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Fri Feb 1 13:34:00 GMT 2008

John has really hit the nail on the head, well said...

Health Care "Management" and Bureaucracy is destroying 
trauma patient care. I believe that the root of our 
arguments is NOT clinical, but resources. Surge capacity 
is  "not economically viable" says the short term 
thinkers, that is until a disaster... and then the blame 
falls on us the clinicians, typical...

In third world health care systems like the NHS in the UK, 
they have no choice but to fight the good fight everyday 
with imposed targets etc. A&E trolleys/wards have become a 
side effect of years of underfunding where patient targets 
have outgrown common human decency let alone trauma 
patient care, EVERYONE should read the NCEPOD report, 
"Trauma Who Cares?" to realise that the NHS once a "crown 
jewel" is now the crown's turd...

My latter is not a dig on Emergency Medicine, FAR FAR FAR 
from it, Hey I'm an Anaesthesiologist with a special 
interest in EM...! EM is the glue in the very fabric of 
good trauma patient care, recognising time critical 
injuries and ensuring the patient gets the definitive care 
they need...

Definitive care to me is the right cloth to cover that 
individuals' needs. And some have a lot more need for 
covering than others!!! If the cloth (resource) is not 
there, the glue (EM) has to do its level best with what 
little scraps of material it has left over. SO STOP 
BLAMING THE GLUE if it does not hold the scraps together 
well!!!

The real argument is ensuring the right cloth is available 
at all times. Off to do some more tailoring...

Dr. van der Velde
EMDM-A
ATACC Disaster Response Coordinator
Trauma Research Fellow in Anaesthesia

Message: 16
Date: Fri, 1 Feb 2008 19:37:06 +1000
From: John Holmes <docjohnholmes at hotmail.com>
Subject: RE: Operating Room Resuscitations
To: "Trauma &amp; Critical Care mailing list" 
<trauma-list at trauma.org>
Message-ID: <BLU131-W22D016B862FA337F8F4561B4300 at phx.gbl>
Content-Type: text/plain; charset="iso-8859-1"

I really cannot believe the silliness of the proposition 
that the ED Resus room should be bypassed. Those of you 
making such propositions seem to be living in a world of 
unlimited resources. In the real world, access to ICUs / 
ORs etc is usually extremely limited. In most hospitals 
the theatre suites are fully booked and the ICUs fully 
occupied. Further, in other than the largest centres, 
these precious resources rarely have immediate manpower 
available. By NECESSITY the ED provides acute care, 
including resuscitation. Of course it should go without 
saying that unstable patients who are in need of 
definitive care - be that in the OR or the angiosuite - 
should get to those places ASAP. But many patients in 
resus rooms do not need hyperurgent definitive 
intervention. And this is even more so with non trauma 
cases. In fact many do not eventually even require to go 
to ICU. The ED provides not only early assessment and 
treatment but also a gatekeeping role.

In reality the ED HAS developed "far beyond immediate 
care". The UK's "4 hour rule" "was politically imposed in 
the UK and has nothing to do with medical care and 
everything to do with bureacrats' targets. It is anathema 
to those of us who see EM as part of a spectrum of care 
working seamlessly with the ICU/CCU/OR etc but NOT 
excluded or bypassed.

John

Dr John L Holmes
Director Emergency Medicine Training
AMC & OLVG
Amsterdam
The Netherlands

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