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Wed Oct 11 18:30:56 BST 2006

I just think if you're going to make something a REQUIREMENT there should be, as much as possible, some evidence or reason for doing so.

Rob

-------------- Original message -------------- 
From: "Bjorn, Pret" <pbjorn at emh.org> 

> I'm sure I could argue this either way, but jeez, does ATLS really need 
> justification in the literature? We know that its component 
> recommendations are evidence-based (if a bit dated from one version to 
> the next); why must we prove that teaching these concepts to providers 
> is helpful? 
> 
> Next thing you know, Cochrane will be complaining that there's no 
> literature supporting medical school. 
> 
> Pret Bjorn, RN 
> Bangor, ME USA 
> 
> 
> -----Original Message----- 
> From: trauma-list-bounces at trauma.org 
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of 
> stefmazur at ausdoctors.net 
> Sent: Wednesday, October 11, 2006 2:15 AM 
> To: Juan Duchesne 
> Cc: trauma-list at trauma.org 
> 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 
> > 
> >wrote: 
> >> 
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> >> 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" <~!B*+R^&>> To: 
> >, <~!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 <~!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 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: Ronald Simon <~!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 <~!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 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 
> >> > 
> >> > 
> >> > 
> >> 
> >> -- 
> >> 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" 
> ><~!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 :<~!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 
> >> > > 
> >> > > 
> >> > > 
> >> > >>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 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 
> >> > > 
> >> > > 
> >> > > 
> >> > 
> >> > -- 
> >> > 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 To change your 
> >> > settings or unsubscribe visit: 
> >> > http://www.trauma.org/traumalist.html 
> >> > 
> >> 
> >> 
> >> 
> >> 
> >> ---------- Forwarded message ---------- 
> >> From: "Hotz, Heidi, RN" <~!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 To change your settings 
> >> or unsubscribe visit: 
> >> http://www.trauma.org/traumalist.html 
> >> 
> >> 
> >> 
> >> 
> >> ---------- Forwarded message ---------- 
> >> From: "Ronald Gross" < Rgross at harthosp.org> 
> >> To: <~!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 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 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" 
> ><~!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....... 
> >> 
> >> >>> 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 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: "Bjorn, Pret" <~!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 
> >> 
> >> 
> >> <> 
> ><><~!B*+R^&>><~!B*+R^&>><~!B*+R^&>> -- 
> >> trauma-list : TRAUMA.ORG To change your settings 
> >> or unsubscribe visit: 
> >> http://www.trauma.org/traumalist.html 
> >> 
> >> 
> >> 
> >-- 
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> >-- 
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> > 
> >-- 
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