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Mon Dec 15 21:46:14 GMT 2008

Our trauma program has flourished, but our surgical and trauma critical care by surgeons has?not been a priority.? I see it as a detriment to this program, and more importantly, to the sickest patients that we admit.? The trauma surgeon does make the call -- to the medical intensivist as they are leaving the trauma bay or the operating room..............

Dell................

-----Original Message-----
From: Robert Smith <rfsmithmd at comcast.net>
To: 'Trauma &amp; Critical Care mailing list' <trauma-list at trauma.org>
Sent: Mon, 15 Dec 2008 2:39 pm
Subject: RE: TRAUMA AND SURGICAL INTENSIVIST COVERAGE

Dell,

Well I'm all for multi-disciplinary. When it's needed. And the trauma
surgeon should be the one that makes that call. I would think that any
trauma service that's set up where another group of docs could write orders
on your patients would be a recipe for disaster. I guess there are a lot of
places that run like that and there may be economic motivators that I've
never had to deal with or see play out. But to my mind, the whole point of
developing trauma was to have one doctor or group of doctors in the same
trauma service take responsibility and control of patients with multisystem
injuries.

Rob Smith

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of moore677 at aol.com
Sent: Monday, December 15, 2008 3:45 PM
To: trauma-list at trauma.org
Subject: Re: TRAUMA AND SURGICAL INTENSIVIST COVERAGE

Thanks Dr. Gross for the stat's.? Many of us argue/proclaim that trauma is a
surgical disease, yet when it comes to the postoperative or post-traumatic
ICU care of the patient, it is no longer our problem.? And for a lot of what
we see, any intensivist will do.? I would argue, however, that some patient
conditions mandate constant surgeon vigilance and care.? For instance, I
operated on a patient with a GSW to the abdomen early yesterday AM.? He
sustained a Grade V burst injury (central extending thru to the right
lateral segments) of the liver.? Fortunately, he responded to?a second round
of packing, factor VIIA, and a host of blood products.? In our institution,
it would be acceptable, if not expected, that the medical intensivist now
manage this patient.? And while I readily acknowledge that?my medical
colleagues are smarter, in my opinion, this patient should only be managed
by a surgeon/surgical intensivist.??I seriously doubt that there would be
any surgeon that would d
 isagree with this statement.? I fully also acknowledge that there is a
shortage of intensivists, and that there are intangible benefits from a
multidisciplinary approach.

Dell....
...............?

-----Original Message-----
From: Gross, Ronald <Ronald.Gross at bhs.org>
To: 'Trauma & Critical Care mailing list' <trauma-list at trauma.org>
Sent: Mon, 15 Dec 2008 7:29 am
Subject: RE: TRAUMA AND SURGICAL INTENSIVIST COVERAGE

Dell,

We are a Level I  Trauma Center with around 1700 trauma admissions/year.  We

have a (woefully undersized) 24 bed Med-Surg ICU that is staffed by
surgical, 
and medical intensivists, as well as a smattering of anesthesiologists, all
of 
whom rotate from the medical to the surgical side.  Some of the medical
folks 
are pulmonologists.  All of this might be changing, however, as we look to 
change the structure to a medical AND surgical ICU, with the medical side
under 
the direction of a pulmonologist, and the surgical side directed by one of
our 
trauma/critical care surgeons.

Ron

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On 
Behalf Of moore677 at aol.com
Sent: Saturday, December 13, 2008 4:16 PM
To: SSherry at LHS.ORG; trauma-list at trauma.org
Subject: Re: TRAUMA AND SURGICAL INTENSIVIST COVERAGE

 Are there other trauma surgeons out there willing to share with me the make
up 
of their trauma/surgical ICU.? PLease tell me how many surgeons, 
anesthesiologists, ED, and pulm/med intensivists make up your staff
coverage.? 
This info would also be greatly beneficial.? Please tell me how many trauma 
admissions you have as well as whether you are a level I or II.

Dell................

-----Original Message-----
From: Sherry, Scott :LPH Trauma <SSherry at LHS.ORG>
To: moore677 at aol.com
Sent: Sat, 13 Dec 2008 1:45 pm
Subject: RE: TRAUMA AND SURGICAL INTENSIVIST COVERAGE

OHSU - portland oregon. has trauma cc trained intensivists for the trauma
icu. 
there is one EM/IM/CC and one Anesthesia CC ICU intensivist in the rotation.

Legacy emanuel protland oregon?- 8 ICU trauma intensivists rotate through
trauma 
er, icu, ward.

From: trauma-list-bounces at trauma.org on behalf of moore677 at aol.
com
Sent: Thu 12/11/2008 3:40 PM
To: trauma-list at trauma.org
Subject: TRAUMA AND SURGICAL INTENSIVIST COVERAGE

Are there any U.S. Level I trauma centers that still have the medical 
intensivists contribute a significant amount of care to your p
atients?? If so, 
and what is their role exactly and how much time do they spend in the ICU?
We are a high volume ACS Level I (4000 trauma service admissions) with a new

general surgery residency and 8 trauma surgeons.? Two of the eight are
surgical 
intensivists and do their own critical care.? Over 90% of the care of our
ICU 
patient's?are currently?done by the medical intensivists.? We are trying to 
develop a?SCC service?whereby we as surgeons can do the majority of the
teaching 
and rounding, but I fear we would need to take on at least 2-3 more surgical

intensivists.? Monies are not available for this.

Suggestions?

Forrest "Dell" Moore, MD
Trauma Critical Care Surgery
St. Joseph's Hospital and Medical Center
Phoenix, AZ
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