non-trauma surgeons doing trauma

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Valerie,

The entire premise of the ACS COT is that the care of the trauma
patient is better when it is rendered by those trained to "do trauma". 
As such, I would refer you to the ACS web site, and to the "optimal
resource document", aka the Green Book, aka "Resources for Optimal Care
of the Injured Patient 2006".  In addition, read “Accidental Death and
Disability: the Neglected Disease of Modern Society” and in the HRSA
model trauma system document, as well as in many issues of the J Trauma;
you will find papers that discuss the very question that you raise - and
that support the contention that outcomes are indeed better in places
where (1) an organized trauma system exists, and (2) care of the trauma
patient is delivered by trained trauma surgeons, and in fact physicians
from all disciplines are trained in the initial resuscitation of the
trauma patient.  One of the first landmark papers was by Shackford,
Mackersie, Hoyt  et al. and was entitled "Impact of a trauma system on
outcome of severely injured patients".  It appeared in the Arch of Surg
in 1987 and you need to find that as well.  A followup to that would be
the article by Mike Mullins, "Influence of a statewide trauma system on
location of hospitalization and outcome of injured patients" which was
published in the J Trauma in 1996.  there have many more papers since,
but why mess with the classics, since we have only continued to prove
their hypothesis and conclusions!

I hope this helps.

Ron

>>> Valerie Malka <osiris11_2000 at yahoo.com> 7/3/2007 6:30 PM >>>
Hello Dr Gross and others
   
  I was in fact talking about non Trauma/Critical Care certified or
trained General Surgeons.
   
  Bearing in mind I am writing from Down Under where certified trauma
surgeons are as rare as hen's teeth......and Critical Care certified
surgeons even rarer! Most of our General Surgeons are NOT trauma or
Critical Care trained.
   
  The reason I have asked this question is that there is a perception
here in the Land of Oz, that essentially anyone can "do" trauma
(operative or non-operative) and in fact it is not seen as a Specialty.
Therefore on that premise the Health Department does NOT think they
necessarily need to designate Levels and concentrate resources and
expertise.
   
  So again........does anyone know of any literature showing different
outcomes between these surgeons, such as we have seen in Consultant or
Attending led and supervised resuscitations/operations etc. There is
clear evidence that the more Senior the presence in trauma care from the
start, the better the outcome but what about type of Senior presence?
   
  Thankyou
   
  Valerie Malka
   


Dr Valerie Malka MBBS,FRACS,MIPH
Director of Trauma Services
Department of Surgery
Westmead Hospital
Westmead, Sydney
Australia, 2145

Tel: 612 9845 7072
Fax: 612 9845 8321
Website: www.westmeadtrauma.org 
Website: www.austraumaconference.org 
       
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