List Archives

Wed Oct 11 16:44:36 BST 2006

First off, my question to you addressed the "legal" tone of your
perceived "duty". I was not questioning your moral or ethical beliefs.
Secondly to assume that I do not stop and help is completely out of
line. I am an RN and Licensed Paramedic in the state of Texas. In the 13
years that I have been involved in these lines of work, I have stopped
and assisted on numerous scenes, regardless of my mode of dress,
proximity to dinner or length of my day. I have stopped and assisted on
scenes in many areas of Texas, at least twice in New Mexico and  three
times in Arizona. For five years I was First Responder Captain of a
volunteer fire department in a rural area of the Hill Country and
responded to calls close to 24/7/365. I have left in the middle of or
missed altogether, family gatherings during holidays and special
occasions. In fact my daughter was 5 before I was present for an entire
birthday party all due to my "faulty" sense of duty that you are so sure
I have.
I too have been on scenes and had to deal with well meaning off-duty
physicians, nurses, pharmacists and Eagle Scouts. For the most part
(except those with EMS training) they are a pain in the butt, because
they do not understand the nature of field interventions and believe
that they should direct care (I once had a Pediatric Oncologist, demand
that I approach a vehicle that had turned on it's side and was not yet
secured by the FD and put a c-collar on the driver). Duty bound or not,
if you come across any scene that I am in charge of you will be
relegated to the audience, unless you are prepared to assume all further
patient care and liability for the patient. And that my friend, is at
the direction of my Medical Director, an MD with EMS training, who
understands just how out of your element you are in the field. Ask your
EMS colleagues how they feel about and deal with physicians on their
scenes. Every EMS service will have a protocol for dealing with that
situation and I think you will find that they are not as impressed with
having you on scene as you are with being on scene.  
You might also want to do some research on Good Samaritan Laws, they do
not automatically protect licensed professionals who offer off-duty
care. Like it or not we are held to a higher standard.
Respectfully,
Rick

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Patrick
Greiffenstein
Sent: Wednesday, October 11, 2006 9:37 AM
To: trauma-list at trauma.org
Subject: Re: trauma-list Digest, Vol 40, Issue 14

 >>> Rick.Moore at TriadHospitals.com 10/10/06 12:55 PM >>>
> Since when is an off-duty physician who happens to be driving by or
> otherwise in the neighborhood "duty bound" to respond and assist?
> REM
>

I hold my ability to intercede or assist to be a sacred duty that
supercedes
legal obligations.  Thankfully, good samaritan laws exist to protect me
as a
care-giver.  So, what would be your excuse?  Have dinner waiting?  It's
been
a long day?  Don't want to dirty your slacks?  I've been saved from
calamity
on more than one occasion by the kindness and sense of duty to their
fellow
man of passing strangers.  I hope you are never in a position where your
life depends on someone with your sense of duty.

respectfully
-patrick

On 10/11/06, trauma-list-request at trauma.org
<trauma-list-request at trauma.org>
wrote:
>
> Send trauma-list mailing list submissions to
>        trauma-list at trauma.org
>
> To subscribe or unsubscribe via the World Wide Web, visit
>        http://list.mistral.net/mailman/listinfo/trauma-list
> or, via email, send a message with subject or body 'help' to
>        trauma-list-request at trauma.org
>
> You can reach the person managing the list at
>        trauma-list-owner at trauma.org
>
> When replying, please edit your Subject line so it is more specific
> than "Re: Contents of trauma-list digest..."
>
>
> Today's Topics:
>
>   1. Re: ATLS training (Paul Bailey)
>   2. Re: ATLS training (kmattox at aol.com)
>   3. Re: RE: ATLS training (stefmazur at ausdoctors.net)
>
>
>
> ---------- Forwarded message ----------
> From: "Paul Bailey" <paul.bailey at gmail.com>
> To: "Trauma &amp, Critical Care mailing list" <trauma-list at trauma.org>
> Date: Wed, 11 Oct 2006 09:24:25 +0800
> Subject: Re: ATLS training
> Where's your evidence?
>
> On 10/11/06, Juan Duchesne <JDuchesne at surgery.umsmed.edu> wrote:
> >
> > ATLS save lives.......end of discussion guys!......this is not about
a
> > certificate, audit, CME or waste of time.....this is about personal
> > commitment in doing what is best for patient care.......We need to
stop
> > this attitude about what ATLS really means.........I will like to
read
> > any LEVEL I EVIDENCE THAT ANY residency ED,SURGERY..... IS EQUAL OR
> > BETTER THAN ATLS TRAINING........if any question place YOURSELF OR
YOUR
> > FAMILY in a rural environment where your first responder is not ATLS
> > trained.......I HAVE BEEN THERE!!!.....AND IS NOT FUN OR
> > FAIR!........END OF DISCUSSION!
> > Let's move on.
> > juan
> >
> > Juan C Duchesne, M.D.
> > University of Mississippi Medical Center
> > Assistant Professor of Surgery/Trauma and Critical Care
> > Louisiana ATLS State Faculty
> > 2500 North State Street
> > Jackson MS 39216
> > >>> Rick.Moore at TriadHospitals.com 10/10/06 12:55 PM >>>
> > Since when is an off-duty physician who happens to be driving by or
> > otherwise in the neighborhood "duty bound" to respond and assist?
> > REM
> >
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org
> > [mailto:trauma-list-bounces at trauma.org] On Behalf Of Patrick
> > Greiffenstein
> > Sent: Tuesday, October 10, 2006 12:42 PM
> > To: trauma-list at trauma.org
> > Subject: Re: ATLS training
> >
> > I agree with Dr Duchesne.  ATLS is a basic skills course that is not
> > very demanding to take and would benefit ANYONE being involved with
any
> > patient.
> > Given the fact that we might come accross a trauma scene outside of
the
> > hospital (I've counted three since I graduated med school four years
> > ago!) and the fact that we as physicians are duty-bound to respond,
it
> > is a course that every physician should take in an ideal world.  One
> > would think that practicing MDs would be well acquainted with most
of
> > the basics covered by ATLS.  As an ATLS instructor I can tell you
that
> > it is absolutely frightening how many general surgeons and
ED-program
> > graduates, not to mention orthopods, FP's, internists and others who
> > have opted to take our course that have clearly no clue what the
basics
> > are (this is AFTER several hours of lecture on the subject).
> >
> > I believe that too much rides on a smoothly-working trauma team and
that
> > redundancy, when feasible, can avert disaster.  If everyone knows
what
> > everyone else is supposed to be doing, things might be missed or
> > overlooked less often.  Given the stakes and the time-constraints, I
> > think a little weekend course twice every decade is a miniscule
price to
> > pay.
> >
> > my 1.5 cent's worth
> >
> > -Patrick Greiffenstein
> > Resident, General Surgery
> > LSUHSC, New Orleans
> > pgreif at lsuhsc.edu
> >
> >
> >
> >
> > On 10/6/06, trauma-list-request at trauma.org
> > <trauma-list-request at trauma.org >
> > wrote:
> > >
> > > Send trauma-list mailing list submissions to
> > >        trauma-list at trauma.org
> > >
> > > To subscribe or unsubscribe via the World Wide Web, visit
> > >        http://list.mistral.net/mailman/listinfo/trauma-list
> > > or, via email, send a message with subject or body 'help' to
> > >        trauma-list-request at trauma.org
> > >
> > > You can reach the person managing the list at
> > >        trauma-list-owner at trauma.org
> > >
> > > When replying, please edit your Subject line so it is more
specific
> > > than "Re: Contents of trauma-list digest..."
> > >
> > >
> > > Today's Topics:
> > >
> > >   1. Re: ATLS for consultants... (Juan Duchesne)
> > >   2. Re: ATLS for consultants... (Ronald Simon)
> > >   3. Re: ATLS for consultants... (Jago Miloguz)
> > >   4. RE: ATLS for consultants... (Hotz, Heidi, RN)
> > >   5. Re: ATLS for consultants... (Ronald Gross)
> > >   6. Re: ATLS for consultants... (Ronald Gross)
> > >   7. NoM Spleen Returns (Bjorn, Pret)
> > >
> > >
> > >
> > > ---------- Forwarded message ----------
> > > From: "Juan Duchesne" <JDuchesne at surgery.umsmed.edu><~!B*+R^&>>
To:
> > <rfsmithmd at comcast.net>, <trauma-list at trauma.org><~!B*+R^&>> Date:
Fri,
> > 06 Oct 2006 08:59:51 -0500
> > > Subject: Re: ATLS for consultants...
> > > I strongly disagree with your statement  Dr. Smith. I work in that
> > > same enviroment you are describing were our ED staff refuse to do
> > > ATLS, their explanation is that ED training (3-4 years) and recert
(q
> > > 10 years) equalls ATLS (2 days q 4 years)......we are just asking
2
> > DAYS for cert.
> > > and one day for recert.!!!! how bad can that be for GOD
> > > sake!!!.............. This is not about MD ego's Dr
Smith........this
> > > is very simple and clinically demostrated: ATLS DEFINITIVELY
IMPACT
> > > PATIENT CARE!!....let all jump on the boat and work as a
> > > team!........As for consultants even if they are not first
responders
> > > to activation we still mandate they get their ATLS.
