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Tue Nov 27 15:40:08 GMT 2007

Dr Bromberg,
 We get a lot of penetrating trauma. For, us mostly golden 15 minutes.
Patients transferred out, are stabilized by the trauma surgeon before
transfer. Point I tried to make (not very effectively), was that trauma
surgeon should be able to provide initial stabilization and than
transition into to primary care for the injured patient. I agree with
your position completely but it has been impossible to recruit sub
specialist for trauma and even harder make them take call, acute care is
the only way out, at least in my opinion.
Naveed

-----Original Message-----
From: William Bromberg [mailto:brombwi1 at memorialhealth.com] 
Sent: Tuesday, November 27, 2007 10:07 AM
To: Ahmed, Naveed 
Subject: RE: Trauma Care in the UK

Every injured patient in the US is guaranteed access to subspecialist
care regardless of ability to pay via transfer to a higher level of
care. This is a mandate under EMTALA. No-one has claimed that to have a
mature trauma system requires every subspecialty at every hospital. The
point is to get the patient to the hospital that they need. However
without a trauma system in place the facilities to which to transfer the
patient are not there.

And before someone points out my apparent hypocrisy between the last two
posts I will add two things. 1. I believe that it should be the state's
job not the feds (anyone remember the tenth amendment?) and 2. "A
foolish consistency is the hobgoblin of little minds"
-----Original Message-----
From: "Ahmed, Naveed " <NAhmed at cchseast.org>
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Sent: 11/27/07 9:26 AM
Subject: RE: Trauma Care in the UK

Dr Khan,
To believe that every injured patient that is brought in the emergency
rooms around the world, especially poor urban hospitals in US, have
access to  a vascular, thoracic and a urologist is like counting virgins
in heaven. A general surgeon should be able to provide damage control in
all/most scenarios, otherwise he/she has no business taking trauma call.
Naveed

-----Original Message-----
From: Saboor Khan [mailto:hpb.surgery at gmail.com]
Sent: Monday, November 26, 2007 12:49 PM
To: Trauma &amp, Critical Care mailing list
Subject: Re: Trauma Care in the UK

Dr Hardcastle

Although the structure of general surgical training in the UK is
changing, until recently prior to being appointed a trainee typically
spent a minimum of 8-9 years in clinical training (+ 2-3 years of
research), rotating through all the various specialties and electing to
sub-specialise in the last two to three years (whilst still taking call
for general surgery, including trauma), much like a 'fellowship'. The
bad old days of 'open ended' training are thankfully over! That said,
the newly appointed consultant is expected (indeed trained) to deal with
abdominal emergency surgery.

There is no formal requirement for critical / intensive care training
becuase these units are manned by dedicated 'intensivists', who are
mostly anaesthetists by training. However, critical care and emergency
surgery (including trauma) are vital parts of all surgical post-graduate
examinaitons, including the exit exam. Finally, it is compulsary to have
attended the 'Care of the critically ill surgical patient'  ( as well as
the
ATLS) course and increasingly trainees rotate through critical care.

'Trauma Surgeons' per se do not exist in the UK, unlike the U.S or other
countries. Trauma patients arrive in the Accident and Emergency
department, and in the medium to large hospitals are attended to by a
trauma team with multi-specialty representation. The organisation of
trauma care in general can be better organised, as discussed in this
thread.

The 'exposure' to penentrating truama is very low indeed and perhaps
that's the reason why you get so many requests for experience. Having
expert vascular on-call round the clock is a welcome development, which
I have no doubt improves outcome for the great majority of vascular
patients.

 You make some 'interesting, comments in your e-mail, and paint a
picture of surgical training in the UK that I do not recognise, i.e., a
newly appointed consultant, unable to assess, manage or operate on
surgical patients outside of their narrow field !

There is increased emphasis on sub-specialistation, but that's a world
wide phenomenon in some guise or another- resources permitting? I am a
bit puzzled, what is your definition of a 'general surgeon'?

Best Wishes,
Saboor Khan
Coventry
UK

On Nov 26, 2007 4:47 AM, Hardcastle, Tim, Dr <tch at sun.ac.za>
<tch at sun.ac.za>
wrote:

> Mike
>
> The other challenge that now exists in the UK is that there are less 
> and less true "General Surgeons"; the majority of the "Trauma 
> Surgeons" are mainly orthopaedic trained, while the GIT surgeons 
> subspecialise even before they finish what we would know as residency.

> They qualify not as "General Surgeons", but as one of Breast-Endocrine

> / Upper GI / Colorectal or Hepato-biliary surgeons. Vascular is also 
> seperate now. This leads to young consultant surgeons who have little 
> idea of the overall patient and the care of trauma in particular. Add 
> to this the lack of a formal ICU requirement in the post-grad training
and you see where some of the deficiencies lie.
>
> For this reason we in South Africa are inundated with requests for 
> people to do three month mini-trauma-fellowships to get some 
> experience in General Trauma care.
>
> Regards
> Dr T C Hardcastle
> M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA) Senior Surgeon / Senior
> Lecturer: Surgery (Trauma and ICU) ATLS  instructor and DSTC Cape Town

> Course Director Intern program Coordinator: Surgery M.Med (Emergency
> Medicine) Executive Committee member Clinical Head (Director): Diana 
> Princess of Wales Trauma Unit Division of Surgery (General) Room 4064 
> Department of Surgical Sciences Tygerberg Hospital / University of 
> Stellenbosch PO Box 19063 Tygerberg 7505 Western Cape South Africa
> e-mail: tch at sun.ac.za
> Cell: +27824681615
> Office: +27219389281 or 4911 pager 0302
>

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