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Thu Oct 12 17:33:38 BST 2006

Dr. Gross,
I do pretty much the same if I am in the bystander role. And I do always
stop also, even though some took my comment to mean that I do not. Based
on this discussion I can say that I would welcome your assistance on
scene anytime. 
Thanks for your comments
REM 

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Ronald Gross
Sent: Thursday, October 12, 2006 10:58 AM
To: Trauma &amp; Critical Care mailing list
Subject: RE: ATLS training

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.

I will stop here, as I think I have beaten this thread to death....  

Take care,
Ron

>>> "Moore, Rick" <Rick.Moore at TriadHospitals.com> 10/12/2006 11:18 AM
>>>
I agree, and in retrospect did not put as much thought as I should have
into my initial reply about being duty bound. Unfortunately many medical
professionals don't see their role on scene as being limited to the
simple ABC's and this is what can cause problems, as was discussed in my
reply post to Patrick and Dr. Bromberg's and Dr. Smith's reply. 
Thanks,
REM 

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Ronald Gross
Sent: Thursday, October 12, 2006 9:39 AM
To: Trauma &amp; Critical Care mailing list
Subject: RE: ATLS training

Rick,

With reference to non-EMS trained medical professionals - if you are in
the field of trauma, you sure as heck better be trained in the art of
practicing in the field, i.e. you need to be able to follow the simple
ABCs of trauma care - and in fact that is exactly what the EMS personnel
are trained to do, among lots of other things!

Now, on to the meat of the matter here; I never did reference the legal
justification/implications about medical professionals who stop and
render aid.  I reacted only to your simple statement, and I quote here,
"Since when is an off-duty physician who happens to be driving by or
otherwise in the neighborhood "duty bound" to respond and assist?" 
Being duty-bound has nothing to do with being legally bound.  And until
our moral and ethical obligations are mandated by law (and that day
might just actually happen) the two are mutually exclusive.  We are
ethically and morally duty-bound to do so, and that has nothing to do
with our legal obligations.  Simple, really.

Best wishes,
Ron

>>> "Moore, Rick" <Rick.Moore at TriadHospitals.com> 10/12/2006 9:24 AM
>>>
Then I am guessing you were disappointed by the comments of Dr.
Bromberg
and Dr. Smith also. Again, I do not dispute the moral/ethical obligation
one feels to stop and help, I dispute making it sound like it is a legal
requirement. And I stand by my comments that non-ems trained medical
professionals are virtually useless in field situations.
REM

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Ronald Gross
Sent: Thursday, October 12, 2006 7:39 AM
To: Trauma &amp; Critical Care mailing list
Subject: RE: ATLS training

Since the day he or she took that thing that you might have forgotten
about - it is called the Hippocratic Oath!

I doubt that that it really matters to you, but your comment really
disappoints me, Rick.

Take care,
Ron

>>> "Moore, Rick" <Rick.Moore at TriadHospitals.com> 10/10/2006 1:55 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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> 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>
> To: <rfsmithmd at comcast.net>, <trauma-list at trauma.org>
> 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>
>
> > 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>
> To: "Trauma &amp; 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>
> >
> >
> >
> >>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 &amp, Critical Care mailing list"
<trauma-list at trauma.org>
> 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>:
> >
> > 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>
> To: 'Trauma &amp' < 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>
> 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 &amp; Critical Care mailing list"
<trauma-list at trauma.org>
> 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>
> 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>>
>
>
> --
> trauma-list : TRAUMA.ORG <http://trauma.org/> To change your
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>
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