> > > juan
> > >
> > > Juan C Duchesne, M.D.
> > > University of Mississippi Medical Center Assistant Professor of
> > > Surgery/Trauma and Critical Care 2500 North State Street Jackson
MS
> > > 39216
> > > >>> rfsmithmd at comcast.net 10/06/06 2:32 AM >>>
> > > I am a huge fan of ATLS but I am curious as to the rational for
> > > requiring consultants OR primary trauma providers to have taken
ATLS.
> > > How will this positively impact the care of the injured patient?
> > > Hopefully the consultants will not be directing the resuscitation
or
> > > initial evaluation of the patient. Conversely ATLS will not have a
> > > meaningful impact on the experience of trauma providers compared
to a
> > > full residency in either surgery or emergency medicine.
> > >
> > > R. Smith MD
> > >
> > > -------------- Original message --------------
> > > From: Ronald Simon <Traumamd at nyc.rr.com><~!B*+R^&>><~!B*+R^&>> >
We
> > are currently having a debate in our State Trauma Advisory
> > > Committee
> > > > about whether trauma related consultants (neurosurg, ortho, ent,
> > > > etc) should be required to have taken ATLS to care for a trauma
pt.
> > > > The question is whether this should be part of the requirements
for
> > > > trauma
> > >
> > > > center designation. No question that members of the trauma
service
> > > > and
> > >
> > > > the ED should but what about the subspecialists? Sure its a good
> > > concept
> > > > but actually getting them to take it is another thing. What is
the
> > > > practice of other trauma systems?
> > > > Thanks
> > > > Ron Simon, MD
> > > > Jacobi Medical Center
> > > > Bronx, NY
> > > >
> > > > --
> > > > trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
> > > > settings or unsubscribe visit:
> > > > http://www.trauma.org/traumalist.html
> > > --
> > > trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
settings
> > > or unsubscribe visit:
> > > http://www.trauma.org/traumalist.html
> > >
> > >
> > >
> > >
> > >
> > > ---------- Forwarded message ----------
> > > From: Ronald Simon <Traumamd at nyc.rr.com><~!B*+R^&>> To: "Trauma &
> > Critical Care mailing list" <
> > > trauma-list at trauma.org>
> > > Date: Fri, 06 Oct 2006 11:15:20 -0400
> > > Subject: Re: ATLS for consultants...
> > > The thoughts behind requiring consultants to take the course is
for
> > > them to understand how we prioritize and why we may ask them to go
> > > away and come back later.
> > > ron simon
> > >
> > > rfsmithmd at comcast.net wrote:
> > >
> > > >I am a huge fan of ATLS but I am curious as to the rational for
> > > >requiring
> > > consultants OR primary trauma providers to have taken ATLS. How
will
> > > this positively impact the care of the injured patient? Hopefully
the
> > > consultants will not be directing the resuscitation or initial
> > > evaluation of the patient. Conversely ATLS will not have a
meaningful
> > > impact on the experience of trauma providers compared to a full
> > > residency in either surgery or emergency medicine.
> > > >
> > > >R. Smith MD
> > > >
> > > >-------------- Original message --------------
> > > >From: Ronald Simon <Traumamd at nyc.rr.com><~!B*+R^&>> >
> > > >
> > > >
> > > >>We are currently having a debate in our State Trauma Advisory
> > > >>Committee about whether trauma related consultants (neurosurg,
> > > >>ortho, ent, etc) should be required to have taken ATLS to care
for a
> >
> > > >>trauma pt. The question is whether this should be part of the
> > > >>requirements for trauma center designation. No question that
members
> >
> > > >>of the trauma service and the ED should but what about the
> > > >>subspecialists? Sure its a good concept but actually getting
them to
> >
> > > >>take it is another thing. What is the practice of other trauma
> > systems?
> > > >>Thanks
> > > >>Ron Simon, MD
> > > >>Jacobi Medical Center
> > > >>Bronx, NY
> > > >>
> > > >>--
> > > >>trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
> > > >>settings or unsubscribe visit:
> > > >>http://www.trauma.org/traumalist.html
> > > >>
> > > >>
> > > >--
> > > >trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
settings
> >
> > > >or unsubscribe visit:
> > > >http://www.trauma.org/traumalist.html
> > > >
> > > >
> > > >
> > >
> > > --
> > > Ronald Simon, MD
> > > Dir of Trauma/SICU
> > > Jacobi Medical Center, Rm 1213
> > > Bronx, NY 10461
> > > 718 918 5598 phone
> > > 718 918 5593 fax
> > >
> > >
> > >
> > >
> > >
> > > ---------- Forwarded message ----------
> > > From: "Jago Miloguz" < japrak at gmail.com>
> > > To: "Trauma &, Critical Care mailing list"
> > <trauma-list at trauma.org><~!B*+R^&>> Date: Fri, 6 Oct 2006 17:58:49
+0200
> > > Subject: Re: ATLS for consultants...
> > > well it would be ideal to have everybody who gets in touch with
trauma
> >
> > > patient pass the ATLS but obviously it is quite irrational to
wish,
> > > but l think it should be officialy mandatory for all personal
dealing
> > > with to intiative managment of trauma patients to pass ATLS(EM
docs
> > > and acute care and trauma surgeons).if every hospital has those
docs
> > > with passed ATLS then patients would probably do just fine with
> > > consultants not passing ATLS.
> > > just my opinion
> > > ante
> > >
> > >
> > > 2006/10/6, Ronald Simon <Traumamd at nyc.rr.com>:<~!B*+R^&>> >
> > > > The thoughts behind requiring consultants to take the course is
for
> > > > them
> > >
> > > > to understand how we prioritize and why we may ask them to go
away
> > > > and come back later.
> > > > ron simon
> > > >
> > > > rfsmithmd at comcast.net wrote:
> > > >
> > > > >I am a huge fan of ATLS but I am curious as to the rational for
> > > requiring
> > > > consultants OR primary trauma providers to have taken ATLS. How
will
> > > this
> > > > positively impact the care of the injured patient? Hopefully the
> > > consultants
> > > > will not be directing the resuscitation or initial evaluation of
the
> >
> > > > patient. Conversely ATLS will not have a meaningful impact on
the
> > > experience
> > > > of trauma providers compared to a full residency in either
surgery
> > > > or emergency medicine.
> > > > >
> > > > >R. Smith MD
> > > > >
> > > > >-------------- Original message --------------
> > > > >From: Ronald Simon <Traumamd at nyc.rr.com >
> > > > >
> > > > >
> > > > >
> > > > >>We are currently having a debate in our State Trauma Advisory
> > > Committee
> > > > >>about whether trauma related consultants (neurosurg, ortho,
ent,
> > > > >>etc) should be required to have taken ATLS to care for a
trauma
> > > > >>pt. The question is whether this should be part of the
> > > > >>requirements for trauma center designation. No question that
> > > > >>members of the trauma service and
> > >
> > > > >>the ED should but what about the subspecialists? Sure its a
good
> > > concept
> > > > >>but actually getting them to take it is another thing. What is
the
> >
> > > > >>practice of other trauma systems?
> > > > >>Thanks
> > > > >>Ron Simon, MD
> > > > >>Jacobi Medical Center
> > > > >>Bronx, NY
> > > > >>
> > > > >>--
> > > > >>trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
> > > > >>settings or unsubscribe visit:
> > > > >>http://www.trauma.org/traumalist.html
> > > > >>
> > > > >>
> > > > >--
> > > > >trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
> > > > >settings or unsubscribe visit:
> > > > >http://www.trauma.org/traumalist.html
> > > > >
> > > > >
> > > > >
> > > >
> > > > --
> > > > Ronald Simon, MD
> > > > Dir of Trauma/SICU
> > > > Jacobi Medical Center, Rm 1213
> > > > Bronx, NY 10461
> > > > 718 918 5598 phone
> > > > 718 918 5593 fax
> > > >
> > > > --
> > > > trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
> > > > settings or unsubscribe visit:
> > > > http://www.trauma.org/traumalist.html
> > > >
> > >
> > >
> > >
> > >
> > > ---------- Forwarded message ----------
> > > From: "Hotz, Heidi, RN" <Heidi.Hotz at cshs.org><~!B*+R^&>> To:
'Trauma
> > &' < trauma-list at trauma.org>
> > > Date: Fri, 6 Oct 2006 09:11:36 -0700
> > > Subject: RE: ATLS for consultants...
> > > Ron,
> > >
> > > All of our EM physicians have completed ATLS once in their
lifetime
> > > (thus, we adhere to the ACS Gold Book criteria.) With regards to
our
> > > consultants from Ortho and Neurosurgery, it is not a formal
> > > requirement, but we have some of them become ATLS Instructors
because
> > > they want to; believe it is their duty working at a Level I trauma
> > > hospital; etc, etc. We have two orthopedic trauma surgeons that
are
> > > Instructors. We run two ATLS courses per year, so they only need
to
> > > teach once yearly.
> > >
> > > Our County trauma contract and State Regs do not require them to
have
> > > ATLS.
