List Archives

Thu Oct 12 16:43:26 BST 2006

In a message dated 10/12/2006 10:16:59 AM Central Standard Time,  
Rgross at harthosp.org writes:

Rick,
Attached is page 561 from the ATLS Faculty Manual, 7th Edition  for your
reference.  Feel free to provide this to the Course  Coordinator at the
site providing the Student courses.
Best of  luck,
Ron

I will also point out that any folks who have a Reserve Military connection  
as a PA or Nurse can apply to take the Combat Casualty Care Course at  Camp 
Bullis Texas...Some senior medics/independent duty corpsmen are also  eligible 
to apply. ATLS is a part of the C4 course, which is designed to take  hospital 
personnel and give them a two week or so introduction to rough field  medicine.

Otherwise, if you are interested, there is a fully integrated course  offered 
by the Minnesota Academy of Family Physicians in conjunction with the  
University Hospital in Minneapolis that offers a team approach to rural trauma  care 
and has for almost 15 years now...something that the ACS Committee on  Trauma 
is just now getting around to with it's "Rural Trauma Team"  program.

the CALS website is _www.calsprogram.org_ (http://www.calsprogram.org) 

The CALS program is designed for *teams* of practitioners from Paramedics  to 
Physicians to work through the course together, and includes skills stations  
to familiarize even sub specialists with the general knowledge needed to 
provide  stabilization of critically ill patients (not just trauma, but any sick 
patient)  while waiting for the appropriate specialist or the transport team to 
 arrive.

As far as the Hippocratic (or Osteopathic) Oath goes, I can see something  of 
a responsibility to stop and render aid if you are the first one to come up  
on a crash incident....with the understanding that despite your 'greater  
knowledge' as a physician, you are limited to what you can do by the equipment  at 
hand...I doubt that even Ken Mattox will claim to be able to do an  emergent 
splenectomy in the field with the kit he carries in his  car, for instance! 
Therefore, your best actions in that situation would be  to maintain C spine 
control, open the airway and stop the bleeding...Scout level  first aid 
stuff...and when the Medics get there, give them a decent report and  get out of their 
way...The single best tool you have available to you in this  instance is a 
cell phone with '911' on speed dial.

Many field medical outfits operate under pretty decent protocols, and on  the 
authority of their own medical controls. If you do not know those medics and  
their protocols, how much use are you going to be? At best, you will find  
yourself either being asked to leave, or being asked to be an IV pole...at  
worst, you may end up in the back of the Highway Patrol car, waiting for the  
ambulance to leave. In some instances, a doc attempting to 'assist' with  advanced 
care has found him or herself having to ride along to the receiving  hospital 
to continue care until the ED Doc has seen the patient...only to find  that 
the ambulance has left and s/he has no ride back to his/her car...

One thing that physicians can do to increase their awareness of how  the 
field medics operate is to spend time teaching said medics...platform  teaching, 
precepting, or riding in the field with them. This will give you a new  
appreciation of what it's like out in 'the blood and the mud' at three am on a  cold 
and sleeting night. It will also make most docs glad that they decided to  
stay out of the medics' way, because if you don't have the prehospital training,  
it's much more likely that you are going to make a fool out of yourself,  
especially if you are on the way back from a liberally lubricated pharmacy  
company sponsored dinner. 

I've seen this scenario more than once, both as a former field medic, and  as 
an ED doc...

ck
Charles S. Krin, DO FAAFP

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