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Fri Oct 3 22:41:01 BST 2008

We have 8 people with assigned jobs. The trauma surgeon, the emergency
physicians and the charge nurse all have the right and responsibility to
throw everybody else out. It does not happen on every case but the
visitors must be SILENT AND OFF TO THE SIDE. Those who do not or if
there is too many they are told to leave. Everyone knows the rules and
obey. We have written protocols to that effect. If any problems do occur
then the blame falls on the trauma surgeon for not keeping the room in
order.

Norman

Norman McSwain MD
Professor, Tulane School of Medicine
Trauma Director, Charity Hospital Trauma Center
norman.mcswain at tulane.edu
504 988 5111

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of rwolfer at aol.com
Sent: Friday, October 03, 2008 4:19 PM
To: trauma-list at trauma.org
Subject: crowd control

Does anyone else have problems regarding "crowd control" at traumas.? It
seems that at our institutions everytime a bad trauma comes in with
impressive injuries, ie open skull fracures, brain extruding, knifes
left in ect, everyone and their brother shows up to "watch" and just get
in the way.? the othher day i had? a really bad case of a yound child
and every medicine, fp resident and med student as well as housekeeper,
nurse RT and high school age "shadowers" showed up and I had a hard time
gettiing them all to get out of the was so my team could treat pt.? One
actually had the gall to state the shadowers had "THE RIGHT" to be there
and wathcning.? what do others do in these cases or is it just here that
has the problem.? i tried the HIPPA card, privacy and human decency but
no one seemed to listen
rw

-----Original Message-----
From: McSwain, Norman E Jr. <nmcswai at tulane.edu>
To: Trauma &amp; Critical Care mailing list <trauma-list at trauma.org>
Sent: Fri, 3 Oct 2008 4:18 pm
Subject: RE: level 1 & 2 hospitals

Rehab availability is required within the hospitals physical facilities
or as a free standing facility
See page 73 of the ACS Resources document 2006

Norman

Norman McSwain MD
Professor, Tulane School of Medicine
Trauma Director, Charity Hospital Trauma Center
norman.mcswain at tulane.edu
504 988 5111

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Bjorn, Pret
Sent: Friday, October 03, 2008 2:44 PM
To: Trauma & Critical Care mailing list
Subject: RE: level 1 & 2 hospitals

Sadly, Ben was at least mostly correct.  And I, not so much.  (You must
be new here: generally, when choosing between Ben and me for inherent
veracity and attention to detail, the smart money is on Ben.)

Turns out there IS actually a discrete requirement for Level-I centers
to guarantee 24-hour MRI services.  While I have doubts that this
comprises any regular functional benefit to most SCI patients (the
distances here in the williwags would make it a very unusual case where
a patient would be best sent past Bangor to Portland), you have to admit
that if it's your isolated and incomplete cord lesion, such capabilities
are attractive.

I'm having less success confirming the requirement for on-site rehab
medicine, although I'd put our (Level II) services up against most Level
I's any day.  And I'd suggest that it's a deeply secondary concern
during the acute phase anyhow.
But as interesting as it all becomes academically, the simple truth is
that I was wrong to poke this skunk and I apologize for the distraction.

Pret 

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Angela
Sent: Friday, October 03, 2008 3:15 PM
To: trauma-list at trauma.org
Subject: level 1 & 2 hospitals

I agree with Pret.  The idea of an "immediate MRI" at my level one
hospital is like saying " civil war" or      " jumbo shrimp". The MRI
center is clear across the hospital campus and paperwork alone can take
forever.  And sometimes these p
t's are so unstable the idea of even
moving them for a pcxr scares me. Our resources are wonderful but the
system backs up easily because of the number of trauma pts we see. On
really busy days ( when a car full of people pull up , all with gsw's,
the helicopter lands with 2 stabbings and 6 trauma OR's are busy.....one
of those days.....all this actually happened when we were in the middle
of a mass casualty drill.. funny ?) , CT's, x-rays and labs can  take
far longer then they ever did when I worked at a level 2 hospital. 