> > >
> > > Hope this helps.
> > >
> > > Best of luck.
> > >
> > > Heidi
> > >
> > > Heidi A. Hotz, RN, Trauma Program Manager Department of Surgery
> > > Cedars-Sinai Medical Center 8700 Beverly Blvd.
> > > Los Angeles, CA 90048
> > >
> > > Office: 310-423-8732
> > > Cell: 310-430-2649
> > > Pager: 310-960-6341
> > > Fax: 310-423-0139
> > >
> > > -----Original Message-----
> > > From: trauma-list-bounces at trauma.org
> > > [mailto:trauma-list-bounces at trauma.org
> > > ]
> > > On Behalf Of Ronald Simon
> > > Sent: Thursday, October 05, 2006 6:16 PM
> > > To: trauma-list at trauma.org
> > > Subject: ATLS for consultants...
> > >
> > > We are currently having a debate in our State Trauma Advisory
> > > Committee about whether trauma related consultants (neurosurg,
ortho,
> > > ent, etc) should be required to have taken ATLS to care for a
trauma
> > > pt. The question is whether this should be part of the
requirements
> > > for trauma center designation. No question that members of the
trauma
> > > service and the ED should but what about the subspecialists? Sure
its
> > > a good concept but actually getting them to take it is another
thing.
> > > What is the practice of other trauma systems?
> > > Thanks
> > > Ron Simon, MD
> > > Jacobi Medical Center
> > > Bronx, NY
> > >
> > > --
> > > trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
settings
> > > or unsubscribe visit:
> > > http://www.trauma.org/traumalist.html
> > >
> > >
> > >
> > >
> > > ---------- Forwarded message ----------
> > > From: "Ronald Gross" < Rgross at harthosp.org>
> > > To: <trauma-list at trauma.org><~!B*+R^&>> Date: Fri, 06 Oct 2006
> > 12:20:12 -0400
> > > Subject: Re: ATLS for consultants...
> > > Ron,
> > >
> > > We require that ortho and neurosurgeons take ATLS at least once.
> > >
> > > Please note that the ACS COT "Optimal Resourses" document states
that,
> >
> > > "At a minimum, orthopaedic surgeons on the trauma team should be
> > > encouraged to successfully complete an ATLS Student Course."  The
same
> >
> > > statement is repeated in the neurosurgical chapter: "At a minimum,
> > > neurosurgeons on the trauma team should be encouraged to
successfully
> > > complete an ATLS Student Course."
> > >
> > > Best wishes,
> > > Ron
> > >
> > > >>> Ronald Simon <Traumamd at nyc.rr.com> 10/5/2006 9:16 PM >>>
> > > We are currently having a debate in our State Trauma Advisory
> > > Committee
> > >
> > > about whether trauma related consultants (neurosurg, ortho, ent,
etc)
> > > should be required to have taken ATLS to care for a trauma pt. The
> > > question is whether this should be part of the requirements for
trauma
> > >
> > > center designation. No question that members of the trauma service
and
> > >
> > > the ED should but what about the subspecialists? Sure its a good
> > > concept but actually getting them to take it is another thing.
What is
> >
> > > the practice of other trauma systems?
> > > Thanks
> > > Ron Simon, MD
> > > Jacobi Medical Center
> > > Bronx, NY
> > >
> > > --
> > > trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
settings
> > > or unsubscribe visit:
> > > http://www.trauma.org/traumalist.html
> > >
> > >
> > >
> > >
> > >
> > >
> > >
> > >
> > > ---------- Forwarded message ----------
> > > From: "Ronald Gross" < Rgross at harthosp.org>
> > > To: "Trauma & Critical Care mailing list"
> > <trauma-list at trauma.org><~!B*+R^&>> Date: Fri, 06 Oct 2006 12:25:41
> > -0400
> > > Subject: Re: ATLS for consultants...
> > > The concept is to ensure that the subspecialists see, learn about
and
> > > understand the overall picture of trauma care, how the concept of
a
> > > systems/team approach to trauma care actually includes them, and
that
> > > they should incorporate it into their lexicon.......
> > >
> > > >>> <rfsmithmd at comcast.net> 10/6/2006 3:32 AM >>>
> > > I am a huge fan of ATLS but I am curious as to the rational for
> > > requiring consultants OR primary trauma providers to have taken
ATLS.
> > > How will this positively impact the care of the injured patient?
> > > Hopefully the consultants will not be directing the resuscitation
or
> > > initial evaluation of the patient. Conversely ATLS will not have a
> > > meaningful impact on the experience of trauma providers compared
to a
> > > full residency in either surgery or emergency medicine.
> > >
> > > R. Smith MD
> > >
> > > -------------- Original message --------------
> > > From: Ronald Simon < Traumamd at nyc.rr.com>
> > >
> > > > We are currently having a debate in our State Trauma Advisory
> > > Committee
> > > > about whether trauma related consultants (neurosurg, ortho, ent,
> > > > etc)
> > >
> > > > should be required to have taken ATLS to care for a trauma pt.
The
> > > > question is whether this should be part of the requirements for
> > > trauma
> > > > center designation. No question that members of the trauma
service
> > > and
> > > > the ED should but what about the subspecialists? Sure its a good
> > > concept
> > > > but actually getting them to take it is another thing. What is
the
> > > > practice of other trauma systems?
> > > > Thanks
> > > > Ron Simon, MD
> > > > Jacobi Medical Center
> > > > Bronx, NY
> > > >
> > > > --
> > > > trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
> > > > settings or unsubscribe visit:
> > > > http://www.trauma.org/traumalist.html
> > > --
> > > trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
settings
> > > or unsubscribe visit:
> > > http://www.trauma.org/traumalist.html
> > >
> > >
> > >
> > >
> > >
> > >
> > >
> > >
> > > ---------- Forwarded message ----------
> > > From: "Bjorn, Pret" <pbjorn at emh.org><~!B*+R^&>> To: <
> > trauma-list at trauma.org>
> > > Date: Fri, 6 Oct 2006 12:18:52 -0400
> > > Subject: NoM Spleen Returns
> > > Adult female MVC.  Left rib fx's 10-12, known splenic inj, read as
> > > Grade I in spite of contrast blush (not intended as the thrust of
this
> >
> > > thread).
> > >
> > > The patient was admitted for two nights, stable throughout, and
> > > discharged with her cooperation and enthusiasm.  She was
prescribed
> > > house arrest for a week, drastically limited activity, and an
office
> > > visit to follow.
> > >
> > > As fate would have it, on post-injury day 6 she suffered a sudden
> > > sharp LUQ pain with what sounds like a brief vagal response.  She
> > > reported immediately to her local ED, where another CT shows both
a
> > > persistent blush plus intraperitoneal hemorrhage (second image).
> > >
> > > At the local hospital, vitals were stable (she was in fact
> > > hypertensive consistent with her medical history) and her labs
were
> > > unremarkable (H&H
> > > 12 and 35, roughly identical to previous discharge numbers).  She
was
> > > admitted to the local hospital for observation, but her counts
slipped
> >
> > > overnight (10 & 27), and so she was transferred back to us.  She
> > > arrives stable and without any major complaints.  Even a little
> > hungry.
> > >
> > > Interested in what others would plan for her.  Observe?  Coil?
Both?
> > > Other?
> > >
> > > Pret Bjorn, RN
> > >
> > >
> > > <<FirstImage.jpg>>
> > <<SecondImage.jpg>><~!B*+R^&>><~!B*+R^&>><~!B*+R^&>> --
> > > trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
settings
> > > or unsubscribe visit:
> > > http://www.trauma.org/traumalist.html
> > >
> > >
> > >
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/traumalist.html
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/traumalist.html
> >
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/traumalist.html
> >
>
>
>
>
> ---------- Forwarded message ----------
> From: kmattox at aol.com
> To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
> Date: Wed, 11 Oct 2006 01:44:16 +0000
> Subject: Re: ATLS training
> ATLS.     Has a firm and standardized foundation.   An announcement to
be
> made soon from ACS about the best of the past and fantastic new
> opportunities in ATLS in the future.   You ain't seen nothing yet.
This
> new development is just about 24 hours old.  The announcement will
come from
> either ACS COT or the Chair of the ATLS committee.    Stay tuned.
>
> K
>
>
> Sent via BlackBerry, return via KMattox at aol.com
>
>
> -----Original Message-----
> From: "Paul Bailey" <paul.bailey at gmail.com>
> Date: Wed, 11 Oct 2006 09:24:25
> To:"Trauma &amp, Critical Care mailing list" <trauma-list at trauma.org>
> Subject: Re: ATLS training
>
> Where's your evidence?
>
> On 10/11/06, Juan Duchesne <JDuchesne at surgery.umsmed.edu> wrote:
> >
> > ATLS save lives.......end of discussion guys!......this is not about
a
> > certificate, audit, CME or waste of time.....this is about personal
> > commitment in doing what is best for patient care.......We need to
stop
> > this attitude about what ATLS really means.........I will like to
read
> > any LEVEL I EVIDENCE THAT ANY residency ED,SURGERY..... IS EQUAL OR
> > BETTER THAN ATLS TRAINING........if any question place YOURSELF OR
YOUR
> > FAMILY in a rural environment where your first responder is not ATLS
> > trained.......I HAVE BEEN THERE!!!.....AND IS NOT FUN OR
> > FAIR!........END OF DISCUSSION!
