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Thu Oct 12 06:11:15 BST 2006

Juan and Pret

Sorry to disillusion you, but Cochrane has already done a trauma / ATLS review: Shakiba H, Dinesh S, Anne MK. Advanced trauma life support training for hospital staff. Cochrane Database Syst Rev. 2004;(3):CD004173. Review. 

Text of abstract:
BACKGROUND: Injury is responsible for an increasing global burden of death and disability. As a result, new models of trauma care have been developed. Many of these, though initially developed in high-income countries, are now being adopted in low and middle-income countries (LMICs). One such trauma care model is advanced trauma life support (ATLS) training in hospitals, which is being promoted in LMICs as a strategy for improving outcomes for victims of trauma. However, the evidence of effectiveness for this health service intervention, in either HIC or LMIC settings, has not been rigorously tested using methodology such as a systematic review. OBJECTIVES: To quantify the effectiveness of hospitals with an ATLS-trained trauma response system versus hospitals without such a response system in reducing mortality and morbidity following trauma. SEARCH STRATEGY: We searched the Cochrane Injuries Group Specialised Register (CIGSR), the Cochrane Controlled Trials Register (CCTR), MEDLINE & PubMed, EMBASE, CINAHL, Science Citation Index, National Research Register, and web-based trials databases such as Current Controlled Trials. We checked references of background papers and contacted authors to identify additional published or unpublished data. SELECTION CRITERIA: Randomised controlled trials, controlled trials, controlled before- and- after studies comparing effectiveness of hospitals with an ATLS-trained trauma response system versus hospitals without such a response system in reducing mortality and morbidity following trauma. DATA COLLECTION AND ANALYSIS: Two reviewers independently applied eligibility criteria to trial reports for inclusion and to extract data. MAIN RESULTS: There is a limited literature relating to this topic but none of the studies identified met the inclusion criteria for this review. REVIEWERS' CONCLUSIONS: There is no clear evidence that ATLS training (or similar) impacts on the outcome for victims of trauma, although there is some evidence that educational initiatives improve knowledge of what to do in emergency situations. Further, there is no evidence that trauma management systems incorporating ATLS training impact positively on outcome. Future research should concentrate on the evaluation of trauma systems incorporating ATLS, both within hospitals and at the health system level, by using rigorous research designs.

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Juan Duchesne
Sent: Thursday, October 12, 2006 12:30 AM
To: trauma-list at trauma.org
Subject: RE: RE: ATLS training

Thanks

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
>>> pbjorn at emh.org 10/11/06 8:34 AM >>>
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
><trauma-list-request at trauma.org >
>wrote:
>>
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>>
>>
>> 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
>>
>>
>>
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