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Sat Oct 18 18:00:07 BST 2008

Sir,

I am not alone in saying that we look up to you. When we attend your tremendous meeting in Las Vegas, we listen to you and the many influential leaders that you have assembled for advice on the challenges in the current trauma world. We also look to all of your and those leader's papers in the literature to refine, re-define and fine-tune the critical care issues and acute surgical techniques with which we then use to treat our sickest patients. 

My thoughts were with the raising death toll in this pre-hospital, aero-medical transport field, the concern over the appropriate launch criteria (clinical versus mechanism versus non-trauma), and the risk that many crews are asked to take with or without the proper aeronautical instruments that should be considered standard by today's technology. Perhaps a national meeting could be arranged to review and make recommendations as to the aforementioned. Perhaps that meeting even mandates change in many areas in such a mode of transport, where it would be considered unethical or "poor care" for patients to be flown and physicians or medical directors would be no longer able to do so without following much more formal guidelines. 

Who knows the literature best? Or more appropriately, who could take all of the literature and assemble the greatest minds that know this field and come out with a declaration of what is known, what is advised and what is not advised for this field? With personal bias exposed and evidence based research placed at the forefront, such a position could in fact be used to influence change. Perhaps even national research projects could be generated that could involve trauma and non-trauma centers to answer questions on such a massive scale that the results could no longer be refuted. Safety would be the goal for patients and crew. The FAA and NTSB could be invited to watch the process or participate. 

If panels at this meeting have a consensus or if research projects are developed, implemented, and later completed, they could learn of what changes needed to be implemented. That body of information could then be taken to the congressional or state legislative bodies to demonstrate what was found and what the medical literature supports and create change form the data as it would save lives and money. It may take time, effort and money, but a course should be plotted for completion of projects and perhaps a follow-up meetings to finish the details.

Such action will save lives. It could save insurance companies big money, so that they are not paying for helicopter flights from a local crash scene to a hospital that is 10 minutes driving time because someone felt that it would be easier or better or safer or however they were feeling at that moment. I had a case just last night where a 9 percent burn was flown from one institution to mine. The patient was "stable" without airway compromise and normal vital signs, but the other institution had a protocol that said that "all burns must be flown"! We asked them several times not to fly the patient and we were refused. Now, the family will now have to pay (eat) over $20,000 dollars for that flight instead of $500 for ground transportation. The patient will be discharged 36 hours after arrival. The risk to the crew and the waste of resources including fuel and the potential need for that helicopter somewhere else in their county having now been lost is just unforgivable and happens many times, but I am sure we all have our war stories.

The bottom line for me was reading for several weeks the urgency in the e-mails and at times the vitriol from www.trauma.org. In your last Las Vegas meeting you praised this website in bringing the world-wide trauma community to together. The audience agreed and applauded. Well, here we sit reading for weeks about this problem. So, I was thinking, if there is one person that has the ability to bring together this community in person, including the greatest minds in trauma, critical care and acute surgery, it is Dr. Kenneth Mattox. It is not presumptuous to ask a great man for help. He knows how to organize and direct such a meeting (we read your e-mails about your helping the Katrina and Rita evacuees at the Superdome and have seen the organization at your Las Vegas meetings), how to do the research, who knows who the participants SHOULD be so that this will not a "white washing" as suugested in a recent e-mail, and how to effect change. Dr. Kenneth Mattox could bring together these forces in just more than an afternoon session but at a larger meeting, perhaps even a closed meeting at first to organize, where ideas could be flushed out and a clearer understanding of what needs to have happen could be decided, and then action taken in whatever form it must, such as a national research project, a position paper, incorporation of other bodies such as the ACS COT, NFTC, EAST, etc, into this effort. The "industry" must have medical evidence based knowledge and input rather than pecuniary concerns or misguided approaches that would not meet such evidence based criteria. It has the greatest chance of the fox watching the henhouse. There must be input into those industry "Standards". We here in Arizona have had three devastating incidents just this year, one of which involved one of my trauma nurse's family members.

It is a tall order, Dr. Mattox, to ask this of you, and I do appreciate this. However, if there is one man that could do this, organize this, meet this challenge, I doubt that few on this website would disagree, that it is you. Now, I apologize for placing you in this "hotseat" or confronting you in front of this site, calling you to action, but perhaps we, the trauma and medical community, need you as a leader that is recognized, to help us confront what needs to be confronted or change what needs to be changed. As for the details on how to do this, when, where, who, those details are for much greater minds than mine, but I do believe that the people are crying out for change. I think we know who that person is and the only question is when . . . I will now sit down and be quiet as I feel I have said perhaps far too much. I apologize if I have offended anyone, including Dr. Mattox or the body of this tremendous website. Perhaps it is my juvenile angst, hubris or immaturity, or all of the above, but it pains me to see this happening and I feel powerless to do anything.

