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

Ronald Gross Rgross at harthosp.org
Sat Apr 22 11:42:45 BST 2006


>"Trauma (true trauma, not scrapes, contusions and isolated broken
bones) is a SURGICAL disease. This nonsense of "studies" not showing the
'value' of an experienced surgeon using their years of judgement to
optimize the full outcome of a true trauma patient is because of the
near impossibility of doing a "study" with this kind of patient."<

Jon - for what it is worth, on this I agree with you 100%!

Best wishes to ya,
Ron

>>> JonWalsh at borgess.com 04/21 7:28 PM >>>
And I make no apologies for my 'surgical perspective' as I AM the one
standing over these patients taking care of them from the minute they
hit the door. If there are, in your area, "many places" where surgeons
aren't willing to make the commitment to the critically injured patient,
then those facilities shouldn't be seeing 'trauma patients'.... Trauma
(true trauma, not scrapes, contusions and isolated broken bones) is a
SURGICAL disease. This nonsense of "studies" not showing the 'value' of
an experienced surgeon using their years of judgement to optimize the
full outcome of a true trauma patient is because of the near
impossibility of doing a "study" with this kind of patient. If you
believe trauma surgeons add no value to the initial care of the trauma
patient,then 1) go convince the ACS COT who continue to see the
'immediate availability' of a surgeon as ESSENTIAL to Trauma Center
verification, and 2) be sure to take your family to a 'trauma center
that has surgeons taking call from home.... And if you would do that, I
feel very badly for your family....

Jcw





----- Original Message -----
From: trauma-list-bounces
Sent: 04/21/2006 07:01 PM
To: "'Trauma &amp; Critical Care mailing list'"
<trauma-list at trauma.org>
Subject: RE: article in the may issue of "Annals of Emergency
Medicine"

Just the kind of response I would expect from a surgeon...unfortunately
in
many places they're just not there themselves for the ruptured spleen
or
open book fracture...and if they are they can't make up their minds!!
:-)


Paul
Emergency Medicine
Sydney
Australia


-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] 
On Behalf Of JonWalsh at borgess.com 
Sent: Saturday, 22 April 2006 3:57 AM
To: Trauma &amp; Critical Care mailing list
Subject: Re: article in the may issue of "Annals of Emergency
Medicine"

Just the kind of article I would expect from an EM physician....
Tell them good luck with the next pt with a ruptured spleen or open
book
pelvic fx....
Jcw




----- Original Message -----
From: trauma-list-bounces
Sent: 04/21/2006 01:20 PM
To: "'Trauma &amp; Critical Care mailing list'"
<trauma-list at trauma.org>
Subject: article in the may issue of "Annals of Emergency Medicine"


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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