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Thu Nov 22 23:52:18 GMT 2007

Karim

Doing ATLS is one thing- that gives you the language.

The punters must then work in a place where they
-have adequate exposure to major trauma and are team leader regularly ? How
much
-have adequate supervision and review of their practice by experienced
senior doctors and nurses
- are in a system which reviews practice ie Does QA
- are in a system which does trauma research and teaching

In other words be in a system which is supported by management and  senior
clinicians experienced in trauma care

Gone are the days when "anyone" can look after Trauma patients

We have the same problem in the Antipodes convincing Government ( Federal
and State)  they should concentrate Trauma care in large centres ; why ?
Because we don't; have the data that smaller boutique trauma centres do any
worse than large volume ones and if large is good, how many ISS > 15 should
one centre receive per year?  400-600, 600-800, ? More

We may have a change of Federal Government this weekend , so will be
"chancing our arm" with them in due course

Regards
Tony Joseph

On 23/11/07 10:18 AM, "Karim Brohi" <karimbrohi at gmail.com> wrote:

> Just to put the record straight I mistated the figures.
> 
> ISS>15:  US: 16% vs UK 30%
> ISS>24:  US: 30% vs UK 46%
> 
> Now apart from the stsem issues, the other thing that is clear form
> the report is that many of the cases of poor clinical care were with
> fundamental ATLS principles.  Now the UK has one of the highest ATLS
> uptakes in the world, with it being pretty much mandatory to progress
> in training in surgery, anaesthesia, emergency medicine etc without it
> from approximately PGY3 onwards.
> 
> So this appears to be either a failure of knowledge retention, which
> is unlikely, but more probable is that it's a failure of
> implementation.  That there is a disconnect between knowing what to do
> and actually doing it.  And I have no doubt that that is not a UK
> problem but a global problem.
> 
> So how do you transition ATLS principles from 'knowing' to 'doing' -
> and how do you do it on a national level?  (This applies to medical
> education in general, but ATLS is a great starting point as it has
> been so extensively studied)
> 
> Ideas?
> 
> Karim
> 
> On 22/11/2007, Tony Joseph <tjoseph at ihug.com.au> wrote:
>> Karim et al
>> 
>> A major issue is that although there are no doubt other health priorities,
>> traumacare is a  relatively easy one to get right by investing in a few
>> major Trauma centers servicing a defined hub of smaller hospitals.
>> The UK definitely has the expertise but not the mandated organisation.
>> 
>> As a large number of Trauma victims are young, it is also cost effective in
>> treating them right the first time so they can get back to work and be
>> productive.
>> Maybe that is an argument your Government can understand.
>> 
>> 43% mortality is pretty convincing something needs to be done urgently?
>> 
>> Also you only have to convince one layer of Government which is a definite
>> advantage?
>> 
>> Regards
>> Tony Joseph
>> 
>> 
>> On 22/11/07 9:48 AM, "Karim Brohi" <karimbrohi at gmail.com> wrote:
>> 
>>> Sadly the state of trauma care in the UK is exactly as portrayed in
>>> the NCEPOD report, if not worse.  It depicts clearly the effect of a
>>> lack of a system and lack of any legislated standards of care on the
>>> quality of care delivered to trauma patients, despite this being a
>>> developed country with huge resources.
>>> 
>>> I'd recommend the report to anyone involved in trauma care, not only
>>> those in the UK, as the findings have implications for all of us.
>>> This is a unique study in that all hospitals in England and Wales are
>>> mandated to submit data to a NCEPOD enquiry, and this is self-reported
>>> data on nearly 800 severely injured patients presenting a country-wide
>>> detailed snapshot of the delivery of trauma care.  Deficiencies in
>>> process of care and their subsequent impact on outcome are relevant to
>>> all of us.
