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article in the may issue of "Annals of Emergency Medicine"

alcalaye at post.tau.ac.il alcalaye at post.tau.ac.il
Fri Apr 21 18:20:33 BST 2006


Dear list-members,
Recently I've read postings about the need for trauma surgeons with education
that will enable them to deal with trauma patients without the need for
physicians from other specialties. In the May issue of the Annals of Emergency
Medicine S.M. Green writes, if I've correctly understood,  that there is no
proof that the routine presence of surgeons in the ER when trauma patients
arrive is beneficial. I've brought you the abstract and wonder what the trauma
masters think about it.
Eli Alkalay
Rural Family Physician
Moshav Herut
Israel


Annals of emergency medicine –may 2006

Is There Evidence to Support the Need for Routine Surgeon Presence on Trauma
Patient Arrival?
Steven M. Green MD ,

The trauma center certification requirements of the American College of Surgeons
include the expectation that, whenever possible, general surgeons be routinely
present at the emergency department arrival of seriously injured patients. The
2 historical factors that originally prompted this requirement, frequent
exploratory laparotomies and emergency physicians without trauma training, no
longer exist in most modern trauma centers. Research from multiple centers and
in multiple varying formats has not identified improvement in patient-oriented
outcomes from early surgeon involvement. Surgeons are not routinely present
during the resuscitative phase of Canadian and European trauma care, with no
demonstrated or perceived decrease in the quality of care. American trauma
surgeons themselves do not consistently believe that their use in this capacity
is either necessary or an efficient distribution of resources. There is not
compelling evidence to support the assumption that trauma outcomes are improved
by the routine presence of surgeons on patient arrival. Research is necessary
to clarify which trauma patients require either emergency or urgent unique
expertise of a general surgeon during the initial phase of trauma management.
Individual trauma centers should be permitted the flexibility necessary to
perform such research and to use such findings to refine and focus their
secondary triage criteria.



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