna
NOT free to do whatever due to my two tax deductions, who depend on
me.
  ----- Original Message ----- 
  From: Steve Urszenyi<mailto:medic.steve at rogers.com> 
  To: 'Trauma & Critical Care mailing
list'<mailto:trauma-list at trauma.org> 
  Sent: Friday, April 15, 2005 8:41 AM
  Subject: RE: Not all helmets are equal


  Do you always cross at the light? Ever run an amber as it was turning
red?
  Forget to put on your seat belt? Drink (even just one drink) and
  drive/swim/boat? Smoke cigarettes? Pipes? Cigars? Wacky tobacky? Run
with
  scissors?

  As a paramedic, I have picked up more pedestrian fatalities (and
shootings
  and stabbings and beatings) in my 22 years on the job than I have
  motorcyclists, with or without full-face helmets. Why do people jay
walk?
  Cross half-way and then stand on the line? Run across the road at
  crosswalks? Bicycle on sidewalks?

  C'mon! I wish everyone would stop proselytizing the full-face helmet
message
  when those same people make equally risky choices on a regular basis.
I
  choose to wear a helmet. But not a full-coverage one. I don't smoke.

  Steve Urszenyi
  Advanced Care Paramedic
  IQ 147, but stubborn as hell
  Toronto, Canada

   
  -----Original Message-----
  From:
trauma-list-bounces at trauma.org<mailto:trauma-list-bounces at trauma.org>
[mailto:trauma-list-bounces at trauma.org] 
  On Behalf Of rwolfer at aol.com<mailto:rwolfer at aol.com>
  Sent: April 14, 2005 03:24 PM
  To: trauma-list at trauma.org<mailto:trauma-list at trauma.org>
  Subject: Re: Not all helmets are equal

  We all thank you. However, Ihave seen many MCC under higher speeds
get
  minimal head injuries. We just had a pt who hit a truck on a
motorcycle
  doing 90mph. No head injury but broke nearly every bone on the right
side of
  his body and sheared his subclavian artery off the inominate on the
right.
  He will likely survive.  His helment , a full face, protected his
head and
  face as he had no injuries above the neck. 
  RW
   


  --
  trauma-list : TRAUMA.ORG
  To change your settings or unsubscribe visit:

<A href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2005-April/"http://www.trauma.org/traumalist.htmlhttp://www.trauma.org/traumalist.html<http://www.trauma.org/traumalist.html>
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/traumalist.html



-----------------------------------------------
Confidentiality Notice

This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential or proprietary information which is legally privileged.  Any unauthorized review, use, disclosure, or distribution is prohibited.  If you are not the intended recipient, please promptly contact the sender by reply e-mail and destroy all copies of the original message.


------------------------------

--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/traumalist.html

End of trauma-list Digest, Vol 22, Issue 24
*******************************************

More information about the trauma-list mailing list