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

Zsolt Balogh zsoltbalogh at yahoo.com
Sun Apr 23 14:31:00 BST 2006

Dear Caesar,
  I agree, that attending surgeon's presence is essential to show role model and leadership. It is very important in relatively soft cases as well to eliminate guess work which we can not afford in trauma. I am in hospital and personally discuss with my trainees at the beside the whole spectrum of the trauma patients from the isolated broken wrist to the penetrating injury to the box. It does not mean that they do not go through the maturing process and they do not have gradually increasing responsibilities. But every case is a challanging learning environment and via every trauma patient the hospital experiences from that this is a different and superior care than people used to. Always real-time decision making. It is our role to provide this, which can not be acquired simply on an ATLS/EMST course and a DSTC course. If I can not add any more to the training of a PGY 7/8 surgical trainee with my comprehensive trauma approach and with the ultimate desire to fix everything
 I will just retire...
  The other important thing that our experience does not increase by staying away from the real-time action, I am passionate about this that is why I am a traumatologist.
  I can assure you that there is one more center in NSW the John Hunter Hospital where the trauma surgeon (at this time only one) is in the hospital.
  Best Regards,
  Zsolt Balogh
Director of Trauma
  John Hunter Hospital
  Newcastle, NSW, Australia
Ian Civil <icivil at xtra.co.nz> wrote:
  Dear Caesar,

Always lurking. I used to be in the hospital on call but feel that with
appropriate teaching of residents and a PGY 7/8 resident physically in the
hospital there is no added benefit for attending presence. I believe the
published US data supports this (bearing in mind to the Auckland 91:9
blunt:penetrating ratio). Prompt availability of attendings in <15 mins is
always available. Same comment applies in relation to education of "general
surgeons" who with DSTC and a range of other educational opportunities can
provide quality trauma care without additional input in all but exceptional
cases. For those exceptional cases, trauma surgeon input is required.
Establishing prospectively what are exceptional cases is the challenge.

Ian Civil
Director of Trauma Services
Auckland City Hospital

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Caesar Ursic
Sent: Sunday, April 23, 2006 10:29 AM
To: Trauma &, Critical Care mailing list
Subject: Re: article in the may issue of "Annals of Emergency Medicine"

Dr Paul M Middleton wrote:

"just try for a moment to think outside the box you are in and imagine
living in a
country (and I am talking about first-world places like the UK, Australia,
New Zealand and many others) where THE ONLY CHOICE is a hospital with this
arrangement. When you say they shouldn't be seeing trauma patients, then
where should they go? I'll just have a chat to ambulance control here in
Sydney shall I, and ask them to divert to Houston, New York, Boston.?"

Paul, wait a sec. Don't paint it with such broad brush strokes. What
you call 'the only choice' ...isn't. The situation in Sydney is not
quite as you describe it. At Westmead Hospital and at Liverpool
Hospital, and until recently at St George Hospital, an attending or
fellow-level surgeon would be in the ER promptly for all major trauma
activations. Michael Sugrue and Scott D'Amours can attest to that at
Liverpool (they sleep there when on call), and Valerie Malka at
Westmead; and I instituted a 'fifteen minute' rule at St George during
my two year tenure there, with specific attending call-in criteria
(and this was part of our quality assurance process). And I'm willing
to bet that a similar policy exists at Auckland Hospital, although I
cannot be 100% sure (Ian, are you lurking?)

CM Ursic, MD
Santa Fe, New Mexico
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