> > Let's move on.
> > juan
> >
> > Juan C Duchesne, M.D.
> > University of Mississippi Medical Center
> > Assistant Professor of Surgery/Trauma and Critical Care
> > Louisiana ATLS State Faculty
> > 2500 North State Street
> > Jackson MS 39216
> > >>> Rick.Moore at TriadHospitals.com 10/10/06 12:55 PM >>>
> > Since when is an off-duty physician who happens to be driving by or
> > otherwise in the neighborhood "duty bound" to respond and assist?
> > REM
> >
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org
> > [mailto:trauma-list-bounces at trauma.org] On Behalf Of Patrick
> > Greiffenstein
> > Sent: Tuesday, October 10, 2006 12:42 PM
> > To: trauma-list at trauma.org
> > Subject: Re: ATLS training
> >
> > I agree with Dr Duchesne.  ATLS is a basic skills course that is not
> > very demanding to take and would benefit ANYONE being involved with
any
> > patient.
> > Given the fact that we might come accross a trauma scene outside of
the
> > hospital (I've counted three since I graduated med school four years
> > ago!) and the fact that we as physicians are duty-bound to respond,
it
> > is a course that every physician should take in an ideal world.  One
> > would think that practicing MDs would be well acquainted with most
of
> > the basics covered by ATLS.  As an ATLS instructor I can tell you
that
> > it is absolutely frightening how many general surgeons and
ED-program
> > graduates, not to mention orthopods, FP's, internists and others who
> > have opted to take our course that have clearly no clue what the
basics
> > are (this is AFTER several hours of lecture on the subject).
> >
> > I believe that too much rides on a smoothly-working trauma team and
that
> > redundancy, when feasible, can avert disaster.  If everyone knows
what
> > everyone else is supposed to be doing, things might be missed or
> > overlooked less often.  Given the stakes and the time-constraints, I
> > think a little weekend course twice every decade is a miniscule
price to
> > pay.
> >
> > my 1.5 cent's worth
> >
> > -Patrick Greiffenstein
> > Resident, General Surgery
> > LSUHSC, New Orleans
> > pgreif at lsuhsc.edu
> >
> >
> >
> >
> > On 10/6/06, trauma-list-request at trauma.org
> > <trauma-list-request at trauma.org >
> > wrote:
> > >
> > > Send trauma-list mailing list submissions to
> > >        trauma-list at trauma.org
> > >
> > > To subscribe or unsubscribe via the World Wide Web, visit
> > >        http://list.mistral.net/mailman/listinfo/trauma-list
> > > or, via email, send a message with subject or body 'help' to
> > >        trauma-list-request at trauma.org
> > >
> > > You can reach the person managing the list at
> > >        trauma-list-owner at trauma.org
> > >
> > > When replying, please edit your Subject line so it is more
specific
> > > than "Re: Contents of trauma-list digest..."
> > >
> > >
> > > Today's Topics:
> > >
> > >   1. Re: ATLS for consultants... (Juan Duchesne)
> > >   2. Re: ATLS for consultants... (Ronald Simon)
> > >   3. Re: ATLS for consultants... (Jago Miloguz)
> > >   4. RE: ATLS for consultants... (Hotz, Heidi, RN)
> > >   5. Re: ATLS for consultants... (Ronald Gross)
> > >   6. Re: ATLS for consultants... (Ronald Gross)
> > >   7. NoM Spleen Returns (Bjorn, Pret)
> > >
> > >
> > >
> > > ---------- Forwarded message ----------
> > > From: "Juan Duchesne" <JDuchesne at surgery.umsmed.edu><~!B*+R^&>>
To:
> > <rfsmithmd at comcast.net>, <trauma-list at trauma.org><~!B*+R^&>> Date:
Fri,
> > 06 Oct 2006 08:59:51 -0500
> > > Subject: Re: ATLS for consultants...
> > > I strongly disagree with your statement  Dr. Smith. I work in that
> > > same enviroment you are describing were our ED staff refuse to do
> > > ATLS, their explanation is that ED training (3-4 years) and recert
(q
> > > 10 years) equalls ATLS (2 days q 4 years)......we are just asking
2
> > DAYS for cert.
> > > and one day for recert.!!!! how bad can that be for GOD
> > > sake!!!.............. This is not about MD ego's Dr
Smith........this
> > > is very simple and clinically demostrated: ATLS DEFINITIVELY
IMPACT
> > > PATIENT CARE!!....let all jump on the boat and work as a
> > > team!........As for consultants even if they are not first
responders
> > > to activation we still mandate they get their ATLS.
> > > juan
> > >
> > > Juan C Duchesne, M.D.
> > > University of Mississippi Medical Center Assistant Professor of
> > > Surgery/Trauma and Critical Care 2500 North State Street Jackson
MS
> > > 39216
> > > >>> rfsmithmd at comcast.net 10/06/06 2:32 AM >>>
> > > I am a huge fan of ATLS but I am curious as to the rational for
> > > requiring consultants OR primary trauma providers to have taken
ATLS.
> > > How will this positively impact the care of the injured patient?
> > > Hopefully the consultants will not be directing the resuscitation
or
> > > initial evaluation of the patient. Conversely ATLS will not have a
> > > meaningful impact on the experience of trauma providers compared
to a
> > > full residency in either surgery or emergency medicine.
> > >
> > > R. Smith MD
> > >
> > > -------------- Original message --------------
> > > From: Ronald Simon <Traumamd at nyc.rr.com><~!B*+R^&>><~!B*+R^&>> >
We
> > are currently having a debate in our State Trauma Advisory
> > > Committee
> > > > about whether trauma related consultants (neurosurg, ortho, ent,
> > > > etc) should be required to have taken ATLS to care for a trauma
pt.
> > > > The question is whether this should be part of the requirements
for
> > > > trauma
> > >
> > > > center designation. No question that members of the trauma
service
> > > > and
> > >
> > > > the ED should but what about the subspecialists? Sure its a good
> > > concept
> > > > but actually getting them to take it is another thing. What is
the
> > > > practice of other trauma systems?
> > > > Thanks
> > > > Ron Simon, MD
> > > > Jacobi Medical Center
> > > > Bronx, NY
> > > >
> > > > --
> > > > trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
> > > > settings or unsubscribe visit:
> > > > http://www.trauma.org/traumalist.html
> > > --
> > > trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
settings
> > > or unsubscribe visit:
> > > http://www.trauma.org/traumalist.html
> > >
> > >
> > >
> > >
> > >
> > > ---------- Forwarded message ----------
> > > From: Ronald Simon <Traumamd at nyc.rr.com><~!B*+R^&>> To: "Trauma &
> > Critical Care mailing list" <
> > > trauma-list at trauma.org>
> > > Date: Fri, 06 Oct 2006 11:15:20 -0400
> > > Subject: Re: ATLS for consultants...
> > > The thoughts behind requiring consultants to take the course is
for
> > > them to understand how we prioritize and why we may ask them to go
> > > away and come back later.
> > > ron simon
> > >
> > > rfsmithmd at comcast.net wrote:
> > >
> > > >I am a huge fan of ATLS but I am curious as to the rational for
> > > >requiring
> > > consultants OR primary trauma providers to have taken ATLS. How
will
> > > this positively impact the care of the injured patient? Hopefully
the
> > > consultants will not be directing the resuscitation or initial
> > > evaluation of the patient. Conversely ATLS will not have a
meaningful
> > > impact on the experience of trauma providers compared to a full
> > > residency in either surgery or emergency medicine.
> > > >
> > > >R. Smith MD
> > > >
> > > >-------------- Original message --------------
> > > >From: Ronald Simon <Traumamd at nyc.rr.com><~!B*+R^&>> >
> > > >
> > > >
> > > >>We are currently having a debate in our State Trauma Advisory
> > > >>Committee about whether trauma related consultants (neurosurg,
> > > >>ortho, ent, etc) should be required to have taken ATLS to care
for a
> >
> > > >>trauma pt. The question is whether this should be part of the
> > > >>requirements for trauma center designation. No question that
members
> >
> > > >>of the trauma service and the ED should but what about the
> > > >>subspecialists? Sure its a good concept but actually getting
them to
> >
> > > >>take it is another thing. What is the practice of other trauma
> > systems?
> > > >>Thanks
> > > >>Ron Simon, MD
> > > >>Jacobi Medical Center
> > > >>Bronx, NY
> > > >>
> > > >>--
> > > >>trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
> > > >>settings or unsubscribe visit:
> > > >>http://www.trauma.org/traumalist.html
> > > >>
> > > >>
> > > >--
> > > >trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
settings
> >
> > > >or unsubscribe visit:
> > > >http://www.trauma.org/traumalist.html
> > > >
> > > >
> > > >
> > >
> > > --
> > > Ronald Simon, MD
> > > Dir of Trauma/SICU
> > > Jacobi Medical Center, Rm 1213
> > > Bronx, NY 10461
> > > 718 918 5598 phone
> > > 718 918 5593 fax
> > >
> > >
> > >
> > >
> > >
> > > ---------- Forwarded message ----------
> > > From: "Jago Miloguz" < japrak at gmail.com>
> > > To: "Trauma &, Critical Care mailing list"
> > <trauma-list at trauma.org><~!B*+R^&>> Date: Fri, 6 Oct 2006 17:58:49
+0200
> > > Subject: Re: ATLS for consultants...
