List Archives

Tue Oct 10 14:42:58 BST 2006

Dear Ron
I have only come into this late.
No one is arguing that if the patient needs an urgent operation  , then the
surgeon should be involved from time of arrival as there is good evidence
that the presence of a surgeon in the resus room shortens the time to OR
significantly. In this country where the trauma laparotomy rate is < 5%, it
is relatively easy to understand why Trauma surgeons are few and far between
because they don;t get to operate. They don;t look after the patient in the
Intensive care unit and they don;t usually clear the cervical spine ( that
is usually left to the Emergency , Orthopedics or Neurosurgical docs).
The trauma team leader is usually either the ER or Intensive care doc, so
the patient would be in deep trouble if we waved them "goodbye" on their way
to ITU, OR or radiology. I am sure Ken was just being provocative in an
earlier post
Regards
Tony Joseph
Sydney, Australia

On 10/10/06 10:50 PM, "Ronald Gross" <Rgross at harthosp.org> wrote:

> Ian,
> 
> With all due respect, as I remember it, surgeons operate, and that
> operation is what the trauma patient needs when the bleeding is audible.
>  Surgeons also provide critical care in the ICU; who better than the
> surgeon who has just done the case, or the surgeon who might do the case
> in the near future, and who knows the patient intimately and understands
> the physiology of the entire patient in front of him/her, to care for
> that patient?  
> 
> As to your colleagues concept about who does trauma, I suggest that he
> come on board here and see just how many of the surgeons on this list DO
> trauma - at the very least that fellow might have to alter his misguided
> concept just a little bit.
> 
> Best wishes,
> Ron
> 
>>>> "Ian Seppelt" <SeppelI at wahs.nsw.gov.au> 10/9/2006 12:20 AM >>>
> Let me weight in to a CONSTRUCTIVE debate!
> 
> Karim has already highlighted the differences between trauma surgery
> in
> the USA and elsewhere in the world, including the difficulty getting
> subspecialised surgeons interested in trauma.
> 
> I saw that first hand when I first bought Ken Mattox's book 'Top
> Knife'. A senior Professor of Surgery (upper GI and oesophageal
> surgery,
> weekly oesophagectomy list, etc) came across me reading it, and I
> described to him the 'Top Knife / Top Gun' analogy, for training the
> 'best of the best'. "BUT", he pointed out to me, "The BEST surgeons
> don't DO trauma".
> 
> So given that in Australia / New Zealand / the UK etc it is difficult
> to get senior surgeons interested in trauma (with notable exceptions),
> for the most part it is Emergency Physicians, Intensivists and
> Anaesthetists that take up the slack. I'm happy to accept that that is
> substandard compared to having a highly trained 'Trauma Surgey
> Attending' present when every seriously injured patient arrives, but
> as
> Craig Ellis asked, where is the evidence that that is actually
> correct?
> 
> 
> What I need is something strong enough that even a senior Professor of
> Surgery will agree that the evidence supports having trauma surgeons
> present in the emergency department when the patient arrives.
> 
> Or could it be that a well trained DOCTOR is what is needed,
> regardless
> of specialty, with the ability to activate emergency surgery for the
> minority of our (predominantly blunt) trauma patients who actually
> need
> an operation?
> 
> Cheers, Ian
> 
> Ian Seppelt FANZCA FJFICM
> Senior Staff Specialist
> Dept of Intensive Care Medicine
> The Nepean Hospital, PO Box 63 Penrith NSW 2751
> Clinical Lecturer, University of Sydney
> 
>>>> karim at trauma.org 5/10/2006 6:19am >>>
> OK, it's possible I overstated the case for the sake of a little
> argument
> (the list has been rather quiet recently!) but there are trends here
> which I
> believe are important.  First, clearly if you are a member of this
> list,
> attend trauma conferences, or are an attending at a level 1 trauma
> centre,
> chances are that you are committed to trauma/emergency care and you
> are
> not
> the subject of my ranting.  However if you consider the whole body of
> surgeons I think the picture looks less rosy - whether you are in the
> UK,
> South Africa, Australia or the US.  If you do not work in a Level 1/2
> trauma
> centre, if you are a resident planning on going straight in to private
> practice, if you are a laparoscopic left adrenal surgeon, I don't
> believe
> the same zeal for trauma or emegency surgery is present.  If I am
> totally
> off base, then I happily stand corrected, and certainly I was
> exaggerating
> to make the point.  But the fact stands that emergency medicine
> developed
> (initially) to fill a vacuum left by surgery, and some specialties
> (witness
> cardiothoracics) are retreating to the operating room.  We need to
> make
> sure
> trauma or acute care surgery doesn't go the same way.
> 
> Karim 
> 
> 
> 
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