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Fri Jul 6 21:27:33 BST 2007

Valerie

No one understand you better than me.
"A Trauma Surgeon is a Complete General Surgeon" was the answer that Dr 
Moore, (I´m almost sure he was, he is in this list he will confirm) to a 
fellow of mine in the First Pan American Congress of Trauma in Guadalajara 
when asked to define a Trauma Surgeon.
I would ad to this, that a trauma surgeon is a surgeon trained in non 
elective surgery, performed on inminent death situations, when multi system 
injuries exist, being able to correctly set a priority list, and solve it 
accordingly with the regular nigth shift in house team. Or at any time of 
day and nigth regardless of any thing, and get the best outcome.
In the Actual Mexico, most General Surgeons are basically trained in Belly 
Surgery and I think its very common in other countries as well, since hiper 
specialization started making specialist in every different organ and 
system.
I was one of the lucky ones that had a chance to get my General Surgery 
training in the trauma system of a 20 million people city, in the times that 
the law ordered all trauma to be taken to our hospitals. The trauma of 
Mexico City was distributed to 4 hospitals of the city gov. and one of the 
Mexican  Red Cross. Worked 36 by 12  hours shifts for 4 years. We got our 
share of trauma to every inch of the body, from head to toe.
 Bibliography, rare or unexistant, no time to write.  But one thing I can 
asure you, If you suffer by missfortune a Trauma in Mexico, your outcome 
will be much better if you´re operated by a Surgeon trained in the "Green 
Cross ´Trauma and Emergency Hospitals of the Federal Distric Department in 
Mexico City.
I can only be anecdotical, but my patients have always done better than the 
those operated by surgeons that belive that  traumatic abdomen surgery is 
Trauma Surgery and call in a hurry for the Vascular Surgeon to stop a big 
bleed., and this I belive is your main worry. I work at nigth at a General 
Hospital that gets most of the Trauma in my town, and during the day 
patients come to me mostly for belly problems, and my fellows ask me to 
operate on the illest of our private practice patients, but rarely call me 
for a thyroidectomy. Thats life I guess, since hyperspecialists were born.
Our profesor was Dr. Alfredo Vicencio Tovar, is very well known in many 
countries. He can confirm what I say.
Most Trauma experience is anecdotical, I belive.Since how many  GSW in the 
abdomen traverse the liver and get the cardiac apex, or get the Pylorus,gall 
blader, rigth kidney and vena cava. I consider it very unlikely to get a 
series of 10 operated by a belly surgeon and compare it to a series of 10 
operated by a Trauma trained Surgeon.
Hope this helps you Valerie

Dr Porfirio Lango
Trauma Surgeon
Mazatlan Mexico
drlango at hotmail.com

----- Original Message ----- 
From: "Valerie Malka" <osiris11_2000 at yahoo.com>
To: "Trauma &amp, Critical Care mailing list" <trauma-list at trauma.org>
Sent: Tuesday, July 03, 2007 4:30 PM
Subject: Re: non-trauma surgeons doing trauma

> 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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