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Mon Sep 15 02:07:02 BST 2008

I would add one additional but very important thought. It is what Dr Mattox and I have been saying but perhaps not too clearly. The system that is currently in use is composed of a bunch of silo's (Ken's term) all of which function within their own silo and do not talk to those in other silo's. or if they do communicate it is hours or days later. This leads to frustration but most importantly it leads to misuse of resources and lack of coordination. It slows the progress of the management of the disaster at hand.

 It would be like two surgeons in the same operating room working on the same patient at the same time but working on different sides of the abdomen without talking to each other. Both trying to use the same instruments and telling the anesthiologist to do different things to the patient because they have different philosophies of resuscitation and what is the best for the patient. Neither surgeon is the leader but both are doing their own thing with no coordination. One surgeon is much slower than the other (one is a plastic surgeon who must make very meticulous movements, is used to dealing with a very stable patient and has plenty of time to think and centuplicate the next move, and the other surgeon usually takes care of GunShotWounds with a rapidly bleeding patient, who is very unstable, the movements must be very quick and decisive. The patient suffers.

That is exactly what is happening with disaster management. There are a bunch of silo leaders who think that they are in charge but do not understand the entire scope of the problem and may not even know what is happening in the other silos. None have the same training. Some are used to quick action and others are used to planning for weeks before making a move. Each has a different philosophy of disaster management. There is no leadership. No one is in charge of all of the silos, so each silo does its own thing. The progress of the disaster flounders

Perhaps I am being too severe but I do not think so.

Norman

Norman McSwain MD
Trauma Director, Charity Hospital
Professor of Surgery, Tulane University
New Orleans LA
504 988 5111
norman.mcswain at tulane.edu <mailto:norman.mcswain at tulane.edu> 

________________________________

From: trauma-list-bounces at trauma.org on behalf of Richard Besserman, M.D., M.S., CHS-V
Sent: Sun 9/14/2008 7:26 PM
To: Trauma &amp; Critical Care mailing list
Subject: Re: [CCM-L] ?? DMAT "Military" hospital and/or clinic

Bob

As one potential after thought to another, I really appreciate your
explanation.  I get it.  I recognize that the perspective of the planners is
global (save as many lives as possible) and that could be in conflict with a
narrower trauma mission.  These folks have a broad range of non-trauma
issues to address.

I sense that the trauma community is far better motivated than other
specialties in medicine to keep involved in disaster issues.  I have great
faith in the value of leadership when fighting uphill battles and am
impressed with the motivation and zeal I have seen so far. Thanks again.
I'll sit back and listen for now.

Dick Besserman

On 9/14/08 4:55 PM, "ALS79 at aol.com" <ALS79 at aol.com> wrote:

> With all due respect Dr. Besserman, what you're reading is the frustration on
> the part of trauma surgery experts who are tired of having federal program
> proponents foisting their ideologies and administrivia into local matters. To
> me, the entry point is those who stick their hands into the chests, bellies
> and
> extremities of those with whom they are expected and entrusted to protect,
> rather than professional planners in DC, who for the most part have no "real
> world" experience in the mitigation of surgical and medical emergencies -
> especially on a massive scale.
>
> What they are saying is that the system is vertically integrated (top-down)
> along federal funding guidelines, and not constructed around rational local
> needs and requirements based on resources and demand. In fact, the medical
> community has been bypassed, and is considered by many an afterthought.
> Property be
> damned, for my money, I want someone who can save my life - even within the
> construct of the federal template. But, no one's listening. Thus, these
> postings.
>
> Bob Kellow
>
>
> **************
> Psssst...Have you heard the news? There's a new
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>      
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[CCM-L] ?? DMAT "Military" hospital and/or clinic