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Wed Aug 30 12:13:09 BST 2006

Dr K

I could not agree more regarding outcomes with Paramedics as cutters - not 
this one that's for sure - You make the interesting observation about 
difficult questions - what I would like to know is why we ask these 
impossible questions ? beyond preventing the untrained trying the impossible 
which is ethically very good as far as I can see.

Cheers
Simon Houstoun
QAS ICP
----- Original Message ----- 
From: <KMATTOX at aol.com>
To: <trauma-list at trauma.org>
Sent: Monday, August 28, 2006 7:26 AM
Subject: Re: pre-hospital C-section

> Crisis C-Sections are emotional and technical challenges.   Let  us say 
> for
> just arguments sake that a family had even discussed this issue and  that 
> a
> couple had tried for years to produce an heir and had been  unsuccessful. 
> Now
> the woman was in the last 2 weeks of her pregnancy  and had a fatal GSW to 
> the
> head, was immediately intubated and arrived at the  hospital hypotensive, 
> but
> with good blood gases,  was brought into an  operating room where the 
> people
> present knew how to do a c-section,  should  they do it, if she arrested 5
> minutes after arrival?  What about if she  arrested at the time of 
> arrival, or
> maybe just 5 minutes prior to  arrival?    Emotion would push each of to 
> strongly
> consider doing  it, and I have been there and done that.
>
> Now is there science for doing a stat c-section in the emergency center,
> with people that really know how to do it, have been trained to be 
> decisive and
> where all the gadgets are present to do a good job.   What are the 
> results?
> Terrible,   Often WORSE THAN  TERRIBLE.   There has been an extremely rare
> isolated good result, but  reportable as an isolated event only.   A very 
> busy
> trauma surgeon, or  obstetrician, in such an institution would average 
> LESS
> THAN ONE during two  lifetimes.
>
> Every time such is done in any trauma center I know of, there is a 
> detailed
> internal review and QA review.    Most of the time the  conclusion is that 
> one
> should NOT do it next time, but with the passage of  several years, 
> someone
> does then try it, thinking they are better than their  predicissors. 
> New QA
> same results.
>
> NOW,,, move this to the pre-hospital area with the surgeon, obstetrician,
> etc. there, the results would be the same.    NOW   let  us make the 
> cutter a
> Paramedic or EMT...........
> You draw the conclusions,,   EVEN if you had the  instruments,  which most
> ambulances do not  have.      Bad outcome-and lots of  questions......
>
> k
>
> 

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