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Mon Nov 7 22:24:36 GMT 2005

That is exactly the disconnet that there is in not
only our medical system, but also our government. 
There are too many fiefdoms that are run for the sole
benefit of one person and not for the good of the
community.  Each of these Silos have no regard for
what their neighbor within their hospital or community
is doing, nor do they care.   Not only are we divided
as a medical community, we even stoop to the point
where we subscribe to the philosopy of every man for
themselves like many in the political arena.  And
those that should be involved in post disaster and pre
disaster management are not allowed to be involved or
choose not to be.
After being in Detroit and Charity, the problem is not
wanting to take care of trauma patients, but the lack
of leadership and monetary management.  Yes, patients
that came to the hospital had no insurance, but in
general this probably represented less than half the
trauma patients.  Poor management from the beginning
to the end of their admission and care leads to lack
of funding.  Adding to this is when the community
knows that they will get free care, why should they
have any insurance?  We sight these major trauma
centers that are in financial ruin, but why not take
an example from those that aren't and see how things
are done?  Federal and state funding was required to
bail out DRH, but why should this funding only come in
times of crisis?  Why not have a system that prevents
this from happening with state and federal
involvement?
There is more to the disconnect than just the system. 

--- KMATTOX at aol.com wrote:

>  
> There is a disconnect among the Rheotoric,
> Regulation and Reality regarding  
> Disaster planning and response, mainly due to the
> fact that the SILOS do not  
> communicate with each other and the more than 20
> identifiable silos think that 
>  the center of the disaster universe is INSIDE their
> windowless  silo.    The 
> biggest problem with disaster lack of communication 
> is not the lack of 
> radios, telephones, and frequencies, but that the
> silos  ignore the silo next to 
> them and consider the other silos  unimportant.  
> The on the ground response for 
> the first 48-72 hours  are totally ignored and most
> of the top down federal 
> and regulatory agency  concepts of the medical
> assets consider the doctors and 
> nurses to be volunteers  and do not include their
> intellectual property to be 
> part of the EOC and  Incident Command planning and
> implimentation.  
>  
> k
>  
>  
> In a message dated 11/7/2005 10:38:28 AM Central
> Standard Time,  
> DWalker at childrenscentralcal.org writes:
> 
> Just  imagine if 500 patients dropped in the average
> Trauma center in the
> USA  with severe ARDS from Avian Influenza,
> Dave
> 
> Trauma centers  ill-prepared for disaster
> 
> Monday, November 7, 2005; Posted: 10:21 a.m.  EST
> (15:21 GMT) 
> 
> Doctors say they probably couldn't handle a major 
> plane crash or any
> other incident with more than 20 or 30 severe 
> injuries.
> 
> "It's a struggle to meet the nightly demand of 911
> calls,"  said Dr.
> Arthur Kellermann, an ER physician at the hospital,
> Grady  Memorial.
> 
> "But somehow we're supposed to deal with a ...
> terrorist  bombing? Or a
> new strain of influenza?"
> 
> Trauma centers and emergency  departments similarly
> are strained in many
> U.S. cities, experts  say.
> 
> "Trauma systems are never more than a couple of
> minor incidents  from
> being overwhelmed," said Larry Gage, president of
> the  National
> Association of Public Hospitals and Health  Systems.
> 
> Hurricane Katrina destroyed New Orleans' only trauma
> center. A  few
> years ago, funding problems nearly closed primary
> trauma centers  in
> Detroit and Los Angeles, and more than a dozen other
> U.S. hospitals  have
> phased-down or shuttered their trauma units since.
> 
> That trend,  along with a growing U.S. population,
> is making it harder
> for many  hospitals to quickly and adequately handle
> severe emergencies.
> 
> "Across  the country, the level of crowding at
> emergency departments has
> reached  levels that are unprecedented in America's
> history," said Dr.
> Kathleen  Clem, chief of emergency medicine at Duke
> University  Medical
> Center.
> 
> Trauma and emergency care is a money loser, serving 
> many patients
> without health insurance. It's also expensive to
> maintain  a
> round-the-clock staff of specialized surgeons and
> trauma-care  medical
> workers.
> 
> In Atlanta, hospitals often pay subspecialists 
> around $1,000 per day to
> take calls for trauma care.
> 
> For those  reasons, many hospitals have gotten out
> of trauma care,
> increasing the load  on those that have stayed in
> that business, industry
> experts  say.
> 
> Grady Memorial is Atlanta's primary emergency care
> center, with  about
> 200,000 visits a year, and it's been getting busier.
> 
> Patient  volumes have been increasing more than 5
> percent a year at the
> 953-bed  hospital, driven by a variety of factors
> including an expanding
> city  population and the closing of trauma centers
> near Atlanta.
> 
> As at other  hospitals, Grady's 100 intensive care
> unit beds are often
> completely  filled, meaning dozens of gurneyed
> patients at a time have to
> wait in the  ER for a bed to open upstairs. That,
> along with a heavy flow
> of new cases,  doesn't allow much room for dealing
> with a  multi-trauma
> incident.
> 
> Grady is expecting a loss of between $9  million and
> $10 million this
> year, and would need more government funding  to
> expand its ICU and
> emergency capabilities, said Dr. Leon Haley Jr., the
>  hospital's chief of
> emergency medicine.
> 
> In New Orleans, the  situation is unusual in that
> hurricane flooding --
> not scarce funding --  closed the main trauma
> center. But some ER doctors
> say that, even before  the floods, they expected
> problems getting the
> center reaccredited this  fall.
> 
> Charity Hospital, once one of the nation's largest
> hospitals, was  home
> to New Orleans' only top-level trauma center, with
> staffing  and
> equipment to handle the most complex emergency
> injuries. The  hospital
> was getting 160,000 emergency and trauma visits a
> year.
> 
> But  650-bed Charity was irreparably damaged by
> floodwaters after
> Hurricane  Katrina. Since then, most of the city's
> trauma and emergency
> cases have  been handled in U.S. Navy ships,
> temporary combat hospital
> tents, and in  four civilian hospitals that have
> managed to restore at
> least some of their  services.
> 
> But the ships left weeks ago. And the combat
> hospital tents,  which are
> currently the city's main trauma center, are
> scheduled to pack up  later
> this month.
> 
> "It's going to be a major problem," said Helen 
> Ruiz, director of the
> emergency department at Touro Infirmary, the only 
> downtown hospital ER
> currently open.
> 
> Charity's parent organization,  the Louisiana State
> University Health
> Care Services Division, is trying to  lease a
> hospital and re-establish a
> trauma center. But it's also struggling  to cover
> bills.
> 
> "We are a bus crash away from complete and total 
> disaster," said Donald
> Smithburg, chief executive of the LSU hospital 
> organization.
> 
> But the story is different in Detroit. Officials at 
> Detroit Receiving
> Hospital, the Motor City's long-standing chief
> trauma  center, said their
> center is on solid footing right now and has been
> able  to handle
> multiple-trauma incidents pretty well.
> 
> But it's a  turnaround, they say, from the situation
> two years ago, when
> budget  shortfalls spurred rumors that the trauma
> center would have to
> close. An  infusion of state money saved the day,
> said Dr. James
> Tyburski, the  hospital's chief of surgery.
> 
> In September, emergency physicians from  across the
> country 
=== message truncated ===

Kumash Patel, MD
Assistant Professor of Surgery
Administrative Chief of Surgery @ University Hospital
Trauma / Critical Care / General Surgery
Tulane University Hospital
1430 Tulane Ave, SL-22
New Orleans, Louisiana 70112

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