> > > well it would be ideal to have everybody who gets in touch with
trauma
> >
> > > patient pass the ATLS but obviously it is quite irrational to
wish,
> > > but l think it should be officialy mandatory for all personal
dealing
> > > with to intiative managment of trauma patients to pass ATLS(EM
docs
> > > and acute care and trauma surgeons).if every hospital has those
docs
> > > with passed ATLS then patients would probably do just fine with
> > > consultants not passing ATLS.
> > > just my opinion
> > > ante
> > >
> > >
> > > 2006/10/6, Ronald Simon <Traumamd at nyc.rr.com>:<~!B*+R^&>> >
> > > > The thoughts behind requiring consultants to take the course is
for
> > > > them
> > >
> > > > to understand how we prioritize and why we may ask them to go
away
> > > > and come back later.
> > > > ron simon
> > > >
> > > > rfsmithmd at comcast.net wrote:
> > > >
> > > > >I am a huge fan of ATLS but I am curious as to the rational for
> > > requiring
> > > > consultants OR primary trauma providers to have taken ATLS. How
will
> > > this
> > > > positively impact the care of the injured patient? Hopefully the
> > > consultants
> > > > will not be directing the resuscitation or initial evaluation of
the
> >
> > > > patient. Conversely ATLS will not have a meaningful impact on
the
> > > experience
> > > > of trauma providers compared to a full residency in either
surgery
> > > > or emergency medicine.
> > > > >
> > > > >R. Smith MD
> > > > >
> > > > >-------------- Original message --------------
> > > > >From: Ronald Simon <Traumamd at nyc.rr.com >
> > > > >
> > > > >
> > > > >
> > > > >>We are currently having a debate in our State Trauma Advisory
> > > Committee
> > > > >>about whether trauma related consultants (neurosurg, ortho,
ent,
> > > > >>etc) should be required to have taken ATLS to care for a
trauma
> > > > >>pt. The question is whether this should be part of the
> > > > >>requirements for trauma center designation. No question that
> > > > >>members of the trauma service and
> > >
> > > > >>the ED should but what about the subspecialists? Sure its a
good
> > > concept
> > > > >>but actually getting them to take it is another thing. What is
the
> >
> > > > >>practice of other trauma systems?
> > > > >>Thanks
> > > > >>Ron Simon, MD
> > > > >>Jacobi Medical Center
> > > > >>Bronx, NY
> > > > >>
> > > > >>--
> > > > >>trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
> > > > >>settings or unsubscribe visit:
> > > > >>http://www.trauma.org/traumalist.html
> > > > >>
> > > > >>
> > > > >--
> > > > >trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
> > > > >settings or unsubscribe visit:
> > > > >http://www.trauma.org/traumalist.html
> > > > >
> > > > >
> > > > >
> > > >
> > > > --
> > > > Ronald Simon, MD
> > > > Dir of Trauma/SICU
> > > > Jacobi Medical Center, Rm 1213
> > > > Bronx, NY 10461
> > > > 718 918 5598 phone
> > > > 718 918 5593 fax
> > > >
> > > > --
> > > > trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
> > > > settings or unsubscribe visit:
> > > > http://www.trauma.org/traumalist.html
> > > >
> > >
> > >
> > >
> > >
> > > ---------- Forwarded message ----------
> > > From: "Hotz, Heidi, RN" <Heidi.Hotz at cshs.org><~!B*+R^&>> To:
'Trauma
> > &' < trauma-list at trauma.org>
> > > Date: Fri, 6 Oct 2006 09:11:36 -0700
> > > Subject: RE: ATLS for consultants...
> > > Ron,
> > >
> > > All of our EM physicians have completed ATLS once in their
lifetime
> > > (thus, we adhere to the ACS Gold Book criteria.) With regards to
our
> > > consultants from Ortho and Neurosurgery, it is not a formal
> > > requirement, but we have some of them become ATLS Instructors
because
> > > they want to; believe it is their duty working at a Level I trauma
> > > hospital; etc, etc. We have two orthopedic trauma surgeons that
are
> > > Instructors. We run two ATLS courses per year, so they only need
to
> > > teach once yearly.
> > >
> > > Our County trauma contract and State Regs do not require them to
have
> > > ATLS.
> > >
> > > Hope this helps.
> > >
> > > Best of luck.
> > >
> > > Heidi
> > >
> > > Heidi A. Hotz, RN, Trauma Program Manager Department of Surgery
> > > Cedars-Sinai Medical Center 8700 Beverly Blvd.
> > > Los Angeles, CA 90048
> > >
> > > Office: 310-423-8732
> > > Cell: 310-430-2649
> > > Pager: 310-960-6341
> > > Fax: 310-423-0139
> > >
> > > -----Original Message-----
> > > From: trauma-list-bounces at trauma.org
> > > [mailto:trauma-list-bounces at trauma.org
> > > ]
> > > On Behalf Of Ronald Simon
> > > Sent: Thursday, October 05, 2006 6:16 PM
> > > To: trauma-list at trauma.org
> > > Subject: ATLS for consultants...
> > >
> > > We are currently having a debate in our State Trauma Advisory
> > > Committee about whether trauma related consultants (neurosurg,
ortho,
> > > ent, etc) should be required to have taken ATLS to care for a
trauma
> > > pt. The question is whether this should be part of the
requirements
> > > for trauma center designation. No question that members of the
trauma
> > > service and the ED should but what about the subspecialists? Sure
its
> > > a good concept but actually getting them to take it is another
thing.
> > > What is the practice of other trauma systems?
> > > Thanks
> > > Ron Simon, MD
> > > Jacobi Medical Center
> > > Bronx, NY
> > >
> > > --
> > > trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
settings
> > > or unsubscribe visit:
> > > http://www.trauma.org/traumalist.html
> > >
> > >
> > >
> > >
> > > ---------- Forwarded message ----------
> > > From: "Ronald Gross" < Rgross at harthosp.org>
> > > To: <trauma-list at trauma.org><~!B*+R^&>> Date: Fri, 06 Oct 2006
> > 12:20:12 -0400
> > > Subject: Re: ATLS for consultants...
> > > Ron,
> > >
> > > We require that ortho and neurosurgeons take ATLS at least once.
> > >
> > > Please note that the ACS COT "Optimal Resourses" document states
that,
> >
> > > "At a minimum, orthopaedic surgeons on the trauma team should be
> > > encouraged to successfully complete an ATLS Student Course."  The
same
> >
> > > statement is repeated in the neurosurgical chapter: "At a minimum,
> > > neurosurgeons on the trauma team should be encouraged to
successfully
> > > complete an ATLS Student Course."
> > >
> > > Best wishes,
> > > Ron
> > >
> > > >>> Ronald Simon <Traumamd at nyc.rr.com> 10/5/2006 9:16 PM >>>
> > > We are currently having a debate in our State Trauma Advisory
> > > Committee
> > >
> > > about whether trauma related consultants (neurosurg, ortho, ent,
etc)
> > > should be required to have taken ATLS to care for a trauma pt. The
> > > question is whether this should be part of the requirements for
trauma
> > >
> > > center designation. No question that members of the trauma service
and
> > >
> > > the ED should but what about the subspecialists? Sure its a good
> > > concept but actually getting them to take it is another thing.
What is
> >
> > > the practice of other trauma systems?
> > > Thanks
> > > Ron Simon, MD
> > > Jacobi Medical Center
> > > Bronx, NY
> > >
> > > --
> > > trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
settings
> > > or unsubscribe visit:
> > > http://www.trauma.org/traumalist.html
> > >
> > >
> > >
> > >
> > >
> > >
> > >
> > >
> > > ---------- Forwarded message ----------
> > > From: "Ronald Gross" < Rgross at harthosp.org>
> > > To: "Trauma & Critical Care mailing list"
> > <trauma-list at trauma.org><~!B*+R^&>> Date: Fri, 06 Oct 2006 12:25:41
> > -0400
> > > Subject: Re: ATLS for consultants...
> > > The concept is to ensure that the subspecialists see, learn about
and
> > > understand the overall picture of trauma care, how the concept of
a
> > > systems/team approach to trauma care actually includes them, and
that
> > > they should incorporate it into their lexicon.......
> > >
> > > >>> <rfsmithmd at comcast.net> 10/6/2006 3:32 AM >>>
> > > I am a huge fan of ATLS but I am curious as to the rational for
> > > requiring consultants OR primary trauma providers to have taken
ATLS.
> > > How will this positively impact the care of the injured patient?