> From: trauma-list-request at trauma.org
> Subject: trauma-list Digest, Vol 64, Issue 3
> To: trauma-list at trauma.org
> Date: Fri, 3 Oct 2008 12:00:10 +0100
> 
> Send trauma-list mailing list submissions to
>   trauma-list at trauma.org
> 
> To subscribe or unsubscribe via the World Wide Web, visit
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> or, via email, send a message with subject or body 'help' to
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> When replying, please edit your Subject line so it is more specific
> than "Re: Contents of trauma-list digest..."
> 
> 
> Today's Topics:
> 
>    1. RE: Early Acute Mgmt in Adults with SCI: Consortium
>       forSpinalCordMedicine Clinical Practice Guidelines(2008) (Pret
Bjorn)
> 
> 
> ----------------------------------------------------------------------
> 
> Message: 1
> Date: Thu, 2 Oct 2008 08:06:45 -0400
> From: "Pret Bjorn" <p.bjorn at netzero.net>
> Subject: RE: Early Acute Mgmt in Adults with SCI: Consortium
>   forSpinalCordMedicine Clinical Practice Guidelines(2008)
> To: "'Trauma & Critical Care mailing list'"
>   <trauma-list at trauma.org>
> Message-ID: <AABEQKQMMA4RX2PJ at smtpout06.vgs.untd.com>
> Content-Type: text/plain; charset="iso-8859-1"
> 
> MIGHT is an important term here.  I'm at home today and don't have my
Green
> Book at hand; but I don't recall these being ACS requirements.  Plus,
there
> are surely more than a few Level II's which boast eithe
r or both.
> 
> Pret
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]
> On Behalf Of Ben Reynolds
> Sent: Wednesday, October 01, 2008 5:01 PM
> To: Trauma & Critical Care mailing list
> Subject: Re: Early Acute Mgmt in Adults with SCI: Consortium
> forSpinalCordMedicine Clinical Practice Guidelines(2008)
> 
> Pret:
> ?
> I don't?agree entirely with your statement.? There are
several?tangible
> advantages that a level 1 trauma center might hold over a level
II/III.
> 1.? Immediate availability of spine MRI.? Which may change treatment
in
> instances of spinal cord injury without CT evidence of?trauma ?(hot
disc,
> acute on chronic disease, spinal epidural, or some other pathology
which
> steers an algorithm toward a benefit of immediate decompression).
> 2.? Availability of spinal cord injury PMR specialists.
> ?
> That's all I got.
> ?
> Ben Reynolds, PA-C
> Pittsburgh, PA
> 
> 
> 
> ----- Original Message ----
> From: "Bjorn, Pret" <pbjorn at emh.org>
> To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
> Sent: Wednesday, October 1, 2008 11:47:28 AM
> Subject: RE: Early Acute Mgmt in Adults with SCI: Consortium for
> SpinalCordMedicine Clinical Practice Guidelines(2008)
> 
> If it helps (it did me), a link to the referenced reference may be
found
> here:
> 
> http://www.spinalcord.org/html/publications/publications_sci.php 
> 
> (Be sure to include the entire address if your email application wraps
> the text)
> 
> Drill around and you should be able to locate (among many other
> interesting-looking documents) a free .pdf for "Early Acute Management
> in Adults with Spinal Cord Injury."
> 
> On page 13, you'll see a summary of recommendations.? Among these:
> "Transfer the patient with a spinal cord injury as soon as possible to
a
> Level I trauma center, as defined by the American College of Surgeons
or
> by state statute."? It goes on to admit essentially that local
protocols
> vary and may properly direct the patient instead to a Leve
l II center.
> There's also qualifying language about spine centers and so forth.?
But
> the implication that a Level I has something special to offer these
> patients is inescapable, and in the real world, flatly incorrect.
> 
> I don't see anything but discouragement for the use of steroids; but
> that's just me skimming.
> 
> As for Dr. Mattox' assertions that Level III centers aspire to the
same
> quality expectations as Levels I and II, I suppose there's room for
that
> interpretation, depending on what exactly the terms "quality" and
> expectations" entail.? What is clear is that the College's
verification
> process distinguishes Level I and II centers from Level III specific
to
> treatment of neurosurgical injury.? Level III's need not possess
systems
> or resources to manage acute neurosurgical emergencies, provided that
> clear, functional, and effective relationships exist with centers that
> do.
> 
> Pret Bjorn, RN
> Bangor, ME USA
> 
> 
> 
> 
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of kmattox at aol.com
> Sent: Wednesday, October 01, 2008 10:34 AM
> To: Trauma & Critical Care mailing list
> Subject: Re: Early Acute Mgmt in Adults with SCI: Consortium for
> SpinalCordMedicine Clinical Practice Guidelines(2008)
> 
> 
> There is no quality difference expectations among Level I, II, and III
> trauma centers.? 
> 
> I hope we no longer are using steroids in pt w SCI.? I can find no
> functional benefit in any paper from steroids in SCI.? ? 
> 
> K
> 
> 
> 
> Sent via BlackBerry by AT&T
> 
> -----Original Message-----
> From: "Howard, Dot" <DotHoward at mhd.com>
> 
> Date: Wed, 1 Oct 2008 09:10:10 
> To: <Trauma-List at Trauma.Org>
> Subject: Early Acute Mgmt in Adults with SCI: Consortium for Spinal
Cord
> ??? Medicine Clinical Practice Guidelines(2008) 
> 
> 
> 
> Certainly it is an extraordinary gift to be provided an extensive
> guideline by the specialists on management of any traumatic injury.
> 
> That being acknowledged, I am
 concerned about the information on page
> one under "Trauma Centers". It notes that the patient should be
> immediately transported to a "Level I trauma center as defined by
> American College of Surgeons or by the state statute... consider
taking
> the patient directly to a Level I center if possible in preference to
> passing through a Level II or III center first." 
> 
> 
> 
> The last time our facility as a Level II was reviewed, we were
required
> by ACS to meet the same standards for neurosurgical care as a Level I.
> Is there another standard for acute care of the patient with spinal
cord
> injury for a I trauma center as defined" by the ACS which is different
> than for the Level II centers? Should all Level IIs be bypassed for a
> Level I center by EMS?
> 
> 
> 
> The guideline defers to the definition of an ACS' Level I, so was this
> approved by the ACS Committee on Trauma or was any input sought from
the
> ACS? Have the ACS COT standards changed? 
> 
> 
> 
> Only those involved in treating the trauma patient in a level II can
> understand the frustration dealing with ignorance that assumes that
the
> level of care provided for a particular injury is better or worse in a
> center because it is a Level I or Level II.
> 
> 
> 
> Everyone in trauma care does understand that trauma care and
especially
> neurosurgical coverage for trauma patients is difficult nationwide and
> to have a guideline to dictate that only a level I can manage these
> cases narrows the already diminishing resources available.? 
> 
> Thank you
> 
> 
> 
>
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> End of trauma-list Digest, Vol 64, Issue 3
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