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Tue Jun 12 20:04:02 BST 2007

Pret,
Thanks for your response. That photo was in the local paper this week. Perhaps 
this flirted with a HIPPA violation. I should have titled the thread, 
hypothetical. A modified response, and perhaps critical thinking could have 
been applied. Anyway, there will be a good discussion at our committee meeting.

--
Kind regards,
Phil
Phil Caropreso, MD, FACS
1813 Grand Avenue
Keokuk, Iowa, USA, 52632
pjcabdds at mchsi.com

----------------------  Original Message:  ---------------------
From:    "Bjorn, Pret" <pbjorn at emh.org>
To:      "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
Subject: RE: EMS management/crush injury
Date:    Tue, 12 Jun 2007 14:24:10 +0000

> Dr. Capropreso,
> 
> Sounds like this thread is wrapping up.  Sorry I missed most of it, and
> that I have little to add.
> 
> First -- and I'm sorry to lead with a downer, BUT -- we should all be
> aware that this discussion contains sufficient context identifiers as to
> flirt with a HIPAA violation.  I already Googled a photo of the crash
> scene.
> 
> We're all good people engaging in a useful performance improvement
> exercise here, but we're doing it in public.  If any subsequent
> information comes from hospital contacts, consent the patient.
> 
> As for all the rest, there's nothing here to suggest that the case was
> handled inappropriately.  The SYSTEM issues become hypothetical, but it
> might be useful to consider the extremes:
> 
> One the one hand: does the Iowa trauma system behave differently if your
> strictly anatomic criteria are combined with physiologic instability?
> It'd be a shame for a patient to die on the way to Des Moines when a
> respectable OR is waiting just down the street.  Maine has many thankful
> citizens who owe there lives to damage control by dedicated surgeons at
> remote "system hospitals" (roughly equivalent to ACS Level III's).
> 
> On the other: can the protocol be aborted if, once the tractor is off,
> we see that the patient has stable vitals and garden-variety orthopedic
> injuries?  Compelling the flight not only impacts the patient (who has
> to deal with being charged thousands of dollars to be treated several
> hours from her home and support); but also may distract the aircraft and
> a CCT team from other more urgent tasks.
> 
> For my own part, I think the "modified scene" response suggested here --
> wherein the local ambulance meets the helicopter at the local hospital
> -- is quite defensible.  First, it's presumably a safer landing zone;
> plus, you can have a surgeon or EM clinician walk along from the
> ambulance to the airframe: nothing wrong with an extra set of trained
> eyes.
> 
> Thanks for the discussion.
> 
> Pret
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of pjcabdds at mchsi.com
> Sent: Tuesday, June 12, 2007 8:41 AM
> To: Trauma &amp; Critical Care mailing list
> Subject: Re: EMS management/crush injury
> 
> Hi Rob,
> Thanks again for taking the time to write and answer the questions that
> I
> presented. Rumor has it that the patient had a traumatic amputation thru
> the
> thigh, and a crush/loss of substance in the opposite leg. Terrible. Such
> injuries will require tertiary care. Obviously, if a leg is severed,
> there is no
> need for suspicion. When I get more definite information, I will forward
> it. A
> few thoughts: transferring a patient on suspicion alone will result in
> significant overtriage; faster transport and bypass of a facility may
> not always
> be the best tactic, ie, in this case, major vessels open up and
> hemorrhage in
> route; decision to transfer/destination may be facilitated by
> discussion/communication with readily available physicians, who are
> actively
> involved with trauma care. 
> 
> --
> Kind regards,
> Phil
> Phil Caropreso, MD, FACS
> 1813 Grand Avenue
> Keokuk, Iowa, USA, 52632
> pjcabdds at mchsi.com
> 
> 
> ----------------------  Original Message:  ---------------------
> From:    "Rob Farnum" <latigo at firehousemail.com>
> To:      <trauma-list at trauma.org>
> Subject: Re: EMS management/crush injury
> Date:    Tue, 12 Jun 2007 03:37:47 +0000
> 
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