> > > Hopefully the consultants will not be directing the resuscitation
or
> > > initial evaluation of the patient. Conversely ATLS will not have a
> > > meaningful impact on the experience of trauma providers compared
to a
> > > full residency in either surgery or emergency medicine.
> > >
> > > R. Smith MD
> > >
> > > -------------- Original message --------------
> > > From: Ronald Simon < Traumamd at nyc.rr.com>
> > >
> > > > We are currently having a debate in our State Trauma Advisory
> > > Committee
> > > > about whether trauma related consultants (neurosurg, ortho, ent,
> > > > etc)
> > >
> > > > should be required to have taken ATLS to care for a trauma pt.
The
> > > > question is whether this should be part of the requirements for
> > > trauma
> > > > center designation. No question that members of the trauma
service
> > > and
> > > > the ED should but what about the subspecialists? Sure its a good
> > > concept
> > > > but actually getting them to take it is another thing. What is
the
> > > > practice of other trauma systems?
> > > > Thanks
> > > > Ron Simon, MD
> > > > Jacobi Medical Center
> > > > Bronx, NY
> > > >
> > > > --
> > > > trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
> > > > settings or unsubscribe visit:
> > > > http://www.trauma.org/traumalist.html
> > > --
> > > trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
settings
> > > or unsubscribe visit:
> > > http://www.trauma.org/traumalist.html
> > >
> > >
> > >
> > >
> > >
> > >
> > >
> > >
> > > ---------- Forwarded message ----------
> > > From: "Bjorn, Pret" <pbjorn at emh.org><~!B*+R^&>> To: <
> > trauma-list at trauma.org>
> > > Date: Fri, 6 Oct 2006 12:18:52 -0400
> > > Subject: NoM Spleen Returns
> > > Adult female MVC.  Left rib fx's 10-12, known splenic inj, read as
> > > Grade I in spite of contrast blush (not intended as the thrust of
this
> >
> > > thread).
> > >
> > > The patient was admitted for two nights, stable throughout, and
> > > discharged with her cooperation and enthusiasm.  She was
prescribed
> > > house arrest for a week, drastically limited activity, and an
office
> > > visit to follow.
> > >
> > > As fate would have it, on post-injury day 6 she suffered a sudden
> > > sharp LUQ pain with what sounds like a brief vagal response.  She
> > > reported immediately to her local ED, where another CT shows both
a
> > > persistent blush plus intraperitoneal hemorrhage (second image).
> > >
> > > At the local hospital, vitals were stable (she was in fact
> > > hypertensive consistent with her medical history) and her labs
were
> > > unremarkable (H&H
> > > 12 and 35, roughly identical to previous discharge numbers).  She
was
> > > admitted to the local hospital for observation, but her counts
slipped
> >
> > > overnight (10 & 27), and so she was transferred back to us.  She
> > > arrives stable and without any major complaints.  Even a little
> > hungry.
> > >
> > > Interested in what others would plan for her.  Observe?  Coil?
Both?
> > > Other?
> > >
> > > Pret Bjorn, RN
> > >
> > >
> > > <<FirstImage.jpg>>
> > <<SecondImage.jpg>><~!B*+R^&>><~!B*+R^&>><~!B*+R^&>> --
> > > trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
settings
> > > or unsubscribe visit:
> > > http://www.trauma.org/traumalist.html
> > >
> > >
> > >
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/traumalist.html
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/traumalist.html
> >
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/traumalist.html
> >
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/traumalist.html
>
>
> ---------- Forwarded message ----------
> From: stefmazur at ausdoctors.net
> To: "Juan Duchesne" <JDuchesne at surgery.umsmed.edu>
> Date: Wed, 11 Oct 2006 07:14:45 +0100
> Subject: Re: RE: ATLS training
> Juan,
> while it would appear ATLS is a useful course in that it helps train
> people who manage trauma to think in a systematic fashion and deal
with
> immediate life threats in such a way that everyone involved knows what
is
> happening (i.e. the "all singing from the same song sheet" analogy),
there
> is a paucity of evidence suggesting it saves lives.  The following is
about
> the best evidence about that it may be of benefit, but wouldn't call
it
> "Gold Standard."
>
> J Trauma. 1993 Jun;34(6):890-8; discussion 898-9.
> Trauma outcome improves following the advanced trauma life support
program
> in a developing country.
>
> Ali J, Adam R, Butler AK, Chang H, Howard M, Gonsalves D, Pitt-Miller
P,
> Stedman M, Winn J, Williams JI.
>
> So the discussion is probably worth having and should
> continue.........maybe someone clever needs to look at the evidence
> supporting it.......maybe there is an even better way.......!
>
> Stefan Mazur
> Emergency Physician
>
> By the way your Caps Lock key seems to be stuck
>
> >ATLS save lives.......end of discussion guys!......this is not about
a
> >certificate, audit, CME or waste of time.....this is about personal
> >commitment in doing what is best for patient care.......We need to
stop
> >this attitude about what ATLS really means.........I will like to
read
> >any LEVEL I EVIDENCE THAT ANY residency ED,SURGERY..... IS EQUAL OR
> >BETTER THAN ATLS TRAINING........if any question place YOURSELF OR
YOUR
> >FAMILY in a rural environment where your first responder is not ATLS
> >trained.......I HAVE BEEN THERE!!!.....AND IS NOT FUN OR
> >FAIR!........END OF DISCUSSION!
> >Let's move on.
> >juan
> >
> >Juan C Duchesne, M.D.
> >University of Mississippi Medical Center
> >Assistant Professor of Surgery/Trauma and Critical Care
> >Louisiana ATLS State Faculty
> >2500 North State Street
> >Jackson MS 39216
> >>>> Rick.Moore at TriadHospitals.com 10/10/06 12:55 PM >>>
> >Since when is an off-duty physician who happens to be driving by or
> >otherwise in the neighborhood "duty bound" to respond and assist?
> >REM
> >
> >-----Original Message-----
> >From: trauma-list-bounces at trauma.org
> >[mailto:trauma-list-bounces at trauma.org] On Behalf Of Patrick
> >Greiffenstein
> >Sent: Tuesday, October 10, 2006 12:42 PM
> >To: trauma-list at trauma.org
> >Subject: Re: ATLS training
> >
> >I agree with Dr Duchesne.  ATLS is a basic skills course that is not
> >very demanding to take and would benefit ANYONE being involved with
any
> >patient.
> >Given the fact that we might come accross a trauma scene outside of
the
> >hospital (I've counted three since I graduated med school four years
> >ago!) and the fact that we as physicians are duty-bound to respond,
it
> >is a course that every physician should take in an ideal world.  One
> >would think that practicing MDs would be well acquainted with most of
> >the basics covered by ATLS.  As an ATLS instructor I can tell you
that
> >it is absolutely frightening how many general surgeons and ED-program
> >graduates, not to mention orthopods, FP's, internists and others who
> >have opted to take our course that have clearly no clue what the
basics
> >are (this is AFTER several hours of lecture on the subject).
> >
> >I believe that too much rides on a smoothly-working trauma team and
that
> >redundancy, when feasible, can avert disaster.  If everyone knows
what
> >everyone else is supposed to be doing, things might be missed or
> >overlooked less often.  Given the stakes and the time-constraints, I
> >think a little weekend course twice every decade is a miniscule price
to
> >pay.
> >
> >my 1.5 cent's worth
> >
> >-Patrick Greiffenstein
> >Resident, General Surgery
> >LSUHSC, New Orleans
> >pgreif at lsuhsc.edu
> >
> >
> >
> >
> >On 10/6/06, trauma-list-request at trauma.org
> ><trauma-list-request at trauma.org >
> >wrote:
> >>
> >> Send trauma-list mailing list submissions to
> >>        trauma-list at trauma.org
> >>
> >> To subscribe or unsubscribe via the World Wide Web, visit
> >>        http://list.mistral.net/mailman/listinfo/trauma-list
> >> or, via email, send a message with subject or body 'help' to
> >>        trauma-list-request at trauma.org
> >>
> >> You can reach the person managing the list at
> >>        trauma-list-owner at trauma.org
> >>
> >> When replying, please edit your Subject line so it is more specific
> >> than "Re: Contents of trauma-list digest..."
> >>
> >>
> >> Today's Topics:
> >>
> >>   1. Re: ATLS for consultants... (Juan Duchesne)
> >>   2. Re: ATLS for consultants... (Ronald Simon)
> >>   3. Re: ATLS for consultants... (Jago Miloguz)
> >>   4. RE: ATLS for consultants... (Hotz, Heidi, RN)
> >>   5. Re: ATLS for consultants... (Ronald Gross)
> >>   6. Re: ATLS for consultants... (Ronald Gross)
> >>   7. NoM Spleen Returns (Bjorn, Pret)
> >>
> >>
> >>
> >> ---------- Forwarded message ----------
> >> From: "Juan Duchesne" <JDuchesne at surgery.umsmed.edu><~!B*+R^&>> To:
> ><rfsmithmd at comcast.net>, <trauma-list at trauma.org><~!B*+R^&>> Date:
Fri,
> >06 Oct 2006 08:59:51 -0500
> >> Subject: Re: ATLS for consultants...
