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Fri Apr 13 22:05:59 BST 2007

In a message dated 4/13/2007 12:48:46 PM Central Daylight Time,  
KMATTOX at aol.com writes:

Only  ONE medical integrated collaborative network for trauma and disaster  
planning and response exists in the United States and that is our trauma  
systems, developed by the ACS COT and now supported and amplified by  your 
SubCommittee on Disaster.  I applaud you, but we still are  boxed out of the EOCs and 
the Unified Commands, being replaced by public  health doctors.  I support all 
that we can do collaboratively with  the public health doctors, but we the 
trauma system have assets that they  do not have.   AFTER the disaster, as was 
the case at the time of  911, is NOT the time to, as an afterthought, think 
about the trauma  system.   During 911, much of the trauma response occurred at  
the hospital, waited for patients to be brought to them in large numbers,  
later to find that patients were taken to non-trauma hospitals (both in NYC  and 
in Washington DC).    

Um...Dr. Mattox, who was it that ended up leading the medical relief effort  
at the Astrodome in August-Sept 2005?

I seem to recall that in a pair of the most wide spread natural disasters  to 
hit the Gulf Coast, there was very little actual major trauma to be  
handled....and a certain well known and highly regarded trauma surgeon was  gracious 
enough to understand his limitations and stepped aside to allow a doc  trained 
in Family Medicine to take over as medical control. 

Similarly, in multiple bombings documented in England, Spain, Israel,  
Afghanistan, and to a lesser extent Iraq, there is a limited number of patients  who 
will survive to need massive trauma care. While our Israeli and  
US/British/NATO trauma colleagues are doing wonders about saving lives on the  retail 
level, the truth is that this only works where the infrastructure is  relatively 
intact and the teams available in excess of the number of incoming  patients. 
If I understood some of the lectures on the subject at the NDMS  conference 
last month, in most situations, many if not most of the  survivors will be tagged 
yellow or green and require mostly orthopedic or  supportive care, not the 
major trauma care we are used to seeing at facilities  such as Ben Taub. I 
believe this was also the case of most of the patients who  were in NYC in Sept 
2001. The ones at the Pentagon were a bit more skewed  towards the trauma/burn 
side, (and it's my understanding that the major burn  center in DC was properly 
utilized) but that field in Pennsylvania only  needed the services of a DMORT.

I agree that there needs to be a better way to make sure that those  
hospitals best capable of handling major traumas get the appropriate cases when  the 
ball goes up, but suspect that in any serious and wide spread disaster  
involving a major metropolitan area, there is going to be an increase in  'medical 
care under austere circumstances' or 'medical care under public health  
quarantine procedures,' rather than an increase in major survivable trauma care. 

Yes, trauma teams need to have a place at the table, but I doubt that  trauma 
surgery will be high on the list of triage priorities in, say, a flu  
pandemic. Dr. Mattox, as a physician leader, I have a question for you: Have you  
completed the FEMA Introduction to Incident Command courses (ICS 100HC, ICS  200 
HC, IS 700 and IS 800)? These courses are required in many locales to  operate 
inside the EOC, and are mandated for department directors and potential  
Hospital Incident Command Staff by October of this year. 

To the rest of you, if you have never heard of these courses, much less  
taken them, I urge you to do so, so that you will be able to intelligently  
communicate with the folks who are expected to run the EOCs at both a hospital,  
local and state government level. From my experience in rural health care, the  
number of folks in leadership positions at a county and regional level who are  
amazed that I, as a physican, was willing to take those courses and then  
contribute to the efforts of folks trying to mitigate and prepare for disaster  
response.

ck
Charles S. Krin, DO FAAFP

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