Very respectfully,

Marc Matthews, MD

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-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of KMATTOX at aol.com
Sent: Friday, October 17, 2008 7:47 PM
To: trauma-list at trauma.org
Cc: Redstart at aol.com; KMATTOX at aol.com
Subject: Re: Block that PUNT (and panel)

Dr. Matthews:   I am intrigued by your  suggestion.     My role at the 
meeting you cited is to be a  catalyst to bring together in one venue the persons 
and subjects you  cited.     It is too late for this year to have a special  
day, but I might have a "blue sky" noon session on Tuesday if there is  interest. 
      I would never be so presumptuous  as to even know all of the agenda 
items or just who all the stakeholders  are.    I do know that today State 
Senators from Maryland  began  calling for witnesses to testify to them about this  
issue.   I do know that it is better if industry creates the STANDARDS  and 
Principles, rather than government creating the  regulations.     

k mattox

In a message dated 10/12/2008 11:01:15 A.M. Central Daylight Time, Marc_Matthews at medprodoctors.com writes:

Okay,  Trauma.org, then everyone on this list server should form a meeting. 
All of  you can get together and discuss it with every single paper ever written. You  can even invite people that are from the government and those from outside the  United States and you can bring these great minds together and wrangle it out.  Imagine the best and the brightest all coming together. Imagine deciding the  reasons for transport and saving lives from needless death yet defining the  reasons for the use of such transport and then tracking your changes. It can  and should be done instead of complaining about others meeting that will  either white wash this or do it wrong!

Dr. Mattox, every year you bring  together many to a meeting in Las Vegas to educate. I been there three times.  I have Dr. Wisner, Knudsen, Rhee, the Dorlacs, Johanigman, Sise, McSwain,  Fildes, Tuggle, and many others, true heroes that discuss the latest on  trauma, acute care surgery and critical care. You have even expanded your  meeting to include a Disaster Preparedness ssection. 
Why not a day, two or  three somewhere to resolve this issue? Of anyone that can organize such a  meeting and decide such issues that has the power to org anize, it is you. It  is a large enough issue for people to have disscussed this for weeks now. If  somewhere "they" are doing it "wrong", then do it right. 
Have that meeting and  then bring it out in the literature and take it up the stairs to Washington.  Get the ACS COT or NFTC behind you and get the US trauma world to go to their  representatives and change it.

This website could be the used as a  launch pad to help save lives in an organized fashion but someone needs to  lead. Now who is it going to be? I nominate Dr. Mattox and then everyone on  this web server to help who has been so bold as to write in and speak up. The  squeaky wheel gets the grease! Either that or we sit here and do nothing. We  need a leader. Who will that be . . . ?

MRM   

________________________________

From:  trauma-list-bounces at trauma.org on behalf of KMATTOX at aol.com
Sent: Sat  10/11/2008 7:24 PM
To: trauma-list at trauma.org
Subject: Block that PUNT  (and panel)

My wife is from Oklahoma.    I and many  of my friends are  from Texas.   I
thoroughly enjoyed  watching the Oklahoma/Texas game  today.     I really did 
 not
have a dog in the  hunt.    But the game with its swings  back and forth was a
GREAT  game.    I heard the stands  yell, "BLOCK THAT PUNT" even   when the
team came to the line to  try for two points and NOT  PUNT.    

It is with GREAT  sadness and frustration, that I have learned and inform anyone who wishes  to know, tremendous, TREMENDOUS forces have formed to BLOCK that Panel  which is being proposed to be formed to look at safety standards , flight criteria,  weather conditions,  charges, and  quality  review by the
regions trauma system.     It is  really SAD  that forces in industry, in
hospitals, and some  individuals have put  considerable pressure on local agencies, state  agencies, federal agencies, and  even individuals to state that a "panel"
is not needed, that the indirect data  is sufficient, and that  deaths have
occurred in ground ambulance  crashes.       A huge diversionary tactic is 
being
orchestrated with as great a focus as  either the democratic or republican 
presidential and congressional  campaign of 2008.    

If this campaign to BLOCK the PANEL is  successful or even achieves a DELAY, then the next deaths from a  preventable helicopter crash, carrying a patient that did not need such a  transport or even a higher level of care, must be 
attributable to societal  lethargy and business strong armed  tactics.     

k

In a message dated 10/11/2008 3:17:51 P.M. Central  Daylight Time, 
bbledsoe at earthlink.net writes:

Perhaps
"the  panel" will be that  introspection.

Bryan

Bryan Bledsoe,  DO,  FACEP

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Block that PUNT (and panel)