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Thu Jan 18 15:37:17 GMT 2007

Hello Ian,

With our experience, the only ones that need ANY tests in a Multiple/Mass
Casualty situations, are the REALLY, REALLY sick ones (very few in each
event).  All the others can wait till the havoc subsides.

Those who DO need blood tests, are not different from the "Regular", "Every
Day" major trauma patient that needs a Type (& cross if you order blood),
and theoretically a test of the acid/base status (Ph, BE or Lactate - pick
your choice).  Supposedly, for recognition of the level of "global ischemia"
the patient is experiencing due to hemorrhagic shock or respiratory failure
prior to initial evaluation in the resuscitation room.  That's what we teach
the residents nowadays, isn't it?  

All the rest of the tests that we take (I admit that we also do foolish
things), are "excess baggage", and are just for "documentation" and
"Baseline".  The sicker the patient, the less they (the tests) are important
since the numbers in the OR will be very different after 30 min in the OR.
However, if the patient is not sick, again, they are not important.

In the majority of admissions to the hospital in the mass casualty incidents
we had, NO ONE bothered to look at the results of the test taken in the ED
for the first few (up to 6 in the larger incidents) hours, unless the
patient was REALLY, REALLY sick (as we said - these were very few in each
incident).

Oh yes! we did look at the test results of those who had minor injuries and
needed discharge notes from the ED.  It is "Politically Incorrect" to take a
blood test and send the patient home without the result.....;-)

My two cents (or Agora, as we say in Israel...)

Cheers,

Mickey

*************************************************
Michael Stein MD
Chairman, Israel Trauma Society,
Director of Trauma, Attending Surgeon,
Department of Surgery,
The Rabin Medical Center, Beilinson Campus,
Petach-Tikva, 49100, Israel
Affiliated with the Sackler Faculty of Medicine,
Tel-Aviv University, Tel-Aviv, Isarel

Cellular: +972  50-763-7752
Tel:  +972  3-937-7043
Fax:  +972  3-937-7042
E-Mail:  mshtein at clalit.org.il
*************************************************

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Ian Seppelt
Sent: Thursday, January 18, 2007 5:10 AM
To: joe.nemeth at mcgill.ca; trauma-list at trauma.org
Subject: Blood tests during a disaster

Following this to get some discussion going ....

In a disaster situation [or even just a trauma surge in your ED] what
are the minimum laboratory requirements / blood tests? Just a Hb / Hct
and cross match? What else is REALLY necessary, and why? Lactate? And if
you don't need all the other tests in a surge situation, then why do you
need them in "everyday" trauma??

Cheers, Ian

Ian Seppelt FANZCA FJFICM
Senior Staff Specialist
Dept of Intensive Care Medicine
The Nepean Hospital, PO Box 63 Penrith NSW 2751
Clinical Lecturer, University of Sydney

>>> joe.nemeth at mcgill.ca 18/01/2007 1:40pm >>>

Question/Survey....

J Trauma Jan 2007....article from Hermann...

who uses 1:1 from the get go? i.e. in the ED/trauma bay...

joe
Emergency Medicine
McGill University
Montreal
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Blood tests during a disaster