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Fri Mar 7 14:14:15 GMT 2008

Dr. Mattox,

I agree with the care of the simple lacerations, etc and that is what is
occuring.  The muddy issue centers around injuries that are somewhere in
between. i.e. a deep laceration that severs tendons or neural structures,
but is not a near amputation.  I feel that this could/should be handled by a
qualified orthopedic surgeon, but we are getting significant push back in
this area.  Thoughts?

AJB

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of KMATTOX at aol.com
Sent: Thursday, March 06, 2008 8:44 PM
To: trauma-list at trauma.org
Subject: Re: Hand Call Coverage at Busy Urban Trauma Centers

I have no real idea what a "Trauma" orthopedist is that is different from a

regular orthopedic surgeon?    I also have taken a close  look at what has 
been attempted to be sent to us at the BTGH as "hand" trauma  from the
immediate 
14 count area.      Every day we  repeatedly get calls for a transfer for a 
higher level of care for a "hand  trauma" case, because they do not have a
hand 
surgeon on  call.     When we ask about the case, it might be a minor  (or 
even major) hand bone fracture.   That is general  orthopedics.    If the
case 
comes to us, it will be treated by an  orthopedist, or a plastic surgeon.
Our 
"HAND SURGEON" is  called in for basically a "replantation" and a couple of 
other  diagnoses.      So....................when we have a  finger tip 
amputation, that just needs a closure, we do not accept a patient in
transfer and 
ask that the emergency physician at the sending hospital close the  wound,
as 
will be done when we receive the patient.   NOT a higher  liver of care.
By 
FAR the majority of cases  that are labeled "hand" can and probably should
be 
managed by the ACUTE CARE  SURGEON (the new name for what was the routine 
garden variety "general surgeon  of the past.        

k

In a message dated 3/6/2008 9:35:02 P.M. Central Standard Time,  
deanlutrin at gmail.com writes:

Andrew

Barring an amputation which could be immediately  salvaged, almost all hands
can wait till the morning. That's how it is done  in most teaching hospitals
in South Africa. Where I work, we have so much  hand trauma that there is a
daily 'hand list' done under axillary block or  some other local
anaesthetic. The occasional abscess needs to be drained at  night and some
debridemens should be done - surely a ortho guy can do that?  As long as you
can make a plan that there is someone who can reimplant  fingers and hands
when that occasionally occurs, I think you can tell the  greedy guys to get
lost.

My two cents

Dean Lutrin
JHB, South  Africa

-----Original Message-----
From:  trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]
On  Behalf Of Dr. Andrew Berson
Sent: Thursday, March 06, 2008 11:45 PM
To:  'Trauma &amp; Critical Care mailing list'
Subject: Hand Call Coverage  at Busy Urban Trauma Centers

To list members:

I'm looking  for input from busy level I and II centers on how hand call
coverage issues  are being handled.  Specifically, is this coverage provided
by the  ortho traumatologist or by a separate hand call list.  The issue
that we are dealing with is that after years of a very successful call
roster for this subspecialty, we are running into a very untenable
situation.  In the past this coverage was provided by the
ortho-traumatologists that had a robust elective hand surgery  practice.
These surgeons are already part of the paid call roster for  orthopedics,
and were providing hand "coverage" on nights where one of  their non-hand
surgery colleagues might be on call for general ortho  trauma.  Now, the
hand surgeons are refusing to provide this coverage  unless they are given
an additional stipend.  The general ortho-trauma  physicians do not feel
comfortable in caring for significant hand issues,  since this is not part
of their elective practice.

The question is,  should a board certified orthopedic surgeon, on a paid
trauma call list at  a busy level II trauma center be capable of evaluating
an injured hand and  at least providing initial management of the injury,
until their "hand  surgery" partner is available the next day, or are we
forced to give into  the demands of the hand specialists and provide another
stipend position on  the call roster.  (It should be mentioned that the
amount being  requested outpaces the stipend paid to the IN HOUSE
Trauma/Acute Care  surgeon, even thought hand call is a home based call
which does not receive  many true emergencies).  

Please give any constructive  feedback.  I would also be interested to know
how many list members  are seeing similar issues with their hand call
rosters.

Thank you in  advance.

Andrew J. Berson, M.D.
Assist. Trauma Director
Memorial  Health System,
Colorado Springs, CO

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Hand Call Coverage at Busy Urban Trauma Centers