> >> I strongly disagree with your statement  Dr. Smith. I work in that
> >> same enviroment you are describing were our ED staff refuse to do
> >> ATLS, their explanation is that ED training (3-4 years) and recert
(q
> >> 10 years) equalls ATLS (2 days q 4 years)......we are just asking 2
> >DAYS for cert.
> >> and one day for recert.!!!! how bad can that be for GOD
> >> sake!!!.............. This is not about MD ego's Dr
Smith........this
> >> is very simple and clinically demostrated: ATLS DEFINITIVELY IMPACT
> >> PATIENT CARE!!....let all jump on the boat and work as a
> >> team!........As for consultants even if they are not first
responders
> >> to activation we still mandate they get their ATLS.
> >> juan
> >>
> >> Juan C Duchesne, M.D.
> >> University of Mississippi Medical Center Assistant Professor of
> >> Surgery/Trauma and Critical Care 2500 North State Street Jackson MS
> >> 39216
> >> >>> rfsmithmd at comcast.net 10/06/06 2:32 AM >>>
> >> I am a huge fan of ATLS but I am curious as to the rational for
> >> requiring consultants OR primary trauma providers to have taken
ATLS.
> >> How will this positively impact the care of the injured patient?
> >> Hopefully the consultants will not be directing the resuscitation
or
> >> initial evaluation of the patient. Conversely ATLS will not have a
> >> meaningful impact on the experience of trauma providers compared to
a
> >> full residency in either surgery or emergency medicine.
> >>
> >> R. Smith MD
> >>
> >> -------------- Original message --------------
> >> From: Ronald Simon <Traumamd at nyc.rr.com><~!B*+R^&>><~!B*+R^&>> > We
> >are currently having a debate in our State Trauma Advisory
> >> Committee
> >> > about whether trauma related consultants (neurosurg, ortho, ent,
> >> > etc) should be required to have taken ATLS to care for a trauma
pt.
> >> > The question is whether this should be part of the requirements
for
> >> > trauma
> >>
> >> > center designation. No question that members of the trauma
service
> >> > and
> >>
> >> > the ED should but what about the subspecialists? Sure its a good
> >> concept
> >> > but actually getting them to take it is another thing. What is
the
> >> > practice of other trauma systems?
> >> > Thanks
> >> > Ron Simon, MD
> >> > Jacobi Medical Center
> >> > Bronx, NY
> >> >
> >> > --
> >> > trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
> >> > settings or unsubscribe visit:
> >> > http://www.trauma.org/traumalist.html
> >> --
> >> trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
settings
> >> or unsubscribe visit:
> >> http://www.trauma.org/traumalist.html
> >>
> >>
> >>
> >>
> >>
> >> ---------- Forwarded message ----------
> >> From: Ronald Simon <Traumamd at nyc.rr.com><~!B*+R^&>> To: "Trauma &
> >Critical Care mailing list" <
> >> trauma-list at trauma.org>
> >> Date: Fri, 06 Oct 2006 11:15:20 -0400
> >> Subject: Re: ATLS for consultants...
> >> The thoughts behind requiring consultants to take the course is for
> >> them to understand how we prioritize and why we may ask them to go
> >> away and come back later.
> >> ron simon
> >>
> >> rfsmithmd at comcast.net wrote:
> >>
> >> >I am a huge fan of ATLS but I am curious as to the rational for
> >> >requiring
> >> consultants OR primary trauma providers to have taken ATLS. How
will
> >> this positively impact the care of the injured patient? Hopefully
the
> >> consultants will not be directing the resuscitation or initial
> >> evaluation of the patient. Conversely ATLS will not have a
meaningful
> >> impact on the experience of trauma providers compared to a full
> >> residency in either surgery or emergency medicine.
> >> >
> >> >R. Smith MD
> >> >
> >> >-------------- Original message --------------
> >> >From: Ronald Simon <Traumamd at nyc.rr.com><~!B*+R^&>> >
> >> >
> >> >
> >> >>We are currently having a debate in our State Trauma Advisory
> >> >>Committee about whether trauma related consultants (neurosurg,
> >> >>ortho, ent, etc) should be required to have taken ATLS to care
for a
> >
> >> >>trauma pt. The question is whether this should be part of the
> >> >>requirements for trauma center designation. No question that
members
> >
> >> >>of the trauma service and the ED should but what about the
> >> >>subspecialists? Sure its a good concept but actually getting them
to
> >
> >> >>take it is another thing. What is the practice of other trauma
> >systems?
> >> >>Thanks
> >> >>Ron Simon, MD
> >> >>Jacobi Medical Center
> >> >>Bronx, NY
> >> >>
> >> >>--
> >> >>trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
> >> >>settings or unsubscribe visit:
> >> >>http://www.trauma.org/traumalist.html
> >> >>
> >> >>
> >> >--
> >> >trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
settings
> >
> >> >or unsubscribe visit:
> >> >http://www.trauma.org/traumalist.html
> >> >
> >> >
> >> >
> >>
> >> --
> >> Ronald Simon, MD
> >> Dir of Trauma/SICU
> >> Jacobi Medical Center, Rm 1213
> >> Bronx, NY 10461
> >> 718 918 5598 phone
> >> 718 918 5593 fax
> >>
> >>
> >>
> >>
> >>
> >> ---------- Forwarded message ----------
> >> From: "Jago Miloguz" < japrak at gmail.com>
> >> To: "Trauma &, Critical Care mailing list"
> ><trauma-list at trauma.org><~!B*+R^&>> Date: Fri, 6 Oct 2006 17:58:49
+0200
> >> Subject: Re: ATLS for consultants...
> >> well it would be ideal to have everybody who gets in touch with
trauma
> >
> >> patient pass the ATLS but obviously it is quite irrational to wish,
> >> but l think it should be officialy mandatory for all personal
dealing
> >> with to intiative managment of trauma patients to pass ATLS(EM docs
> >> and acute care and trauma surgeons).if every hospital has those
docs
> >> with passed ATLS then patients would probably do just fine with
> >> consultants not passing ATLS.
> >> just my opinion
> >> ante
> >>
> >>
> >> 2006/10/6, Ronald Simon <Traumamd at nyc.rr.com>:<~!B*+R^&>> >
> >> > The thoughts behind requiring consultants to take the course is
for
> >> > them
> >>
> >> > to understand how we prioritize and why we may ask them to go
away
> >> > and come back later.
> >> > ron simon
> >> >
> >> > rfsmithmd at comcast.net wrote:
> >> >
> >> > >I am a huge fan of ATLS but I am curious as to the rational for
> >> requiring
> >> > consultants OR primary trauma providers to have taken ATLS. How
will
> >> this
> >> > positively impact the care of the injured patient? Hopefully the
> >> consultants
> >> > will not be directing the resuscitation or initial evaluation of
the
> >
> >> > patient. Conversely ATLS will not have a meaningful impact on the
> >> experience
> >> > of trauma providers compared to a full residency in either
surgery
> >> > or emergency medicine.
> >> > >
> >> > >R. Smith MD
> >> > >
> >> > >-------------- Original message --------------
> >> > >From: Ronald Simon <Traumamd at nyc.rr.com >
> >> > >
> >> > >
> >> > >
> >> > >>We are currently having a debate in our State Trauma Advisory
> >> Committee
> >> > >>about whether trauma related consultants (neurosurg, ortho,
ent,
> >> > >>etc) should be required to have taken ATLS to care for a trauma
> >> > >>pt. The question is whether this should be part of the
> >> > >>requirements for trauma center designation. No question that
> >> > >>members of the trauma service and
> >>
> >> > >>the ED should but what about the subspecialists? Sure its a
good
> >> concept
> >> > >>but actually getting them to take it is another thing. What is
the
> >
> >> > >>practice of other trauma systems?
> >> > >>Thanks
> >> > >>Ron Simon, MD
> >> > >>Jacobi Medical Center
> >> > >>Bronx, NY
> >> > >>
> >> > >>--
> >> > >>trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
> >> > >>settings or unsubscribe visit:
> >> > >>http://www.trauma.org/traumalist.html
> >> > >>
> >> > >>
> >> > >--
> >> > >trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
> >> > >settings or unsubscribe visit:
> >> > >http://www.trauma.org/traumalist.html
> >> > >
> >> > >
> >> > >
> >> >
> >> > --
> >> > Ronald Simon, MD
> >> > Dir of Trauma/SICU
> >> > Jacobi Medical Center, Rm 1213
> >> > Bronx, NY 10461
> >> > 718 918 5598 phone
> >> > 718 918 5593 fax
> >> >
> >> > --
> >> > trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
> >> > settings or unsubscribe visit:
> >> > http://www.trauma.org/traumalist.html
> >> >
> >>
> >>
> >>
> >>
> >> ---------- Forwarded message ----------
> >> From: "Hotz, Heidi, RN" <Heidi.Hotz at cshs.org><~!B*+R^&>> To:
'Trauma
> >&' < trauma-list at trauma.org>
> >> Date: Fri, 6 Oct 2006 09:11:36 -0700
> >> Subject: RE: ATLS for consultants...
