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Thu Jan 3 13:15:17 GMT 2008

I'm left with a strang feeling that this is a version of "Groundhog Day", the movie with Bill Murray. Seems we are replaying things over and over.

Maybe there will never be the kind of evidence that will conclusively answer the question "Scoop and haul or stay and play?" However, seems everything we do on scene or in route (fluids, intubation, etc.) in the US is associated with less favorable outcomes. And of course there's the study from La County/USC where you were better off if your family or a stranger drove you into the hospital. I'm an older surgeon (57) who's concluded that I need to abandon all my assumptions at the door and check everything with whatever proven and promising evidence is around - trying to avoid that old saw "Never let science get in the way of perfectly good fetish."

Mike Sise
San Diego

________________________________

From: Charles Brault [mailto:c_brault at yahoo.com]
Sent: Wed 1/2/2008 5:39 PM
To: Trauma &amp; Critical Care mailing list
Subject: Re: British Surgeon: "Princess Diana might have survived if treated faster"

Let's make sure I am well understood

Considering an 8 min BLS response time
10 min scene time
A BLS transport if NO ALS available
A 5 min transport time to a level 1 Trauma center (let's make that 10 min)

Ladi Di would have been in a trauma center
On the 10th min as opposed to the 90th min of the Paris SAMU intervention

I don't know

But If something could have been done

It would have been on the 10th minute

And not the 90th min

Charles

----- Original Message ----
From: caesar ursic <cmursic at gmail.com>
To: "Trauma &, Critical Care mailing list" <trauma-list at trauma.org>
Sent: Sunday, December 30, 2007 9:25:48 PM
Subject: Re: British Surgeon: "Princess Diana might have survived if treated faster"

Dr. Mattox:
Her injury may very well have been unsalvageable, given what is now known
about the autopsy.  And I agree that your original assertion was that she
got the best care available at the time.  But my point is simply this:   that
care was not, based on what is known about the sequence of events on that
morning, appropriate or 'the best' given the prehospital literature as we
know it and as was available then.  Had she sustained, instead of a
pericardial rupture, a torn vena cava, or a tension pneumothorax and a
fractured pelvis, or a grade IV spleen fracture, she could have easily have
been just as unstable, just as hypotensive, just as prone to pre-hospital
cardiac arrest given the initial delays in moving her out.  And stopping an
ambulance on the streets, less than 1 km form a hospital with a surgical
team standing by, because the patient is too unstable to move, must be
recognized for what it is - an outdated, dangerous approach.  In Paris,
Houston, Shanghai, Melbourne, Buenos Aires or anywhere else that an
organized prehospital system exists.

On Dec 30, 2007 5:12 PM, <KMATTOX at aol.com> wrote:

> THe comment (actually my  comment) was that this patient received the
>  very
> best that Paris had to offer at the time.    (I stand by  that specific
> comment).      At that time and even now,  the Paris "EMS SYSTEM" strongly
> believes
> that their system of SAMU, manned by  anesthesiologist trained in critical
> care
> and taking a patient to one of the  rotating hospitals to receive
> "emergencies, and being met by anesthesiologists  in a "reanimation room",
> not a shock
> room, and not with a trauma team, is  superior to systems in other cities
> in
> France, and other  countries.  The German system is different from the
> British
> system,  which is different from the Riyadh system, which is different
> from
> the Baltimore  system, which is different from the Albuquerque system, and
> on
> and on  .
>
> What this patient received in Paris that night was as good as it could
> have
> been in Paris that night even if any one of us had been present in the
>  city.
>    Some would argue that the German or French  SAMU pre-hospital systems
> is
> superior to our load and go system of Houston and  other cities.    We
> should
> argue that in the literature with  data, and I think we can.
>
> Caesar in an earlier post stated that it would have taken an special
> aleignment of stars to have resulted in a save.  The first 10 minute
>  loss of pulse
> was when the talking patient was moved from setting upright in the   car,
> to
> forced to lie supine on a stretcher on the ground.    10  minutes of CPR,
> position changes, fluids and  epinephrine.    Return of pulse and
> attention turned
> to  other victims.
>
> Cardiac herniation and death is quite common; ask any medical examiner or
> review the trauma pathology literature.    I know of no reports  of ANY
> survivors who have had a prehospital cardiac cesation or loss of pulse,
>  who have had
> an EC thoracotomy via a median sternotomy or anteriolateral   thoracotomy.
> NONE.  ZILCH.    I have  looked and looked.  I can find survivors who
> have
> had a right sided  cardiac herniation which was picked up hours later in a
> patient that never had  any loss of pulse, who did survive.
>
> So, my comments still stand and I do believe I have been politically
> correct.
>
> k
>
>
>
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> (http://food.aol.com/top-rated-recipes?NCID=aoltop00030000000004)
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British Surgeon: "Princess Diana might have survived if treated faster"