>>> 
>>> Anyone in the UK who doesn't recognise these deficiencies is frankly
>>> blinkered to reality.  2000-2005 outcomes for severe injury (ISS>15):
>>> UK Mortality 43%; US mortality 16% (these are not figures in the
>>> report, this compares UK TARN data to US NTDB data).
>>> 
>>> The fault lies not with individual specialties, providers or
>>> hospitals, but with the lack of a appropriately resourced national
>>> trauma system, with legislated standards of care and on-going
>>> monitoring of the health of that system.
>>> 
>>> This is the latest in a long litany of reports since the Ormond-Clarke
>>> report first recommended a UK trauma system in 1961.  In 2011 it will
>>> be 50 years.  It's about time.
>>> 
>>> PDF available: http://213.198.120.192/2007b.htm
>>> 
>>> Karim
>>> 
>>> On 21/11/2007, Ronald Gross <Rgross at harthosp.org> wrote:
>>>> Jonathan,
>>>> 
>>>> We should have all learned a long time ago that much of what is written in
>>>> today's press is far from being entirely factual.  Personally, I take
>>>> everything I read or hear in the press with a shaker of salt, 'cause a
>>>> grain
>>>> won't do it any more.  This article reminds me of the NYT article about
>>>> John
>>>> Holcomb, the "aggressive Army surgeon". Yup, the very same one that I had
>>>> the
>>>> pleasure of working with on more that one occasion, usually indirectly, and
>>>> always with superb outcomes for the ones that matter most - the soldier who
>>>> I
>>>> had been entrusted to care for!
>>>> 
>>>> Take care, and don't dispair!  UH OH!! I best quit - I'm starting to wax
>>>> poetic...  :-0
>>>> 
>>>> Ron
>>>> 
>>>>>>> "Jonathan Marrow" <jonathan at marrow.com> 11/21/2007 12:37 PM >>>
>>>> I could write a long essay in response, Connie.  Whilst I am the first to
>>>> accept that there is lots of room for improvement in trauma care in the UK
>>>> I
>>>> don't think trauma-list members should accept that the picture you paint is
>>>> the only view of trauma care over here.
>>>> 
>>>> I am hoping that someone will be able to take up some of your points in
>>>> detail.   I can't do that right now as I am off to teach on an ATLS Course.
>>>> 
>>>> All the best
>>>> Jonathan Marrow
>>>> (UK Emergency Physician)
>>>> 
>>>> ----- Original Message -----
>>>> From: "Connie Potter" <Connie at traumafoundation.org>
>>>> To: <trauma-list at trauma.org>
>>>> Sent: Wednesday, November 21, 2007 4:11 PM
>>>> Subject: Trauma Care in the UK
>>>> 
>>>> 
>>>> 
>>>> Trauma care in the UK, with a few exceptions, is similar to that in the
>>>> US in the 60's.  The injured patient is taken to the nearest facility
>>>> where chaos ensues in many situations.
>>>> 
>>>> Basically, there is no standard ED triage training (this is a project
>>>> being brought in by a consulting firm from the US called Modeladvice,
>>>> inc.), and no trauma system.  Karen Dunwell at modeladvice.com is
>>>> working with a number of HCA's (see below) to bring their healthcare
>>>> system into the 21st Century.  They have a new website which I have not
>>>> seen but might be of interest to you.
>>>> 
>>>> The UK for the past year has been undergoing radical reorganization of
>>>> its Health Care Areas (HCA's) and bringing DRG's into their system.
>>>> They are also focusing on significant problems needing areas of
>>>> improvement such as waiting times for orthpaedic procedures, operations
>>>> that can be done on a outpatient basis (previously none), etc.
>>>> 
>>>> You are correct that the UK needs an organized trauma system.  That in
>>>> the US is incomplete as well.  England, Scotland and Ireland also have
>>>> many other basic healthcare operational problems that may take
>>>> precedence over trauma (sound familiar?).  Simple training in our most
>>>> commonly accepted ED triage processes would be a great step for the UK.
>>>> 
>>>> 
>>>> This was an interesting topic for our Society.
>>>> 
>>>> Connie Potter, Executive Director
>>>> National Foundation for Trauma Care
>>>> (505) 525-9511
>>>> 
>>>> 
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