> >> Ron,
> >>
> >> All of our EM physicians have completed ATLS once in their lifetime
> >> (thus, we adhere to the ACS Gold Book criteria.) With regards to
our
> >> consultants from Ortho and Neurosurgery, it is not a formal
> >> requirement, but we have some of them become ATLS Instructors
because
> >> they want to; believe it is their duty working at a Level I trauma
> >> hospital; etc, etc. We have two orthopedic trauma surgeons that are
> >> Instructors. We run two ATLS courses per year, so they only need to
> >> teach once yearly.
> >>
> >> Our County trauma contract and State Regs do not require them to
have
> >> ATLS.
> >>
> >> Hope this helps.
> >>
> >> Best of luck.
> >>
> >> Heidi
> >>
> >> Heidi A. Hotz, RN, Trauma Program Manager Department of Surgery
> >> Cedars-Sinai Medical Center 8700 Beverly Blvd.
> >> Los Angeles, CA 90048
> >>
> >> Office: 310-423-8732
> >> Cell: 310-430-2649
> >> Pager: 310-960-6341
> >> Fax: 310-423-0139
> >>
> >> -----Original Message-----
> >> From: trauma-list-bounces at trauma.org
> >> [mailto:trauma-list-bounces at trauma.org
> >> ]
> >> On Behalf Of Ronald Simon
> >> Sent: Thursday, October 05, 2006 6:16 PM
> >> To: trauma-list at trauma.org
> >> Subject: ATLS for consultants...
> >>
> >> We are currently having a debate in our State Trauma Advisory
> >> Committee about whether trauma related consultants (neurosurg,
ortho,
> >> ent, etc) should be required to have taken ATLS to care for a
trauma
> >> pt. The question is whether this should be part of the requirements
> >> for trauma center designation. No question that members of the
trauma
> >> service and the ED should but what about the subspecialists? Sure
its
> >> a good concept but actually getting them to take it is another
thing.
> >> What is the practice of other trauma systems?
> >> Thanks
> >> Ron Simon, MD
> >> Jacobi Medical Center
> >> Bronx, NY
> >>
> >> --
> >> trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
settings
> >> or unsubscribe visit:
> >> http://www.trauma.org/traumalist.html
> >>
> >>
> >>
> >>
> >> ---------- Forwarded message ----------
> >> From: "Ronald Gross" < Rgross at harthosp.org>
> >> To: <trauma-list at trauma.org><~!B*+R^&>> Date: Fri, 06 Oct 2006
> >12:20:12 -0400
> >> Subject: Re: ATLS for consultants...
> >> Ron,
> >>
> >> We require that ortho and neurosurgeons take ATLS at least once.
> >>
> >> Please note that the ACS COT "Optimal Resourses" document states
that,
> >
> >> "At a minimum, orthopaedic surgeons on the trauma team should be
> >> encouraged to successfully complete an ATLS Student Course."  The
same
> >
> >> statement is repeated in the neurosurgical chapter: "At a minimum,
> >> neurosurgeons on the trauma team should be encouraged to
successfully
> >> complete an ATLS Student Course."
> >>
> >> Best wishes,
> >> Ron
> >>
> >> >>> Ronald Simon <Traumamd at nyc.rr.com> 10/5/2006 9:16 PM >>>
> >> We are currently having a debate in our State Trauma Advisory
> >> Committee
> >>
> >> about whether trauma related consultants (neurosurg, ortho, ent,
etc)
> >> should be required to have taken ATLS to care for a trauma pt. The
> >> question is whether this should be part of the requirements for
trauma
> >>
> >> center designation. No question that members of the trauma service
and
> >>
> >> the ED should but what about the subspecialists? Sure its a good
> >> concept but actually getting them to take it is another thing. What
is
> >
> >> the practice of other trauma systems?
> >> Thanks
> >> Ron Simon, MD
> >> Jacobi Medical Center
> >> Bronx, NY
> >>
> >> --
> >> trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
settings
> >> or unsubscribe visit:
> >> http://www.trauma.org/traumalist.html
> >>
> >>
> >>
> >>
> >>
> >>
> >>
> >>
> >> ---------- Forwarded message ----------
> >> From: "Ronald Gross" < Rgross at harthosp.org>
> >> To: "Trauma & Critical Care mailing list"
> ><trauma-list at trauma.org><~!B*+R^&>> Date: Fri, 06 Oct 2006 12:25:41
> >-0400
> >> Subject: Re: ATLS for consultants...
> >> The concept is to ensure that the subspecialists see, learn about
and
> >> understand the overall picture of trauma care, how the concept of a
> >> systems/team approach to trauma care actually includes them, and
that
> >> they should incorporate it into their lexicon.......
> >>
> >> >>> <rfsmithmd at comcast.net> 10/6/2006 3:32 AM >>>
> >> I am a huge fan of ATLS but I am curious as to the rational for
> >> requiring consultants OR primary trauma providers to have taken
ATLS.
> >> How will this positively impact the care of the injured patient?
> >> Hopefully the consultants will not be directing the resuscitation
or
> >> initial evaluation of the patient. Conversely ATLS will not have a
> >> meaningful impact on the experience of trauma providers compared to
a
> >> full residency in either surgery or emergency medicine.
> >>
> >> R. Smith MD
> >>
> >> -------------- Original message --------------
> >> From: Ronald Simon < Traumamd at nyc.rr.com>
> >>
> >> > We are currently having a debate in our State Trauma Advisory
> >> Committee
> >> > about whether trauma related consultants (neurosurg, ortho, ent,
> >> > etc)
> >>
> >> > should be required to have taken ATLS to care for a trauma pt.
The
> >> > question is whether this should be part of the requirements for
> >> trauma
> >> > center designation. No question that members of the trauma
service
> >> and
> >> > the ED should but what about the subspecialists? Sure its a good
> >> concept
> >> > but actually getting them to take it is another thing. What is
the
> >> > practice of other trauma systems?
> >> > Thanks
> >> > Ron Simon, MD
> >> > Jacobi Medical Center
> >> > Bronx, NY
> >> >
> >> > --
> >> > trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
> >> > settings or unsubscribe visit:
> >> > http://www.trauma.org/traumalist.html
> >> --
> >> trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
settings
> >> or unsubscribe visit:
> >> http://www.trauma.org/traumalist.html
> >>
> >>
> >>
> >>
> >>
> >>
> >>
> >>
> >> ---------- Forwarded message ----------
> >> From: "Bjorn, Pret" <pbjorn at emh.org><~!B*+R^&>> To: <
> >trauma-list at trauma.org>
> >> Date: Fri, 6 Oct 2006 12:18:52 -0400
> >> Subject: NoM Spleen Returns
> >> Adult female MVC.  Left rib fx's 10-12, known splenic inj, read as
> >> Grade I in spite of contrast blush (not intended as the thrust of
this
> >
> >> thread).
> >>
> >> The patient was admitted for two nights, stable throughout, and
> >> discharged with her cooperation and enthusiasm.  She was prescribed
> >> house arrest for a week, drastically limited activity, and an
office
> >> visit to follow.
> >>
> >> As fate would have it, on post-injury day 6 she suffered a sudden
> >> sharp LUQ pain with what sounds like a brief vagal response.  She
> >> reported immediately to her local ED, where another CT shows both a
> >> persistent blush plus intraperitoneal hemorrhage (second image).
> >>
> >> At the local hospital, vitals were stable (she was in fact
> >> hypertensive consistent with her medical history) and her labs were
> >> unremarkable (H&H
> >> 12 and 35, roughly identical to previous discharge numbers).  She
was
> >> admitted to the local hospital for observation, but her counts
slipped
> >
> >> overnight (10 & 27), and so she was transferred back to us.  She
> >> arrives stable and without any major complaints.  Even a little
> >hungry.
> >>
> >> Interested in what others would plan for her.  Observe?  Coil?
Both?
> >> Other?
> >>
> >> Pret Bjorn, RN
> >>
> >>
> >> <<FirstImage.jpg>>
> ><<SecondImage.jpg>><~!B*+R^&>><~!B*+R^&>><~!B*+R^&>> --
> >> trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
settings
> >> or unsubscribe visit:
> >> http://www.trauma.org/traumalist.html
> >>
> >>
> >>
> >--
> >trauma-list : TRAUMA.ORG
> >To change your settings or unsubscribe visit:
> >http://www.trauma.org/traumalist.html
> >--
> >trauma-list : TRAUMA.ORG
> >To change your settings or unsubscribe visit:
> >http://www.trauma.org/traumalist.html
> >
> >--
> >trauma-list : TRAUMA.ORG
> >To change your settings or unsubscribe visit:
> >http://www.trauma.org/traumalist.html
> >
>
>_______________________________________________________________________
_
> >Ausdoctors.net e-mail is protected from spam and viruses
>
>_______________________________________________________________________
> >
> >
> >
>
>
>
________________________________________________________________________
> Ausdoctors.net e-mail is protected from spam and viruses
>
_______________________________________________________________________
>
>
>
>
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/traumalist.html
>
>
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/traumalist.html

List Archives

For your convenience, find the Trauma List Archive Below

trauma-list Digest, Vol 40, Issue 14