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Thu Dec 7 18:11:16 GMT 2006

Do they perform the needed interventions in a vehicle they come in? I assume
they can't do them in the outlying hospitals.

Anyway, is this an area not served by an organized regional trauma system?
If it is then there should be established referral patterns and contracts in
place for transportation. Surely this would be better in terms of cost and
patient care. I'm still stuck with how it is easier in terms of cost or time
to transport in the surgical critical care team than to get transport for
the patient to a trauma center. For what it must cost you could get Air
Force One. And last I heard aggressive resuscitation without concomitant
surgical intervention isn't necessarily such a good thing. 

Rob

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Moore677 at aol.com
Sent: Thursday, December 07, 2006 12:40 PM
To: trauma-list at trauma.org
Subject: Re: New Burn Centers in NYC and Mobile Surgical team

In a message dated 12/7/2006 11:07:20 AM Central Standard Time,
rfsmithmd at comcast.net writes:
Patients "who won't survive transport to Level I centers" is one of my pet
peeves. If some one is dieing from an injury that requires immediate
surgical intervention and they won't live through a transport then they
won't survive waiting for the traveling surgeons to save the day either. How
does this save lives? Am I missing something? However long it takes the
traveling team to get there is how long it would take the patient to get to
an actual trauma center isn't it?

Rob Smith
You are correct, as there are many patients that will die.  The dilemma is
deciding which patients will benefit from the transport team?  Please keep
in mind that many small hospitals do not have the personnel or the resources
to aggressively resuscitate a severely injured patient.  Also, it is not
uncommon to have delays of several hours from time of initial injury to
actual arrival to the Level I.  These contribute to a very high mortality
that might be averted with prompt arrival of an experienced critical care
surgeon.  The list below is taken from Dr. Long, and while we don't
necessarily agree with all of the indications, several deserve serious
consideration...................we have 
had several cases this year where we feel we could have saved some lives!   

Dell  

INDICATION FOR ACTIVATION Any critically ill patient who would benefit from
rapid surgical intervention or resuscitation that is not readily available
at the referral hospital is a candidate for help from the MSTT. The MSTT can
offer level I trauma resuscitation and surgical and bypass intervention to
patients who otherwise might not survive transport to a trauma center due to
injuries that may include:
- suspected ruptured aortas (thoracic) in combination with other injuries;
- cardiac injuries, temporarily repaired but leaking;
- penetrating trauma-impalement with a retained object that makes transport
difficult or requires vascular repair;
- major pulmonary injuries with hypoxemia;
- major liver, inferior vena cava, or pancreatic injuries;
- massive pelvic injuries;
- major vascular problems (ie, leaking abdominal aortic aneurysms);
- profound hypothermia requiring cardiopulmonary bypass;
- respiratory distress syndrome requiring extracorporeal membrane
oxygenation (ECMO); and
- traumatic amputations from wreckage extrication measures.
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New Burn Centers in NYC and Mobile Surgical team