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Sat Aug 18 18:52:26 BST 2007

Tim,

Absolutely. My comment referred to the trauma patient that is UNSTABLE who
should go to either the OR or the angio suite for EMERGENCY intervention. I
meant to state that and hereby clarify so now. I didn't intend to refer to
STABLE patients in my statement which does, as you quite rightly say, change
things in that those patients do not then need to be IMMEDIATELY "scooped
and run" to the OR. However I am aware of many occasions where trauma
patients have languished in certain A+Es/EDs for many hours with cyclic
volume resuscitation because they were "STABLE" and didn't need to go
straight to the OR, which is undoubtedly harmful to the patients and their
outcomes! This though is a different debate.

I agree completely with what you say regarding STABLE trauma patients who
have selective non-operative management and can go to either the ICU, CT
scanner +/- angio suite or even the "normal" ward. Naturally it depends upon
each individual patient, their injuries and their determined clinical
management plan as to where they should go next for further care.

This leaves aside the issue of STABLE trauma patients who MAY still go
straight to the OR for surgery once their condition has been RAPIDLY
"optimised" without further delay.

Matthew R

Surgery UK

-----Original Message-----
From: Hardcastle, Tim, Dr <tch at sun.ac.za> [mailto:tch at sun.ac.za] 
Sent: 18 August 2007 05:28
To: Trauma &amp; Critical Care mailing list
Subject: RE: Transfer - NO [Stating a Fact!]

Matt

Qualify your statement to say "the UNSTABLE trauma patient" and I'm
altogether with you.

Stable patients deserve a work-up; this has been where SNOM has come from -
they get sorted in the ED then go to the ICU / ward, rather than the OR.
This group is NOT best served by direct transfer to the OR.

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-----

            "There is no role for the A+E/ED in trauma. It is merely to keep

the patient warm whilst being 'scooped and run' to the OR! A+E/ED doctors
role in trauma are as pre-hospital care clinicians which many of them have
now encompassed to become trauma team leaders with air
ambulances/pre-hospital care teams etc. They are there

to implement the Platinum 10 or the Diamond 5.that is get the patient to the
OR as quickly as possible for definitive or damage control surgery using
permissive hypotension etc.!!"

The latter comment has prompted many antagonistic comments within the

A+Es/EDs of many of my regional hospitals for my outspoken opinion. I am

sorry about this..but I will not apologise for stating what is obvious in

acting in the patient's best interests.

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Transfer - NO [Stating a Fact!]