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Mon Dec 31 14:00:27 GMT 2007

I'm arriving late to the thread (busy holiday, if no Wii -- I'm
increasingly skeptical about this "Santa Claus" fellow), but it's
reminiscent of a long discussion we've repeated every couple of years on
the same topic.

Diana's was a "prehospital arrest" solely because the prehospital
interval was between fifteen- and twenty-fold what it might have been in
scores of other urban systems existing at that time.  Most accounts
describe her not only perfusing but respectably conscious for several
minutes at the scene, during which time her thoroughly deceased
companions were receiving futile attention from the rescue teams.  Not
to mention the FORTY MINUTES devoted to transport.  Three and a half
miles?  Bystanders could have carried her faster.

While her injuries may indeed have been overwhelming, it can be fairly
argued that if only in terms of contemporary management, she was a
victim of paradigm.

Pret Bjorn, RN
Bangor, ME USA

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Mike Smertka
Sent: Monday, December 31, 2007 6:08 AM
To: Trauma &amp, Critical Care mailing list
Subject: Re: British Surgeon: "Princess Diana might have survived if
treatedfaster"

Please entertain me being the devil's advocate,

  If I understand this thread correctly a review of the treatment 10
years later over 2 countries, somebody decides she may have been
savable? Just for my simplicity: high speed rendezvous with inanimate
object, prolonged extrication, prehospital cardiac arrest. Does anyone
believe it would have turned out differenty? Has anyone ever seen anyone
recover from that? As an alternative reality, lets say she was
transported to the hospital promptly. Do any of us actually believe that
she would have woken up? Would we now be discussing whether 10 years on
it was time to pull the plug? 

  Now I am willing to stipulate that if the princess was a 20 year
chronic alcoholic, and crashed head on at 70+ mph into a minivan
carrying the Beaver family, on their way home from church, she probably
would have walked away. But absent crashing into the hospital door,
being ejected onto the gourney, where the trauma team was just having a
meeting, what is the blunt cardiac arrest survival rate today? Much less
ten years ago? In any country in the entire world?

  Why don't these people just let her rest in peace. In another 10 years
we can look at it again, and the facts will be altered just enough that
we could create a reasonable theory she was killed by the same people as
JFK. 

  But to defend the French for a minute. Some years back (prior to this
event) I was having a discussion about the US prehospital system
compared to that in France. During the discussion it was brought up that
the measure of what makes one successful is different. What if the goal
is not to flood the emergency room with every patient who calls? What if
the goal is to reduce the cost of emergency care? What if you have to
take into account what will help the most people even if some are
considered acceptable losses? Hopefully nobody measures their system on
the survival to discharge of trauma arrests. But please consider, if you
bring all the equipment you can and a few people with you, what really
is the difference if your hospital is on wheels or you are thrown into a
pickup truck to the hospital? It seems to me what you need is a surgeon
with some equipment, the venue is really trivial. MASH hospitals were
basically tents. Nobody would argue they were beneficial. More
 over, lets stipulate somebody tossed her in a car and drove as fast as
they could with due regard for public safety. We might be arguing that
not enough was done for her in the prehospital setting. 

  Forgive the conspiracy theory, but not one person outside of our
little world have I heard say: "trauma kills people like Princess Diana,
maybe we should put more resources into making sure we provide the best
possible care to those who are injured so they will recover and live
happily ever after." Has anyone set up or received money from the
Princess Di memorial trauma charity? 

  I think the whole point behind this inquest is to sell another book or
news paper. Read all about it! How I would have saved the princess
looking back on it in hindsight! "In Western society people only get
killed from bad judgement on TV." I hate having my picture taken by
people I know, much less people i don't. But it is part of celebrety
life. If you want the money and fame, then you have to accept people
will pay for the picture of you doing the simplest things. 

  Just to throw in a war story, on my first day ever as an EMT, my first
ever call was a multi casualty MVA. 6 people, 3 ejected dead at the
scene, 3 flown without stopping for pressors to an outstanding trauma
center with some of the best physicians I have ever met. All died, later
it was determined only the driver had alcohol in his system. So for my
cynicism, cause of death was getting in the car with a driver who had
been drinking. the Rest is just the details of it. 

  The real question of the day, in 2017 will we be asking how Bhutto
died? was it the skull fracture from the lever or a gsw? 

  Mike

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British Surgeon: "Princess Diana might have survived if treatedfaster"