List Archives

Fri Aug 17 17:43:52 BST 2007

Ken

We have this resource - you just wrote to it (called trama-list @ trauma.org)!

See you in Montreal?

Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS  instructor and DSTC Cape Town Course Director
Intern program Coordinator: Surgery
M.Med (Emergency Medicine) Executive Committee member
Clinical Head (Director): Diana Princess of Wales Trauma Unit
Division of Surgery (General) Room 4064
Department of Surgical Sciences
Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of KMATTOX at aol.com
Sent: Friday, August 17, 2007 6:34 PM
To: trauma-list at trauma.org
Subject: Calls, e-mail, Consultation in lieu of TRANSFER

My dear friends:  

The transfer, 80 hour week, etc. discussions are giving me  angina.    We can 
do better than this.   Our challenges  are not rocket science.   We do know 
what is right and wrong, and what  we can and cannot do.   Just look at the 
fantastic surgical miracles  which have been achieved in Afghanistan and Iraq and 
Germany,  etc.      

For 20 years I have attempted to get several professional surgical  
organizations to form a formal or informal 24 hour a day available consultation  
service.    For political, economic, licensure, and medical-legal  reasons, this 
idea has NOT achieved traction.  

The idea was that a person could contact a friend and just ask for advice,  
much as one would do at the doctors lounge at the hospital.    I  get at least 
one phone call a day even now with someone somewhere asking me to  explain 
something I have written or what do I think.   I never send a  bill and as far as 
I know this is not a practice of medicine.   I am  just talking to a friend 
as I am talking to you now.     

Most of us on this list server have given advice to a colleague, a  resident, 
a friend etc. on the internet or on the phone.   We are very  adept in 
focusing in on just what might be done and what are some options for a  particular 
set of anatomic or surgical challenges.     We do  it all the time with 
residents.     

SOME WHERE this kind of service MUST be codified formally, such as through  
this web site, or others,      

In the case we have been discussing regarding Level III to Level I  transfer, 
any one of more than 500 people on this list server would have been  happy to 
talk to the surgeon on the way to the operating room or in the  operating 
room and just had a chat.    I can talk almost anyone  through how to pack a 
liver or take out a spleen if they are  uncomfortable.    I can describe a few 
tricks about  conditions, much as we have done in Top Knife, to anyone, often 
shortening an  operation using a trick that the surgeon had not been exposed to  
before.   After the damage control at hospital 1 the patient can  be tansfered 
to the Level I for the more complex aortic injury  evaluation.     

For goodness sake, we are doing this kind of communication, damage control,  
packaging, transfer to Landsduhl, secondary operation, transfer to Walter 
Reed,  and tertiary operation EVERY DAY.  EVERY DAY.    We MUST  apply this kind 
of lesson to civilian practice EVERYWHERE.  

What can I do to make this happen and get this wonderful potential resource  
started?/

k

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Calls, e-mail, Consultation in lieu of TRANSFER