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Mon Oct 17 17:11:30 BST 2005

No, I didn't see that article, but I'll bet he is affiliated with an ACS
designated Level I center. Andy is being kind in pointing out the author's
conclusion is "bold". My experience is that only roughly 15% of those with
penetrating chest trauma need thoracotomy, and most are effectively treated
with tube thoracostomy, volume replacement, and occasionally temporary
airway support if needed. Further, (and I would need the collaboration of my
surgical colleagues here), I suspect the need for extracorporeal perfusion
is rarely needed even if thoracotomy is required.

The danger in following this author's recommendation is many would be placed
in harm's way unnecessarily for want of a chest tube, moderate volume
replacement, and observation. 

Don Benson, DO, FACEP
Emergency Medicine 
St. John Hospital
Detroit
bensonblues at comcast.net

-----Original Message-----
From: Andrew J Bowman [mailto:sumieb at compuserve.com] 
Sent: Thursday, October 13, 2005 11:29 PM
To: trauma-list at trauma.org
Cc: trauma-list at trauma.org; ems-l at SCHADONE.COM;
Paramedicine at yahoogroups.com; texasems-l at yahoogroups.com; ems-l at naemsp.org
Subject: Re: Level I versus Level II

Does the article address having 2 similar ED's (non trauma designation) 
with only difference being one has cardiopulmonary bypass and the other 
does not (on call from home, not in house 24/7).  Any effect on outcomes 
with chest trauma?

Andrew Bowman

> Did everyone catch the article entitled "The Effect of Trauma Center
> Designation and Trauma Volume on Outcome in Specific Injuries" Annuals 
of
> Surgery, Volume 242, Number 4, October 2005, Pages 512-519.
>
> I think one of the boldest conclusions the primary author makes is " It
> might be appropriate that for certain types of trauma, such as 
penetrating
> injuries to the chest or abdomen with hypotension, the paramedics 
bypass the
> Level II center in favor of the Level I center."
>
>  Jim<
>
> James Richardson, MBA, EMT-P
> Field Coordinator
> HealthONE, EMS
> 303-788-6468 Office
>
>
>
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Level I versus Level II