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Fri Aug 17 12:37:47 BST 2007

I agree with everything that has been said about this patient. The system
and this Trauma Center's performance need some serious attention. Any level
of Trauma Center should have people willing to open an abdomen at some
point.

If I may, I'd like to offer a slightly different viewpoint and perhaps
CHANGE the presentation slightly. Dr. Levasseur brings up the essential
point, to my mind. For whatever reason this patient was not going to go to
the OR at the receiving hospital. We all agree this is wrong. What if they
had actually said, we can't go to the OR because ...... fill in the blank.
Surgeon says he/she is uncomfortable, can't find the surgeon, whatever. Then
what? Functionally this is what was being said. It is very hard to ACUTELY
FORCE someone at another institution to do the right thing for a patient. In
the past we've argued about accepting patients from non Trauma that were too
sick to transfer. I have totally disagreed with that. Do we take a
principled stand and leave the patient to their ultimate fate or accept
responsibility for a whole lot of badness that shouldn't be our
responsibility?

If you accept the transfer the patient may well die and it will be "your
fault". If you refuse the transfer the patient will die for sure and it will
be their fault. If I or a loved one were the patient I'd rather go with the
slim chance than with no chance. Just a thought.

And I totally agree with Dr. Mattox's statement that the
regulating/certifying agency needs to take very prompt and vigorous action.

Rob Smith MD (the Minority Report)

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Jean Levasseur
Sent: Thursday, August 16, 2007 11:20 PM
To: Trauma &amp; Critical Care mailing list
Subject: Re: Transfer - NO

May I ask a "naive" question...

What was the patient doing in the "CT scan 2 hours after arrival "  
with a "systolic BP 0f 40-60" ??

J Levasseur MD
Joliette, QC, Canada

A question to the group.  Does a Level 1 Trauma Center have a   
responsibility
to accept an "unstable" patient from a Level 3 Trauma  Center?  30yr  
male
MVC, GCS 15, systolic BP 40-60. Resuscitation with  crystalloids and  
PRBC.  CT
revealed liver & spleen laceration and  suspected aortic injury. OR  
team in
house but no cardiothoracic  capabilities.  Level 1 Trauma Center is  
about 15
miles  away.

Le 07-08-16 à 23:00, ABMoss at aol.com a écrit :

>
> Unfortunately, the patient died in CT scan 2 hours after arrival at  
> Level  3.
> Autopsy is pending.
>
>
> In a message dated 8/16/2007 10:18:17 PM Eastern Daylight Time,
> KMATTOX at aol.com writes:
>
> As  presented a number of comments can be made:
>
> 1.    It  is contra indicated and probably unethical to  transfer  
> this person
>
> from one trauma center (level 3) to another trauma center  (level  1)
> 2.    There is no quality difference nor should there  be  any outcome
> difference between a Verified or Certified Level 3 trauma  Center   
> and a
> Level I
> Trauma Center,   NON whatsoever.,  except for  neurosurgery and
> cardiopulmonary
> bypass (and then even  MAYBE)
> 3.  A level 3 trauma surgery should be able with  personnel,   
> equipment., and
> protocols to take care of anything in the  abdomen, any vascular   
> trauma not
> requiring CPB,  ALL orthopedic  injuries, ALL neck injuries and  most
> thoracic
> injuries with the same  outcome as a Level I trauma  center.
> 4.    A  patient with a suspected thoracic aortic injury  is NOT  
> unstable
> from
> the aortic injury, unless there is total disruption of the  aorta  
> and  total
> instability manifest as death.
> 5.    As  described, this patient should have the LOCAL  surgeons  
> at the
> Level
> 3 trauma center do an open laparotomy NOW, and take care  of  
> whatever  is
> required to control the bleeding or sepsis.
> 6.   To transfer this patient as described will  DECREASE his  
> chances  of
> survival and increase the  complications.
>
> Kenneth L. Mattox,  MD
> Houston
>
>
>
>
>
>
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Transfer - NO?