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Wed Apr 18 14:19:04 BST 2007

Pret,
     Same here.  I agree with Dr. Mattox's point, and I have been unable to sleep thinking about scenarios including my local campus.  Perhaps when those involved have a chance to catch their breath they can share with us.
Susanna
CST
Trauma spec.
Bloomington, In  
  ----- Original Message ----- 
  From: Bjorn, Pret<mailto:pbjorn at emh.org> 
  To: Trauma &amp; Critical Care mailing list<mailto:trauma-list at trauma.org> 
  Sent: Wednesday, April 18, 2007 8:01 AM
  Subject: VT Massacre -- TRAUMA Systems and Responses

  I admire and support Dr. Mattox' "Root Causes" thread; but frankly, I
  fear that dissecting the social cellulitis of mental and behavioral
  health in America will be a mostly empty exercise, at least for the
  Trauma-List.

  Could we instead -- or at least in addition -- talk a little about the
  Virginia trauma system?  What little I've heard via the media suggests
  high function at every level, and I'd like to know more about it.  What
  are the local resources; what is the architecture of the system; how was
  it triggered; was the intra-system communication preplanned or ad lib;
  ditto the prehospital transport system...

  Don't get me wrong: I'm deeply interested in public policy and believe
  that Ken's motivations are honorable.  In most other circumstances I'd
  probably be joining in the prevention discussion.  But I work about
  eight miles from a major university, and have spent the last couple of
  days considering how Virginia's nightmare could have easily taken place
  in Maine.  I'm hopeful that we would have responded as capably; but if
  there's anything we all might learn from, I want to get started.

  Pret Bjorn, RN
  EMMC Trauma Program
  Bangor, ME USA

  -----Original Message-----
  From: trauma-list-bounces at trauma.org<mailto:trauma-list-bounces at trauma.org>
  [mailto:trauma-list-bounces at trauma.org] On Behalf Of KMATTOX at aol.com<mailto:KMATTOX at aol.com>
  Sent: Tuesday, April 17, 2007 4:48 PM
  To: dbthemedic at hotmail.com<mailto:dbthemedic at hotmail.com>; med-events at ccm-l.org<mailto:med-events at ccm-l.org>
  Cc: trauma-list at trauma.org<mailto:trauma-list at trauma.org>
  Subject: Root Causes

  Although I should use my allocated bandwidth time to talk about trauma
  and  
  to compliment those who have done a good job in Virginia's trauma
  response, I  
  want to talk about a totally different subject which has consumed
  increasingly 
   more and more of my administrative time.   

  The subject is Mental & Behavoral Health.    

  Since the closure of state mental health and psychiatric hospitals,
  there  
  has been an increasing effort to push the responsibility for
  identification and  
  treatment more to the local level.  That is perhaps as it should be, but

  funding has been sparse to negligible.   Hardly a family, and many of
  our 
  colleagues are affected by depression, and other mental health
  diagnoses.   
  Treatment is sporadic and expensive.   

  Add a mental health problem as a co morbid factor to diabetes, heart
  attack, 
  pneumonia, trauma, etc, and we have a really big  problem.    

  Houston is the 4th largest city in the US.   It has a fast growth  rate.

  In 2000, 3000 inpatient psychiatry beds  existed.   In 2007 there are
  700, 
  despite an almost doubling of the  population in those 7 years.   One
  public 
  psychiatric hospital (HCPC)  has more than 300 built beds, but less than
  90 are 
  staffed and there are no iv  fluids, no syringes, no IM medications in
  this 
  hospital.  ANY , ANY co  morbid condition results in an attempted
  transfer out 
  instantaneously to BTGH  were there is tight overcrowding of mental
  health 
  conditions.   Up to  37% of the admissions to medicine and surgery,
  including trauma, 
  have a mental  health component.   

  We have 20 in hospital mental health beds, 12 Emergency Center closed
  beds,  
  and up to 12 close observation sites in the emergency center proper.
  We 
  have at any time more than 20-40 inpatients on the surgery or medical
  wards  who 
  have both medical and mental health problems, often the mental health  
  problems are severe.      If we tripled the number of  in-hospital
  mental health 
  beds, they would be filled in 12  hours    

  Now back to the subject that prompted this post.   I suspect  that much
  of 
  the violence, wild use of firearms, and other human/social  outbursts
  may have a 
  mental health overtone, an untreated or undertreated  condition.    

  Finally:

  IF THE MENTAL HEALTH CRISIS IN HOUSTON, IN TEXAS, IN THE UNITED STATES
  IS  
  NOT ADDRESSED SYSTEMATICALLY, MORE HUMAN OUTBURSTS ARE GOING TO  HAPPEN.
  IN MY 
  VIEW WHAT WE ARE SEEING IN VIOLENCE IN OUR SOCIETY HAS  AS ONE ROOT
  CAUSE, 
  OUR BROKEN MENTAL HEALTH INFRASTRUCTURE.  

  Kenneth L. Mattox, MD
  Houston

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