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Thu Oct 12 18:02:30 BST 2006

It has been an interesting "discussion".

Our trauma victims are often carted to the nearest ill equipped hospital in
the next available cab or van and most of them do survive. The first we know
about it is usually when the vehicle screeches to a halt outside the
emergency dept. There is no "ETA 3 minutes" .

Our average post-trauma mortality is supposed to be 7 per day across the
whole of India.

I did the ATLS in Manchester,UK during my training and I think it is a good
course but that it is all it is, a course to show you ONE effective way of
dealing with the acutely traumatised patient.The manual itself says "this is
not the only way". I used to be in the Trauma team (occassionally) while
working in the UK years ago.

I think many of us are missing the point here -  a person does best what he
does regularly . Out in the field a trained experienced paramedic is
probably worth more than a few orthopaedic/general surgeons put together and
vice versa in a hospital. Give me an arthroscope and i am probably better
than many orthopods but show me a laryngoscope in an emergency and i may not
know one end from the other.

Someone said" 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,....that have clearly no clue what the
basics are (this is AFTER several hours of lecture on the subject)."

This is exactly how I would feel if someone asked me to teach shoulder or
wrist arthroscopy to a group of medical studemts or junior residents. I am
not saying ATLS is that difficult ;-) but to someone who is not used to
thinking in terms of milliseconds of survival time,it is a bit too much to
take in especially if they are not confronting trauma on a daily basis.

We are all good in our own fields (or atleast we believe we are)- let us not
forget that it is not just the paramedics (which we lack here in india)or
the flashy ambulances(which we lack in many parts of India) or the Emergency
docs or the orthopods or the surgeons or the ATLS instructors or the ATLS
providers who save patients, it is the whole team of dedicated, overworked,
and (usually) underpaid people who for some reason or the other have chosen
to become part of the team. I am sure there are good paramedics and bad
paramedics just as there are good and bad docs (of different specialties).

Some patients will die irrespective of what we do and many survive in spite
of what we do.

sorry to intrude.

thanks

rajesh

Dr.K.R.Rajesh, MS(Orth),Diplomate National Board(Ortho),FRCS
(Gen),FRCS(Orth)
Consultant Orthopaedic Surgeon
Division of Arthroscopy ,Upper Limb Surgery & Joint Replacement Surgery.
Cosmopolitan Hospital
Trivandrum,Kerala,India.

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Krin135 at aol.com
Sent: 12 October 2006 21:41
To: trauma-list at trauma.org
Subject: Re: ATLS training

In a message dated 10/12/2006 10:59:15 AM Central Standard Time,
Rgross at harthosp.org writes:

Rick,
I will tell you how I do things in the field.  I will do  whatever it is
I can to care for the patient till the calvary  arrives.  And when the
EMS personnel do arrive, I give them my report,  step aside and hand over
the care to them with the statement, "How can I  best help other than
staying out of your way?"  If they need - and ask  for - my help or my
clinical expertise, I will give it.  If I need to  go with them to the
receiving facility, I will do so - although that   has been necessary
only a couple of times in my 30 years since graduating  from med school
(and as my wife will tell you, I always stop, if just to  ask if I can
help).

In short, I think it was Bill who said it  best;, we, as surgeons, can
be of best use in the ED, and that is the best  place for the patient, as
opposed to the field, where time is of the  essence, and transport should
never be delayed by a good samaritan who  wants to do more than is
necessary in the pre-hospital  setting.

As my other post shows, I heartily agree with you on this, Ron...and in my
19 years since graduation, I've helped out on more than a few scenes,
usually
with medics whom I have helped train and knew their protocols, and haven't
yet
 had to ride in on any of them.

About the only time that I can think that I provided truly 'advanced care'
on the scene was one where I was 'First In' and helped with a messy
extrication.  The patient had an open dislocation of his ankle, and, after
the
extrication, I  was able to reduce the dislocation and restore the blood
flow to his
foot.

Outside of that, it's been ABCD and help with the lifting...

ck
Charles S. Krin, DO FAAFP
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