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Fri Aug 17 17:45:22 BST 2007

I hear ya Rob.  I believe that the point of this thread is to clarify what should happen, what really did happen, and how we can collectively suggest ways that the "right" thing does get done.

Take care,
Ron

>>> "Robert F. Smith" <rfsmithmd at comcast.net> 8/17/2007 12:28 PM >>>
Ron,

Yeah that's all I meant. I if I were the Trauma Director at the receiving
hospital, I honestly don't know if I would want to put my team and my
institution in that position. It's easier for me to speak for the white
knights when I won't be the one going into battle.

Rob

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] 
On Behalf Of Ronald Gross
Sent: Friday, August 17, 2007 12:19 PM
To: 'Trauma &amp; Critical Care mailing list'
Subject: RE: Transfer

Rob,

If they will not, cannot, or are not, well then, accept the patient knowing
the obvious - the poor SOB is most likely gonna die en route.  

Then what?  Document, then pray.....and I ain't the religious sort.

Ron

>>> "Robert F. Smith" <rfsmithmd at comcast.net> 8/17/2007 11:46 AM >>>
Ron,

I understand they CAN or SHOULD but they're NOT for whatever reason. So now
what? Stamp our feet, scream at them etc. but if that doesn't work then
what? And how much time do you think it makes sense to waste trying to
acutely educate them or convincing them to do something they apparently
don't want to do while time is running out for the patient?

Rob

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] 

On Behalf Of Ronald Gross
Sent: Friday, August 17, 2007 11:35 AM
To: 'Trauma &amp; Critical Care mailing list'
Subject: RE: Transfer

Hi Rob,

Looks like you and I are gonna disagree for (I believe) the first time.

The fact is that they CAN - or rather let me say that as a Level III Trauma
Center, they SHOULD without a doubt have the ability to care for this
patient.  Cold steel to the abdomen, spleen in a bucket, pack the abdomen
and then send the patient who most likely is now hemodynamically stable
after about one hour OR LESS in the OR.  

No screwing around, no VOMIT, no x-rays or angios, just an incision.  If
they don't have an OR or a surgeon, then, to repeat what has already been
said, the hospital and the system are broken beyond belief; the system
doesn't exist and the hospital is merely an outpatient clinic.

My turn to say IMHO!  ;-)

Take care, Rob!  Give my best to your better half!

Ron

>>> "Robert F. Smith" <rfsmithmd at comcast.net> 8/17/2007 10:43 AM >>>

NO!!

The level I Trauma Center has the responsibility to accept an unstable
patient only after the sending hospital has stabilized the patient to the
best of their abilities and cannot offer the patient anything further. 

Ron,

I totally disagree with this. IMHO as soon as it is clear that the original
hospital will not or cannot adequately care for the patient transfer
immediately. If it is me or my loved one please do not "stabilize" first.
Stabilize = screwing around with crystalloid and blood and VOMIT till death
or further decompensation. Please put me in a fast ambulance and send me to
the hospital that is willing and able to immediately care for my injuries.

Rob

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