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Sat Aug 19 10:30:16 BST 2006

Ok, help me with this one.  When a Code Trauma (highest level of activation)
is called should anesthesia be a part of the team?  Once the patient is
evaluated and if found to need to go to the OR urgently should the patient
be taken to anesthesia holding.  If so how long in holding is too long?

The bottom-line to all of my questions is the role of anesthesia in the
trauma service.

thanks, 

Errington C. Thompson, MD, FACS, FCCM
Trauma/Surgical Critical Care
Mission Hospital
Asheville, NC
Author - A Letter to America
www.whereistheoutrage.net

Everyone deserves to make an informed decision
                                - Errington Thompson, MD

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Ronald Gross
Sent: Thursday, August 17, 2006 4:58 PM
To: trauma-list at trauma.org
Subject: Re: Alcohol Screening

"We need to worry less about the insurance response, and more about
injury prevention and address the risk taking behaviors of these
drivers!"

Thank you, Laura.......I couldn't have said it better!

Ron

>>> "LAURA STEPHENS" <LSTEPH at parknet.pmh.org> 08/17/06 3:03 PM >>>
Working in a level one trauma center, I have often drawn both legal
blood alcohol levels, as well as diagnostic BAC's.  The legal blood
alcohol levels were always drawn, and placed in blood tubes provided by
the officer, after obtaining consent  from the patient.  Betadine was
used in place of alcohol, as to not affect the results, and careful
documentation was completed for the chain of custody,  to include which
officer took posession of the tube, and badge number.  It was also
clearly documented that betadine was was used in lieu of alcohol, and
allowed to air dry before the venipuncture was completed.  This was to
allow for better prosecution of the case.  When it came to blood alcohol
levels drawn as part of the trauma lab panel, it was not treated as
carefully as legal blood alcohol's were.  Alcohol pads were and are
routinely used to draw labs, which are generally drawn at the same time
the IV was placed.   We routinely send BAC's and urine tox on all trauma
patients, to identify those with potential alcohol or drug  related
problems.  You cannot address problems, unless you know they exist, and
even though there may be enough  non-laboratory evidence of alcohol
intoxication, i.e. smell,  or self report,  that without hard evidence
the patient may not be willing to discuss or admit to  the alcohol
related trauma.  In the 8 1/2 years I have worked in this trauma center,
I can only recall 2-3 payment denials due to positive testing of ETOH. 
We need to worry less about the insurance response, and more about
injury prevention and address the risk taking behaviors of these
drivers!  I applaud the ACS mandate, and I think the medical community
should embrace this mandate, and put in place  interventions and injury
prevention programs, so maybe we will have fewer alcohol related
traumas.

LStephens, RN, CEN
Dallas, TX

>>> bryanboling at gmail.com 8/17/06 9:47 AM >>>
When I was a tech in the ED, we used to draw tubes for the police. 
However,
they were ADDITIONAL tubes drawn for the purpose of evidence collection,
not
our regular labs, and it was with the patient's "consent."  I put
consent in
quotes because we have an implied consent law here that says if a police
officer suscpects someone of driving under the influence, he can request
they give a blood/breath/urine sample (most times they get the choice -
breath is free, blood or urine they MIGHT have to pay for - but if
they're
in the ED for treatment, blood test is free too, and dependending on the
nature and injuries, might be the "required" way, but I digress...). 
They
can refuse, but refusal gets their license suspended.  So, I never ahd a
patient refuse when it was put to them like that.

We drew the labs into special tubes with the officer observing and then
had
to sign a form saying we'd drawn it from the right patient and the tubes
were covered (sealed I suppose) with a label that the officer had to
cosign
with us.  I suppose that prevents tampering down the line?  Then they
took
the tubes to some other lab they didn't go to the hospital lab.

We routinely drew BALs on trauma patients and typically ran a urine drug
screen if there was any indication they might have anything on board. 
But
this was simply to know what we were dealing with pharmacologically (and
the
occasional ED game "guess the BAL") and not for any kind of legal
proceeding.

bryan

On 8/17/06, Lorick Fox, PA-C <lorick at lorick.org> wrote:
>
>
> Since there is no chain of custody, I would be surprised if a blood
> alcohol
> obtained in the hospital was admissible for criminal prosecution.
> On the other hand, I have heard of police officers watching blood
tubes
> drawn and then seizing them as evidence.
>
> Anyone actually KNOW:
> (1) if hospital labs are admissible and
> (2) if the "seizure of blood tubes" is anything more than urban
legend?
>
> BTW, I am leaving Egypt next month to join Cardiovascular Associates,
LLC
> in
> the Norfolk, Virginia area www.cval.org (doing EP).  However, I will
be
> returning to volunteer EMS as well, so I'll actually see more trauma.
>
> Lorick Fox, MPAS, PA-C
> SEAVIN Medical
> Gianaclis Support Complex
> 011-20-3-448-2335x2001 or 2207
> www.Lorick.org 
>
>
>
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